STRUCTURE: An emerging London clinical commissioning group and its patient forum are lobbying the health secretary to protect it from forced merger, after the CCG’s chair raised concerns.

The patient forum of the Victoria Clinical Commissioning Group in Westminster agreed to write to Andrew Lansley about its fears the Department of Health will set a minimum 200,000 population for CCGs.

Members of the forum have also been urged to write to their Conservative MP Mark Field, calling on him to lobby Mr Lansley in turn.

Minutes of a meeting of the group this week, seen by HSJ, show Dr Munday told the group he believed the government would take “a critical decision” on the size of patient groupings on 24 November - the date the NHS Operating Framework 2012-13 is expected to be published - and that “it is feared that a financial viability threshold of over 200,000 patients may be imposed”. Currently the CCG has eight practice members with around 50,000 patients in total.

If it is forced to become larger, he said, “plan B” was “exploring a federated structure with the like-minded Central London Health CCG”.

Dr Munday is a former Conservative councillor who rallied emerging GP commissioning leaders to support Mr Lansley in the spring. He told HSJ the minimum size would be dictated by the CCG management cost allowance, which is due to be confirmed in the operating framework later this month.

There are fears it will be too low for small groups to be affordable. Dr Munday said he was calling for an allowance of £1m plus £20 per patient, which he said would allow groups of VCCG to survive.

The same patient forum meeting also discussed support for the CCG’s commissioning intentions. Minutes say: “The forum gave support to the establishment of the locally and patient focussed VCCG, approved the general direction of the [CCG’s] commissioning intentions especially the retention of and enhancement of the services from the South Westminster Centre for Health and if necessary the seeking of a federated relationship with CLH whilst maintaining as much as possible the distinctive nature of patient representation and influence of the area in any arrangement.”

As well as being CCG chair, Dr Munday is a partner at a practice with a surgery at South Westminster Centre for Health. However, he said he rents space at the centre for a branch surgery, and would not have a financial interest in extending services there. Most are currently run by several London community and acute providers.

Dr Munday said in a statement: “We would prefer to move forward as a small CCG and together with like-minded smaller CCGs are discussing with ministers how we might do this. However, we need to consider what we would do if this was not possible and it makes sense to discuss how we could move forward together with our neighbouring CCG, Central London Healthcare.

“The South Westminster Centre for Health is a large health centre owned by Chelsea and Westminster Trustees. A wide range of services are provided by a number of organisations including Imperial, Chelsea and Westminster, Central London Community Health and Healthshare who all lease space in the centre.  The health centre has proved popular with local people and VCC wish to build on this by retaining and enhancing services where appropriate.

“I have a small branch surgery in the health centre which is also leased so there is no conflict of interest.  As a general point of principle, if a conflict of interest arose with any of our members, they would be asked to step out of any procurement process.”