GPs face years of contractual and financial upheaval as NHS managers plan for the drastic funding shortfalls predicted over the next decade.
NHS policymakers are considering everything from a salaried GP workforce to charging patients for appointments.
PCTs will start by reviewing all types of GP contract to work out how savings can be made, PCT Network director David Stout told GP newspaper.
NHS managers will eventually have to consider whether GPs should work for 'managed organisations', if the model of GPs as independent contractors proves to be unsustainable, said Mr Stout.
Charging patients to see their GP was 'on the longlist' of radical ideas to reduce demand on the NHS and to make savings, he said.
Last week, on the eve of its annual conference in Liverpool, the NHS Confederation estimated that, by 2016, the NHS in England would face a funding shortfall of £15 billion.
A Scottish government spokesman said it could not make a similar forecast until it knew what its funding from Westminster would be.
NHS Confederation Wales said the country's NHS was being reorganised and a clearer picture was not expected until October.
NHS Confederation Northern Ireland agreed it was too early to tell.
An 'urgent mood' had gripped the Merseyside conference, said Mr Stout, with many sessions dedicated to redesigning services to make savings.
Opening the conference, NHS Confederation director Steve Barnett told NHS managers 'nothing is off limits' in the quest to make savings.
Chris Ham, professor of health policy at the University of Birmingham, said GPs should expect pay freezes and an expansion of their core work.
'The days of throwing more funding at GPs for more work is yesterday's news,' he added.
The NHS Confederation's policy director Nigel Edwards told GP that 'no sector would be exempt' from the cutbacks. The GP contract will have to be reviewed if the Conservatives are elected next year, he said.
One of the first targets for savings would be from GPs' QOF income, said Mr Edwards.
Ideas floated at the NHS Confederation conference to make savings in primary care and reduce demand on the NHS:
The plans threaten to make discussions at the annual conference of LMCs in London last week an irrelevance.
GPC chairman Dr Laurence Buckman said he would not 'rise to the bait' of the proposals.
'I've got a radical solution - halve the number of NHS managers and cut their pay.
'You can't cut people's pay and expect them to deliver good quality healthcare,' he said.
GPs' pay was 'nothing to do with (managers),' said Dr Buckman. 'I would like managers to expand their core work.'
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