The size and number of CCGs has been too determined by “conservative views” on financial risk and costs of corporate and clinical governance, it is claimed.
In response to the publication of the configuration details of all 212 CCGs by the NHS Commissioning Board (NHS CB), Dr Michael Dixon, Chair of the NHS Alliance, warned CCGs are in danger of “missing the plot”.
He fears the ‘powers-that-be’ tasked with designing the new commissioning structure have only one model in mind – recreating the old PCT-style system.
“Sadly, 212 is a similar number to the amount of PCTs we had and an enormous reduction from the pathfinder pilots set off last year,” he said.
“It is slightly disappointing the CCGs are so large and there isn’t more variability.
“We haven’t been bold enough to allow higher numbers of smaller CCGs through the net, if only just to test their prowess.
“The size has been too determinant on the not-so generous management allowance and the rather conservative views on financial risk and costs of corporate and clinical governance.”
While Dr Dixon said a greater number of smaller CCGs would have led to more inventiveness and a little bit more ‘thinking outside the box’ when it came to balancing the books, he conceded “there hasn’t been too much blood spilt” as “an awful lot” of lost small CCG leaders have managed to remerge as leaders of the larger organisations.
Dr Charles Alessi, Chair of the National Association of Primary Care (NAPC), said, to his knowledge, any attempts to coerce CCGs into taking on different configurations at the start of the reforms process “have all been resolved to the CCG’s satisfaction”.
Thanks to this he is now less concerned by the details around CCG configuration.
“As long as CCGs recognise their role is to represent their member practices, it doesn’t particularly matter what its size and shape is,” he said.
Management in Practice analysis of the NHS CB’s published documents on CCG configuration shows 33 CCGs still fall below the patient population average of between 150,000 and 300,000.
Dr Dixon hopes such CCGs will be allowed to continue as they are to provide “competition” for the larger CCGs over how they engage with their member practices.