Nurse-led social enterprises, such as Central Surrey Health, have already taken over PCT provider functions in some areas.

But the final report of Lord Darzi's NHS Next Stage Review, released last week, outlined moves to enhance incentives for clinicians to create more of the not-for-profit bodies, and sell their services back to the NHS as independent contractors.

These include allowing staff to retain their NHS pension rights, and a guarantee that social enterprise contractors would not face competition for their first three years of business.

Health secretary Alan Johnson also said that staff who wanted to create social enterprises would have a 'right to be heard'. He told Parliament: 'PCTs that are being difficult will have to treat a request from staff seriously.'

The report adds: 'PCTs will be obliged to consider such requests, and if the PCT board approves the business case, support the development of the social enterprise.'

Ceri Jones, senior policy officer for the Social Enterprise Coalition, said this was a 'very big step'.

But she said she was concerned by the report's suggestion that employees could only keep their pensions while they work 'wholly on NHS-funded work'. If social enterprises are expected to compete in the free market, but cannot seek non-NHS income, this could be a cause for concern, she said.

Howard Catton, head of policy at the RCN, said that these measures would be toothless unless matched by funding for training in bidding and financial management.

'The reality is the people you're competing for contracts with will be the likes of Virgin, United Health and Kaiser Permanente,' he said. 'I don't think it's a level playing field at this point.'

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