The national plan's proposals for patient advocacy and liaison services (PALs) have sown confusion about the future of community health councils.

CHCs are the only aspect of the 1974 NHS reorganisation that have survived unchanged to the present day, and ministers are known to have been reviewing their future. Many of the functions suggested for PALs appear to repackage functions previously carried out by CHCs.

Donna Covey, director of the Association of Community Health Councils for England and Wales, said CHCs had been calling for a review of their functions for some time. She suggested they could have a new role in primary care.

Central Manchester CHC chief officer Nik Barstow said hospital-based advocates could affect their independence. He also criticsed the 'emphasis on hospitals', saying about half the complaints he dealt with were about GP services.

Elizabeth Manero, chief officer of London Health Link, said it 'wouldn't make any sense' to set up a national network of patient advocates separate from CHCs.