Primary care trusts are planning to merge into larger organisations. Senior NHS figures have told HSJ they could continue to exist as a “plan B” if proposals to scrap PCTs and strategic health authorities falter.

Proposals to share management are being examined in numerous PCTs in London and in the East of England. Senior sources in other regions said executives would increasingly be shared between PCTs in their patch. In addition to full mergers in areas including Essex and London, sources in three English regions said PCTs are planning to significantly accelerate sharing staff and functions.

The move is a reaction to staff, particularly just below director level, quitting their jobs because of the planned abolition of PCTs.

One senior strategic health authority director said PCTs were expecting to need to implement their contingency plans from November onwards, when they expect the first tranche of staff to leave.

Several senior commissioning sources said the resulting organisations - larger PCTs with much greater clinical commissioning input - may last beyond 2013-14, when PCTs are meant to be abolished, as a “plan B” to full implementation of the white paper.

The reconfiguration of PCTs is being planned as the white paper faces significant professional and political opposition, with many organisations due to publish consultation responses in coming weeks and a bill to enter Parliament not long after.

A senior commissioner involved in implementing the reforms said PCTs were looking at sharing functions covering larger populations.

The source said: “If plan A doesn’t emerge, I don’t think plan B is to go back to what we’ve had - too much water will have flowed under the bridge.” They said although the organisations that might emerge would not match health secretary Andrew Lansley’s vision, they would “adhere to the spirit of the white paper but not exactly to the letter”.

A senior source in another region, also closely involved with implementing the reforms, said: “Everything is on the table. We can create something that is a more focused and effective mechanism without knowing what the end state [will] be.”

King’s Fund chief executive Chris Ham has said the white paper reforms “may never be implemented” because of failure to convince NHS staff, reach agreement with the British Medical Association or sustain political support.

He told HSJ: “If the government gets into difficulties with the BMA, or operational pressures raise questions about how quickly and how far the government can go, you could see a scenario in a year or 18 months where you end up with fewer, larger PCTs.

“There could be a continued role for what I would call local system leaders.”

However, Professor Ham said the Department of Health would not support such plans in the short term as it was determined to maintain momentum for the reforms.

Read more

Eight PCTs to share single management