Speaking exclusively to GP, Dr Gerada said it was becoming increasingly clear that GPs would be responsible for delivering most of the £20 billion DoH efficiency savings target.
'I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services,' she said.
'But I think it's going to be very obvious now that GPs' role, certainly in the first few years, is about cutting services.'
The need to make savings would force GPs to focus on cuts, not redesigning services, Dr Gerada said. They face tough decisions, she added. 'This is not about keeping patients away from their first outpatient appointment.
'This is about noticing and planning how many neonatal cots we need, how many surgical procedures are carried out, what the cap is on funding for certain emergency services.'
Dr Gerada said delivering the full weight of the efficiency challenge will be an 'enormous responsibility' for GPs.
'Some GPs are already doing it, but I think reality is going to come home,' she said.
Dr Gerada said the DoH had yet to act on the concerns of the RCGP and other organisations about the reforms.
'It has not really addressed the concerns around any willing provider resulting in duplication and fragmentation of the NHS, the role of Monitor in enforcing competition law and issues around practice boundaries and choice.'
She said she hoped as the government matures it will begin to take stock of concerns that have been raised.
But she had been reassured of the prime minister and health secretary's commitment to the principles of NHS.
'What I take from that is reassurance that at no time will patients have to pay top-up fees for any part of healthcare services.'