After all the hullaballoo, the controversial Health & Social Care Bill quietly achieved Royal Assent during the afternoon of the final Tuesday in March. One suspects that the difficulties the Government had in getting the legislation passed through will be dwarfed by the challenges the NHS faces in implementing its complex measures. Tuesday 27 March was most likely the calm before the storm.

At present, the NHS is in transition. Within twelve months, 151 Primary Care Trusts will be replaced by circa 250 Clinical Commissioning Groups, spearheaded by a National Commissioning Board. Of course we already know this. But while we wait for the momentous occasion to arrive, how does the pharmaceutical industry approach the critical issue of targeting its key customers?

As Mike Sobanja, Chief Executive of NHS Alliance, notes in this issue, pharma is currently embarking on a new game: “spot the commissioner”. PCTs are currently legally accountable for around 80% of a total NHS budget of roughly £110 billion. Of this, approximately £30 billion has already been delegated to CCGs operating in shadow format. The challenge for medical sales professionals does not end at identifying who holds the purse strings for that £30 billion. The trick, once they have, is to understand their customers’ environments – and their commissioning intentions in their own specific disease areas – in order to have the best chance of securing a slice of the pie.

The next twelve months will provide the strongest test yet for the industry’s recently-acquired penchant for the account management model. Faced with a health service in transition and a ‘confusion of NHS customer-groups’ (Ed. – the most appropriate of collective nouns), the battle ahead will be tough.

Only account managers with the most robust local knowledge will win.

Chris Ross, Editor.

NHS Chief Executive Sir David Nicholson has said he expects the remaining work on the NHS' organisational design to be completed by May.

In a letter to NHS staff following Royal Assent of the Health and Social Care Bill, Sir David said that the future of employees would be confirmed by the end of the year, when the transition will be complete.

But he warned that jobs will undoubtedly be lost by the time new statutory organisations take effect next April.

"The passage of the Bill gives us real clarity and certainty about our future direction,” he said, but “there is an enormous amount to do to prepare for the bulk of the statutory changes”.

In terms of the timetable, the remaining senior appointments will be made within the commissioning structure during May and June. Then, from July to December 2012, the NHS will complete the remaining phases of the transition to ensure new organisations are fully operational from April 2013.

The document outlines a “particular need to retain the skills of certain staff in business critical roles” but admits jobs will be lost with redundancies impacting the budgets of new organisations from 2013/2014. Key milestones for the development of CCGs were also outlined. In July 2012, the first wave of authorisation applications will be accepted – followed by dates in September, October and November.

The NHS Commissioning Board will begin as an Executive Non-Departmental Public Body in October and take on the responsibility for the authorisation of CCGs before it and authorised CCGs take on full statutory powers from April 2013.

In a separate letter released on the same day, Health Secretary Andrew Lansley wrote to NHS staff thanking them for their work during the passage of the Health Bill to Royal Assent.

Mr Lansley said: “The Health and Social Care Act will, in reality, empower NHS clinicians to determine the type of health services needed in their local area, using their clinical expertise and their knowledge to ensure NHS services meet the needs of patients.

“I hope you and your colleagues in the NHS will take advantage of the new freedoms the Act has put in place.”

The Government looks set to have won its battle over the Health and Social Care Bill after the last attempt to halt the legislation failed in the House of Commons.

An emergency debate by Labour to block the changes to the Bill until a risk register was published was defeated by 328 votes to 246.

Andy Burnham, Shadow Health Secretary – who pushed for the risk register to be published – said that the general public would “struggle to understand” how MPs had made “such momentous decisions” without considering all of the evidence on the reforms.

Final amendments to the controversial reforms were approved by MPs paving the way for Royal Assent for the Bill before the break for Easter next week.

Peers in the House of Lords approved the Bill on Monday evening.

The changes to the structure of the NHS will see Strategic Health Authorities and Primary Care Trusts abolished in favour of local Clinical Commissioning Groups. The move, which will see GPs given budgetary responsibilities and the opportunity to outsource services privately, has been widely opposed.

Mr Burnham admitted that the legislation becoming law was inevitable and the only hope left to defeat the Government’s plans would be a “change of heart” from the Lib Dems.

“We have given this fight everything that we had,” he said. “All I can say is our fight will go on to protect and restore this party’s finest achievement.”