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From an ex-Contracts Director viewpoint, based on many years experience and successful delivery:
In any organisation, only 4% of senior officers " know what they are doing" and can do it competently in relation to resource planning and commercial decisions. The 4% carry the 96% for a key part of the year, when it matters. Often they are VSMs or second tier officers, often they are lower down in the "reward pecking order ".Therefore the CCGs need to make sure they have recruited the 4%, or not let them be voluntarily redundant ! If they do that, it doesn't really matter whether the 4% are internal or external, or what the size of the overall workforce is. its all about good people who get the job done.