The Department of Health said all PCTs should be offering IVF treatment from next April.
PCTs need to consider the detail of the full guideline, take stock, and review their services.
All PCTs are supposed to offer at least one IVF cycle from April next year.
However, it was under pressure from above to ensure PCTs signed up to the scheme.
Three out of four PCTs indicated that they were concerned about the high cost of providing the treatment.
PCTs should not refuse to fund Herceptin solely on the grounds of cost.
"It is important to remember that PCTs must balance competing priorities for a wide range of services, " he added.
Of particular concern are the apparent weaknesses in the arrangements established by the PCTs to ensure effective financial governance.
BBC: NEWS | UK | England | Beds/Bucks/Herts | Trust to face minister over loss
PCTs have until the autumn to agree the changes with regional health bosses.
The existing Primary Care Trusts (PCTs), which manage hospitals, would be abolished and replaced by the clinical commissioning groups (CCGs).
The PCTs are committed to further savings over the coming years but the report questions their ability to achieve them.
BBC: NEWS | UK | England | Beds/Bucks/Herts | Trust to face minister over loss
The opposition parties also want to do something about the primary-care trusts (PCTs), the purchasers in the NHS internal market.
However, just one in three of the 53 PCTs that took part in the survey said they planned to do so.
Professor Alan Maynard, chairman of the Vale of York CCG, said other PCTs across England had managed to balance their books.
Both Manchester and Liverpool PCTs also have the highest incidences of the disease, the research by the Roy Castle Lung Cancer Foundation, shows.
Meanwhile, the government has ordered PCTs to make sure future dentist registrations are conducted on the phone or via the internet rather than in person.
University Hospital said it was in a good position to study the affect of the drugs because it treated patients from different PCTs across the Midlands.
Dentistry saw the biggest single rise - 75% - but this was put down to the cost of a new contract that PCTs took responsibility for.
Under the plans, England's 152 primary care trusts (PCTs) are to be abolished and GP consortiums across the country will assume responsibility for the commissioning of services for patients.
Currently, the Department of Health then passes these down through 10 strategic health authorities and then to the PCTs who have to ensure they are implemented.
And the spokesman added he hoped the data would help PCTs compare how they were spending NHS money with other trusts in a bid to improve efficiency and care.
The hospital trust has hospital sites at Hemel Hempstead, Watford and St Albans but the report also covers the Primary Care Trusts (PCTs) in Dacorum, Hertsmere and Three Rivers.
BBC: NEWS | UK | England | Beds/Bucks/Herts | Trust to face minister over loss
Gordon Lishman, director general of Age Concern, said they were fearful that the new framework alone would not result in the cultural change in PCTs needed to reduce the variation.
Meanwhile, the Conservatives used other figures from PCTs to show the cost of providing out-of-hours GP care under a new contract, which came in in 2004, is three times what was expected.
She added that the BMA's figures were based on a sample of less than a third of PCTs, whilst the Department's were more detailed and wider ranging, covering 96% of England and Wales.
It was only at the later date that it became clear both PCTs and health authorities would go, leaving GPs working in consortiums responsible for the majority of health care provided in hospitals and the community.
BBC: Health reforms in England took NHS by surprise, MPs say
The Department of Health says it is to issue a "get tough" message to those PCTs who are unnecessarily planning to close community hospitals in the face of local opposition, telling them such closures should not be implemented as "short-term budgetary pressures".
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