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CCG mergers - what to consider

20 June 2018

Many CCGs are looking at how they can strengthen and formalise their collaborative working arrangements with neighbouring CCGs. As part of this process, there will inevitably need to be a discussion about whether such arrangements could be or are a precursor to a formal merger.

NHS England’s guidance for CCGs applying to merge sets out the criteria that will need to be satisfied. It also emphasises that the “process to merge two or more CCGs will require the commitment and leadership of CCGs’ governing bodies. Mergers should only be considered when there are demonstrable benefits to patients from the proposal, and the management of the merger will not be detrimental to the performance of the individual CCGs throughout the process”.

In determining whether to approve a merger NHS England will consider various factors, including the statutory-based criteria, such as:

  • Coterminosity with local authorities

    Where coterminosity is an issue, a good working relationship with the relevant local authorities and a clear narrative about why coterminosity has not been achieved will be required.
  • Clinically-led

    It is essential to ensure the continued engagement and support of the members of each relevant CCG during a proposed merger process. Engaging with members only on the ‘formal’ aspects of the merger e.g. a new Constitution, is not enough; they need to be actively engaged throughout the process and new governance arrangements must ensure strong clinical leadership. Where possible, governance arrangements should be designed to avoid any appearance of priority being given to one of the merging parties.
  • Financial management

    Financial factors, and the potential for cost-savings through economies of scale, are often one of the key issues driving a merger. Clear financial controls and assurance, including appropriate governance arrangements for any transitional period, will be needed. A due diligence exercise to establish liabilities and key risks should also be undertaken.
  • Arrangements with other CCGs

    Aside from ensuring that any established patterns of partnership working are reviewed and revised to reflect the proposed merger, specific issues relating to other neighbouring CCGs may also need to be considered. For example, if one neighbouring CCG has decided not to participate in a merger but will still need to work in close collaboration with the new CCG, then careful consideration will need to be given as to how this will work; will a joint committee arrangement be needed? Or is something less formal sufficient?

 In addition, NHS England will also consider:

  • Strategic purpose

    Is there a good case for merger supporting the strategic intention in the relevant STP? One of the other factors that NHS England looks at is whether the arrangements are 'future proofed'. Grounding the proposals in wider system change will help to make the case for change. Linked to this…
  • Prior progress

    Is there a clear track record of strong collaborative working? Ideally this will include formal joint working through joint committees, at least in the run-up to any formal merger.

    This will help demonstrate a shared commitment to a merged entity; the ability to work together (including the ability to deal with disputes or disagreements); and help to shape the governance structure of the new entity.
  • Leadership support

    Wide support for the merger from across the STP will help to support the case for change. As above, joint working will help to support this.
  • Ability to engage with local communities

    One of the challenges of bringing two or more smaller organisations together is the need to try and ensure continued flexibility, accountability and responsiveness to local communities. Ensuring that governance arrangements provide for appropriate layers of accountability and decision-making will help with this, as will the use of locality (or equivalent) arrangements to enable membership involvement at smaller, more local footprints. Such arrangements should be reflected in a revised CCG Constitution and any associated documents, such as a CCG Handbook and/or collaboration agreements.

Although these factors are formally linked to any proposal to merge, they form a helpful framework when considering any proposal to develop closer and more formal integrated working. Ensuring that they inform the development of such proposals and the assurance of any integrated working will ultimately make it easier to develop a merger case for change.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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