Integrated care systems in England could become statutory NHS organisations that take on the current commissioning and other statutory functions of clinical commissioning groups.

‘Integrating Care’, a paper discussed at last week’s NHS England and NHS Improvement board meeting, describes options for giving ICSs “a firmer footing in legislation, likely to take affect from April 2022 subject to Parliamentary decision”. The proposals sit alongside other recommendations aimed at removing legislative barriers to integration across health bodies and with social care.

To give each ICS “the best possible opportunity to invest in and deliver joined-up, more preventative care, tailored to local people’s needs,” NHSE&I proposes to increasingly organise the finances of the NHS at ICS level.

“We want ICSs to be key bodies for financial accountability. That means that we will create a ‘single pot,’ which brings together current CCG commissioning budgets, primary care budgets, the majority of specialised commissioning spend, the budgets for certain other directly commissioned services, central support or sustainability funding and nationally-held transformation funding that is allocated to systems,” the paper says.

“ICS leaders will be expected to use new freedoms to delegate significant budgets to ‘place’ level, which might include resources for general practice, other primary care, community services, and continuing healthcare.”

There are currently 42 ICSs across England that are already established or currently operating as their precursor organisations, sustainability and transformation partnerships (STPs), but NHS England expects them all to be ready to operate as ICS from April 2021 in line with timescales set out in the NHS Long Term Plan.

If responsibility for commissioning is wrested from the 135 CCGs in England this would mark a significant centralisation of NHS bureaucracy.

NHSE&I are inviting views on proposed legislative options set out in the paper by January 8 2021.