The NHS Commissioning Board is attempting to stem the rapid drop in the number of senior clinical advisers by bringing in more expertise from primary care, NHS medical director Sir Bruce Keogh has told HSJ.

Since January, five national clinical directors – so called “tsars” who act as senior advisers to the Department of Health – have left. Meanwhile, the remaining 22 have had their contracts extended temporarily, mostly from March until the end of October.

Some tsars have previously told HSJ they were concerned about the future of national clinical leadership as the roles move from a DH base to the commissioning board.

Last week saw national clinical lead for quality and productivity Sir John Oldham announce he would leave the post later this year and not seek a commissioning board role while national ambulance director and London Ambulance Service chief executive Peter Bradley said he would quit after the Olympics to take up a role in New Zealand.

It has also emerged that national clinical director for health and work Dame Carol Black is no longer in post; nor are the directors for transplantation, Chris Rudge; equality and human rights, Surinder Sharma; pharmacy in primary care, Jonathan Mason; and pharmacy in hospital care, Martin Stephens.

Sir Bruce, who is the board’s medical director designate, told HSJ he planned to “review the entire complement” of national clinical directors. Extending the contracts on a temporary basis meant the board would have the freedom to really “think it through”. He wanted a “broader spectrum” of clinical representation, with increased focus on primary care.

Announcing his decision not to transfer to the commissioning board, Sir John Oldham told HSJ he wanted to focus on improving the quality of GP provision and felt he could do that better from “outside”.

He warned the commissioning board should make sure it did not recreate the “balance of inputs” found in the DH, with its heavy bias towards secondary care.

“My belief is we should be creating a set off affiliates at the front line around the country – nurses, allied health professionals, doctors and managers – who continue their day job but can be brought in for ‘task and finish’ work so we keep a current between the centre and the front line.”

Sir John, who has been leading quality, improvement, productivity and prevention programme workstreams on long term conditions and urgent care, will complete his work system redesign and piloting the year-of-care tariff before leaving when his contact comes to an end in late 2012.