There is a shortage of applicants to run commissioning support services, HSJ has learned, sparking fears that the jobs are proving unattractive to senior NHS managers.

NHS Commissioning Board director of commissioning development Dame Barbara Hakin told HSJ that too few candidates had put themselves forward to fill every CSS managing director post, and a second round of recruitment was required.

Dame Barbara said: “I’m not sure people have realised how big these jobs are – the salary is quite high, and these organisations are going to have many millions of pounds of hard edged budgets, and huge numbers of staff.

“They’ve got big geographies and lots of clinical commissioning groups relying on them to do a lot of work… people are a bit behind on the scope for these organisations to have a massive impact on [service] transformation.”

The first wave of appointments is expected to be announced either this week or next. Initial applications were limited to a pool of “at risk” senior primary care trust and strategic health authority managers.

There are currently 24 proposed CSSs. A survey of clinical commissioning groups undertaken in March found CCGs intended to spend an average of £11.52 per head of population on CSSs, suggesting the market will be worth around £575m a year. CSS managing directors will be appointed on “very senior manager” salaries likely to be around £140,000 per annum.

The second recruitment round will give PCT and SHA chiefs another chance to apply, but will also be wider, and could involve “headhunting” managers from the NHS provider sector.

Dame Barbara said the best candidates would have “gravitas and humility”. She said: “I truly believe that the best people for these jobs are senior NHS managers who can demonstrate commercial acumen and an innovative approach.”

She acknowledged that CSSs could become risky organisations to work for if they failed to keep CCGs as their customers.

One PCT cluster chief executive said: “No one expects CSSs to become independent [which is the stated policy intent]. They will suffer death by a thousand cuts as GPs gradually commission more and more activity from other providers.”

A current CSS manager told HSJ that potential candidates have been put off after their CSS only narrowly passed “checkpoint two” of the board’s assurance process, raising questions over its long-term viability.

Elizabeth Wade, NHS Confederation head of commissioning policy and membership, said although CSSs were a relative “unknown” in the new structure, they could be places where “ambitious, talented managers  can shape their own destiny”.