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PCTs have had ‘broad hints' that the government will try to change the regulations in time to allow two or three GPs in each of the new surgeries to be untrained.

The DoH is using its five-year Equitable Access in Primary Medical Care programme, backed by a £250 million access fund, to plant 113 new surgeries in the 50 most under-doctored PCTs in England.

Officially, PCTs maintain that the new surgeries, serving ‘at least' 6,000 patients, will be staffed by four GPs.

But Phil Emmott, a health management consultant and former deputy chief executive of Bury PCT, says he has ‘indications from colleagues that one doctor has to be vocationally trained but the others would not have to be'.

‘By the time these surgeries are open it may be possible to staff them with junior doctors who haven't completed vocational training,' he said.

The new grade would introduce a new type of primary care doctor below principals, salaried GPs, locums and registrars.

Professor Chris Drinkwater, president of the NHS Alliance, said the plan would help the government deal with the ‘glut' of doctors completing their postgraduate training this year.

‘It is market forces,' he said. ‘If you've got an oversupply of doctors, you can force down wages.'

The new staff grade doctors would need to be supervised, but ‘there are no clear criteria for what supervised means', he added.

Medical directors and directors of clinical services at the new surgeries have to be GPs, under specifications sent to PCTs by the DoH. But it has not sent specifications for the other staff GPs.

At present GPs cannot practice unless they are listed on the GP register, for which they require vocational training. But these rules could be amended by primary legislation.

Dr Richard Vautrey, deputy GPC chairman, said: ‘It confirms our fears that patients will be offered a lower standard of general practice through the Darzi centres,' he said.

A DoH spokesperson said: ‘Actual staffing is a matter for local consultation.'

The new practices must be working towards accreditation within 18 months to offer training from the first postgraduate to the last year of GP training, says the DoH.

PCTs will receive a fixed sum of £708,000 in 2009/10 and £1,150,000 in 2010/11 for each Darzi surgery they open.

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