NHS London and the Department of Health are in talks about merging London’s 31 primary care trusts into just six bodies, HSJ has learned.

The six organisations would be based around the geographic sectors PCTs have already been working through in recent months.

Together the PCTs have a budget of more than £16bn and reported a surplus of around £350m last financial year.

However, each of the PCTs has been set management cost reduction targets of at least 50 per cent over the next three years.

A spokesman for NHS London said: “Consolidating 31 PCTs into six is one of the options.

“We are currently discussing how these changes would work with PCTs and GPs across the capital, as well as colleagues at the DH.

“Once we have a way forward, we are keen to move on as quickly as possible.”

The spokesman said the move was prompted by the need to ensure performance did not slip during the transition to the new structure, as set out in the white paper earlier this year.

He added: “This year’s world class commissioning scores show that some PCTs in London are not yet performing as we would expect. At the same time we are working to drive down management costs to protect frontline services.”

The chief executive of one London PCT reacted angrily, telling HSJ the proposal was symptomatic of the DH’s “centralising” tendencies, which had come to the fore since the white paper’s publication.

The chief executive said: “Now they don’t even trust us to abolish ourselves.”

It is not clear whether the strategic health authority’s plans entail a full merger which would require a statutory consultation and act of Parliament, or a de facto merger.

The latter was hinted at in NHS chief executive Sir David Nicholson’s letter to NHS chief executives earlier this week and would involve appointing a single executive team and joint chair across several PCTs.

There is also a concern that while a de facto merger would help PCTs cut their management costs, it could risk eliminating the local commissioning functions and knowledge which PCTs are supposed to hand over to GP consortia.

NHS Ealing chief executive Robert Creighton said: “We have to balance the need for significant savings in management costs with the importance of working with GPs to design and implement systems for the future.”