I am not sure whether this time last year anyone could have predicted what massive changes would have been wrought across commissioning in England – and not a single piece of legislation has been passed.

We are moving from a dispersed form of governance, PCTs each with their own boards, with executive and non-executive directors, to a single operating model spanning the whole of England. There will be one board; the NHS commissioning board. Beneath that the strategic health authorities will have been merged into four units in anticipation of the future architecture predicated on the passage of legislation. PCTs have been clustered and management teams dispersed, in many PCTs, to support clinical commissioning groups (CCGs). Until April of this year I had a planning team, which has, all bar three people, been aligned and assigned to CCGs. A diverse range of CCGs has sprung up. Some are very small. Some are the size of their predecessor PCT. The functions of CCGs and most recently the draft process for their authorisation have now been published. The CCGs will have to address governance, but as far as I can see will not have boards but will have “governing bodies.” The accountable officer will be accountable to the NHS Commissioning Board.

At first this might seem like a massive centralised command and control structure. Yet, there is a counter argument. It could be said that commissioning has aped provision for too long; multiple separate boards all assuming they had autonomy. Yet year after year the operating framework is published, directing what the system expects local commissioners to do. The “National” in National Health Service requires a clear framework, a set of outcomes, agreed with the public, to be delivered. It is the taxpayer who funds the NHS. Surely, this is now the role of the NHS Commissioning Board – to work with the public and create clarity about what the NHS should be delivering? Once the “what” has been decided the critical next step is the “how.” Who better to understand the context and the professional relationships and pathways through which delivery can be achieved than local professionals? I deliberately say professionals, not just GPs. However the jewel in the crown of the NHS, the primary care registered list, makes collectives of general practices great building blocks for this approach. The function of CCGs must be “how.” The strategy comes from above but the tactics come from below. The system needs direction and delivery, not command and control.

The radical transformation of commissioning for England is becoming apparent. The next steps on this journey will be critical to ensure that the opportunities and potential are realised. It requires a huge change in mindset and behaviours, which is why, in the next few weeks, we are taking stock of the situation with our constituent CCGs to reflect and prepare for the next steps.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.