The DoH has said some local enhanced services (LESs) will not count towards PCTs' target of 50 per cent of practices opening extended hours, say local GP negotiators.
Dr Grant Ingrams, secretary of GPC West Midlands, said that he had heard it reported around the country.
'PCTs are telling us that they are under a lot of pressure. One chief executive told me, but asked not to be quoted, that the PCT is being told: "You are not allowed any imagination here."'
Dr Nigel Watson, chief executive of Wessex LMCs, said the DoH had briefed SHAs not to allow concurrent working for practices with fewer than 12,000 patients and to stop GPs being paid monthly rather than quarterly.
The 139 practices in the South West that have signed up to a LES would have trouble unpicking the four-year deal, said Dr Watson.
It is unclear how many practices around the country may be affected, but a recent GP survey showed that 94 per cent of PCTs had developed an LES that differed in some way from the directed enhanced service (DES) interim guidance.
Dr Ingrams and Dr Watson, whose LMCs cover almost a fifth of PCTs, were puzzled as to why the DoH appeared to be making it more difficult for practices to open extended hours.
'Is the whole thing being set up to fail?' asked Dr Ingrams.
'One might wonder whether if, next year, PCTs haven't reached their targets, we will see another wave of Darzi centres because GPs haven't sorted out access.'
Dr Watson thought it was because of the perception that GPs gained too much from the new contract.
'I don't believe it's being set up to fail. I would be pretty hacked off if I was Gordon Brown and I found out civil servants sought to make one of my main policies a failure.
'They feel they gave too much away with the contract.'
PCTs across the West Midlands and Wessex maintain that the LESs are working well and deny that they have been told to tighten up the terms.
A spokesman for the DoH said that there was no 'official requirement for GPs to comply' with their original recommendations. The final extended hours DES is expected to be published in October.
Comment below and tell us what you think