The future for PCTs may include employing practice staff, taking on many more salaried doctors and even providing social care.

One obvious step for PCTs would be to directly employ staff in general practices. This, however, can only happen with the consent of the staff and the GPs involved.

Although some unions claim many practice staff would prefer to have the standard terms and conditions a PCT could offer, there has been little enthusiasm among GPs for relinquishing 'their' staff.

However, this may change as the structure of general practices develop. A number of PCTs have been looking at employing salaried GPs, often through personal medical services schemes. It would be anomalous if their staff were not then also directly employed.

PCTs could see a major expansion in staff numbers if social care was also brought under their umbrella.