GPs who want them should be given hard budgets now, with the details of national policy filled in later, according to a report from the NHS Alliance.

If the NHS is to survive one of its toughest financial challenges yet, the coalition government needs to move quickly towards clinically led commissioning, says the report Developing GP Commissioning.

Health secretary Andrew Lansley has told Department of Health officials he wants GP commissioning up and running by April 2012, though NHS chief executive David Nicholson has said he doubts whether this is achievable.

But the Alliance argues that this timescale is too long and that some GPs, especially those currently  involved in practice based commissioning, are ready to pilot and implement hard budgets now.

Report author and NHS Alliance clinical commissioning federation director Julie Wood said: “Now it’s time to act. The government needs to move quickly and work closely with those ready to take this model forward.”

The NHS Alliance report sets out a vision of commissioning involving a wide range of clinicians – not just GPs – and managers and working in a co-operative local clinical partnership.

It says GPs “are clearly key” but it is not just about them. Instead it says GPs should lead co-operatives that include a range of other clinicians, managers, patients and other organisations to ensure the “best possible local commissioning decisions”.

The report says:  “We need to move from our current systems and embrace clinically empowered commissioning in the way that we describe now.  We do not have the luxury of time to debate every bit of the detail.

“We need the Department of Health to instruct its PCTs to transform its commissioning in this way and to do it quickly.”