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CCGs to become part of ICSs under wide-ranging NHS reforms

CCGs to become part of ICSs under wide-ranging NHS reforms

The Government has set out plans for wide-ranging reforms to how health and social care services are commissioned in England, including CCG functions being taken over by integrated care systems (ICSs).

The white paper for a new Health and Care Bill, published today, said the Department of Health and Social Care will ‘bring forward measures for statutory Integrated Care Systems (ICSs)’.

Meanwhile, the NHS and local authorities ‘will be given a duty to collaborate with each other’ and the controversial section 75 of the Health and Social Care Act 2012 – which mandated for all NHS contracts to be put out to competitive tender – will be scrapped.

The Government said this will ‘remove much of the transactional bureaucracy that has made sensible decision-making harder’.

Under the plans, which ‘will start to be implemented in 2022’, CCGs will ‘become part of’ ICSs, with ICSs to take on their ‘allocative function’.

The white paper said: ‘A statutory ICS will be formed in each ICS area. These will be made up of a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership, bringing together the NHS, local government and partners e.g. community health providers. We would expect the public name of each ICS NHS Body to reflect its geographical location – for example, NHS Nottinghamshire or NHS North West London.’

Although the reforms mark a departure from ‘GP-led’ commissioning, each ICS board will need to have ‘representatives’ from general practice, as well as NHS trusts and local authorities.

The paper added: ‘ICSs will also need to ensure they have appropriate clinical advice when making decisions.’

In a foreword, the Government said the proposals are aimed at ‘removing the barriers that stop the system from being truly integrated’.

It said that the Covid-19 pandemic had ‘accelerated’ at pace ‘collaboration across health and social care’ and argued this showed what can be achieved by working together ‘flexibly, adopting new technology focused on the needs of the patient’ while ‘bureaucratic rules’ are ‘set aside’.

Finally, the Government claimed it wants to make the system ‘more accountable and responsive to the people that work in it and the people that use it’.

To this effect, the proposed legislation will see the health secretary resuming some direct powers over NHS England – which in turn will be fully merged with NHS Improvement; as well as Monitor and the NHS Trust Development Authority.

The document said: ‘Our proposals will ensure NHS England, in a new combined form, is accountable to Government and the taxpayers that use it while maintaining its clinical and day-to-day operational independence.’

In a statement to the House of Commons this afternoon, where he laid out the proposals, health secretary Matt Hancock said: ‘The white paper provides a statutory basis for unified national leadership of the NHS, merging three different bodies that legally oversee the NHS into one – as NHS England.

‘NHS England will have clinical and day-to-day operational independence. But the Secretary of State will be empowered to set direction for the NHS and intervene where necessary.’

A Bill will be laid before Parliament to legislate on the reforms, which are based on proposals made in the NHS Long-term Plan, ‘later in the year’ when ‘time allows’, the DHSC said.

But health think tanks have warned that reforms could be ‘distracting’ and the BMA – which campaigned against the 2012 Health and Social Care Act – said that clinicians did not have the time during the middle of a pandemic to properly review proposals.

Previously, the BMA has said that NHS England proposals to abolish CCGs were of ‘significant concern’ for GPs and could cause ‘significant changes to their working lives’ if they go ahead.



Please note, only GPs are permitted to add comments to articles

Paul Hartley 11 February, 2021 2:30 pm

Here we go again. Yet another reorganisation. I hope it works.

Michael Mullineux 11 February, 2021 2:57 pm

The turning of the wheel or the turning of the thumbscrews?

Patrufini Duffy 11 February, 2021 3:00 pm

Whatever the acronym, this Government shafted you in 2020 and every year prior, and will lead to more than 200,000 deaths very soon.

Nazaff Adam 11 February, 2021 3:42 pm

Do these guys not look at history
Back to old Health Authorities with few tweaks.
What a waste with constant reorganisation and paying off fat redundancies and reappointment of dame personel.

Steven Berg 11 February, 2021 4:13 pm

Sounds a lot like the Regional Health Authorities which existed when I entered GP in 1976.

David Banner 11 February, 2021 7:58 pm

So decades of ruinous reform circle back to where we began. I was at a meeting pre-pandemic where an exciting new idea to allocate a dedicated Health Visitor to each Practice was unveiled. I didn’t know whether to laugh or cry.

