GPs must not be “dragooned” into forming particular consortia, NHS chief executive Sir David Nicholson has told chiefs in a letter outlining the next stage of the transition.

The letter warns senior NHS leaders overseeing the white paper changes that “it is not a race” to have the first or the most GP consortia established, or to rush through unsustainable solutions on the provider side.”

Sir David added: “For commissioning, this is not about dragooning GPs into administrative boundaries that they do not feel any allegiance with.

“It is certainly not about replicating current structures with some new players involved. The proposals represent a fundamental change, not just in structure, but in culture and ways of working.”

National groups are being created to oversee changes to commissioning and provision. National leads will discuss the transition with the regional leads, named in a separate annex, in a new commissioning development board and provider development board.

NHS North East chief executive and national managing director of provider development Ian Dalton is to create a national reference group for the provider side work to advise on implementation and policy issues. This group will be chaired by Central Manchester University Hospitals Foundation Trust chief executive Mike Deegan.

Sir David highlighted four particular areas requiring immediate local attention:

  • Proposed changes to local authorities and the creation of the public health service
  • Proposed changes to the provider system
  • Work on patient empowerment through choice and information
  • Improving care pathways

Sir David said: “I know that it is a time of personal and professional uncertainty for many of you around the country and I admire and appreciate your dedication and professionalism in those circumstances.

“It underlines to me the excellence of the public service managers we are lucky to have.”

Strategic health authority and primary care trust employees will need to be provided with developmental support to enable them to undertake their future roles, the letter states.

To provide greater flexibility with governance arrangements, arrangements are being made for PCT chairs and non executive directors to be allowed to sit on more than one PCT board.

Sir David also set out the areas that boards should be focussing on to maintain control of quality and finance during the transition. These are:

  • Quality and productivity plans
  • Rising emergency activity
  • Preparing for winter emergency activity and supporting people to live at home
  • The commitment in the NHS Constitution to maintaining a maximum 18 weeks between referral and treatment