A joint report by the NHS Alliance and think tank The Nuffield Trust says radical solutions are needed to 'nudge clinically led commissioning into life'.

Beyond PBC proposes multi-specialty groups of clinicians taking responsibility for designing health services.

These 'local clinical partnerships' (LCPs) should be given population-based budgets covering at least 100,000 people, the report says.

It also suggests adding incentives to GMS and PMS contracts to get GPs to join an LCP.

The report is the latest to conclude that PBC is failing to deliver consistently across the country - an admission made by DoH national clinical director for primary care Dr David Colin-Thome recently (GP, 16 October).

A DoH spokesman said the report was 'a helpful contribution to the debate' and added that there was already scope for PCTs to develop partnerships between different clinicians.

NHS Alliance PBC lead Dr David Jenner said that any development of PBC was dependent on whether clinicians were given any authority.

'Both the government and the opposition have PBC on the menu and have talked about more accountability. But the worst case scenario is that GPs are made more accountable but still have no authority,' he said.

Dr Jenner added that commissioning budgets should be kept separate from the GP contract, but incentives for practices to engage in commissioning would be helpful.

Incentives would have to be 'sophisticated' said Dr Jenner, to avoid the ethically dubious system of payments to cut referrals, which some PCTs use.

'It might be that there are incentives for trying to set up a service to deal with more patients yourself, instead of referring them,' he said.