CCGs have joined a party that too often appears to have started without them. They are bound by rules that would constrain their ability to commission, for example, section 75 and the right of hospitals to impose Payment by Results.
CCG budgets are being raided mercilessly by others, such as specialist commissioners and NHS PropCo, and many already see them as fall guys for the most severe financial challenges the NHS has ever witnessed.
That describes the negative, but the positive is far stronger. Already, it is clear the new clinical leaders of CCGs are strong, committed and clever. They will not be deterred by the skewed rules, vested interests and inertia of the system they inherited.
Clinical commissioning may be only just over 100 days old, but clinical commissioners are men and women with a mission who will not be messed around. Collectively, they want to challenge a system that has relentlessly removed resources from health into care and from primary care into secondary care. Many are already able to celebrate outstanding achievements.
I would advise hospital trusts or national bodies that think they can queen it over the new clinical commissioners to think again. We now have a new set of strong clinical leaders who will square up to any organisation or vested interest that threatens the sovereignty of those commissioners, or the health, wellbeing and services of their patients.
Clinical commissioners are determined to make a difference; they are well connected to frontline clinicians and patients, and carry an authority and strength the NHS has not seen before.
They will not be stopped - they are frontline clinicians, there to make a difference. The commitment to social responsibility and improving local health will rapidly become the agenda of all frontline clinicians and patients and, in time, create change the NHS has awaited for so many years.
Dr Dixon is interim president of NHS Clinical Commissioners and chairman of NHS Alliance. Read more from him on Inside Commissioning at www.insidecommissioning.com.