ICBs to get legal responsibility for primary care commissioning after NHSE abolition

ICBs will get legal responsibility for primary care commissioning when NHS England is abolished, in order to make sure that services are ‘tailored’ to local needs, the Government has said.

As announced in the King’s speech earlier this week, the Government will push forward with NHS reforms including introducing the single patient record and abolishing NHS England, with legal responsibility for primary care commissioning being transferred to ICBs.

The health bill, which was introduced in the House of Commons yesterday, will abolish NHS England by transferring its functions into the Department of Health and Social Care or the wider system, and support ICBs to ‘become strategic commissioners by transferring responsibilities for all but the most specialised commissioning functions to ICBs’, including primary care, dentistry, ophthalmology and pharmacy.

The legislation means that ICBs, who already control commissioning of primary care since 2022 thought a delegation agreement with NHS England, will hold legal responsibility after the commissioner’s abolition.

The Government said that allowing ICBs to take control of all but the most specialised commissioning will devolve decision-making ‘to a local level’, tailored to the needs of local populations.

The bill proposes to place the legal responsibility for commissioning most health services directly on ICBs, except for:

• public health services, where the direct legal responsibility will remain with the health secretary
• high-security psychiatric services, where the direct legal responsibility will be conferred on the health secretary

The impact assessment document clarified that ICBs already control the commissioning of:

• primary care services (GPs, pharmacy, dental and optometry) through a delegation agreement with NHS England
• secondary dental services, such as paediatric dentistry, through a delegation agreement with NHS England
• secondary care services (for example, hospital and other accommodation, nursing and ambulance, and other services for the diagnosis and treatment of illness) – these have been the direct legal responsibility of ICBs since they were established by the Health and Care Act 2022

It said: ‘This means that when the legal responsibility for primary care and secondary dental services is conferred on ICBs through primary legislation and subject to Parliamentary approval, in practice, ICBs will be continuing with their existing work.

‘Allowing ICBs to take control of all but the most specialised commissioning will devolve decision-making to a local level, compared to when commissioning is controlled centrally by a national body.

‘This means that healthcare services should be better tailored to the needs of local populations as decisions will be made closer to the people they serve, with a more intimate understanding of service users, patients and carers and family.’

It comes after ICBs were urged to take a ‘bold’ approach to planning services, including decommissioning services from GP practices and looking ‘beyond traditional healthcare providers’, as part of NHS England’s strategic commissioning framework last year.

Now the Government said that the framework was meant to ‘clarify expectations’ on ICBs and allow them to ‘start preparing to take on new commissioning functions’ in anticipation of the bill progress through Parliament.

Where ICBs are preparing to transfer functions to other parties, including through formally delegating statutory functions to another statutory body, they will ‘only do so where there is another party ready and better placed than the ICB to discharge them’, the document added.