Powys LHB has been under pressure since announcing cutbacks

It found that problems with management had resulted in concerns about patient safety.

The NHS clinical governance support and development unit (CGSDU) investigation was ordered by the Welsh Assembly Government after complaints by GPs.

The LHB said it was vital services were safe, while the assembly government said patient safety was paramount.

The inquiry, which is in two phases, focused on management and patient safety.

A number of problems were identified, including the size of the board which had made it difficult to manage, said the CGSDU.

REPORT FINDINGS The size and composition of the board makes it difficult to manage Engaging GPs in changes has not been successful Staff shortages lead to frequent unscheduled closures of minor injuries units (MIU) Too few patients mean MIU staff cannot gain experience and maintain skills

In addition, it said Powys was the only LHB in Wales to provide and commission health services, and board members had found it arduous combining the two roles.

Meanwhile, some board members were failing to hear about incidents relating to patient safety, while there are also concerns about some hospitals' minor injuries units.

The CGSDU said: "Reports on clinical governance, patient safety and complaints were at the end of the agenda, and some members have to leave early to travel long distances - we believe the LHB is already addressing this issue and we welcome that."

Powys LHB has been under pressure since it announced plans to reduce services at Llanidloes, Knighton, Bronllys and Builth Wells hospitals in September last year.

GPs met former Health Minister Brian Gibbons to raise concerns

Action groups were formed soon afterwards and have held a series of protests and public meetings.

But the LHB has said it was facing a �3.5m deficit, and that hospital buildings were outdated and patients deserved better.

In March, some of the county's GPs met then Health Minister Brian Gibbons and criticised the LHB's patient safety record, and the way it delivered health care.

Three months later the LHB's chief executive Andy Williams stepped down.

In response to the findings, Powys LHB chairman Chris Mann said: "As a resident of Powys myself - as indeed are most of the LHB staff - I know how vitally important a high quality, strong healthcare network is.

"It is also vital that the people of Powys have access to safe and consistent services.

"We will make sure that the people of Powys have safe healthcare services that reflect the rural nature of the county at the same time as ensuring the best possible care."

A spokesman for the assembly government said as part of the LHB's response to the findings, all minor injury services in Powys would be reviewed and "action taken to improve services where necessary".