Primary care trusts have been told that ministers could strip them of their commissioning role unless they show a marked improvement in performance.
NHS Confederation PCT Network director David Stout said trusts have until the next government to improve commissioning.
Speaking at the NHS Employers conference in Birmingham, Mr Stout said ministers would probably abandon commissioning altogether unless PCTs showed it could work. 'There will be a new government in a couple of years, and if we haven't succeeded in getting commissioning to work it's likely there will be another set of reorganisations or the abandonment of commissioning,' he said.
Mr Stout was introducing a draft Department of Health document that aims to improve commissioning. Delegates were asked to comment on its aims, such as using patient feedback to influence commissioning.
Two weeks ago, the DoH appointed 14 private firms to help PCTs commission services, as part as the framework for securing external support for commissioners (for more background, click here).
Mr Stout said PCTs had two years to prove themselves. He added: 'I don't think I have come across a single PCT that I can say is doing a brilliant job in commissioning.'
Luton PCT chief executive Regina Shakespeare agreed: 'It's a race against time,' she said.
The draft document will feed into the NHS operating framework, expected to be published in December. Mr Stout said it was likely to include a system of measuring PCTs' progress on commissioning.