Clinical commissioning groups (CCGs) in England should be allowed to appraise the new NHS Commissioning Board (NCB), say GP leaders calling for "a new relationship" between the NCB and CCGs.
The Clinical Commissioning Coalition, set up by the NHS Alliance and the National Association of Primary Care (NAPC), is demanding an equal relationship with the NCB over fears that current proposals appear "too top-heavy".
It wants to see the representation of clinical commissioners "at every level" – from the NCB to the CCGs themselves – and warns that arms-length interaction "is not enough".
"As I speak to CCGs throughout England, too few feel they are really being liberated," said Dr Michael Dixon, NHS Alliance Chairman (pictured).
Michael Ramsden, NAPC Chief Executive, added: "We hear often that decisions about the NHS will come from the consulting room rather than from Whitehall.
"That must mean that the 'rules of engagement' are equally decided between clinical commissioners and the NCB, rather than tablets of stone handed down from above."
The coalition says the "disinterested voice" of clinical commissioners themselves must be part of the authorisation process, and proposes that one of its representatives should sit on every panel authorising CCGs.
Annual appraisal, it says, should be a "two-way" process and argues that while the NCB will need to appraise CCGs, CCGs themselves should collectively be able to appraise the NCB as to whether it has been able to support their work and enable them to produce better health outcomes.
Dr Dixon said: "If command and control is dead then 360-degree appraisal must become the norm."
He warned that unless this two-way process accelerates rapidly, "clinical commissioners will feel more shackled than liberated and the huge potential gains of enlisting frontline clinical commissioners will be lost."