• Officials discussing whether to require only one CCG per ICS
  • Stricter rule would reduce CCGs from 191 to 40
  • Some local leaders support move, but some ICS are strongly opposed
  • ICS lead says: “The days of central prescription on these issues should be over.”

NHS England is considering a stricter approach to clinical commissioning group mergers, which would drive a reduction from 191 to around 40.

The proposal, to move to a requirement that each integrated care system has only one CCG, faces strong opposition from some local system leaders, who want to keep multiple groups. Many others support the stricter line, however.

The NHS long-term plan in January said only that there would “typically” be “a single CCG for each ICS area”. This is being applied variably, and many areas are planning CCG mergers which do not match their ICS or STP.

NHSE directors are now discussing with ICS and STP leaders whether to move to the stricter requirement, and are likely to make a decision in coming weeks, several senior sources said.

If adopted, it would in theory mean a reduction from today’s 191 CCGs to around 40 over the next two years, as there are currently 42 STPs and ICSs. In theory STPs/ICSs could split, increasing the number, but this has happened nowhere so far.

In July, HSJ found 86 CCGs were proposing to merge next year, but several of these plans do not match full ICS areas.

The policy change would be most difficult for large systems with multiple strong localities and councils, including leading ICSs like Greater Manchester and West Yorkshire and Harrogate, and the move is opposed by these. One of their objections is it could damage links with local authorities, which in a few cases share senior leaders and staff with CCGs.

West Yorkshire and Harrogate ICS leader Rob Webster said: “We have a consistent and well-founded strategy on CCGs that sees more done at WY&H level through our joint committee, more done in each of our six places through joint arrangements with local authorities, and within each place some CCG staff and functions transferring into provider groupings to help collaboration and joined up care.

“Moving to one CCG for WY&H would risk undermining our approach and our relationships with our local authorities, who are equal partners. We have no intention of doing so. The days of central prescription on these issues should be over as we move away from a focus on structure and onto services, populations and improving outcomes.”

Chris Ham, Coventry and Warwickshire STP chair and former King’s Fund chief executive, said: “There needs to be greater clarity on roles and functions before NHSE decides on form.

“What will be done by systems and what at place? How can local authorities, GPs and others be assured that their interests won’t be ignored as CCGs merge? The move is rightly to fewer larger CCGs but maybe not one per system.”

However, another ICS leader told HSJ a strict blanket rule would be useful for most systems, and would aid simplification of structures and decision-making. There have long been calls – especially from provider trust leaders – for substantial CCG mergers and cost reductions.

National officials and STP/ICS leaders are also debating potential guidance to define the roles of STPs and ICSs, and how they relate to the seven new NHS England/Improvement regional teams created in April – for example, how much assurance and performance management should be with the ICS.

An NHSE spokesman said: “As the NHS long-term plan sets out, in future it is expected that there will typically be one CCG per ICS.

“As part of this, the NHS is required by government to reduce administrative costs by another 20 per cent so that savings can be reinvested in local health services, so CCGs are therefore right to look for solutions which deliver efficiencies as well as more joined-up decisions within a local area.”

NHS Clinical Commissioners chief executive Julie Wood said: “The direction of travel towards more integration is the right one, but mergers should be decided locally. Our members are very clear that a one to one relationship between a CCG and the current ICS footprint is not the right answer in all circumstances and we continue to work with NHSE to determine how ‘atypicality’ should work and be allowed to continue.”