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CCGs to be replaced as commissioners by ICSs, under NHS England proposals


GP commissioning


NHS England wants all CCGs to merge across their integrated care system (ICS) boundaries by April 2022, as part of proposed changes to legislation designed to hand ICSs the direct commissioning power.

In board papers published today, NHS England also said it will create a ‘single pot’ of funding, bringing together CCG commissioning and primary care budgets along with other funding allocated to systems.

The NHS long-term plan said ICSs will cover the country by 2021 – with ‘typically’ one CCG per ICS area – meaning there will be fewer commissioners who will become responsible for larger geographical areas.

But LMCs have previously warned that a reduction in the number of CCGs in England so they match the number of ICSs will ‘reduce the voice’ of practices.

NHS England’s new board papers recommended two options for ‘enshrining ICSs in legislation without triggering a distracting top-down re-organisation’.

The first is for a ‘statutory committee model with an accountable officer that binds together current statutory organisations’.

The papers said: ‘In accordance with our stated ambition, there would be one aligned CCG only per ICS footprint under this model and new powers would allow CCGs to delegate many of [their] population health functions to providers.’

The second proposed option is for a ‘statutory corporate NHS body model that additionally brings CCG statutory functions into the ICS’.

Under this model, ICSs would be established by ‘repurposing CCGs’ and would ‘take on’ CCGs’ commissioning functions alongside other duties, the papers said.

They added that the CCG governing body and GP membership model would be ‘replaced’ by a board including representatives from NHS providers, primary care and local government as well as executive roles ‘as a minimum’.

However, individual organisations would no longer have the power of veto, the papers said.

NHS England added that if either of the legislative proposals go ahead, ‘current CCG functions would subsequently be absorbed to become core ICS business’.

However, they said that there will be ‘flexibility for local areas to make full use of the local relationships and expertise currently residing in CCGs’. 

The papers added: ‘We will create a ‘single pot,’ which brings together current CCG commissioning budgets, primary care budgets, the majority of specialised commissioning spend, the budgets for certain other directly commissioned services, central support or sustainability funding and nationally-held transformation funding that is allocated to systems.’

They said: ‘We expect that every system will be ready to operate as an ICS from April 2021, in line with the timetable set out in the NHS long-term Plan.’

But smaller ICSs may need to ‘formally combine’ after April 2022, NHS England said.

They said: ‘ICSs need to be of sufficient size to carry out their “at scale” activities effectively, while having sufficiently strong links into local communities at a much more local level in places and neighbourhoods. 

‘Pragmatically we are supporting ICSs through to April 2022 at their current size and scale, but we recognise that smaller systems will need to join up functions, particularly for provider collaboration. We will support the ability for ICSs to more formally combine as they take on new roles where this is supported locally.’

And commissioning functions must be ‘coterminous’ with ICS boundaries ‘before April 2022’, they said.

Meanwhile, the papers said NHS England is ‘seeking to provide stability of employment’ for CCG staff.

They said: ‘As CCG functions move into new bodies we will make a “continued employment promise” for staff carrying out commissioning functions. 

‘We will preserve terms and conditions to the new organisations (even if not required by law) to help provide stability and to remove uncertainty.’

Responding to the proposals, NHS Clinical Commissioners said that the ‘local stewardship role of CCGs and their joint working with local authorities must not be lost’.

CEO Lou Patten said: ‘CCGs have been hugely successful in developing the vitally important partnership between clinicians, managers and lay members. 

‘It has been enlightening over the past few years to have a strong united clinical view about major service changes, patient pathways and the principle of primary care being the cornerstone of patient-centred care. This sets a really strong legacy for Integrated Care Systems.’

She added: ‘Whilst recognising that the majority of commissioning functions will continue at ICS level in what is being proposed, the great work at neighbourhood and place, enhanced by the focus on the pandemic must continue. The local stewardship role of CCGs and their joint working with local authorities must not be lost – we cannot throw the baby out with the bathwater.’

NHS Clinical Commissioners will ‘seek to influence NHSEI at the highest level in order to minimise disruption and destabilisation, consolidate the positive, and ensure the fantastic legacy of CCGs lives on in ICSs’, Ms Patten added.

NHS England said it is ‘inviting views’ on the proposals to be submitted by 8 January.

Last month, GP members of one of eight CCGs involved in a proposed merger for April 2021 voted against the plans.

READERS' COMMENTS [14]

DJ Marlow 26 November, 2020 6:23 pm

FFS, but sadly entirely predictable. A cycle of reorganisation every few years is now the norm; the politicisation of the NHS. Solving nothing and creating new problems.

