The paper said that GP commissioning should be used to support new forms of care delivery and should, from the outset, involve secondary care clinicians alongside primary care teams.

Removing the policy barriers to integrated care in England outlines that by allocating consortia capitated budgets, policy-makers are creating 'embryonic integrated care organisations'.

'This puts GP commissioners in the position of taking "make-or-buy" decisions because they combine responsibility for commissioning and many elements of service provision,' it said.

The report also recommended that secondary care colleagues work with primary care teams to commission services. It said this could lead to the emergence of new forms of 'multi-speciality' commissioning and provision that could help bring care closer to home and reduce reliance on hospital services.

'It is imperative that the NHS of the future gives much more attention to the development of systems of care to further improve performance and to enable the efficiency challenge that has been laid down by the government to be met,' it said.

• Click here to read the full Nuffield Trust report