Health minister describes how the scheme would work
Private firms could be drafted in to run struggling NHS hospitals and primary care trusts in England, ministers have announced.
Executives from companies or from better-performing NHS trusts could be used to replace existing bosses.
Ministers say it is one of a range of options aimed at improving performance, but insist no NHS assets or staff would be transferred to private companies.
The British Medical Association said it had "grave concerns" about the plans.
In October the government is to publish new criteria for quality, safety and financial performance, which all NHS trusts in England will be expected to meet.
About 20 trusts are expected to be identified as falling short and to be given a deadline to turn things around.
Bringing private management in will simply accelerate the process of privatisation of services which will have catastrophic effects for the patients and the public at large
Professor Allyson Pollock University of Edinburgh
The Department of Health said although private firms would be allowed to provide management services at NHS trusts, front-line staff would remain NHS employees.
Officials said it was not expected that "huge numbers" of NHS trusts would be affected.
It is thought about 20 trusts labelled weak by a Healthcare Commission report last autumn could be identified as candidates.
Health Minister Ben Bradshaw said the likelihood was that in the majority of cases management would be taken over by other NHS units.
"But there may be examples where no NHS hospital is interested in taking over a failing hospital, or where local NHS managers think that in order to have more competition and choice for people locally that bringing in a private manager on a franchise arrangement will be the most sensible idea.
"Our experience is that you can when you bring in, not just the private sector, but the voluntary sector, help drive up standards in local health areas."
The BMA warned the scheme amounted effectively to privatising parts of the NHS and could lead to "fragmentation" within the health service.
Dr Jonathan Fielden, addressing the BMA Consultants Conference on Wednesday, accused ministers of knowing little of the complexities of the NHS.
He said: "You can't just fly in management. There is no evidence that private management is any better in the NHS.
"How many of us have seen our Trusts bring in the management consultants, paying through the nose, only to get a half baked solution and one that the real talent in the NHS could have delivered for less?"
Professor Allyson Pollock, head of the Centre for International Public Health Policy at the University of Edinburgh, said: "Bringing private management in will simply accelerate the process of privatisation of services which will have catastrophic effects for the patients and the public at large.
"It will mean less care for everyone, and more money for profits and shareholders."
It seems to me that this is treating a symptom, rather than actually getting to the source of the disease
Nigel Edwards NHS Confederation
Nigel Edwards, of the NHS Confederation, said the government had tried drafting in private sector management unsuccessfully before - at the Good Hope Hospital in Sutton Coldfield in 2003.
"What it revealed is that the reason that hospitals tend to fail is often much more complicated and much more difficult than just poor managment."
Mr Edwards said a much more detailed analysis of why hospitals were failing was needed.
"It seems to me that this is treating a symptom, rather than actually getting to the source of the disease."
Anna Walker, chief executive of the Healthcare Commission, said: "We strongly welcome the government's commitment to driving up standards of care on behalf of patients, and tackling poor performance before it becomes a crisis."
The private sector has already been given an important role in the NHS in England. The government spent heavily on privately-run hospitals and treatment centres to cut waiting times for operations, and private firms are now starting to get a foothold in general practice.
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