The NHS Commissioning Board (NCB) went into operation in shadow form today (31 October 2011).
The board, headed by NHS Chief Executive Sir David Nicholson (pictured, with the health secretary) and chaired by Professor Malcolm Grant, a barrister and academic lawyer, will operate as a special health authority over the next year.
During this time it will work with the Department of Health to agree the method for establishing and authorising GP-led clinical commissioning groups (CCGs).
It will also organise resources to allow the NHS Commissioning Board to operate successfully as an independent body from October 2012, subject to the successful passage of the Health and Social Care Bill through parliament.
Once fully established, the NCB will performance-manage CCGs as well as commission some national and regional services.
Nicholson said: "Building this new system over the next two years, while delivering for our patients, increasing productivity and improving the quality of care, is a major challenge.
"But I firmly believe that what we are trying to achieve – a stronger, more innovative and more coherent commissioning system – will be critical to sustaining the NHS in years to come."
Sir David Nicholson summed up his ambition for the NCB as "using the £80bn commissioning budget to secure the best possible outcomes for NHS patients".
He said that the NCB will need to be "obsessed" with improving quality and involving patients if it is to succeed in offering "real choice and control to patients".
Subject to the approval of the Health Bill, the NCB is expected to become fully operational on 1 April 2013, when it takes on its complete legal responsibilities for managing the NHS commissioning system.
Critics, however, have already suggested that the NCB could be overbearing and centralising.
Mike Farrar, Chief Executive of the NHS Confederation, has said the NCB faces several "potential bear traps", and warned that it must "avoid the danger of being seen as unaccountable to the public, overbearing to the health service, or ineffective in delivering tangible benefits to patients".
Farrar also said the NCB will need to show "it will not hold on to power or drown commissioners in guidance and bureaucracy".
"If power remains centralised with the board, enthusiasm for commissioning among local clinicians and managers will wane," he said.
Leaders of the Clinical Commissioning Coalition, set up the NHS Alliance and the National Association of Primary Care (NAPC), have demanded that CCGs are not held at arms' length by the NCB, but should be part of the authorisation process themselves.
Dr Michael Dixon, NHS Alliance Chair, has suggested that CCGs "will be put in a position where other bodies will be telling them what to do, which goes against the government's commitment to put them at the heart of modernisation plans."
Are you confident that the NCB will work effectively with GP commissioners? Your comments (terms and conditions apply):
"Not if Nicholson has anything to do with it. He talks about quality but is driven by keeping costs down on behalf of his Political masters. Who are the representatives of the Medical, Nursing and Para-medical Professions on the NCB? Who are the patient representatives on the the NCB?" – Phil Coates, Midlands