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Access to medical and rehabilitation services for a range of disadvantaged groups could be affected by a funding shortage in primary care, writes Derren Hayes.

Family doctors may refuse to provide specialist medical services for substance misusers, asylum seekers and the homeless if primary care trusts refuse to fund them from next April.

Many PCTs, particularly in inner cities, are giving millions of pounds to overspent hospital trusts to balance their books, and are unlikely to have the cash to fully fund services for disadvantaged groups.

Traditionally GPs have provided these "enhanced" services without being paid the full cost of doing so by the government. But under the new GP contract, agreed in June, doctors will be able to "opt-out".

The new contract had been expected to improve services for these groups, because it rewards GPs for offering the services at local surgeries. GPs receive £1,000 a year for each category of enhanced service they provide, plus an additional payment of between £200 and £500 per patient.

However, this is reliant on PCTs, which are responsible for three quarters of the NHS budget, having enough funds and deciding the groups are a local health priority.

If they decide not to fund the service at a practice level, PCTs would instead be forced to fund a single specialist service provided by one GP surgery or the voluntary sector.

Dr David Jenner, the professional executive committee lead for the NHS Alliance, said: "It won't mean that GPs will stop registering asylum seekers or treating those with alcohol problems, but it will be a real base-level service, such as making sure they are otherwise healthy and having access to general advice."

Enhanced services, by contrast, would include blood and urine screening, drug testing and detoxification, and maintenance treatment.

Andrew Dearden, chairperson of the British Medical Association's community care committee, said many GPs wanted to provide enhanced services, but would opt out if not adequately funded.