Two Suffolk CCGs have merged to have "greater influence" over their local hospital.
The decision to merge Ipswich CCG IPSCOM and the East Suffolk Federation was made by GPs at the end of 2011.
The merged CCG will now have a patient population of 380,000 and will cover 41 practices.
Chief Executive of NHS Suffolk Paul Watson told MiP one of the decisions to merge was to have a "greater degree of influence over their local hospital".
He said members from the two separate CCGs experienced "difficulty" in being heard and directing change at Ipswich Hospital.
"If a hospital has two or three commissioners all asking for different pathways, it is very difficult to implement them all," he said.
"You can end up with small commissioners being very frustrated because they cannot get the changes they need.
"The two CCGs needed to merge in order to have greater negotiating leverage with the hospital."
Melanie Craig, Chief Operating Officer for the IPSCOM/East Suffolk Federation merged CCG, said it was becoming too "chaotic" for the two CCGs to continue to try to redesign pathways around one hospital.
She acknowledged the 'strength in numbers' approach would bring about a "better relationship" with the hospital but denied there was any conflict between the CCGs and Ipswich Hospital.
Ipswich Hospital declined an interview with MiP but Andy Burroughs, Director of Business Development at Ipswich Hospital, issued this statement:
"The hospital is keen to build on the existing strong relationships we have with NHS Suffolk and the developing CCGs in East Suffolk," he said.
"Our clinicians are already engaging with representatives from Ipscom and East Suffolk in agreeing key commissioning priorities for the new financial year."
The 14 commissioning GPs sitting on the IPSCOM and East Suffolk Federation CCGs will also have to stand for election to secure a place on the newly-merged CCG, which will enter into shadow form from April 2012.
Under the new structure, seven GPs will be elected to sit on the CCG board and seven GPs will be appointed to serve on a clinical executive basis.
"Some of the GP faces may change but there will be a great deal of continuity between the new arrangements and the old arrangements," said Watson.
"GPs that have been involved in the CCGs for the last year have built up a lot of expertise and authority and will be excellent candidates for taking on roles next year."
The merger will also see IPSCOM/East Suffolk appoint a nurse, consultant and non-executive members to its CCG for the first time.
By Louise Naughton