Integrated Care Systems

Published on: 18th April 2016 | Updated on: 1st April 2022

In 2016, the NHS and local government came together in 44 areas across England to develop proposals to improve health and care. They formed new partnerships – Sustainability and Transformation Partnerships (STPs) – to run services in a more coordinated way, to agree system-wide priorities, and to plan collectively how to improve peoples’ day-to-day health.

STPs have subsequently evolved into 42 Integrated Care Systems (ICS), a new form of even closer collaboration between the NHS and local government.

Click on a heading below for more information. 

Creating local plans and partnerships

In December 2015, the NHS planning guidance document for 2016/17 and beyond was published (summarised in PSNC Briefing 006/16: Delivering the Forward View: NHS planning guidance 2016/17 to 2020/21), which advised that every health and care system in England would have to produce a Sustainability and Transformation Plan, to drive forward the aims of the NHS Five Year Forward View (5YFV).

These plans would form the basis for place-based planning and commissioning of services, to cover the five-year period between October 2016 and March 2021. The NHS organisations which came together to develop the plans subsequently formed Sustainability and Transformation Partnerships (STPs).

In the planning guidance, the national health and care bodies highlighted the three main challenges detailed in the Five-Year Forward View that needed to be tackled, to:

  1. close the health and wellbeing gap;
  2. drive transformation and close the care and quality gap; and
  3. close the finance and efficiency gap.

The planning guidance also emphasised the need to focus on prevention and care redesign. The concept of STPs was therefore introduced in the planning guidance as a way of bringing together health and social care at the most locally relevant geographical level and aligning the plans of partner organisations in that area.

Aims of STPs

The aims of STPs, as outlined in a letter sent from the Chief Executives of the national health and care bodies, are to:

  • engage patients, staff and communities from the start, developing priorities through the eyes of those who use and pay for the NHS;
  • develop services that reflect the needs of patients and improve outcomes by 2020/21 and, in doing so, help close the three gaps across the health and care system that are highlighted above;
  • mobilise local energy and enthusiasm around place-based systems of health and care, and develop the partnerships, governance and capacity to deliver;
  • provide a better way of spreading and connecting successful local initiatives, providing a platform for investment from the Sustainability and Transformation Fund; and
  • develop a coherent national picture that will help national bodies support what local areas are trying to achieve.

The STP footprints

In order to create the plans, Clinical Commissioning Groups (CCGs), local authorities (LAs) and other health and care services had to come together, and in January 2016 the formation of 44 STP ‘footprints’ was announced. These are geographic areas in which people and organisations are working together to develop robust plans to transform the way that health and care is planned and delivered for their populations.

In forming the footprints, local areas took the following factors into account:

  • geography (including patient flow, travels links and how people use services);
  • scale (the ability to generate solutions which will deliver sustainable, transformed health and care which is clinically and financially sound);
  • fit with footprints of existing change programmes and relationships;
  • the financial sustainability of organisations in an area; and
  • leadership capacity and capability to support change.

Since the initial creation of the footprints, some areas, e.g. the north east and north Cumbria, have started to move to consolidate their STP footprints into larger areas.

Further information on the STP footprints and a map of the footprint geographies can be found on NHS England’s website.

What do STPs do?

STPs are a vehicle for collaborative working formed of NHS bodies (CCGs, NHS England and NHS Trusts) and local government.

STPs must cover all areas of CCGs’ and NHS England commissioned activity including specialised services and primary medical care. STPs must also cover better integration with local authority services, including, but not limited to, prevention and social care, reflecting locally agreed health and wellbeing strategies.

In May 2016, a series of ‘aide-mémoires’ (quick guides) were published which set out what success would look like in 2020 for STP footprints. PSNC Briefing: 047/16: STP aides-mémoire (quick guides) summarises the elements most relevant to community pharmacy. 

The development of ICS

In Next Steps on the Five Year Forward View, NHS England stated its intention that STPs should evolve to become Integrated Care Systems (ICS); ICS were formerly known as Accountable Care Systems. In January 2019, the NHS Long Term Plan set out the aim that every part of England will be covered by an ICS by April 2021, replacing STPs, but building on their good work to date. ICS are population-based models of care that integrate primary, secondary, community and other health and care services and are a way of creating shared local responsibility for:

  • Managing NHS resources more efficiently/effectively to improve quality of care and access to care, improve health outcomes, and reduce inequalities in quality, access and outcomes. This means being able to focus both on delivering financial and performance standards, and addressing the population health challenges within each system;
  • Building wider partnerships with local government and other community partners to help address wider determinants of health and wellbeing and provide better, more independent lives for people with complex needs; and
  • Creating the capacity to implement system-wide changes.

