Any changes to local authority boundaries under the local government white paper should be considered very carefully, the NHS Confederation has warned.
The confederation is concerned that the white paper gives scope for councils to make boundary changes in the wake of primary care trust reconfiguration.
NHS Confederation deputy director of policy Jo Webber said: 'We are concerned about the scope to change the boundaries for local authorities. Recent experience of PCT restructuring has been painful and has hindered rather than helped trusts improve patient care.
'This was reflected in the annual healthcheck. In any reorganisation, we must be certain that the benefits outweigh the costs.
'There is currently 70 per cent coterminosity between PCT boundaries and those of LAs - we would not want this figure to reduce.
A reduction in coterminous boundaries would be disappointing given that coterminosity was a key objective of the recent reorganisations in primary care.'
Ms Webber also said the new arrangements should ensure closer working between local authorities and PCTs, including clinicians.
'Practice-based commissioners need to be part of the equation. A recent NHS Confederation poll of NHS PCT chief executives showed that only 25 per cent of respondents had processes that linked their practice-based commissioners into the joint commissioning process.'
Under the white paper proposals, overview and scrutiny committees will be strengthened to allow them to call on local public service providers - such as NHS managers - for evidence and demand a response to reports from the council.
Local area agreements will include a single set of targets for improvement, tailored to local needs and agreed between government and local partners.
There will be a duty for councils and other local partners to work together to agree LAA priorities.
There will be around 35 priorities for each area agreed with government, tailored to local needs through the LAA, plus statutory education and childcare targets.