NHS North East and North West are to be united – along with NHS Yorkshire and the Humber – HSJ understands.

NHS chief executive Sir David Nicholson is drawing up plans for four sub-national directorates of the NHS Commissioning Board – the word regional is still banned by the DH – and, it is believed, details will be announced next month.

Senior sources say the three northern strategic health authorities will be clustered from October, moving towards a single group of directors with one chief executive. It would be a return to the system of regional directors of health and social care introduced in 2001.

Bill McCarthy, Yorkshire and the Humber chief executive for two years, and Ian Dalton, national director for provider development and previously NHS North East chief executive, are rumoured to be in the frame for the top job.

Another unanswered question is where the directorate will be based. Most of the NHS Commissioning Board’s national staff are to be based in Leeds – a decision made before the bill amendments handed back some responsibility for the NHS to the health secretary in Whitehall – but it may also want a base elsewhere in the region.

Several emerging clinical commissioning groups in the region are under pressure to redesign themselves in light of the government’s changes to reform plans, especially the “expectation” that CCGs will not cross local authority boundaries.

For example, there is the Airedale, Wharfedale and Craven commissioning group – Craven is in North Yorkshire, the other two are in Bradford. But the pathfinder already has strong local engagement and appears well set to fight its corner. Other emerging commissioning groups may not be so well placed.