Clinical commissioning groups will have to take full responsibility for the actions of commissioning support services, a legal expert has warned.

Bob Senior, Director of Medical Services at legal firm RSM Tenon, told delegates at the Commissioning Show how the Government wants CCGs to be fully accountable for all commissioning decisions.

He said CCGs cannot delegate responsibility and the “buck stops with you” if anything wrong were to happen during the commissioning of services.

CCGs were told how they would need to “do everything better for less money” when they take full control of health budgets next year and were warned to “look carefully at contract negotiations” to avoid any legal issues.

“You will have limited resources,” said Mr Senior. “Make sure you get something out of it that you want, not what they try to impose. This is your responsibility, your funding, your contract.”

Mr Senior also revealed how smaller CCGs are already struggling to deal with patient management costs and were cutting GP involvement as a result.

He told delegates how one commissioning group in the Midlands had reduced the number of doctors on its board from six to two to trim costs.

Developing commissioning groups, he said, are struggling to cope with the money allocated for patient management. “You can’t do everything you want in a small local CCG so as a result CCGs are generally becoming bigger than they originally hoped for,” he said. “The smaller CCGs are finding that £25 per head is too tight to do anything like the GP involvement they hoped for.”

CCGs may go the way of GP fundholding, according to senior NHS manager Sir Robert Naylor.

The Chief Executive of UCLH said the new structure would create “a vacuum of strategic leadership and direction”, making further reform necessary.

He also claimed that “rationalisation” of services was already being arranged between providers “behind the scenes”.

Speaking at the King’s Fund, Naylor said: “The jury is still very much out on whether the latest commissioning arrangements will last any longer than fundholding did.”

Whoever won the next general election, he said, it was inevitable that another NHS reorganisation would be needed to provide “strategic leadership”.

In the absence of SHAs, Naylor argued, the CCGs would not be “cohesive enough” to determine healthcare priorities in major cities.

He was sceptical of the ability of the NHS Commissioning Board to provide the necessary “strategic leadership”.

Speaking at the Commissioning Show in the same week, Naylor said: “My main fear is that GP commissioning will lead to ever-increasing fragmentation.”

His experience of London-based commissioners indicated that their concern was with day to day service issues, and they were unable to make strategic decisions on issues such as “the future of cancer care”.

Those decisions were being made “behind the scenes in discussions between providers”, he said.

An example was the way UCLH had “swapped” services with the Royal Free Foundation Trust, with one taking on neurosurgery and the other liver surgery.

The NHS in England spends 10% less per patient than health services in other UK countries, according to a new National Audit Office (NAO) report.

There are also fewer nurses, midwives and healthcare visitors per 100,000 people in England than in Scotland, Wales or Northern Ireland, and only the former pay prescription charges.

However, life expectancy is highest in England, and average hospital stays for acute care are shortest.

The first official report comparing health systems across the UK shows that the impact of austerity measures on healthcare spending has been deeper in England than in Scotland or Wales.

The NAO report’s findings include the following (for 2008-2010):

A DH spokesman commented: “England spends less per person on health care than Northern Ireland, Scotland and Wales but has similar if not better health outcomes.”

However, differences in underlying health demographics and care pathways mean that comparisons are not straightforward.

For example, while the figures suggest that recent cuts in Welsh healthcare spending may have affected services, it is difficult to correlate the relatively low life expectancy in Scotland with any health service metric.

The ABPI has questioned the amount of money the NHS spends on new and innovative medicines.

A new forecast from the Office of Health Economics shows spending on innovative branded medicines is set to shrink over the next three years.

Stephen Whitehead, Chief Executive of the ABPI, said the decline is “bad news” for the discovery of future life saving drugs and “ultimately the health and wellbeing of UK patients.”

Research found that the total amount spent on the NHS is actually set to rise by 2.5% annually until 2015. However, expenditure during that time on new branded medicines will rise by just 1.3%.

There will be a very slight increase in the growth of the total amount spent on medicines each year by the NHS from 3.5% to 3.7% per year until 2015 – driven mainly by an increase in the amount of generics purchased.

But, research found, spending on medication launched between 2012 and 2015 will account for less than 2% of overall spending on medicines.

“This report spells out the very good value for money that the NHS derives from our medicines and shows the system is achieving huge savings from medicines coming off patent,” said Stephen Whitehead.

“But I am deeply concerned that these savings are not being reinvested back into the system because these figures show our spending on the newest and most advanced medicines is declining in real terms.”

The ABPI CEO also called for a change in thinking by the NHS around medication where drugs are seen as an investment and not expenditure.

“Looking ahead, as we start to prepare for negotiations with Government on the next medicines pricing scheme, we need to see our medicines rewarded for the high risk and cost of research and development,” he said. “And once medicines are ready for use by patients, we want them available on the NHS as quickly as possible so as many patients as possible can reap the health benefits.”