The chair of the largest CCG in England is "confident" it can deliver the same level of localised care as a CCG a quarter of its size.
Cambridgeshire and Peterborough CCG cemented its status as the largest CCG in England when it decided to merge 8 of its CCGs into one super-CCG in December 2011.
Dr Simon Hambling, Chair of the Cambridgeshire and Peterborough CCG's Transition Delivery Board, now presides over a patient population standing at a colossal 855,000.
The merger was initially designed to overcome issues around geographical boundaries and the pull of increased financial security proved difficult to resist for debt-ridden Peterborough.
"It is better for the long-term security of a CCG to become part of a bigger and financially robust organisation," Dr Hambling told MiP.
"I have always seen size as crucial to the success of any CCG and achieving critical mass is key.
"While I understand the concerns over our size, I am confident the merged CCG can deliver the same localised services as a CCG covering 200,000 patients."
Dr Hambling said it took him "the best part of a year" to convince his fellow GP commissioners that bigger was better.
He credits the Future Forum's advice that CCGs should not cross local authority boundaries as "sealing the deal".
Another benefit of the merger is that commissioning support will be kept within the CCG – an important answer to the 'anti-privitisation' argument, said Dr Hambling.
"Keeping the commissioning support services in-house means we avoid becoming fragmented and reliant on something that will eventually become a commercial CSO," he said.
"It also means we avoid the accusation of privitisation."
Wakefield CCG Chair Dr Phillip Earnshaw told MiP "he didn't see the point" of developing a CCG larger than 350,000.
"By becoming too big, a CCG risks bringing practices along as passengers," he said
"A large CCG undermines the reasons behind the reforms."
By Louise Naughton