Some GPs want to take on more specialist work

The National Primary Care and Development Centre report is described in Pulse magazine.

The analysis raised concerns over GPs doing minor surgery, and the cost of specialist care in the community.

The Department of Health said the public supported moves to provide care closer to home.

A white paper published in January last year set out plans to move care away from hospitals and into the community by encouraging GPs to carry out more specialist services.

Doctors 'at war'

Professor Martin Roland, director of the centre, analysed the proposals.

If specialists and GPs don't get on and won't speak to each other, then services won't work as well - and could potentially be unsafe Professor Martin Roland

He told the BBC: "While there were good examples where care was moved and a high quality was maintained - such as diabetes care - there were also examples of things such as minor surgery, where there were significant quality problems."

One of the areas where there were concerns was the excision of potentially cancerous moles by GPs.

Professor Roland said there was evidence that they were not always removed properly.

In general, the report also says moving minor surgery out to GPs had "little impact on waiting times".

GP specialists had not always been properly monitored or integrated into local health services, said Professor Rowland.

"If the GPs are being mentored by local consultants and are accredited for the work they are doing, the system can work very well.

"But if specialists and GPs don't get on - which they don't in some places - and won't speak to each other, then services won't work as well - and could potentially be unsafe."

'No universal solution'

Initiatives such as having specialist clinics in the community or putting diagnostic equipment into GPs' surgeries might not be cost-effective because patients could be dealt with more efficiently in hospital, the report warned.

It is all about providing NHS patients with what they want Department of Health

Professor Roland said: "It simply relates to the greater economies of scale that can be achieved in hospitals."

He added that, because GPs' salaries are higher than that of the average hospital doctor, asking them to carry out work in their practices could be more expensive.

The report showed there was not a "one size fits all" solution, he went on.

"While there might be benefits to patients in terms of convenience for the new arrangements, the government needs to think very carefully about whether that's worthwhile in terms of increasing costs and possible quality problems."

'No gimmick'

Dr Richard Vautrey, of the British Medical Association's GPs Committee, said the report should be considered very carefully before the government pushed ahead further with plans to move more care out of hospitals.

"It is vital that consultants and GPs work together to decide where and how best to carry out procedures, using the right skills and the right facilities," he said.

And Dr Susan Burge, president of the British Association of Dermatologists, said: "We agree there is a huge variability in terms of monitoring GP specialist services. and that running services without the input of consultants could be unsafe."

A Department of Health spokesperson said the public supported moves to provide care closer to home.

"The shift in care is not a short-term gimmick dreamt up in the corridors of Whitehall, nor is it a cost-saving measure to appease the bean counters.

"It is all about providing NHS patients with what they want - the right care, in the right place, performed by the appropriately skilled person."

However, the spokesperson said patient safety would remain a top priority.