A new report from the National Audit Office has found that in 2017/18, 42% (87 of 207) of Clinical Commissioning Groups (CCGs) were rated either ‘requires improvement’ or ‘inadequate’, with as little as 10% rated as ‘outstanding’.

Twenty-four are currently deemed to be failing, or at risk of failing, it warns.

Also, an increasing number of CCGs were found to be overspending against their total budget plan: in 2017/18, 75 (36%) spent more than planned with a total overspend of £213 million across all CCGs, compared to 57 CCGs in 2016/17 and 56 in 2015/16.

As part of their total budget plan, CCGs have consistently spent less than their running costs funding, which has been reduced from £1.35 billion in 2013-14 to £1.21 billion currently, and will be slashed by a further 20% by 20/21, the NAO noted.

CCGs plan and commission most of the hospital and community NHS services in the local areas for which they are responsible, and are led by a governing body made up of GPs, other clinicians including a nurse and a secondary care consultant.

They were established as part of the Health and Social Care Act in 2012 to help health services be more responsive to patients’ needs and to align clinical and financial decision-making.

However, according to the report, neither the Department of Health and Social Care nor NHS England have undertaken an overall assessment of CCGs’ progress in achieving their policy objectives since they were introduced.

NHS England is expected to “step in where it thinks CCGs are diverging from good practice, but has not set out the criteria it will use to determine when to step in", it says.

Amyas Morse, the head of the NAO, said: “We have seen almost three decades of change to NHS commissioning. It would be a huge waste if in five years’ time NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval.

"The current restructuring of CCGs must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a much-needed prolonged period of stability.”