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Primary care trusts will need to work closely with local authorities to manage public health issues, tackle the underlying causes of ill health, and act as full partners in regeneration activities, the Kings Fund has warned, writes Lauren Revans.

Research by the think-tank, conducted between November 2001 and February this year, was published this week to coincide with the introduction of the changes in the delivery of health services set out in 'Shifting the Balance of Power'.

The reformed system will see power – and the large majority of the NHS budget – shifted towards frontline staff in PCTs. The number of health authorities will be cut from 98 to 28 from next week and they will take on an increasingly strategic role, including performance management of PCTs and NHS trusts. Subject to progress with the NHS Reform and Health Care Professions Bill, these 28 new health authorities are expected to formally become strategic health authorities by October.

Meanwhile, the eight regional department of health offices have been abolished and replaced with four directors of health and social care.

In its research, the Kings Fund identifies a "perceived danger" that individuals’ specialities might be lost as large teams based in health authorities are broken down into smaller PCTs and practitioners take on more generic functions.

"Public health is only one of many competing responsibilities for London’s 30 PCTs – and, to date, they and their partners have had little opportunity to work out in detail how they will organise public health locally under new structures," the reports says.

It warns that health visitor vacancies in London could "hamper some PCTs’ efforts to deliver public health", with some areas facing vacancy rates of 9 per cent, compared with a London average of 2.3 per cent and national average of 1.9 per cent.

"This could have significant implications for working with vulnerable population groups to reduce local health inequalities," it says.

'Public Health in the Balance: Getting it right for London' from www.kingsfund.org.uk