With the Primary Care Networks (PCN) dominating the majority of our attention, little is known about the advances being made at a higher strategic level within the NHS. Let’s spare a thought for the Integrated Care Systems (ICS). This article sets out why ICSs are being created/developed, what is their role is within the NHS, what impact they will have on health and care services, what future developments can we expect and what can practice do now to support and shape the future of health and care services.
Firstly, why are ICSs being created/developed? NHS England is responsible for commissioning £17.7bn of specialised services. Many of these services are commissioned as part of broader care pathway and often have multiple commissioning organisations involved i.e. clinical commissioning groups (CCGs) and local authorities.
This fragmented commissioning model can occasionally lead to misaligned incentives, under-investment in interventions and disjointed care for patients.
ICSs bring together local organisations, including primary and specialist care, physical and mental health services, and health with social care, in a realistic and practical way for the purposes of planning services to ensure that care pathways are based on the specific requirements of the local population, reduce fragmentation and give local services and organisations more say in how specialised budgets are spent in their area. Thus, hopefully making greater use of local know-how about local patient needs.
What is their role is within the NHS? By April 2021, ICSs will cover the whole country, growing out of the current network of Sustainability and Transformation Partnerships (STPs).
ICSs will operate at ‘place’ level i.e. covering populations circa 250,000 to 500,000 people and will bring organisations together to focus on population health management, service redesign and the Long-Term Plan implementation.
ICSs will have a key role in working with Local Authorities at ‘place’ level. And it is through ICSs that commissioners will make shared decisions with providers on how to use resources, design services and improve population health by streamlining and standardising care pathways across a whole area. By making better use of data, ICSs will improve how health and care services address wider health factors such as housing, environmental quality and access to good employment and training.
What impact will they have on health and care services? With population health management capabilities ICSs will have an advisory role on NHS England-led specialised services’ planning boards. Each planning board will decide on the services it will prioritise and support the design of new integrated care models for different patient groups.
ICSs should have clear plans to deliver the service changes set out in the Long-Term Plan; improving patient experience, outcomes and addressing health inequalities. However, initially, they are likely to focus on services where there is a clear overlap in commissioned services.
It is important to note that the decisions made at ICS level will be for the benefit of larger populations of people and perhaps not for the benefit of individual practice populations.
It is essential therefore that practices engage now with their PCN and PCN Clinical Directors to ensure that their voice is heard about the issues facing their practice population, issues relating to local services or lack of and present solutions to those issues.
Practices should be heard not just at ‘neighbourhood’ level (PCN level covering populations circa 30,000 to 50,000 people) but taken forward by their clinical directors to ‘place’ level (ICS covering populations circa 250,000 to 500,000 people) where funding the care design can benefit the ICSs’ population.
What future developments can we expect? Beyond 2019/20 NHS England will announce further financial improvements that will support ICSs to deliver integrated care. It will be at ICS level where commissioners and providers make shared decisions about financial planning and service and care redesign.
ICSs will begin to “earn” financial autonomy and therefore gain greater control over resources on the basis of a track record of strong financial and performance delivery, assessed by an accountability and performance framework.
What does this mean for the future of General Practice? ICSs are being hailed as the future of health and care integration in England. Many of the published documents indicate that ICSs will want to work with General Practice rather than against. Practice Managers, while having one hand on the practice tiller, should also be keenly interested in the development of their ICSs, as this is where funding and service design/re-design will take place.
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