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 |
|||
