Major Reorganisation of Local Health Services Planned

Eight clinical commission groups could be merged into single organisation

A significant change in the organisation of the NHS in west London is being considered after the publication of a new report. This advocates the consolidation of eight clinical commission groups (CCGs) into a single body. The CCGs affected would be Brent, Central London, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow and West London.

CCGs were created following the Health and Social Care Act in 2012, and replaced Primary Care Trusts on 1 April 2013. They are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.

The North West London Collaboration of CCGs has published a case for change, setting out why they believe a single organisation could enable quicker decisions, greater efficiency and more resources being freed up for patient care rather than administrative costs.

They report also claims a merger could enable the CCGs to reduce health inequalities, ending any suggestion of a postcode lottery by making services equitable across the eight boroughs. The document makes clear, however, that it would be critical for commissioners to retain key relationships at local level, working closely with local councils, other NHS organisations, Healthwatch and the voluntary sector.

Earlier this year, NHS chief executive Simon Stevens confirmed that there will be ‘significantly fewer’ CCGs resulting in a ‘natural churn’ or redundancies.

Mark Easton, Accountable Officer for the eight CCGs, said: “We are exploring the option of moving to a single CCG, with a view to merging the eight organisations.

“We can work more effectively for patients as a single statutory body. We have unwarranted variation in health outcomes and duplication across eight boroughs – by reducing this inefficiency we can improve quality and reduce inequalities. We need to save money – the running cost reductions will make a small contribution to our savings requirement, but the more significant savings will come from reducing duplication and operating as an integrated rather than competitive system.”

“We would of course retain a focus and a presence in each of the eight CCG areas and we would want local relationships and programmes to continue to be managed at local level. We are talking to local authority colleagues, provider trusts and local GPs about how we would continue to work together in future. In all of this, it is crucial that services remain accountable to local residents in each borough and that patients and the public have the chance to shape and feedback on health services.”

The aim is to move towards a single partnership across all eight boroughs, known as an integrated care system (ICS), in which all health and care organisations in North West London work as a single team. It is expected that this ICS will include a single CCG.

New national guidance in the NHS Long Term Plan published in January suggests reducing the number of CCGs so that there is ‘typically one per Sustainability and Transformation Partnership area’ – which would mean 44 CCGs nationwide and five in London. The document also states that, by 2020/21, individual CCG running cost allowances ‘will be 20% lower in real terms than in 2017/18, and CCGs may therefore wish to explore the efficiency opportunities of merging with neighbouring CCGs’.

The CCGs will be discussing the proposed move to a single organisation at governing body meetings and a decision is expected later this year. There will also be discussions with GP members, local authorities, provider trusts and Healthwatch organisations.

May 29, 2019