Clinical commissioning groups taking on responsibility for primary care will have to work within current “running costs as far as possible”, NHS England has said.

This condition was spelled out in a letter circulated to CCGs and NHS England area teams last week, from the organisation’s chief operating officer Dame Barbara Hakin and its commissioning development director Ros Roughton.

The letter follows an announcement by NHS England’s chief Simon Stevens this month that he would soon invite CCGs to apply for responsibility to co-commission primary care services.

This has been the sole responsibility of NHS England since April last year.

The letter sets out further details of the co-commissioning plan, points towards likely limitations and includes details of how to apply (see attached).

It stated: “CCGs will be expected to ensure that their proposals take advantage of synergies with existing areas of CCG activity and enable functions to be discharged within existing CCG running costs as far as possible.

“Expressions of interest will need to indicate where proposals would rely upon area team staff working under the supervision of CCGs.”

This suggests the transfer of staff and running cost funds from NHS England to CCGs may be very limited.

Many CCGs already report problems operating within their running cost limit - which is fixed at around £25 per member of their population.

CCG leaders have previously said they would need additional running cost funds if they were to take on additional responsibility.

Meanwhile, the letter also asked CCGs to specify the preferred form a co-commissioning arrangement could take and what the timetable for implementing it should be.

It said there are a “spectrum of potential forms”, starting with simply “greater CCG involvement in influencing commissioning decisions made by NHS England area teams”.

Another option would be “joint commissioning arrangements, whereby CCGs and area teams make decisions together, potentially supported by pooled funding arrangements”.

A further step towards CCG responsibility would be “delegated commissioning arrangements, whereby CCGs carry out defined functions on behalf of NHS England”.

In this case NHS England’s area teams would “hold CCGs to account for how effectively they carry out these functions”.