Finance managers have raised renewed concerns that a lack of guidance on implementing the detail of the government's NHS reforms could lead to financial instability.

Leaders of the Healthcare Financial Management Association, which has repeatedly called for a 'route map' setting out the work needed, said last week that major signposts were still missing.

Chair Jaki Meekings said it welcomed 'the direction of travel' but more detail was needed on a raft of issues, including allocations to primary care groups and how specialist services were to be purchased in the future, 'if there is to be a managed transition into the new financial year'.

'The first stage of implementing The New NHS white paper is substantially complete, ' she said. 'The NHS must now learn the lessons from that exercise and avoid further waste of scarce professional resources.'

Ms Meekings, finance director of Wiltshire health authority, said HAs had 'effectively dismantled the internal market' by drawing up baselines for recurrent allocations to PCGs.

NHS Executive guidance says the baselines should be calculated by adding basic hospital and community health services allocations to a prescribing baseline and current general medical services spending.

Deductions had to be made for patients living in an HA area but registered with a GP elsewhere, for HA spending and for 'collective commissioning' before PCGs received their shares.

But Ms Meekings said calculating the cost of treating patients living across the new boundaries had 'confirmed the absolute need' for more specific guidance.

'In the absence of a consistent national methodology, HAs have calculated the amounts to be transferred and great variations are reported. The cost varies from£200 to£500 in one region. That is nonsense. It cannot be right.'

Ms Meekings added that the system of extra-contractual referrals had also been dismantled, to make way for outof-area treatments.

But she said a coherent policy on the new system was needed urgently because 'if we cannot deliver these very high profile services, we will have real problems of perception with the public'.

Barry Elliott, finance director of Bart's and the Royal London trust, said: 'Trusts and HAs have been working through their ECRs and agreeing baselines. The second part of the work is to roll ECRs into service agreements or OATs, which are seen as a default position.

'The problem is that until guidelines for specialist services come out that cannot be done.'

He added that OATs might force large tertiary centres to deal with 'many, many' commissioners and actually increase bureaucracy.

Consultation on OATs suggested that 'lead commissioners' could be appointed for specialist services, but Mr Elliott said little progress had been made on the suggestion.