Many clinical commissioning groups are currently “too small to survive”, NHS Future Forum chair Steve Field has warned.

Professor Field said that as commissioning groups began to increasingly understand future governance arrangements some would also realise they needed to merge to continue.

Speaking last week at a meeting of the All Party Parliamentary Group on Primary Care and Public Health, he said: “The key is going to be the authorisation process.

“There is a toolkit that is being trialled at the moment that seems pretty good to help consortia look at how they can move forward into the new world of clinical commissioning groups.

“It will become apparent to many of them that they are probably too small to survive in the new world and they will need to look at merging,” he said.

A document produced by NHS Yorkshire and Humber, with input from the Department of Health and seen by HSJ, demonstrates some would be too small to employ sufficient staff to carry out their functions, because there will be a limited management allowance.

Speaking separately to HSJ, Professor Field said he thought commissioning groups with a population of less than 10,000 would struggle to influence decision making in their local areas. He said: “They are not going to be able to make very many decisions for their patients.”

They should “start looking around them now for groups with whom they should merge with” but try and “maintain their local flavour” within any new, larger grouping, he said.   

Also speaking at the meeting, NHS Cumbria medical director Michael Bewick said primary care trust clusters should play a role in starting to “bring together clinical commissioning groups to a reasonable size”.

“I think a lot of them are too small to make these bigger transformational changes that are necessary,” he said.

Dr Bewick added: “You can make a much more cogent argument about why it’s important to restrict the growth of secondary care and to make it shrink because you’ve actually got something in place that the public will trust and realise all the professions are tied into.”

However, Professor Field said that while the forum’s report had “triggered” an “entirely appropriate” response, he remained opposed to other health professions having seats on the boards of commissioning groups.

He said: “It has gone further than we recommended and in some areas that might cause some difficulties. I think it’s a mistake to say there must be a specialist doctor on each of the boards.”

He said he was not opposed in any way to them being on boards but that it should not be prescribed, as the make up of boards needed to reflect local circumstances.

Professor Field added: “All the consortia I’ve met, and I’ve met many hundreds, are all involving specialists and nurses anyway and I’m not into tokenism.”

Responding to Professor Field’s comments on commissioning group size, NHS Alliance chair Michael Dixon said it should depend largely on location than a set ideal.

He said: “At this stage in the game, no one should discriminate on the basis of size provided the CCG has a reasonable business plan.

“We are embarking on new territory, we should not carry forward the assumptions of the past and if ‘small is beautiful’ CCGs can show their worth, then good luck to them,” he said.

“CCGs should decide. It is not up to the NHS Commissioning Board or anyone else to dictate – if only because the every part of the country is different, there is no good evidence and if a group of people are sufficiently determined I suspect they will be able to make a success of this whatever their size,” Dr Dixon added.