GPs could be forced into large 'primary care centres' under a PCT proposal to 'franchise' GP services.
Heart of Birmingham PCT wants to replace 76 mainly small or single-handed practices with 24 larger, franchised units.
The franchised centres will operate to a standard contract setting out everything from staff uniforms and logos to opening hours and cleaning rotas.
The bidding process for the franchises to run the units will be open to the private sector as well as existing practices or groups of practices - although incumbent GPs will have preferred-provider status.
The Heart of Birmingham PCT's report, 'Corporate Franchise Strategy', suggests GPs join together to form limited companies, or 'assemble appropriate levels of resources' and prove their business acumen.
It expresses clear interest in large companies like Virgin, Tesco and ASDA as competitors for the franchises, and says 'these organisations are confident they can replicate the best aspects of the GP partnership's relationship with its patients'.
The report proposes a 'service specification' to create consistent healthcare models across all the health centres. Franchises will work under 'strong brand identification' to assure patients of quality.
The system is loosely based on fast-food business strategy and has been condemned by GPs as a step towards cheap, corporate healthcare, dubbed 'McMedicine'.
The report's author, Sarb Basi, the PCT's director of service development, said: 'We can learn much from companies like McDonald's.'
Dr Sandy Bradbrook, chief executive of the PCT, said he wanted to see the concept piloted within the next 12 months.
Former Heart of Birmingham GP Dr Fay Wilson said practices on the PCT's outskirts were asking how they could switch to neighbouring PCTs.
Heart of Birmingham is seen as a maverick PCT, she added.
'We could see a while back that this was not the place to be. We moved to South Birmingham PCT, but some right in the middle have no choice,' she said.
Dr Charles Zuckerman, medical secretary at Birmingham LMC, said plans would 'tear up general practice in this country'.
'This would make life difficult for PMS practices, effectively strong-arming them into little groups with what would be a less favourable contract,' he said.
After initially being used in the 24 primary care centres, the franchise system would be applied to diagnostic centres, urgent care centres, and all other contractors from whom the PCT commissions services.
The Heart of Birmingham PCT would ultimately manage the whole of primary care, said Dr Zuckerman. 'How it plans to manage the whole of general practice, I don't know.'
View the PCT plan
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