STRUCTURE: Greater Manchester’s clinical commissioning groups are developing a pact to work collectively after April 2013, to ensure they are strong enough to deal with powerful hospital providers.

NHS Greater Manchester medical director Raj Patel told HSJ that clinical commissioners need a way to preserve citywide decision making after primary care trusts are abolished in April 2013.

He believes the 13 clinical commissioning groups will reach an agreement ensuring they could work “as one for the population of Greater Manchester, and will be big enough and strong enough to flex [their] muscles with big providers”.

Dr Patel, who also chairs the city’s clinical strategy board and Tameside and Glossop Clinical Commissioning Group, said: “My view is that at the moment there is no system management beyond April 2013.”

He added: “The system management across England appears to be, well, market forces will prevail and CCGs will either work in competition or collaboration.

“My view is that unless somebody stimulates the system ahead of that Greater Manchester will be left with 13 CCGs who will be working in isolation [to negotiate] with large providers.”

NHS Greater Manchester last week approved creation of the strategy board, which includes senior directors from the PCT cluster alongside representatives of all the CCGs.

The strategy board’s first job will be to oversee development of a new clinical strategy for the Greater Manchester area, which could lead to major reconfiguration of hospital services.

But Dr Patel said it would also “commission collaboratively across the whole of Greater Manchester when it’s best for us to do so”.

He added: “What this board can’t do at this moment in time is contractually bind a CCG, because it’s not a statutory body.

“But we hope to create a memorandum of understanding during the next six to eight months, as we move towards authorisation of Greater Manchester’s CCGs.

“That will give us the basis as statutory bodies to work together collectively.”

In some cases, this would simply mean CCGs contributing resources to allow one service to be commissioned for all, he explained.

In other circumstances, such as reconfigurations, it could mean all commissioners agreeing to be bound by a decision even if it disadvantaged some of them financially.