Dr James Kingsland, the DoH’s national clinical commissioning network lead for England, said PCTs across the country are ‘advising, informing or sometimes directing’ CCGs to amalgamate.
He said some are telling CCGs that they must cover populations of 300,000 if they are to be financially viable.
He raised concerns that if this advice is followed around 150 CCGs would be created – equivalent to the number of PCTs.
He said: ‘I would be very guarded about the creation of organisations that are the same size of PCTs.
‘The average tax payer would have grave concerns about a reform that just re-structured and re-designed what we already had.’
Dr Kingsland warned that influencing a CCG to merge would be ‘disenfranchising’ for the constituent practices and GPs.
He said: ‘If we are seeing larger forms developed it's not through an empowered, enthused programme. It’s more a resignation that with the information they have been given they can’t do anything else’.
Meanwhile, Dr Paul Zollinger-Read, director of commissioning development at East of England SHA, said that the fixed costs for running CCGs are likely to be around £1.3m a year.
He said this means that for a CCG covering a population of 70,000 there would be ‘nothing left’ for commissioning support.
He agreed that some CCGs are now considering mergers, but said others are discussing options of sharing support functions or federating.
He said: ‘Covering populations of 70,000 and 100,000 is do-able if you address the other issues such as federating.
‘But if you have your fixed costs and don’t share any functions then CCGs won’t get there.’