Up to 19 independent primary care trusts could be established in the first wave of the government's reform of community and family health services next April.

Proposals for 43 more PCTs, which will provide primary and community care as well as commissioning hospital services, will go out to consultation this week for an October 2000 start.

All but one of the bids for April 2000 are for the most powerful level-four PCT status.

Ministers finally unveiled details of the applications last week. Most primary care groups have chosen to go it alone, despite predictions that they would have to merge to form larger trusts.

Sixty-seven PCGs made the initial 62 bids for PCT status. They now go out to local consultation before health secretary Alan Milburn makes his final decision.

Health minister John Denham said: 'The high level of support for our plans to modernise the NHS is clearly demonstrated by the tremendous response we have received from local GPs and nurses.'

Supporters of the government's reforms welcomed the figures.

Claire Perry, chair of the New Health Network's executive group and chief executive of Bromley health authority said: 'This is a huge vote of confidence in the government's policy.'

But a former pioneering fundholder, who is leading a bid for first-wave PCT status, questioned support for the policy.

Dr Howard Freeman, chair of Nelson PCG in south London, said: 'I don't think 19 out of 481 primary care groups is a vote of confidence. The test will be whether general practice is enthused about the policy a few years hence.

He added: 'Can they cross the hurdle of getting 50 per cent of all GPs?'

Department of Health officials said every application except one put forward by the 30 September deadline was now going to consultation for either an April or October start.

The exception is Wakefield SouthWest PCG, which withdrew its application last week, saying it needed more time to prepare its proposal.

Dr Lisa Llewellyn, chief executive of Peterborough South PCG, said her members did not want to be bounced into trust status by the announcement.

'This is not done and dusted, ' she added.

'We have agreed that PCT status has advantages but we are still consulting on the idea.'

NHS PCG Alliance secretary Dr Chris James warned: 'You should not assume that being a figure on a DoH spreadsheet gives you any form of approval. That can only come from the community.'

Dr James said he was 'surprised' at the large number of bids for an April launch. His PCG, Central Southampton, is waiting until October 2000 in order to carry out a 'thorough' local consultation.

But a leading opponent of PCGs and PCTs warned that all applicants were being 'misled' by the government.

Birmingham GP Dr Vijay Abrol, a 'reluctant' board member of Ladywood PCG, said: 'GPs will have very little say in the running of PCTs.

'We have stayed independent contractors but this will treat us like salaried employees without giving us the benefits such as paid overtime.'

The second wave of 116 personal medical services pilots, which allow more flexible working, including salaried GP posts, goes live this month.

See news focus, page 14.