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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.