A look at Healthcare Change across England

Blog Post: Integrated Care Systems and Boards - the future?

Recent Background:

After much change in the past few decades and no small amount of confusion within and without the sector, as part of the NHS Long Term plan NHS England established 42 Integrated Care Boards (ICB’s) in July of 2022. The Boards having a mixture of Executive and Non Executive representation and other members taken from across Secondary Care (NHS Trusts), Primary Care (GP Surgeries) and Local Government.

Each ICB being the official/statutory organisation responsible for the respective Integrated Care Systems (ICS). In summary, the ICS being the tailored planning, commissioning and delivery of healthcare in each area.

Healthcare Change:

It feels remiss at this point not to add a small grumble; as an organisation that is responsible for understanding and tracking the structure of Public Services and ultimately translating that knowledge and information into data and systems that can be consumed by folks across the Public, Third and Private Sectors, the NHS has probably been the biggest purveyor of change over the past few decades. Driven, broadly by different political ideas and financial necessities the warp and weft of the planning and commissioning of local and regional healthcare has changed (?) regularly and quite significantly since the 1990’s. Now, we like change (otherwise nobody would need us), but equally, hopefully, the new organisations and delivery models for health and care will persist for a little while!


We have seen (each would warrant a more forensic post in their own right):

- 500 local Primary Care Groups (PCG’s) become 300 Primary Care Trusts (PCT’s)

- Those PCT’s merge down into 150 (less local?) organisations.

- 7 Regional Health Authorities become Strategic Health Authorities and then ultimately be disbanded.

- The establishment of 300 Clinical Commissioning Groups (CCG’s) and their subsequent merger into around half of that number covering larger areas.

- The creation of 44 sustainability and transformation plan areas/footprints across the 7 NHS regions and ultimately their transition/replacement in the form of Integrated Care Systems.

- The merger and replacement of the remaining CCG’s with Integrated Care Boards.

This new - more regional (each ICB covers an average of around 1.5million people) and somewhat more joined up - approach to healthcare delivery is interesting in that - as demonstrated above - to ensure a greater degree of ‘localisation’ has also necessitated the creation of Primary Care Networks (PCN’s) that sit between ICB’s and GP Practices - these (currently) being around 1400 partnerships between GP Surgeries that enable a more nuanced approach to local health need and service, and include support and share resources (eg clinical pharmacists, social prescribers and physiotherapists) across typically 4-5 Practices covering around 40,000 people.

The question is: will the structure remain consistent and robust, or will we be seeing more system wide change to come in the short or medium term!?


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