DH clinical commissioning network lead for England Dr James Kingsland told GP that there was an ‘awful lot of interpretation going on’ over how the Health Bill should be implemented.

‘Some CCGs are being supported by PCTs. Others are being told they must reconfigure or they won’t be authorised.

‘Which is interesting at this early point when we haven’t got the Bill enacted into law.’

Dr Kingsland’s own CCG, NHS Wirral Alliance, received a ‘red’ rating in a risk assessment that is the first step towards formal authorisation.

But the CCG declined to reconfigure to secure a green rating. Dr Kingsland said: ‘No one has articulated the detail of why we are failing.’

He pointed out that the group had already successfully procured a new mental health service. He said the CCG was close to the Quality, Innovation Productivity and Prevention (QIPP) savings target of 4%.

‘We are showing a small underspend, in the 2-3% region. If we get to 4% we’ve managed our QIPP agenda for the next year. So we already have indicators that we are heading along a good path.’

Dr Kingsland said changing day-to-day clinical behaviour was the key to generating major NHS savings, and this was easier to promote on a small scale. Commissioning for large-scale operations such as ambulance services could be done by small CCGs working together, he said.