An NCB document, Design of the NHS Commissioning Board, outlines the 11 key risks which the board believes it will face.

One of the risks the board foresaw for the future was its ability of carry out its functions with half the resources that are currently used.

Under the risk ‘resilience’ the report said ‘delivery of functions with 50% less resource by 2014/15’.

The total running costs budget for the NCB in 2014/15 will be £492m. This is half on what was previously spent on providing the same functions.

NHS Confederation chief executive Mike Farrar has expressed concerns that the reduction in management within the board could pose a ‘real danger’ to patient care.

He said: ‘The board itself recognises there are significant risks in reducing the level of management in the new system. As the trade organisation for the health service, we have consistently backed the delivery of efficiencies to ensure the maximum resource is available for commissioners to put into patient care for their populations. But, the levels of management set out here could pose a real danger to effective patient care.

‘It doesn't matter whether the people filling these positions have an administrative or a clinical background, the fact remains that if insufficient money is spent on the organisation of care then patient outcomes will suffer.

‘I am really worried that we are reducing this capacity to dangerously low levels. I fear that this level of reduction will undermine the ability of the NHS to achieve the tasks it will be set. We urge them to reconsider the level of resource they dedicate to the organisation of patient care.’

The document also revealed how plans will put five layers of management between the board and the ‘front line’.

‘In most cases there should be no more than five layers of management in each directorate, from national director to the 'front line',’ the report said.  

The board will employ 3,500 people in total. Around 200 staff will work in regional ‘sectors’ and 800 will work at the NCB’s centre in Leeds.

The remaining 2,500 staff will be located in 50 local offices around England, covering the same area as PCT clusters.

The offices will be responsible for supporting and monitoring clinical commissioning groups (CCG) and commissioning some primary care services such as family health services.

Around £175m of the board’s budget will be set aside to cover local office costs – on average each local office will have a budget of £3.5m.

CCGs will receive £25 per head management allowance to cover their running costs. A CCG with a population of 200,000 would therefore receive £5m.