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Health minister Lord Hunt said last week that responses to the government's proposals to radically reform the NHS had been "quite positive", but admitted there were still concerns about the pace of change and the ability of primary care trusts to take on hugely increased responsibilities.

Shifting the Balance of Power, put out for consultation in the summer, is intended to place front-line staff in charge of front-line services and give them the power to respond to their local communities' needs, with clear national standards.

The document proposes making PCTs "the lead NHS organisation in assessing need, planning and securing all health services and improving health". Hunt said that, by 2004, PCTs would be responsible for £44 billion - or three-quarters of the NHS annual budget.

"PCTs are going to have a really crucial role not just in terms of money, but in terms of integrating health and social care," Hunt said. "Working with social services is going to be very, very important in achieving improvements in service."

But John Ransford, head of social affairs, health and housing at the Local Government Association, warned that pre-occupation with structures could be a barrier to the development of partnerships.

"The Department of Health is recreating PCTs to do something they were never envisaged to do," Ransford said. "Most parts of the country haven't even got PCTs yet."