STRUCTURE: Five clinical commissioning groups in North London could form a federation to redesign acute, mental health and primary care services.

Camden, Islington, Barnet, Enfield and Haringey CCGs are looking at whether to form a federation or a joint committee to make decisions on how to redesign urgent and emergency care, mental health and primary care services, and address a potential £408m funding gap.

A report by the CCGs, in Haringey CCG’s October board papers, also said the area is considering a “potential north central London sub-regional London devolution application” because “collaborating on our respective powers, challenges and assets could add system-wide value”.

Camden Town, north London

The CCGs in north London hope to address a potential £408m funding gap

Mayor of London Boris Johnson revealed last week at an NHS England event that devolution deals will be piloted in north east London.

The growth in population across the five CCG areas is expected to outstrip national growth over the next five years. Twelve per cent growth in population up to 2020 is predicted in north central London, compared to 7 per cent nationally.

The CCGs agree they need to work together with local authorities and providers and at a “bigger scale” to bring about “system-wide change” to address the “challenging clinical demand landscape” and “remaining financial gap”, the report said.

The groups have prioritised redesign of acute services with an “immediate focus” on urgent and emergency care, mental health with focus on inpatient care, primary care, and the NHS estate.

The mental health work could include centralising specialised services to “reach threshold of ‘critical mass’”.

Commissioners will also look at how they can address the funding gap by “optimising the use and costs” of the NHS and local authority estates.

Several governance models are being considered, which include a federation where the CCGs delegate authority over certain areas to a central organisation, and a joint committee where decisions are taken by a majority vote of CCG representatives.