The move towards larger integrated organisations will make CCGs more distant from practices and will reduce support for PCNs, an LMC has cautioned.
Essex LMCs expressed concerns over national proposals to reduce the number of CCGs in England so they match the number of Integrated Care Systems (ICSs). They intend to ballot all Essex practices as to whether they are in favour of CCG mergers before Christmas.
The LMC said any ‘enforced hasty top-down change’ will result in GP practices having less input in local decisions and prevent the successful delivery of the NHS long-term plan.
It comes after CCGs in mid and south Essex announced in September their intention to consider to start the application process to merge their five CCGs into one by April 2021.
As part of the long-term plan, ICSs will cover the country by 2021 – which will see one CCG per ICS area – meaning there will be fewer commissioners who will become responsible for larger geographical areas.
Following the announcement, CCG mergers have increased, while more recently four CCGs in Cheshire revealed their plans to merge in April 2020.
‘Disadvantage bottom-up integration’
In an email sent last week to GP practices, and seen by our sister publication Pulse, Essex LMCs chief executive Dr Brian Balmer said reducing the number of CCGs will ‘disadvantage bottom-up integration via PCNs’.
He said: ‘You may be aware that NHS England plans to merge CCGs into larger Sustainability and Transformation Partnership (STP) wide organisations by April 2021. This plan rather neglects the fact that CCGs are member organisations and that such a change would involve an agreed change in constitutions, but NHS England has stated that mergers will only occur where they have the support of practices.
‘The merger plans are part of a move towards ICS which form part of the delivery of the NHS long-term plan. The Essex LMCs believe that these changes will have a profound influence on practices and the development of primary care, and that practices must be properly consulted prior to such plans becoming inevitable due to reductions in staffing and management changes within CCGs.’
The LMCs pointed out that NHS England proposals and any ‘enforced hasty top-down change’ come with a string of problems.
- Larger CCGs will be more distant from practices and reduce their voice;
- A move to more remote CCGs will disadvantage bottom-up integration via PCNs;
- CCG managers will be less able to support PCNs during 18 months of CCG merger and cost-cutting plans;
- Too rapid top-down integration risks the successful delivery of the long-term plan;
- Fewer, larger CCGs will not strengthen commissioning and control secondary care costs as the integrated system will be dependent on, and built around, large acute trusts.
The LMCs will hold a vote with all practices in Essex before Christmas to ‘clarify the support for the NHS England plans’.
Dr Balmer said: ‘We will send information to practices at that time and will attempt to give a balanced view of the proposals but at present, we are struggling to see any benefits to primary care or patient health and welfare to be gained from this change.’
Earlier this year, the Public Accounts Committee, which has been scrutinising CCG performance, said GPs should be involved in CCG decisions, as services are increasingly commissioned across larger areas and commissioners risk ‘losing touch’ with their local population.
In July, the BMA wrote to NHS England demanding that mergers only go ahead after receiving approval from their member practice, after warning that current guidance does not allow GP practices to have sufficient input in CCG merger proposals.
And last month, North Staffordshire LMC urged GP members to block the merger of their CCG with five others over budget fears.