Plans to abolish small independent surgeries and force family doctors to move to “one-stop shops” serving up to 20,000 patients are being backed by the Government.

The Times has learnt that ministers are supporting a pilot scheme in Birmingham that will require GPs to reapply for their own jobs as part of a wide-ranging franchise scheme.

The Department of Health sees it as a future model for primary care practice, which would radically alter the way that patients are treated by GPs.

Family doctors would operate out of newly built supersurgeries that would be open evenings and weekends and offer services from X-rays to mental health advice.

The pilot scheme, in central Birmingham and Sandwell, involves moving about 70 GPs into 24 new premises and requiring them to sign up to a system of standards to address the “variable” quality of care across the city. The primary care trust (PCT) will grant them the right to provide services under the NHS brand for between five and ten years and will protect them from competition during that period. In return, the GPs will have to agree to provide care to agreed standards, which would cover staffing, opening hours, skills and a customer-complaints procedure.

GPs who resist the plans and refuse to move are “doomed”, according to the British Medical Association. Gordon Brown has made reform of their working hours a personal priority, three years after 90 per cent of them opted out of providing out-of-hours cover.

A Department of Health source said that the trial was being closely watched and, if successful, it would be put forward as a model for GP services elsewhere in the country.

Ben Bradshaw, the Health Minister, said: “Improving the quality and flexibility of GP services is a priority for the public. I applaud initiatives such as Birmingham’s to respond to the views and needs of the local community and modernise primary care services.”

The Heart of Birmingham PCT believes that supersurgeries, with a “critical mass” of more than 15,000 patients and up to 20,000, will allow doctors to buy in bulk and provide a greater range of services. The trust insists that the aim of the reorganisation is not to make savings. At the moment the average practice has three or four GPs and serves 6,000 patients.

The plan involves doctors signing up to ten-year “franchise agreements” with the local trusts. In return, the PCT will be able to stipulate what services it wishes each surgery to offer.

The proposal aims to create a “market structure” in local GP healthcare, which could ultimately allow private providers to play a major role. But the Birmingham plan seems to run counter to the Government’s policy of practice-based commissioning – the idea that GPs, and not PCTs, make the decisions about how care is to be organised and paid for.

A trust document, Corporate Franchise Strategy, says: “There is a growing interest in primary care as a future market from a number of nonhealth organisations who are convinced they can be effective and efficient suppliers of these services in terms of both quality and cost.

“Many of these organisations have well established and trusted brand names such as Virgin, Tesco and Asda. These organisations are confident they can replicate the best aspects of the GP partnership’s relationship with its patients, as they do this with their own customers on a daily basis. It will therefore be in the interests of the PCT to have a market structure which in the future allows for easy entrance for new providers and easy exit for current providers.”

After an uproar by doctors, the trust has clarified that for the time being “only our local GPs will be considered. We are not looking anywhere else.”

Andrew Lansley, the Shadow Health Secretary, said: “This is the wrong way round. PCTs are being given greater responsibility but GPs are trusted and should have greater independence.”

Norman Lamb, health spokesman for the Liberal Democrats, said: “There is no point in moving doctors for the sake of it. The test will be if it improves access, but we have to allow local experimentation.”

Laurence Buckman, the chairman of the BMA’s GP committee, called the plan nonsense. “The Government seem determined to do permanent damage to all existing practices. They are not interested in the quality of care, continuity of care or competence. Evenings and weekends – that’s the only thing that matters to Gordon Brown.”

But David Stout, the PCT network director for the NHS Confederation, which represents trusts nationwide, said that health chiefs had looked at how franchises with an agreed set of standards of service had worked in the retail sector for companies such as Tesco. “It’s a PCT’s job to drive up the quality of healthcare and this is an ambitious plan to do just that,” he said.

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