Bryan Anglim 26 November, 2020 7:50 pm

Of course – it’s been more than 5 years since the last reorganisation.

Kevlar Cardie 26 November, 2020 8:54 pm

Shiny new deckchairs on the Titanic.
Goody, goody gumdrops.

Not on your nelly 26 November, 2020 9:55 pm

SHA anyone?

Anony Mouse 26 November, 2020 11:19 pm

plus ça change, plus c’est la même chose

Turn out The lights 27 November, 2020 7:23 am

Round and round it goes as it slips away down the plughole for ever.The exodus continues.

Michael Mullineux 27 November, 2020 9:09 am

Vortex of mediocrity

A non 27 November, 2020 9:30 am

How long with will this particular administrative configuration last? ..with in the layers of pen pushing detached NHS bureaucracy exists a certain type of civil servant, who’s job last for just a couple of years, with very little knowledge of what was going on before they arrived or what exactly it is the organisation they work in actually does. Oblivious to their ignorance they have enormous confidence in their abilities and a unshakable belief that their fresh pair of eyes is probably all that’s needed to find a way of sorting out all the mess left behind by their predecessor. They spend a few months looking at the the ‘broken system’ as they see it FROM THEIR DESK and hold meetings with other similarly inappropriately self confident pen pushers who also arrived recently. In the absence of any real understanding they genuinely believe all thats needed is a reorganisation of the system AS THEY SEE IT. A management shuffle. An administrative rearrangement. They then leave for another job and someone else inherits their desk. The new arrival thinks the last guy was crap and s/he is so much better..and they do it all again. These people have too much power and not enough accountability. And there’s nothing we can do about it

Andrew Bamji 27 November, 2020 10:05 am

When I started as an NHS consultant in 1983 this was more or less the system we had. But institutional memory seems not to exist any more; it’s the bureaucratic equivalent of Alzheimer’s. People interested in the shifting NHS sands might be amused by (shameless puff coming) my book “Mad Medicine”: Myths, Maxims and Mayhem in the NHS” (available on Amazon) which devotes a fair amount of time to the topic.

Peter English 27 November, 2020 10:15 am

The wheel continues to turn.

FPC, FHSA, Fundholding practices, PCGs, PCTs, CCGs. ICSs…,

As I wrote a few years ago,[1] “Politicians realise that people trust their general practitioners more than politicians or faceless commissioners in the health authority, primary care trust, or whatever the organisation is called at the time; a few enthusiastic GPs with an eye to improving services for their patients—and, possibly, their income—actively campaigning to do it better than the existing commissioning body; changes are made so that all GPs have to commission; and the enterprise fails because, once everybody has to do it, the incentives to a few pilot practices disappear, and, anyway, most GPs are more interested in being GPs than commissioners.”

So they keep creating bodies in which trusted GPs are the commissioners; and they keep ensuring that they fail and revert to being something like a 1980s Health Authority…

Do you remember how, when PCTs were first created, they were far too small to function effectively? So they merged, and they merged..

I started my current job (as a CCDC) in East Surrey Health Authority in Feb 1998 (I’ve been TUPEd or equivalent several times since!), having been assured at my interview that the two Surrey HAs would merge within a year or two.

Well, they were abolished and FIVE PCTs were created to replace them. And then they merged to become a single, Surrey-wide PCT, with a popn of just over 1million – about the right size for all but specialist commissioning.

English PMB. Commissioning in English NHS: the market delusion. BMJ 2010;340(may11_2):c2522- PMID: 20460326, DOI: 10.1136/bmj.c2522 (http://www.bmj.com/cgi/content/full/340/may11_2/c2522).

David OHagan 27 November, 2020 1:31 pm

This time they have decided to get rid of GPs. It is a pretence that PCNs will have the ability and strength to stand up to a million patient plus provider lead organisation, even if they were funded to do this. PCNs have been under funded to employ health trainers.

The reorganisations continue, this one has been promised since 2016, it might happen this time?

Andrew Jackson 27 November, 2020 4:36 pm

The endless merry go round to balance the benefits of scale but retain local representation.

terry sullivan 27 November, 2020 5:08 pm

a solution

abolish nhse and phe

dfh and sos and ministers can then do what they are overpaid to do

savings billions every year

terry sullivan 27 November, 2020 5:09 pm

next step–abolish dfh and nhs

no need for govt in provision of healthcare–and all must pay