National standards for out of hours providers could be extended to cover some in-hours services.

Department of Health urgent care team lead Chris Dowse said the move follows requests from primary care trusts, which want to commission urgent care more effectively. "A lot of PCTs have said the quality standards we have for out of hours help enormously with commissioning - can we not do this for other parts of the urgent care pathway?" she said.

The standards cover governance arrangements, waits for assessments and consultations, effectiveness and capacity planning.

Ms Dowse said she expected the standards would only apply, at least initially, to urgent care clinics, walk-in centres, minor injury units and the new centres open from 8am to 8pm. But implementing them in general practice would prove "challenging", she said.

Her comments came after the DH confirmed it has had talks with the NHS Alliance about how practice-based commissioning can "contribute to delivery of the urgent care strategy".

Commissioning consortiums

The alliance wants GP consortiums to be able to commission urgent care, particularly out of hours services. He said this would give practice-based commissioning consortiums greater control over hospital admissions, many of which are referrals from urgent care services other than GPs.

Speaking at the Alliance's annual urgent care conference, head of practice-based commissioning David Jenner said: "When you start looking at your PBC budgets and you take out the prescribing element, urgent care accounts for two thirds. Seventy-five per cent of non-elective admissions are not initiated by the practices themselves," he said.

"For commissioners who are looking at trying to move money around to invest upstream, if you have not got a hold of what is going on in your out of hours provision, potentially you are handing over more and more money to the acute trust."

PCT Network director David Stout supported the idea, saying: "PBC as a device to get clinicians involved in commissioning and design of any service is a good idea and I don't see why out of hours care is any different."

Lord Darzi's next stage review promised practice-based commissioning would be reinvigorated and redefined.