Tom McCarthy says: 'Community trusts recognise the writing is on the wall. A number have already begun to seek active alliances with GPs to safeguard their organisations. It makes sense because the trusts have the management expertise while GPs have the clinical expertise.'

Chief executive of Optimum Health Services trust, Annie Brough, warns: 'It is important that community trusts do not get hung up about the survival of organisations. We must focus on maintaining services.'