GPs have taken up less than half of the available leadership positions in the emerging clinical commissioning groups (CCG) in England, sparking fears that the profession is being pushed aside from the decision-making process on which services to offer patients.

According to an investigation by Pulse magazine, responses from 100 CCGs revealed that just 645 out of 1,325 board positions (49%) were held by GPs (with five unable to confirm their board's makeup), leading some to question whether their role in commissioning is being watered down.

In some regions of the country GP representation on the CCG boards was surprisingly low, such as Nottingham West with 20% and Bury with 21%. On the other side of the coin, Medway, Sandwell and West Birmingham CCGs GPs held at least 75% of board positions, the survey revealed.

Guy Mansford, clinical lead and deputy chair of Nottingham West CCG, told Pulse that in his area practices were slashing the number of GP board members from five to two to cut costs and address potential issues of conflict of interest.

However, in a subsequent comment posted on Pulse's website he also points out that the money saved by this action has enabled the establishment of a Clinical Innovation group on which the rest of the GPs sit.

"There they do what they do best, which is think up innovative clinical pathways together with our patient reps. These are then signed off by our small lean board which handles the conflicts of interest," he stressed.

And speaking at an NHS Commissioning Board meeting last week, Dame Barbara Hakin, the government's National Director for Commissioning, reportedly also put a positive slant on things, claiming that the trend to allow a greater number of non-GPs on CCG boards was allowing other groups to have a bigger say in the commissioning of services, the magazine reports.