Clinical commissioning groups (CCGs) should resist keeping commissioning support in house to avoid recreating primary care trusts (PCTs), a CSU lead has said.
Stephen Childs, managing director of the North East Commissioning Support Unit (CSU), expressed his "surprise" over the number of GPs "who vented frustration" about the PCT-system in the past who are now "beginning to recreate the same system".
"There are more CSUs doing commissioning support in-house than we would have expected," he said.
"Many GPs involved in PCTs became disillusioned with the organisations and walked when they became too big and overburdened. I can't help but think that the cycle is beginning to emerge again with CCGs choosing to do their own commissioning support and that would be a great shame."
Childs said he feels a "moral obligation" to make sure that the "huge opportunities" to drive out inefficiencies under the reforms are grasped and to stop organisations from "drifting back into the old set up".
Rob Bacon, managing director of Birmingham, Black Country and Solihull CSU, said the number of CCGs keeping their commissioning support in house has "surpassed his expectations".
"We didn't anticipate that CCGs would want to do so much of their own commissioning support," he said.
Dr Johnny Marshall, interim partnership development director at NHS Clinical Commissioners, said Childs' fears are "perfectly valid" and are a "legitimate challenge" that CCGs need to "reflect on".
However, he is not surprised that different CCGs are trying different ways of working.
"At the moment we don't know the best way of doing commissioning support," said Dr Marshall, who is also an advisory member of the NHS Commissioning Board Authority Future Design Group.
"There will inevitably be a period where CCGs will find out what works well and what needs reviewing. You will then start to see a gradual improvement in the system as that learning takes place."
Dr James Kingsland, president of the National Association of Primary Care and the Department of Health's clinical commissioning network lead, said many CCGs are in fact worried that CSU organisations are the ones guilty of recreating PCTs as they are largely populated by ex-PCT managers.
He said those CCGs keeping commissioning support 'in house' could be a "good thing" but depends on how and who is running the activity.
"If CCGs are analysing population health, looking at activity data and assessing current service provision against clinical need in house, we did we create them?" he said.
"I don't think clinicians need to get involved in the process by which you secure a service in relation to the population's need, we should be getting expert managers to do that."
A spokesperson for the NHS Commissioning Board said: "CCGs are free to use their running costs allowance to seek support and additional capability from whomever they wish, and their decisions on the balance between internal and external support will depend on a number of factors including the key challenges across their local health economy and their style of working.
"The CCG authorisation process will ensure that these decisions are consistent, proportionate, transparent, legally-compliant and supportive of effective, efficient clinical commissioning."