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Revealed: the 100-fold variation in CCG workforce size

There is a more than a 100-fold variation in the numbers of people employed by clinical commissioning groups, HSJ research has found. The revelation has prompted concern over the viability of smaller CCGs

Commissioning workforce size graphs

NHS commissioning workforce following the transition to the new organisational structure in April. The research gathered workforce data from CCGs, NHS England, Public Health England, commissioning support units, Health Education England and NHS Property Services. It found that while some CCGs employ as few as three full time equivalent staff, others employ more than 300.

The scale of this divergence is not explained by differences in the size of populations CCGs cover - this varies by a factor of 13 - or the amount of support services CCGs buy in from CSUs, for which HSJ has previously found varies threefold.

Median CCG headcount

The remainder of the difference is down to CCGs electing to share their management teams. Fareham and Gosport CCG, for instance, employs three full time equivalent staff, but has a shared management team with two of its neighbours: South Eastern Hampshire, which employs 38 FTE staff, and Portsmouth, which has 66 FTE staff.

Newcastle North and East and Newcastle West CCGs have no employees on their payroll, as they are in an “alliance” arrangement with Gateshead CCG, which employs 37 FTE staff.

King’s Fund fellow Chris Naylor told HSJ there was no “ideal size” for a commissioning organisation but the smaller CCGs with alliance arrangements carried a risk of alienating local practices that wanted to avoid working across larger areas.

“You can envisage that over time some of the smaller CCGs working in alliances can start asking questions about whether it makes sense to continue as separate organisations or whether there’s a case for merging,” he said.

CSU FTE headcounts

Marisa Howes, national communications and policy officer for Managers in Partnership, said her members expected to see more “churn” in organisational structures as “we don’t think some of the smaller ones are viable”.

One CCG source told HSJ they expected the groups to become more uniform in how much back office support they bought in over the next year, as the optimum scale for various functions became clearer. Rupert Gowrley, a director at MHP Health Mandate, agreed more “harmonisation” between CCGs was likely.

However, smaller CCGs defended their arrangements. Four in Berkshire, each with only 3.1 non-shared FTE staff, said their structure was “economic and efficient”, enabling them to scale up for shared transformation programmes while retaining a local focus for other work.

A spokeswoman for all four said: “We are truly independent organisations. We acknowledge our structures are unique and, as such, we regularly review our structures and processes.”

Meanwhile, a spokeswoman for Fareham and Gosport said: “Mergers are not inevitable as each CCG has a separate governing body and separate clinical cabinet made up of local GPs, which are focused around commissioning health services for their distinct population.”

The largest CCGs are those that opted to retain support services in house rather than use CSUs. These are: Northern, Eastern and Western Devon, which employs 369 FTE staff; Dorset, which employs 229 FTE staff; and Cambridgeshire and Peterborough, with 228 FTE staff.

HSJ has data for 124 out of 211 CCGs. They employ 16.6 FTE staff per 100,000 population - this makes CCGs just over a quarter of the size of the PCT sector, which employed 63.9 FTEs for every 100,000 people. Assuming the 124 were representative, the data suggests the CCG sector as a whole employs around 9,000 FTE staff, compared with the 35,585 employed by PCTs in February 2013.

Read the in-depth analysis of CCG workforce numbers

Distribution of pay graph

  • UPDATE 18 June. The CSU workforce data has been revised. The original statistics NHS England sent to us contained errors which have now been corrected.
  • UPDATE 19 June. West Suffolk CCG’s high number of employees per 100,000 population is due to the fact it hosts a shared management function, which also covers Ipswich and East Suffolk CCG.

Readers' comments (12)

  • If smaller CCGs decide to merge, what effect will this have upon patient expectation of commissioning related to Local needs that we were sold in the advert? Will provision for rural practices become swamped by urban requirements or will we still be given consideration? Will this produce apparent (or real) imbalance in cost per patient? We do live in interesting times, don't we?

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  • Think there may be a few problems with the data. Saw a FOI which may have been associated with this.
    Request was less than clear and we only responded with actual staff in post excluding vacancies and interims.

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  • Lets get on with the next reorganisation now! Merge, bring back the people we have lost to redundancy and PCTs?

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  • Our CCG, towards the high end in terms of population covered and staff employed, is already having to recruit to newly created new posts, as they seriously underestimated the staff required to manage some functions. The size of some staff portfolios, particularly at 8a and above, have proven untenable even in the few months since preparing for transfer and post-CCG launch.

    Particularly galling as some of the new posts are essentially roles that were made redundant during the transfer from PCT, but those staff, with the attendant corporate memory, are unlikely to return.

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  • Re anon 8.51am - here's a typical FOI we sent out (some later ones excluded the final question):


    Can you tell me:

    • How many staff does your CCG employ? If possible, I would like this expressed both in terms of full time equivalent and overall headcount. If you have a figure for known vacancies, can you tell me that as well, please?

    • Can you provide me with a breakdown of your CCG’s workforce by pay banding? Please include very senior managers and any people not employed on Agenda for Change terms and conditions.

    These two questions are the priorities. However, if the information is there, can you also tell me:

    • Can you also tell me how the new staff were appointed? For instance were they recruited through the transition job matching process, or was it done through open competition?

    If that last question adds too much complexity, forget it – I don’t want the enquiry to fall apart if the third question is a problem.

    Please do give me a call if this doesn’t make sense or if you need more information.

    Thanks again

    David Williams, HSJ

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  • Good analysis HSJ. But how does the overall commissioning headcount/spend compare to what we had before. From a provider perspective our contract meetings now seem to have more people in the room representing the commissioner than before the reforms. It almost seems like the CCG and CSU are man-marking each other. Still no clinicains there either!

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  • The success of CCGs will be in philosophy not structure or scale. One of the strengths of the CCG model may lay with the divesity of approach.

    This would include;
    Developing the membership, and creating the space for multi-sector clinical conversations. Providing renewed momentum for involving patients and stakeholders in shaping services.

    A relentless focus on service quality, patient experience, and health outcome.

    Successful CCGs may challenge conventional thinking regarding organisational structure and scale. Many will concentrate more on creating an environment and culture with their partners to jointly develop services that meet the challenges we can anticipate over the next 3-5 years.

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  • Although I predicted that CCG's will eventually end up recreating PCT's I had not expected the discussions to commence less than three months after the 'big bang'. There are other reasons why there are too many CCG's. These concern reconfiguration, integration and commissioning power more important than discussing the minimum critical mass of operation.The 2012 Act 'Balkanised' commissioning.

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  • Have your readers come across the quote (said to be from Gaius Petronius) about the consequences of solving corporate problems by re-organisation?
    I find it very worrying that it appears (paraphrased) in Vol. 1 of Francis' report on Mid-Staffs. The third sentence of para 6.471 introducing his comments about replacing LINk with Healthwatch reads "Experience in this, as in so many other areas, is that reorganisation by abolishing one body to create another can be distracting and disguise a weakening of public protection behind unwise claims of improvement."
    How prescient! And appropriate for CCGs, etc too, from some of these comments!

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  • Without knowing how much of each CCG's duties are being undertaken on their behalf by commissioning support units this is pretty meaningless, isn't it?

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