NHS London has told PCTs they must have plans to deliver against 'affordability assumptions' that include slicing 15 per cent off the drugs budget and imposing a flat £50 fee per consultation outside core hours.

London's PCTs are looking to shift work from hospitals to primary care as cuts of £5 billion by 2017 loom for NHS London, says London's NHS on the Brink, a report commissioned by the BMA's London Regional Council.

From 2011, NHS London faces a 4 per cent rise in activity with no growth in real-term budgets, says author John Lister. 'PCTs are being pressed to cut back.

But the only way this can save money is if they dump a load of extra work on to GPs and primary care staff,' he said.

He said the 'affordability assumptions' are 'a potted summary' of McKinsey research into making £20 billion savings across the NHS.

GPC negotiator and west London GP Dr Chaand Nagpaul said the plan to cut appointment times was 'quite ludicrous'.

NHS London will discuss its plans with London GP leaders. A spokesman said the plans were based on best practice.