NHS managers are showing signs of breaking with government policy by calling for a complete overhaul of practice based commissioning.

A primary care trust chief executive and a senior strategic health authority manager have gone public, telling HSJ they think practice based commissioning should be changed. Until now, NHS managers have been reluctant to discuss alternatives despite evidence GPs are not changing commissioning patterns.

A 2008 King's Fund study found GPs had received nearly£100m of incentive payments but that few were commissioning new services.

NHS North West director of health system development Alison Tonge suggested practice based commissioning could be split in two, with PCT commissioners given a duty to engage clinicians as part of a care pathway and system design team.

Hull PCT chief executive Chris Long said he backed bringing together GPs, local authorities and the public under a "locality director" who would report to the PCT chief executive.