New commissioning “clusters” could foretell a reduction in the number of primary care trust of up to  50 per cent, HSJ has been told.

New commissioning “clusters” could foretell a reduction in the number of primary care trusts by up to  50 per cent, HSJ has been told.

HSJ research has found that seven of the 10 strategic health authority regions in England have now reorganised their PCTs into sub-regional “clusters”, “sectors” or “health economies” (see box).

Although most SHAs say the move is primarily designed to strengthen commissioning, some admit it could also help PCTs achieve the targeted 30 per cent reduction in their management costs over the next four years, set by this year’s NHS operating framework.

NHS London reorganised its 17 PCTs into six “sectors” in April last year to enable more effective commissioning of services and give “more clout” in holding providers to account.

But a spokesperson for the SHA said that would also help reduce management costs through “making much better use of resources”.

NHS West Midlands was the first SHA to cite a reduction in management costs as the primary reason for reorganising its 17 PCTs into five “clusters”.

NHS West Midlands chief executive Ian Cumming said last month that without the restructure, PCTs in the region did not feel able to deliver the 30 per cent reduction in management costs.

Other SHAs have stopped short of describing the change as a move designed to make administration savings.

However, the seven SHA regions HSJ has obtained detailed plans for are creating just 37 clusters or sectors from 116 independent PCTs – indicating a potential reduction in lead commissioning organisations of over two thirds.

NHS Alliance chief executive Michael Sobanja said clustering PCTs “identifies a direction of travel” for the NHS over the next few years. “The pressure will be on to consolidate all types of NHS organisations. This could be the start of a huge shift across the whole of the health service,” he said.

“Over the next couple of years, the number of PCTs could fall by up to half. No matter which party wins the election, there will be fewer PCTs and undoubtedly fewer people employed in PCTs in the future.”

Clusters: PCTS of the future?

  • London 31 PCTs working in six “sectors”
  • East Midlands All nine PCTs now operate through five “health economies”
  • South West The 14 PCTs are working in eight regional “working groups” to pilot “new ways of working” to improve quality and make best use of resources
  • South Central The nine PCTs now operate through two “clusters”
  • North East The 12 PCTs share four senior management teams
  • North West All 24 PCTs organised into seven “regional groups”
  • West Midlands All 17 PCTs work in five “clusters”
  • South East Coast No definite plans to restructure – eight PCTs in the region work together informally at county level to address issues that cross boundaries
  • Yorks and the Humber No plans to cluster
  • East of England No definite plans from SHA to “cluster” or “sector” PCTs

HSJ’s NHS Governance conference is in London on 16-17 June,