The new system of Primary Care Groups (PCGs) will replace the GP fundholding scheme introduced by the Conservatives.

Individual GP practices will no longer hold their own budgets for drugs and hospital care. Instead GPs will have to work in groups of 50 doctors to decide how health care should be provided for populations of approximately 100,000 people.

Jacqui Cirillo, a fundholding manager at a GP practice in Marlow, Buckinghamshire, will lose her job as a result of the abolition of fundholding.

Jacqui Cirillo: 'I am deserting a sinking ship'

She said: "I am quite happy to be deserting a sinking ship. I do not believe that PCGs are going to work because I do not think enough money is being injected into the system, and I think GPs should spend more time with their patients, not on administrative duties."

Dr Chris North, a partner at the same practice, said: "The problem with PCGs is that they are going to involve much larger groups who are not used to working together, have no tradition of working together, and the efforts that are going to have to be put in to make that work are huge."

Public will blame GPs

Dr North warned that GPs would now be made responsible by the public for decisions taken to ration treatment, and would have to deny patients certain types of care.

Dr Judy Gilley: GPs need more encouragement

Dr Judy Gilley, a GP negotiator for the British Medical Association, said it was important the good parts of GP fundholding - and an alternative system currently being used under which GPs have a say in planning health services, but the budget is held by the local health authority - should be retained under the PCG system.

She said: "GPs have been given a leading role in the new primary care groups, but they are anxious that this will take more of them out of their practices and away from direct work with patients.

"We also remain concerned at the government's failure to encourage GPs to get involved in the new system, which does require GP input."

The BMA believes pay rates offered to GPs who take an active role in PCGs will not adequately cover the cost of being away from their surgeries.

Doctors must regulate themselves

Dr Peter Hawker, chairman of the BMA's consultants committee, welcomed moves to strengthen professional self regulation.

However, he said: "Doctors expect government to recognise the unique combination of complex clinical skills, leadership and dedication which senior doctors contribute to patient care and to refrain from heavy handed attempts to over-regulate every area of their professional lives."

Karen Caines, director of the Institute of Health Services Management, said it was vital that the NHS Modernisation Bill was pushed through in time for the NHS to prepare properly for the launch of the new system next April.

"The reforms are welcome but it will place onerous new duties on managers to deliver a high quality service," she said.

"Without proper pace and tone, the implementation will be crude and ineffective. A lot of work, money and efforts has gone into the pilot projects which go live on April 1, 1999 and this must not be lost.'

The NHS Confederation, which represents health authorities and trusts, said the scale, pace, cost and management complexity of delivering the NHS modernisation agenda was being underestimated.

Stephen Thornton, chief executive of the NHS Confederation, said: "Expectations of how the modernisation agenda can be delivered must be checked - its radicalism has been underestimated in many quarters.

"It is a huge agenda which is supported by NHS organisations but will require a NHS cultural revolution.