NHS chief executive Sir David Nicholson has advised East of England strategic health authority to make “demonstrable improvements” in its relationships with primary care trusts.

Sir David made the recommendation to NHS East of England chair Keith Pearson last month in a letter accompanying a report on the Department of Health’s findings from the SHA assurance process.

Performance expectations and performance management appear to be more challenging than supportive

NHS East of England was the first SHA to formally undergo the assurance process when it was visited in September by senior DH representatives including Sir David and NHS medical director Sir Bruce Keogh.

Although Sir David praised the SHA for a “hugely successful turnaround” in bringing the region out of financial deficit, he said this had “placed a strain” on relationships with some PCTs and service providers.

“Performance expectations and performance management appear to be more challenging than supportive while conflict could be handled more effectively in the region,” he said.

Sir David also said the SHA needed “to refresh its leadership development processes”.

In a report responding to Sir David’s letter and the assurance panel findings, NHS East of England director of workforce Stephen Welfare acknowledged that the SHA needed to develop a “more bottom-up, cooperative approach”.

The SHA has developed an action plan, which includes a “compact” outlining required behaviours and communication styles, and investment in change management and leadership development.