Primary care trusts will be expected to take the lead in developing proposals for local service redesign and ensuring patient and public involvement at all stages under Lord Darzi's proposals.

PCTs will be tasked with ensuring patients, the public and others are involved in all stages of the development of proposals, "not just at an advanced stage", the guidance said.

They must also hold "early and ongoing" discussions with local authority overview and scrutiny committees, which can refer disputes up to the Department of Health and ultimately to the independent reconfiguration panel.

Also, clinical leaders in PCTs will be responsible for "generating, leading and managing major service change" and ensuring frontline and other staff are engaged throughout.

NHS Alliance co-vice chair and director of quality and performance at South Staffordshire PCT Yvonne Sawbridge said the strategy required local input, strategic overview and mutual respect.

"As long as in every region PCTs are left to understand their local issues within the broad framework of the strategy, it will be fine. But where a strategy is imposed and people are performance-managed around one size fits all, it won't work," she said.

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