Starting today, 42 Integrated Care Systems (ICSs) will change the way health and care services are planned, paid for and delivered across England. Clinical Commissioning Groups (CCGs) are now a thing of the past as ICSs step up to take their place, moving England towards a more joined-up model of care.

This transfer of commissioning powers is a significant step toward the NHS’ goal to tackle wellbeing inequalities across the country as it allows for decisions to be made that best suit the needs of local populations. NHS services will work closely with local authorities and other partners in the geographical region to deliver community-focused care and, hopefully, improve patient outcomes. Leaning on community services and using them to their full capabilities should also help alleviate some strain on the NHS.

Amanda Pritchard, NHS chief executive, said:

‘Integrated care systems have the power to truly transform the way that we care for people up and down the country – not only will the NHS provide care when someone is unwell or has an accident but alongside our local government partners, we must also now play an increasing key role in managing peoples’ health so that we can catch more killer conditions earlier and save lives.’

Community care

ICSs provide an opportunity to deliver a larger portion of care in the community. This means signposting people to alternative services that can support, supplement, or replace GP care. This will also further enmesh typical NHS health services with social care services, creating clearer pathways – and better communication – between the two.

Professor Vic Rayner OBE, CEO of the National Care Forum, commented:

‘Social care providers, especially not-for-profit providers, are deeply rooted in their local communities. […] Their knowledge and expertise will ensure that together with their partners they can tackle the deep-rooted health inequalities and improve the health and wellbeing of people who live and work in their area.’

A greater presence in the community will also help ICSs deliver care to those who need it most, whenever they may need it. One GP practice in Stockport is already going just this through blood pressure checks in community locations such as betting shops and sports clubs, helping identify and prevent hypertension issues before people end up in hospital. With waiting lists for care still spiralling and A&E waiting times reaching alarming heights, these alternative avenues of care will be welcomed with open arms. Community care also supports preventative action whereby people are supported to stay healthy throughout their lives as opposed to only having contact with services in points of ill health or crisis.

Easier access to checks and tests will also help identify conditions earlier and make sure that people are aware of the alternative options they have, rather than always relying on their GP, calling 999, or attending A&E for something that could have been handled by another service.

How are ICSs structured?

ICSs consist of three core levels: system, place, and neighbourhood.

‘System’, the top level, covers around 1 to 2 million people within a defined geographical area. This is where strategic planning takes place and where budgetary decisions are made.

The next step down – dubbed ‘place’ in NHS literature – covers places with populations between 250,000-500,000. These ‘places’ are less clearly defined and may be organised along town, city, or council boundaries.

The lowest level, ‘neighbourhoods’, cover populations of around 30,000 to 50,000 people, brought together by Primary Care Networks (PCNs).

This is a very basic and distilled description of the structure, more comprehensive information on how ICSs are structured can be found here. This may well be updated following the ICSs coming into force today and as almost inevitable kinks are smoothed out in the coming months.

Transitions to new systems are often bumpy and can be concerning for those who are working in roles that will be affected by the changes. Luckily, people’s jobs are safe while this transition unfolds: the Employment Commitment laid out in the framework design documentation ‘asks affected organisations not to carry out significant internal organisational change and not to displace people’ during the transition period.

This new structure is hoped to bring much-needed support to services, patients and staff. The effectiveness of the change remains to be seen, but the overall outlook is optimistic.