GPs could be given the opportunity to bypass primary care trusts and hand commissioning to private sector organisations under Conservative plans.

Shadow health minister Mark Simmonds told HSJ that using companies such as Humana would be an option where GPs did not want to become commissioners.

The Conservatives have pledged to give GPs real commissioning budgets - the practice based commissioning system does not allow this.

Mr Simmonds acknowledged some GPs would not want to take on commissioning work.

Primary care trusts’ expertise might be called on in these situations. “There may also be circumstances where if there’s a continuing reluctance [from GPs] we may have to bring in others to commission on their behalf.”

“Federated” groups of GPs would be allowed to select whether another GP consortium, the PCT or a private firm did the commissioning, he said.

“We need to emancipate and empower GPs, and practice based commissioning doesn’t deliver.”

Mr Simmonds said commissioners would be paid to hit targets under an expanded quality and outcomes framework encompassing preventive measures.

But he would not say whether PCTs would be downsized as a result of moving some commissioning work into primary care. “That’s part of the discussion and decisions we need to make about where resources are allocated.”

Mr Simmonds called for a “greater aligning of incentives” between GPs, pharmacists, nurses and primary care trusts - including using the quality and outcomes framework.

He said: “We need much more effective commissioning and that means we have to have commissioning that is ultimately focused around driving improved patient outcomes.”

In order to avoid conflicts of interest he said GPs would be expected to use a “tendering process” to appoint providers.