Speaking at the NHS Alliance conference in Manchester on Wednesday, Dame Barbara Hakin, England’s national managing director of commissioning development, said: ‘I can’t underestimate to all of you – the money is going to be incredibly tight.’
‘If we don’t find great economies of scale in commissioning support it is going to be difficult for everyone,’ she added.
The BMA has recently announced its opposition to the Bill over concerns that guidance on commissioning support would force CCGs to employ private companies.
Dr James Howarth, a GP CCG chairman in Lincolnshire, asked Dame Barbara: ‘We were recently told that we must purchase organisational development from a particular company whose name you would all know. We were consequently told it was simply pre-empting a national directive. How do you feel that fits with our choice and the competition of private providers?’
Dame Hakin said she was unable to comment on the individual case in Lincolnshire.
The BMA recently advised CCGs to collaborate or merge in order to have enough resource to run their own in-house commissioning support.
NHS Alliance GMS/PMS lead and Mid Devon PBC Consortium chairman Dr David Jenner who was also speaking at the conference agreed. He argued that larger CCGs would allow GPs to focus on clinical work without getting overly involved in bureaucracy.
However NHS Alliance GP Commissioning Federation national co-lead Dr Shane Gordon said he thought CCGs ought to stay small, in order for GP constituents to feel connected with their leaders.
‘If you make an organisation too big people won’t know their leaders, they wont connect with them and they wont follow them.’
Dr Gordon said that once a CCG’s population increased over 300-350,000 the cost gains it would achieve would be minimal.
However Dr Gordon said the financial constraints of the £25 per head management allowance meant it was also important for CCGs not to be too small.
‘Below 75,000 you’ve got no money to actually commission services with, and that’s a real problem,’ he said.