One of the purported strengths of the new commissioning system is that clinicians working together will be able to achieve more because of their common background.

The potential misunderstandings between clinician and non-clinician will be removed and better solutions will be reached more rapidly. It is believed this collegiate approach will be to the fore not only within clinical commissioning groups, but also between CCGs and medical leads at providers or those sitting on clinical senates.

It is also, as HSJ’s cover feature makes clear, important that a close relationship is formed between CCGs and the medical leads of the NHS Commissioning Board’s local area teams.

Cynics may argue that without the mitigating role of NHS managers, the potential for rows between those who can all claim “professional” insight will be even greater. But let us assume, as is likely to be the case, that medics in these roles will have the inclination and ability to work together. 

They will then have to determine who takes the lead, on what decisions and in what circumstances. Medics have inherent respect for the opinions of fellow doctors, but properly integrated healthcare does not conform to neat professional boundaries. Hammering out a shared vision will be uncomfortable for many.

The quality “surveillance groups” being created to monitor the new system may be where many of these tensions surface. Issues identified in these forums will need a doorstep to be delivered to. That responsibility may be shared – between a commissioner and provider, for example – but any pain resulting from attempts to solve the problem is often likely to affect one party more than another.  

The biggest challenge for individual medics taking a greater involvement in the planning and organisation of NHS services may not be to grasp the intricacies of commissioning or service redesign, but to acknowledge they will be held responsible for decisions in which their voice is one of many – and not always the loudest.