The DoH primary care czar has given his frankest admission yet that practice-based commissioning (PBC) is not working.

'I think this corpse is not for resuscitation,' Dr David Colin-Thome told a conference in London last week.

DoH national clinical director of primary care Dr Colin-Thome insisted the redesign of clinical pathways was still crucial to cutting NHS costs.

But he said: 'There doesn't seem to be much traction with PCTs. PBC is not taking off in any systematic way.'

NHS Alliance PBC lead Dr David Jenner said it was unusual to hear such remarks from Dr Colin-Thome.

'It's the sort of thing he normally tells me off for saying. I do not doubt that it is failing in many areas, but it is still absolutely on the Labour and Conservative manifestos.'

Meanwhile Nigel Edwards, director of policy at the NHS Confederation, said Conservative plans to force GPs to commission services would create opportunities for private companies to do it on their behalf.

Some GPs will not be willing or able to take on commissioning, he said. 'There will be opportunities for companies like Humana to do this work on their behalf.'

Mr Edwards said questions remain over Tory plans. 'It will make for intriguing negotiations, and require resources.'

Dr Jenner said the threat of multinationals taking control was a lever that may be used to push GPs into commissioning.

Dr Jenner warned that the Tory plans would involve a 'fundamental renegotiation of the contract'. 'I think the Conservatives know where they are heading with this but it is nowhere near being agreed by the GPC.'

Mr Edwards also said specialists such as diabetologists could move out of hospitals and become practice partners under the Conservatives' plans.