HSJ has obtained details of how primary care trusts plan to form the 50-odd clusters tasked with leading the local transition to consortium commissioning.

***Updated 4 February 2011, see new map in “related files”***

Plans from all regions apart from the South West and Yorkshire and The Humber show the biggest cluster is likely to be Greater Manchester, which could consist of up to 10 PCTs and cover a population in excess of 2.6 million.

At present Tees cluster is the smallest planned cluster with four PCTs covering a population of just 560,000.

PCTs have until June this year to cluster. The potential clustering arrangements have caused heated debate as they involve the merging of management teams. Clusters will have one chief executive who will be the accountable officer. PCTs within the clusters will retain their boards and statutory responsibilities but could share executive and non-executive directors.

At present, the around half of planned clusters consist of three or more PCTs and will cover populations averaging 1 million, compared with the PCT average of 350,000.

However as many as seven large PCTs - Cumbria, North Yorkshire and York, Norfolk, Suffolk, Surrey, Lincolnshire and Hertfordshire - may continue as standalone PCTs. Hertfordshire’s two PCTs merged to become a single organisation last year.

New Department of Health guidance issued earlier this week confirmed clusters would lead the local “smooth transfer of all residual PCT functions to new structure” and in 2012-13 “prepare handover of statutory responsibilities”.

However, senior NHS sources have suggested clusters could survive beyond the abolition of PCTs planned for April 2013. At last week’s Commons public accounts committee Sir David Nicholson, chief executive of the NHS and of the proposed NHS Commissioning Board, said the board would have regional arms.

He said: “It will have management tiers. You can call them regions or not but there won’t be me and then all the consortia.”

Earlier this week the DH’s response to the Commons health committee’s report on commissioning said: “PCT clusters will continue to act as transition vehicles until at least April 2013. Beyond April 2013, it will be for the Commissioning Board to determine how it organises itself. [The board] is expected to take an early view of any local support structure it needs and the extent to which clusters can act as a pathway to that structure.”

But PCT Network director David Stout told HSJ it did not mean all clusters would keep their initial form. He said when consortia were “switched on” only a part of the remaining cluster functions would relate to the Commissioning Board, which may not be sufficient to justify their continued existence.

Paul Zollinger-Read, the departing joint chief executive of Cambridgeshire and Peterborough PCTs, said although clusters “are clearly part of the transition”, it was unlikely the board would need as many as 50 “semi-autonomous outposts”.

Dr Zollinger-Read will now focus on his role as part of the DH’s transition team. He said clustering would be a challenge for PCTs with very different financial situations. Cambridgeshire underspent by £0.5m last year while Peterborough overspent by £12.8m. While clustered PCTs cannot pool their budgets they could “look at how you use management resources” to tackle financial problems, he said.

Meanwhile there are concerns clustering will undermine integration with local authority social care services. Graham Burgess, the joint chief executive of Blackburn with Darwen Council and NHS Care Trust Plus, told HSJ’s sister publication Local Government Chronicle: “Integration arrangements which are seen to be really cutting edge are being undermined.”

The DH guidance said individual PCTs would remain responsible for maintaining joint working arrangements with local authorities up until the end of 2012-13 and directors of public health “will not be consolidated at a cluster level”, to support the transfer of responsibilities to local authorities.

*** This story was updated on February 3rd. HSJ apologises for errors included in the original version. The situation is developing with a number of cluster arrangements still being negotiated. ***

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