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HOT TOPIC: To merge or not to merge?

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As NHS England approves a number of mergers in different regions across the UK, a number of professionals and local members of the public who rely on CCG services are concerned that the important local knowledge that comes with the small organisations will be lost.

However, CCG bosses have been quick to quash the concerns, saying that merger plans will not affect care services negatively. It is hoped that the merger process will actually help streamline services and in turn, improve their offering to local people.

One boss, commenting on an upcoming merger between four Clinical Commissioning Groups in Worcestershire and Herefordshire, was categorical in his statement that health and care services would not be affected.

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The merger will see a single NHS Herefordshire and Worcestershire CCG created, replacing the individual CCGs in Herefordshire, Redditch, Bromsgrove, Worcestershire and Wyre Forest.

Doctors have assured patients and those working in the access and mobility industry that the merger, which CCGs hope to complete by April 1st, 2020, will not affect any care services.

CCGs spokesman, Simon Trickett, told the Worcester Observer:  “Our main priority is, and always will be, our patients and the health and wellbeing of our local population. Having already set up combined governance and decision-making arrangements across the four CCGs, this is the next logical step.”

The spokesperson did go on to detail how the organisation hopes the merger can actually reduce the duplication of roles across each of the merging CCGs.

AMP has reported on the approved mergers up and down the country, and the feeling each time seems to be the same – that streamlined services will only be of benefit to the people in the local community.

Midway through 2019 was when the flurry of CCG applications to merge came through. A large application in September saw four groups in Surrey apply to become one. East Surrey, North West Surrey, Guildford and Waverley and Surrey Downs Clinical Commissioning Groups consulted on the proposed merger, which would see one group formed to cover the Surrey Heartlands area.

The single commissioning group would be responsible for a population of around 1m people.

In a statement, the CCGs said that the merger was in line with the NHS’s long-term plan, which set the expectation for health and care organisations to work more collaboratively across local areas and to take more collective responsibility for improving local help.

As part of this move to work more collaboratively, there is also an expectation that CCGs come together across their respective health and local authority areas.

Over the past 18 months, Guildford and Waverley, North West Surrey and Surrey Downs CCGs have been working more closely together, with one joint accountable officer and one executive team.

In a statement released as part of the potential move, the groups said: “Longer-term, the move to create one CCG is part of our wider journey towards developing more joined up health and care, and our overall ambition to improve the health of the local population.

“Much of this will be delivered at a very local level, through our Integrated Care Partnerships and Primary Care Networks which, over time, will create tangible improvements to the way care is delivered, better value for money and new and exciting ways of working.”

Adding: “At the same time, we will be able to focus on supporting and developing those services which are best delivered across Surrey, such as mental health as well as children’s health services.”

With NHS England approving a lot of applications that came through including Tees Valley and Warwickshire, it was not all smooth sailing, the Warrington and Halton proposed merger was shelved due to a lack of support.

The proposal would have seen the closure of both CCGs and the creation of a new one in April next year to help reduce running costs.

In a statement sent to Access and Mobility Professional, a spokesperson for NHS Warrington Clinical Commissioning Group said: “In terms of the outcome of the vote, from a Warrington CCG perspective it was positive in that 85% of those GP practices that submitted a vote, accepted the recommendation to a formal merger of NHS Halton CCG and NHS Warrington CCG. However, only 31% of the Halton CCG practices that submitted a vote accepted the recommendation.

“As there was not sufficient support for the proposed merger from the membership of NHS Halton CCG, at this point we have not submitted the ‘merger’ application to NHS England.

“We will now take some time to consider the impact of this decision and next steps in terms of what other actions need to be taken to address the financial gap.”

Elsewhere though, the internal reaction towards the mergers was mostly positive, with teams expecting that operating as a single unit will only serve the local people better and more efficiently.

NHS England/Improvement also formally approved an application to bring together Cheshire’s four NHS Clinical Commissioning Groups, set to be implemented by April 1, 2020.

Already supported by Cheshire residents and GPs, NHS England said it hopes the move will bring together the planning and buying of health services across the county.

Accountable officer Clare Watson, said: “We are delighted to receive approval from NHS England/Improvement for our application to bring together the four Cheshire CCGs. I would like to thank everyone who has been involved in supporting our work to come together so far. This includes staff, GP members, partner organisations and the people of Cheshire.”

Adding: “Working together as Cheshire will enable us to strengthen our work as a single team to ensure the people of Cheshire are able to access consistently good care – wherever they live. It will also enable us to further support the development of Integrated Care Partnerships in Cheshire East and Cheshire West which will provide more care closer to home.”

A public engagement exercise conducted across Cheshire in May and June 2019 drew widespread support for proposals to bring together the four CCGs, with 76.5% of the 376 respondents in favour of the creation of a single Cheshire CCG.

A subsequent ballot of GP member practices in each of the four CCG areas drew even stronger support, with 86% of responses across Cheshire in favour of a merger, a different opinion to the one in Warrington and Halton.

Four Herefordshire and Worcestershire CCGs confirmed a 2020 merger in October while three in North Yorkshire did so in November.

Norfolk and Waveney also voted to merge, as did Shropshire and Telford, but the latter was not successful. The proposal to become a single CCG was rejected by NHS England last month, saying they did not meet the criteria but since, it has emerged the proposal could be set for a quick return.

According to a report from the Shropshire Star, it was expected the plans would be on hold until September 2020, but David Evans, who has been appointed the single accountable officer for both CCGs, says he has been given firm assurances the plans could be looked at sooner.

He also blamed what he described as an “ambitious” timescale set for the merger as the reason why NHS England did not back the scheme.

He said: “Following the formal application to NHS England NHS Improvement on September 30, a panel meeting was convened by the regional team to consider the application in more detail on October 11.”

Adding: “Following this panel meeting the CCGs were informed that the application had been unsuccessful on this occasion, mainly due to the fact that the CCGs had not had enough time to develop the strategic thinking, which meant some of the key evidence and documentation submitted with the application did not fully meet the NHS England/NHS Improvement application criteria.”

The Shropshire Star report continued: “However, the panel have provided very positive feedback on the application, acknowledging the effort and contribution in developing the application by the two CCGs. The panel’s view was that if the CCGs had more time, the application would have been stronger and the late start clearly disadvantaged our application.”

Critically, he confirmed: “The panel have also made a firm offer to support the CCGs to make a further application earlier than the normal deadline of September 2020, as they believe our application can be enhanced to meet the 10 application criteria in full, if we continue to work at pace. We have an assurance meeting scheduled with NHS England/NHS Improvement on November 20 where we hope we can agree our new application timeframe.”

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Alex Douglas

The author Alex Douglas

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