No primary care trusts in England achieved an “excellent” grade for their financial management in high profile “health checks” published by a government watchdog this week.

PCTs control well over half the NHS budget and commission most health services within the NHS - taking decisions on which pharmaceutical and other treatments to fund for their own populations.

The Healthcare Commission report found that none of the 303 former PCTs, which were merged into 154 bodies this month, handled their resources well enough to rate excellent and just 93 (31%) were awarded the label “good”. That left 24 (8%) in the bottom category, “weak”, and more than half, 155, ranked “fair”.

Health Secretary Patricia Hewitt claimed that this month’s re-organisation would boost financial capacity within PCTs.

Acute trusts, led by the foundation hospitals, did better with 10% achieving an excellent rating. However, more than four in ten (42%) were accorded “weak” status - reflecting the numbers which ran up large deficits last year.

Healthcare Commission chief executive Anna Walker said: ““This is a worrying picture of an NHS where financial management is not good enough. It is no secret that the NHS has struggled with finances over the past year. But this assessment shows it is not only deficits that are the problem. It shows that many organisations do not have adequate financial systems in place.”

She continued that this would ultimately hit patient care unless it was put right.

Trusts were also assessed for the quality of their services with the grading based on performance against around d 150 clinical criteria. Again, weaknesses amongst the former PCTs were exposed with 67% accorded “fair” or “weak” status. Just six of the former PCTs (2%) won an “excellent” ranking.

Trusts ranked “weak” in either category will have to agree improvement plans with their strategic health authority within a month.

Sir Ian Kennedy, the commission’s chairman, said that overall the results pointed towards real improvement in the NHS but those assessed as weak must meet many more of the “core standards” by next year if patients are to be reassured.

While hailing the results as evidence of improvement, Ms Hewitt warned against “complacency” across the NHS. She described the health checks as “the toughest and most comprehensive” in the organisation’s history.

The British Medical Association seized on the figures to call for greater clinical freedom within NHS organisations and a halt to NHS reform.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee, said: “The NHS needs a period of stability to address the financial management across all NHS trusts.”