The majority of primary care trust clusters are planning to set up their own commissioning support organisations for clinical commissioning groups, it has been reported.
An investigation by the Health Service Journal found that the 50 current PCT clusters plan to set up 41 CSOs.
However, clusters could face pressure to form bigger CSOs as strategic health authority clusters consider the viability of some of the proposals.
As things stand, there will be three CSOs in London, one in Birmingham and one covering the whole of the North East.
Smaller PCT clusters, such as Luton and Bedfordshire, have indicated they might need to extend beyond cluster boundaries to form a viable CSO.
So far only one CCG, Peterborough and Cambridgeshire, has indicated that it will provide most of its commissioning support in-house, funded by the management allowance for its 860,000 patient population.
A number of PCTs and emerging CCGs have issued tenders for commissioning support, including IT and information support, and indicated that they are willing for the private sector to take on some or all of these functions.
SHA clusters have also been carrying out risk assessments on CCGs. According to BMJ Careers, around 94% of emerging CCGs have passed the risk assessment on their configuration, with 62% rated as ‘green’ overall, 33% ‘amber’ and only 6% ‘red’.
The SHA assessment of CCGs looked at engagement with member practices, geography and patient population, relationship with local authority boundaries and size.
Groups rated green and amber are expected to take over commissioning budgets from April this year and then act as shadow CCGs with PCT support until full authorisation in April 2013.
The results of the risk assessment suggest that smaller CCGs may be allowed to go-ahead despite calls from the BMA before Christmas for CCGs to cover a minimum of 750,000 patients.
The SHA assessment rated 75% of groups as ‘green’ for their size and gave a red rating on size to only 5% of CCGs.
SHA clusters are due to receive detailed business plans from PCTs on commissioning support organisations by the end of March.