Clinical commissioners have told health secretary Andrew Lansley that they are frustrated with the support they are being offered, and called on him to ensure they can operate freely.

Mr Lansley heard the results of a survey of clinical commissioning group leaders yesterday at a conference held by the National Association of Primary Care and the NHS Alliance’s joint Clinical Commissioning Coalition, which was launched this week.

The survey, based on 131 responses from GPs and managers in clinical commissioning groups, found half felt restricted because they were only able to receive commissioning support from their local primary care trust. A third said they were not able to shape the support on offer, and only 22 per cent said they were confident they would get the right support.

Sixty-one per cent said they were “very engaged” in their local quality, innovation, productivity and prevention plan, and 30 per cent of CCGs would be asking the NHS Commissioning Board to allow them to cross local authority boundaries.

NHS Alliance chair Michael Dixon, presenting the findings to Mr Lansley, said a third of CCGs felt under pressure to become larger, while two thirds expected they would inherit debts from NHS organisations.

Dr Dixon said GPs were keen to be part of smaller organisations. “If you’re small, you can be entrepreneurial, and engaged,” and called on Mr Lansley to “allow different sizes to see what happens, and not just assume you know what the right size is”. He also said the process of authorisation for CCGs should be “developmental and supportive”, and not “a driving test you have to do every year”.

However more positively, 90 per cent said they felt engaged in commissioning, and half felt they were “liberated” commissioners.

NAPC chair Johnny Marshall said commissioning support was a “burning issue” among GPs. He emphasised the importance of localism and told Mr Lansley: “It should be nationally supported… [but] having the ability to determine how things are done locally, we think is absolutely key to our success.”

Mr Lansley told the conference: “Do tell the NHS Commissioning Board what you want them to do. One of their jobs may well be to go about the task of ensuring you have the market from which you want to purchase commissioning support. Don’t wait for them to tell you – you tell them.

“Some of your support may come from the independent sector where there are specific specialist skills – but the vast majority will grow from the knowledge and capacity that already exists in the NHS. They will be working for you. You will be in charge – you will have the budget. If you’re not getting value for money, you can decide to change it.”

He said the DH would publish more on future commissioning support for CCGs would be published later this month.