Commissioners and future commissioners in the North East, like everywhere else, have much to do in the next 16 months, but there are signs of change.

Within County Durham Primary Care Trust, five small GP groups have agreed to merge to become two larger ones which, it is hoped, will go on to become statutory clinical commissioning groups from April 2013.

A reader commenting on HSJ Local insists the previous groups – Easington, Sedgefield, Derwentside, DCLS and Dales – will retain autonomy. They say: “The above localities have insisted on keeping their sovereignty and identity with a delegated scheme for decision making and budgets. Forming two CCGs is a vehicle to risk share via pooled budgets and share contracting.”

Meanwhile, the North East PCTs have confirmed they are also seeking a pretty large economy of scale, by developing a single commissioning support unit for the region’s CCGs, which will cover a 2.6m population.

In South Tyneside, the emerging CCG already matches its PCT area – but it may have other problems. The patch historically overspends on acute care, and makes up for it by underspending in primary care and public health. But the CCG’s budget will not include those budgets – hindering South Tyneside’s ability to balance the books.

A finance board paper observes that although “‘bottom line’ variance [this year is in] surplus, the main driving factors are budgets that will ultimately transfer to either the local authority or the NHS Commissioning Board post April 2013”.

It says: “The CCG working alongside the PCT must take actions to remedy the secondary care over-performance as current forecasts will not be sustainable.”