Monitor chief executive David Bennett has said the scrapping of the purchaser-provider split envisaged by Sir David Nicholson may not be in NHS England’s power.

Sir David, the outgoing chief executive of NHS England, used an HSJ interview published today to say his organisation was already “thinking about the possibility of mutual [organisations and] social enterprises, and also about whether the straightforward commissioner-provider split is the right thing for all communities”.

The chief executive called on the service to look closely at US “health maintenance organisations” Geisinger and Kaiser Permanente, which serve as insurer and provider for a defined membership.

But Mr Bennett said in an interview this afternoon: “It’s possible that this is where the system might end up, a series of separate HMOs [but] it’s going to be a while before we get there. It could fundamentally change what we do.

“That’s a government issue, I don’t think it’s in anyone’s power as an arm’s length body, NHS England or Monitor”.

He said the existing system could accommodate a prime provider model, where a larger organisation commissioned smaller units of care, and this already happened in some places.

He also stressed that it was difficult to comment without more details of what Sir David envisaged.

But Mr Bennett was clear that dropping the authorisation standard for aspiring foundation trusts was a “bad idea”.

Sir David told HSJ he condemned the idea of a “cookie cutter foundation trust pipeline”, which would see all NHS trusts become foundations.

NHS England’s strategy document would examine “whether the foundation trust is the right model for all [provider] organisations in the NHS”, he said. “We should liberate people… if they think [alternative models] are the right thing to do, they should do it.”

Mr Bennett told HSJ that any move to drop the assessment standards applicants must currently meet was “a bad idea”.

He said: “Every NHS provider of care should meet that standard. It may be appropriate to look at alternative arrangements for the governance. If you are not a public provider you don’t have to meet the same standards. The requirements on non-NHS providers are a lot lower, [for example] fit and proper person.

“If the suggestion [is] that hospital trusts are not able to meet our standards and can continue not meeting our standards then that’s a bad idea.”

Mr Bennett also said he was “concerned” about how unique the factors that caused the dip in accident and emegency performance this year were.