If you work in or around the National Health Service, you will likely be aware of the merger between CCGs within certain areas of England.
If you’re not involved directly, or just unaware of what’s going on at the top levels of the NHS infrastructure, you might not know what CCGs are, what their role is in the NHS, or what the endgame for CCG mergers looks like.
Where is the NHS headed?
Clinical Commissioning Groups (CCGs) are responsible for commissioning the hospital-based and wider community NHS services in their local areas. Commissioning involves deciding which services are required by their local populations and ensuring their provision, and despite their vital purpose CCGs themselves are a relatively new construct. Following the introduction of the Health and Social Care Act 2012, CCGs were introduced to replace Primary Care Trusts (PCT’s) as the organisations responsible for the delivery of healthcare services across local populations. 211 CCGs were originally formed across England, but their numbers have been gradually declining in recent years. In 2019 this decline was accelerated due to increasing encouragement for CCGs to consider merging, with an aim to cover larger geographic areas with the resulting organisation. Throughout 2020, the total number of CCGs reduced from 191 to 135, with a second wave of mergers planned for April 2021 when 9 new CCGs will be created from the amalgamation of 38 existing groups. This paves the way for management of merged CCGs through a regional Integrated Care System (ICS).
Integrated Care Systems are designed to play a key part in the NHS Long Term Plan, and are intended to change how healthcare services are planned, purchased, and delivered in the future. ICSs are essentially a partnership that combines commissioners and providers of NHS services to plan for and meet the needs of the population across a geographical area, working in conjunction with local authorities and other local partners. The thinking behind the mergers is that separate CCGs should be merged within their corresponding or shared Local Government Authority (LGA) boundaries, and that there should, ideally, be one CCG per ICS. Each ICS will then become the new overarching organisation for supply and management of care services in each local government area, meaning that the geographical footprint of CCG, ICS, and LGA will be matched.
Just a formality?
Although not officially merged, geographically adjacent CCGs were already working together prior to the changes proposed and those already put in place, so the new configuration will be formalising their cooperation. The purpose of the mergers goes a long way beyond formalising relationships though – the mergers are a major part of efficiency drives to reduce overall annual spend on the NHS. Mergers between CCGs have ostensibly been driven by a 20% reduction in CCG administrative budgets, which will eventually, based on the target reductions in CCG numbers, result in approximately £80 billion of the overall NHS budget being shared by just over 100 remaining CCG’s.
Losing the local view?
All this merging and centralisation represents a great opportunity to improve efficiency and reduce spending, but CCGs were originally founded on the basis that they understand their local population, and their purpose was to concentrate resources towards optimising outcomes for their locality. The effect on the core purpose of CCGs by mergers is yet unknown, and there are a great many concerns about the impact this will have on local NHS users, with institutions such as the BMA worrying about inevitable shrinking of accountability, engagement, and funding. Not only that but many companies (GKA included) that work closely with, and within, the NHS could be directly affected by mergers and efficiency drives focusing on reducing numbers of CCGs. This reduction, and its consequential thinning of the field of potential contracts, could have the knock-on effect of reducing viable competition in some areas of supply and services. There is potentially better news for employees within the NHS, as promises have been made to ensure continuity for most full-time workers to help alleviate workforce anxiety due to ongoing and upcoming mergers.
Where there is change…
Rather than a wholly negative prognosis, changes on this scale — and the movement to a more streamlined administration — should present the opportunity for industries working within and around the NHS to work closer and more efficiently with the new infrastructure. GKA worked closely with the current crop of CCGs to conduct medical market research for many years, and the company looks forward to being involved with more efficient, leaner organisations where access to healthcare professionals and relevant patient data will, hopefully, be made a little easier thanks to consolidation and reduced complexity. Shakeups of any large system tend to yield immediate opportunities for start-ups and established businesses alike, as well as presenting more long-term, strategic avenues for growth in companies with solid relationships or favoured supplier status. Although the NHS is a public-sector entity, it drags an enormous network of industry in its wake, much of which could be set to benefit from the inevitable disruption.
Whatever the outcome, there’s no denying that for companies that work in the healthcare ecosystem, the ongoing transformation for NHS England makes for an interesting and exciting journey.
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