There are concerns over how specialised service commissioning will be controlled at regional level after strategic health authorities and primary care trusts are abolished.

The white paper says commissioning specialised services - worth around £10bn in total - will become the responsibility of the NHS commissioning board. Although it adds that GP consortia “will have influence and involvement”.

Specialised Healthcare Alliance director John Murray said the white paper reflects his view that specialised commissioning should be controlled by a central board without PCT involvement. But he said there were “immediate concerns” around whether there would be some form of regional structure for specialised commissioning.

He was particularly concerned about the amount of oversight the central commissioning board would have over specialist services and whether it would have sufficient capacity to ensure quality was maintained across the country.

Mr Murray said more details were needed on designation - the process of checking that specialised service providers deliver an agreed quality and level of care within clear financial and clinical standards - and how the role of monitor“>Monitor, as a possible regulator of competition, would sit with this.

At present, designation - one of the recommendations of the 2006 Carter review into specialised commissioning - is carried out by specialised commissioning groups aligned with strategic health authorities, which are set to be abolished.

Mr Murray said: “One of the key components of Carter was that specialised services should be designated, because otherwise there’s a risk you will have inadequate clinical expertise, [and] inadequate patient volumes to sustain that expertise.

“We would see designation being a matter for the NHS commissioning board and its regional offices, but Monitor will need to recognise that the clinical quality and safety of services for people with rare and complex conditions is not always compatible with free contestability.”