Published: 14/10/2004, Volume II4, No. 5927 Page 7

Primary care trusts must become more 'sharp-edged' commissioners if they are to avoid being 'held to ransom' by private providers and 'strait-jacketed' by regulators when legally binding contracts are introduced, the NHS Alliance has warned.

A discussion paper launched ahead of the alliance's annual conference next week sets out the role of PCTs as the 'main players' and 'ultimate determinants' of whether the NHS becomes 'destabilised' by 'cherry-picking' private providers.

'Corner shops have become big branded supermarkets - the same could happen in the NHS with large companies developing services as a loss leader to develop a monopoly and swallowing up local GP practices, ' said alliance chair Dr Michael Dixon.

'The whole premise of primary care as continuous, holistic and personal care could be lost by fracturing the system. It is a crucial reminder of the importance of PCTs and their overall commissioning role in primary care.'

'There is been lot of talk of practice-led commissioning, but PCTs are crucial if we are to hold it all together, 'he added, referring to the commissioning challenges anticipated in a system characterised by foundation trusts, payment by results and patient choice.

lHealth minister John Hutton is today due to announce new quality requirements confirming that patients will always be able to see a GP if their condition requires it.

The Department of Health said the guidance would show exactly what ministers expect the NHS to deliver for patients in the evenings and at weekends.