As the NHS shifts towards Integrated Care Systems (ICS) a question you must ask is what this looks like for you from a commissioning standpoint.
Integration means different things to different people and different organisations. If you’re not on top of the culture shift, you risk missing out on opportunities and your approach becoming irrelevant.
I have seen some remarkable delivery in my work with the GPs and Consultants both working out of General Practice and delivering First and Follow-up appointments between them. At the other end of the scale, I’ve seen complete resistance to any form of change or integration. So, understanding the level maturity of each ICS is vital to adapt your approach strategy accordingly.
There’s a shift towards a standardised approach to patient care
2020 has seen the CCG landscape shift and, in terms of commissioning, I am already seeing the commissioner/provider split disappear. Some CCGs now request that hospitals subcontract as the way to redesign, rather than unpicking and recommissioning.
What is also clear is a desire for a high quality and standardised approach without unwarranted variation. The right patient, seen in the right place, at the right time, by the correct healthcare professional and with the right resource available to them.
So, what is the future for CCGs and commissioning as we move towards ICS?
Clinical Commissioning Groups (CCGs) are here to stay for the time being
In the short term, at least the next 12 months, it is wrong to think that Clinical Commissioning Groups (CCGs) will no longer exist. They will remain statutory organisations, with the same responsibilities they have now. This may change with the appetite within NHS England to amend the Health and Social Care Act 2012, which brought them into being, appearing in late November 2020. Until legislative change happens, CCGs will remain the statutory body responsible for commissioning. However, whilst their statutory and legal duties remain the same, there is no doubt their role and function will change as we move forward into the world of ICSs.
If the legislative change this document proposes comes to fruition it confirms the demise of the CCGs within the next 2 years and CCG statutory functions moved into the Integrated Care Systems. It will also require the introduction of Provider Collaboratives and Place-based Partnerships, along with a move to a single system budget with a blended payment model for secondary care.
This sets a clear direction of travel and some further big changes ahead.
Changes to the way CCGs function on a practical level are well under way and most have now merged so they align and collaborate with local authorities. We moved from 209 in 2012 to 135 as of 1st April 2020. However, the pace of change will vary from ICS to ICS, depending on the level of maturity within the ICS.
Whilst they will retain their statutory duties and function, the reality is the commissioner/provider split is already disappearing as part of that shift into ICS. Other statutory responsibilities will be shared with ICSs, or devolved in their entirety, as the ICS demonstrates it has reached a level of maturity where such responsibilities can be passed to them.
Payment methods are likely to change
In terms of contracting, Payment by Results (PbR) is likely to disappear, with a return to block contracts, which was made mandatory when the Covid pandemic arrived. At the time of writing, this remains the case, with every hospital currently on block contract. PbR and block contracts are the current and most common methods of payment (assuming PbR returns post Covid); however, they are likely to change to become an integrated budget or a single payment across the ICS. The constituent organisations will then need to work together to understand their population needs, the associated service requirements to meet those needs whilst considering prevention, and all within the envelope of funding that they have.
And what of those who work in CCGs and whose roles will no longer be required? Well, the need to understand service requirements and ensure delivery hasn’t gone away, and we’re starting to see those in commissioning roles, as well as medicines management, move across to ICSs. What remains to be seen is how mindsets will change once in a different environment.
So, mapping your local Integrated Care System has never been more critical to identify the right customer to work with. These articles will help you understand the importance of identifying the level of maturity of the ICS that’s local to you, how and why you need to do your research, establishing who the customer is and engaging with those who are business-ready and in a position to work with you.
Feel free to connect with me on LinkedIn if you’d like to discuss any of the points raised in this article.
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. Download your free guide: here
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