Anthony Sumara, who has been interim chief executive of Hillingdon PCT since October, proposes to put three out of four commissioning support services out to tender, and to hand clinical services to a new provider.
Under the proposals, the PCT would retain only its core functions like governance and emergency planning, as well as patient and public involvement.
The move could see the PCT, which has£54m of historic debt, and is predicting an in-year deficit of£11m, reduced from a staff of '300 to 30', he said. But he said the chances of the board agreeing to the move were 50:50.
The Proposal to Procure commissioning strategic outline case was published by the PCT on January 23.
It states: 'Outsourcing the majority of the PCT commissioning functions gives the greatest benefit and the greatest probability of success,' when compared with three other options: doing nothing, building internal capability and developing synergies with other organisations.
If the project gets approval in June the contracts will go out to tender.
Mr Sumara told HSJ: 'I want to get rid of everything, outsource it - and we are distancing the PCT from its provider functions.'
The government's commissioning framework allows PCTs to choose which areas they wish to outsource. The DoH is expected to publish its list of recommended commissioning experts within weeks.
Hillingdon is looking at three of the four main categories identified in the framework: assessment and planning; contracting and procurement; and performance management to ensure better accountability.
The organisation is currently working on defining what residual functions a PCT should hold.
Mr Sumara said responsibility for monthly emergency planning, managing the outsourcing, governance of money, accountability and development of the market would remain with the PCT.
'You need a PCT because you need a statutory body to receive the money from government.
'We are also deciding what will happen to the provider side - should it come under the hospital or become a social enterprise?
'We will keep public-patient engagement as we have a better idea on how to engage with the public locally and the voluntary sector than, say, [information analysts] Dr Foster,' he said.
'The PCT is not giving up responsibility. We are doing this as part of our recovery and to get some clarity around what a PCT should be doing.'
'It's commercialising, not privatising and the public don't care - it's not about the provider services, it's about men in grey suits. It will still be free at the point of access.'
The next step is to develop the outline business case for consideration by the board in April 2007 and appoint a dedicated project team.
The strategic outline case states: 'Hillingdon PCT commissioning is currently weak and not fit for purpose. For example, acute providers will continue to over-perform by£9.8m in 2006-07, adding to the historic debt.'
Mr Sumara said: 'At the moment it is 50:50 whether it will be approved but I do think it will save us money and I do think it will get the go-ahead.
'I don't think we are big enough for some companies but they will start with us with a view to providing a service across London.'
Some of the risk factors considered in the proposals include: the supplier's set-up costs exceeding the potential gains of the contract; the delivery of financial balance for the PCT taking longer than currently planned; the requirement to repay the historic debt making the contract unattractive to outsourced suppliers; and an adverse reaction from the public.
The document says the PCT's historic deficit is the 'biggest barrier to the successful outsourcing of commissioning activities'.
When Mr Sumara arrived in October 2006 the historic debt was recorded at£43m, with£22m recurring deficit. The PCT says it is now predicting a year-end deficit of£11m, but assesses its historic debts at£54m.
The trust has also appointed a new chair, Mike Robinson, who takes up post today. Mr Robinson was chief executive of South Gloucestershire unitary council from 1995-2003.