The NHS Alliance has warned that PCTs have been told to put plans in place by the end of March to transfer services they currently provide themselves to hospitals, on the basis that this is the DoH's 'preferred option'.

The DoH confirmed that guidance will be published shortly to set out options for reforming PCT provider arms.

A spokeswoman said there was 'no national blueprint' for the options PCTs can choose for their community services.

But she added: 'This could mean integration with hospital services. It should result in innovative proposals that bring community services closer to GP primary care and social care services.'

NHS Alliance chairman Dr Michael Dixon warned of a 'very ill wind against primary care and general practice'.

'In the distant future, if a hospital has swallowed up community services then the next meal is likely to be general practice,' he said.

'I think patients, clinicians, and managers need to not only be aware of this, but also be extremely vocal about the situation. If they care for their patients they need to speak up and act.'

GPC chairman Dr Laurence Buckman last year said DoH plans to encourage acute trusts to run GP services - set out in NHS 2010-2015: From Good To Great - signalled health secretary Andy Burnham's desire to 'get rid of general practice completely'.

The document said the DoH planned to 'remove the boundaries NHS foundation trusts face in expanding their services' and that they would be 'considered to run primary medical services'.

GP leaders fear that moves to encourage hospitals to provide GP services coupled with the eradication of practice boundaries could create a two-tier system in which practices are forced to compete with a new breed of super-provider.

Dr Peter Holden, a GPC negotiator, said it is 'certainly possible' that this could create a situation where GP practices would have to compete against hospital practices if plans to abolish practice boundaries are carried through.

He added: 'I'm concerned that politicians are making changes, the consequences of which they don't understand, nor will they be around to answer for.'

Dr Dixon said the aim of integration was to save money: 'The explicit reason for the move is that the NHS is going to have to save an enormous amount of money over the next couple of years, and this is a speedy financial fix.'

Dr Dixon warned that job cuts are likely in community services as they become integrated with hospitals.

The DoH spokeswoman said the guidance document due to be published shortly was likely to be called Final Guidance on Assurance Process for Community Services.