Cumbria and Western Cheshire primary care trusts are at the greatest risk of being unable to meet baseline performance goals in the next six to 12 months, according to the third and final wave of primary care fitness for purpose results.
Cumbria PCT corporate affairs director Ross Forbes said the results were no surprise because the organisation was not fully formed when the process began in January.
'We had to merge three PCTs and we were brand new and still in the process of looking at the structure. If we were to go through it again in a couple of months we would come out a great deal higher,' he said.
'The process is not something that judges, it's a helpful diagnostic tool. We are going to use it to set up the best possible organisation to deliver what we need to.'
Western Cheshire PCT chief executive Helen Bellairs, who worked on the development of fitness for purpose with the Department of Health, said: 'Our organisation had been running for three weeks when the process was carried out in October but I wanted to get in there in the beginning to help inform our development plan.
'We were£42m in debt and we knew the previous organisations were not fit for purpose. The process showed what was wrong with previous organisations so we could make it better.'
Bradford and Airedale teaching PCT came out best in the third wave of results, presenting the least risk in the organisational assessment but with room for improvement on strategic planning and monitoring of commissioning.
Chief executive Simon Morritt said: 'We made an early decision that if fitness for purpose was going to work for us we would need to take the process seriously and prepare well. We were able to use the process to help build the new organisation and ensure our energies are focused on commissioning.'
Fitness for purpose looked at finance, strategy, governance, external relations and emergency planning. The commissioning diagnostic assessment looked at strategic planning, care pathway management, provider management and monitoring.