STRUCTURE: NHS North of England has highlighted problems with the structure of 14 prospective clinical commissioning groups in the patch, including one in Wirral of which prominent GP commissioner James Kingsland is a member.

The groups are noted as problems because they are too small, cross local authority boundaries, do not have a clear geography, or a mixture of the three.

The Department of Health asked CCGs, with their strategic health authorities, to apply a “diagnostic” tool to test their structure ahead of the authorisation process. The process looked at whether they have a clear boundary and population (member practices are mostly neighbouring); do not cross council boundaries without the support of the councils; and are large enough to be financially viable.

A commissioning development board paper for NHS North of England shows the results of the process, which rates groups red, amber or green. The SHA Cluster paper says there are 74 emerging CCGs in the North, not including Barnsley, where the number of CCGs has not been decided.

Nationally, the DH has said around 90 per cent of groups have been rated green.

Dr Kingsland, president of the National Association of Primary Care and national director of a DH-funded clinical commissioning network, is a member of the Wirral NHS Alliance group.

When HSJ reported on the fact its member practices are geographically mixed in with those of other groups in March last year, Dr Kingsland commented: “One reason we are small is that everyone [all practices] understands [the work] and is involved. We’ve got a collective viewpoint of what we’re trying to achieve.”

The groups rated red and amber in the North, with reasons, are:

Red

NHS Wakefield District - South Elmsall, Rycroft and the Grange - Impact of size

NHS Barnsley - Configuration still under discussion - Geography- boundary / population. GPs are currently in two groups, but the PCT Cluster/SHA have not agreed this.

Wirral - Wirral NHS Alliance - Geography - boundary population; Impact of size (too small)

Ashton, Leigh & Wigan & Halton & St Helens - United League Commissioning - Geography - boundary / population; Geography - local authority boundaries; Impact of size (too small)

Amber

Airedale, Wharfedale and Craven - Geography-local authority boundaries

NHS North Yorkshire & York - Vale of York Commissioning Consortium - Geography - local authority boundaries

Cumbria - Cumbria CCG (inc Bentham) - Geography - local authority - boundaries

Wirral - Wirral GP Commissioning Consortium Geography- boundary / population

Wirral - Wirral Health Commissioning Consortium - Geography - boundary / population

Ashton, Leigh & Wigan - Aston, Leigh and Wigan CCG Geography ‐ boundary / population

Tameside & Glossop - Tameside & Glossop - local authority boundaries

Liverpool - Liverpool Matchworks GP Commissioning Consortia - Geography - boundary / population

Liverpool - Liverpool Central GP Commissioning Consortium - Geography - boundary / population

Halton & St Helens St Helens Health - Geography - boundary / population