NHS England executives - speaking at a board meeting - outlined plans to abolish the organisation’s two-tier field structure, merging its local area teams, which commission primary care, with regional teams.
Job cuts are expected. Original estimates were that over 600 NHS England staff could be affected by the reorganisation, although the number is now ‘significantly less’, national director for transformation and corporate operations Karen Wheeler told the board meeting.
Around nine out of 10 CCGs has bid for a role in commissioning primary care, and NHS England believes a third of CCGs are ready to take full control of primary care.
Practices fear lack of support
The GPC has warned that reductions in area teams' capacity and staffing could undermine support for practices. Practices have continued to face problems with support over issues such as payment and contractual queries long after the abolition of PCTs.
Ms Wheeler said the reorganisation, just 18 months after NHS England was formed, aimed to ensure it was meeting its requirements and to make savings.
‘We would not have chosen to do this. We would have chosen to make some changes at the organisation, but not in terms of stripping out the level of numbers of resources that we are doing and it is causing some difficult decisions,' she said.
A consultation with staff unions will begin on 1 October after final changes are made to the plans which will be implemented in April 2015.
Board papers say the new field force structure will reduce senior management and merge, reshape and resize regional and local structures.
'There are some things that we are going to have to stop doing and there are certainly also things that we are still going to do but do less of,' said Ms Wheeler.
Real frustration for GPs
GPC chairman Dr Chaand Nagpaul said: 'One of the real frustrations for GPs and their practices has been the diminished support in terms of day-to-day admin with problems and queries that are not answered in time, and turnover of staff - it is difficult to get answers on anything from payment to contractual issues. This is taking up a considerable amount of time in practices and we are getting feedback about frustration.
'It would be concerning if further administrative reductions result in a further reduction in support for practices.'
National director for commissioning operations Dame Barbara Hakin suggested the move to co-commissioning of primary care by CCGs would allow NHS England area teams to make the changes required by the cuts.
‘Coupled with our direction of travel - primary care co-commissioning - it is really important that our field force steps back and ensures it does its major role. We've still got a major role in direct commissioning, although more of that is moving to CCGs, but our role in supporting and assuring CCGs is a greater one, not doing for them what they in so many places have so ably identified they can do for themselves.'
She added: ‘We need to ensure that where appropriate CCGs can take on more responsibility.’
Ms Wheeler said ensuring the organisation had the right resources in the right place for future needs was a key risk bosses would be working on ahead of the consultation.
Chief executive Simon Stevens said: ‘Some of the changes we are making here are changes we would want to make, one year into the organisation in order to adjust in light of the circumstances we find ourselves in. Some of them are changes we are being required to make in order to reduce our running costs.’
At the same meeting, national director for commissioning strategy Ian Dodge updated the board on co-commissioning plans. A joint group with NHS Clinical Commissioners and the Commissioning Assembly is working on policy design detail for CCGs and guidance will be published in November.
The first co-commissioning arrangements are expected to be in place from April 2015.
How will the co-commissioning of GP services by CCGs change primary care? Find out more about our conference: Commissioning Primary Care 2014