Hot Topic: Changes to NHS Structure

Advice & Insight From Interview Specialists

Recent changes to the structure of the NHS may seem a little confusing, but they are necessary knowledge for your medical school interviews. In particular, that means the change from CCGs – mentioning CCGs at interview today will show that you are not up-to-date with the latest changes in the health service. Here, we will look at the changes that have been made, and break them down so that they can be easily understood and discussed in your MMIs.

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What is an ICS?

An ICS is an integrated care system. This is a partnership of different organisations that all come together to both plan and deliver health and social care, and crucially also improve the broader lives of people in a given area. 42 ICSs were established in England on the 1st July 2022.

An ICS includes both an ICP and an ICB, as well as other services from local authorities and ‘place-based partnerships’ which involve locals and voluntary organisations, for example.

An ICP is an integrated care partnership, or in other words a committee jointly formed between the NHS integrated care board and all local authorities that are within the ICS area. It brings together a range of different partners who together should work to improve the care, health and wellbeing of the population. Membership is determined locally – in other words, within the particular region. The ICP will produce an integrated care strategy specific for the needs of the population of that area.

An ICB is an integrated care board. This is an NHS organisation that develops plans for the health needs of the population of an area, manages the NHS budget, and provides health services in the ICS area. Due to the creation of ICBs, CCGs (Clinical Commissioning Groups) have been closed down.

What are the specific purposes of ICSs?

The specific purpose of ICSs are to ‘bring partner organisations together’ in order to:

  • improve outcomes in population health and healthcare
  • tackle inequalities in outcomes, experience and access
  • enhance productivity and value for money
  • help the NHS support broader social and economic development.

Additionally, ‘complex challenges’ are to be addressed, which include supporting people to stay independent, improving the health of young people, enacting preventative care, supporting those with chronic conditions or mental health problems, caring for those with complex needs as our population ages, and maximising the use of our collective resources.

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What do doctors make of these changes?

The BMA states that it is ‘supportive of efforts to improve collaboration both within the NHS and across the health and care sector’ and that it recognises ‘the potential value of greater integration’ However, the BMA has pinpointed numerous issues with ICSs and the manner in which they are being deployed. In particular, the BMA highlights that ICSs may not protect the pay or working conditions of doctors; that they may not ensure a strong voice for doctors; that it may be hard to rid them of private involvement; that they may not respect national negotiation processes regarding working conditions and pay.

A particular issue is the lack of clinical leadership within the ICBs, and of public health expertise on the boards. It has been noted that not one of the 42 ICB constitutions has a role for a representative of hospital doctors. Meanwhile, the NHS has stated that clinical representation will be ‘central to the leadership of progress of ICSs’ – but this doesn’t seem to be borne out by the manner in which they are being implemented. As it stands, each ICB is required to have at least one representative of primary care on their board – in other words, a GP. Additionally, an ICB must have a medical director at the board level, who can come from any area of Medicine, and will work alongside a nursing director. However, this is the sum total of the guarantee of clinical involvement for an entire board, controlling an entire area. As it stands, 26 ICBs have the statutory minimum of one primary care representative, and only 17 ICBs specify that their primary care representative will be a GP. Only two ICBs have guaranteed a voting position for public health specialists, and 20 ICBs fail to mention any public health role at all. There is therefore a very real concern that medics and public health will fail to be acknowledged in the leadership of a service that is dedicated to health.

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