Primary care trusts will struggle to provide the extra services promised by the government unless extra cash is invested in NHS managers, it has been claimed.

Health secretary Alan Milburn has promised that 75 per cent of funding will go directly to primary care by 2004, but following last week's Queen's speech, both the NHS Confederation and senior managers have said the pledge to slash bureaucracy - especially the abolition of up to two-thirds of health authorities - has to be further thought through.

NHS Confederation policy adviser Nigel Edwards said: 'We have a lot of good staff, but they are going to have to deal with delivering the improvements to the service as well as dealing with reorganisation. That is going to be difficult because the process of change seems unrelenting. '

His fears have been echoed by David Panter, chief executive of Hillingdon PCT, who warned that extra management resources will have to be made available to PCTs if they are to be a success.

'When we were set up, it was with the understanding that we would be taking on extra responsibilities. And I think we are in a very strong position to deliver the extra services. My fear is that not everyone is quite so prepared. '

He said that management costs at Hillingdon were around£11. 50 per head of the region's population - at other PCTs the figure was no greater than£7. 50 and at HAs closer to£1.

'This is my concern - that at some other PCTs they will not be able to take on the new additional responsibilities without management resources, ' he said.