Doctors demand NHSE reconsider ‘watered down’ CCG merger rules
Our associates have been advising and supporting NHS clients with consultations on their CCG merger proposals for several years. The English NHS Long Term Plan sets out aims that mean we’re seeing more CCGs apply to NHS England for permission to merge and we discussed the lessons learned from this new batch of consultation exercises at our recent health associates’ update session.
NHS England published an update to its CCG merger guidance earlier this year and this article claims it has been ‘watered down’ and GPs “are extremely alarmed that mergers [are] moving forward … without clear approval from, or sufficient engagement with, local GPs”
There is a clear difference between engagement with and approval from. If anything, in our view the updated guidance strengthens the requirements around engagement of GPs including requirements that each of the existing “CCGs have engaged with, and seriously considered the views of, their GP member practices,[…] record the level of support and the prevailing views of each existing CCG’s member practices […], and that the existing CCG’ observations on those views.” All good practice that can of course be delivered through a consultation. So if merger applications are moving forward without sufficient engagement with GPs, as the article claims, we can expect NHS England to knock those back.
‘Clear approval from’ GP members is a different matter. Since the initial application process to form CCGs, which by default required the members’ approval, member practice approval has not been a requirement of this process. The updated guidance leaves out its predecessor’s statement that merger proposals should ‘ideally’ have been agreed with GP members and if that’s a critical factor, then perhaps ‘watered down’ is fair comment. But at worst it’s minor dilution. In all other senses working through the updated guidance with clients we feel its greater clarity gives it some additional strength.
Doctors have demanded NHS England review how clinical commissioning group merger decisions are being made amid concern they are going ahead without clear approval from GPs.
In a letter to NHS England earlier this week, British Medical Association GP committee chair Richard Vautrey warned official guidance in April had “watered down the need for commissioners to secure the support of local practices before pursuing mergers”.
He wrote: “We have heard from members who are extremely alarmed that mergers appear to be rapidly moving forward in their areas without clear approval from, or sufficient engagement with, local GPs…
“However, GPC strongly believes that all such mergers should only be sanctioned if CCGs can clearly demonstrate that approval has been obtained from local member practices and PCNs.”
The letter, addressed to NHSE’s acting director of primary care Nikita Kanani and director of primary care delivery Dominic Hardy, comes as a record number of CCGs are planning mergers. HSJ revealed on Tuesday nearly half of England’s 191 CCGs are involved in talks over mergers by next April.
Dr Vautrey warned CCG mergers, particularly across large areas, risked diminishing CCG accountability to local GPs and could reduce clinicians’ input “constituting a significant loss of expertise, which will inevitably undermine the quality of commissioning for specific localities and populations”.
He also raised concerns over how future spending will be allocated, particularly for primary care, and whether newly-merged CCGs “will honour previous commitments or increase investment further”.
“Financial transparency and accountability to member practices is extremely important, not least in fulfilling the ‘NHS first’ pledge to increase the investment in primary care made within the long-term plan,” he added.
“We would therefore request that you outline how CCG allocations and spending on general practice will be publicly accountable, both before and after any merger takes place.”
Dr Vautrey also underlined opposition to mergers being carried out due to the national mandate set by NHS England to cut CCG running costs by 20 per cent.
An NHSE spokesman said: “Commissioners are indeed required to reduce their administrative costs by 20 per cent and all savings are being reinvested in local health services.
“CCGs are therefore right to look for efficiencies, while at the same time individual GP practices also have the opportunity to work closely with their primary care network on strengthening local GP and primary care services.”
HSJ earlier this week revealed that 86 CCGs are currently discussing mergers in the biggest cull of commissioning organisations since half of primary care trusts were axed in 2006. If all those currently in the pipeline are approved by NHS England, total numbers of CCGs would fall by about a third to 126 ahead of further reductions by 2021.
The NHS long-term plan stated that, by April 2021, all of England will be covered by integrated care systems involving a CCG or CCGs working together to make a single set of commissioning decisions at system level.
This article originally appeared on HSJ (paid subscription)
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