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GPs risk losing £3,000 each following a Department of Health crackdown on how they comply with access targets.

Ministers have ordered PCTs to stop practices restricting pre-booked appointments to achieve 48-hour access. A Department of Health memo to all strategic health authorities expressed concern that 'practices may be reporting success while operating appointment systems which restrict booking ahead. This is not acceptable.'

GP leaders said it would be 'absolutely impossible' to offer unlimited pre-bookable slots and achieve 48-hour access as there were not enough doctors to do both.

PCTs have said they will dock quality pay from practices that flout the new rule. Some £1,250 in quality pay and £1,666 in directed enhanced service pay is also available per GP for hitting the access target.

Bristol North PCT said it would have no option but to dock access quality pay if practices continued to use restrictive booking practices.

The crackdown emerged as the latest national patient survey cast doubt on the Government's claim that 98.5 per cent of patients can see a GP in two working days. Only 54 per cent of patients questioned said they could get 48-hour access.

GPC deputy chair Dr Laurence Buckman denounced ministers' 'amoral position' and said the 'corrupt and stupid' 48-hour access target could no longer be met. 'People will say they cannot work like this and are being forced to take a pay cut,' he said. 'This is a squeeze at both ends. It's inexplicable how anyone could do this as there are only so many patients you can see in 24 hours.'

Dr Mike Scott, a GP in Newcastle, said: 'I think our practice will find it very difficult, particularly at times when partners are on holiday.'

The Government's National Primary Care Development Team, which has already attempted a purge on practices that fail to offer pre-bookable appointments, estimates up to 12 per cent of practices are still doing so.

•Southampton City PCT, at the centre of media allegations that it warned practices when access was to be assessed, denied rigging figures. A spokeswoman said the Government had told the PCT it was acceptable for practices to be warned and to bring in locums to hit the target.

By Nerys Hairon

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