“Weak” health and wellbeing boards could result in the NHS Commissioning Board playing the leading role in driving the performance of GP consortia, the King’s Fund has warned in a report.

The concerns come as evidence has emerged that few primary care trust directors are directly involved in setting up the emerging boards.

The King’s Fund report Accountability in the NHS criticises what it describes as “weaknesses in the accountability arrangements” currently set out in the Health and Social Care Bill, particularly those which relate to health and wellbeing boards and commissioning consortia.

The report argues that the weakness of the boards may result in the NHS Commissioning Board “intervening in the work of consortia to drive performance, undermining the government’s aim of reducing top-down management”.

The report adds: “Furthermore, if health and wellbeing boards lack (or are perceived to lack) any real influence, they may face significant difficulties in attracting a sufficiently experienced and authoritative membership.”

A benchmarking exercise on the development of health and wellbeing boards in 46 council areas, carried out in March and April by consultancy firm Cordis Bright, found a quarter already had a full shadow board in place.

A further half expected to have one by September – six months before the government’s April 2012 target.

However, fewer than half of the emergent health and well-being boards had a primary care trust chief executive or chair, or local authority chief executive, currently sitting on them.

Although the Health Bill does not stipulate these roles should be represented on boards – unlike directors of public health, for example – it does call on councils to appoint anybody they think “appropriate”.

But Association of Directors of Public Health chief executive Nicola Close warned that in a small number of areas even directors of public health had yet to be included on the boards.

She said: “Public health professional expertise is vital to get this right.”