Agenda item

Primary Care networks, Interim CCG Clusters and Integrated Care System Structures


Mark Easton provided a brief update on numerous changes to the CCG operating model. Engagement had commenced about the move towards a single CCG.  The CCGs had begun to explore what would happen within the transitional year and to develop an understanding of what happened at both CCG and borough levels.  This had led to some engagement work prior to December 2019 and there were proposals in train to cluster management teams.  It was clarified that this was not about having four clusters that would exist as autonomous structures.  The intention was to have 8 CCGs with 8 managing directors and to maintain some shared functions with 20% of staff working between boroughs and 80% working locally. 


Councillor Coleman commented that the move towards clusters presupposed a merger which was yet to be agreed and that the criteria and conditions for the merger had not been made known.  Councillor Coleman requested that the NWL Collaborative CCGs provided information about what conditions would have to be met for a merger to proceed.  He also requested that the Committee be provided with the details of the work plans identified in paragraph 1.3 of the report.  He continued that he had been surprised by a letter consulting CCG staff about prospective cluster arrangements without having discussed these arrangements with the Council.  It had been reported that H&F would be clustered with Ealing and Hounslow, but this was not the case.  H&F CCG was to be potentially clustered with Central and West London CCGs, an unwanted arrangement that reflected a historic local government arrangement between the three boroughs and which no longer existed. Councillor Coleman also sought clarification about the financial and administrative needs of GP at Hand and how this would be met by the NWL Collaborative.


In response Mark Easton referred to agreement reached between the 8 CCGs to merge in principle. In a caveat to this, there remained several issues that members of the governing bodies requested further information about.  Broadly speaking these were encapsulated by five bullet points contained at page 13 of the Agenda.  A more detailed paper had been submitted to the Joint Committee (of the NWL Collaborative) and covered the areas which the governing bodies said that they wanted to be satisfied about before they recommended that their members should vote in favour of a merger. Currently, the Collaborative was developing the answers to the questions posed by the governing bodies.  It was confirmed that this would be shared with the Committee when it was finalised. The document was essentially a derivative of the document produced in December 2019 and was currently in development. It was anticipated that this would be ready over the course of the next week.  It was hoped that a further consultation document would be published for staff but that the priority would be to work out arrangements for the interim year before worked commenced on the longer-term changes.  In response to a question about when this might be made available it was explained that this currently being worked on and that it would be shared when it was fit for public consumption and at the earliest opportunity. This would be a question of weeks as it would need to be ready before it was presented to the governing bodies in June 2020.


Responding to Councillor Coleman’s earlier point regarding consultation about cluster arrangements Mark Easton contended that the Council had been consulted by describing and making known the potential options available. The chief executive officers of each Council had been informed by letter. Councillor Coleman expressed his fundamental disagreement that this qualified as ‘consultation’ and that this had not been discussed with the Council. Mark Easton asserted that his view was different.  The clusters would share 20% of the costs arising from the shared functions referred to earlier.  The groupings would not form the basis of integrated care and were subject to on-going discussions.  This was an emergent point in development, and he explained that the CCGs were aware that WCC regarded the potential cluster arrangement as being ‘bi-borough’. It was confirmed that the administrative cost of GP at Hand would be broadly shared.  It was acknowledged that this was a huge financial burden for H&F CCG, but that this was expected to reduce.  Prompted by a request for further details about the shared functions and what these were Mark Easton felt it was not appropriate to share the details in advance of sharing this with CCG staff. 


ACTION: To receive a briefing about the conditions required to be met in order to for the CCGs to move forward with plans to merge.


ACTION: For the NWL Collaborative to share work plans once finalised.




That the Committee considered and noted the report.

Supporting documents: