The model ICB blueprint – What are the implications for the independent sector?

On Tuesday this week NHS England revealed its latest thinking on the future of integrated care boards, with the publication internally, leaked more widely by the Health Service Journal, of a document outlining what a model ICB should look like. 

The blueprint for future ICB roles and responsibilities has been created by NHS England alongside ICB leaders, and gives a good indication of how the centre, and those currently driving system working, see responsibilities and accountabilities shifting over the coming months and years. At the heart of the changes are the three shifts that the Government has set out it wants to make to the NHS – from analogue to digital, from treatment to prevention, and from hospital to community. However, some uncertainties remain, with the document explicitly leaving out discussion of how neighbourhood working might develop until the Government’s ten year plan for health has been published later this summer. 

Where, then, are the key changes? Most fundamentally, ICBs are being asked to focus on strategic commissioning and system leadership to improve population health, moving away from performance management and oversight of providers. They will be expected to use data and intelligence to better understand their own populations and develop a corresponding long-term strategy to improve health outcomes.  

On a financial and contractual level, ICBs will be expected to play a stronger role in managing and shaping their markets. Service specifications should be linked to outcomes, and ICBs will be expected to encourage new providers where gaps exist in the market. Once services have been commissioned, ICBs will be responsible for evaluating impact and outcomes. In practical terms, providers are likely to see more active contract management than has previously been the case. Further detail will be needed, however, on how a firmer approach to market management can work alongside patient choice – this will be a key area to understand as more detailed plans are developed 

In spite of holding the reins on population health, ICBs have been asked to give away many of their current responsibilities to other tiers of hierarchy (to the centre, regions, or providers) or else to organisations that have not yet been created. In particular, responsibility for primary care and the development of neighbourhood and place based partnerships will be allocated to neighbourhood health providers over time, while responsibility for workforce training and development will be given to providers and regional teams. The blueprint also has little to say on patient safety and quality, with these responsibilities moving to providers and the CQC. 

These changes leave a number of big questions outstanding for independent providers and the way that they work with NHS organisations, which may not be fully answered until the publication of the ten year plan. For these changes to be successfully delivered, it is vital that on one hand, the transfer of some responsibilities to NHS trusts doesn’t lead to some of the siloed behaviours that ICSs have sought to move away from, while on the other that the development of neighbourhood health teams, and the role of lead providers, creates opportunity for providers of all types to exercise leadership and help shape the healthcare in their areas based on their understanding and expertise. Independent healthcare providers stand ready to help contribute to these changes and ensure that the NHS is able to deliver on improving patient outcomes and experiences. 

NHS England are clear that this document is the first stage of discussion for how ICBs should work. If you’d like to share your perspectives on how the system changes might affect your organisation, please do get in touch with [email protected].