PCTs are preparing the ground for local negotiations over delivery of the swine flu vaccine, as fears mount that a national agreement will not be possible.
Some GP leaders are warning that PCTs may attempt to cut practices out of the loop by approaching Darzi centres to deliver the jabs.
They also warned that PCTs may approach practice nurses directly, in a bid to get them to deliver vaccines without practices' consent.
A national plan to pay practices to deliver the two-stage vaccination was expected some time ago. But it has been repeatedly delayed, as negotiations between the GPC and the DoH have run into problems.
GPC negotiator Dr Beth McCarron-Nash said negotiators were spending 'every waking hour' working on a deal. 'Hopefully we're coming to a conclusion soon, but we are fighting to make sure that it is right for practices,' she said.
GPC member Dr Fay Wilson said it would be 'very prudent for PCTs to be coming up with a plan B'.
Some LMC leaders have warned that PCTs could use local negotiation to cut contract holders out of any deal.
In a recent email to Thames Valley practices, Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, warned that PCTs may be tempted to approach practice nurses directly, in an attempt to trick them into offering treatments that were not included in the contract.
'I imagine many of you will have seen this tactic before, and had to put a brake on the magnanimity of your staff,' he wrote.
Dr Grant Ingrams, secretary of the West Midlands LMC, said that some managers would attempt such dirty tricks. But he added that 'only a stupid PCT would do that'. 'If they do, they have commissioned a service, but not agreed a price up-front.'
He said practices should be open with nurses, and tell them that practice income funds their salaries, so they should not agree to do things for free if PCTs approach them.
Dr David Jenner, GMS contract lead at the NHS Alliance, predicted a national deal would be reached on paying for the vaccination programme, but it 'would not be terribly attractive', and not every practice would choose to offer the service.
PCTs 'very much do not want to pay extra for it', he said. 'But if they do not want to pay extra they will have to partially suspend QOF.'
He added that, while the programme focused on 'at-risk' groups, access to health records meant GP practices were the only realistic place to deliver it.
'It could be done through the new Darzi clinics. They have the capacity,' he added. 'But they are often not conveniently located.'