According to documents published by NHS England, CCGs across the country face ‘constitution change, merger or dissolution’ from as early as April 2020.
This comes after 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'. This suggests that England’s 191 commissioning groups could be cut by more than 75% to match the number of STPs.
NHS England has confirmed that CCGs can begin to apply to make constitutional changes, mergers or dissolve completely ‘at any time of year’, with changes taking effect from April 2020.
However, any applications for constitutional change involving a variation in a CCG’s boundary or its list of members must be made by 30 June this year in order to be implemented from next April.
CCGs wishing to merge from April 2020 must apply to do so by 30 September this year, although NHS England said late applications by 31 October 2019 will be considered ‘on a case by case basis where they support implementation of the long-term plan’.
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’.
'Right direction of travel'
Julie Wood, chief executive of NHS Clinical Commissioners (NHSCC) described the guidance as ‘helpful’ and said that the move towards integration was the ‘right direction of travel’ for CCGs.
‘The move to ‘typically’ one CCG per ICS was signalled in the long-term plan, but it is still not clear how many ICSs we will have, or where they will map on to current STP footprints,’ she said.
‘Clinical commissioners want to stay connected to their constituent places and for their systems to make sense for the populations they serve, which means it’s 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.’
In January, NHS chief executive Simon Stevens confirmed that there will be ‘significantly fewer’ CCGs under the reforms set out on the long-term plan - resulting in a ‘natural churn’ or redundancies.
His comments came during a House of Commions public accounts committee meeting, in which Gareth Snell MP asked Mr Stevens whether the major organisational reform meant there would be ‘significantly fewer’ CCGs in England - citing the figure of ‘around 44' to match the number of STPs.
Mr Stevens confirmed: ‘In all likelihood, yes.’ However, he insisted: ‘We haven’t declared a number of that nature. We don’t think it would be the right thing to pull a number out of the air like that.’