Established NHS organisations are stifling entrepreneurialism by engaging in 'obstructive, disruptive and protectionist behaviours', the NHS Alliance has warned.

Innovation in primary care is being hampered by primary care trusts' preference for working with members of the traditional 'NHS family' according to a report by the organisation.

Making Trouble for the NHS? entrepreneurs and innovators in primary care, and the barriers they face, states: 'Obstructive, disruptive and protectionist behaviours from the 'NHS family' have been repeatedly reported by those interviewed for this report.

'People who are currently trying to provide new services do not feel that they have access to a level playing field, and that the degree of preference shown to 'NHS family' providers is unfair.

'There is a clear risk of oblique obstruction preventing the development of entrepreneurial provision.'

Supporting innovators

An organisation should be set up to 'support entrepreneurs who can show that they are being obstructed' and that 'have formal influence on pacts and commissioning clusters', the report recommends. Entrepreneurs should complement existing NHS services but challenge them where necessary, it adds.

The title of the report is based on a quote from NHS chief executive David Nicholson at last November's NHS Alliance conference: 'I encourage you in primary care and the NHS Alliance to make trouble - to root out bad deals and services.'

It is being launched today at the alliance's spring conference.

Two other papers addressing competition and partnership working are also to be published by the alliance today.

Only Connect suggests Local Involvement Networks (LINks), which are set to replace patient and public involvement forums, could act as a voice for practice-based commissioning clusters.

The second paper, Competition or co-operation? the new commissioning dilemma, warns that more sophisticated negotiating tactics between commissioners and providers are needed to balance the twin demands of competition and co-operation.