North Central London Integrated Care System

The NHS Long Term Plan sets out priorities and changes to the way health services will be delivered, with a focus on integration. This provides an opportunity to design health services around residents’ needs, rather than organisations.

Changing how we work together will allow us to work differently as partners to tackle current issues in the system, deliver more consistent and improved outcomes, a better experience for residents, and future financial stability. Working together in this way will allow local services to provide better and more joined-up care for patients that is tailored to individual needs.

Covid-19 has seen a fundamental change to how we collaborate, breaking down barriers that previously existed between organisations to create a true partnership approach to health and care. We have learnt a lot about how the system can come together and we want to build on this knowledge and experience as we develop an Integrated Care System (ICS) for NCL.

North Central London was formally designated as an Integrated Care System by NHS England and NHS Improvement in December 2020. Designation is a clear endorsement of our system-wide commitment, and capability, to deliver integrated care and marks an important milestone in our five boroughs’ partnership journey. Work will now continue on progressing our Integrated Care System development plans, linked to priority areas.

Published in late 2020, this paper builds on the roadmap set out in the NHS Long Term Plan. There is much in this document that is positive, with the ambitions closely reflecting those of the North Central London Integrated Care System - such as building integrated out-of-hospital care around ‘place’ with primary care at the centre, developing population health management approaches, and using digital technology to shape care pathways. Clinical leadership would remain at the heart of the future system.

Significantly, the paper includes an indicative timescale for providing a statutory footing for Integrated Care Systems from April 2020. Two options for a firmer legislative basis for Integrated Care Systems are set out - with a stronger case for a fully integrated health system (Option 2) outlined in the paper.

The proposal is not to abolish commissioning completely but about reshaping CCG functions with more focus on strategic commissioning through systems and on population health outcomes. The proposed options encompass CCG statutory functions and the requirement for the organisational form of CCGs to evolve, which may include moving some commissioning functions into new bodies.

Two NCL responses were submitted, by the NCL ICS and NCL CCG, which are  available on this page. The NCL ICS response was submitted on behalf of the system by Mike Cooke, independent chair. This confirmed support for option 2 in the proposals, to establish ICSs as statutory bodies from April 2022 and to press on at pace with the necessary transition to the new arrangements.

The CCG response highlights in particular the achievements and commitments of NCL CCG and its predecessor CCGs, and the important legacy which they will leave for the ICS to take forward. We emphasised the vital importance of supporting the expert and experienced staff of the CCG, who will form the core of the workforce for the ICS.

The headline issues covered in the NCL CCG response – which recognised the important of working closely with Local Authorities - were:

  • reducing health inequalities
  • population health and population health management
  • primary care development, leadership and oversight
  • clinical leadership; working at place and locality level
  • strategic commissioning
  • management of the system during the COVID pandemic
  • the need for public accountability for the ICS
  • and ways of consulting and delivering on major service changes in a timely way.

Following the end of the national engagement, we expect to receive a summary of the key themes raised, together with guidance on next steps to implement agreed changes.  Locally, we are developing a transition plan with our partners across the ICS.

As set out in the NHS England and NHS Improvement publication, the priority will be the ‘”continuation of the good work being carried out by the current group of staff and promoting best practice in engaging, consulting and supporting the workforce during a carefully planned transition, minimising disruption to staff.”

The following important commitments made by NHSE/I in their proposal:

  • Not to make significant changes to roles below the most senior leadership roles before the end of March 2022;
  • To minimise impact of organisational change on current staff by focusing on continuation of existing good work through the transition and not amending terms and conditions; and
  • Offer opportunities for continued employment up to March 2022 for all those who wish to play a part in the future.

The Executive Management Team will carefully consider what future changes related to the wider NHS direction of travel mean for our staff, and to supporting everyone through this period of transition and minimising disruption and anxiety for staff. Updates will be brought, for discussion, to Directorate Briefings and other staff forums. Staff are encouraged to discuss what support they would find most helpful during this time with their line managers and Directors.