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Huge variation in CCG staff numbers

There will be huge variation between clinical commissioning groups’ internal staff numbers and their reliance on independent support services, according to the first analysis of the structure of the new groups.

However, HSJ has also learned CCGs in total are likely to employ significantly fewer people than the independent commissioning support providers which will carry out much of their day-to-day work.

The most recent Department of Health estimates are for 4,200-6,300 staff in CCGs and 8,000 in commissioning support units, HSJ understands.

HSJ examined detailed staff structures provided by a sample of 18 of the 35 CCGs which are being assessed in the first wave of the authorisation process.

Some of the variation in numbers is explained by CCGs’ population size, but much is down to decisions about how much work is contracted out.

NHS Bedfordshire CCG is planning to employ 125 staff, as well as a 20-strong quality team shared with another CCG. Its population is 432,000 so there will be nearly three staff for every 10,000 population.

If all CCGs employed staff at the same rate, the national total would be more than 15,000. That would leave minimal staffing and income for CSUs, and make many of them unviable.

NHS Great Yarmouth and Waveney CCG is another example of a CCG planning to employ a lot of staff, with 55 employees, despite its relatively small population of 230,800.

In contrast, NHS Portsmouth CCG, with a population of 216,000, plans to directly employ only 12.9 whole time equivalent staff. It will share a further 17 with neighbouring CCGs and 18 with a local authority.

NHS East Riding of Yorkshire CCG has a population of 300,000 but is planning to employ only 28 staff directly - fewer than one person per 10,000 population. If that ratio was repeated across England, the total CCG workforce would total only about 4,600, and would be dwarfed by CSUs probably employing about 10,000 nationally.

The variation in the sample is expected to be repeated across other CCGs.

The national reliance on external commissioning support, and specifically for CCGs with few staff of their own, comes despite concern about CCGs becoming reliant on and led by CSUs. Government policy is for CSUs to be privatised by 2016. Meanwhile, only six of the 18 CCGs’ structures have a senior executive nurse post, although a further 10 have a member of staff whose job title includes the words quality or safety.

Readers' comments (7)

  • Neither buy or build is the right answer currently in terms of commissioning support - a build option stands a good chance of delivering largely what we had in the past - poor capability and no scale, whilst a buy option puts you at the mercy of CSSs which are pretty ropy outfits at the moment with our local one seemingly pre-occupied with creating top heavy structures, with fat salaries, which will only result in less people on the ground and an even poorer service - rock and hard place i think.

    But at least when we come to recommissioning the thing properly during 2013/14 we should be able to make imrovements either way - the high indirect overheads currently being stuffed into the CSSs and the mouths of their executive, without much accountability it seems should ensure that a commercial offering or a move in house will win either way - a real shame and an opportunity lost - but what else can you expect when you move people out of PCTs and give them a quasi commercial play thing to foul up.

    Through the authorisation process i expect to be tested in what is my "Plan B" if the CSS fails to deliver, having invested a lot in them, rather than creating in house capacity - anyone that can tell me what the objective answer to that question is is welcome to join the panel !!!!

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  • Harry Longman

    Dear Anonymous, you have some views worth fighting for, so come out in the open.
    What depresses me about the article is that it sees commissioning in terms of supply of man hours. If it takes 100 staff for a population of 300,000, then it would take 200 for a population of 600,000. Clearly nonsense. This is all about capability, and if 10 people can build something brilliant and scaleable, they could commission for 30,000 or 30,000,000 in pretty much the same way.

    Your point seems to be that never mind the structures, they are full of the same ol' folks doing the same ol' thing, unknowingly, unbrilliantly, unscaleably. Who am I to argue?

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  • From an ex-Contracts Director viewpoint, based on many years experience and successful delivery:
    In any organisation, only 4% of senior officers " know what they are doing" and can do it competently in relation to resource planning and commercial decisions. The 4% carry the 96% for a key part of the year, when it matters. Often they are VSMs or second tier officers, often they are lower down in the "reward pecking order ".Therefore the CCGs need to make sure they have recruited the 4%, or not let them be voluntarily redundant ! If they do that, it doesn't really matter whether the 4% are internal or external, or what the size of the overall workforce is. its all about good people who get the job done.

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  • I couldn't agree more with the previous comment. There are some very experienced and competent people albeit many are now external to the NHS who are outcome and results driven who can orovide high quality support to CCGs - the 4% identified above. The real trick for CCGs is not to waste public resources on large CSU structures unless they can demonstrate value for money and a different delivery strategy. In my opinion the smart CCGs will employ a core number of staff at CCG level which gives the COO confidence that he/she has the appropriate level of skills to fulfil the integrated governance responsibilities of the CCG, commission a core shared 'back office' function to cover finance and Information support which is probably much less than the infrastructures being created in the current CSUs and then keep some resource to 'buy in' expertise to lead and support particular projects or at key times during the year. Contrary to popular belief this type of quality input doesn't come with the price tag attributed to the big management consultancies and can be a very cost effective way of delivering what is a complex agenda for CCGs.

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  • "A 20-strong quality team" means 20 less front-line staff to provide quality. Maybe not quite the right balance of spending?

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  • An interesting comparission, that would make the article more helpful, would be to look at the numbers of people under the old system and the number under the new. I wonder if the reduction reflect the retoric at the start of the process?

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  • I think numbers of staff AND the paybill pre and post would be a good analysis - if the downgrading of jobs in my health community is anything to go by, we may not just have fewer people but they're doing a lot more for less. And the true numbers will always be masked by how much is spent on interim/ consultancy (I don't mean one man/ woman bands but big companies) rather than growing our own talent instead of forcing it out by poor HR.

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