CCG Mergers - Maximising Commissioning Efficiencies
Since 2019, Clinical Commissioning Groups (CCGs) have been encouraged by NHS England/Improvement to consider merging, in a bid to streamline commissioning, support system-wide working and benefit from a single direction across the entire system.
Due to its expertise in transforming processes and developing efficiencies, NHS Shared Business Services (NHS SBS) was asked to partner with NHS E&I to merge 74 CCG financial ledgers into just 18 new ledgers. This was a large and hugely complex merger programme, completed on time and to budget at the height of the Covid-19 pandemic.
The challenge of validating, extracting, cleansing and importing data on a massive scale was set against the huge additional pressures of the Covid-19 pandemic. To give an idea of complexity, one aspect of the programme involved the transfer of 74,000 purchase invoices from legacy ledgers to new ledgers in a swift, accurate and verifiable manner.
For the newly formed CCGs to transact independently, pay their suppliers and account for their actions, the financial ledgers had to go live on 1 April 2020.
All members of the programme team were mindful of the impact on services should the programme go wrong or deadlines not be met. On top of this, the requirement for the NHS to pay invoices urgently to help manage the pressures of Covid-19 meant that this process could not be delayed.
In order to meet the Go Live date, NHS SBS and NHS E&I developed a comprehensive plan which brought together every project, discipline and strand of work. Whilst being achievable it was ambitious, requiring a fast pace and rock-solid project management.
The plan highlighted 514 individual tasks per merger, which all had to take place at the right time and in the correct order. This was an essential factor in the clear management of data transfer tasks which were delivered quickly using economies of scale.
The overall programme involved around 300 people across multiple organisations. To be successful, collaborative working across all parties with strong communications was crucial. Everyone had an essential role to play. Stakeholder buy-in and strong partnership working were demonstrated throughout the project as each party had an incentive to meet the ambitious Go Live date.
Every project was carefully structured on Prince 2 project management principles with governance in place to ensure visibility to the individual project boards and project sponsors as well as NHS SBS and NHS E&I.
A trusted system was implemented to carefully and collaboratively monitor progress at project level. A series of project hubs took a controlled approach to all project deliverables and any risks were raised early and reported through the programme hierarchy. A RAG status reporting structure was also created to ensure visibility at every level.
The introduction of robotic process automation meant that teams were able to transfer invoices far faster and with greater accuracy than would have been possible manually, thus ensuring that supplier payments were not delayed. Project plans and project documentation were used across the programme and were written in a way that allows them be re-used for all future large-scale programmes of work with scope for minor customisations.
The transition was enabled thanks to robust programme and project governance, efficient resource management and a clear focus on the needs and requirements of the project's stakeholders.
The team delivered a seamless transition between the legacy ledgers and new ledgers. The move to home working required some quick-thinking and flexibility but changes to project plans and timelines ensured that ultimately there was no impact to Go Live dates.
Crucially, the smooth transition for all CCGs meant that there was no disruption to service. This was even more important during that period of extreme pressure to ensure fast payment of invoices to both NHS and non-NHS suppliers.
In addition, by enabling CCGs to move to their new ledgers immediately, all reporting capabilities were instantly available for NHS E&I and CCG leadership to enable them to track and monitor spend at this critical time.
Due to the success of the project, the learnings and best practice are now being shared more widely. The approach to stakeholder management in particular has already been replicated with the CCG mergers which are planned for April 2021 with sessions held with stakeholders in October 2020.
What our partners say
"It was a seamless and painless process. The CCG mergers are one of the best examples of why we need a single financial platform. On the day that the mergers went live, a record amount of cash flowed around the NHS."
Adrian Snarr, director of financial control, NHS England and NHS Improvement