VITAL GP cover at community hospitals could be lost in the autumn with potentially catastrophic effects on demand for acute hospital beds, British Medical Association Wales leaders have warned.

Many family doctors currently providing day and out-of-hours cover at community hospitals intend to stop in September unless national agreement can be reached on pay and other issues.

One practice, covering Chepstow community hospital, has given notice to Gwent Healthcare Trust that it will not do work there from September 27. A Gwent GP leader believes there will "almost certainly be others".

"It's definitely an issue in Gwent, perhaps smaller here than in rural Wales where hospitals can be isolated, but with our bed problems, community hospitals are a key safety valve," said Gwent Local Medical Committee chairman Dr David Bailey.

Trusts may be able to bring in other staff as cover in some cases but not others, and as a result some patients might have to go to already busy acute hospitals.

GPs have traditionally looked after patients in community hospitals under very localised agreements with NHS trusts.

The BMA argues that for years GPs have received a pittance for this work, some practices providing 24-hour community hospital cover for as little as £500 a year.

The BMA's Welsh GP committee chairman Dr Andrew Dearden said doctors want a national agreement. The organisation submitted proposals to the Assembly five weeks ago, but has heard nothing.

"We understand Jane Hutt (health minister) favours a national agreement and we should have had Assembly proposals two-and-a-half weeks ago. We have very little time to reach agreement before the end of September." This deadline is important as the time when new arrangements are introduced to provide out-of-hours cover for regular GP patients, and doctors want community hospital arrangements settled too.

Dr Dearden also fears trusts may use the situation as a means to close community hospitals, blaming GPs.

"There's not a GP in Wales being paid for out-of-hours work in community hospitals, and we estimate they get under £1 an hour on average per GP, for day work, about £3.50 per practice.

"GPs do not want to earn a fortune, just a reasonable amount for day work in community hospitals."