A CCG with a population of less than 100,000 may be too small to act "entirely independent" for it to fulfill all its statutory functions.
A 'work in progress' paper, CCGs – Addressing outstanding size and configuration issues, published by The Clinical Commissioning Coalition - a body born from the NHS Alliance and the National Association of Primary Care (NAPC), reveals a call for clarity among CCG leaders as they are faced with pressures on minimum sizing.
Both the NHS Alliance and the NAPC have received reports that a number of emerging CCGs are being "strongly encouraged" to re-think their shape, size and fit by SHAs, PCT clusters and Local Authorities.
CCGs are also being pushed to become much larger against their wish as a direct result of the 'Ready Reckoner' interactive tool - designed to help test out potential running costs for emerging CCGs - "overselling" the funds needed to cover essential governance requirements.
While the coalition points out the running costs allocation (RCA) should not determine a CCG's size, its report shows a CCG with a population of 100,000 (18 practices) and a running cost allocation (RCA) of £2,550,000 at £25 per head would struggle to retain "sufficient funds" to purchase commissioning support after covering all governance requirements and providing the required assurance.
The coalition's paper recommends that discrete parts of CCGs could be given delegated authority to determine their use of budget, contract/commissioning intentions and service changes – although it acknowledges further work is needed to develop the "menu of options".
"This document, though not yet completely finalised, will provide smaller CCGs with food for thought on the options before them, in terms of managing risk, and financial autonomy," said Mike Ramsden, Chief Executive of NAPC.
"A missing piece of the jigsaw, however, is the Secretary of State's expected announcement on management allowances for smaller CCGs, which should be published shortly and will enable interim decisions to be taken on CCG configurations."
The Clinical Commissioning Coalition will meet with a small group of "interested" CCGs to discuss the paper's outcomes and publish a revised document next month.