PCTs will have veto on Darzi integrated care pilots

There will be a national assessment of bids to take part in the pilot. PCT support will be crucial.

The pilots will see new organisations bridge traditional boundaries, for example between primary and community care.

NHS director general for commissioning and system management Mark Britnell and national primary care director David Colin-Thome told HSJ how the pilots will work.

Mr Britnell said: "We will work with SHAs and PCTs in particular to think of a suitable process to identify and award suitable applications. It's important to stress all bids have to be supported by PCTs. Commissioners have a very important role."

Criteria for integrated care pilot bids will be decided in the autumn. Both the Department of Health and the Treasury would be involved.

Mr Britnell said private sector organisations could support but not lead pilots: "We see a strong role in the private sector supporting social enterprises and integrated care organisations. We don't see that same role in terms of leading these organisations at this stage."

Dr Colin-Thome said that potential bidders would not have to tender but would be expected to show their "energy and competitiveness".

"The test [is] how can you both compete and collaborate and the pilots may well begin to demonstrate this is possible," he added.

Selection is expected to begin before the end of this calendar year, with frontrunners identified before the end of the financial year.

Potential bidders will be expected to be "radically innovative", to ensure patient choice and to include proposals for clinical governance.

Mr Britnell and Dr Colin-Thome also gave more detail on the new primary and community care strategy.

Mr Britnell said that in response to PCT requests the DH would provide guidance "better explaining, refining and defining the options available" for provider arms, possibly in the operating framework.

He highlighted arm's-length bodies, care trusts, community foundation trusts, social enterprises, integrated care organisation pilots and property companies (which manage PCT estates) as possible models.

But Dr Colin-Thome warned: "If PCTs keep their provider arm, they need some clarity of what metric they use to measure effectiveness."

Practice based commissioning consortia are now "entitled" to better information and financial and management support from PCTs.

Mr Britnell said PCTs should put concerns over accountability aside. "This is not a unique management problem which is the sole responsibility of PCTs. Every large organisation that has clinicians working for it faces these problems day to day."