Detailed proposals to make a radical reduction in the number of Scottish trusts have been issued by health boards.
The plans, which would cut the number of trusts from 47 to 27 or 29, follow the publication of the white paper, Designed to Care , last December.
It envisaged the creation of a network of primary care and acute trusts across Scotland. The government also indicated that it expected health board areas to be served by just one acute trust, unless there were special circumstances.
Health boards were asked to produce proposals for reconfiguring trusts by the end of March, and a threemonth public consultation exercise is now underway.
Consultation documents issued by the 12 health boards involved show most have produced plans for one acute and one primary care trust.
The biggest upheavals are likely to be in Glasgow, where the number of trusts will be reduced from eight to three, and Edinburgh, where they will be reduced from six to two or three.
Greater Glasgow health board has issued proposals to reduce the eight existing trusts in the city to three, with two acute trusts covering areas north and south of the Clyde.
Chief executive Chris Spry anticipated few problems in creating a southside trust, since 'there has been widespread support already for the way in which the Southern General Hospital and Victoria Infirmary have started to work together'.
He acknowledged that the situation north of the river was 'more complicated', but said: 'The board can see that having just one trust will help collaboration whereas keeping three or just having two would perpetuate unhelpful rivalries.'
In a briefing paper, Unison speculates that one trust is proposed north of the river because the white paper says Glasgow should have two acute trusts.
'The Scottish Office would therefore be reluctant to allow three on the basis that this would encourage multi acute trust applications from other health board areas, ' it suggests.
The briefing also suggests that 'major cuts' will have to be made to deal with Glasgow's 'dire financial crisis' and 'two trusts might provide unwelcome focus for opposition to such cuts'.
Lothian health board has put forward two options for trust reconfiguration. Option one proposes the creation of one acute and one primary care trust.
Option two proposes creating one acute trust, a primary care trust for Edinburgh, East Lothian and Midlothian and a trust to run local hospital services and primary care in West Lothian.
British Medical Association Scottish secretary Brian Potter said reconfiguring trusts in Lothian would be contentious because lobby groups were reluctant to see services run by the integrated trust in West Lothian split between two new trusts. The second option would leave this structure substantially intact.
Overall, Dr Potter said doctors welcomed the reconfiguration.
'This must not just be a rebadging exercise in which everybody moves around and goes on doing a similar job in a new organisation, ' he said. 'We will be pushing for this to release real money for patient care.'