The configuration of the new local NHS organisations – 212 CCGs and 27 NHS Commissioning Board local area teams – has been agreed.

The list of proposed CCGs, which replace the 50 PCT clusters, is divided into four application waves spread over the next five months.

The 27 NHSCB branches replace the 28 SHAs and represent an ‘upward delegation’ of their responsibilities.

These new commissioning authorities now cover the whole of England.

The NHSCB Authority has published the geography, names and member practices of the proposed CCGs. Once the Board is established as a statutory body, it will approve these details.

Each proposed CCG has been assigned to one of four application waves for authorisation: 35 in wave 1 (July 2012), 70 in wave 2 (September), 67 in wave 3 (October) and 40 in wave 4 (November).

The 27 NHSCB local area teams (LATs) are likely to comprise three in London and seven to nine in each of the three regions North, South and Midlands and East.

Each local team will include an overall director and medical, nursing and finance directors, as well as general managers.

According to the Health Service Journal, 28 area teams were planned – but in order to avoid comparisons with the previous 28 SHAs, one was dropped.

Around 10 LATs will commission specialised services on behalf of several other LATs, while a few LATs will take a national lead in specialised areas such as optometry and military health.

The teams will be formed from staff members appointed to the NHSCB in the coming months.

The NHSCB’s annual running cost budget has been agreed at £527m.

The NHS is broadly meeting its financial and quality targets, but the national figures “mask significant local variation”, according to a King’s Fund report.

The proportion of patients spending over four hours in A&E has increased by a quarter since 2011, but other key performance indicators were more stable.

A survey of NHS finance directors showed that more than half were pessimistic about their local health economy in the coming year.

The Kings Fund quarterly monitoring report How is the NHS performing? combines national data on performance against key targets with survey feedback that shows the NHS is highly uneven in how (and how well) it meets the QIPP agenda.

Of 23 NHS finance directors responding to a survey, 7 said they were not confident of meeting their productivity targets for 2012/13 (the King’s Fund notes that the sample is not statistically representative).

The national figures indicate that waiting times for treatment are stable, but the NHS is narrowly failing (by 1%) to limit the proportion of patients waiting over 18 weeks to 8%.

Delayed transfers of care – a common problem for elderly patients – are also stable overall, but nearly half of the survey respondents reported an increase.

The proportion of patients spending over four hours in A&E has fallen over the past year, but remains overall more than 25% higher than in 2010/11. There is evidence of considerable variation between providers.

As Health Secretary Andrew Lansley has pointed out, that does not mean that 25% more people are not being seen within four hours. However, an increase in waiting times is undoubtedly the underlying cause of the difference.

John Appleby, Chief Economist at the King’s Fund, commented: “Overall, the NHS continues to perform well, despite the spending squeeze. However, this masks growing pressures in hospitals and significant performance issues in some NHS organisations.”

Of the 23 survey respondents, only 16 were confident of meeting their QIPP targets for this year, while 18 were using service rationing and/or rationing of GP referrals to help meet these targets.