Sir David Nicholson has predicted “big changes” on the day the NHS Commissioning Board (NHSCB) takes over its new responsibilities.

The NHS Commissioning Board Chief Executive said Monday 1 October 2012 was a “landmark” day in the history of the NHS as the NHSCB takes full control of its budget.

Writing in The Guardian, Sir David outlined how the Board plans to split the health service’s £85m budget.

He explained how around £60m will be allocated to clinical commissioning groups to “plan and pay” for local health needs.

The remaining £25m will then be used by the Board on “community services” and on more “specialist services” for conditions that are more complex and rarer.

Sir David said that patients “won’t notice a difference” immediately as a result of the changes, but was confident “they will start to experience real improvements” soon.

The Board’s CEO outlined how it had recruited experienced healthcare professionals to “key positions” so it can make the correct decisions “made on the best clinical advice.”

However, Nicholson said the “most significant shift” in emphasis is the way “we underpin all that we do” with a single focus on “improving the quality of care for our patients”.

Nicholson added that there are “no better words” to explain the work of the NHSCB than the principles and values set out in the opening paragraph of its constitution. The four short sentences describe how the NHS “belongs to the people”, how the health service aims to support patients “mentally and physically well”, to work at the “limits of science”, and to touch the lives of individuals at “times of basic human need, when care and compassion are what matter most.”

The NHS Commissioning Board (NHS CB) has again started the recruitment process for nine local area team (LAT) directors – after failing to fill the positions in July.

Positions for the lead roles in areas such as East Anglia, Lancashire, West Yorkshire and Kent and Medway have a salary of £140,000 a year.

The NHS CB, which is currently in process of recruiting Commissioning Support Unit (CSU) financial directors, is also conducting the final stages of the final round of appointments for CSU managing directors.

Currently, 16 of the 23 MD positions have been filled by the board. However, it is not yet known when the further six positions will be filled, meaning certain interim managers will remain in charge to oversee the majority of the CSU development period.

Alongside the LAT and CSU roles, the NHS CB is also searching for 19 directors to fill various vacancies. These include director of HR, financial control and other recently announced senior posts, such as chief analyst and director of intelligence. All 19 positions have salaries of more than 100k.

Several clinical commissioning groups (CCGs) have been moved between different waves of authorisation by the NHS Commissioning Board due to errors and time constraints.

Administrative issues saw NHS St Helens CCG and NHS Lincolnshire West CCG moved from the third wave of authorisation into the second.

NHS Newark and Sherwood CCG also confirmed it had swapped waves at the request of the Board to help “simplify a very large administrative task”, a spokesperson for the NHSCB said.

The Commissioning Board insists the errors in which authorisation wave the commissioning groups were in resulted in “minor changes”.

St Helens CCG said that despite the confusion its timetable “has not changed” and it remains confident of being authorised as part of the third wave.

“One nationally published document erroneously listed us as being in the second wave,” said a spokesperson for the CCG.

“As soon as we became aware of this we informed the NHSCB about the problem.”

A spokesperson for NHS Newark and Sherwood CCG revealed their move was made after a request by the NHSCB on grounds of convenience.

“We originally applied to be part of wave two of the authorisation process, however we were asked by the NHSCB if we could go in wave three,” said the spokesperson.

“This was due to the number of CCGs undergoing the process in wave two and because we share some joint management functions with our neighbouring CCG, NHS Mansfield and Ashfield CCG, which is also due to be considered within wave three.

“We were happy with this approach and are confidently moving towards authorisation in the autumn.”

Meanwhile, NHS Trafford CCG has requested to move back to wave four in order for it to work on its authorisation.

The NHS Commissioning Board Authority (NHSCBA) has appointed its 15th Commissioning Support Unit (CSU) managing director.

Tim Andrews has been appointed to lead the Cheshire, Warrington and Wirral CSU after serving as its interim MD. He also previously led the Commissioning Lab.

