A NEW era in healthcare dawns in Oxfordshire on Monday morning. But the arrival of a new trust with a bigger budget than both the John Radcliffe Hospital is likely to pass largely unnoticed across the county.

The Oxfordshire Primary Care Trust comes into being with a £692m budget and the job of providing or buying the bulk of the county's healthcare.

But the giant trust represents a step back in time as much as a new chapter for the local NHS. For it brings together five short lived Oxfordshire PCTs - Cherwell, Vale, North East, South West, South East and Oxford - bringing to an end an experiment that many believe was costly and bureaucratic.

The new trust will begin life as one of the largest primary care bodies in the country, serving a population of 592,000. It has the job of contracting services from 86 GP practices, 98 pharmacies and 100 dental practices.

But from day one it will also be charged with the job of delivering £18m in savings by March 2007 as its contribution to the NHS recovery plan for the region.

Andrea Young, chief executive of the new PCT, said: "I am confident that we have the necessary plans to achieve financial stability. We are developing a new PCT structure that will build on our past achievements. It has the potential to become truly innovative.

"There will always be more demand than any health system can afford and decisions need to be made about how much we can spend on cancer care, on cardiac services, on mental health, on the care of older people and children in the county. We want to work with local communities in a more meaningful way to determine those priorities."

Hundreds of clinical staff now move across to the new organisation. But Ms Young said patients would not be affected by the shake-up, although the new body would reduce bureaucracy. It meant one instead of five chief executives and savings in management alone would come to over £1m.

Reforms are likely to centre on the role of GPs, with doctors expected to take greater responsibility for spending on prescriptions and referrals to consultants. The role of community hospitals and the number of services commissioned from private companies will among the controversial issues facing the new trust and on which it will be judged.

A key part of the reform plans, said the chief executive, will involve bringing health decisions closer to the public.

This will involve supporting GPs and support staff as they work together with a devolved budget from the PCT to commission services for patients. The new arrangement, known as practice-based commissiong, aims to give clinicians greater responsibiliites in the management of healthcare spending and priorities. GPs will also be urged to reduce the number of referrals to hospitals when treatments can be given locally.

Dr Stephen Richards, a GP at the Woodcote/Goring surgery, who is the interim chairman of the PCT Clinical Executive, said: "We are hopiting that the changes will give real GP and nurse engagement to the new single PCT board. It will only be possible to deal with the current financial challenges by having increased clinical engagement."

Last week it emerged that the trust would be targeting the biggest overspending GP practices, to help them change their costly drug prescribing habits.

A report says: "Prescribing is overspent by £1.3m against target, although the overspending trend has reduced considerably in the last month."