North Staffordshire LMC obtained the letter from West Midlands SHA to PCT chief executives suggesting GMS practices be charged for each unreferred patient who has to visit an 'alternative health centre'.
The alternative health centres could become 'quasi-GMS' providers in areas with the worst access to GP services, the letter advised. North Staffordshire is among the worst 10 per cent of PCTs for access.
As part of a national project to improve access, patients could be allowed to register at A&E departments and pharmacies as an alternative to GP practices.
According to the letter, 'recharging' would mean GMS practices would be charged for patients who are seen elsewhere.
PCT chief executives were sent the letter detailing ideas to improve access that the DoH's National Implementation Team (NIT) would be discussing on upcoming visits to the area.
A spokesman for West Midlands SHA said: 'The suggestions were part of the NIT's terms of reference for their visits to the SHA and some of our PCTs. They were listed in our letter to provide information for our PCTs about the national project. These included issues and topics that could be explored by the NIT during the project and visits.
'This is at an early stage and there are a range of options that could be explored before any firm proposals are developed.'
Glen Sergeant, head of corporate and public affairs at North Staffordshire PCT, said that there were plans to put primary care urgent care units within A&E departments, but said he had not heard of any of the proposals in the letter.
North Staffordshire LMC chairman Dr David Hughes said: 'We are aware of some radical thoughts at strategic level that have been passed down to the PCT for its consideration.'
Dr Hughes said: 'Some of the ideas weren't quite as daft, like practice-based commissioning being used to commission and incentivise extended hours. We would welcome costing and piloting extended hours to improve access, but it must never be compulsory.'
GPC chairman Dr Laurence Buckman said the proposals were 'nonsense'.
'This idea is a non-runner. You can't register patients in an A&E department. There is no mechanism for doing this and it is not legal,' he said.
A DoH spokesman said that Dr David Colin-Thome, leader of the national project on access, did not want to comment on 'such a local issue' and that the proposals were still at 'an early discussion stage'.
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