In a letter to managers and senior staff, NHS chief executive Sir David Nicholson says that all service changes should be signed off by consortia, or other GP representatives if consortia have not yet formed. PCTs will have to amend their proposals if it does not have the support of local GPs.

'As the service is expected to move increasingly towards a GP-led commissioning model, decisions now should be consistent with intentions for the future,' Sir David writes.

PCTs should ‘obtain written sign-off from relevant local consortia representatives. If this cannot be obtained, commissioners should revisit and address any concerns or amend proposals,’ his letter states.

He also calls for consortia and PCTs to review how well GPs are being engaged in proposed service changes and the transition to GP-commissioning.

The letter follows health secretary Andrew Lansley’s announcement that any major existing or planned service changes must have the support of GPs.

Mr Lansley’s pledge meant that many of the reforms set in motion under former health minister Lord Darzi, such as the capital’s ambitious Healthcare for London plans, have grinded to a halt.

The health secretary hopes to devolve full commissioning responsibility to GP consortia by 2013, prompting the NHS Alliance to urge GPs to form consortia as 'quickly as possible'. GPC chairman Dr Laurence Buckman, however, advised GPs not to 'rush into anything.'