King’s Fund calls for flexibility on size of CCGs

The fund’s new publication – Thinking differently about commissioning: learning from new approaches to local planning ­– examines how three CCGs have rethought the role of commissioning to implement more collaborative ways of planning services. It believes the case studies show the benefits of place-based collaboration between commissioners and providers in local geographies.

Joint working across the NHS and local authorities was found to create different types of conversations, help remove perverse incentives and support the implementation of population health-focused planning strategies.

Forty-four sustainability and transformation partnerships were set up in 2016 with 14 having subsequently been designated as integrated care systems. The NHS is currently working towards having integrated care systems covering the whole of England by April 2021, with the recent planning guidance reiterating that there should typically be one CCG per system.

Seventy-four CCGs are due to merge to form 18 new CCGs in April, taking the total number of CCGs from 191 to 135.

However, the King’s Fund report raised concerns about the merger programme. ‘There is a risk that CCG mergers undermine the benefits of place-based working,’ the report said. ‘NHS England and NHS Improvement should therefore be permissive rather than prescriptive about the future shape of commissioning organisations.’

It added that this meant the national bodies ‘holding their nerve’ on the non-restrictive policy that has characterised their approach to date. ‘It means that rather than stipulating the structure and size of CCGs within ICSs, they should listen to local leaders and their insights about what works in each area and take decisions on a case-by-case basis.’

Across the three case study areas, strategic planning was increasingly a collective activity and procurement processes were being simplified. Financial arrangements were typically based on block or aligned incentive contracts and competitive procurement was seen as a tool of last resort. Performance monitoring was also increasingly focused on system performance.

The sites were implementing these changes in different ways and pursuing different priorities. Bradford District and Craven for example were focusing on collaboration between NHS bodies while both South Tyneside and Tameside and Glossop were focusing on collaboration between the NHS and local government.

In all cases, strong relationships among key stakeholders were central to the new ways of working.

The NHS Confederation said the report was a welcome recognition of the increasing importance of collaboration. ‘The case studies set out in the report are a useful illustration of how commissioning needs to develop within ICSs,’ said Nick Ville, the Confederation’s director of membership and policy (pictured), ‘with evidence that collaborative arrangements work best when CCGs and systems are approximately coterminous with local authorities.’

He added that there needed to be ‘flexibility on the notion of place to allow local authorities to play a key role in future partnership working, regardless of their size and footprint’.