Major shake-up of NHS operation in Preston, Chorley and South Ribble

The two organisations responsible for planning and purchasing the majority of healthcare services across Central Lancashire will close down today (30th June) as part of a major England-wide restructure of the NHS.

The Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCGs) had overseen the provision of both pre-planned and urgent and emergency care - as well as community health, mental health and maternity services - since they were established in April 2013. They have also had a role in commissioning GP - or primary care - services for the past seven years.

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Under government legislation introduced earlier this year, the two bodies will cease to exist and their functions, along with those of their six counterparts elsewhere in Lancashire, will be transferred to a new statutory organisation which will discharge the former CCG role at a much broader, county-wide level - although there will be no change to how patients access frontline health services as part of the switch.

Denis Gizzi, chief officer of the two Central Lancashire CCGs, at their Leyland headquarters

Nationally, CCGs have controlled about 60 percent of the NHS budget since their inception.

NHS Lancashire and South Cumbria will tomorrow assume responsibility for healthcare spending and the day-to-day running of the health service across that wider region. It will be one of 42 integrated care boards (ICBs) established nationwide.

Alongside Lancashire and South Cumbria’s ICB will be an integrated care partnership (ICP), which will see a range of relevant organisations sitting together as part of a committee designed to deliver more joined-up and coherent health and care services for what will be a population of 1.8 million people - as opposed to the 395,000 served by Central Lancashire’s CCGs.

The new, formal partnership will include local authorities, voluntary, community, faith and social enterprise organisations and independent healthcare providers. Lancashire and South Cumbria was one of the first parts of the country to move towards an integrated care model almost five years ago and has operated a board which has overseen collaboration work in the area to date.

Dr. Lyndsey Dickinson, chair of Chorley and South Ribble CCG since 2019

The two CCGs in Central Lancashire have worked increasingly closely over the years, sharing an executive team and, since 2019, holding joint meetings rather than the near-identical agendas which they used to discuss separately up until that point.

However, they have remained distinct organisations, with their memberships made up of GP practices from across the three districts of Preston, Chorley and South Ribble.

Denis Gizzi, the chief officer for the two organisations since 2017, told their final governing body meeting earlier this month that he was “not massively sad” at the passing of CCGs, because “these organisations have a shelf life - and we’ve had a good one”.

However, he paid tribute to the work that had been done by them - and how they had operated.

Dr. Sumantra Mukerji, chair of Greater Preston CCG since 2017

“One of the things I always look at in organisations is their ability to move away from groupthink. [That] is where you ..are discussing challenges, but there might only be one or two ideas [put forward] and the rest of you are thinking, ‘Well, I’m not so sure that’s going to work’ - but nobody says anything.

“We definitely haven’t done that, we’ve had strong, significant and appropriate challenge all the way through, which I think has helped us to get to where we want to be,” Mr. Gizzi added.

Chorley and South Ribble CCG chair and clinical lead, Dr Lyndsey Dickinson, said that the pandemic had seen the health service’s resilience tested, but added:

“I think it has also formed some really strong partnerships across our organisations and …that gives me hope for the future.” She also paid tribute to the “wonderful team” that she had worked with.

Meanwhile, Greater Preston CCG chair and clinical lead, Dr. Sumantra Mukerji, said that the five years he had spent in the role were “not without challenges”.

“Initially, I used to dread those challenges, but after a while, I didn't anymore - I actually welcomed [them],” he added.

The meeting heard that the Greater Preston and Chorley and South Ribble CCGs would be closing with an "allowable deficit" - okayed by NHS England - of £1m on each of their balance sheets, in relation to prescribing pre-payments. This arrangement was to enable a "clean" set of accounts to be handed over to the ICB.

Denis Gizzi said that the two CCGs were passing on a "stable economy", havng been brought back from a "precarious financial position" five years ago.

NEW ORDER

Although the new Lancashire and South Cumbria integrated care board will serve a vast and disparate area compared to the clinical commissioning groups it replaces, health thinktank The King's Fund says that a key premise of the reforms is that much of the work to join up health and social care and improve population health will be undertaken at a more local level.

This will involve areas known as "places" - perhaps akin to the footprints served by a hospital - and also even smaller geographies called "neighbourhoods". The thinktank says that the legislation underpinning the changes gives local leaders "flexibility" in terms of any arrangements they introduce.

Lancashire and South Cumbria's ICB recuited Kevin Lavery as its chief executive - at the time, in a designate capacity - late last year. Mr Lavery has previously been the chief executive officer for the City of Newcastle-upon-Tyne, Cornwall Council and the City of Wellington in New Zealand.

The ICB will be chaired by David Flory, while Dr. David Levy - previously a regional medical director for NHS England - will be the organisation’s chief medical officer.