The number of primary care trusts in England could be significantly reduced under Conservative health plans, it is reported.
Under a Conservative government, GPs would be given many of the commissioning responsibilities previously held by PCTs.
Shadow health secretary Andrew Lansley told LGC’s sister title HSJ this would give GP practices would get “real opportunities to save and reinvest, and real control over contracts”.
Mr Lansley said this would combine “the decision-taking responsibility for where and how patients are treated with the finances which are necessary to support it”.
But David Furness, health project leader at the Social Market Foundation think tank, said the implications of an enhanced role for practice-based commissioning were “much more significant than has been [previously] discussed”.
If consortiums took on more responsibility for commissioning health services there could be less rationale - and management funds - for all 152 PCTs.
In some areas, such as north London and the East Midlands, PCTs have already merged some of their commissioning responsibilities to reduce costs and potentially increase their relative strength over acute providers.
Asked if the Conservatives would want to see more such mergers, a spokesman said: “It would be perfectly reasonable to aggregate, but it will be up to them [PCTs] to decide. It would be done on an organic bottom-up way if [they] choose to do so.”
Sources within the NHS, who have been asked to advise the Conservatives on the development of their health policy, said they thought the party would ideally like to see strategic health authorities and PCTs merged to create maybe 40 strategic commissioning bodies, organised around city regions.
That would resolve the perceived problem of PCTs being “too small” to negotiate good value from large acute hospitals.
However, a spokesman for the Conservatives denied they were planning to merge SHAs and PCTs. He said it was “very clear that’s not what we are planning”.
Both Tory leader David Cameron and Mr Lansley have pledged they will not subject the NHS to another round of structural reorganisation.
Mr Lansley said PCTs would play an important role organising contracts between commissioning consortiums and acute providers.