More than half of primary care groups look set to take on trust status by next April, a regional survey by HSJ has revealed.

Health minister John Denham is expected to announce shortly that between 25 and 30 new primary care trusts will go live in October. Those PCTs are due to start up in shadow form next month. Added to the 101 expressions of interest being considered by regional offices for PCT status next April and the 17 already in existence, the figures suggest 150 PCTs could be live by April 2001.

Given that many PCTs involve mergers, this means more than half of the original 481 PCGs launched last April could be part of trusts within two years of their launch. A further round of PCT formations is scheduled to be in place by April 2002.

But experts in primary care are divided over whether the pace of change has been rushed by central pressure.

NHS Alliance chair Dr Mike Dixon said GPs continued to feel 'threatened' by the developments in primary care and that those rushing to become PCTs risked becoming 'impotent' if they did so without support from their GP communities.

'I think there is a major problem here. There is a lot of dissent among the ranks and it is up to people like myself to make the argument that the ends justify the means. Going ahead without GP support, there's the danger that the PCTs will become impotent, much like the old district health authorities.'

But Dr Peter Smith, chair of the National Association of Primary Care, expressed relief that PCGs had been given the 'awful lot of support' they needed, though he acknowledged that to some GPs it could seem as though this support was 'interfering' with their everyday work.

In London, PCG chief executives and chairs have attacked what they see as confusion and division within the NHS Executive. A number of those consulting to become PCTs in April 2001 say that they are under covert pressure to merge into large trusts that coincide with local authority boundaries. The arguments put forward to them are financial and bureaucratic, they say. They also say that there is strong pressure on the regional office from social services departments which want to work with one PCT.

One chief executive said: 'It's beginning to look like a stitch-up between regional directors and Denham. We are told on one level that it's very much up to local determination and that we must get a great deal of support from the primary care team at region, then on another we are getting the message from the bureaucrats that only one PCT per borough will be approved.'

A second chief executive added: 'There is a division within the Executive. The performance management side is pressing for coterminous PCTs, but the primary care folk are saying PCTs should be built around existing communities and PCGs.'

Another PCG insider said: 'The big issue is whether region is there to set policy or act as performance managers. If the policy is that we should be coterminous, then make it happen. But there is no clear message.'

A spokeswoman for London regional office said a 'stocktake' of PCT plans before Easter had suggested that the 'norm' was coterminosity with local authority boundaries, though applications would be looked at individually. She insisted there was no 'formal policy' in place.

See news focus, page 13-14; comment, page 21.