12 Clinical Commissioning Groups (CCGs) are forming the Northern CCG Joint Committee. This collaboration will cover a population of around 3m people via the furthest north CCGs in England, although these CCGs already had a network of less formal working that has been going since CCGs were established. The paper proposing this collaboration can be found here and it recommends a collaboration and consistency to enable difficult decisions to be managed across a geography (e.g. redesigning hospital services, working with the ambulance provider). It also sets out ideas for joint commissioning – this has particular implications for specialised commissioning and alignment with Strategic Clinical Networks. It also signals future assimilation of the local Commissioning Support Units back into the mainstream NHS as well as an assumption that the two Sustainability and Transformation Partnerships covered by these CCGs will come together. This all reinforces the NHS policy direction of travel to consolidation (de facto mergers) and working together to manage difficult decisions around hospital configuration and “rationing” decisions. Pharma and MedTech needs to consider this direction around formularies, guidance, Carter Review type procurement and specialised commissioning decisions in particular. It also links to reinforced use of such sub-structural arrangements as the Northern Treatment Advisory Group.