Clinical commissioning groups were first created back in 2012 when the Health and Social Care act had it’s big shakeup. This new dogma of clinical hierarchy overtook the previously established primary care trusts in a move to simplify the ‘rule-making’ and governance within different NHS areas. In July 2022, these groups became known as Integrated Care Systems (ICS) in the new Health and Care Act 2022, with the previous groups being wound down. Each ICS has has two statutory elements, an integrated care partnership (ICP) and integrated care board (ICB). ICS are a group of GP practices, surgeries or services that come together to oversee the services, care and outreach in a particular geographical area, choosing the best care for patients. The ICS can be used to address specific care needs to populations in geographical areas and allow for flexibility based on conditions of the local populous. This would allow a ICS to commission more screening in older populations for atrial fibrillation, or a greater emphasis on cancer screening for certain ethnic groups who are populous in the ICS catchment, for example.
Integrated care partnerships, within the ICS are a committee formed between the care board and all of the upper tier local authorities within the catchment area. The ICP brings together partners which improve public health and are assigned on a local membership basis. The ICP makes the care strategy on how to meet the specific health and wellbeing needs of the local area, giving a bit more specificity to the care mission than CCG. The integrated care board is responsible for developing further that plan proposed by the integrated care boards, but also is concerned with the management of budget and allocation of resources within the ICS area. These formed when the CCGs folded under the new Health and Care Act 2022.
ICS use their funding to assign and purchase services for community they oversee and even have the flexibility to use services from providers who may be independent, as long as they meet NHS standards. This flexibility allows a more co-ordinated response and a better input of bottom-up healthcare which allows the individuals in the ICS to establish more services based on the direct feedback of patients themselves. For example, particular areas which have intravenous drug use may be able to have feedback from nurses or patients on the lack of services, and allocate funds to clinics and independent providers to provide for the individuals in need. This dynamic approach is a better fit than the heavy-handed approach of ‘these are the only services’ which was seen in the past, meaning patients can make use of the ‘use it or lose it’ paradigm in this healthcare model.
According to the NHS ICS website, 60% of the NHS budget is assigned to ICS, which oversee a large amount of secondary care services and aid in the co-ordination of GP services. The services that are typical of these groups include;
Mental health services
Patient wellness and special population care
Urgent and emergency care
Community health centres
Who is included in the ICS boards? Elected officials who often oversee the assignments of services, funds and resources include senior clinicians, GPs, nurses, care consultants and even lay members, to get a range of population and expertise. These tightknit groups help to oversee care for under 100,000 to over a million patients depending on area, and take part in initiatives like ‘local solutions for national challenges’.
ICS deployment in practice - during the coronavirus pandemic, a good amount of autonomy was given to ICS to oversee local testing in the hopes to improve compliance, and allow a good co-ordination with a test and trace system. With NICE recommending 3 new therapeutics for treatment of coronavirus in the community (Paxlovid, RoActemra and Olumiant), ICS can decide which patients to expedite for treatment in the community with the cocktail of new drugs. In this vein, the ICS can decide to treat certain populations to prevent hospitalisation, as well as reacting to the efficacy of treatment within that catchment area, leaning more on that therapeutic if they have local success and experience.