The NHS should have learned from the organisation hokey-cokey of the past two decades that merging CCGs will not them the sustainability and impact they need

Some events produce a Pavlovian response in healthcare leaders. The news of the first merger of clinical commissioning groups falls firmly into that category.

The gut reaction will be “here we go” – the long predicted rationalisation of CCGs has begun. But HSJ would caution against such a black and white judgement and hope that the NHS has learned from the organisational hokey-cokey of the past two decades.

Ridiculous numbers

The number of commissioners in some parts of the country does border on the ridiculous.

The idea that people in Kent, Surrey and Sussex require 20 organisations to commission their healthcare needs (excluding specialist and primary care or public health services of course) would surely cause titters of embarrassment if suggested now. This does not mean there will or should be a wave of CCG mergers.

‘CCGs can best command providers’ attention if they are buying on behalf of a large population’

The strength of CCGs is their local leadership who are close to their community, can provide clinical legitimacy and – crucially – able to engage GP colleagues. Merge too many CCGs and that USP crumbles.

However what should, and probably will, happen is an acceleration of CCGs and other commissioners working together.

CCGs can best command the attention of providers if they are buying on behalf of a large population, say around 500,000.

The attraction of alliances

Pressures on management spending are also making it difficult for CCGs to operate independently.

Tackling these issues does not demand merger, but it does make alliance increasingly attractive. These alliances could be with other CCGs, support units or local authorities.

This week’s suggestion by shadow Treasury chief secretary Chris Leslie that a future Labour government would encourage a leaner approach to public service commissioning is one clear sign of the direction of travel that – privately – the government is unlikely to argue with.

‘Fifty or so alliances might give CCGs the sustainability and impact they need’

The trail has already been blazed by local authorities, many of which share a wide range of back office functions and board posts, including chief executives.

CCGs in both Bradford and Berkshire are following suit by sharing chief officers.

The primary care trust clusters which preceded the reforms offer a logical and tested model for CCG management infrastructure.

So those looking for CCGs to rationalise to match, for example, the 150 PCTs they succeeded are barking up the wrong tree. But 50 or so alliances might give CCGs the sustainability and impact they need.