Thousands of staff working for the NHS in Cornwall will be managed by a private organisation after the plans were approved by managers.
A community interest company (CIC) will be set up by Cornwall PCT outside the NHS to manage the 2,400 staff.
The management shift will affect 14 community hospitals, language and speech therapists and school and district nurses.
The trust said that staff and patients should not be concerned, but unions said the measures would "demolish the NHS".
The government has given PCTs and the Cornish trust a deadline of 1 April 2011 to offload its staff management responsibilities.
The measures are being carried out in order to separate providing services and commissioning services after the government suggested it would make the NHS more efficient.
From April 2013, GPs will take over the responsibilities handled by PCTs as their services are reduced.
The number of CICs has soared since they were introduced by the Labour government in 2005, to more than 4,000.
And as CICs are social enterprise firms they don't give money back to owners or shareholders, instead reinvesting in the community or business.
But the alterations could "demolish the NHS as we know it", according to Unison's Chris Dayus.
Staff were also said to be worried about the future of their pay and conditions.
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