Primary and secondary care organisations must work together to deliver the best service to patients, rather than working in 'adversarial competition', the NHS Alliance has warned.

In a report, Integrated healthcare services: the future of commissioning and provision of out-of-hospital healthcare in the NHS, published today, the NHS Alliance outlines proposals it says will create a "seamless healthcare system".

Author Dr Minoo Irani, chair of the alliance's specialists in primary care network, warned that "adversarial competition, resulting from practice-based commissioning and payment by results, has led to primary care trusts, NHS trusts and foundation trusts competing for organisational preservation, while clinicians have been polarised into professional self-preservation mode".

"The needs of the patient for a seamless healthcare system risk being compromised unless something is done to address this wrong sort of competition," he added.

The report proposes integrated provider organisations based around one or more practice-based commissioning groups, depending on population size.

It also suggests the creation of community specialists and consultants, whose expertise and status would be equivalent to their hospital-based counterparts.