There are no health authority mergers planned - the new strategic health authorities are to be completely new bodies with the functions of current HAs more or less inherited by primary care trusts.
That was the message from Dorset HA chief executive and Modernisation Board member Ian Carruthers in a preview of the Department of Health consultation document on SHAs due for release next week.
PCTs will keep their current roles, but will also be responsible for provision of mental health services, for managing dentistry, optometry and pharmacy, subject to legislation. They will also be responsible for key links with local government.
That could mean that local councils would have to deal with several PCTs, which Mr Carruthers acknowledged 'our colleagues in local government will find hard'. He warned that GPs could find the broader role of PCTs difficult to handle, and said ways needed to be found to ensure they still felt involved.
But he believed further progression to care trust status would not be rushed and suggested that PCTs should use all the Health and Social Care Act flexibilities to the limit before exploring progress to the next level.
The 30 new SHAs will cover populations of between 1.2 million and 2.6 million and will be up and running from next April, with the prime role of ensuring that the NHS plan is delivered.
'One prime function will be to make an annual accountability agreement with the Department of Health and deliver it in their local area, ' he explained. They would have performance management as a key function, support service redesign and ensure continuity, have clinical governance and IT responsibilities, make service agreements and resource allocations for the trusts in their areas and have to sign off the business plans of each trust.
'We are not talking about the merger of health authorities here - they are new and different organisations. It is a new intermediate tier, and I believe they shouldn't be called health authorities as that is simply creating confusion, 'Mr Carruthers insisted.
He stressed the performance management role of the SHAs would be 'supportive and developmental'. There would be 'swift intervention'when the need arose - though 'only on the big things'.
He likened the SHAs to 'coaches' in terms of management style: 'Coaches are not soft - sometimes they have to be hard and sometimes players have to be dropped. . . we do not live in a lovely, cuddly world.'
Though they wouldn't hold the budgets, they would be able to restrict access to cash if trusts were not meeting their target. Mr Carruthers asked: 'Are you more influential when you hold the budget or when you control what people do with it?'
The shifts in the power balance would, Mr Carruthers admitted, create some tensions between acute trusts and PCTs, and would require a shift in behaviour.