Exclusive: GPs say they have firm evidence now that the government is planning to privatise the National Health Service as part of its reforms.
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In a document seen by Channel 4 News, plans are laid out for how services will be bought for patients.
And family doctors say the details show for the first time the scale of the involvement of private companies. The document, Developing Commissioning Support: Towards Services Excellence, is a draft sent out to various health organisations.
Under the NHS reforms, GP practices will form consortia and they will manage about 60 per cent of England's NHS budget. But it has been acknowledged that some GPs will not want to - or be capable of - managing such huge enterprises.
This document sets out how commissioning support units can be set up.
No private market?
Richard Vautrey, deputy chair of the British Medical Association's (BMA) GP committee, said that the document was quite explicit in suggesting that the government was going to create a market for private companies to come in and take over these services and that commissioning groups would be too small do without support.
The government argues that commissioning groups (the GP consortia) will have the final say and will retain control. Dr Vautrey said not.
The GPs will simply be too small to have any clout. Dr Richard Vautrey, BMA
"Ultimately the commissioning support talk could wag the commissioning group's tail," he said.
"The GPs will simply be too small to have any clout."
The private companies, which could include the likes of KPMG or United Health, will not be able to start providing these services until 2016 and in the meantime the document lays out how staff from the soon-to-be defunct primary care trusts could carry out this work.
Doctors Channel 4 News has spoken to point to two pages in particular in the document. On page 14, the "back office functions" are laid out, which doctors say include "identifying best value providers to respond to service needs. Formal contract management, tendering and negotiations."
Page 16 states that clinical procurement - that is, purchasing healthcare - should be carried out at an appropriate scale, which includes learning disability and community services.
Dr Jonathan Tomlinson, an east London GP and blogger, said: "The document says that GPs who are wanting to design services from their patients will have to get support from private companies. However that support is so comprehensive as to include absolutely everything that commissioning involves.
"In other words, looking at the needs of their local population, choosing and designing the services that they need, managing the contracts, monitoring the quality. There's almost nothing left for us to do. And it even goes so far as saying that they can see a role for GPs perhaps in managing learning difficulties or other small local community services but even then private companies will be doing the directing."
This all comes a fortnight after the Department of Health signed a deal with the private company, Circle, to run Hinchingbrooke Hospital in Cambridgeshire. However, GPs say this document goes further. Circle will be in charge of "providing" a service. This will be the private sector purchasing patient care and ultimately deciding what they do and do not want to buy.
There are real concerns this is a further step towards the privatisation of some aspects of NHS services. Professor Chris Ham, King's Fund
Fury and concern
The British Medical Association is now to discuss the document at its council meeting on Thursday. But Channel 4 News understands that members of the BMA's GP committee reacted with fury when they were shown it last week and have demanded the leadership takes a stronger stand against the reforms.
The Royal College of GPs is also planning to discuss it at its next council meeting.
The think tank, the Kings Fund, said that it had always been acknowledged that GPs would not do the commissioning - or buying of care - on their own.
Professor Chris Ham, King's Fund chief executive, said: "What GPs are worried about is that they will have to increasingly rely on the private sector to provide them with the expertise they need to manage £60bn of public money. There could be benefits from that if they get access to better, more expert people but of course there are real concerns this is a further step towards the privatisation of some aspects of NHS services."
No government minister was available for interview, but a Department of Health spokesman told Channel 4 News that it was wrong to claim the NHS was to be privatised. He said this document was quite simply about back office functions.
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