'Foundations should not be surprised if PCTs prove fierce negotiators this year. However, their complaint is about a lack of planning.'

At the beginning of the year the Commons health select committee warned that disruption caused by primary care trust reconfiguration could put health reform and improvement into neutral for at least 18 months. That warning seems to be borne out according to the confidential report by Monitor seen by HSJthis week.

The report, due to be published in the autumn, argues that their financial stability and performance on key targets are being put at risk because of 'lack of clarity in future commissioning plans'. It points out that the situation is not just bad but getting worse.

The disruption is worsened by tightly controlled spending plans for PCTs this year, which together mean that contracting disputes from last year are not getting resolved and new ones are arising. The pressure on activity will be felt most by those health economies where foundations rely on a large proportion of their income from a small number of PCTs, particularly when there are commitments to independent providers.

Foundations should not be surprised if PCTs prove fierce negotiators this year. However, their complaint is about a lack of planning. This results in, for example, 'performance standards being imposed at a late stage and without clinical input'.

The situation is exposing relationships that have suffered from poor tending over the years. There will be no more pressing test of the new strategic health authorities in their ability to heal some of these worsening rifts.