HCL Issue 10 - Page 32

INSIGHT What does the future hold for CCGs? The long-term plan placed greater emphasis on integration and set out how the health service will reform over the next 10 years. But what will this mean for CCGs? Valeria Fiore finds out ore than 200 CCGs were introduced in 2013 to replace primary care trusts (PCTs) as the commissioners of most services funded by NHS England. At present, there are 195 CCGs in England. This total is set to drop to 191 with the merger of several CCGs next month – and under current plans, it looks likely that there will be even fewer in the coming years. The long-term plan said that, by April 2021, integrated care systems (ICSs) will cover the whole country. In order to allow ICSs to endorse a single set of commissioning decisions at system level, commissioning arrangements will be ‘streamlined’ and this ‘will typically involve a single CCG for each ICS area’. It is not known yet how many ICSs there will be by 2021, as the long-term plan only states they will ‘grow out’ of the current 44 sustainability and transformation partnerships (STPs). Speaking in Parliament in January, NHS England chief executive Simon Stevens said that, ‘in all likelihood’, there would be a smaller number of CCGs to match the number of ICSs. M What power will CCGs hold? Under the long-term plan, CCGs are expected to become ‘leaner, more strategic Healthcare Leader 2019 Issue 10 organisations that support providers to partner with local government and other community organisations on population health, service redesign and long-term plan implementation’. The plan does not clarify what this will mean for CCGs in practice, but it seems probable they will have to share part of their powers with other local organisations. Together with trusts, primary care networks, local authorities and the voluntary and community sector, CCGs will be represented on ICS boards by a member of their organisation. Where will the money go? When CCGs replaced PCTs in 2013, they were given responsibility for managing about 60% of the NHS budget, commissioning most of the secondary care and GP services. In the long-term plan, NHS England said it will continue to favour the unification of ‘health and social care budgets where councils and CCGs agree this makes sense’. This would make it more common for CCGs to share their resources with local councils. More details about the integration of health and social care services will be revealed as part of the social care green paper, which according to health minister Stephen Hammond will now be published ‘before April’. However, NHS England said that CCGs and local councils could combine their resources through four models that have proved successful in the past: • Budget pooling: between a council and CCG for some or all of their responsibilities. • Individual service user budget pooling: using personal health and social care budgets. • The Salford model: in which the NHS oversees a ‘pooled budget for all adult health and care services with a joint commissioning team’. • CCG accountable officer model: the CCG and local authority ask Simon Stevens to designate the council chief executive or director of adult social care as the CCG accountable officer. How will CCGs make savings? The five-year funding settlement of £20.5bn annually, announced by Prime Minister Theresa May in June 2018, will help NHS organisations balance their finances by 2023/24, according to the long-term plan. This will be achieved by ‘reducing year on year the number of trusts and CCGs individually in deficit, so that all NHS organisations are in balance by 2023/24’, the long-term plan said. In practical terms this will mean that CCGs will need to take a closer look at their finances. Not only will they have a reduced commissioner sustainability fund – which will eventually be phased out, starting from this year – they will also be required to cut their administrative costs by 20% to maximise the funds available for direct patient care. Will more CCGs merge? According to a BMA briefing on the NHS Operational Planning and Contracting Guidance 2019/20, CCGs could opt to reduce costs by merging, with the planning guidance asking them ‘to propose new approaches to efficiencies’. Chief executive of NHS Birmingham and Solihull CCG Paul Jennings believes it is likely that there will be more CCG mergers in the future and that merging could come with number of benefits. He told Healthcare Leader: ‘Since merging in April 2018, we have already seen a number of demonstrable benefits over and above the predicted ones of financial efficiencies, streamlined decision-making and clearer governance. ‘We now have a much stronger and credible voice in the local system and also a clearer role in our STP. We can offer greater consistency for our patients, we have seen significantly strengthened relationships with our partners which support and enable delivery, and have been able to retain and refocus our talent and people.’ More online For more features and analysis, visit healthcareleadernews.com 32