Dr James Kingsland, DH clinical commissioning network lead for England, told GP in January that emerging CCGs should stand their ground if NHS managers said they would not be authorised unless they merged.
His comments came after his own NHS Wirral Alliance CCG in Merseyside was ‘red-rated’ in a risk assessment process seen as the first step towards authorisation.
But he said the CCG had taken a pragmatic decision to merge with two neighbours.
‘We are now covering exactly the geography of the PCT,’ he said.
Dr Kingsland said: ‘We changed because it became clear the law would not allow what we first aspired to. It became clear that configuration would not be approved.
‘You have got to define an exact geography. I didn’t necessarily like it or think it was the best way to configure.
‘The three CCGs in Wirral were negatively rated just on geography. It was made clear the three areas would not be authorised. So we had discussions on having one geographical area, but within the agreement, we make clear we have three areas.’
He said it was important for GPs to ‘work within the rules and make the best of them’.
The original three CCGs will retain much of their independence, he added, but with overall responsibilities and risk management shared across the area.
He said that the fundamental difference that would remain between the CCG and the former PCT was GP engagement.
‘We have to be clear that we want to do something dramatically different,’ he said. ‘The difference will be clinical engagement – we have to create a very, very different environment and culture.’
Dr Kingsland said that ‘every GP in every practice is doing something’, from redesigning clinical processes to reviewing activity in different areas.
‘No PCT ever had that before,’ he said.
‘We have a very different outlook in how we are creating services for patients that the PCT did not do.’