Just what we need

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Just what we need

By Adam Irvine

An integrated care system (ICS) is a big partnership between all the organisations that meet health and care needs across an area. Part of the NHS Long Term Plan, an ICS includes acute hospitals, councils, pharmacies, general practices, dentists, optometrists, mental health trusts and community trusts. With an April 2022 target for implementation, we’re starting to learn more about what they will look and feel like, and how they will be governed.

There are still parts that need to go through the lawmakers, but the latest planning guidance lays out more than we’ve seen before. If the vision is to be realised, then innovation will be key, as will reshaping regulation to keep the checks and balances while losing the bureaucracy that gets in the way of people doing a good job. Innovation will flourish locally by breaking down silos. 

An ICS has a number of major agenda items to tackle:

Improving population health. The system focus should be less about responding to ill health and more about population health and maintenance of wellbeing. On a typical process map, this means a shift left as we are moving the intervention point earlier in the process

Tackling inequalities. It is clear that inequalities have increased during the pandemic, continuing a trend that stretches back to the Black Report in the 1980s. Inventiveness will be vital if we are to have a chance of changing direction

Improving quality and increasing value. This will be about using evidence, ensuring we’re doing what works well, gaining synergies from integrated working, and standardising practice where it’s important to do so

Social value. We must ensure the health service (and wider public services) contribute not just by providing health and care, but where they are anchor institutions and major employers, through their impact on other elements of social value, such as climate change and supporting local regeneration. 

In such a broad and wide-ranging agenda, it can be difficult to see where we may fit. For that we need to break things down a little further.

Organisationally, an ICS will have two boards. The partnership board will provide strategic leadership across the ‘system’ and tackle the integration agenda. It will be where the big strategic decisions, those that cannot happen at the lower ‘place’ level, are taken. For example, dealing with our less viable hospitals or getting ICS-wide health promotion programmes up and running.

It’s going to be an exciting journey, and one I hope will be just what we need

What is now the commissioning budget will be distributed locally by the NHS board to NHS providers for hospitals, to provider collaboratives for other services, to tertiary services if their funding is devolved. It’s likely, although a final determination has yet to be made, that the management of community pharmacy’s national contractual framework will be held somewhere within the ICS. Personally, I don’t see the contract moving from a national framework. However, local management will be needed, as through the NHS England & NHS Improvement local area teams now.

This can be a big opportunity for community pharmacy. If the framework remains firm and controlled at the national level, then having the same commissioning body purchasing health services locally – in general practice, in hospitals and in pharmacies – means more agility to bring about change to pathways. Capacity can be released, where it has been difficult to do so before. 

Too often in recent years, schemes that would be hugely beneficial to patients have been too difficult to implement because they would involve moving budget from one NHS silo to another. I’m optimistic that change will become more possible if those barriers drop away. As a result, the management of long term conditions could move closer to the patient in their local pharmacy, where they are seen more often. Pharmacy could play a greater role in local delivery of things like sexual health services, if service capacity is released. 

Local pharmaceutical committees (LPCs) will need to stay close to this agenda for their voice to be heard at the appropriate level. In Cheshire and Merseyside, this is via the Primary Care Provider Leadership Forum, where we have places for pharmacy across the patch and a clear route to the main Health and Care Partnership Board, but each place will be slightly different. If you don’t know already, make sure you ask. 

It is likely that these structures will need to form networks of pharmacy contractors that can influence change as we go along, grappling with and arranging support as well as training elements for the workforce as we adapt to the new world. 

It’s going to be an exciting journey, and one I hope will be just what we need. 


Adam Irvine is chief executive officer, Community Pharmacy Cheshire & Wirral

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