As the NHS Commissioning Board Authority goes live, the NHS Confederation has warned that the Board must avoid the "bear traps" of being seen as unaccountable, overbearing and ineffective.

The Board Authority is the shadow form of the NHS Commissioning Board. It will - subject to the Health and Social Care Bill’s successful passage through Parliament - focus on designing an innovative business model for the Board. It will also work in partnership with clinical commissioning group (CCG) leaders, GPs and the Department of Health to agree the method for establishing, authorising and running CCGs, and create the infrastructure and organise the resources to allow the NHS Commissioning Board to operate successfully as an independent body from October 2012.

It is envisaged that the Board will become fully operational on April 1, 2013, when it takes on its complete legal responsibilities for managing the NHS commissioning system.

"Building this new system over the next two years, while delivering for our patients, increasing productivity and improving the quality of care, is a major challenge, But I firmly believe that what we are trying to achieve - a stronger, more innovative and more coherent commissioning system - will be critical to sustaining the NHS in years to come," said NHS chief executive Sir David Nicholson, as the Board Authority went live on October 31.

He added: "putting patients at the heart of all we do means we must be obsessed with improving quality outcomes, obsessed with involving patients at every stage of organisation and service development and obsessed with the availability of clear and accessible information. Only then can we create a system that offers real choice and control to patients."

The Board's creation has been strongly welcomed by the NHS Confederation, whose chief executive, Mike Farrar, said: "we want and need it to be successful. If it isn't, the whole NHS is going to have a very big problem, especially with the current financial pressures building daily."

However, he warned that the Board faces a number of potential "bear traps," and that it must act “to avoid the danger of being seen as unaccountable to the public, overbearing to the health service or ineffective in delivering tangible benefits to patients." 

The Board must, through its early actions, show that is "not where we are heading," he said. "That will mean setting an example by demonstrating public accountability and clinical leadership. It also means showing it will not hold on to power or drown commissioners in guidance and bureaucracy." 

"We need to empower our new local commissioners, not stifle their enthusiasm. They need guidance which is just that - guidance, not mandatory rules. They want the freedom to act and drive change where they need to for their patients," Mr Farrar stressed.

"Early and genuine" engagement with local commissioners and providers will be crucial to help the Board strike the right balance between national oversight and local control, the Confederation adds.