Just one GP required on ICS boards that will replace CCGs as commissioners

Just one GP will be required to be appointed to the boards of the ICSs which are set to replace CCGs as commissioners of health services, new NHS England guidance has said.

The guidance, published today, outlines the ‘current expectations’ for ICS board composition, although it says that the ‘statutory minimum’ board membership will be set out in legislation.

NHS England said that ‘in most cases’, the boards of ICS NHS bodies will include a ‘minimum’ of three ‘partner’ members with ‘at least’ one from GP providers, one from NHS trusts or foundation trusts and one from the local authority with statutory social care responsibility.

All three partner members are expected to be ‘full members of the unitary board’ but not act as ‘delegates’ of their sectors, it added.

The boards will also include a chair plus a minimum of two other independent non-executive directors who do not ‘normally’ hold positions in other ICS health and care organisations and four executive roles including a medical and nursing director, it said.

However, NHS England added that it expects every ICS board to establish roles ‘above’ the minimum level in order to ‘carry out its functions effectively’.

The guidance added that the appointment process to partner roles and the ‘rules of qualification’ for membership will be set out in ICSs’ constitutions, which will be ‘subject to agreement’ with NHS England and must be consistent with any legislative requirements.

NHS England will publish further guidance on the ‘composition and operation of the board, including a draft model constitution’, it said.

It added that the board and any committees should ‘ensure they take into account the perspectives and expertise of all relevant partners’, such as primary care.

And further ‘place-based partnerships’ within ICSs should also involve primary care provider leadership – who have an ‘important role’ representing local population needs at ‘neighbourhood level’ – such as PCNs, it said.

NHS England said: ‘Primary care should be represented and involved in decision-making at all levels of the ICS, including strategic decision-making forums at place and system level. 

‘It should be recognised that there is no single voice for primary care in the health and care system, and so ICSs should explore different and flexible ways for seeking primary care professional involvement in decision-making.’

It added: ‘ICSs should explore approaches that enable plans to be built up from population needs at neighbourhood and place level, ensuring primary care professionals are involved throughout this process.’

Meanwhile, PCNs should consider working together across ICSs through ‘peer support’ and leading on ‘place-based service transformation programmes’ on each other’s behalf, backed by additional resources, it said.

It added: ‘ICSs and place-based partnerships should also consider the support PCN clinical directors, as well as the wider primary care profession, may need to develop primary care and play their role in transforming community-based services. 

‘Place-based partnerships may also wish to consider how to leverage targeted operational support to their PCNs, for example with regard to data and analytics for population health management approaches, HR support or project management.’

All ICSs should ‘actively’ encourage and support clinical leadership, including providing ‘protected time and resource’ so that clinical leaders are ‘fully involved as key decision-makers, with a central role in setting and implementing ICS strategy’, it said.

Recruitment of ICS board members should be completed by the end of the third quarter in 2021/22 so that they are ‘ready to operate in shadow form’, while recruitment of all other leaders should be completed by the end of the fourth quarter, it added.

Gateshead and South Tyneside LMC chair Dr Paul Evans told Pulse that the reference to potential multiple GP involvement is ‘encouraging’ and that any ICS ‘choosing to limit it to a single GP representative would be doing both patients and primary care a disservice’.

However, he warned that the plans offer no commitment to give general practice an ‘equal footing’ on ICS boards and committees and that LMC involvement is essential to ensure non-PCN practices are represented.

He said: ‘By failing to mention LMCs, this also gives scope for them to be bypassed, and for less-experienced (in terms of contractual issues, eg. PCN CDs), or conflicted (as provider organisations) bodies to be taken as “the voice of general practice”. This would be a threat. 

‘I hope it is an accidental omission, as surely NHSE would not wish to bypass those with a statutory role, expertise and a track record of protecting the interests of GPs.’

The guidance also set out expectations that:

• ‘All’ CCG functions and duties will transfer to ICS NHS bodies, including commissioning responsibilities and contracts while NHS England will delegate certain functions including the ‘commissioning of primary care’
• ICS NHS bodies will be responsible for ‘ensuring NHS services and performance are restored following the pandemic’
• National primary care contracts supplemented locally will ‘evolve to support longer-term, outcomes-based agreements, with less transactional monitoring and greater dialogue on how shared objectives are achieved’
• ICSs will establish ‘collective accountability’ between partner organisations for ‘whole-system delivery and performance’
• ICSs will develop and support ‘one workforce’ across the ICS in line with the NHS People Plan.

It acknowledged that developing ICSs during 2021/22 in preparation for new statutory arrangements from next year is a ‘significant ask’.

The guidance is based on NHS England’s ‘expectations’ on the content of legislation to be presented to Parliament ‘shortly’ and is subject to ‘amendment and approval’, it said.

It added: ‘Systems may make reasonable preparatory steps in advance of legislation but should not act as though the legislation is in place or inevitable.’

Last month, GP leaders warned that more must be done to prevent ‘tokenistic’ GP representation on ICSs, amid ongoing concerns.

In February, the Government announced plans for ICSs to be given the statutory power to commission NHS services currently held by CCGs in England, as part of wider NHS reforms.

NHS England has told Pulse that it will continue to negotiate a national GP contract following the overhaul.

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.

LMCs and CCG leaders have also raised concerns about the plans.