Nearly half of clinical commissioning groups in England are proposing to merge next year in what would be the biggest cull of NHS organisations for more than a decade, according to the Health Services Journal.

Eighty-six CCGs have confirmed or are consulting over consolidations by April 2020, reports HSJ. Four areas – Bradford, North Yorkshire, Nottingham and Nottinghamshire, and Shropshire – have so far formally agreed to apply to merge.

A further 17 areas are planning to make applications if local talks are successful – among them Kent and Medway, Durham and Teesside, Staffordshire and Stoke-on-Trent, and Herefordshire and Worcestershire. London is likely to see the biggest change, if a total of 25 CCGs in the capital become four in April, as is currently proposed.

There is a September deadline for 2020 merger proposals. Any changes have to be approved by NHSE, which is encouraging mergers to help cost-savings and the development of system working.

The proposed mergers can be viewed on an online map.