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'And with the prospect of a funding squeeze that will certainly have an impact on patients, this is no time to introduce an ideologically driven policy that forces GPs to become NHS managers.

'At best this will be a waste of time, at worst a waste of money.' They pay the salaries of GPs and dentists, buy in drugs, 'commission' hospital appointments and operations on behalf They are NHS units which manage and fund healthcare provision at local level.

Chris Ham, chief executive of the King's Fund healthcare charity, said: 'This is the biggest change in the NHS since 1948.

Effectively what the Government is doing is turning the NHS upside down.' He added: 'We don't know whether there will be a net saving as a result of all this.' Nigel Edwards, of the NHS Confederation, which represents trusts, said: 'It is hard to stress just how radical this is.

Andrew Lansley wants GPs to take over the entire commissioning role.

Family doctors will be expected to join together in local 'consortia' - probably around 500 across the country - to organise healthcare and decide which services to buy from hospitals and other organisations in their areas.

Family doctors will take over responsibility for spending £70billion from NHS managers, thousands of whom could lose their jobs as their organisations are abolished.

Mr Lansley claims that management costs could be cut by 45 per cent.

Mr Lansley says the GP revolution will improve care because doctors know better than managers what is best for their patients.

They could also employ managers from abolished primary care trusts.

This has led to scepticism that the plan would actually save money.

Mr Lansley said: 'The sick must not pay for the debt crisis left by the previous administration. Shadow Health Secretary and Labour leadership candidate Andy Burnham said ten years of 'painstaking work' to raise standards in the NHS had been 'thrown in the air'.

'It is a huge gamble with an NHS that is working well for patients,' he said.

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GPs, and fund other services such as public health and out-of-hours care.

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