Speakers at a conference in London last week organised by Wellards, which provides e-learning for the pharmaceutical and medtech industries, included health economists and top DoH officials. They cannot be named because the event was held under Chatham House rules.

One speaker warned that QIPP was ‘only the start’ of efficiency savings. Another said: ‘As they emerge, I think CCGs will have a critical role in identifying areas for disinvestment.’

CCGs would be good at ‘disinvestments around community-based services’, but struggle with complex deals involving hospital mergers, he said.

They will need ‘strategic commissioners somewhere in the system’ to help them make those decisions, he added.

Speaking after the event, Dr Stephen Kell, a GP and executive chairman of the Bassetlaw Commissioning Organisation in Nottinghamshire, agreed that CCGs would need additional support.

‘Major strategic decisions will need input from commissioning support organisations, strategic partners and public engagement,’ he said.

‘The future shape of the strategic support, providing guidance and regional perspective, is not yet clear but will be important.’

Dr Jonny Marshall, chairman of the National Association of Primary Care, told GP providers and commissioners should be involved in disinvestments.

Providers need to adapt services to offer CCGs cost-effective solutions, he said. ‘I would hope its not just about strategic commissioning, it’s also about strategic providing.’

The conference heard that QIPP savings, dubbed the ‘Nicholson challenge’, were only the start.

‘It looks increasingly likely that the Nicholson challenge is the first phase of an ongoing challenge,’ the speaker said.

The first 40% of QIPP savings had been achieved, but this was ‘by far the easiest chunk to deliver’.

Achieving further savings would result in price controls tightening and resources ‘being choked’, he said.