NHS Assembly co-chair and former RCGP chair Dr Clare Gerada told the House of Commons health and social care committee that she was against ‘more top-down reorganisation’ of CCGs.
After the NHS Assembly's first meeting, she added, it was clear that the committee also ‘overwhelmingly didn’t want forced mergers of CCGs and they certainly don’t want more top-down reorganisation’.
The committee's stance could set up a clash with NHS England as reforms set out in the long-term plan take shape and increase pressure on CCGs to join forces.
GPonline reported last month that the number of CCGs in England could be cut by up to 75% within a year as part of a service redesign that will see commissioning groups merge to align with local STPs and integrated care systems (ICSs).
Meanwhile, documents published by NHS England setting out how CCGs can apply for ‘constitution change, merger or dissolution’ make clear 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'.
NHS England chief executive Simon Stevens has also said that there will be ‘significantly fewer’ CCGs under the reforms set out on the long-term plan - resulting in a ‘natural churn’ or redundancies.
Pressure on CCGs to merge has grown since the NHS long-term plan, published in January, revealed that integrated care systems (ICSs) would be rolled out across England by 2021, 'growing out of the current network of sustainability and transformation partnerships (STPs)'.
There are just 44 STPs and NHS England has previously said these could evolve into ICSs. The long-term plan said there would be typically 'a single CCG for each ICS area', with CCGs set to become 'leaner, more strategic organisations' - suggesting that England’s 191 commissioning groups could be cut or merged to match the number of STPs.
Dr Gerada added that although the NHS Assembly was ‘absolutely in favour’ of the changes proposed by the long-term plan, supporting GPs through the reorganisation of primary care would be vital in ensuring its success.
‘I would like us to bring it back to the ground level and to make sure we don't forget what we’re trying to deliver in all of this,' she said.
'The worry I have is unless we engage care staff and GPs through facilitation - at the moment there’s no support around the legal frameworks, the governance frameworks, even the issue about PCNs being accountable for VAT, holding NHS pensions - unless we engage GPs what we’ve actually got is what we had prior to the 2012 act, paradoxically, where we have lots and lots of organisations, lots and lots of acronyms and [GPs are left] trying to make sense of all this.’
Dr Gerada went on to praise the long-term plan as ‘the right direction of travel’, and confirmed that the NHS Assembly had ‘a whole host of meetings’ in the pipeline, with plans to ‘look at workforce’ next.
Julie Wood, chief executive of NHS Clinical Commissioners (NHSCC) has previously told GPonline that the move towards integration was the ‘right direction of travel’ for CCGs, adding that it was ‘still not clear how many ICSs we will have, or where they will map on to current STP footprints.’
However, she did confirm that it was ‘likely that the future number of CCGs to be more than the current 44 STPs.’
Ms Wood said that NHSCC was already aware of ‘several’ CCGs planning to merge, adding: ‘We are pleased that NHS England has listened to views from us and no doubt others, to give as long as possible for essential stakeholder engagement and therefore extend the deadline for merger applications to September. Over the next few months we will be working hard to ensure our members are supported in any merger process and have the opportunity to learn from other CCGs that have already merged.’