The government’s formal coalition agreement confirms GPs will be given commissioning powers - but leaves unanswered questions over their precise responsibilities.

The paper said the government would “strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf”.

But it said PCTs would “commission those residual services that are best undertaken at a wider level”.

The new independent NHS board would “allocate resources and provide commissioning guidelines”.

Commenting on the announcements, Primary Care Foundation director Rick Stern welcomed moves towards “democratising PCT boards” but said there would always be tension between GP-level and larger scale commissioning.

He said: “The question marks would be over how they are going to provide the resources and support to enable GPs to really do that. The obstacles are how the resources are going to be provided to let people do it and how we can be sure the bureaucracy lets go.”

He added: “Probably the majority [of GPs] have limited interest in being involved in the wider commissioning of services.”

NHS Alliance chief executive Mike Sobanja said the question of who a PCT chief executive was accountable to - the locally elected and appointed PCT board members or the new NHS board that will now appoint to the chief exec post - “needs to be sorted and sorted fast”.

He added: “There will need to be a closer partnership between PCTs and the practice based commissioning partnership groups, it raises the question of accountability for PBC groups going forward.”

He welcomed an extension to clinical commissioning but said the line between the “residual services” organised by the PCT and the PBC needed to be set locally, “there shouldn’t be a one-size fits all approach”.

The NHS will also develop a 24-hour urgent care service in England, “including GP out-of-hours services” with a renegotiated GP contract and an incentive system to improve primary care in “disadvantaged areas”.