![\"Martin](\"http:\/\/www.bmj.com\/site\/blog\/icons\/martin_mcshane.jpg\")
We are now constantly discussing the transition process and the programme of work we have mapped, which we need to follow to deliver the structural changes demanded by the reforms. This sits alongside the planning process, with the plan for 2012\/13 shuttling back and forth between the SHA, PCT cluster, Clinical Commissioning Groups (CCGs), various key providers and Health and Well-Being Board. Then there are the contract negotiations, which people who have been involved will know, have a degree of all-consuming intensity at this time of year.\nWe have reduced our management costs, so we are fairly certain we now sit within the management cost envelope we are likely to have for CCGs beyond 2013. Staying within the cost envelope is dependent, primarily, on our CCGs being able to secure the commissioning support they need within the \u00a325 per head of population they have been told they will have, without any unanticipated central top slicing\u2014or demands. We are getting a detailed understanding of what commissioning support will cost. We are moving from “John Wayne” commissioning (\u201ca commissioner will do what a commissioner has to do\u201d) to costed commissioning.<\/p>\n