Health minister Lord Darzi has put clinical leadership at the centre of his next stage review.

Clinicians must "step up" their work with managers and play their part in making "tough decisions" about services and resources, he said.

Speaking to HSJ in advance of today's publication of  A High Quality Workforce  - one element of the next stage review - Lord Darzi said he envisaged "a lot of clinicians will now be responsible and will have tremendous powers within the system".

Hospital doctors will hold their own budgets and GPs will have greater freedom under practice based commissioning.

Darzi review

In exchange for these new powers and new management positions, clinicians will be expected to use their professional skills to assess the evidence base for service reconfigurations and the distribution of resources.

"Patients, the public and staff alike expect to see clinical leaders explicitly making the case for these changes to services which evidence shows will improve patient care," the review states. The review follows resistance from a number of clinicians across the NHS to the regionalisation of specialist services.

But Lord Darzi said a new accountability structure would ensure high-quality clinical leadership that would be measured in terms of overall outcomes for patients. Medical training programmes will now include management and leadership skills as standard.

The workforce report also commits to implementing Sir John Tooke's recommendation to establish a new body, Medical Education England, to scrutinise the quality of training and to commission training places for doctors and dentists.

Training for other professional groups will be commissioned by strategic health authorities, guided by another new body, the Centre for Excellence, which will gather and analyse data to effectively model future demand for different specialties.

Mirroring reforms elsewhere in the NHS, deaneries will need to establish a formal split between the commissioning and provision of training and education. This will help ensure objective assessments of the quality of training programmes, the report says.

With the shift towards more primary care, the workforce strategy places particular emphasis on GPs. Eighthundred extra GP training places will be made available to meet the ambition that "at least" half of all doctors entering specialist training do so as GPs. This will be done using "existing resources".

Some training funds will now be ringfenced to guard against the "raids" on training funds seen over the last few years. Students will be able to shop around for their training using a share of up to £4.3bn training funds that will follow the student.

The report also commits the DH to a review of healthcare professions not currently regulated. It specifically mentions clinical psychologists. "Those workers whose role involves significant risk should have proportionate assurance arrangements to ensure safe and high-quality care for patients," Lord Darzi's report says.