18 June 2021

NHS England launches ICSs Design framework

NHS England launched its Integrated Care Systems (ICSs): Design framework this week.

It follows previous consultations, including the White Paper 'Working Together to improve health and social care for all' in February, which proposed fundamental changes to how NHS care is commissioned in England. The proposals included replacing CCGs with ICSs and making significant changes to procurement regulations. 

The framework sets out NHS England's expectations for the next phase of reforms, with "the anticipated establishment of statutory ICS NHS bodies from April 2022".

As set out in the White Paper, the forthcoming Health and Care Bill will define "a high-level legislative framework" rather than "bring forward detailed or prescriptive legislation on how [ICSs] Partnerships should operate".

Subject to Parliament passing the Bill, ICSs will comprise:

• An ICS Partnership ¬-a broad alliance of organisations and representatives concerned with improving the care, health, and wellbeing of the population, jointly convened by local authorities and the NHS
• A statutory ICS NHS body, bringing the NHS together locally to improve population health and care.

The framework gives more detail on how the new system will operate, including, for example, the functions of the ICS Partnership and ICS NHS body, governance and management arrangements, partnership working, good practice and the financial framework that will underpin new systems.

It also helpfully reconfirms the NHS commitment that "primary care contracts will continue to be negotiated nationally", for which FODO and the other optical bodies have argued.

However, it also notes that:

• ICS NHS bodies, which will include GP services from the outset, "might also take on primary dental services, general ophthalmic and pharmaceutical services commissioning at some future date
• "Functions NHS England and NHS Improvement will be delegating [include] commissioning of primary care and appropriate specialised services"
• NHS England expects "contracts health service providers hold (NHS Standard, or national primary care supplemented locally) to evolve to support longer-term, outcomes-based agreements, with less transactional monitoring and greater dialogue on how shared objectives are achieved".

Proposals would also mean the end of CCGs:

• "All CCG functions and duties will transfer to an ICS NHS body when they are established, along with all CCG assets and liabilities, including their commissioning responsibilities and contracts."

This means that locally commissioned eye care services under the NHS Standard Contract, such as MECS or CUES, will transfer to ICS NHS bodies

The framework also makes apparent that: "ICSs should explore different and flexible ways for seeking primary care professional involvement in decision-making. In particular, primary care should have an important role in the development of shared plans at place and system, ensuring they represent the needs of their local populations at the neighbourhood level of the ICS, including with regards to health inequalities and inequality in access to services."

NHS England usually means only GPs when it talks at a high level about primary care. Dentists, pharmacists, and we as primary eye care have challenged this, but there is a long way to go to embed voice and influence for eye care at the local and ICS level.

FODO will continue to work with sector partners to monitor, respond where necessary and challenge these reforms on your behalf.

If, in the meantime, you have any questions or would like to get more involved with our policy work, please email [email protected].