Only half of clinical commissioning groups will be given full permission to take on budgets by April 2013 – creating a two-tier NHS – one of the most senior leaders of the movement has predicted.

NHS Alliance chair Michael Dixon also claims the prime minister is failing to support clinical commissioners.

In a new year’s message shared with HSJ, Dr Dixon said a lack of support for the change in government outside of the Department of Health, and from the NHS Commissioning Board, was stopping GPs engaging and therefore being authorised.

Dr Dixon, a GP and one of the leading supporters of the commissioning changes, said overly strict requirements for authorisation would also stop some groups. CCGs are due to take over about £60bn NHS funding when primary care trusts are abolished in April 2013, but the government has said they will only do so where they are “ready and willing”.

Where CCGs do not take over, the NHS Commissioning Board may take on responsibility or arrange alternatives, although it has not said how it will do this.

Dr Dixon’s new year message, which will be sent to CCGs, says Mr Lansley and his fellow health ministers “seem to be lone voices” in the government as champions of clinical commissioning. In particular he indicates Number 10 is not taking clinical commissioning “seriously”.

This has “led some [GPs] to question whether they really are intended to be the new force for the future NHS or just the fodder for any future blame”, he says.

“The coalition government, as a whole, must put its full weight behind CCGs and CCG leaders. If they do represent the future of the NHS then they must be explicitly recognised and celebrated as such.

“If government fails to recognise this and to recognise this fast then the heart and soul of clinical commissioning will walk. The prime minister and coalition government must see this as a crisis far beyond the importance of compromising with any self interested factions within or outside the NHS.”

He is also concerned the Commissioning Board is not involving CCG leaders in its design and is undertaking “performance management”, rather than empowering emerging CCGs.

Dr Dixon said it was repeating mistakes he warned about 10 years ago when PCTs were created leading to, it was later recognised, a lack of clinical engagement.

He said the actions were leading to a “shortage of leaders and followers” of CCGs. He said: “If we carry on like this… we will get 50 per cent going live [by April 2013].”

Dr Dixon said it would “create a very fractured system, one half run by the old show and one run by the new lot”.

He said: “Getting a higher percentage will depend on getting the government and the commissioning board to take it more seriously.”