Primary care is integral to making the £20bn savings that the NHS is expected to make over the next few years and improving the patient experience. But we are facing huge organisational change; the first wave of clinical commissioning groups (CCGs) has been announced this week, with further waves expected by April.

As they find their feet, it is unclear how efficient CCGs will be at commissioning cost-effective services in the first few years. Primary care trusts (PCTs) are currently tasked with ensuring there are no overspends on existing budgets. CCGs will take over that work next year. As they are phased out, many PCTs are passing all their work (and money) in the form of "block contracts" to hospitals. This means hospitals have a contract to care for a patient population regardless of the actual care given. An amount is agreed for each contract (usually for a 12-month period) based on many pieces of work, such as for elective orthopaedic surgery and ultrasound diagnostics, or new and follow-up clinic appointments. Patient choice will therefore be hampered, because, for example, if I refer my patient to a non-contracted hospital or community setting, it would incur further costs.

Hospital trusts have been feeling the pinch, since both tariffs – the amount paid for each surgical procedure, scan or clinic attendance – and elective work are going down. Hospital beds may be full but it is the elective, not the emergency, work that is more lucrative. They have to think of new ways to generate income and cut costs. But block contracts can mean their income is assured regardless of how much work is undertaken. This is reminiscent of the privately run independent sector treatment centres introduced by the last government, which were paid upfront for block contracts to carry out fast-track diagnostic and elective procedures such as hip operations and cataract surgery. Though waiting lists went down, there were many other confounding factors (such as a big drive to reduce hospital referrals) and, in the end, they never gave the NHS full value for money.

We as GPs are getting better at managing patients in our community clinics and in their homes. For instance, where previously if we saw a patient with a suspected deep vein thrombosis (clot) in the leg, they would attend the hospital daily for blood-thinning injections while waiting for a scan, now they can attend local GP clinics.

Most bed occupancy in hospitals is owing to lengthy stays – bed-blocking – by older people who have many co-morbidities and complex social needs. This can only be improved by creating medical and social care pathways that allow them to be treated in community settings. But if PCTs invest all their funds in hospital block contracts there will be no money available for any further innovation or community-based projects.

I am all in favour of my patients being cared for by local providers of NHS services, be they GPs, nurses or hospital consultants. But there is really no room within the current financial climate to contract services through the same old inefficient providers. The Department of Health has emphasised the need to offer choice to our patients' choice, and provide convenient and specialised services closer to home. Yet awarding block contracts is incongruent with these national policies.