NHS England has approved unprecedented changes to clinical commissioning groups across the country, consolidating 18 CCGs into six.
The national body’s commissioning committee has approved the six mergers in principle with the expectation they will come into force in April 2018, the Health Service Journal reports.
It is by far the biggest commissioning consolidation since CCGs were established in 2013, with mergers approved in only two areas - City of Manchester and Newcastle Gateshead - prior to this.
The mergers to take place in 2018 are:
- Birmingham CrossCity, Birmingham South and Central, and Solihull;
- Leeds West, Leeds North, and Leeds South and East;
- Bristol, North Somerset and South Gloucestershire;
- Aylesbury Vale and Chiltern;
- A new Berkshire West CCG, created by the merger of Newbury & District CCG, North & West Reading CCG, South Reading CCG and Wokingham CCG
- A new East Berkshire CCG, created by the merger of Bracknell & Ascot CCG, Slough CCG, Windsor, Ascot & Maidenhead CCG
The mergers remain dependent on the CCGs meeting several conditions, such as chair and senior management appointments, and a single commissioning and finance strategy.
An NHS spokeswoman said: “Each proposed merger builds on current joint working between local health areas. NHS England’s commissioning committee has approved these mergers subject to specified conditions and, if met, the new arrangements will come into place at the start of the new financial year.”
Meanwhile, it was also announced last week that four CCGs in Sussex are to share a single accountable officer as they start working as a “commissioning alliance” while from next April the six CCGs in Staffordshire will share a single accountable officer.
The two new Berkshire CCGs will match the patches of their predecessor primary care trusts, which were abolished in 2013 - as will the newly merged CCGs for Leeds and for Buckinghamshire.
With some notable exceptions, the majority of CCGs involved in the six mergers are well regarded and are already cooperating, with shared leadership and joint commissioning.
The exceptions are Bristol, which is rated requires improvement, and North Somerset, South Gloucestershire and Solihull, which are inadequate.
The biggest of the new CCGs will be Birmingham and Solihull, which, taking into account a shared west Birmingham budget with West Birmingham and Sandwell CCG, will have a budget of about £2bn and cover 1.3 million people.
The shift will herald a major reconfiguration of service commissioning across Birmingham, with new multi-provider or prime provider contracts for service across the city, based on distinct services or diseases, such as diabetes. A similar, but separate, process will take place for Solihull.
The exact make-up and priorities for these new contracts will be determined by a “refresh” of the Birmingham and Solihull sustainability and transformation plan, which is expected next month.
While having a bigger budget, HSJ understands the merged CCG will likely be slimmer, devolving some of its responsibility to lead providers or accountable care partnerships.
Both merged Berkshire CCGs will be involved in one of the first nine accountable care systems picked by NHS England in March.
For the four Berkshire West CCGs, plans to merge have been in development since 2014.
The three CCGs that will form East Berkshire CCGs are all part of the highly regarded Frimley Health sustainability and transformation partnership (and ACS), one of only five rated outstanding in July.
East Berkshire CCG accountable officer, John Lisle, said “The merger is a natural next step in working closer together across East Berkshire, where we have shared a management team for over a year now.”