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Some CCGs – ‘too small’ to be independent

Discussion paper launched on CCG size-issues

Jo Carlowe

Thursday, 24 November 2011

Clinical commissioning groups (CCGs) with small population groups may be too small to act independently.

The Clinical Commissioning Coalition, set up by the NHS Alliance and the National Association of Primary Care, has reached this conclusion in its discussion paper on CCG size and configuration issues, published this week.

From preliminary discussions and cost analysis the paper, CCGs – Addressing outstanding size and configuration issues, notes that a CCG with less than approximately 100k population may be too small to act entirely independently with an exclusive management team and to fulfil all statutory functions.

The paper states that there is evidence to suggest that ‘to maintain a sense of localness for the clinicians forming the group, whilst having a critical mass for managing clinical and financial risk, organisations will need to have a population base of at least 100,000’.

To address some of the issues, the paper makes some recommendations. With regard to size/ flexibility and localness – in order to support innovative practices or groups of practices, discrete parts of CCGs could, the paper recommends, be given delegated authority to determine their use of budget, contract/commissioning intentions and service changes.

Furthermore, the Coalition says CCGs will need to be sufficiently flexible to allow the different patches or operating areas to develop at variable speed. In addition, it states that with regard to geography, guidance should be clarified to ensure that there is no overlap of population responsibility between CCGs.

And with regard to proportionate governance, it is suggested that chairs, accountable officers and other governing body members can be shared in the same way as they are shared now between SHAs and PCTs as long as there is a clear governance framework that specifies who is responsible for what.

Mike Ramsden, Chief Executive of NAPC commented: “This is a very useful document for CCGs, though not yet completely finalised, and will provide smaller CCGs with food for thought on the options before them, in terms of managing risk, and financial autonomy. 

“A missing piece of the jigsaw, however, is the Secretary of State’s expected announcement on management allowances for smaller CCGs, which should be published shortly and will enable interim decisions to be taken on local CCG configurations.”

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