Draft guidance on CCG governance arrangements says the accountable officer role could be filled by an ‘individual who is not an employee of the CCG’.

It says where a clinician is appointed as the accountable officer the CCG will also need a senior manager or managers who take on the operational responsibility for the group.

Last month the GPC warned that only CCGs that have a 'remarkable resemblance' to PCTs would be authorised. This latest announcement is likely to fuel the fears further.

The draft guidance says: ‘It is vitally important that CCGs remain clinically led, able to stay in touch with their member practices and bring together the broadest range of clinical professionals to include patterns of care and focus on patient needs.

‘Yet at the same time include a broader range of leaders who will give the appropriate assurances about probity and governance.’

The document also confirms that all CCGs will be able to commission services from GP practices.

Previously, it was expected that this would only be permitted in a handful of cases.

Towards establishment: Creating responsive and accountable clinical commissioning groups also outlines that CCGs will need to have ‘effective arrangements’ to bind together the contribution of member practices to CCG activities.

It says a memorandum of understanding will need to be developed with each of the member practices and that the DoH will be working to create a model template for CCGs to work from.

It follows concerns that practices are being forced to sign ‘draconian’ legal agreements in order to become a member of CCG.