• ICS model is “central to delivery” of the long-term plan
  • Will “typically involve” one CCG per ICS area
  • Centre considering new licence conditions and longer-term contracts to enforce providers to collaborate with CCGs
  • Legislative asks include asking commissioners and providers to share “new duties” and make joint decisions

The whole of England is to be covered by integrated care systems in just over two years, the NHS long-term plan has said.

The document said ICS “will be central to the delivery of the long-term plan and by April 2021 [NHS England] wants ICSs covering the whole country”.

The plan confirmed that moving to nationwide ICS “will typically involve a single [clinical commissioning group] for each ICS area”. It also said: “CCGs will become leaner, more strategic organisations that support providers to partner with local government and other community organisations.”

It does not outline what size it expects the ICS to be but said it will “support each developing system to produce and implement a clear development plan and timetable”. HSJ had previously reported that ICS were likely to cover populations of 1 million or more.

The plan does not detail how advanced these ICS must be by 2021 but said each area will “have the opportunity to earn greater authority as they develop and perform” through a new ICS performance framework. This will include “earned financial autonomy”.

The most “challenged systems” will also be subject to an intensive support programme from NHS England and NHS Improvement which will include peer support from more developed ICS.

The recently retired chief executive of the King’s Fund, Sir Chris Ham, had previously said that setting a national blueprint and timeline for ICS would be a “huge mistake”.

Provider/commissioner collaboration

The long-term plan said providers “will be required to contribute to ICS goals and performance” and the centre is considering “potential new licence conditions” and “longer-term contracts” to enforce this collaboration. 

It also said there will be a “duty to collaborate” for providers and CCGs, and “neither trusts nor CCGs will pursue actions which, whilst potentially improving their institutional financial position, would result in a worse position for the system overall”. It said this would be “supported by a system oversight approach” which would look at system and individual performance in the round.

The centre is asking for legislation that would help enforce these changes by allowing CCGs and providers to share “new duties” and jointly make decisions such as through joint committees. It is not clear if or when new legislation will be introduced to parliament, and without legal changes, how NHS England’s plans for financial collaboration will be enforced.

The paper also said “every ICS will have”:

  • A partnership board with members from commissioners, trusts, and primary care. It said there is a “clear expectation that [local authorities and the third sector will] wish to participate”.
  • A non-executive chair subject to approval by NHS England and NHS Improvement.
  • “Sufficient clinical and management capacity drawn from across their constituent organisations”.
  • “Greater emphasis” placed by the Care Quality Commission on system-wide quality.
  • Clinical leadership to be aligned to the ICS area, with Cancer Alliances, for example, aligned to one or more ICS.