The first analysis of the budgets set to be given to clinical commissioning groups shows huge variation and has sparked concern about services being destabilised by a shortage of cash.
Budgets range from £18m for the Red House – the single practice which wants to become a commissioning group on its own - to £835m for Cambridgeshire and Peterborough CCG, which covers the area of two primary care trusts.
The figures come from HSJ analysis of information published by the Department of Health on Tuesday. The DH said the figures were “baseline spending estimates”, not final budget allocations, but said they should be used for planning services.
They highlight the huge disparity in the size of emerging CCGs. However, the DH information points out that several of the smallest CCGs have been “red-rated” by their strategic health authorities. It means they are likely to need to merge with others if they are to be authorised to take on budgets by the NHS Commissioning Board.
The DH document constitutes the first time the department has published such a list of emerging CCGs and shows 244 across England. It is a steep fall from the 335 proposed CCGs identified by HSJ in March last year, and groups are continuing to merge.
It is also the most detailed indication from the DH of how health funds will be split. About £64.7bn will go to CCGs and £23.4bn to the NHS Commissioning Board, which has responsibility for specialist and family health services. Meanwhile, £210m will go to Public Health England and £2.1bn to local authorities, which are together taking on public health.
Currently all the spending is managed by primary care trusts. The DH indications are based on data collected from PCTs about how they spent their money in 2010-11.
HSJ has also estimated the budget per head of population for 183 of the CCGs. It shows a significant variation from £757 to £1,116.
There are different winners and losers compared to PCT allocations. The five PCTs with the largest per-head funding in 2010-11 – with an average deprivation index of 43 - were City and Hackney, Islington, Liverpool, Newham and Knowsley.
The average deprivation index of the top-five CCGs is 26.3, suggesting there is a much weaker link between funding and deprivation.
The NHS Confederation has warned that getting allocations wrong could mean commissioners have insufficient funds to pay for services, destabilising services.
The DH document, Baseline Spending Estimates for the new NHS and Public Health Commissioning Architecture, admits there are significant problems with the information.
It says some areas have underestimated spending on specialised services. But CCG budgets do not include funding for their “geographical responsibilities”, for example prisoners and people not registered with a GP, so overall final budgets are likely to be slightly larger than the estimates.
NHS Confederation deputy chief executive David Stout said the DH was attempting to match future funding for each service area to what has been spent in the past. Mr Stout said if a budget is significantly wrong it could mean “chaos ensues”.
However, if it correctly fixes spending to historic patterns, he said it means “you are stuck with whatever you spent before”. He said some CCGs are likely to believe their budget is too small to meet needs and complain.
National Association of Primary Care council member Johnny Marshall said budgets should be decided by health need rather than past spending, as far as possible. He said: “If CCGs are going to manage through a difficult economic period we need to ensure we have got these allocations are closely matched to health need.”
The Local Government Association has also complained that local council budgets for public health are fixed to past spending of PCTs on public health, which is very variable.
The DH document says it will decide at a later date whether to move CCGs and councils towards budgets based on needs, rather than past spending.