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Integrated Care System - Health and Social Care Bill Update

on Thursday, 19 August 2021.

Further to the publication of the DHSC's Health and Social Care White Paper earlier this year, the Health and Social Care Bill was put before Parliament in early July which would put the proposed changes on a legislative footing.

The White Paper itself was built on the recommendations made by NHS England and NHS Improvement regarding integrated care as well as attempts to remove bureaucracy.

Key Areas of the Health and Social Care Bill

  • The integrated care system (ICS) will have two responsible boards responsible for the running of the ICS - an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP). 
  • The ICB would be constituted with a minimum membership of a Chair, a Chief Executive and three "ordinary members" which must include a member nominated by local NHS trusts and FTs, one jointly nominated by primary care providers and one jointly nominated by local authorities for that ICS area.
  • The ICB will have a number of general duties including promoting the NHS constitution, improving the quality of services, reducing inequalities and promoting patient involvement and choice as well as promoting integration.  In addition, in making decisions it must have regard to:

- the health and well-being of the people of England

- the quality of services provided to individuals by relevant bodies, or in pursuance of arrangements made by relevant bodies, for or in connection with the prevention, diagnosis or treatment of illness, as part of the health service in England

- efficiency and sustainability in relation to the use of resources by relevant bodies for the purposes of the health service in England

  • The ICP is established by the ICB, and the relevant local authority for the area must prepare a strategy (an “integrated care strategy”) setting out how the assessed needs in relation to its area are to be met by the exercise of functions of:

- the integrated care board for its area

- NHS England

- the responsible local authorities whose areas coincide with or fall wholly or partly within its area

  • Locally, there is the flexibility for the ICB to appoint committees and sub-committees to assist in the exercise of its functions

Coronavirus Legal Advice

How Primary Care Networks Function Within an ICS?

Of key interest to general practice will be how primary care is represented in the decision-making process. PCNs have been described as the foundation of ICS and whilst one GP member is required to sit on the ICB, the BMA has flagged the importance of clinical leadership at each level of the ICS and, noting the ability of the ICB to make additional appointments, is arguing for greater GP representation on the ICB as well as other clinicians and LMC representatives. It is expected that the role of primary care networks within an ICS will be prescribed by NHS England at a future date. Concerns have been raised from a range of stakeholders around the future of funding in primary care when the current five-year contract arrangements ends, particularly with the development of pooled budgets and whether this might extend to include funding currently allocated to primary care.

The Bill also looks to remove current requirements around procurement and competition.  Whilst this has been welcomed by NHS providers, there is no guarantee that this will mean NHS providers being guaranteed NHS contracts and could equally be used to award contracts to private contractors more easily.  Much focus will fall on how the procurement regime will develop and whether this will benefit or detriment NHS providers.

If you would like any assistance with ICS arrangements, please contact Mark Jarvis in our Healthcare Law team on 020 7665 0880, or complete the form below.

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