NHS chief executive Sir David Nicholson has said that NHS staff who do not support the changes in the white paper should leave the health service now.

Sir David told the NHS Employers conference last week that the NHS faced the “biggest management of change exercise in the world.”

He said the changes outlined in the government white paper ‘Equity and Excellence: Liberating the NHS’ would have to be managed alongside the £20 billion savings already outlined for the service.

Sir David said himself had “gone through a whole series of emotions about the service and how we take things forward. ” He also said: “There are people in the service who essentially hate all this. My view is that they should go.”

The NHS chief executive told the conference that 2,000 people had already left through the Mutually Assured Resignation Scheme. This was at a cost of £40m, but he claimed it would generate savings in a year of £70m.

He added: “For all sorts of reasons that’s a good deal and we need to think about how we expand that in future.”

The NHS chief executive said a second group of staff, those who did not want to be part of the new structures but were prepared to support the transition, should be given some certainty over what will happen to them.

He said the third group of people, who he defined as those who supported the ideas in the white paper, should be helped to learn new skills if necessary and moved into new positions as quickly as possible.

Nicholson said the NHS also needed to see how quickly it could move people to the places where they would work in future. He added: “We need to start moving people now from primary care trusts into consortia and into local government.”

Nicholson also warned that if GP consortia went to the private and independent sector for all their commissioning support it would cost the NHS £1.5 billion in terms of staff currently working in strategic health authorities and PCTs.

He said it was also “simply not credible” for private sector providers to think they had the capacity to deliver commissioning support as such scale.

Nicholson said he believed those providing commissioning support would continue to do so and the NHS needed to help them and create the conditions in which they could give that support.