Ministers want to move care out of hospitals and into the community

The cost of non-emergency hospital surgery is currently fixed across England under a new funding scheme.

The NHS Alliance said if the same price structure is introduced as guidance suggests for primary care, there will be no incentive to shift care.

The government said no decision had been taken but it would be consulting on future plans in the autumn.

In a white paper in January, ministers set out a plan to move care away from hospitals and into the community by encouraging GPs to carry out more specialist services.

I don't think a national tariff will be appropriate for primary care Michael Dixon, of the NHS Alliance

It was envisaged family doctors would start doing minor surgery, running asthma clinics and providing sexual health services traditionally confined to hospitals.

The costs of treatments such as these when carried out in hospital are currently fixed under the national tariff for Payment by Results, a new funding formula being rolled out in the NHS.

Payment by Results means that hospitals are paid per patient treated, rather than getting lump sums based on past activity.

The government believes it will make the health service more responsive to patients.

Under Payment by Results each treatment has a fixed price which primary care trusts have to pay the hospital.

Prices

If that treatment is carried out in the community - as it is increasingly being after the white paper - GPs and other community providers are free to negotiate their own prices locally.

But the government has yet to unveil exactly what it will do in the future.

The NHS Alliance fears it could mean treatment carried out in the community will come under the tariff system.

Chairman Michael Dixon said: "If primary care trusts have to pay the same price whether it is done in hospitals or in the community, where is the incentive to move care out of the secondary sector?

"I don't think a national tariff will be appropriate for primary care."

A Department of Health spokesperson said: "The key objective of Payment by Results is to ensure value for money in the commissioning of NHS services.

"Payment by Results does not apply to services commissioned from GPs and other primary care providers.

"Funding for these services continues to be negotiated through the contracting process.