Some embryonic consortia are considering only accepting high-performing practices, according to LMC leaders.
The White Paper Liberating the NHS makes clear that practices must join consortia to remain entitled to hold a patient list. If consortia press ahead with plans to set entry requirements, less attractive practices may be forced out of business.
Dr Robert Morley, executive secretary of Birmingham LMC, said some GPs had suggested only practices with RCGP accreditation should be accepted. Accreditation is a new RCGP scheme to demonstrate practices' competence across a range of key quality indicators.
'That is totally unacceptable,' he said. 'It's quite clearly cherry-picking and discriminates against struggling practices.'
Dr Morley called for more guidance from the DoH to prevent 'anarchy and chaos' as GPs across large areas attempt to form consortia.
He pointed out that consortia may be prevented from excluding low-performing practices because the NHS Commissioning Board was likely to have the power to assign practices to consortia.
Dr John Canning, secretary of Cleveland LMC, warned that consortia rejecting poor practices would be less able to improve health across their region. 'That involves helping practices who are looking after the most disadvantaged populations,' he said.
But Dr Mark Sanford-Wood, chairman of Devon LMC, said if consortia are heavily punished for overspending, it would 'turn up the heat' on their worst performing member practices.
Dr Morley said there were still problems engaging the full GP community in plans for consortia. 'We've seen practice-based commissioners assuming a mandate to lead on this, although PCTs have made it clear that GP consortia will be a different animal,' he said.
Dr Sanford-Wood added that PCTs were reluctant to reorganise existing groups of GPs.
The GPC has repeatedly warned practices not to sign up to any formal arrangements until more detail on GP commissioning is established.