The relationship between local government and general practice suggested in the White Paper is taking us into unknown territory, says Bob Hudson.

Reaction to the NHS [Equity and excellence] White Paper has been fast and furious, with much of the commentary focusing on the potential for privatisation of healthcare.

Much less attention has been paid to another ‘p' – partnership working – yet this could potentially be of greater significance.

In his first appearance before the health select committee last month, health secretary, Andrew Lansley, said: ‘The most significant statement in the White Paper is not that we are going to have GP commissioning, but that we are going to ally it with a strategic role for local authorities.'

Since then, the embryonic proposals contained in the White Paper have been fleshed-out by several supporting consultation documents, one of which is on ‘local democratic legitimacy' – and the latter carries the signatures of both the health secretary and CLG secretary (‘Council role upgrade in health service overhaul', The MJ, 29 July).

Local authorities are seen as having a greater responsibility for health in four areas:

leading on Joint strategic needs assessments (JSNAs) as now, although with enhanced health involvement

supporting local voice and the exercise of patient choice through the new local HealthWatch agencies, funded by and accountable to local authorities

leading on health improvement – a transferred function from primary care trusts (PCTs)

promoting joined-up commissioning of local NHS services, social care and health improvement.

It is the latter, operationalised through new statutory health and wellbeing boards, led by local authorities, which could end up being of most interest. The Government sees them as having four functions: