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

by Costanza Pearce
27 November 2020

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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.