Our merger proposals

East Surrey CCG is considering a merger with North West Surrey, Guildford and Waverley and Surrey Downs CCGs to form one larger commissioning organisation. 

Background

In June this year, the Governing Bodies of East Surrey CCG, Guildford and Waverley CCG, North West Surrey CCG and Surrey Downs CCG all agreed to explore a potential merger of the four CCGs.  If successful this would create one new commissioning organisation across the area known as Surrey Heartlands from April 2020 (see below):

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Context

The new NHS Long-Term Plan, published in January this year, set the expectation for health and care organisations (i.e. hospitals, mental health and community services, GPs, the ambulance service, commissioners and local authorities) to work more collaboratively across local areas and to take more collective responsibility for improving the health of local populations. 

East Surrey CCG will become a part of Surrey Heartlands which brings together the health and care organisations across most of Surrey into one partnership.  Working together, we have created one set of priorities across our system that all organisations have agreed.  This is summarised in the new Health and Wellbeing Strategy for Surrey which can be found here:  https://www.healthysurrey.org.uk/about/strategy

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 much more closely together, with one Joint Accountable Officer and one Executive Team.  So merging the CCGs to create one larger commissioning organisation would seem the logical next step and also builds on these national expectations. 

East Surrey partners (previously part of the Sussex and East Surrey Alliance) have recently joined the Surrey Heartlands system and East Surrey CCG has also indicated they wish to explore a merger of CCGs.

What are the key benefits of a merger?

Creating one organisation will help to:

  • Create closer alignment with Surrey County Council:  in particular supporting more joined up working with social care, and helping us tackle the wider determinants of health – so working together on areas such as pollution and poor health prevention across our health and care system.
  •  Support the development of local partnerships:  merging our CCGs will allow us to focus on supporting our new local Integrated Care Partnerships (ICPs), groups of local health and care organisations (including borough councils and voluntary/community sector members) who are working together across the existing CCG geographies.  Having one CCG means we can focus on a clearer separation of roles; the CCG would retain its statutory duties, with local planning and decision-making devolved from the CCG to the local partnerships.  We will also be able to offer more support, through the ICPs, to our new Primary Care Networks, groups of GP practices working together in local networks to support patients at a neighbourhood level.

More information on Integrated Care Partnerships and how the Surrey Heartlands system is working is available on the Surrey Heartlands website at www.surreyheartlands.uk

  • Create economies of scale and remove duplication: by not running as many boards and committees, e.g. fewer Governing Bodies, and other potential efficiencies of doing things once.  And, although not a major factor, a merger is likely to contribute towards the 20% running cost reduction expected of all CCGs this year.
  • Support the national direction:  with the expectation that CCGs come together across health and care systems, merging now would mean getting on with the process so we can move more quickly to making the improvements we want to make across both our local areas and across Surrey Heartlands.

How will having one larger commissioning organisation benefit patients?

  • In the short-term we don’t expect there to be a direct impact on patients and the public following a merger as CCGs don’t provide front-line health and care services. 
  • However, some technical changes will be necessary such as a new CCG name/brand, website and external contact points.  There may also be a change in how some of our partner organisations make contact with the CCG, and some change to internal team structures.  Any changes would of course be widely communicated as appropriate.
  • 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.  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 and children’s services. 

Next steps

As CCGs are membership organisations, we will be inviting our member practices to vote on a new Constitution for the proposed new organisation in September.  We will then submit a formal application to merge to NHS England/Improvement by the end of September.

If successful we expect the new organisation to be formed from 1st April 2020. 

Do you have any questions/concerns?

We want to make sure that all our members, stakeholders, patients and the public have the opportunity to ask any questions/voice concerns about the proposed merger.  If you would like to make a comment or submit a question, please send this to: sesc.comms@nhs.net

Frequently asked questions:

What about loss of local control?  CCGs were originally set up to allow more clinical decision-making at a much more local level [than the previous Primary Care Trusts]. 

Centralisation is not the reason for the merger.  Rather, the case for change is based on a recognition of the value of local systems working in partnership.  Our local Integrated Care Partnerships (ICPs) will be empowered to take forward local planning and delivery through a devolved model (from the CCG’s Governing Body) which will allow a greater focus on local issues and new ways of working.  This will include a population based budget for each ICP (with the local Primary Care Networks a key part of these local partnerships).

To do this we also need to realise efficiencies – to enable support to ICPs and PCNs at the same time as meeting the mandated 20% reduction in CCG running costs – so through a streamlined Governing Body, one set of annual reports and accounts and so on we will be contributing to those savings.

How will the voice of local member practices be heard in a larger CCG?  Will there still be locality representation and clinical leadership at Governing Body level?

We will need to ensure we have the right local representation on the Governing Body and other committees and that we are preserving clinical leadership.  We are currently working this through and our member practices will be voting on a proposed new Constitution in September.  

How will any historical debt be resolved, and how will financial allocations work in a new organisation?

Historic debt:  We recognise that there is historic debt within our system.  Coming together as a single CCG does not really impact on this – there will continue to be debt in the system and it will be reported under a single organisation.  In terms of risk, it is unlikely this would increase.  However how we bring our finances together and how we manage our collective financial position as a wider system is an area that will need to be carefully managed moving forward.

Financial allocations: Our intention would be to continue to use the CCG funding formulas used by NHS England.  So, if we receive one total allocation in future, we would divide this based on the current method of calculation used to ensure each area continues to receive a fair allocation, in line with previous planning assumptions.