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Primary care trusts working in deprived areas are already struggling to provide core services without the additional burden of becoming involved in care trusts, a conference heard last week.

Gerald Wistow, director of the Nuffield Institute for Health at Leeds University, claimed that attempting to introduce care trusts against a backdrop of services under pressure was "short-sighted and self-defeating".

He told a London conference on care trusts this week: "We do not have secure primary care services in all areas of deprivation. Chief executives of PCTs are being pushed into setting up care trusts by health authorities even though they may not want to."

Wistow added that redefining the responsibilities of agencies involved in care trusts will lead to a "medicalising of the care programme" and that further integration with the NHS may result in some older people feeling isolated from their communities.

Meanwhile, doctors leaders have warned that health professionals "need a rest" from constant reform and cannot cope with the upheaval involved in setting up care trusts.

Dr Michael Dixon, chairperson of the GPs' body NHS Alliance, said: "For the time being the NHS is suffering exhaustion from all the changes and any further re-arrangement of the furniture would be very detrimental to morale. The change from PCG (primary care group) to PCT has paralysed any significant delivery for six months," he said.

Dixon, who is also a committee member for mid-Devon PCT, said: "PCTs can do 90 per cent of the functions of a care trust given an imaginative relationship between the PCT and social services."

Dr Dixon welcomed the 15 care trust pilots around the country, but stressed that the initiative has to be seen as a long-term solution to service delivery problems.

His concerns were supported by Dr Rhidian Morris, an executive committee member of the National Association of Primary Care, who said there were many positive aspects of local government that the health service could learn from.

But he warned that the financial systems of the NHS and local authorities were "almost incompatible with each other".