Labour's health spokesman, Chris Smith, hinted strongly yesterday that he would end the practice of political appointments to NHS trust boards by advertising for candidates.

The Secretary of State for Health currently decides who chairs such quangos. But Mr Smith said he was "looking seriously" at such posts being advertised.

Labour has tried to ease fears that it would sweep away some Tory sympathisers on trust boards and replace them with its own placemen.

Yesterday, speaking on LWT's Jonathan Dimbleby programme, Mr Smith said: "We do need seriously to look at the appointments to the boards of these trusts because at the moment they are not particularly representative of the communities that they serve.

"Many of the early appointments particularly that were made to the trust boards were made on partisan grounds by Conservative ministers."

Mr Smith also reaffirmed his plans to oblige GPs to join together in "locality groups", which would jointly commission services and run their budgets collectively.

The scheme would be up and running within three years of Labour taking power and is aimed at ending what Labour sees as a two-tier service, with GP fundholders' patients enjoying some advantages over non-fundholding GPs' patients.

"What's happened at the moment, with some GPs becoming fundholders and other GPs not becoming fundholders, is that we have the same patients with the same conditions, living in the same area, being treated in different ways. There is a two-tier health service being created by this," he said.

However, Mr Smith insisted that if GP fundholders in the group wanted to remain running their own budgets, they could do so, but only if a majority of the other practices in the local area agreed.

Mr Smith said that although some of his proposals would not require changes in the law, he hoped those that did could be legislated for in Mr Blair's first Queen's Speech.

The shadow Health secretary was sanguine about the fact that in the first year of a Labour government he would not get more money for health spending than the figure which has already been spelled out by the Conservative Chancellor Kenneth Clarke for 1997-98.

He said: "I have to operate within the departmental budget for the whole of the first year and I have to be able to demonstrate that what we're doing is spending that money well and wisely and cutting down on waste - only then could I even dream of going to Cabinet and arguing for more resources."

However, Mr Smith predicted that by tackling unemployment, funds could be freed up for spending in areas such as health in a Labour government's second year.