Merger process begins for Wiltshire Clinical Commissioning Group

Wiltshire Clinical Commissioning Group (CCG), which holds the NHS budget for the county, had two important meetings in public on Tuesday (June 25).  As marlborough.news has been reporting, big changes are underway.

The CCG’s AGM was followed by an extraordinary meeting of their governing body that approved moves toward a formal merger with the Bath & North East Somerset (BaNES) and Swindon CCGs by April 2020.

It was a bit surreal: the AGM showed Wiltshire CCG had had a good year – both good financially and good in its achievements.  Though as Wiltshire CCG’s Linda Prosser stated: “That doesn’t mean that everything’s perfect – we know that.” 

But the merger – which will take away their identity as a stand-alone organisation – has been ordained by their regional bosses at NHS England.  It developed from the decision in October to have an over-arching executive board for the three CCGs. 

The proposals now go to Swindon CCG (June 27) and BaNES CCG (July 4).   As CCGs are membership organisations, the GP members in each CCG have a vote on the merger.  Eventually they have to apply for merger and it is then approved (if all goes well) by NHS England – who anyway want it to go ahead.

The new CCG will be known as BSW – for BaNES, Swindon and Wiltshire.  The other BSW, the BSW STP (Sustainability & Transformation Partnership) – with the same geographical footprint as the three CCGs – will carry on. 

Unlike the CCGs, BSW STP is not a statutory body – more ‘a coalition of the willing’ made up of 14 partner organisations including CCGs, acute hospitals and local authorities.  It is unclear whether its role will change as duplications with the new BSW emerge.

Already there are new faces among the soon-to-be merged governing bodies. Tracey Cox is BSW’s Chief Executive, Gill May (former Director of Nursing and Transformation at Swindon CCG), becomes BSW’s Director of Nursing and Quality, and Caroline Gregory, Swindon CCG’s Chief Finance Officer, is taking on the same role at BSW.

The paper before the meeting was somewhat opaque as – in the words of Sarah James (BSW’s ‘Programme Director for Transition’) to the meeting: “…most people in the room were there during the discussions” – that led to the path toward merger.

The paper did spell out some of the risks in the merger – staff turnover may increase due to the scale of change, decision making may not be agile enough, timescales to complete the merger are ‘challenging’ and member GP practices and stakeholders may not support it.

There are financial considerations too.  The merger needs to save 20 per cent on running costs.  And there are savings to be made across BSW STP of about £70 million a year.

The timing of all this is somewhat strange.  The 2012 Health and Social Care Act (the legislative instrument for the Lansley/Coalition reorganisation of the NHS) is still in force.  There has been word in Whitehall that changes to it may be considered – but when?  Some changes are even due for consultation.

But progress in health policy – and especially social care policy – has seized up.  Brought to a halt  by the Brexit stagnation that has hit the government and a civil service concentrating on ‘no deal’ and ‘what deal?’ imperatives – and has halted legislative programmes. Linda Prosser spoke about “…the much long-promised government Green Paper on social care – without that Green Paper we are really struggling to plan far in advance.”  The only green thing about this vital policy paper is the long grass it has been kicked into.

Is the urgency of this move towards merger a case of ‘while the cat’s away playing with the Brexit ball of wool’ or is it more like executive decisions filling the non-Brexit vacuum in politics – while it lasts?  Even, perhaps, before the new prime minister gets down to domestic policies?

Until we know a great deal more about the merger – we do not even know where it will have its headquarters – and its place in the new NHS jigsaw, we shall not know how it might affect the people of Wiltshire.

The full paper on the merger can be read here.