Integrated Care System
Integrated Care Systems were formalised as legal entities with statutory powers and responsibilities following the passage of the 2022 Health and Care Act. They are part of a fundamental shift in the way health and social care is organised, away from competition and towards collaboration to integrate services. They comprise two key components:
- Integrated Care Boards (ICBs) – statutory bodies responsible for planning and funding NHS services
- Integrated Care Partnerships (ICPs) – statutory committees bringing together system partners, including local authorities, VCSE organisations and other local partners, to develop a health and care strategy.
ICSs have four key aims:
- Improving population health and care outcomes
- Tackling health and care inequalities
- Enhancing productivity and value for money
- Helping the NHS to support social and economic development.
We have two ICSs in our Lancashire & Cumbria LMC footprint:
- Lancashire & South Cumbria Health and Care Partnership covering approximately 1.8 million people.
- North East and North Cumbria (NENC) covering approximately 3.1 million people.
Integrated Care Boards & Partnerships
It is the role of the ICB to allocate the NHS budget and commission services for the population, taking over the functions previously held by CCGs, and also absorbing some planning roles from NHS England. Each ICB has a five-year plan that sets out how they will meet the health needs of their population. ICBs will have their own leadership team made up of a Chair and Chief Executive and with membership from Acute and Foundation Trusts, Local Authorities and General Practice.
The ICB’s five-year plan must have regard to their partner ICP’s integrated care strategy, which is built on local joint strategic needs assessments developed with the involvement of communities and Healthwatch. ICPs have a broad focus, which covers the ICS-wide strategy, public health, social care, and wider issues impacting the health and wellbeing of the local population. ICPs operate as a statutory committee bringing together the NHS and Local Authorities as equal partners.
Integrated Neighbourhood Teams
The Fuller Report published in 2022 signalled that Integrated Neighbourhood Teams (INTs) need to evolve from PCNs and be rooted in a sense of shared ownership for improving health and wellbeing of the population. This new vision for integrating primary care brings teams from PCNs, wider primary care providers, secondary care, social care, domiciliary care, and the voluntary sector who work together to share resources and information and form multidisciplinary teams (MDTs). In order to achieve this there should be a culture of collaboration, with a strong sense of trust between primary care and other system partners so that these teams can problem solve together for the betterment of health and wellbeing of their population.
The Fuller Report states that delivering INTs is going to need a “step-change in progress, with a systemic cross-sector realignment to form multi-organisational and sector teams…” Some of the recommendations to achieve this include:
- Full alignment of clinical and operational workforce from community health providers to neighbourhood footprints, working alongside specialist teams from the acute and mental health trusts.
- Making available back-office and transformation functions for PCNs, including HR, quality improvement, OD, data & analytics, and finance.
- A shared, system-wide approach to estates, including NHS trust participation in system estates reviews.
INTs in both Lancashire & Cumbria are in various stages of their journey. Some are being formed around PCN footprints and some around Place footprints, connected to their Health & Wellbeing Boards. In some areas, INTs are also referred to as Integrated Care Communities (ICCs).
Primary Care Networks (PCNs)
PCNs are groups of General Practices working closely together, with other primary and community care staff and health and care organisations, providing integrated services to their local populations. There are 50 PCNs across Lancashire and Cumbria - 42 in Lancs & South Cumbria and 8 in North Cumbria. You can find the list of PCNs here.
In April 2019, GPC and NHS England agreed a DES (Directed Enhanced Service) to fund and support, individual GP practices to establish/ join PCNs covering populations of between 30,000 to 50,000.
The Network DES is reviewed each year with increasing investment and responsibilities given to PCNs. Allied to this investment is the “Additional Roles Reimbursement Scheme” (ARRS) whereby certain specified funded roles become available to PCNs. In the first year each PCN was allowed one clinical pharmacist (70% funded) and one social prescriber. (100% funded) In the second year there was a major disagreement between the profession and NHSE about the over prescriptiveness and demands placed on PCNs by the service specifications published in draft form. In the subsequent negotiations the Service Specifications were simplified and streamlined and the expanded roles under the Additional Roles reimbursement scheme were all funded at 100%. The 23/24 DES is here
The role and function of PCNs does not require them to be a legal entity in themselves (although some groups of practices do chose to incorporate) but there must be robust governance in place. Their mandate is simply to perform the commissioned responsibilities set out in the Network DES (an extension of the GMS contract of each practice) and this is a collective responsibility of all the practices within the network. Each must appoint a Clinical Director whose accountability is to the PCN members (para 5.3.1 – Network Contract DES) There is no specified accountability upwards.
It is very clear that there is a massive operational agenda in managing, planning, and delivering community and primary care services, linking in with social and voluntary sector providers. It is also abundantly clear that there is currently very little infrastructure or planned infrastructure to allow this to happen. So, whilst GPs are nominally in charge, they do not have the tools or the time to do the job.
Then there is the aspiration to undertake population health management which will bring a whole new level of complexity, analysis, and management into primary care.
Over and above this operational management challenge there is an expectation that PCNs, through their Clinical Director and acting collectively with other PCN CDs, will play a critical role in shaping and supporting their Integrated Care System, helping to ensure full engagement of primary care in developing and implementing local system plans. (para 5.3.1.f - Network Contract DES)