There was initial hostility in Sefton to the whole idea of primary care groups. The local medical committee balloted its members, achieving a 61 per cent response rate, and found that 72 per cent were against the new organisations.

Retiring LMC chair Forbes Innes then told the national LMCs conference in London: 'For PCGs to work we expect to have assurances that the concessions extracted from ministers are robust enough to stand up to action.

'We need a shadow year in which we can let these groups evolve into a sensible form.'

But Sue Jones, director of primary care at Sefton health authority, says the ballot has not really affected the process of establishing PCGs.

'It was part of the greater political agenda of strengthening the arm of the British Medical Association's negotiators, but in reality GPs are far more positive,' she says.

'We have a population of 290,000, probably split three ways. There is a historical west to east divide, but consultation is still going on at the moment.'

Frederick Vitty, incoming chair of the LMC, says it decided to put GPs' concerns 'on one side' to make sure it was involved in the discussions. He also feels that Mr Milburn's letter has 'allayed' GPs' biggest concerns.

Meanwhile, Ms Jones says: 'A lot of things have to develop. If they did not it would be such a top-down situation that it would not have any authenticity in terms of truly locally driven care.'