Warwickshire has seen one of the biggest rows over the establishment of primary care groups.

'The geography is easy,' says Warwickshire local medical committee chair Andrew Kennedy. 'Practices will go into areas with which they are comfortable, worked out on district council borders. The problem has been with how they will be run.'

The LMC claims that Warwickshire health authority chief executive Mike Marchment held discussions with staff-side representatives and others on what PCG boards should look like, but that GPs were excluded from discussions and then told they would be in a minority on the boards of the five PCGs likely to be established.

The LMC voted not to approve the model - although Dr Kennedy says it did not hold a vote of no confidence in Mr Marchment, as reported in the GP press. 'We did not need to,' he says.

The situation has been largely resolved because Mr Milburn's letter to the GMC makes it clear GPs can choose to be in a majority on PCG boards. And Mr Marchment is leaving to take up another post.

'The charitable interpretation of what happened is that the timetable for establishing PCGs is ludicrously tight and Mike decided to push ahead before waiting for guidance,' says Dr Kennedy.

'Uncharitably, you might say this was the direction Mike would have wanted things to go in and he went for it.'

Mr Marchment says: 'If we stepped back and waited for guidance we would not get everything in place that needs to be in place.

'I can take some criticism for being ahead of the game,' he adds.