London’s commissioning support body is reviewing its management structure and its chief executive is on “extended leave” - less than 10 months after it was established.

Commissioning Support for London was set up by NHS London and the capital’s 31 primary care trusts in April, with the aim of helping them improve world class commissioning scores through services such as spending analysis and in contracting and claims management.

It is no surprise we need to think hard about our role in the future. We are an overhead, so it is money coming out of patient care

But it emerged this week that CSL chief executive Rhona McLeod - who joined the organisation from Bupa and was previously a director at Royal Mail - was currently on “extended leave”.

A CSL spokesman said NHS Harrow chief executive Sarah Crowther had stepped in under the title of executive chair, and was leading a review of the organisation’s management structure.

The spokesman said: “CSL is looking at its management with a view to determining whether it has the right structures in place for the future.”

A PCT source said commissioners had become concerned at the cost of the organisation, which had a budget of £32m for 2009-10.

Speaking at the London Health 09 event last week, CSL director for London programmes Christina Craig said: “It is no surprise we need to think hard about our role in the future. We are an overhead, so it is money coming out of patient care.”

She added CSL was considering partnering with private companies to provide its services to PCTs.

Ms Craig said: “We need to develop an operating model that can survive the economic reality of the NHS.”

CSL last week published guidance on children and young people’s care that should lead to more being provided outside hospital. It says too many young people are presenting to accident and emergency and being admitted to hospital unnecessarily, and too much elective care is being provided in hospital.

The report says admitting fewer patients and moving more paediatric surgery to specialist hospitals would mean fewer hospitals needed to run 24 hour paediatric units. Additionally it said more services should be provided in the community at GP practices, health centres and children’s centres.

NHS London medical director Andy Mitchell said the guidance also helped GPs to “get a better range of paediatric skills”.

HSJ’s Intelligent Information for World Class Commissioning is on 8 December. For details visit www.hsj-infowcc.com