CORRIDORS OF POWER SW1 CITY OF WESTMINSTER

The welter of changes to healthcare provision on 1 April could see the date go down as one of the most significant for years.

The introduction of foundation trusts, via last year's Health and Social Care Act, kept the government on its toes, and this year's initiatives are still exercising the powers-that-be in Whitehall and Westminster.

Ministers are also poring over a problem that could have the peculiar effect of alienating a significant body of GPs, just as the new contract is introduced, while pleasing many others.

Aware of headlines claiming a return to GP fundholding, the government is keen to prevent practice-based commissioning developing into a row between personal medical services and general medical services GPs. It is believed a decision has therefore been taken that would allow all GPs to take up the policy, but beginning with a series of pilots rather than a free-for-all. Expect an announcement in the next couple of weeks.

Last month, HSJ reported that foundation trust chief executives decided not to form a representative body outside the NHS Confederation (news, pages 4-5, 4 March), but to try to develop a strong separate identity within the organisation.

HSJ understands that none other than foundations regulator Bill Moyes also believes an effective lobby group is essential - in or out ofthe confederation. With so much of the detail on how foundations will function within the NHS yet to be worked out, it is felt important that foundations lead the thinking. If nothing else it will be a good test of how successfully they are weaning themselves off the NHS dependency culture.