His appointment follows five other MDs being selected by the NHSCBA in the second round of recruitment. The Authority initially planned to appoint 14 MDs during the second phase of recruitment but failed to fill its target of 14 positions.

The Commissioning Board has been criticised by certain CCGs for the amount of time it has taken to fill all 23 MD positions for CSUs. Dr Joe McGilligan, Chair of ESyDoc CCG, claimed the delay in appointing a MD for his regional CSU was slowing down the group’s authorisation process.

The Board recently renamed commissioning support organisations as CSUs in an attempt to differentiate those which are to be hosted until 2016 and suppliers from the private sector.

Regional directors of the NHS Commissioning Board and Trust Development Authority will take over operational responsibility from PCT and SHA leaders from 1 October.

NHS Chief Executive Sir David Nicholson announced the decision to appoint new NHS leaders six months ahead of the formal transition date in a letter to all chief executives of current NHS bodies.

This will be the “last significant organisational change” before April 2013, Nicholson said, and its aim is to “achieve the right combination of resilience in the current system and effective leadership of the new system”.

Regional directors of the NHSCB and NHS TDA will manage ongoing operational delivery for 2012/13 and planning for 2013/14. They will be accountable to the PCTs and SHAs for current system delivery and to the Board and TDA for future planning and development.

The SHAs and PCTs will retain their statutory functions and governance arrangements until April 2013, but will no longer have operational responsibility. There will be no formal transfer of budgets or staff before then.

Regional directors of the NHSCB will take on management responsibility for the teams managing operational delivery and planning. NHS TDA regional directors will do the same in relation to Foundation Trust activity.

Health Education England will take on responsibility for workforce planning, education and training from 31 October 2012. Public Health England will take on its functions from January 2013. The new arrangements will not affect the schedule or roles for CCGs or local authorities.

The national configuration of some key aspects of commissioning support has been outlined by the NHS Commissioning Board.

Business intelligence, clinical procurement and business support services will be provided by the emerging Commissioning Support Units (CSUs), individually or in collaborative networks.

Communication services are likely to be provided nationally by four or five centres, but details have not been finalised.

The NHSCB now uses the term CSUs to cover the 23 NHS commissioning support service providers that it will host until 2016, as opposed to the wider market in commissioning support services that will be open to CCGs.

Business intelligence services will manage and integrate clinical data. Nine providers have been approved: collaboratives for North West, North East and North Yorkshire and Humber, South and West Yorkshire, Greater East Midlands, London, and the South; and the single CSUs Central Southern, Best West and Birmingham, Black Country and Solihull.

Clinical procurement services will cover market analysis and engagement as well as procurement activities. Thirteen providers have been approved: North West collaborative, North East, South Yorkshire and Bassetlaw, Greater East Midlands, Norfolk and Waveney, Essex, North Central and East London, North West London, Surrey and Sussex, Commissioning Support South, Central Southern, Best West and Birmingham, Black Country and Solihull.

Business support services will include HR, payroll and legal support. All individual CSUs will be allowed to provide or source these services.

These announcements follow the assessment of CSUs’ ability to provide these ‘scale’ services according to defined standards, within an appropriate and sustainable cost framework, and with the capacity to deliver across the stated region.

CCGs in poorer areas of the country will have their targets adjusted to reflect the demographic of their patients, the NHS Commissioning Board (NHSCB) has said.

The decision comes after NICE published its recommended indicators for inclusion in the NHS Commissioning Outcomes Framework (COF) – the system by which GPs will be assessed and financially rewarded.

A spokesperson for the NHSCB said that a “robust approach to case-mix adjustment will be needed”.

The BMA backed the proposal and called for potential indicators to be piloted across the country in order not to discriminate against GPs based in poorer areas.

