At the Primary Care Live conference in London last week, NHS Confederation PCT Network director David Stout said maintaining high standards would be a huge challenge as NHS reforms took effect.
He added that GP consortia should inherit PCT debts to force them to make tough decisions on NHS spending.
Mr Stout said a top-slice could be taken from all GP consortia budgets to pay off PCT debts. But he added: 'This has the downside of penalising areas that didn't cause the debt.'
Mr Stout said his 'preferred option' for managing PCT deficits was to transfer them to local consortia. He accepted this would be 'unpopular', but he could not see 'any other option'.
He said: 'My rationale for saying GP consortia should inherit the debt is because if they don't, they have no incentive to engage in difficult decision making. Consortia are the successors to the existing bodies and now have a part to play in resolving financial difficulties'.
Mr Stout's view puts him at odds with the BMA, which believes inheriting PCT debts will prevent consortia functioning to their full potential.
Mr Stout warned that the quality of services could deteriorate and 'serious financial deficits' emerge as NHS reforms are pushed through.
He said: 'If the NHS starts to go seriously awry before we get to 2013, we may never get to implement the White Paper because something else will have to be done to deal with a crisis as it emerges.'
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