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Tony Blair is on the brink of ordering a renewed clampdown on GPs who are restricting booked appointments, a senior Department of Health official has revealed.

Head of primary care Gary Belfield said there was also 'real anxiety' on the part of the Prime Minister and Health Secretary John Reid at the fact only a fifth of PCTs have

taken on responsibility for out-of-hours.

'From the Prime Minister and Secretary of State down there is a real anxiety about out-of-hours. So far 60 have taken it on, which means there are 240 to go,' said Mr Belfield.

'There is real concern. From my perspective reading the papers it's quite depressing.'

He added that the department's performance watchdog, the Recovery and Support Unit, was taking a more active interest in the issue.

The warning over restricting appointments is the second this year and comes as the December deadline for 100 per cent of practices to offer 48-hour access approaches.

Mr Belfield told a breakfast meeting at the NHS Alliance conference that practices in London were the worst offenders.

'There is a big issue coming round the corner of restrictive booking, which is against the spirit of the target, so we are doing work with people on that.

'The Secretary of State and Prime Minister again are interested in that. It's a big London issue.'

Mr Belfield added that the Government would be putting increasing pressure on PCTs to deliver the controversial Choose and Book scheme, which has come up against massive GP opposition.

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