STRUCTURE: Nine of 12 prospective clinical commissioning groups in the Birmingham and Solihull PCT Cluster have been rated “red” for their structure, by a Department of Health assessment tool.

The PCTs in the cluster are Birmingham East and North, South Birmingham, Heart of Birmingham, and Solihull Care Trust.

The ratings are the result of a Department of Health pre-authorisation tool, designed primarily to assess the size and shape of groups.

PCT board documents suggest there are plans to overcome some of the red ratings by merging and federating groups.

The paper says Healthworks, Pioneers 4 Health, Smartcare and ICOF - all of which are red-rated - are planning to form a “West Birmingham Federation”. They may also federate with two Sandwell CCGs, although that will require local authority agreement.

It says SBIC - which is red rated - could join with ICC. They would still need to agree joint working on contracting, it says. There are “on-going discussions” between UBC and Equity, both of which are red rated.

Sparkfield and BICC are red-rated and no solutions are noted. Forward Health and Solihull CCGs are amber rated.

The board paper says: “Risk assessment work - CCGs have received clear guidance with regard to their pre authorisation risk assessment. This identifies that a significant number of our CCGs will struggle to be authorised without significant change in their membership.”

The paper details other work on commissioning development.

Another cluster board paper notes: “The Birmingham and Solihull Cluster currently have the largest number of emerging CCGs compared to the rest of the country; other core cities have negotiated down to either one or two consortiums.

“Birmingham and Solihull Cluster are currently working with its consortia to review their populations, financial stability and size.”