ICSs (Integrated Care Systems) are now seen by NHS leaders as the future of health and care integration in England, with the NHS Long Term Plan establishing a target for every area in the country to be covered by one by 2021.
Introduced in 2017 as an evolution of STPs (Sustainability and Transformation Partnerships), ICSs are a more advanced model of integration which focuses on formalising system-wide collaboration without major contractual change.
There are currently 14 ICSs across England, with more set to emerge in the near future, and their development presents both challenges and opportunities for doctors. The BMA’s member briefing explores these implications and what ICSs may mean for the way doctors work.
Read the briefing
What are ICSs?
ICSs and are a new way of planning and organising the delivery of health and care services. They bring together NHS, local authority, and third sector bodies to take on collective responsibility for the resources and health of the population of a defined area, with the aim of delivering better, more integrated care for patients.
ICSs do not require substantial contractual or structural change. Instead, they are secured by an alliance agreement between member organisations which overlays (but does not replace) regular commissioning processes and contracts. The agreement should also set out shared commitments on; achieving greater integration, managing resources, delivering services, and governance arrangements.
ICSs work on three key levels:
Work is focused on partners working together to set strategy, finance, workforce planning, and agree overall levels of integration
Normally based around towns within a system, work at ‘place’ level centres on the planning of localised services and the delivery of secondary and community care
This level is based around PCNs (primary care networks), groups of GP practices covering populations of 30,000 to 50,000 people. MDTs (multi-disciplinary teams) will be central to PCNs, with clinicians and health and care professionals from a wide range of services working together to provide primary and community care.
What the BMA thinks of ICSs
ICSs may well be able to break down barriers between services, support doctors to collaborate, and facilitate the move towards a model of co-operation over competition, but significant questions regarding their development remain.
We have established five principles, which we believe ICSs and any other model of integration must meet if they are to be successful. We believe any model must:
- Ensure the pay and conditions of all NHS staff are fully protected
- Protect the partnership model of general practice and GPs’ independent contractor status
- Only be pursued with demonstrable engagement with frontline clinicians and the public, and must allow local stakeholders to meaningfully and constructively challenge plans
- Be given proper funding and time to develop, with patient care and the integration of services prioritised ahead of financial imperatives and savings
- Be operated by NHS bodies, free from competition and privatisation
ICPs (Integrated Care Providers)
ICSs were introduced at the same time as ICPs (Integrated Care Providers) and the two are often conflated. However, they are distinct models of integration and pose different implications for doctors and the NHS.
Unlike ICSs, ICPs involve merging multiple services into a single contract held by a single provider. The BMA opposes their introduction, as they increase the risk of the privatisation of NHS services and are incompatible with the independent contractor status of GPs. Visit the ICP webpage for more information.