Dozens of CCGs look set to merge after the 2012/13 NHS Operating Framework published today set GP commissioners a management allowance of £25 a head and said that CCGs should be ‘coterminous with a single local Health and Wellbeing Board'.
SHA clusters have been charged with ensuring that ‘any outstanding configuration issues' are ‘resolved by the end of March 2012', in a move expected to trigger a wave of mergers among smaller clinical commissioning groups.
The £25 per head figure is at the lower end of the predicted range for the CCG management allowance, which GP commissioners were previously advised would be between £25 and £35. It comes after a Government-backed paper from the NHS Alliance and NAPC earlier this week warned that funding at that level would mean CCGs would need to cover at least 100,000 patients in order to manage clinical and financial risk.
The NAPC/NHS Alliance discussion paper said CCGs covering populations below the 100,000 patient threshold may be ‘too small to act entirely independently with an exclusive management team and to fulfil all statutory functions'. But the bodies said larger CCGs could devolve commissioning functions to smaller groups in order to retain a sense of localism in commissioning.
Some 63 of the Government's 257 pathfinder CCGs currently cover populations below 100,000.
The framework published today said: ‘From 2013/14, the running cost allowance for CCGs is expected to be £25 per head of population per annum.' It added that ‘this is before any entitlement to a quality premium', but failed to offer any further details on how the quality premium will work. Ministers remain deadlocked with the BMA over its implementation , with GP leaders fiercely opposed to plans to tie a proportion of practice income to GPs' commissioning targets.
On CCG boundaries, the framework said: ‘As far as possible CCGs should be coterminous with a single local Health and Wellbeing Board.'
Dr Michael Dixon, NHS Alliance chair, said that he hoped flexibility would be allowed to permit successful smaller groups to continue, even it meant they spent a little more than £25.
‘£25 is an absolute bare minimum. It will make it difficult for CCGs under 100,000 to be sustainable. I think the very small ones will need to [merge]. The trick will be how they keep their leaders and practices fully engaged.'
He warned that if too many CCGs were forced to merge because of the low management costs, the system would simply be re-creating PCTs.
‘Far too many CCGs seem to be the same size of PCTs. The forces on high seem to be recreating old structures.'