Eight London clinical commissioning groups are set to stop using their commissioning support unit and bring its functions in-house, HSJ understands.
The CCGs in north west London are reviewing the services they purchase from North West London CSU, with the findings due to be published at the end of April.
HSJ understands from sources in the CCGs that they will not renew their service level agreement with the support services provider. The agreement expires in September.
An outline business case for the CCGs covering Brent, Ealing, Harrow, Hillingdon, Hounslow, Kensington and Chelsea, Westminster, and Hammersmith and Fulham to bring the services in-house has been considered by their governing bodies.
It is understood to be their preferred option.
An internal North West London CSU document obtained by HSJ said this would remove approximately three-quarters of its business and would see staff transferred to the CCGs.
It said “Remaining services to non-CCG customers and corporate services would continue with plans to merge with the South London and Kent and Medway CSUs.”
The document added that it was “disappointing that [the] hard work of [the organisation] has not been recognised”.
HSJ understands some GPs perceived the CSU to be more focused on growing its other business to the detriment of its work with the eight CCGs.
The move has caused concern among other CSUs, which are worried that other CCGs will wish to follow the example of north west London. Such an outcome would fundamentally undermine the commissioning support sector.
The eight CCGs also approved another two potentially far-reaching schemes last week.
One will see the richer groups in the east of the sector agreeing to pool budgets with the rest of the CCGs to bail out areas that have traditionally been under-funded by the national allocations formula.
Harrow and Hillingdon boroughs recorded deficits as primary care trusts and are set to do so again as clinical commissioning groups.
The eight CCG chairs have agreed to move £35m to these areas from the surpluses in other boroughs. It is working with NHS England on the details of this.
The north west London CCG leaders also announced they were working with NHS England to commission primary care across all eight boroughs.
To avoid conflicts of interest primary care is currently commissioned by NHS England, apart from local enhanced services contracts, which CCGs commission and which cover services like minor surgery and children’s flu vaccinations.
The north west London CCGs are examining, with NHS England, the possibility of co-commissioning primary care.
This could include GMS/PMS budgets, rents and property budgets and enhanced services, with extra investment in primary and community care.
The CCGs hope this will support the shift towards providing more services in the community, as set out in their Shaping a Healthier Future plan.
Dr Ian Goodman, chair of the eight CCGs’ collaboration board, said: “These proposals on how we allocate our funding and how we commission primary care will hugely improve our ability to deliver better services. This is a key moment for the development of the NHS in the hands of its leaders, the GP community.
“As GPs we are all genuinely very excited about this. It reflects how well we as eight CCGs and their chairs can tackle tricky problems to bring about a result that benefits all the patients within north west London.
“We consider that this is perhaps the most important decision we have made.”
An NHS England spokeswoman said: “NHS England will work with the local CCGs and other local stakeholders over the next few weeks to go through their proposals from an assurance perspective and we hope to announce the outcome as soon as possible.”
One source in a north west London provider trust said: “We are concerned about how CCGs may behave with us later – for example varied contracts, different CQUINs programmes - which would become increasingly difficult to manage.
“Some GPs are also working under some assumptions that requiring change through contracts is the most effective method, whereas we believe collaboration and joint working get the best results for patients.”