Proposal for Lancashire-wide NHS organisation - but a pledge that local decision-making will remain

The eight NHS organisations that currently design health services for different parts of Lancashire could merge into a single body for the whole of the county next year.

But health bosses are pledging that local decision-making will continue even if plans to combine the region’s clinical commissioning groups (CCGs) get the go-ahead.

The proposed single commissioning body would cover all of Lancashire and South Cumbria

The proposed single commissioning body would cover all of Lancashire and South Cumbria

Under the proposals, a pan-regional CCG would be created – along with five new locality commissioning teams covering the same areas as the county’s existing integrated care partnerships (ICPs) between health and social care organisations.

Dr. Amanda Doyle, chief officer of the Lancashire and South Cumbria integrated care system (ICS), said that the proposed move was “not about centralisation, but avoiding duplication” of administrative functions.

She said: “The [single] CCG might also commission services…across larger footprints,” she told a meeting of Lancashire County Council’s health scrutiny committee.

“For very specialist services that treat complex and serious illness, we have to make consistent decisions.

“But most primary and community services…will continue to be planned and delivered in local places. Most of the things GPs want to influence – local care pathways, priorities for local patients and the things where different parts of the patch have different levels of need and demand – will still happen locally.”

The Lancashire-wide CCG – which would also cover South Cumbria – would comprise members who would also lead the new local commissioning teams, including a clinical director, managing director and lay representative from each area. The overarching body would have a single accountable officer, chief finance officer, chief nurse and secondary care doctor.

Committee member David Whipp said he feared a “the lowest common denominator” approach would result from the proposed set-up, as well as a loss of power for GPs.

Papers presented to the committee state that the new local teams would continue to have clinical leadership. However, the proposed system would still represent a geographically broader local commissioning arrangement than currently exists – reduced from eight distinct areas to five.

Current CCG budgets, as agreed until 2024, would be unaltered under the plans – with a guarantee that the money will still flow to the same areas even if the organisational changes are implemented in the meantime. But beyond that date, a single CCG could develop a new funding distribution methodology enabling it to target areas of particular health inequality.

The annual running costs of the eight existing CCGs amount to £36m out of a combined budget of £2.9bn. Committee members heard that the money saved could be reinvested in services.

The use of the five ICP areas as the basis for the proposed locality commissioners is designed to complement a focus on the so-called “primary care networks” introduced across England last year – collaborations between clusters of GP practices covering 30-50,000 patients, designed to broaden community-based “neighbourhood” healthcare.

A consultation has now begun with the existing CCGs, whose memberships are made up of GP practices from the areas they serve. Each of the eight would have to agree to the changes before they could be introduced – and a vote on the issue is expected in May.

Last year, a proposal to merge just the Greater Preston and Chorley and South Ribble CCGs was rejected by the members of both organisations.

If the latest proposals are approved, the new arrangements would come into force in April 2021.

EXISTING CCGs

Most of the current CCGs have partnered with one of their neighbours to share workforces - but they remain separate entities.

Blackburn with Darwen

Blackpool

Chorley and South Ribble

East Lancashire

Fylde and Wyre

Greater Preston

Morecambe Bay

West Lancashire CCG

PROPOSED LOCALITY COMMISSIONING AREAS

Central Lancashire

Fylde and Wyre

Morecambe Bay

Pennine Lancashire

West Lancashire