Primary care trusts that are successful in world class commissioning may win the right to name the salaries of their senior managers and non-executive directors.

Permission to operate across a three to five-year financial cycle and "lighter touch" scrutiny by strategic health authorities are other prizes that could be available under the Department of Health's initiative to boost PCT commissioning skills.

The NHS Confederation's PCT Network has selected these three options as the incentives it would like to reward successful world class commissioners. Its response follows a consultation exercise that saw PCTs select potential incentives from a list of options.

The DH is now expected to consider the document, with a final announcement due soon.

Potential pitfalls

PCT Network director David Stout conceded that allowing trusts to run their financial cycles across several years could cause problems "if everyone overspent at the same time". He added: "The methods for delivering it are not altogether clear but the desire is pretty strong in PCTs."

Combined with being able to set salaries, the incentive would move PCTs nearer to experiencing some of the freedoms enjoyed by foundation trusts.

There is a feeling among many senior PCT managers that restrictions on salary-setting have put them at a disadvantage when trying to attract top-level recruits. Mr Stout said: "We want to be able to match foundation trusts in terms of that sort of flexibility so that we're competing on an even playing field."

He revealed that PCTs had rejected proposals for a more flexible capital regime, to be able to appoint their own auditors or to win foundation-style freedoms from Agenda for Change and the NHS pension scheme.

Moderate freedom

But he said the network had suggested freedoms that were "not that radical" to avoid creating a two-tier system, where "world class" PCTs could outstrip other trusts. He said: "We have to think how you design freedoms and incentives that can be delivered."

Mr Stout's comments came as delegates at the Labour party conference in Manchester acknow-ledged that PCTs still had much work to do.

Speaking at a fringe meeting on commissioning, health minister Ivan Lewis said: "It's absolutely crucial we see a step change in the way commissioning decisions are made and also have world class commissioners who no longer think in very narrow, conventional terms about achieving outcomes."

NHS Confederation chair Bryan Stoten described PCTs' progress as "bumpy". He said: "It's only slowly getting there and we don't expect it all to get perfect tomorrow."

HSJ's conference Fundamentals of Commissioning will be held on 8 October in London.