Sir David Nicholson says he will prevent the NHS Commissioning Board becoming “the greatest quango in the sky” by maintaining an “ambition” for the whole country to be covered by active clinical commissioning groups.

The government faced criticism its new reform plans would create a massive centralisation of budgets with the commissioning board – a single organisation – because it will hold budgets where local CCGs are not ready.

Sir David acknowledged the possibility in a speech at the Commissioning Show in London today. He said: “The NHS Commissioning Board could become the greatest quango in the sky we have seen. It needs to have clinicians at its heart and it needs to make sure the power house for change is the clinical commissioning groups.

 “Our ambition must be to cover the whole country – this is something we need to make happen. My job is to make CCGs the best they can possibly be – I don’t want to make them jump over hoops.

“If we start in a place where we have an ambition to cover the whole country [with CCGs] and to help and support people – that puts the commissioning board in a much better place than a quango.”

HSJ this week reported calls from senior figures for the Department of Health to set targets for development of the groups.

Speaking about clinical senates, new groups proposed by the government this week, Sir David said he expected there to be about 14 or 15 across England, and they would be involved in leading “significant service change”.

He said: “We needed a mechanism that brought clinicians together over a broader footprint – primary, secondary and tertiary… A group that can plan the pattern of service across a particular system. They are there to help and support and advice and to ease the change we need to make.”

Another point made by Sir David was NHS could move quickly away from paying for activity – as under the current payment by results system. He said the NHS was “completely moving away” from the system, which is seen as pushing up costs.

He said: “We are going to be incentivising people around outcomes not activity. This is going to have to change in the next few years… We are going to look very quickly at the tariff system.” He suggested there would be “a whole set” of pilots of different payment systems.