The need to reduce operating costs by 20% has had many CCGs start to discuss mergers. Sharing boundaries with local authorities makes sense from an adult social care and health integration perspective. This can create very large areas where the usual flow of patients to providers is not quite aligned to local authority boundaries. Surrey and Sussex Healthcare Trust and Epsom and St Helier University Hospitals Trust are both examples of providers that straddle local authority and CCG boundaries.  This is not a new issue and some of the proposed CCGs look similar in size to their predecessor PCT. 

CCGs have many challenges to meet not least of all managing the merger process whilst maintaining GP engagement, establishing Primary Care networks, maintaining financial control and supporting the transformation agenda needed to make a success of the long term.