• A third of English population now overseen by 13 CCG accountable officers, working across 59 CCGs
  • Population managed by commissioning leaders varies from 2 million to fewer than 250,000
  • NHS England’s long term plan expected to propose a restructuring of commissioning across STPs

Almost a third of England’s population is now overseen by 13 clinical commissioning group leaders, according to new analysis.

HSJ has looked at how many CCGs in each “sustainability and transformation partnership” share an accountable officer, and which regions have the highest populations per commissioning leader.

There is significant country wide variation in the rationalisation of commissioning posts across England. Thirty one per cent of the population is now managed by 13 AOs who work across 59 CCGs. They are located in the 12 STPs that have the highest levels of joint CCG leadership.

In comparison, there are 11 STPs in which the average population served by each CCG AO is less than 300,000 people (see interactive chart).

As STPs have emerged, there has been a requirement for CCGs to significantly reduce their management costs, which has offered greater incentive to move to shared leadership models. NHS England’s 10 year plan is also likely to propose a restructuring of the commissioning system.

The health economies with the largest population per AO are both based in London, each serving around 2 million people. The North West and North East London STPs both have one AO — Mark Easton and Jane Milligan — for their groups of eight and seven CCGs respectively.

Shropshire and Telford and Wrekin STP has the lowest average population managed by each AO, at just over 243,000. The two CCGs in the region each have an AO, and there are “currently no plans in place” to share one.

Shropshire CCG acknowledged the “national direction of travel for CCGs is to create single commissioners at an STP footprint level”, but said this was a “complex process”. Telford and Wrekin CCG said it “jointly commission[s] a range of services [and] will continue to explore new ways of collaboration”.

The two CCGs have previously struggled to reach shared decisions, such as over the highly controversial reconfiguration of emergency services in the patch.

Although there are fewer AO posts, Julie Wood, chief executive of NHS Clinical Commissioners, told HSJ that new roles are being created beneath them, including chief nurses and transformational directors.

She said: “As CCGs share AOs there are some economies of scale but an AO working across a lot of CCGs can’t be everywhere. You need to put something back in, in terms of leadership of those places.

“Systems need to work through what commissioning changes come out of long term plan and what that means for the sort of leadership roles needed in each place”.

Under the long-term plan, regions will likely be asked to commission care at three levels: neighbourhood (populations of 30,000-50,000); place (populations of 150,000-500,000); and system (populations of 1 million or more).

Sussex and East Surrey STP, which has a single AO across eight CCGs covering a population of 1.8 million, said its model ensures commissioning is “carried out in a more joined-up way” and provides “consistent strategic oversight”.

Greater Manchester has a high number of AOs, but this reflects the move to integrate with local authorities. More than half of the 10 positions have now been filled by the corresponding council chief executive on a shared basis.

Cheshire and Merseyside STP has nine AOs across 12 CCGs, although the four CCGs in Cheshire are currently searching for a single AO.

Although most AOs remain in post in Norfolk and Waveney STP, a spokesman said plans to develop a single management team across all five CCGs are set to be approved in November. The five CCGs will retain statutory independence.

There does not appear to be a clear correlation between the quality of commissioning in an area and the size of population covered by an AO.

CCG accountable officers in each health economy

STPNumber of CCGsNumber of CCG leaders
Bath, Swindon and Wiltshire 3 3
Birmingham and Solihull 1 1
Bristol, North Somerset and South Gloucestershire 1 1
Buckinghamshire, Oxfordshire and Berkshire West 3 2
Cambridgeshire and Peterborough 1 1
Cheshire and Merseyside 12 9
Cornwall and the Isles of Scilly 1 1
Coventry and Warwickshire 3 2
Derbyshire 4 1
Devon 2 1
Dorset 1 1
Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby 5 4
Frimley Health 3 2
Gloucestershire 1 1
Greater Manchester 10 10
Hampshire and the Isle of Wight 7 4
Herefordshire and Worcestershire 4 1
Hertfordshire and West Essex 3 3
Humber, Coast and Vale 6 5
Kent and Medway 8 1
Lancashire and South Cumbria 8 6
Leicester, Leicestershire and Rutland 3 3
Lincolnshire 4 3
Mid and South Essex 5 4
Milton Keynes, Bedfordshire and Luton 3 1
Norfolk and Waveney 5 4
North Central London 5 1
North East London 7 1
North West London 8 1
Northamptonshire 2 1
Northumberland, Tyne and Wear and North Durham 6 5
Nottinghamshire 6 2
Shropshire and Telford and Wrekin 2 2
Somerset 1 1
South East London 6 2
South West London 6 2
South Yorkshire and Bassetlaw 5 5
Staffordshire 6 1
Suffolk and North East Essex 3 2
Surrey Heartlands 3 1
Sussex and East Surrey 8 1
The Black Country 4 3
West Yorkshire 9 6
West, North and East Cumbria  1 1

 Updated at 5.30pm on 5 November 2018 to clarify the information provided by Norfolk and Waveney STP.