Over a third of clinical commissioning groups (CCGs) say they have not been fully involved in shaping the commissioning support offer that has been put in place locally, a new survey has found.

47% of CCGs say they are fully involved, but 32% say they are not involved while 21% are "not sure,"  according to the survey, which was conducted by the NHS Alliance and the National Association of Primary Care (NAPC). 

Moreover, 46% said they feel constricted in the commissioning support offer available to them, compared to 35% who say they do not. 44% said they feel the style of working with the NHS Commissioning Board and transitional Primary Care Trust (PCT) clusters is too centralist, while 19% feel it is too prescriptive and only 18% describe it as "about right."

Of those who feel restricted, 60% said they were offered existing PCT cluster support only, 40% were given no choice at all, 47% were not made aware of all possible choices and 21% said they would have to bear the financial consequences of not taking the PCT offer. 

When asked about obstacles or issues that they feel are getting in the way of making the transition into CCGs, respondents cited layers of management, bureaucracy and top-down direction, which they say are stifling innovation and hindering CCGs' ability to make a difference at local level.

"Concerns about increasing tiers of hierarchy are being put into the system when there are already plenty of checks and balances," said one respondent, who added: "it doesn't feel we have any less red tape and bureaucracy at all, but hopefully still enough space to make it very different at grass roots. Please don't stifle us - we will lose the will to be involved."

Another respondent cited "too many meetings focused on structures with no relevance to empowering CCGs or transforming clinical care," and said that this is not a liberating process - rather, it is "painful, show and bureaucratic."

The survey also found that most CCGs are confident they will be ready for full authorisation to go live in April 2013, with 17% "very confident," 43% "confident," 24% "not sure" and 15% "not confident."

35% of CCGs describe the emerging relationship with PCT clusters as "locally enabling and permissive" and 34% find them "developmental and supportive," but 32% feel they are "controlling and directing" and 30% say they are "performance-managing and centralist." 28% believe they are "mirroring previous style," while 16% believe that it is "too early to tell."

Only a small percentage of emerging CCGs say they feel confident that they are commissioning services as they see fit within available resources, with just 4% saying they are "fully confident," 27% "fairly confident," 50% "not confident" and 19% are "not sure."