A giant US health firm is to take over GP services in Derbyshire, starting what is expected to be a new era of private sector involvement in the NHS.
A white paper is expected later this month on out-of-hospital care
The European arm of United Health has been chosen by local health chiefs to run two practices.
The move comes as the government prepares to unveil new plans for NHS community services later this month.
Ministers have already indicated they want more private and voluntary sector involvement in NHS community services.
To date, private firms have largely been interested in providing hospital services for the NHS, by 2008 they are expected to carry out one in 10 non-emergency operations.
But Health Secretary Patricia Hewitt said she wants to see alternative providers come into the NHS community market to help improve access to services in the most deprived areas.
The push will form a central plank of the forthcoming white paper on out-of-hospital care.
UnitedHealth Europe is not the first firm to run NHS GP services, but the few practices that are run privately are the exception rather than the rule.
North Eastern Derbyshire Primary Care Trust choose UnitedHealth Europe from a shortlist of six bids.
The company's president is Simon Stevens, Tony Blair's former health adviser.
The details of the contract are still being ironed out, but the deal on offer is to run a practice in the village of Creswell and another in Derby.
PCT chief executive Dr Martin McShane said the move should be seen in the context of GPs always being independent contractors since the NHS was set up in 1948.
And he added: "The practices will adhere to NHS principles and values, patients will not see a difference."
The British Medical Association said it was adopting a neutral stance to such moves, saying what was important was that private firms were not given an advantage in the tendering process.
Dr Hamish Meldrum, chairman of the BMA's GPs committee, said: "We want to see patients getting good access to primary care, particularly in under doctored areas.
"Equally we would want to ensure that the bidding processes are not set up so that only large independent providers can compete.
"We don't have enough information to know whether that was the case in Derbyshire."