Health commissioners bring in jobs freeze and share cost-cutting merger plans

Posted On 20 May 2019 at 1:28 pm

Health commissioners have brought in a jobs freeze as they prepare to decide on a series of mergers aimed in part at cutting running costs.

The mergers are expected to reduce the number of clinical commissioning groups (CCGs) in Sussex from seven to three.

The Brighton and Hove CCG, which has annual budget of about £400 million, is expected to remain formally independent while working increasingly closely with the new organisation covering East Sussex.

Adam Doyle, currently the chief executive of all the CCGs in Sussex, said: “It is widely recognised that our individual CCGs are no longer able to operate and commission effectively and efficiently for the changing needs of our populations.

“This is due to the relatively small size of CCGs which has meant that across our health and care system there have been inconsistency in how services have been commissioned, there has been unnecessary duplication in work, it has been difficult to commission at scale when needed and it has been increasingly difficult to recruit and retain specialist expertise and skills among our staff.”

Mr Doyle added: “All CCGs across the country are required by NHS England to reduce their running costs by 20 per cent by April 2020.

“This represents a significant proportion of the running costs for each of our individual CCGs and it is clear they will no longer be able to work as independent organisations in the future.

“Changing the configurations of the CCGs and streamlining our processes and ways of working will help us achieve the required cost reduction.”

He said that there would not be a total jobs freeze but most recruitment to permanent posts would be put on hold.

CCGs were created in place of primary care trusts (PCTs) under NHS reforms in the Health and Social Care Act 2012.

Existing local PCTs – similar in size to the current CCGs – were merged before the reforms took effect into one trust to commission services across Sussex.

Since the CCGs were created, they have had fewer staff despite doing similar work to their predecessor PCTs.

And they have attracted criticism for some of their decisions, including controversial changes to the Patient Transport Service (PTS) arrangements which gave rise to problems for staff and non-emergency patients.

Most recently, the Brighton and Hove CCG cut funding for the disability advice service provided by local charity Possability People at short notice. When councillors learnt of the move, even the ruling Labour administration in Brighton and Hove was quick to distance itself from the decision.

Since the creation of the Brighton and Hove CCG, the area has suffered one of the highest rates of closure of doctors’ surgeries in the country. It has continued the PCT’s work in replacing old surgery buildings with newer ones although it recently scrapped plans for the Ardingly Court surgery in Brighton to relocate to more suitable premises near by.

The proposed changes to CCG boundaries would reflect the boundaries of the three Sussex councils that commission social care – Brighton and Hove City Council, East Sussex County Council and West Sussex County Council.

The proposals reflect the pressure on health and social care commissioners to work more closely together, with an emphasis on greater “integration”.

Adam Doyle

Here is the full text of a message from Mr Doyle about the proposed changes.

Dear colleague,

I am sending you this message today to outline proposals that are being discussed around the future commissioning arrangements for our CCGs. This is a long message but I would like you to read it in full so you are all aware of what the current situation is with the direction of travel for our organisations.

As you know, our governing bodies have been exploring how commissioning can be done more effectively in future to bring greater benefits for our populations. As a result of these discussions, the following options will be considered by our governing bodies in June, which would see some of our CCGs merging to create commissioning bodies working across our local authority footprints.

  • Coastal West Sussex, Crawley and Horsham and Mid Sussex CCGs would merge to become one CCG for West Sussex.
  • High Weald Lewes Havens, Eastbourne, Hailsham and Seaford and Hastings and Rother CCGs would merge to become one CCG for East Sussex.
  • Brighton and Hove would remain as a single CCG but, due to its relatively small size, would work closely with the CCGs in East Sussex, through joint committees and teams.
  • East Surrey CCG would formally integrate with the Surrey Integrated Care System and no longer work within the management structure of our CCGs.

If these proposals are agreed by the governing bodies in June, recommendations to formally apply to NHS England for approval for the mergers will then be discussed with the GP memberships.

There are many reasons why these changes are being considered now and I have attached a useful document that gives further details. However, it essentially boils down to three main factors.

Firstly, it is widely recognised that our individual CCGs are no longer able to operate and commission effectively and efficiently for the changing needs of our populations. This is due to the relatively small size of CCGs, which has meant that across our health and care system there have been inconsistency in how services have been commissioned, there has been unnecessary duplication in work, it has been difficult to commission at scale when needed and it has been increasingly difficult to recruit and retain specialist expertise and skills among our staff.

Secondly, our local health and care system has to respond to the expectations of the NHS Long-Term Plan, which outlines a fundamental shift in how CCGs will work and how future commissioning will be done. This involves the expectation of greater integration with local authorities and other partners, with commissioning arrangements and configurations that will support the formation of Integrated Care Partnerships (ICPs) and Primary Care Networks (PCNs).

Thirdly, all CCGs across the country are required by NHS England to reduce their running costs by 20 per cent by April 2020. This represents a significant proportion of the running costs for each of our individual CCGs and it is clear they will no longer be able to work as independent organisations in the future. Changing the configurations of the CCGs and streamlining our processes and ways of working will help us achieve the required cost reduction while also being able to commission effectively for our populations.

Our governing bodies recognise that these proposals would not only address the three points above, but also provide the foundation to develop a new model of commissioning that focuses on more integrated work with local authorities to improve population health outcomes and a reduction in health inequalities.

However, while the proposals are expected to bring positive benefits of our populations, I am aware that they will cause some immediate levels of anxiety and concern among our staff, especially around the required 20 per cent reduction in running costs, so it is important we are all open and honest about what this might mean.

The first point to stress is that all of this will mean different things to different members of staff and we do not currently have all the answers to the many questions that you will have.

Work is currently under way to fully understand what changes we will need to make and it is expected that a large part of the required savings will be achieved if the proposals for merging CCGs are agreed and once we can work in a more effective way within a new operating model.

Work around the new operating model will be done over the weeks ahead and this will need the input and involvement of individuals and teams across our CCGs to make sure we get it right. The new operating model will represent an opportunity for our staff to work in more effective ways in the future, build new skills and experience and to help shape the design and delivery of future services.

However, we do all have to recognise that it will require a lot of change and there will be periods of uncertainty for all of us which we all need to support each other through.

While we work all the details through, we have to make sure we are not making decisions now that may not be right later. This includes the recruitment of new staff as, clearly, it would not make any sense to bring new people into our organisations in posts that may then quickly have to change in the future.

As a result, the new executive team have agreed that we will tighten up the recruitment process and, until we know exactly how we are going to work in the future, only business-critical posts will be filled with permanent appointments.

This does not mean there is a total vacancy “freeze”, as there will be the need to make short term and fixed appointments, but it does mean that there will need to be clear justifications of why appointments need to be made now.

We recognise that this will make some of your lives more difficult in the short term but we feel it is the best course of action to make sure we are in a good position to develop and change into the new ways of working.

To ensure you are able to discuss, raise concerns and ask questions about all of this, we will continue to update and brief staff over the next few weeks. There are standing staff briefings at all our offices this week and we are arranging staff engagement sessions where you will be able to further discuss this with members of the executive team.

I will, of course, keep you fully updated and, if you have any immediate concerns or questions, please either contact myself directly, speak to your line manager or email sesc.comms@nhs.net.

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