The 50 primary care trust clusters could set up as many as 41 commissioning support services nationwide, an HSJ investigation has revealed.
However, that number is set to reduce as some of the cluster-sized organisations are not considered viable in the medium term.
Mergers and more regional collaboration are already planned following the first wave of assessment from strategic health authorities.
Clusters were almost universally keen to stress their plans were at an early stage, and that discussions were ongoing about the final size of the CSS they are setting up, and what support services would be on offer.
“Prospectus documents” detailing their initial commissioning support offers were submitted to SHAs at the end of December. SHAs have now considered the proposals and fed views back to clusters. Detailed business plans are due by March.
In the North East, the proposed CSS covers the entire region.
Although the East Midlands initially planned one CSS per PCT cluster, there are indications that more collaboration will take place across clusters. Philip Da Silva, director of commissioning development for the Derbyshire and Derby City cluster, told HSJ: “The starting point is the fixed geography of the cluster – however we shouldn’t be constrained in our thinking… the current plans are likely to change.”
He said clusters in the East Midlands were learning from the example of specialist commissioning at a regional level.
In the Midlands and East several clusters said they would work on a “hub and spoke” model, offering different services to each CCG depending on its in-house capability. For example, Nottinghamshire’s CSS will offer fewer services to the CCG in Nottingham, as this will be larger than others in the county and able to do more in-house.
A spokeswoman for the Luton and Bedfordshire cluster said “any future viable CSS” would have to be wider than the cluster’s boundaries.
“Initial positive discussions have been held with PCT clusters within the East Midlands,” she said.
The Black Country cluster said it was exploring “possible opportunities for building closer working relationships with neighbouring clusters such as Birmingham and Solihull”.
HSJ also understands a merger is likely between CSSs being set up by the Berkshire and Oxfordshire and Buckinghamshire clusters.
In London, three CSS organisations are planned. HSJ understands there will be one CSS each for the north east and north west of the capital. However, doubts remain over the viability of one CSS for south London and a meeting between cluster officials and the SHA is planned for next week.
Clusters in the South West would not outline their plans. Current plans are understood to feature one CSS per cluster; however, HSJ understands the Bath and North East Somerset/Wiltshire cluster had proposed setting up a CSS, but this is now expected to merge with a commissioning support service from Swindon and Gloucestershire.
Cambridgeshire and Peterborough CCG plans in-house commissioning support
Cambridgeshire and Peterborough is the only primary care trust cluster not currently planning to set up a commissioning support service.
The cluster is setting up only one clinical commissioning group, to serve a population of 856,000. HSJ’s investigation revealed that because the planned CCG is so large, it will not be necessary to generate economies of scale by providing commissioning support jointly with neighbouring areas.
The cluster expects that its CCG will have enough funding from the running cost allowance, which is calculated per head of local population served, to provide most of its own commissioning support in-house.
The CCG’s own services will then be used to support its “locality commissioning groups”, which will do most commissioning with devolved budgets on smaller patches within the Peterborough and Cambridgeshire area.
However, plans remain provisional, as the single CCG for the cluster was formally agreed only at the beginning of 2012.