• CCG merger in north west London would create single body covering 2.2 million people with £2.9bn allocation
  • Merger in south west London would create 1.7 million population group with £2bn allocation

Clinical commissioning groups in London are planning mergers that would form the two largest CCGs in England.

In north west London, the eight groups covering the patch have produced a “case for change” paper, with a proposed timeline to merge by April 2020.

The eight CCGs cover a population of 2.2 million and have a combined financial allocation of £2.9bn for 2019-20. They make up the North West London Sustainability and Transformation Partnership.

HSJ understands the six CCGs in south west London are also pursuing a merger into one organisation by March 2020. It would be the second largest CCG, behind its neighbour in north west London, covering a population of 1.7 million with a 2019-20 allocation of just over £2bn. The area makes up South West London STP.

At present, the largest CCGs by population are Devon, and Birmingham and Solihull. These have about 1.2 million people each and both formed from mergers in recent years.

The NHS long-term plan states England should be covered by integrated care systems by April 2021, and says a “typical” ICS should have one CCG across its patch. Several existing ICS have multiple CCG members, however.

The north west London CCGs said in a statement they believe a merger would save money and iron out unwarranted variation, “ending any suggestion of a postcode lottery by making services equitable across the eight boroughs”.

The eight CCGs have been meeting as a joint committee since December 2018 and have had a single accountable officer, Mark Easton, for a year.

They are now consulting on the merger with local Healthwatch bodies, GPs, local authorities and provider trusts, and are looking to put a final proposal to NHS England in September.

The case for change includes a possible structure for the ICS, which incorporates a “CCG local delivery team” in each borough-wide “integrated care partnership”. The ICPs will include secondary care providers, primary care networks, local government and the voluntary sector.

The eight CCGs are also developing a system-wide financial recovery plan, having begun the financial year with a combined deficit of £100m.

The merger will help reduce the running costs of the CCG, which will make “a small contribution to our savings requirement,” according to Mr Easton.

The bigger financial savings “will come from reducing duplication and operating as an integrated rather than competitive system,” he added.

The merger will likely lead to job cuts in the unified CCG but, as there are several open vacancies and interim staff employed across the patch, “there are likely to be few compulsory redundancies among substantive NHS staff”, the case for change paper said.

In south west London, one of the boroughs – Croydon – recently went out to appoint a “single leader” for both Croydon CCG and Croydon Health Services Trust. It is not clear whether this would complicate an STP-wide CCG merger.

The eight CCGs planning to merge in the north west are:

  • Brent;
  • Central London (Westminster);
  • Ealing;
  • Hammersmith and Fulham;
  • Harrow;
  • Hillingdon;
  • Hounslow; and
  • West London. 

The six CCGs planning to merge in the south west are:

  • Croydon;
  • Kingston;
  • Merton;
  • Richmond;
  • Sutton; and
  • Wandsworth.