Concerns have been raised over two out of three primary care trusts' strategic plans, the first scores for world class commissioning reveal.
PCTs' strategies, financial management and board skills were assessed by strategic health authority-led panels using a traffic light system - with a green light indicating "no concerns".
But only a third were rated green for their strategies. Performance in financial management and board skills was better, with more than a third and around half getting a green light respectively.
Some PCTs managed to get three green ratings, while at least one got three red ratings. Strategic health authorities are expected to take the lead in driving improvements in the performance of the poorest PCTs.
The scores were released after SHAs checked to make sure they were assessing PCTs on a level playing field regionally. They have yet to be cross-checked nationally.
Performance was also assessed against 10 "competencies" covering leadership, market management, collaboration and information.
In general, trusts did best at working with partners and clinicians and locally leading the NHS. The results suggest PCTs are strong on local leadership but weaker on technical aspects of commissioning.
PCT Network director David Stout said it was good PCTs were showing leadership but warned: "Significant stimulation of the market, use of competition and procurement skills haven't been the meat and drink of the NHS for the last 60 years."
He said managers needed to do more "collectively" to improve in these areas, which are "the weakest bit of the system we've just established but also the hardest to do".
Initial results show the most popular local priorities chosen by PCTs are preventing smoking and admissions to hospital due to alcohol, targeting deaths from chronic vascular disease, improving death rates at home and cutting teen pregnancies.
Pressure to improve
DH director general for commissioning and system management Mark Britnell told a conference last week PCTs would face more pressure to improve. He said: "2009-10 will be where the rate of improvement has to dramatically increase." He described "flashes of brilliance" across the country which the DH would try to develop, but warned competencies would be "tightened", with "more grit in the system".
He said the DH had not "forgotten" about freedoms promised to those who did well in world class commissioning. He said: "The economic turbulence in the autumn has meant that we've had to spend more time thinking as a department and with Her Majesty's Treasury about them, but they will come."
Following national checks today, individual PCTs are expected to reveal their scores in February.
PCT SKILLS RANKED
Working with community partners
Locally leading the NHS
Collaborating with clinicians
Promoting improvement and innovation
Engaging with the public and patients
Managing knowledge and assessing need
Managing the local health system
Securing procurement skills
Stimulating the market