Health Secretary has told CCGs to 'push back' against 'bullying' tactics by PCT and SHA clusters used to dictate size and set-up.
Speaking at the NHS Alliance's annual conference in Manchester yesterday (30th November), Andrew Lansley told CCG leaders 'bigger isn't necessarily better'.
He said even small CCGs are big organisations and advised them to look outside of the health sector to the education system to see how smaller organisations can be run.
He said it was "perfectly possible" for small CCGs to work.
"Being small doesn't mean you are terrible. It means you can integrate with other practices, providing there are the right incentives," said Dr Niti Pall, Chair and Clinical Lead, pathfinder Healthcare Developments CIC.
"We still think talking about money is bad – it's not – it provides incentives and as long as the outcomes are good at the end of it, it is the right way to go."
Lansley also looked to reassure CCG leaders that the behaviour of PCT and SHA clusters will change once they become part of the National Commissioning Board.
"[PCT and SHA clusters] are still legally accountable until April 2013 and as such have a legitimate right to ask small CCGs how they will manage and big CCGs how they will maintain engagement," he said.
"This is a transition period and responsibilities and accountabilities are become gradually devolved.
"In many places we are already seeing a substantial devolution of accountability. PCT and SHA clusters have been asked to take the maximum devolution next year to fully prepare for CCGs coming out of shadow form in 2013."
The advice comes as an NHS Alliance survey reveals six in ten CCGs feel they are being "bullied" by PCT and SHA clusters into altering their size and set-up.
Also speaking at the conference, Sir David Nicholson, Chief Executive of the NHS and soon-to-be Chair of the NCB, said "there is no right size for clinical commissioning nor is there a right place to set organisational boundaries."
He said CCGs now have all the information they need to "get on with the job" but admitted it will be "very difficult" to drive on until we get the size right.