Dr Mary-Louise Irvine, BMA Council member, said that anything that “unfairly discriminates” GPs who need resources the most should be tested first. “If my resources are shrunk it’s more difficult to deliver good care,” said the south-east London GP. “I think the indicators should be piloted and evaluated to get them right.”

Indicators in the COF include reducing emergency admissions and providing care for stroke patients, plus ones for COPD, maternal care and access to mental health services.

The NHS Commissioning Board (NHSCB) has appointed five more managing directors for commissioning support units (CSUs) in the second round of recruitment – nine less than expected.

They include Nick Relph at South London CSU, Clodagh Warde Robinson at Surrey and Sussex CSU, Maddy Ruff for North Yorkshire and Humber CSU, Alison Hughes, West Yorkshire CSU and Daryl Robertson, Kent and Medway CSU.

The Commissioning Board said it will make further appointments in “due course”.

The appointments come after the NHSCB confirmed nine managing directors in the first round of recruitment.

Also, Andrew Kenworthy, Chief Executive of NHS South London, is set to join the Commissioning Board Authority’s Commissioning Development Directorate via an IMAS assignment as Director of the CSU Transition Programme.

Meanwhile, the Commissioning Board Authority has recruited three Very Senior Managers. Bob Ricketts joins as Director of Commissioning Support Strategy and Market Development, the DH’s Colin Douglas has been appointed Director of Communications and Ann Johnson has been recruited as Director of Financial and Corporate Performance.

A new report from NHS Clinical Commissioners (NHSCC), based on a simulation exercise, aims to help CCGs meet their commissioning support unit needs.

A scenario workshop held in May 2012 explored how CCGs can most effectively draw on CSU resources when commissioning local services.

The report identifies the need of CCGs for greater clarity on the CSU options available to them and how the organisations can best work together.

It describes how six emerging CCGs, four CSUs and an acute hospital trust worked together to develop an operational plan, redesign COPD services, and implement the redesign.

Key learning points identified in the report included:

• CCGs need to understand the support options available to them locally and nationally, while CSUs need to market their services more effectively.

• Both CCGs and CSUs need to understand when clinical leadership is necessary in commissioning and when other CCG members can lead the process.

• The role of the wider clinical team, including nurses and hospital specialists, in guiding the commissioning process needs to be developed.

• The customer/supplier relationship between CCGs and CSUs needs to be explored and tested.

Julie Wood (pictured), Interim Commissioning Development Director at NHSCC, said: “It is absolutely crucial that clinical commissioners receive the support they need to create a robust strategy for their work with commissioning support services.

“Not only do CCGs need a lot more clarity on the options available to them in terms of using CSSs, but they also need to be able to access a range of practical support which is relevant to their requirements.”

Dame Barbara Hakin, National Director of Commissioning Development, commented: “There is still a great deal of work to do to ensure that clinical commissioners have all the support they need, and we have used the insights from this report to inform the next phase of the NHS Commissioning Board Authority’s programme of practical, targeted CCG and CSU development support.”

Up to 6,000 jobs may be lost over the coming months as part of the final transitional stages of the new NHS structure, a leading union boss has predicted.

It’s believed that 400 jobs at the Birmingham, Solihull and Black Country PCT and a further 400 positions at Greater Manchester PCT will be the first axed.

Jon Restell, Chief Executive of Managers in Practice, said he was “expecting something big to happen” in the next three months due to the NHS still needing to “downsize”.

The wave of job cuts are as a result of CCGs, CSS and the NHSCB only now calculating how many employees they will be able to afford when they are fully authorised from next April.

The hundreds of jobs predicted to go in the Midlands and the North West have also been replicated in other parts of England. However, regions such as London reduced posts “harder and earlier” in the restructuring process, Restell said.

A reduction of 400 posts at the Birmingham, Solihull and Black Country PCT would result in a 30% reduction in staff. However, it’s expected that those who will lose their jobs will take on new roles in the local CSSs, council public health teams, Public Health England and other bodies formed after the reforms.