Vital appointments to the new commissioning system have fallen further behind schedule, the NHS Commissioning Board has admitted, causing significant knock-on problems for the transition process.

A progress report due to be considered by its governing board on Thursday highlights a significant risk the organisation “may fail to populate its organisational structure by March 2013”, just ahead of it taking on full responsibility in the new system. More immediately, a large majority of its director and deputy director posts, including the leaders of its local area teams, had not been appointed as HSJ went to press.

The posts were due to be filled in June, but it is now hoped “the large majority” will be complete by the end of July.

In relation to the operations directorate – which will employ the vast majority of the board’s staff – the progress report says there is a risk “we will see key talent migrating to other organisations on the basis that the recruitment process is taking too long”.

HSJ understands there have been disagreements over the structure of local teams, with some senior officials arguing flexible arrangements would improve the attractiveness of jobs. Clinical commissioning group representatives prefer all teams to have the same structure and operating model, to stop the teams over-reaching.

One senior NHS commissioning source said: “A lot of senior people in the system don’t fancy any of the senior jobs [in the new structures]. So as well as being expensive, it [the commissioning transition] means a major loss of expertise and organisational memory.”

Other reasons for the delay include problems deciding the functions and design of parts of the board; and disagreements about which primary care trust and strategic health authority posts will transfer to new

The unfilled posts are critical to the next stages of the commissioning transition. Local directors will be responsible for tasks including authorising and developing CCGs, holding them to account, and directly commissioning specialist and primary care.

A board report on recruitment says “delays in finalising the detailed organisational design” mean moves to fill more junior posts, due to start at the beginning of July, have also been delayed. Despite the problems, a revised recruitment plan says all 4,000 board staff will be appointed by January.

Speaking to HSJ in January, board managing director Bill McCarthy said losing staff was the biggest risk to its success and to mitigate it the organisation should give “the right support, right help and as much clarity as early as we can”.

Commissioning clarity?

  • Only 10 out of 23 commissioning support services have appointed managing directors
  • The make-up and functions of clinical networks and senates are still awaited
  • esponsibility is unclear in important areas including some public health functions, major reconfigurations and winter planning
  • Commissioning board and CCG budgets – and the rules for setting them – are unknown