• Eight CCGs in Lancashire and south Cumbria to merge
  • Move is needed to make progress on “tricky decisions” around hospital reconfiguration
  • But merger could prove controversial in some areas

System leaders have drawn up plans to merge eight clinical commissioning groups into one organisation, to take some “really tricky decisions”.

The plan would see all the CCGs in Lancashire and south Cumbria form a single “strategic commissioner” by April 2021, after operating in shadow form from next year.

The region has already been classed as an “integrated care system” by NHS England, and has a substantial leadership team in place. The ICS team has a budget of £6.5m this year.

Gary Raphael, executive director of finance and investment for the ICS, outlined the plans during a small session at the NHS Expo event last week.

He said: “The place we need to get to is where we can enforce decisions on a majority basis. We are at that glass ceiling where consensus has got us so far and we’ve shown good signs of how we’re collaborating.

“But to get to some of the really tricky decisions to meet the requirements of the long-term plan is to break this glass ceiling and we think the way to do this is to move from eight CCGs to one.

“The CCG needs to be more about strategic planning, capital funding, the digital agenda and such like…. We think we can get a higher level of unity of decision making as commissioners.”

The CCGs are required to cut their costs by 20 per cent, in line with national policy, but Mr Raphael said “we’re not talking about major job losses”.

The majority of people currently working for CCGs would transfer to the “integrated care partnerships” operating in five areas, he said. The ICPs largely cover the footprint of the acute trusts.

The CCGs’ merger is likely to prove controversial in parts of the region, however, such as in central Lancashire where GPs recently rejected proposals to merge the CCGs covering Greater Preston, and Chorley and South Ribble.

Objections could also spring from Blackburn with Darwen and Blackpool, which are both served by unitary local authorities.

The other CCGs cover Morecambe Bay, West Lancashire, Fylde and Wyre, and East Lancashire.

Kevin McGee, chief executive of East Lancashire Hospitals Trust, recently said leaders need to have “honest conversations” about the acute reconfigurations that are needed in Lancashire. The four acute providers reported a combined deficit of £133m last year.

NHSE confirmed the move to larger commissioning groups earlier this year, when it said every area of the country should be covered by an ICS by 2021, and that this would “typically” involve a single CCG.

In a statement, the ICS said the plan would ensure the effective development of primary care networks and ICPs in each area.

Andrew Bennett, executive lead for commissioning, added: “We’ve been working on a place-based approach to commissioning over the past two years, building on the best work undertaken by local organisations to integrate care in neighbourhoods and local areas. We have also acknowledged that at times, commissioning activity has been fragmented and a single CCG will allow us to take a collective approach to setting standards and outcomes.

“NHS England [has] set out a clear process for CCGs to follow in these circumstances. This will involve sharing a formal case for change with our staff, our partners and our member practices.”