Primary care trusts' role in providing services is in jeopardy as the government launches a root and branch review of their structures.
A slashed number of primary care organisations could find their provision and commissioning roles dramatically scaled down under the government's Fit for Purpose review, which is to be launched soon.
NHS chief executive Sir Nigel Crisp hinted that PCTs that were divesting their provider roles were 'the future' during a question and answer session following his keynote speech at the NHS Confederation conference last week.
He told Brighton and Hove PCT chief executive Gary Needle 'you are the future' after Mr Needle explained how his PCT has no provider role. Mr Needle was not available for comment.
Sir Nigel had told delegates that a 'framework' for the review would be handed out 'in the next few weeks' which would 'define clearly what are the functions of PCTs in the future'. This would lead to a 'smaller number of PCTs able to operate effectively in the new world.'
The review is being managed at the Department of Health by newly appointed former Hampshire and Isle of Wight strategic health authority chief executive Gareth Cruddace.
South Yorkshire SHA chief executive Mike Farrar said that the notion of 'community services' being delivered by a 'large state provider' would be challenged if contestability was introduced within primary care - as it has been between foundation trusts and independent sector treatment centres, in the acute sector.
He said that would be a key question of the review, alongside the future role of locality-based commissioning models and the role of PCTs and local authorities in improving public health.
And he suggested that around a quarter of provision might need to be retained by PCTs in order to 'resist fluctuations in the market'.
However, newly anointed NHS Confederation PCT chief executives' forum chair Kevin Barton, who is also chief executive of Lambeth PCT, said the debate should not automoatically focus on largscale structural change.