So-called 'host' primary care trusts could be set up to deliver public health services on behalf of other local trusts, according to the Health Development Agency.
The organisation is celebrating its first anniversary after it emerged from the remnants of the doomed Health Education Authority with around half its workforce and a slashed budget.
Chief executive Richard Parish has outlined three 'models' for the provision of public health initiatives: 'We could see PCTs develop their own public health teams along the more traditional lines.
But we could also end up with, say, three or four PCTs coming together and offering combined services to a region.'
A third option, he said, would see several PCTs joining up, with one becoming a 'host' trust offering public health services to all members of the partnership.
Despite the challenges in helping to deliver the government's numerous pledges on public health - including ambitious promises to reduce the stark health inequalities between rich and poor - Mr Parish said public health workers have been enthusiastic about the agency's input over the past 12 months.
He stressed that 'no one person' could deliver public health targets and much of the HDA's work over the coming year would be about investigating which NHS tier is best suited to provide different services.
It has raised concerns, however.
Executive member of the NHS Alliance Chris Drinkwater said public health was a ground-level service. He believed that being distant from local communities, which he feared could happen under pooled or host PCTs, is likely to undermine delivery.
'There has to be that connection for the policy to be effective, ' he said. 'I have been concerned that with the merger of more and more PCTs, public health initiatives might not work. They have got to function at a local level, or there is a real danger they will simply replicate health authorities.'
The need for action within communities is recognised by the HDA - especially with the patchy development of health improvement programmes.
Many primary care managers have complained about the abstract jargon of the policy guidance, some saying HImPs have amounted to nothing more than a blue-sky philosophy.
Mr Parish told HSJ: 'Some of the criticisms are valid, especially during the first year of HImPs. But I would stress that there is wide variation in what PCTs are offering up and down the country.
Some of the projects have been very good, dealing with specific issues at local level. Others have struggled, and It is been more about public health providing a context for service delivery, which is not so much what we want to see.'
The HDA has no direct powers to change the approach of some PCTs and primary care groups, but would exert its influence through 'persuasion, argument and wit', Mr Parish said.
He revealed that the agency is also looking at creating a standard curriculum for public health training. 'At the moment there is a core curriculum offered by institutions, but a substantial amount of the courses vary from each other. We think getting the agency involved will raise standards and help provide improved training for people coming into the service.'