Since the beginning of 2019, CCGs (clinical commissioning groups) in England have been encouraged to consider merging to cover larger areas.
This guidance informs BMA members and LMCs about CCG mergers. It sets out how changes are taking place, why they are happening, when mergers are likely to take place, as well as the BMA’s position. It also gives practical advice on what doctors can do to ensure their voices are heard.
Download the full guidance
Why CCG mergers are taking place
The intention is to support system-wide working and more streamlined commissioning, with the single CCG directing commissioning across the entire system. They would also work directly with other partners across the system, including the ICS (integrated care structure) or STP (sustainability and transformation plan) leadership, PCNs (primary care networks), PCN clinical directors, NHS trusts, community and mental health care providers, local authorities and others. This reflects a longer-term trend of closer co-operation between CCGs.
When changes are happening
- There is no specific target date for their completion, but more mergers are expected through 2020.
- Any applications after October 2019 will be considered for April 2021.
- There were two mergers in 2019 - Devon CCG and Derby and Derbyshire CCG.
- Reports suggest at least 55 merger applications were submitted by September 2019.
- There are only 42 ICS and STP footprints, suggesting these may change.
What you can do
- Engage with your local LMC and support their local lobbying activity, find details of your LMC.
- Share information and examples with colleagues nationally and regionally, so that others can learn from opportunities and challenges you have encountered – this could be through local networks, national committees, LMCs, or the BMA's regional structures.
- Highlight both positive and negative examples with the BMA, so that we are able to raise issues and spread best practice on your behalf.
- Consider what agreements and assurances you need and can get from your local CCGs before supporting (or challenging) a merger.
- Collaborating with local colleagues, including through your LMC, to present as united a voice as possible for general practice.
If you have any concerns or questions about a CCG merger in your area, or an example you would like to highlight, contact us at [email protected]
How GPs are approaching mergers
A number of proposed mergers have been stalled, stopped, or heavily influenced by local practices and LMCs, local authorities and other NHS bodies.
GPs and LMCs should be heavily engaged with and involved in the proposals to help achieve a stronger CCG - helping to amplify the voice of general practice to a system-wide level.
GPs and LMCs may wish to oppose, challenge, or support a CCG merger and should make that judgement based on their situation.
See criteria on what CCGs need to be successful in their merger applicationfrom NHS England.
Download the full guidance for examples of LMC and GP practice involvement in proposals.
The BMA view
The BMA strongly believes that as CCGs were established as GP-led membership organisations, any changes, including mergers, should always be decided by local GPs, clinicians, and CCG member practices – not driven by national policy. We are concerned that mergers are being enforced to reduce CCG administrative budgets.
See a summary of BMA members' concerns below (download the report for full details):
- Loss of continuity of funding and support
- Local understanding and input
- Undermining local relationships
- Strength of voice
- Engagement and accountability
We have raised these concerns with NHS England.