Strategic health authorities are forcing primary care trusts to divest themselves of their provider functions, PCT chiefs have claimed.
The 2008-09 operating framework says that PCTs "should review their requirements for community services and use this process to consider all the options for models of provision".
In the meantime, it says that all PCTs should create an internal separation between their commissioning and provider functions by 1 April and ensure in-house providers are not given favourable treatment.
But at last week's PCT Network conference, PCT leaders told David Nicholson they were concerned that "nine out of 10" SHAs were translating the operating framework to mean that PCTs should divest themselves entirely of their provider arms within the next few months.
PCT Network director David Stout told HSJ: "There is a sense some SHAs are pushing for a complete separation: ie, a divestment of services entirely." He said that while it was unlikely this pressure was being applied in an explicit way, it could be exerted in the criteria SHAs were developing to judge whether each PCT's internal review was satisfactory.
Pressed on the issue during the conference, NHS chief executive David Nicholson said: "The policy couldn't be clearer: it is for PCTs to decide what to do with their providers."
But he added: "We need to make sure we are commissioning these services appropriately and we don't have 152 community foundation trusts just reinventing a monopoly. The days when we can just roll contracts forward are gone."
NHS Alliance chair Michael Dixon warned that the NHS was being "rushed" into outsourcing PCT provider arms. He said the new practice-based commissioning consortiums may be interested in bidding to take over some of those functions, but few were in a position to do that immediately. That left just large companies or community foundations.
The understanding that PCTs must outsource provider functions to comply with the gradual encroachment of European procurement law into health was misinformed, said NHS Confederation EU unit director Elisabetta Zanon. There was nothing in the EU treaty that said public bodies could not keep things "in house", she explained. Rather, they must ensure they did not discriminate against European providers only if they did decide to outsource.
For more analysis, see this week's leader.
HSJ's Transforming PCT Provider Services conference is on 30 April, www.hsj-providerservices.co.uk