It’s self-evident that the leadership implications of the White Paper are enormously challenging for boards and teams. But above all else they will be challenging for chief executives who not only will be expected to provide stronger and more visible leadership but also help manage the emotions generated by thousands of staff concerned about their future.

Furthermore, the chief executive role is immediately more difficult because the structural architecture between the national commissioning board and GP commissioners is not yet known. The sooner proposals emerge the sooner managers perhaps can relax a little as they see possible future career opportunities.   

The centre has a vital role in framing the context for the national changes in order for chief executives to help staff (and themselves) understand and contribute to creating the new future for the NHS. David Nicholson’s letter to chief executives clearly starts this process.

However, let us hope there isn’t a national initiative to reinvent change management processes when the literature is so well known. This would be very distracting and unnecessary process. It’s worth remembering that only two things are unforgiveable when leading change - not meeting implementation deadlines and leaders not being honest in their communications because both heighten personal and organisational anxiety. 

Many people will be distracted by looking for a more secure personal future. This is legitimate and leaders must accept that staff will now put themselves - rather than their organisation and perhaps the NHS - first. So let’s not be surprised when performance dips, as it often does at times of major change. Government in particular should be supportive and resist appearing to be punitive when this happens. After all, it is managers who have led implementation of the NHS successes to date and it is managers who will lead the transition to the new arrangements.