Clinicians and managers will be expected to work together to take joint decisions on commissioning under radical proposals to reform professional executive committees.
A Department of Health consultation document, published today, will suggest that PEC members should be given specific roles and be expected to work with specific directors throughout the week to take key decisions.
The size of PECs - which could be renamed clinical executives - will be reduced and they will be given a tighter remit to focus on the core business of primary care trusts.
The proposals envisage 'nothing less than a complete revolution in the way clinicians are working in the NHS', according to NHS Alliance chair Dr Michael Dixon.
The DoH paper was written by Dr Peter Reader, facilitator of the alliance's PEC chair network. It is due to be published at the alliance's conference in Bournemouth today.
'We want to see equality of decision-making between clinicians and managers,' said Dr Dixon. 'Clinicians need to make decisions rather than just advising on the sidelines. We have got to hand clinicians the reins as well as to expect them to carry out orders if we are to improve the NHS.'
The paper was compiled after submissions had been invited from major stakeholders, including the British Medical Association and PCT chief executives.
Although the document acknowledges there should be no 'single &Quot;right&Quot; model' for PECs because of wide variation in PCT sizes and demographies, it says there is a need for 'guiding principles and facilitation' from the DoH.
The report says: 'All stakeholders agreed that the PEC needs to change. As well as reflecting the changing role of PCTs, which will become primarily commissioning organisations, contributors acknowledged that the old PECs exhibit variable success.'
The PEC will 'shed some of its broader roles' to enable it to focus on 'strategy and the core business of the PCT'. 'They [the PECs] should be implementers and champions of innovation,' the report says. PECs should continue to be multiprofessional, although it should retain a majority of practising clinicians. But it should be smaller - containing four to eight professional members.
And the members should have 'clear job descriptions, key lead areas and tasks, and should be accountable for their delivery', enabling clinicians to work with PCT directors on key tasks throughout the week.
Clinicians should be 'properly renumerated', although rates should be equal for all PEC members.
The document suggests that PECs should no longer be restricted to clinical issues and that their key functions should be: setting and communicating the vision and strategic direction of the PCT; commissioning and managing the market; clinical effectiveness and clinical governance; and leading communication with partners and stakeholders.
The paper says the role of PECs would have to change as practice-based commissioning matures. In future the PEC will need to: link commissioning into the broader PCT strategy and identify gaps in service; encourage the development of provision and patient choice; and champion health inequalities, health promotion and public involvement.
And it warns that the need for good communication between practice-based commissioners will be 'a challenge', but essential.
To avoid conflicts of interest, the document suggests that all practice-based commissioning projects and providers should be assessed by a PEC sub-committee excluding those who might have an interest.
'Success will depend on improved communications throughout the NHS and with partners - and upon cultural and attitudinal change at senior levels,' says the paper. 'It is likely to require new development and training for both managers and clinicians. The two groups have much to learn from each other.'
Senior management 'should see themselves as much a part of the PEC as the clinicians,' it adds.
Dr Dixon said PECs needed to change. 'The PEC really hasn't been an engine room - it's been more like a House of Lords; a talking shop,' he said. 'We don't want to return to the old days when the PEC sometimes ended up discussing drains at community hospitals rather than the core business of commissioning.'
The proposals will be open to consultation for three months and the DoH will publish final plans in the new year.
Read the consultation here