Health Minister Edwin Poots' ambitious plan to save Northern Ireland's health service looks set to fail before it begins as he faces a revolt by GPs across Northern Ireland.
Doctors' leaders have warned that the overhaul of the way health and social care is delivered will prove "impossible" if Mr Poots imposes a proposed new contract on GPs.
It comes after Mr Poots announced the outcome of the public consultation into Transforming Your Care (TYC) – a major shake-up of the health service here.
A major theme of TYC is reducing reliance on our hospitals by providing more care in the community.
However, the British Medical Association (BMA) in Northern Ireland has said GP surgeries will be unable to cope with the additional workload associated with TYC at the same time as proposed changes to the GP contract.
Speaking to the Belfast Telegraph, Mr Poots said he is hopeful an agreement can be reached with GPs before April 1 – the date the new contract is due to begin.
However, he was unwilling to comment on the future of TYC in the event of unsuccessful negotiations.
"I am not considering this at this moment and believe it is incumbent on us to reach an agreement, and that is something we will have to do," he said.
Dr Tom Black, chair of the BMA's GP committee in Northern Ireland, urged the minister to act to address the current impasse.
"A failure to reach agreement will result in GPs being unable to engage with TYC at any level at this time," he said.
"GPs are very concerned about the impact on patient care, including access to services, increased prescribing, increased dependence on secondary care, and a huge increased focus on targets and box-ticking, rather than dealing with the patient as a person.
"I think the system needs to understand GPs are work-saturated and have had a decrease in resources for every one of the last seven years and cannot possibly take on two of the biggest changes we have ever seen both on the same day.
"We are very disappointed as the system seems to lack leadership – someone within the system must understand these two things can't happen at the same time and we look to the minister to make a decision."
The situation arose after annual UK-wide negotiations on the new GP contract broke down, leading to separate negotiations in each nation.
An agreement has been reached in Scotland and Wales, but the contract is to be imposed in England.
Doctors here have expressed outrage at the current proposals for Northern Ireland which they have said will actually put some patients' lives at risk.
The General Medical Services (GMS) contract is the UK-wide contract between general practices and primary care organisations for primary care services to local communities. NHS employers led talks with the General Practitioners Committee, part of the BMA, on changes to the GMS contract. The contract began in 2003 covering a number of areas, including running a practice and setting out standards and targets.