Speaking at the NHS Alliance conference in Manchester on Wednesday, Mr Lansley stressed the important of CCGs not giving in to outside pressure and being allowed to dictate their own size.
‘Frankly you (CCG leaders) have to make your decisions about CCGs,’ he added.
Mr Lansley said one option for smaller groups could be to come together with other small CCGs as larger CCGs but maintaining locality budgets.
‘Having larger CCGs which bring commissioning support and contracting arrangements on a larger scale is certainly happening and will enable smaller CCGs to realise that you don’t have to use £25 per head to try to cover every aspect without any benefit of economies of scale,’ Mr Lansley added.
The health secretary argued that if you compare CCGs with schools, which are smaller organisations managing the requirements of a statutory body with smaller budgets, then it is clear that it is quite possible to work successfully as a smaller organisation.
‘When we talk about this scale of running costs, you will look at the governance and the statutory duties of a statutory body and say all these things, but actually many of them bear comparison with the governing body of a school.
‘The average CCG in England has 200,000 patients. Let’s half that - 100,000. Even on that basis, at £25 per head we’re talking about £2.5 million, the running costs, the programme budget could be of the order of £150 million plus.
‘Most schools which are managing most of these statutory requirements for their governing body are doing it on the basis of about 1,500 children are doing it on a budget of £7.5 million, probably less than a couple of thousand is available for the administration.’
Mr Lansley stressed that even small CCGs are in fact large organisations ‘It is perfectly possible to do it,’ he added.
Mr Lansley also said that CCGs must consider the patient make up of each of its member practices when allocating indicative budgets.
Kent GP Dr Mark Ironmonger raised concerns over the increased costs of running a practice within a rural community. He said: ‘All our GPs are town-based in our CCG and we’ve got a real difference in our practices, we have a lot of young children and a lot of elderly.’
Dr Ironmonger said that most of the practices in his local area did not have many young, fit patients who did not often require consultations or prescriptions.
‘I just think that needs to be taken into account when you’re talking about comparisons,’ Dr Ironmonger said.
Mr Lansley said that ‘rural proofing’ clinical commissioning was something that the DoH has deliberately continuously set out to consider in the context of NHS reforms.
He said he hoped that the advice the DoH was receiving from the committee on resource allocation would help with ‘rural proofing’.
‘We’re moving progressively to a place where we’ve got literally practice-level and to an extent patient-level costing in relation to services that are provided. And that will help us to ensure that, not only the allocations to CCGs, but within CCGs the decisions you make about indicative resources should be reflective of the prospective burden of disease and hence costs, of the populations we look after.’