Hillingdon primary care trust in London may become the first to hand over almost all its core functions to the private sector, including the commissioning of millions of pounds of care for National Health Service patients.

The move, which is likely to provoke bitter opposition from the health service unions, would see the private sector taking over not just the provision of community services but the assessment, planning, contracting, procurement and performance management of £258m a year's worth of health care for its local population.