Potential consortium leaders will “walk away” unless they are handed sufficient autonomy, leading GP commissioners have warned the NHS chief executive.

The warning comes the week after Sir David Nicholson, who is also chief executive elect of the NHS Commissioning Board, told HSJ the board would withhold commissioning responsibilities from consortia that were not ready to adopt them.

NHS Alliance chair Michael Dixon said Sir David had to assure emerging consortium leaders he was fully committed to handing over responsibilities or they would lose confidence.

Dr Dixon said: “I know David Nicholson will be under pressure from the Treasury and others to show he has got a grip on things, so he is going to have to walk a tightrope between that and making GP consortia feel they are really going to be [taking on commissioning].

“His rhetoric and what he does in the next few months is going to be very important. David is going to have to prove to frontline commissioners that he really does trust us.”

Dr Dixon said if the board gave the impression it would be “straitjacketing” consortia, then GP leaders “will walk away” from the reforms.

Regarding the design of the board, Dr Dixon said local consortia should be represented in its governance, for example by nominating half of its non-executive members.

Sir David, who is developing plans for the board, told HSJ last week it will have a significant role in commissioning and holding consortia to account, and will not be “shy” of leading.

His comments confirmed the planned handover of commissioning responsibility to consortia would be limited in some cases. This means the board may retain more responsibility than previously thought.

National Association of Primary Care chair Johnny Marshall said Sir David would be judged on whether he could turn “warm words” about designing the board in collaboration with emerging consortia into “warm actions”.

Dr Marshall said primary care trust clusters, which will come under the board’s direction, should be judged by their success in “accelerating GP commissioning” rather than merely by finance and performance control.

He said: “If they get that right they will be effective and their legacy will be to remove the need for themselves to exist.

“If they get caught in a more centralist model they could stifle development and hinder development.”

Dr Marshall said that PCT clusters should “understand the needs of their customers as GP consortia”.