CCG leaders: ‘Worryingly fast’ move to hand commissioning powers to ICSs

CCG leaders are concerned about the ‘worryingly fast’ pace at which NHS England proposes to hand over commissioning powers to integrated care systems (ICSs). 

The proposals, set out in November 2020, outlined two options for giving ICSs statutory powers. One is a statutory committee with an accountable officer that binds together ‘current statutory organisations’, the other is a model that brings CCG functions into the ICS. 

NHS England wants all CCGs to merge across their ICS boundaries by April 2022.

In response to the national consultation on the changes, NHS Clinical Commissioners (NHSCC) said its CCG members favoured option two, but that the proposed changes had too short a timescale.

It said in its response: ‘Option 2 (statutory footing to ICSs) was a big step for members to consider, as it felt less place led, the pace of change was also worryingly fast and the proposals effectively end the current governance arrangements for CCGs.’

However it noted this course of action ‘offers a more strategic approach to CCG planning and resource allocation functions’.

It said it was an approach in which ‘scale reduces risk’ and ‘will enable the delegation of population budgets and aligned incentives to system provider collaboratives, to improve services for the benefit of local citizens’.

NHSCC added that while it backs its 300 members and agrees that option two is a ‘positive step forward’, there are some ‘significant concerns’ that must be addressed first. 

It said: ‘Our members have raised significant issues about the timescale and timing for transition under option two and the disruption it will cause.

‘We must ensure that the implementation of option two (if agreed) offers the least disruption possible to CCG staff and their senior teams and offers integrated care systems the best start as statutory organisations.’

CCG leaders said if option two is accepted then it means ‘a lot to do’ in the next 15 months.

‘For example, there is very little time to establish shadow boards and authorise ICSs to be able to take on statutory functions – held by CCGs,’ the NHSCC document said. 

It added: ‘Without focused support for CCGs to transition – we are in danger of repeating the disruption of the 2012 reforms and making our members appear irrelevant when there is a lot of work for them to do in order to transition but also manage the transition of some specific statutory functions i.e., NHS CHC, section 117, EPPR, safeguarding, primary care estates, public consultation and engagement and equalities (to name a few).’

The NHSCC also warned that the ‘wealth of knowledge and expertise’ possessed by CCGs and their staff must not be ‘lost during transition’.

It said expertise in areas such commissioning leadership and the model for population health, public accountability and scrutiny, and independent quality monitoring needed to be retained.

NHSCC said the first of NHS England’s two options – which would involve working with local authorities – was not viewed to be as suitable.

‘Members felt the dual ICS and CCG accountable officer model would be
extremely confusing in terms of system leadership and delegated CCG powers,’ it said.

It added that this option ‘could work well in areas where partnership working is less mature’ – suiting a few CCGs – but many members felt ‘it had the potential to delay what is viewed as an inevitable move to an ICS statutory footing’.

The NHSCC also criticised ‘the style’ of how NHS England’s proposal was announced and said knowledge of its existence came to many CCG staff ‘via the media’.

‘This is contrary to the principles of the NHS People Plan and caused a lot of distress to CCG staff at a time when they were under significant local pressure responding to Covid-19,’ the body said. 

It added: ‘There must be a strong commitment from NHSEI from this point onwards to providing clear communication and coproduction with CCGs around their transition in the next 15 months.’

The BMA has said that NHS England’s proposals to abolish CCGs are of ‘significant concern’ for GPs.

In its response to the consultation it noted a ‘serious lack of clarity regarding the practical implications of transferring CCG powers to ICSs’.

A version of this story was first published by Pulse’s sister title Healthcare Leader.