The Health Secretary Andrew Lansley will press ahead with handing GPs control of £80bn of the £100bn health budget tomorrow despite No 10 and the Treasury undergoing a "wobble" over his controversial plan.
Mr Lansley will announce the first wave of "pathfinder practices", pilot schemes under which GPs will take charge of commissioning services for their patients. GP commissioning will be rolled out nationally from 2013 in changes that will eventually see the 152 primary care trusts (PCTs) disappear.
However, there are jitters at the highest level of Government about what experts have described as the biggest shake-up in the National Health Service since it was set up in 1948. Oliver Letwin, the Cabinet Office Minister in charge of Government policy and one of Mr Cameron's closest allies, has been asked by No 10 to review the plans.
One minister told The Independent: "The concern is over whether it is the right time to make such a big change because the NHS is under pressure to make huge efficiency savings. There could be significant financial risks."
The Liberal Democrats were shocked and angry when Mr Lansley announced the shake-up because it was not in the Coalition Agreement. But one Government insider said: "This is not a row between the Tories and Liberal Democrats. It is a debate between the Health Department on one side and No 10 and the Treasury on the other. There's a wobble because people want to be sure that it has been properly thought through."
Some ministers doubt whether the planned GP-led consortia could implement such a big reform when the NHS, despite having its budget ring-fenced, is under pressure to find savings to cope with medical advances and people living longer. Mr Lansley insists that abolishing PCTs is the only way to make big efficiency gains of 4 per cent a year for the next four years.
He denies claims that he is trying to turn family doctors into administrators, saying they will not be forced to take charge of commissioning against their will. An ally of the Health Secretary said yesterday: "There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms."
Although the NHS Bill implementing the shake-up has been delayed until the new year, that has been due to drafting difficulties, according to the Department of Health. Next week Mr Lansley will insist his timetable is on track by publishing his response to the consultation exercise about the White Paper he issued this summer.
John Healey, the shadow Health Secretary, said last night: "If Andrew Lansley is going to test his high-risk plans, he should wait for Oliver Letwin's review and make sure he has the full confidence of the Prime Minister behind him. This is the point for the Health Secretary to pause and listen to the chorus of concern about his plans, not press ahead with the first stage of implementation."
Lansley's big idea
* Plans to hand GP practices responsibility for most health services in England were set out in a White Paper in July.
* At present, 80 per cent of the £100bn-a-year NHS budget is held by local managers working for 152 primary care trusts (PCTs), which are in charge of commissioning services, such as hospitals, GPs, mental health units and community clinics.
* Andrew Lansley, the Health Secretary, wants to transfer much of that responsibility to GPs working in consortia. PCTs and strategic health authorities would be phased out as funding switches to GPs.
* However, some experts fear that GPs may not have the skills or desire to take on the role and ask how they would be held accountable.