Outgoing NHS England chief executive Sir David Nicholson has rated his organisation just five out of 10.

Speaking at the Commissioning Live conference yesterday, one of his last public appearances in his role, Sir David assessed how the organisations created by the Health and Social Care Act had been doing in their first year.

He reserved most praise for CCGs, which he rated eight of out ten and said had done “remarkably well”, but rated all other new organisations, including commissioning support units, clinical networks and senates five out of 10 or lower.

“If you think about the potential problems you could have had, how the wheels might have fallen off, on the whole I think CCGs have held it brilliantly together,” he said.

He admitted NHS England’s weakness has been in its own direct commissioning.

“Part of the downside of the way in which commissioning is organised at the moment is the split between primary care and other services at a local level, and the split between specialised commissioning and general services,” he said. “You can see how at the seams of these we’ve got really significant issues to tackle.”

He advocated joint arrangements between CCGs and NHS England in commissioning primary care and said it is “really important that we move onto that quickly”, with NHS England’s resources delegated to CCG level.

He CCGs should also have a role in specialised commissioning “to ensure that people don’t fall between the divisions in the commissioning architectures”.

However, he praised NHS England as an organisation for operating beyond the electoral cycle.

Sir David acknowledged there was a “mixed reception” to how commissioning supports units are doing, which he rated five out of ten, but be pointed out that they were “literally starting at ground zero”.

“These are brand new organisations. They’ve never operated in a customer focused way,” he added.

He said CSUs needed to be given the benefit of doubt over and the next year urged CCGs wanting to bring services in house to “sit and think about it a bit a more”. 

“One of the great strengths of CCGs is the idea of a lean, clinically focused organisation,” he said. “We don’t want… [them] to grow into PCTs by another name.”

He was most critical of clinical senates, which he rated just four out of 10. “I don’t quite see the benefits coming through at the moment,” he said.