John Harrison, chief executive of Vocare, which runs out-of-hours and urgent care in the north-east of England, said a 'triple whammy' of extended practice hours, NHS 111 and expanding foundation trusts could push out GP providers by 2020.
Speaking to members of Urgent Health UK (UHUK), the umbrella body for social enterprise providers, Mr Harrison said CCGs were commissioning 'combined A&E and urgent care contracts, gifted to hospital trusts', with the urgent care element either recommissioned by hospitals, or taken in-house.
Problems in A&E were caused by Payment by Results, he said, which encouraged trusts to maintain demand. A&E services were 'addicted to Payment by Results', he added.
'Weaning them off is going to be hard. They are happy to do anything if it keeps that turnstile going.' Out-of-hours providers, he warned, must emphasise their strengths in home visiting and general practice management to survive.
GP leaders have called for NHS 111 and out-of-hours services to be integrated, but pressure on GP providers could undermine this approach.
GPC out-of-hours care lead Dr Peter Holden told the conference the NHS should integrate all out-of-hours care as a 'single entity', with call handling and triage by senior clinicians, and control over the NHS 111 directory of services, end-of-life and out-of-hours community nursing services.
'That's the level I think we should be at,' he said. 'But the concept that hordes of us should be out on the roads at nights and weekends is not going to wash.'
Dr Holden suggested the GPC was ready to accept that GPs should take responsibility for oversight of out-of-hours service quality as part of the 2014/15 contract.
Shropshire CCG's accountable officer, GP Dr Caron Morton, told UHUK members out-of-hours providers could be the 'linchpin around which integration can happen'.
Commissioners, she said, were looking for new models of urgent care provision, but out-of-hours providers were not being invited to local integration discussions.
'You are very well placed for integration,' Dr Morton said. 'You are not placed directly within the NHS, you're not in specific hospitals, you are out there in the community.'
Dr Morton called for local solutions to problems with NHS 111, and 'softening' of the rules to allow greater local flexibility.