Primary care groups and primary care trusts are today's NHS buzz- words. Next April the first PCTs will break free of health authority control, commanding budgets of£60m and with power to change the way hospital and community care is organised.
PCGs, the forerunners of the new trusts, have only been formally established since April this year, but the Department of Health insists there is a 'flurry' of interest in moving to trust status.
Interested parties say officials have revised their forecasts downwards since predicting 20 or 30 trusts in the first wave. Officials now expect only 10 to go live, and the Treasury is said to be putting pressure on the DoH to keep costs down - fledgling PCTs can claim up to£275,000 in start-up costs.
Clive Parr, chief executive of the National Association of Primary Care, says: 'I would be surprised if there were more than 10 that will go live on 1 April.
'The guidance has not long been out and PCGs themselves have not long been established. Many will want to wait and see how the first few do before taking a decision.'
But HSJ has tracked down some of those still eager to join the government's bright new dawn.
Level-four PCTs will take over the running of community health services as well as commissioning secondary care and providing primary care. And it seems that the one thing the first applicants have in common is that they are much smaller than predicted.
Mergers with other PCGs may come later, but these groups are starting out on their own.
North East Lincolnshire PCG, covering 170,000 people, is meeting officials from Trent regional office this week to finalise its proposals. 'It is vital to take forward the success we have already achieved as a PCG,' says chief executive Roz Gower.
'We are becoming frustrated by some of the limitations of being an HA sub-committee. We want to get on with integrating services and building a flexible, integrated workforce that can attract professionals into the area.'
The PCG wants to set up a different governance system to the government's proposals.
Ms Gower says the group is looking for a 'grassroots-driven model' based on a 'professional college' of GPs, nurses, professions allied to medicine, dentists, opticians and pharmacists.
The chair of the college would take the chair of what ministers describe as the trust's 'engine room' - the executive. There would also be an extra lay member on the trust board.
DoH guidance suggests that the executive would handle day to day decisions, priorities and investment plans, with the board deciding executive members' pay, proposals for spending on GP premises and general medical services local development.
But this PCG sees it a little differently. Its draft application for PCT status says: 'It is proposed that the executive board makes operational and strategic decisions. These would then be proposed to the trust board for ratification as necessary.'
On the borders between Norfolk and Cambridgeshire, four PCGs are hoping to become separate top-level PCTs.
The groups, all with populations of around 100,000, will co-operate and share community services diverted from North West Anglia Healthcare trust.
Alan Burns, chief executive of Cambridgeshire HA, says the district 'doesn't believe in mergers'.
'We prefer small units that GPs and clinical staff can engage with.' Instead of forming a super-PCT around the community trust, the different groups will 'distribute community staff between them'.
District nurses will be employed by different PCTs, but specialist services such as community paediatrics will go to one of the four PCTs, which will then provide services for the other trusts.
The changes will leave North West Anglian Healthcare trust with only£20m of its£30m budget, covering a community hospital, mental health and learning difficulty services.
In Northamptonshire, Daventry PCG is also applying for level-four status. But unlike the North West Anglia group, Daventry is planning 'a phased approach' to acquiring community services.
Chief executive Julia Squire says the PCG is working with Northampton Community Healthcare trust, which serves other PCGs as well, to 'make sure we do not mess up services by taking them out'.
A project team is co-ordinating discussions between the would-be PCT and community and acute trusts to decide what will happen to services such as school nursing and mental healthcare. The PCG is carrying out a health needs assessment of each general practice to decide how to configure services.
The PCT consultation is complicated by a wider debate about reconfiguring health services across the county. Ms Squire says the PCG is 'struggling with how to have a meaningful consultation on PCT status within all this'.
Chair Dr Kevin Herbert says Daventry is also keen to alter the proposed governance arrangements. The suggested model is 'too political', creating tension between the executive and the board.
While no decisions have yet been made, Daventry is looking for a system, possibly with more lay members, that 'has the respect of the professionals and the public'.
Southampton East PCG, with a population of about 134,000, was a front- runner for early PCT status. Chair Dr David Paynton says the attraction is 'being able to provide services as well as commissioning, being able to develop intermediate care and having greater control of a unified budget'.
The PCG's finances are 'very compartmentalised' making it difficult to create a more flexible health service with different sectors working together.
But the final shape of the Southampton PCT has not yet been decided. Dr Payton says: 'There is no fixed template and we will need a lot of support from the regional office so that we can learn as we go.'