The ongoing debate about the controversial polyclinic proposals has been joined by the government's rural advocate.
In the Commission for Rural Communities' submission to Lord Darzi's review of NHS services, the so called "supersurgeries" proposals, have been assessed as unworkable in the countryside.
The Commission, which surveyed rural PCTS, GPs and other health professionals, submitted its findings to the Darzi review this week.
It takes issue with the "lack of flexibility" built into the proposals for new services and their failure to "accurately reflect local needs and circumstances."
The report said: "PCTs have indicated to us that local decision-making is often constrained and market driven.
"In one case, the decision to put new GP centre in an urban location has been taken in response to market forces - greater number of patients, better financial outcomes and profit margins rather than taking into account of gaps in current provision (no GPs in a large rural area) and local need."
Dr Stuart Burgess, chairman of the CRC and the government's Rural Advocate, said: "In our submission we have emphasised the need for flexibility in the design and provision of rural healthcare, rather than the replication of services that work in an urban setting."