The government has announced plans to shake-up the NHS, in what could become the most significant restructuring for decades.
The proposals are aimed at giving doctors greater say in the management of services, and patients more choice over their treatment.
The reform blueprint, published by Health Secretary Andrew Lansley, will oblige GP practices to join forces to commission treatment directly.
PCTs, which currently handle the multimillion-pound budgets, face the axe, along with strategic health authorities.
An independent NHS Commissioning Board will oversee the new regime, with local councils taking over the public health element of PCTs' work.
Under plans set out in a white paper, the government also promised to scrap "top-down" targets in favour of a regime based on clinical outcomes.
Patients will also be handed more choice over how and where they are treated.
The document warned that NHS job losses were "inevitable" but said it was vital to switch cash from bureaucracy into frontline services.
Mr Lansley said: "The sick must not pay for the debt crisis left by the previous administration. But the NHS is a priority for reform too.
"Investment has not been matched by reform. So we will reform the NHS to use those resources more effectively for the benefit of patients."
Mr Lansley said the new structure would "put patients right at the heart of decisions made about their care (and) put clinicians in the driving seat on decisions about services".
Under the new model, consortia of GPs in England will be directly responsible for commissioning the "great majority" of NHS services for their patients.
Specialist commissioning will be carried out by the new board, which will also distribute funds to the consortia, which the government wants to have in place by next year.
Copyright © Press Association 2010
Your comments (terms and conditions apply):
"I can't see the greater good if service provider and service purchaser are the same body. Where and how the check and balance mechanism comes into play?" – Name and address withheld
"I think Andrew Lansley needs to ensure this decision is not just political and that his decisions are based on sound research and consultation with the GPs and the wider NHS. If it does not work then it will result in even greater financial loss to the money he is promising to invest in improved patient care. I personally can't see it in such simplistic terms" – A Care, West Midlands
"This might just work if the not-so-small army of redundant PCT staff are simply absorbed into the new Commissioning Consortia. The lack of business awareness shown by some PCT staff over the past 10 years needs to be countered by a seriously competitive application process for the jobs that remain to run commissioning in consorita. That and a robust reappraisal of the Tariff please!" – Alan Moore, Cheshire
"GPs can't even be trusted to handle patient information securely due to lack of Information Governance infrastructure and historical poor performance in terms of Information Governance Assurance. How on earth are they going to manage commissioning? They are neither suitably qualified to do so. The skills and expertise lies with PCT commissioning staff. This is a foolish idea which will cost us even more to implement" – Adam Hunt, London
"Gosh you mean drs might actually get to see patients instead of attending mind-numbing meetings with PCT and similar and have less paperwork to do – there's a thought. Realistically practice managers will do the bulk of the fundholding work" – Name and address withheld