Giving clinicians responsibility for how to spend money and more central control over NHS procurement have been proposed by think tanks as alternative answers to making savings.

Civitas health unit director James Gubb said the NHS should take a “different tack” from that suggested in the McKinsey report.

Staff wages is the big ticket item [but] job cuts shouldn’t be necessary as there’s plenty of scope for making the NHS much more productive and efficient

He said the “shopping list” of potential savings outlined by McKinsey was akin to the “top heavy approach” previously used by the government - for example in the NHS Plan - which had wasted considerable sums of money.

Control over both cost savings and care quality in the health service would be better handled through “local - and particularly clinical - ownership”, he said.

“They are the only ones who can truly know their operating margins and have a hold on cultural elements of change, [eg] involving clinicians in performance measurement,” he told HSJ.

Mr Gubb added: “We should not lose sight of what tends to drive performance and quality in other industries: competition, pluralism and the openness to disruptive innovation and new ways of working that this tends to breed.”

But the think tank Policy Exchange said there should be more central control over NHS procurement and better ideas sharing, to save the NHS millions without slashing jobs.

Policy Exchange head of health and social care Henry Featherstone said: “Staff wages is the big ticket item [but] job cuts shouldn’t be necessary as there’s plenty of scope for making the NHS much more productive and efficient.”

A central procurement body should replace existing hubs and develop common data standards for all NHS procurement systems, the think tank has said. It suggests some of the spending on innovation be used for dissemination and implementation.

It said that of the £2.7bn spent on creating new ideas only about £153m goes into spreading the innovations to patient level.