Primary health services are about to undergo their biggest shake-up in nearly a decade, shifting some hospital services into the community and creating new super-clinics.

The kinds of services the integrated family health centres might offer are expected to include minor skin surgery, referral to diagnostic imaging and consultations with hospital specialists.

The shake-up is also likely to help meet Health Minister Tony Ryall's aim to halve the number of primary health organisations (PHOs), the contracting groups that now sit between district health boards and health providers such as GPs and nursing practices.

Mr Ryall has written to five health boards urging a reduction in the number of PHOs in their districts. Among them were Auckland DHB, which has five, and Waitemata with six.

Before the 2008 election the National Party promised to "maintain PHOs and enhance the positive role they play in primary care", but Mr Ryall now wants mergers to "bulk up" PHOs and reduce the $33 million a year the state spends on their management fees.

He said his push for integrated family health centres was in line with Labour's 2001 Primary Health Care Strategy, which lowered patient charges through state subsidies and created PHOs but never achieved its hope of having multi-disciplinary health teams collaborating with hospitals and providing more healthcare in the community.

Some interpret the changes as a PHO take-over by doctors and a downgrading of community input. But Mr Ryall said he wanted doctors, nurses and other health workers to take a stronger role in the leadership of health services because that made the services more effective and efficient.

"Most people in the country wouldn't know a PHO if they fell over it. This plan of strong community engagement is probably more of a myth."

The Health Ministry has provisionally accepted nine bids from groups of PHOs and DHBs for devolution of some hospital services to primary care - they must remain free to patients - and the creation of integrated family health centres.

Business plans must be submitted next month and Mr Ryall wants new services to start up gradually from July.

Three bids cover Auckland, including those from the National Maori PHO Coalition and a regional Pacific health grouping.

The largest bid nationally involves 274 Auckland general practice teams, 11 PHOs and the region's three health boards. It covers more than a million enrolled patients.

This bid, by the Greater Auckland Integrated Health Network, plans to establish up to 12 integrated family health centres within three years as "hubs" to which nearby practices can refer patients for services including after-hours care, chronic care and some hospital services.

"Network partners have indicated they have the relationships and facility to access private sector capital to establish the ... centres," the bid says.

A Waitemata DHB discussion document suggests creating up to 10 centres in its district.

Larger ones would enrol patients and provide general practice care, meaning existing clinics would need to shift into these centres; but some smaller centres would focus on extended-hours care and additional services, leaving general practice care to existing GP clinics.

Waimauku GP Marc Paton said he was shocked that such "radical and fundamental changes", which he was told of little more than a week ago, were being "rushed through".

There had been almost no consultation with clinicians and the public.

"This will have a much greater impact than the laboratory debacle," Dr Paton said.

The network's spokeswoman, Professor Cindy Farquhar, could not be reached for comment.


On offer:

Services provided by integrated family health centres could include:

* 24-hour accident and medical care.
* Laboratory collection, some on-site testing.
* Clinical psychology, counselling.
* Dental care.
* Midwifery clinics.
* Acute assessment and observation beds.
* Minor surgery.
* Consultations with specialists.
* Referral for magnetic resonance imaging.