Ch,ch,changes. The next couple of months are going to see a sea change in the management of commissioning across England. The appointments to the NHS Commissioning Board (NHSCB) sectors are being made. Appointing to these four posts will allow the wave of appointments to the local offices, to be renamed as local area teams, to be made. The commissioning support services are passing through “checkpoint two” and being set up to receive large numbers of staff from PCT clusters.

Initially, they will be hosted by the NHSCB but no-one is quite sure how quickly some might want to become independent. The clinical commissioning groups (CCGs) are heading for authorisation with the first wave announced. Subsequent waves will come thick and fast. Public health staff are increasingly co-located with local authorities. By Christmas the new architecture should be in place, whilst the old remains a shell – a virtual framework, which for legal reasons, remains a requirement but in reality will have been totally usurped by the new bodies.

What is also becoming very tangible is the fact that commissioning will be driven far more as one organisation; from the NHSCB, the only commissioning board for England, through to local area teams. Clinical commissioning groups have governing bodies – not boards. Their accountable officers will be in direct line of sight of the NHSCB. The way someone described it to me recently was “the heat shield between primary care and the centre has gone.” The nature of the relationship for commissioning between primary care and the centre has changed. PCTs had to try and involve GPs in commissioning whilst also dealing with their contract as providers. That conflict of interest has now been separated out. CCGs are about commissioning. The NHSCB, through their local area teams will be addressing GP provider contract performance issues. Like a good cop, bad cop routine I am sure they will want to work the new system in partnership.

The other radical change to structures is that it is all one organisation.  Structures can be changed quickly and purposefully, as within any large organisation. As anyone who has worked in a large organisation will know, that last sentence is only theoretically true. Good practice and law means proper and meaningful staff consultation is required which takes time and effort. But with the abolition of PCTs and their hundreds of non-executive directors, if the NHSCB wants to change the sectors and local area teams so they are greater or lesser in number it can do so. There is a line management structure, right across the country, which has never existed before.

Is that good or bad? It could be either. My sense is that there is massive potential for good – with the right culture and processes, but it will require a new set of behaviours from people like me or as Bowie put it “Ch-Ch-Changes, Just gonna have to be a different man.”

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.