There is an “urgent need” to clarify the relationship between commissioning consortia and public health structures, according to experts.

The recommendation is in a report co-written by the NHS Alliance, Solutions for Public Health and Sir Muir Gray, leader of the government’s quality, innovation, productivity and prevention (QIPP) programme’s “right care” workstream.

The report says there is widespread confusion among GPs regarding emerging public health structures. There is an “urgent need” for a framework providing clarity on how consortia will work with Public Health England - the national body being established in 2014 - and public health directors transferred to local authorities, it warns.

Without this, “there is a risk of mechanisms for accessing public health support not being in place during the crucial [consortium] set-up and development period”.

The conclusions are based on findings from a summit in January of primary care and public health experts.

Consortia will have a major role, either through direct commissioning or working in collaboration, across the three domains of health improvement, health services and health protection, the report says.

But it warned: “This is challenging and difficult for GP commissioners to grasp, particularly when there is still substantial lack of clarity over processes and resources.”

Referring to health protection, the report notes: “Some GPs are already confused about the scope of the current health protection function, including the split between national and local responsibilities.

“Once the Health Protection Agency is abolished and new structures and arrangements are put in place there could be cause for even greater confusion. The level of knowledge of expected roles and relationships among GP consortia is currently low,” it says.

The report also says consortia were unclear where they would access technical public health skills for commissioning, particularly for large populations.

It was unlikely they could afford their own teams and it was unclear from the Health Bill how far the duties of directors of public health extended in providing such support.

The report says: “Options for future access for GP consortia to those public health staff with specialist skills in this area of expertise needs to be defined urgently.”

It also highlights the fact that the most important strategic relationship in future for health improvement would be between local directors of public health and consortia.

But this would be complicated by the “lack of coterminosity between consortia and local government boundaries in many areas”.