While strategic health authorities wind down to their abolition – now slightly delayed – clustering has begun to meddle with the map.

Initially, when primary care trusts were told to cluster, NHS East Midlands told Northamptonshire PCT that it was big enough to exist on its own.

But GPs, MPs and the local authorities insisted that Northamptonshire had a “natural community” with Milton Keynes, part of the South Central region.

Eventually it was agreed the two cross-border operations would cluster, and now it seems Milton Keynes has changed its region as well. Milton Keynes PCT’s board papers reveal that NHS East Midlands’ financial control total will include Milton Keynes’ allocation and the SHA has to look after the PCT’s performance management.

Luckily, to make room for the addition, East Midlands is also shedding a PCT on its northern edge. NHS Bassetlaw is to be subsumed into the South Yorkshire PCT cluster.

Meanwhile, the deal for Circle to take on the running of Hinchingbrooke Health Care Trust has been delayed awaiting “ministerial approval”.

This could be of concern to other trusts in East Anglia for which foundation status is looking like a stretch. NHS East of England submitted the business case for the deal to the DH and the Treasury in December, but is still awaiting sign-off which was expected on 31 March.

The SHA said it received notification on 1 April from the DH that “their review was ongoing”.

The contract’s start date, anticipated to be 90 days after ministerial approval, will now be delayed beyond the proposed date of 1 June.

The SHA said it is hoped approvals will be received soon.