The British Medical Association has proposed the creation of an organisation to bridge the gap between purchaser and provider and move towards single-system working.

Its discussion paper, A Rational Way Forward for the NHS in England, recommends that health economy foundation trusts (HEFTs) 'could be created to overlay the purchaser-provider divide', which, the report states, 'is likely to frustrate ambitions to form co-ordinated networks and forge pathways across primary and secondary care'.

It says such a model should be encouraged where 'stubborn divisions remain' between commissioners and providers to ensure a mature commissioning process.

The board of the HEFT would include provider and commissioner representation from hospitals, general practice, community providers and public health representatives. It would plan and deliver healthcare across the local health economy. When in place they would supersede other foundation trusts. Under the HEFT model, local citizens would be encouraged to participate as members.

BMA GPs committee chair Dr Hamish Meldrum said it would be an evolutionary process and not dictated from the centre.

'I am not suggesting that we scrap PCTs but that we get away from divided structures. We want closer commissioner-provider collaboration. It may be that will move towards HEFTs.

'There is an artificial divide between those who commission and those who provide and it is not helpful.'

The paper also recommends that there should be an independent board of governors, appointed by Parliament, to prevent the 'day-to-day dabbling' of politicians in the NHS.

BMA chair Dr James Johnson said: 'Ministers would still set the budget and the direction of travel for the NHS but it would then be down to the board to implement that without political interference.'

He said that blaming health secretary Patricia Hewitt for the latest outbreak of Clostridium difficile prevented individual trusts being held to account.

'It cannot be good for the secretary of state to have to react to every story in the local papers; it cannot be the best use of a senior politician's time.'

Ministers would be able to defer questions on the NHS to the board and focus of public health matters. The board would uphold the BMA's other chief recommendation - a constitution, which would detail the core values of the. NHS, and a charter explaining what the public could expect from the service.

It would also appoint an executive management board to be responsible for 'guiding the performance and the national operations of the NHS'.

The paper also recommends an elected local health council to provide a link between the community and health professions/managers.

It also called for an independent review of the structures of provision of public health and says that with the introduction of the. independent board, the DoH should review its role and focus on providing adequate resources to deliver the constitution and public health agenda.