Clinical commissioning is behind schedule in many areas with the transfer of staff from primary care trusts stalled and just over a year remaining before the NHS’s structural overhaul is supposed to be complete.

HSJ analysis of progress in half of PCTs shows 33 per cent have not formally delegated any budget to emerging clinical commissioning groups. That is despite PCTs being asked to delegate funds from April last year.

About 44 per cent of CCGs’ final “eligible” budget – which excludes primary care and some specialist services spending – has been delegated, amounting to £15bn in the 73 PCTs. CCGs are due to take on statutory responsibility and the majority of PCT budgets in April next year.

67% of PCTs have delegated a budget to a CCG

It appears many PCT areas have been unable to delegate budgets because they have not confirmed the structure of their CCGs.

For example, the Birmingham and Solihull PCT cluster said there were now five planned CCGs in its area – down from the 12 previously proposed – but the practice membership of each remains unconfirmed.

The cluster said in a statement: “Now CCGs have formed themselves into what is believed to be a more permanent arrangement, the cluster is working to delegate all budgets relating to CCGs and [plans to] have agreement… from April 2012.”


Total budget dedicated to CCGs

(March 2011: £7.6bn)

Discussions about CCG structure are also still continuing in many areas including parts of the North East, Hertfordshire, Surrey and Barnsley.

The total number of emerging CCGs identified by HSJ – looking at the most recent available information from all PCTs – is 279. It is the fullest picture of emerging CCGs to date.

  • Click on the graph attached right to see the latest CCG population data

Many GP groups have decided to merge in recent months. The current number of CCGs is a 17 per cent fall from the 335 identified by HSJ in March 2011, but it is still nearly double the number of PCTs.

Meanwhile, PCTs are also meant to be formally “assigning” staff to emerging CCGs and other organisations that will employ them after PCTs are abolished in April 2013.

However, 55 per cent of the 73 PCTs which provided information had not assigned any staff. Where they had, the numbers varied from a handful to more than 200. The finding comes as the Department of Health has ordered PCTs and strategic health authorities to tell all staff where they will work in future in a letter on 31 January, even where this is still unclear (see story, right).

NHS Confederation deputy chief executive David Stout said the fact PCTs had not formally assigned individuals did not mean they did not have “staff [involved] in supporting CCGs”.

He said controversy and the delay to the Health Bill had held back change on the ground and meant the DH had been slow to publish critical details.

Mr Stout said: “It’s difficult to press on with some things until the legislation has passed. If the bill was storming through Parliament and there hadn’t been a pause we would be further ahead.”

He said delays to delegating budgets could cause problems for the CCG authorisation process, due to begin by October, because CCGs’ handling of the funds was one of the ways the DH was planning to judge their readiness.

One PCT cluster chief executive involved in national policy development told HSJ the large amount of work left to do posed a huge risk to the changes being implemented successfully.

He said: “The April 2013 deadline is not going to shift. People are very conscious of the fact that’s not very long away. CCGs are expected to be authorisation ready in nine months and we have got shitloads to do in that nine months.”

National Association of Primary Care chair Charles Alessi said: “It is disturbing that the processes which are supposed to be in place are moving so slowly. Resources are not flowing as quickly as they should be.

“Inevitably it is leading to significant disengagement [of GPs]. If we are not careful we will go into a state of suspended animation.”

DH director of commissioning development Dame Barbara Hakin told HSJ: “The vast majority of GP practices are engaged in the reforms and form part of a pathfinder clinical commissioning group.”

She said “about half” the eligible funds for delegation had been “applied for by CCGs”.

HSJ analysed information about the transition requested from all PCTs and PCT clusters in November and December 2011. However, not all provided full information.