GPs are in a row with the Government over the Covid vaccine roll-out, with doctors warning that the current plans could leave them bankrupt.
Primary care leaders have indicated that some surgeries may refuse to sign up to the national effort unless health chiefs promise more money and to pay the extra costs of delivering the jabs up front.
They are also demanding to be released from the obligation to perform various routine services, such as asthma monitoring for low-low risk patients, while the roll-out takes place.
It comes amid lingering bad blood between family doctors and the Government following the first wave of the pandemic, when there were claims that a slowness to reimburse practices for emergency measures such as personal protective equipment and perspex screens had left them financially exposed.
Watch: How will COVID-19 vaccines be rolled out?
The British Medical Association (BMA) has struck a deal in principle on behalf of GPs to administer Covid vaccines in all parts of the country once approval is granted, which could come as soon as this week.
However, it still remains for GP practices – which are private businesses – to sign up to the contract individually.
Now a letter from Doctors' Association UK GP Committee to Matt Hancock, the Health Secretary, and NHS leaders warns that surgeries may be deterred from participating if the costs of hiring extra staff, laying on transport to vaccination hubs, installing fridges and reconfiguring surgeries to cope with the flow of patients are only paid retrospectively.
"This is a huge undertaking and poses a significant financial risk to primary care, who will have to shoulder the financial burden," the letter states. "We cannot ask this of GPs when so much is at stake nationally... There needs to be a higher fee to acknowledge the huge ask and realistic costs of this programme."
NHS leaders are confident that enough practices will sign up to ensure nationwide coverage for the roll-out. On Monday night, they pointed to £170 million of funding to help the programme take shape.
Under the current plans, local clusters of about five practices covering approximately 50,000 patients, known as Primary Care Networks, will combine to organise vaccine delivery. It could mean transforming one surgery into a vaccine hub, while moving the normal services usually performed there to the neighbouring practices or hiring new premises altogether.
Renting buildings with enough space to ensure social distancing and adequate parking could push practices to the brink, warned Dr Vimesh Patel, from the DAUK GP committee.
"Many colleagues have huge concerns over the feasibility of this," he said. "I hope the profession is strong enough to say no to the arrangements if they are unrealistic."
Dr Richard Vautrey, who led the negotiations as the head of the BMA's General Practice Committee, said he was "hopeful" that all practices would sign up, but acknowledged that significant uncertainties over the specifics of the roll-out plan remain.
One particular concern GPs have is that, if a patient does not return for the second dose of a two-part vaccine, the practice will not be reimbursed by the centre.
Dr Vautrey is also pressuring the Government to suspend safety inspections by the Care Quality Commission, as well as various bureaucratic duties, while the roll-out takes place.
"We cannot do this [vaccination] at the same time as we do all the normal things," he said. "There has to be flexibility."
Watch: Pfizer-BioNTech apply for EU authorization
The row came as Moderna, the second vaccine candidate to announce its results in November, announced that it had sought regulatory approval in the US, having said its jab is 94 per cent effective.
Mr Hancock said the company had already been feeding data to the UK regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA) "for some time".
An NHS spokesman said: "We have had an incredible response from GP teams in every part of the country who want to play their part in delivering a potentially life-saving vaccine.
"A deal has been reached with the British Medical Association to ensure GPs are able to protect their patients with coronavirus vaccines, including £20 million of setup funding for the vaccination programme alongside £150 million for wider general practice capacity."