CCGs may go the way of GP fundholding, according to senior NHS manager Sir Robert Naylor.
The Chief Executive of UCLH said the new structure would create “a vacuum of strategic leadership and direction”, making further reform necessary.
He also claimed that “rationalisation” of services was already being arranged between providers “behind the scenes”.
Speaking at the King’s Fund, Naylor said: “The jury is still very much out on whether the latest commissioning arrangements will last any longer than fundholding did.”
Whoever won the next general election, he said, it was inevitable that another NHS reorganisation would be needed to provide “strategic leadership”.
In the absence of SHAs, Naylor argued, the CCGs would not be “cohesive enough” to determine healthcare priorities in major cities.
He was sceptical of the ability of the NHS Commissioning Board to provide the necessary “strategic leadership”.
Speaking at the Commissioning Show in the same week, Naylor said: “My main fear is that GP commissioning will lead to ever-increasing fragmentation.”
His experience of London-based commissioners indicated that their concern was with day to day service issues, and they were unable to make strategic decisions on issues such as “the future of cancer care”.
Those decisions were being made “behind the scenes in discussions between providers”, he said.
An example was the way UCLH had “swapped” services with the Royal Free Foundation Trust, with one taking on neurosurgery and the other liver surgery.