The must read stories and talking points in the NHS

All change

This week has seen news of the biggest shake-up in the clinical commissioning group landscape since the organisations were formed in 2013.

Following the approval (in principle) of four mergers in Leeds, Birmingham and Solihull, the Bristol area and Buckinghamshire, which HSJ revealed on Thursday, NHS England confirmed it also gave the green light (in principle) to turn seven CCGs into two in Berkshire.

A new Berkshire West CCG will be created by merging Newbury and District, North and West Reading, South Reading and Wokingham. Meanwhile, East Berkshire CCG brings together Bracknell and Ascot, Slough, and Windsor, Ascot and Maidenhead.

So that’s 18 CCGs becoming six by April 2018 – and consolidation from 211 in 2013 to 195 next year.

Until this week, mergers had only been approved and completed in two areas – Newcastle/Gateshead and Manchester.

Simon Stevens effectively put a freeze on them when he took over at NHS England in April 2014, but there were signals last year that the moratorium was being lifted – and clearly mergers are now back in.

It raises the question of whether the floodgates are open, taking CCGs rapidly towards: the 150-odd total at the end of the primary care trust era; the 50 commissioner ballpark figure favoured by many; or even just 20-30 regional system managers, as accountable providers take flight across the nation.

With health legislation off the table, widespread CCG mergers is one of the few routes open for simplifying decision-making and bringing systems together.

More than a dozen other CCGs have joined the ranks of those with shared accountable officers recently, and are working closer together in non-merger type ways, which could obviously develop into full statutory embrace. These are:

If you’re struggling to keep up with all this hokey-cokey, check the latest version of HSJ’s CCG map to see what’s going on in your patch.

This is your £4bn warning

The health service needs a minimum of £4bn additional revenue just to sustain day-to-day services, the NHS Confederation has warned.

Ahead of the budget later this month, the confederation, which represents 500 NHS organisations, has called for a £4bn uplift in the annual revenue budget over the next two years, as well as a transformation fund of £2bn a year.

It says further funding should also be awarded in addition to this, to cover an expected uplift in staff pay.

Confed chief executive Niall Dickson told HSJ a “comprehensive and objective” assessment of NHS funding would be needed in the longer term but the “precarious state” of services means additional funding is required urgently.

He added: “Even with this additional funding there will still be a major challenge to recruit the staff needed to keep the system going.

“We are also clear that anything the health service receives should be matched by equivalent levels of increase for adult social care.”