By Nick Triggle
BBC News health reporter
The push to cut the number of unnecessary hospital admissions is at risk because GPs are refusing to run their own budgets, doctors say.
From April, GPs have been able to take charge of their own budgets
Government proposals are set to be unveiled at the end of the month to improve access to community services from GPs to sexual health clinics.
But the drive is largely dependent on doctors taking on their own budgets to commission a new range of services.
Doctors' leaders claim most do not want the responsibility.
Dr Hamish Meldrum, chairman of the British Medical Association's GPs committee, said: "With GPs not on board, the whole push could be undermined.
Family doctors have been able to assume control of budgets from primary care trusts since April
GPs are said to be more responsive to need as they act as gatekeepers to the NHS and will commission more innovative services in community settings
In places where it has been adopted, doctors have developed specialist clinics to carry out treatment which would have traditionally been done in hospitals
The forthcoming white paper on out-of-hospital care will stress the need for more treatment to be done in the community
"The problem is that the NHS is gripped by deficits and doctors understandably do not want to take on budgets where cuts are being made.
"I think there is also an issue over management costs of running budgets and the fact that a new contract has just come in coupled with other government reforms. They just don't want the budgets on top of it all."
It is estimated that a little over a quarter of GP practices in England have taken on responsibility for budgets under a scheme launched last year called practice-based commissioning.
It has been designed to encourage doctors to provide specialist services such as diabetes clinics as well as paying for innovative community-based schemes run by nurses and hospital consultants.
Local health bodies, called primary care trusts, commission services in areas where doctors do not have the responsibility.
But supporters of GP commissioning claim doctors are more responsive to need, as they act as gatekeepers to the rest of the NHS.
The white paper, expected at the end of January, is likely to stress a more community services-focused NHS to reduce the amount of costly hospital treatment.
Dr Mike Dixon, chairman of the NHS Alliance, which represents primary care professionals, said the scheme offered GPs a unique opportunity to help redesign community services.
But Dr Dixon, whose Devon practice has taken responsibility for its own budget, added: "I can understand why doctors are being turned off.
"I think the government needs to offer better incentives about what they can do with the money otherwise it will threaten what the white paper will recommend."
But the Department of Health said it expected many more practices to come on board over the course of the year.
A spokesman said: "Practice-based commissioning remains voluntary for practices, but given the significant benefits that it offers, we would expect that it will be taken up by the majority of practices."