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The Department of Health is considering issuing referral guidelines for GPs who take on practice-based commissioning.
Some control over commissioning may also be taken out of GPs' hands and decided by larger PCTs or strategic health authorities.
The moves, which were revealed by the Prime Minister's former health adviser, Professor Julian Le Grand, have been triggered by fears GPs will fail to cut demand for hospital services.
Professor Le Grand, who advised Tony Blair in the year up the last election, said the Payment by Results tariff system gave hospitals an incentive to carry out large amounts of activity in order to maximise income.
If GPs did not act as a brake on this by cutting referrals, NHS spending would rise dramatically.
He said: 'There is a discussion within the department about whether there should be referral guidelines. On balance I would be against that.
'We're putting in place a whole series of drivers that are likely to push up demand. We are going to need some strong instruments to control demand.'
Professor Le Grand said the Government's decision to introduce foundation hospitals, payment by results and practice-based commissioning 'in entirely the wrong order' had led to the problem.
Dr Mo Dewji, clinical director for primary care contracting at the department and a GP in Milton Keynes, said a framework for referrals was necessary for practice-based commissioning to work. 'But there has got to be enough flexibility to allow clinicians to hold a budget and get maximum benefit,' he added.
GP said introducing referral guidelines would be 'bizarre'.
Dr Mike Dixon, chair
of the NHS Alliance, said practice-based commissioning needed 'every bit of help to get going'.
He added: 'If this has greater currency then that is against the principles of practice-based commissioning'.
A department spokeswoman there were no plans to issue national referral guidelines during the roll-out of practice-based commissioning but alternative approaches would be considered once it was up and running.
By Daile Pepper