The mantra for the reconfiguration of specialist care services is 'centralised where necessary, localised where possible'. Clinicians will play a lead role in determining what is possible under the proposals.

The guidance calls for a lead clinician, from primary or secondary care as appropriate, to be appointed for each consultation and charged with ensuring their clinical colleagues are involved at each step of the process.

NHS Confederation deputy policy director Jo Webber said that although many proposals would be likely to accelerate the shift of care out of hospital and into the community, "it's not all about closing down hospital services, but about changing the way they are delivered, including looking to what the hospital trust could deliver in the community".

She said that in some cases hospital trusts might extend their services by vertically integrating provision along patient pathways from community services through to acute.

But she warned that PCT plans to radically redraw local services could be affected by the independent status of foundation trusts, which might stand aloof from local reconfiguration talks because their catchment area extends further afield.