CCG leaders fear they will not be able to make the necessary "unpopular decisions" for fear of a "kick back" from the NHS Commissioning Board's (NHS CB) yearly 'reauthorisation process'.
Fears centre around the 360° feedback survey - part of the CCG 'reauthorisation process', which will involve all "relevant partners" of CCGs, including member practices, local authorities, health and wellbeing boards, NHS providers, HealthWatch and other patient groups.
The 360° survey will allow the NHS CB to scrutinise the relationships between CCGs and its stakeholders.
Dr Howard Stoate, Chair of Bexley CCG, said thanks to the vast number of organisations tasked with holding the GP-led groups to account, CCGs would inevitabley be "blocked at every turn by immoveable forces" if were to do what they "really wanted to do".
"The CCG has to be reauthorised every year, and that has to depend on a 360° survey from the local authority and from our providers," he said.
"So when it comes to authorisation each year, we will be judged by people like the acute trusts and the local council on how we have done, and if we have made decisions that were unpopular, you can bet your boots that there will be one hell of a kick-back and the National Commissioning Board will put more and more conditions on reauthorisation."
Bromley commissioning GP Dr Atul Arora said the constraints being placed on CCGs means "they are being held at the neck" rendering them "unable to move below the surface".
Speaking to Management in Practice, Health Secretary Andrew Lansley said while there is a responsibility on the part of the NHS CB for the performance management of CCGs, he denied there will be a reauthorisation process as such.
He also rejected the view that the NHS CB's performance management should have a "chilling effect" on a CCG's autonomy.
"Once a CCG is authorised, it is only a matter for the NHS CB to step in if under the regulations it is clear a CCG is failing to meet its duties," said Lansley.
"The NHS CB must have a means by way to exercise the performance management of CCGs but I don't think it's correct to treat it as a top-down performance management system that should in any sense have a chilling effect on the autonomy of the CCGs to take the decisions they think are in their patients interest."
Dr Stoate said mergers between CCGs will be the only way CCGs will be able to have enough "clout" to effectively call their providers to account.
He argued CCGs outside of London will need to have a patient population of a million patients, with numbers in London exceeding that– a far cry from the current CCG average size of between 150,000 and 300,000.