Doctors could be given responsibility for most health services under a radical shake-up of the NHS to be outlined shortly, reports claim.
Up to £80bn could reportedly be distributed to family doctors with strategic health authorities and primary care trusts scrapped under the plans.
GPs could also have to organise out-of-hours services, in a move which could see them resume responsibility for 24-hour care.
The changes - to be outlined in a government white paper to be published next week - are in line with the coalition government’s view that GPs are best placed to understand patients’ needs and to decide where money should be spent.
But there are said to be fears within government that family doctors may not have the skills or desire to take on the role. Others have raised questions about accountability.
There are currently some 150 PCTs and SHAs, which oversee NHS trusts and supervise local NHS services.
At present, the government allocates funds to local trusts, which then pay for patients in their area to be treated in hospital.
Under the new proposals, doctors would receive the money instead and pay hospitals directly for referrals.
A spokesman for the Department of Health said: “The details of our plans for a patient-centred NHS will be published in a white paper shortly.
“In recent speeches, the Health Secretary has set out the values and vision for an NHS centred on patients; we will ensure that patients share in decisions about their care - ‘no decision about me, without me’.
“He has already emphasised the need to liberate the NHS to focus on outcomes and improving results for patients, as reflected in the revised Operating Framework which was published on the 21st June 2010.
“And in a speech to the BMA on 2nd July, he highlighted the importance of empowering doctors and nurses in the NHS to deliver quality standards and services.”
The acting chief executive of the NHS Confederation, Nigel Edwards, told BBC Radio 4’s Today programme: “In transition to this new system there are some quite significant risks.
“Obviously it is going to take time to implement this and the PCTs at the moment are the people who keep the lid on the performance and financial management of the system.”
Mr Edwards said that the reform would move the NHS from a market in which a number of large organisations place big contracts to one more like the gas or telecoms market in which demand is shaped by many individual purchasing decisions.