Dr Michelle Drage, joint chief executive of Londonwide LMCs, believes all practices in the capital will be expected to become part of a polysystem and acute trusts will shape what services they provide. 

After a two-month investigation by Londonwide LMCs, Dr Drage believes PCTs in the capital are under particular SHA pressure to shift hospital work towards GPs working in ‘polysystems' and ‘vertically integrate' community services with the acute sector.

GP practices would become ‘little more than chronic disease and outpatient management centres', Dr Drage said in a video interview with Healthcare Republic.

Dr Drage predicts the 31 PCTs in London will be formally merged into five commissioning 'sectors' next year, leading to a 'further blurring of primary care'.

Foundations trusts and the acute sector are now a greater threat to general practice than the commercial sector, said Dr Drage.  She urged practices to ‘pull together in networks and federate' to protect themselves against the threat.