The two GP-led groups which plan and purchase healthcare services across Central Lancashire have rejected a proposed merger which would have saved around £400,000 per year.
The Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCGs) already share the vast majority of their staff and are run by the same executive team.
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However, they each have a separate governing body made up of five GP directors and lay members from their respective areas.
The membership of each CGG - which comprises every practice in the locality - was asked to vote on whether they should become a single organisation. But the proposal was roundly rejected, with 95 percent against the idea in Preston and 63 percent voting it down in Chorley and South Ribble.
The Local Democracy Reporting Service understands that the decision has been greeted with dismay by the near 100-strong CCG workforce, some of whom fear that the entire burden of £1.2m in cost savings which need to be made this year will now fall on them. One staff member said colleagues felt as though some GP directors had pressed for members to maintain the status quo.
But Dr. Sumantra Mukerji, chair of the Greater Preston CCG, said GP members would have “weighed up the pros and cons and come to their own conclusions”.
“They are smart people - and I think they have looked at what is right for their patients,” said Dr. Mukerji, who stressed that he was not speaking on behalf of the membership and had to remain neutral as a CCG chair.
“I suppose [GPs] wanted to keep the services close to their communities. There is also a difference in the demographics and the needs of the two populations and, recently, people have been worried about hospital care, too - so those kind of things might have played on their minds.”
Dr. Mukerji added that the clinical input provided by GP directors to the work of the CCG was “absolutely vital”.
According to the latest accounts, those GP directors receive between £35,000 and £65,000 per year for working between two and three half-day sessions per week. The chairs of the two organisations receive between £115,000 and £120,000 annually, including pension contributions.
The creation of a single governing body would have contributed to about a third of the required savings in CCG running costs which have been demanded by the government during 2019/20.
Dr. Gora Bangi, chair of Chorley and South Ribble CCG, said that he took seriously the potential implications of the decision for staff.
“I’ll leave no stone unturned if even one staff member has to lose their job. I’m also absolutely clear that we need to reflect on this whole piece of work and [ensure] that we learn from it,” Dr. Bangi said.
Denis Gizzi, chief officer at both CCGs, said that all governing body members have to comply with strict policies to manage conflicts of interest - and that independent lay members had been assured that they had done so throughout the month which members were given to decide how to vote.
“My staff might think that it wasn’t such a good decision, because there was an obvious way to make savings and [members] haven’t taken it.
“My role is to keep engaging the staff and explaining that there are many ways of achieving that savings target without a merger - [which] wasn’t going to deliver it in full anyway.
“We are already very management efficient in Central Lancashire - we’ve got one team running two CCGs. So it could be argued that it’s a bit unfair to ask us to make 20 percent savings, but the rules are the rules.
“I'm confident we can do it without a merger,” Mr. Gizzi added.
WHAT HAPPENS NOW?
The governing bodies of the two CCGs have given the go-ahead for managers to investigate the possibility of them sitting together in a single meeting - while remaining two separate entities.
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Some of the CCGs’ sub-committees already operate in a similar way and maintain distinct voting.
It would end the practice whereby the Greater Preston and Chorley and South Ribble governing bodies meet on consecutive days every other month, are presented with the same reports from the same management team and discuss an identical agenda.
In the absence of a formal merger, finance director Matt Gaunt said the proposal offered a “potential productivity saving” which is “not inconsiderable, but not huge”. The savings would be generated primarily by freeing up officer time and reducing the cost of having to rent two meeting spaces for the gatherings, which are open to the public.
But it will first need to be established if it is permissible for CCGs to meet outside of their geographical area, which would be a consequence of the proposed arrangement. Vice chair Paul Richardson said he hoped that it would be a matter of “accessibility [for the public] rather than geography”.
At the most recent meeting of the two governing bodies, members also rejected the option of maintaining two vacant GP director posts, for which a recruitment process will now begin. They also approved the continuation of the arrangement to share the lay vice chair between the two organisations.
The NHS long-term plan, published in January, suggested that a single CCG should eventually serve an entire Integrated Care System (ICS) area - in this region, that would be the whole of Lancashire and South Cumbria.
But Greater Preston and Chorley and South Ribble CCG chair, Denis Gizzi, told the Local Democracy Reporting Service that the variation in ICS sizes across the country meant that such an ambition might not be desirable.
“GP practices are members of CCGs and they influence them clinically. If you aggregate that up to the level of Lancashire and South Cumbria, how can a GP in South Ribble maintain the sanctity of their opinion when they are so far removed?
“It ceases to be a CCG [in that scenario] and becomes a strategic commissioning group. I completely agree that we should have one of those, but it’s not a CCG,” he said.
£1.2m - the saving required across Central Lancashire’s two CCGs this year, representing 20 percent of their total running costs.
£400,000 - the annual estimated saving which would have been generated by merging the Greater Preston and Chorley and South Ribble CCGs.
1 out of 22 - proportion of GP practices in Greater Preston which supported a merger.
8 out of 22 - proportion of GP practices in Chorley and South Ribble which supported a merger.