Exclusive PCT clusters in several SHAs are imposing their structures and staff onto clinical commissioning groups, and attempting to set themselves up as the sole providers of commissioning support beyond April 2013, as the land-grab for power in the new-look NHS intensifies.
A Department of Health GP adviser told Pulse a series of clusters across England were ‘dictating' to CCGs and top-slicing management budgets ahead of the full handover of commissioning responsibility.
A DH team has now begun compiling evidence of where PCT clusters have overstepped the mark, with areas affected understood to include trusts in the West Midlands and the North West.
But a GP sitting on the board of one PCT cluster said it was taking an ‘evolution not revolution' approach – and warned it was essential that some continuity was retained beyond 2013.
It comes after CCG leaders last week warned health secretary Andrew Lansley they were being forced into a centralised model by PCT clusters and budgetary constraints.
Dr James Kingsland, the DH's national clinical commissioning network lead and a GP in Wallasey, Merseyside, said the DH had evidence PCT bosses were attempting to wrestle control of CCG management budgets in ‘more than one SHA'.
He said: ‘Too many areas are being told that clusters are now and forever the only commissioning support they can ever have. Some are being told that as a result, their management costs will be top-sliced by the PCT to run their commissioning support. It takes away the full ownership from CCGs.'
‘Too many colleagues are saying that "bottom-up" is rhetoric, not reality.'
But Dr Simon Stockill, a GP in Headingley,and clinical chair of NHS Leeds, said it was necessary to retain some semblance of continuity amid the widescale confusion caused by the reforms.
‘My big concern is CCGs will end up carrying the can for a botched reorganisation. If too many levels of support are taken away, and the level of management expertise is low, you risk throwing the baby out with the bathwater.'
‘My feeling is clusters will have a role beyond 2013. I would be very nervous if David Nicholson allowed no supporting structures for new developing organisations.'
Dr Samar Mukherjee, a GP in Birmingham and chair of the Intelligent Commissioning Federation, said his PCT cluster had been proactive in aligning staff to CCGs, but had not gone as far as putting a blanket ban on external support.
He said: ‘The purpose of the bill was to transfer responsibility to GPs. It might be a similar model but the decision-making should be more clinically led.'