terry sullivan 11 February, 2021 8:33 pm

lms–hancock is odd and has no ability

terry sullivan 11 February, 2021 8:34 pm

privatize the nhs–its the only way to remove the politicians and unions

Vinci Ho 11 February, 2021 8:46 pm

As expected . We go around in a big circle
(1)l cannot remember how many times I mentioned section 75 on this platform last 9 years . I would argue that its presence had contributed to further downfall of general practice. The
APMS practice contracts granted throughout this period of time ,are stifling the liberty of having new GMS contracts approved .
It also begs the question exactly how much private providers had really contributed to the system to solve, if not actually aggravate , pre-existing problems and inequities. Against the backdrop of the global financial crisis in 2008 , the Health and Social Care Act was perfect medium to go along with policy of austerity , where the clandestine theme was ‘cheaper for more is better ‘ where insouciant private companies would say yes to everything in order to win contracts . The ramifications of this travesty are omnipresent and still prevalent.
(2)Like I wrote in the beginning of the pandemic , the old model had failed miserably and the Tories clearly have to swallow their pride by now , after so many fiasco followed by multiple u-turns . This abolition of a legislation fervently supported by their own ex-leader is another ignominious U-turn with no apology and zero remorse .
(3)Their reputation in handling the health ( and social care) service during the pandemic is undoubtedly appalling . As I always say , incompetence is bloody worse than malevolence . The failure of NHS England to keep up with every step of this vicious pandemic is beyond heart-sinking. ‘Working tirelessly’ , as the DHSC referred to , was never a satisfactory response to calamities of this scale .
Notwithstanding, this does not necessarily give ‘pleasure’ to the opposition party as the logical argument other political parties would most definitely fail to deliver . The bottom line is merely being out of touch with the frontline ‘soldiers’ of NHS . The academics should take no comfort either , living at the summit of Ivory Tower blinded by unrealistic confidence and bigotry . The stark reality was the government and an well underinvested NHS were never , contrary to what the CMO proclaimed, ready for the pandemic or in fact , any pandemic . The number of hospital/ITU beds , ventilators and PPE are only some deplorable examples for people to remember in this tragic Covid 19 story .
(4) Fundamentally , the public just needs clear , easily digested but also scientifically reliable messages . There is a balance between preferred options appropriate to difficult circumstances and so called proven evidence to support decisions . Ultimately, the public needs to understand why and be explained in simple language with frequent reminders . Collectivism is justified in confronting a national threat but rules must be implemented with absolute consistency by the government. Any punishment must be about the best interest, public health in this case ,of the country . But perhaps the infamous British hypocrisy is always in the way ?
(5)Then the motive of writing up the Health and Social Care Act by the Coalition government was open to historical judgement of whether it stemmed from an act of ‘good’ fait or a ploy to destroy NHS( and general practice) in its hitherto form of existence.
(5) Finally , the timing of introducing this ‘reform’ appears to be egregious in the middle of the pandemic but in fact , politically duplicitous and calculated as we are currently under ‘command and control ‘ under another legislation namely ,Coronavirus Act 2020 . The health secretary will have all the authority to run the system .If it is not now , then when ?

A soul can only be searched if it is humbled with honesty ………………

Vinci Ho 11 February, 2021 8:51 pm

….act of ‘good’ faith ….

David Mummery 11 February, 2021 10:56 pm

Basically the managerial classes will continue attending huge numbers of well paid and mostly pointless meetings, totally removed from frontline General Practice

Adrian Chudyk 12 February, 2021 9:19 am

My French is poor but even I know- plus ça change, plus c’est la même chose

Kevlar Cardie 12 February, 2021 9:35 am

This is categorically NOT a link to a Youtube clip of a stool being polished, so there is no reason to delete it.

Gerard Bulger 12 February, 2021 9:56 am

NHS Musical chairs. When you read that functions will be taken over by another body you realise the same people will have different titles. But the functions do not need doing at all. It might be that this time they realise that with hints about purchaser provider split ending. There is no need for most NHS bureaucracy: I saw this first hand in Australia where there is no administrative system between the doctor and the central payment system. No CQC, no CCGs, nothing. The only missive you might get from State Government is about Dengue of Covid. The reason is the Fee for service system which does has other problems, but means the central Government has all the levers it thinks it needs. Knee operations poor value? Tweak the fees down discouraging hospital/Consultants doing them. Instant effect, no tedious meetings at each state, CCGs of whatever, who papers are then ignored. Alas to deal with NHS bureaucracy will mean sacking at least 350,000 people. The coalition bottled out in the last “reform” in a recession and now with Covid bigger recession they might not dare once again.

David jenkins 12 February, 2021 10:36 am

deckchairs ? titanic ? ring any bells ?

David jenkins 12 February, 2021 10:41 am

some years ago, in wales, the powers that be decided to reduce the number of health boards from 22 down to 7.

this was supposed to save shedloads of money – only 7 medical directors, chief nursing officers, senior wigleewoos etc etc etc. instead of 22

how many redundancies do you think this made ?……………………………………..


Patrufini Duffy 12 February, 2021 5:35 pm

The aim is to make you social care.

terry sullivan 12 February, 2021 5:35 pm

i think hancock has megalomania–it usually affects those with no competence

John Glasspool 12 February, 2021 6:35 pm

Anyone remember …….”The Department of Health and Social Security”?

C P 12 February, 2021 7:28 pm

As a FT young (ish) partner I’m leaving the NHS. Good luck to all who remain.

Reply moderated
Simon Gilbert 13 February, 2021 4:01 pm

Year 1
Step 1: acute trust overspends by millions
Step 2: at ICS board meeting ‘sorry all the discretionary money goes to secondary care as the money has been spent already’
Step 3: acute trust transformation plan agreed (dump all work to primary care)
Year 2
Step 1: ‘Hi I’m primary care and I’ve overspent as everyone dumps work on me’
Step 2: ‘Oh well you have to learn to balance your books’
Step 3: ‘Hello we’re the bailiffs and we get your house as you have unlimited liability’

David jenkins 22 February, 2021 5:41 pm

John Glasspool12 February, 2021 6:35 pm
Anyone remember …….”The Department of Health and Social Security”?

known in wales as “the department of stealth and total obscurity” !