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For commissioning groups ‘size isn’t everything’, say researchers

Smaller commissioning groups can function just as well as larger ones, with deprivation a more powerful factor in determining performance, concludes a new study.

The GPC and RCGP have called for clinical commissioning group (CCG) mergers to ensure all groups cover a population of between one and five million patients, but a new study to be published in the British Journal of General Practice next month found smaller organisations outperform larger ones on some measures.

The study compared 36 performance measures from all 152 PCTs in England and controlled for confounding variables such as urban/rurality, ethnic diversity and level of deprivation.

In all, 14 indicators showed a link between size and effectiveness, and on ten measures the larger PCTs were more effective. These included lower mortality rates, lower hospital admissions and better screening uptake, but there was no link found with measures of financial or commissioning ability.

 However, smaller PCTs tended to perform better on four measures, including smoking cessation rates, generic statin prescribing and satisfaction with opening hours.

The authors suggest that larger PCTs may tend to do better because they serve more affluent, rural and less ethnically diverse populations, whereas small PCTs tend to be inner city enclaves.

By contrast, deprivation had a greater influence on the effectiveness of PCTs across more measures, with ethnicity being a strong influence on some outcomes, such as the coverage of screening programmes.

Author Professor Deborah Sharp, researcher in primary healthcare at the University of Bristol and a GP in the city, said: ‘The present analysis suggests that smaller commissioning organisations can function as effectively as larger ones, across a broad range of performance measurement.’

‘But, given the enormous pressure to reduce management costs, it is likely that larger CCGs will be the norm.’

BJGP 2012; 62: 28-29