HSJ’s second Barometer survey of those leading clinical commissioning groups reveals the new organisations are still full of confidence as they get ready to take full responsibility for £60bn of NHS cash in April.

There are signs they are growing more aware of the likely impact of financial constraint on their ability to ensure service quality. However, the belief CCGs will begin to improve health services relatively quickly remains as rock solid as it was in the first survey last autumn.

The one noticeable trend between the two snapshots is the sign of growing tension between CCGs and the NHS Commissioning Board. In the autumn, 14 per cent of respondents identified lack of support from the board as a “significant barrier” to becoming an effective organisation. In the latest survey, that number has risen to 20 per cent. The problem appears to lie mainly not with the board’s HQ or the local area teams, but with its regional arms.

‘Sir David Nicholson will not be happy to hear that CCGs are “still fixated on feeding the beast”’

One in five CCG leads said the relationship with their regional team was “unhelpful, very unhelpful or bullying”. This concern appears to be partly linked to the delays in confirming staff arrangements which will hopefully disappear once what a respondent referred to as the “stultifying process of transition” is completed.

More worrying is the sign that bad old habits are resurfacing. Board chief executive Sir David Nicholson told HSJ that he wants a system very different from the existing arrangements in which local organisations decide their own destinies and were not constantly waiting for regional and national sign-off.

He will not be happy to hear that CCGs are “still fixated on feeding the beast and assuring everyone that plans are delivering and that there are improvement plans in place and the money is sorted” or that “every layer seems to need to know whatever it feels it needs to know ‘urgently’, and demands information through multiple routes”.

There also appears little chance of change while, as one respondent puts it: “Performance management by PCT cluster/local area team replicates the unhelpful way the strategic health authority always did it and the regional national commissioning board director is back to being as awful as they always used to be.”