A clinical commissioning group has opted out of a regional strategic commissioning arrangement and another CCG has asked for more assurances before joining.

The “single strategic commissioner” arrangement for Kent and Medway could now include only six of the eight CCGs originally planned after Thanet pulled out and South Kent Coast GPs asked for more detail on local autonomy.

The accountable officer for South Kent Coast, Hazel Smith, had already been announced as the transitional “director of partnerships” for the new commissioning body. She resigned from Thanet CCG last week.

The single strategic commissioner arrangement was due to start in April.

In a statement Thanet CCG said it had “decided not to pursue a path to be a part of formal arrangements” for the commissioner. GPs on South Kent Coast CCG’s governing body have asked for more detailed information and the balance between working at scale and retaining local autonomy before making a decision on whether to join. A further meeting with them is being arranged.

The single strategic commissioner was seen as a potential pathway to a single CCG covering the entire county – although no decision has been made on this.

A spokesperson for the six CCGs said: “The development of the strategic commissioner is underway and all eight CCGs’ governing body members, lay members and senior management teams are invited to be part of shaping it, including looking at which parts of CCG commissioning functions and responsibilities should be led by the strategic commissioner and which by individual CCGs.”

The single commissioner will share a single accountable officer – still to be announced – and a senior management team. The accountable officers of the existing CCGs have all taken on transitional roles.

The two CCGs’ reluctance to get involved is thought to be linked to concerns that their areas could lose out as health services in the county change. Thanet is certain to lose its stroke unit, for example, as the county moves to three hyperacute and acute stroke centres. Consultation on options for other acute services in the east of the county is expected to start later this year.

Thanet CCG has said it would continue to work with the other CCGs on development of the strategic commissioner and on a range of strategic service improvement plans, recognising some functions would be better undertaken as part of a larger geography.

  • Update, 5 March 10:30am

Hazel Smith resigned as Accountable Officer for Thanet CCG with effect from 28 February.

A CCG spokesperson said she remains as accountable officer for South Kent Coast CCG, “with the statutory responsibilities that entails”.

“This will continue to be the case unless or until there is a decision by the CCG’s governing body and GP membership to change its governance arrangements.”

In addition to her AO role, Ms Smith is taking on the additional transitional role of director of partnerships for Kent and Medway.