Extra time for Integrated Care Systems – but how best to use it?

The most common questions I’m being asked by pharmaceutical, medical technology and device companies since the start of the year are around the development of integrated care systems.

Originally planned for April, NHS England has now confirmed that the implementation of integrated care systems will begin from July instead.

This gives healthcare systems a breather and allows them to focus on ongoing Covid pressures. But how does the Industry make the most of the extra time it has been given?

Three levels to work on

The first thing to understand is that pharma, med tech and device companies are going to have to start operating at three levels:

  • Full system level.
  • Place level – this is usually the local authority footprint and, for many, the former Clinical Commissioning Group footprint.
  • Primary care network level.

There will be 42 integrated care systems. We don’t know how many places there are currently, but we have to keep in mind in total there are 333 local authorities in England made up of 5 different types, who could all have a place:

  • county councils
  • district councils
  • unitary authorities
  • metropolitan districts
  • London boroughs

The table in this link shows the number of each type of council: https://www.gov.uk/guidance/local-government-structure-and-elections

Underpinning that will be the 1,250 primary care networks, which are all based on registered patient lists, typically serving natural communities of between 30,000 and 50,000 people.

Get on the right path

From the Industry’s perspective, it’s always been assumed that the key to success is operating at system level. To an extent, that is still correct. But what we can’t ignore is the shift to place-based planning and place-based execution.

Systems are going to be tasked with shifting big chunks of budget down to place level. Over time, we’ll see them dissolving the boundaries between primary care and secondary care. There will be a much more integrated planning process, followed by much better integrated service provision.

So, there’s an opportunity straight away for pharma, med tech and device companies. As these new pathways start to function, it could mean within an integrated care system there are three or four different places who, tasked with delivering the same outcome, might tackle it in slightly different ways.

So, there’s definitely an opportunity to influence at place level and then – a level below that – you’ve got the primary care networks.

To Warwickshire – and beyond

For example, let’s take Coventry and Warwickshire. We’ve got one integrated care system and we’ve got four places – Coventry, Rugby, South Warwickshire and North Warwickshire. And then we’ve got the primary care networks that underpin that.

In North Warwickshire, there’s currently five primary care networks. Projects can be started in one practice or in one network and then scale to cover the whole of North Warwickshire. And from there, they might scale up to influence what happens at system level.

There is a big focus now on population health, particularly the standard issue prevention agenda around alcohol, smoking, obesity and sexual health. But equally there’s a focus on tackling the wider determinants of health – preventing unnecessary appointments, unnecessary referrals and unnecessary admissions into hospital.

There’s a focus on improving patient outcomes and the biggest area of focus is tackling health inequalities, really addressing population needs. This links back to the NHS long term plan.

The preventative health agenda within that plan has been handed to the integrated care systems, who will hand it to place and down to network. That will mean tackling unwarranted variation, perhaps the creation of a high quality, standardised, complete pathway approach.

Precious extra time to shift your thinking

So, there’s a really good agenda outlined above that Industry can engage with. Yes, we’re moving to integrated care systems and yes, that move has been delayed to the beginning of July. But that gives pharma, med tech and device companies that little bit of extra time to get to grips with what’s going on.

Industry’s focus on system is understandable – but unless you start focusing on place, you risk missing out completely.

Scott McKenzie helps pharmaceutical, medical technology and device firms increase revenue by getting their products and services in front of the right NHS decision makers. If you want to get your products fully embedded into treatment pathways we can help you. We’ve doubled revenue for our clients and can share these processes with you too. If you want to improve the way you sell to the NHS you can watch our free webinar here.