Private companies providing finance to develop primary care premises may play a key role in the managing of the centres in what could amount to a national franchise for primary care.

The private finance initiativestyle deals, which could include the private sector managing batches of primary care premises and some clinical services such as nursing and physiotherapy, is one option for delivering the government's NHS plan target of 500 one-stop health centres and the refurbishment or replacement of up to 3,000 GP premises by 2004.

'We would not wish to rule this out, ' said a Department of Health spokesperson, provided it had the 'support of local stakeholders'.

The proposal would most likely apply in areas targeted for development through the public/private sector company NHS Local Improvement Finance Trust.

Local NHS LIFTs will be set up in areas of greatest need to finance and develop 'batches' of premises, which they will own and lease to GPs.

The scheme is expected to provide investment of up to£1bn overall and around half of all primary care premises development. But the private sector could also take over management and responsibility for staff.

Clive Parr, chief executive of the National Association of Primary Care, said: 'As a principle we have no problem with it, but the devil is in the detail. It could be very beneficial in areas where GPs have no interest or experience in premises or service development, or are already hard pressed and want to get on with delivering medicine.'

But Chris Town, chief executive of North Peterborough primary care trust, said he felt 'uncomfortable with the idea as it detracts from PCTs' role in integrating local services'.

Harry Hyman, managing director of Primary Health Properties - which claims to be the largest independent owner of primary care medical centres in the country - said if the opportunity was there, 'we would have great interest'.

'Adopting a unified management structure across a number of different units on a pan-PCT basis could bring economies of scale and management discipline and rigour' to what is currently 'an incredibly fragmented system', he told HSJ.

Others in the private sector are more cautious. Barry Panton, chair of financiers and developers Prime, said: 'We are enthusiastic about taking responsibility, but only at a pace that is tolerable. . . at the moment our company, and none of our competitors, has the skills.'

Dr Tony Stanton, chair of the British Medical Association practice premises sub-committee, described it as 'another step on the road to privatisation of the health service'.

'We would be very concerned if we ended up with the same terms of service for employees as is the experience in fast-food outlets, ' he added.

Royal College of Nursing policy adviser for primary care Mark Jones said that, while the college had no qualms about whether practice nurses were managed by a GP or an 'agency acting on behalf of that GP', concerns arose over whether the push for efficiency could 'drive down professional standards'.