A clinical commissioning champion has found himself close to depression over the government's proposed health reforms.
Dr Michael Dixon, Chair of the NHS Alliance, told MiP he felt "close to despair" towards the end of 2011, believing clinical commissioning "will lose" whether the controversial Health Bill is passed or not.
"To be frank, I was close to depression before Christmas because it seemed like there was no way out of the past. Even if the legislation went through, we would be back to square one," he said.
However, "chinks of light" have shone through in 2012 and picked up Dr Dixon's mood.
"I feel a lot more confident now because I see a real determination among CCG leaders to make changes happen," he said.
"I did fear that the challenges and limitations being placed upon CCGs was a universal problem, but now I know around a third of CCGs are being allowed the freedom to progress, which is heartening."
While, he appears more optimistic, Dr Dixon warns clinical commissioning success is not a "forgone conclusion".
"There is a very real danger that CCGs will be wrongfooted and all the forces that have managed to keep clinical commissioning out for the last 15 years will succeed," he said.
Dr Dixon is especially critical of the NHS Commissioning Board's structure, and claims the appointment of the "same old faces" to senior positions on the board will risk replicating "more of the same".
He claims the NCB does not look like a board "whose primary purpose is to commission".
"If we are to keep a lot of the old faces, we need each of them to recognise that their role in the new world is different to that of the old. It would be too easy to carry on business as normal," he said.
"They need to prove to us that they understand the difference in working. Otherwise it looks like the same old thing."
The NCB announced five more appointments last week (3 February). They are:
By Louise Naughton