NHS England chief executive Sir David Nicholson has told HSJ it is time to question whether “the straightforward commissioner-provider split” is the best way to organise care for some communities.

He also called for the “cookie cutter” policy of all NHS providers becoming foundations trusts to be abandoned.

The NHS England chief executive announced a major review of NHS strategy in an exclusive interview with HSJ in the run up to this week’s NHS Confederation conference.

Sir David, who has announced he will retire by March next year, insisted he would not be “reaching for my pipe and slippers” in his remaining months in the post. He said NHS England’s strategy would seek to “liberate” the service to “experiment” with a range of solutions to challenges faced by the NHS.

“The idea you could have one model in a sort of Stalinist way driven from the centre seems out of kilter really with the kind of NHS we want to create,” he said.

NHS England will publish a “case for change” in the coming weeks then lead a national discussion with the public on a three-to-five year NHS service strategy. There will also be a “call for evidence” and review of the best “provider landscape”. Findings are expected to be published early next year.

Sir David highlighted the uniting of commissioners and providers as one of the main ideas to be explored in the strategy review.

“We’re very interested in thinking about integration of commissioning and provision and we can work with Monitor and others on how that could work, in particular circumstances and against particular sets of challenges.”

He said NHS England was already “thinking about the possibility of mutual [organisations and] social enterprises, and also about whether the straightforward commissioner-provider split is the right thing for all communities”.

Sir David called on the service to look closely at US organisations Geisinger and Kaiser Permanente, which serve as insurer and provider for a defined membership.  He said: “We need to be much more creative about those sorts of models of integration, which go beyond simple provider integration.”

The review will consider “the different ways of organising ourselves from, on the one hand, chains of hospitals, through to integration,” he said.

Sir David also condemned the idea of a “cookie cutter foundation trust pipeline”. The strategy will examine “whether the foundation trust is the right model for all [provider] organisations in the NHS”, he said. “We should liberate people… if they think [alternative models] are the right thing to do, they should do it.”

Sir David said the strategy work, which will also include discussions in each locality, should lead to service transformation. Progress on this had been “variable across the country” since 2008, he claimed.

He said the strategy work was based on a strength of the NHS reforms − the creation of a “vehicle” in NHS England which is “separate from the government [and can] look strategically… see outside of the electoral cycle”. It can also look beyond the current design of the commissioning system, he said.

“The [government’s] mandate doesn’t say you [have to] build a great commissioning system; it says you have to improve outcomes. So of course we’re interested in the nature of the NHS that’s being created. We’re not a regulator of commissioners.”

He added: “The NHS needs and wants a sense of direction, which I think NHS England can provide.”

Sir David has said he may retire before March if his replacement is appointed. Asked whether his successor would necessarily follow his strategy work, he said: “If we do it properly.” The successor is likely to be involved in the final stages of the work.

Sir David said NHS England had a strong set of non-executive directors. “They want to create something which is long-lasting and not something which will shift every time you have either a new executive director or even a new government.”

“What is really important to the chair in appointing my successor is to get someone who buys into the values and principles of NHS England.”

Part of the NHS England’s strategy will specifically cover specialised services, which it commissions directly. Sir David said NHS England could potentially identify “a smaller group of organisations which are equipped and organised” to provide these, with which it could “essentially concentrate and centralise” services. It could “give them much more flexibility in the way those things are operated”.