Private firms could take over GP surgeries unless they provide out-of-hours cover, according to a Department of Health letter.
It reportedly tells Primary Care Trusts (PCTs) to come up with plans to persuade doctors to "respond to the needs and expectations of their patients, for instance by opening practices for longer periods".
And it says using alternative providers from the private sector should be considered as one way of achieving this.
Dr Laurence Buckman, chair of the British Medical Association's GP committee, said: "It is a very aggressively worded letter which I don't think can be interpreted in any other way but as giving primary care to the private sector.
"PCTs are being told that their performance will be judged on how well they do this."
But Department of Health commissioning director Mark Britnell said: "The Fairness in Primary Care programme will work with PCTs with the fewest GPs for their populations, and address long-standing inequalities in service provision where traditional general practice has failed to respond.
"There is an inverse care law whereby those who require most care are also those in the least doctored areas.
"We are determined to tackle this issue, and will work with both the public and private sectors to ensure this problem is addressed."
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"There never was any real surgeries on Saturdays prior to the 2004 contract in many areas, with weekends being emergency clinics. The government is looking back with rose coloured glasses and trying to reinstate something that never was in most places. They will then claim some sort of major victory if it comes in rather than realising they made a mistake with the contract" - Ron Dutton, Cornwall
"I completely agree with Neelam. I cannot resign myself to the fact that all public wishes, no matter how absurd, have to be met by already overworked practices. Where do we draw the line? Having experience of health care services abroad, both as a user and as a manager, I think the NHS provides very high quality services, and that it would be best to concentrate on the targets and objectives we already have, rather than asking GPs and their staff to stretch themselves even further" - Virginia, London
"So with over 80% of patients happy with the opening hours of their doctor's surgeries, this governement is going to continue to privatise the NHS by the back door to satisfy the minority who can't be bothered to take a couple of hours off work to attend their doctor? By that logic, at the next election, the party with the fewest votes will get elected!" - Jerry Cooke, Kent
"Am I missing something here? The practice pays for the OOH care, or certainly contributes towards the cost. Remember the £6K per GP?" - Name and address supplied
"Not fair. The government has raised people's expectations to ridiculous levels. Now patients expect to be treated for minor ailments, coughs, sneezes etc within 24hrs at any time place they choose. Instead of nannying the public, the money should be spent on re-educating them. Has anyone done an audit on who attends OOH and why?" Neelam Ben-Haque, London