Primary care leaders last week signalled their willingness to enter talks about a possible merger of the three main lobby groups.
But already tensions have emerged, indicating there could be a fierce struggle for power in the post-fundholding NHS.
Merger talk was mooted amid continuing concerns about how fundholding will be phased out, what will happen to fundholder savings and overspends, and how the new primary care localities will be managed.
The National Association of Fundholding Practices, which was highly influential under the Conservatives, the National Association of Commissioning GPs and the Association of Independent Multifunds face change as their previous campaigning role may no longer be appropriate.
But NAFP chair Rhidian Morris said NAFP believed there was still a role for the groups, whether they operated alone or together. These organisations exerted a powerful influence on the health service and must not disappear, he said.
Talk of merger surfaced as Dr Morris revealed that NAFP was embarking on a process of self-examination. He told the Journal he could not formally propose a merger with NACGP and AIM because it had not yet been discussed or decided by the NAFP council. The other groups may not want it anyway.
But, expressing a personal view, he said it was sensible to have one strong primary care organisation to look after the 'development needs' of all professional groups in the sector.
He stressed that the organisation would in no way be a 'threat' or a 'challenge' to the British Medical Association's general medical services committee, which negotiates GP pay and conditions, or local medical committees.
Ron Singer, secretary of NACGP, agreed there was a 'secondary role' for a primary care organisation other than the GMSC, whose focus should be education and training.
Speaking in a personal capacity, Dr Singer said he agreed with the direction Dr Morris was pursuing, but warned: 'It is possible that NACGP will want to retain its own identity.
'We would want to be in the driving seat. I am not sure we would want to ditch it all, having pioneered the commissioning idea in the first place, on the basis of other organisations' conversion.'
Dr Singer added: 'The history of trying to work with NAFP has not been easy to date.'
Michael D'Souza, chair of AIM, said it would openly collaborate with any pro-NHS organisation, which should, in contrast to previous ones, be based more on policy and less on personality, he said.
Meanwhile, NAFP has called for a 'level playing field' in the appointment of staff to manage the new localities to ensure fundholding management expertise is not lost to the NHS. Dr Morris said there were fears that health authorities could pack localities with their own people. NAFP thinks GPs should be involved in the appointments process.