CCGs should have minimum populations of 100,000

Clinical commissioning groups (CCGs) covering a population below 100,000 will not be viable but larger CCGs could delegate authority to smaller groups, the NHS Alliance and National Association of Primary Care (NAPC) have said.

Mike Ramsden: document will provide smaller CCGs with food for thought on the options before them
Mike Ramsden: document will provide smaller CCGs with food for thought on the options before them

The Clinical Commissioning Coalition, set up by the NHS Alliance and the NAPC, has published a discussion paper on CCG size and configuration issues.

The coalition looked at the potential budgets of CCGs covering populations of 50,000, 100,000 and 300,000 with a running cost allowance of £25 and £30 per patient head.

The scenarios took into account unavoidable costs such as board staff and public meetings, the minimum core costs of running an organisation and other costs which could either be shared with or purchased as commissioning support.

It found that a CCG covering a population of less than 100,000 ‘seemed too small to act entirely independently with an exclusive management team and be able to fulfil all statutory functions, from a running cost allowance and good governance perspective’.

However a CCG with a population of 100,000 and above would have sufficient funds after unavoidable costs to purchase the needed level of support whilst still ensure sufficient core staff to help support the assurance that will be needed, the report said.

The coalition recognised that CCGs which wish to remain small may feel ‘stifled’ by governance requirements and minimum avoidable costs.

‘Localism, flexibility and identity are critical’ so larger CCGs may want to delegate authority to sub sets within the CCG,' Julie Wood, NHS Alliance national director clinical commissioning said.

These ‘sub sets’ could be given delegated authority for a particular budget, such as community services or prescribing, she said.

NAPC chief executive Mike Ramsden said: 'This is a very useful document for CCGs, though not yet completely finalised, and will provide smaller CCGs with food for thought on the options before them, in terms of managing risk, and financial autonomy.’

A meeting of a small group of CCGs has been scheduled for the 14 December and a revised paper will be published for wider discussion, with a view to complete the work by the end of January 2012, the coalition said.

The NHS operating framework, to be published on Thursday, is expected to outline what the running cost allowance for CCGs will be.

The scenarios detailed below cover CCG populations of 50,000, 100,000 and 300,000 at a RCA of £25 and £35 per head.

£25 per head

 

50,000 (15 practices)

100,000 (18 practices)

300,000 (46 practices)

 

Total cost

Cost per head

Total cost

Cost per head

Total cost

Cost per head

Running cost allocation

1,250,000

25

2,500,000

25

7,500,000

25

Unavoidable costs

666,000

13.32

737,000

7.37

760,000

2.53

Core costs (clinical engagement, support staff)

217,000

4.34

617,000

6.17

1,089,000

3.63

Numbers of staff (including chair, accountable officer, lay members, clinicians, admin and in the larger populations includes more support staff)

4.4 wte

10 wte

14 wte

Total

883,000

17.66

1,355,000

13.55

1,849,000

6.16

Balance for all other bought in costs eg commissioning support

367,000

7.34

1,145,000

11.45

5,651,000

18.84

What might this buy?

(Equivalent to band 7 posts)

8.6 wte

27 wte

133 wte

£35 per head

 

50,000 (15 practices)

100,000 (18 practices)

300,000 (46 practices)

 

Total cost

Cost per head

Total cost

Cost per head

Total cost

Cost per head

Running cost allocation

1,250,000

35

3,500,000

35

7,500,000

35

Unavoidable costs

666,000

13.32

737,000

7.37

760,000

2.53

Core costs (clinical engagement)

217,000

4.34

617,000

6.17

1,089,000

3.63

Numbers of staff

4.40wte

10.00 wte

14.00 wte

Total

883,000

17.66

1,355,000

13.55

1,849,000

6.16

Balance for all other bought in costs eg commissioning support

867,000

17.34

2,145,000

21.45

8,651,000

28.84

What might this buy?

(Equivalent to band 7 posts)

20.4 wte

50 wte

204 wte

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