A number of STPs have now evolved into ICS, in which NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve. The belief is that local services can provide better and more joined-up care for patients when different organisations work together in this way. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. And systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs. By working alongside councils, and drawing on the expertise of others such as local charities and community groups, the NHS can help people to live healthier lives for longer, and to stay out of hospital when they do not need to be there. Specifically, in the context of implementation of the NHS Long Term Plan, ICss should take forward the five major practical changes to the NHS service model described in Chapter 1, namely:

  1. Boost ‘out-of-hospital’ care, and finally dissolve the historic divide between primary and community services;
  2. The NHS will re-design and reduce pressure on emergency hospital services;
  3. People will get more control over their own health, and more personalised care when they need it;
  4. Digitally-enabled primary and outpatient care will go mainstream across the NHS; and
  5. Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new ICSs.

In return, ICS leaders gain greater freedoms to manage the operational and financial performance of services in their area. They will draw on the experience of the Vanguard sites, which led the development of new care models across the country. Integrated Care Providers (ICP) In some ICS, commissioners may decide to let a contract for the provision of most secondary and community services to one NHS provider – an Integrated Care Provider; these were previously described as Accountable Care Organisations. A draft Integrated Care Provider contract has been developed by NHS England to be used in this circumstance, which could include general practices providing primary medical services as part of the ICP. NHS England undertook a consultation on the draft ICP contract in 2018 and its response to the consultation is awaited. Where are ICS operating? From April 2018, the first wave of ICS began assuming accountability for local operational and financial performance.

  • South Yorkshire and Bassetlaw
  • Frimley Health and Care
  • Dorset
  • Bedfordshire, Luton and Milton Keynes
  • Nottinghamshire
  • Lancashire and South Cumbria
  • Berkshire West
  • Buckinghamshire
  • Greater Manchester (devolution deal)
  • Surrey Heartlands (devolution deal)

Four further ICS were approved later in 2018:

  • Gloucestershire
  • West Yorkshire and Harrogate
  • Suffolk and North East Essex
  • North Cumbria

Three further ICS were approved in June 2019:

  • North East and North Cumbria
  • South East London
  • Buckinghamshire, Oxfordshire and Berkshire West

Information on each of these ICS can be found on the NHS England website.

STPs, ICS and NHS planning
The NHS Long Term Plan aim that every part of England will be covered by an ICS by April 2021, brings with it an expectation that planning within health and care will occur at several levels. It is also expected that by 2021, typically, there will be one CCG per ICS. Planning is likely to take place at the following levels:

 Level Purpose  Priorities
 Neighbourhood (30-50k people)  Primary Care Networks (PCNs) will be the focus for this level, strengthening primary care, supporting collaborative working across groups of general practices and other health and care providers, and adopting integrated service provision for the local population, with a strong focus on prevention.Most ICSs now report near full coverage of PCNs, although these naturally differ in maturity. At minimum, PCNs collaborate to deliver extended access and sharing functions or workforce to reduce day-to-day pressures. The more mature have developed flexible workforce models, integrating with other NHS and local government services and are beginning to provide anticipatory care for people at risk of unnecessary hospitalisation.
  • integrate primary and community services
  • implement integrated care models
  • embed and use population health management approaches
  • roll out primary care networks with expanded neighbourhood teams
  • embed primary care network contractand shared savings scheme
  • appoint named accountable clinical director of each network
 Place (250-500k people) This is likely to be at borough/local council level, aiming to integrate primary, community, local government and hospital services, with the development of new service models for anticipatory care. This should be the engine room of resource planning, care redesign and population health management for local communities. Most ICSs say that about 80% or more of their work is organised around the place or neighbourhood level.
  • closer working with local government and voluntary sector partners on prevention and health inequalities
  • primary care network leadership to form part of provider alliances or other collaborative arrangements
  • implement integrated care models
  • embed population health management approaches
  • deliver Long Term Plan commitments on care delivery and redesign
  • implement Enhanced Health in Care Homes model
 System (1-3 million people) At this level of planning, there is a capacity to support system-wide transformation.  This includes workforce, capital and estates planning, digital, specialised services and reconfiguring the acute care landscape. They oversee a single operating plan and system control total that encompasses CCGs and NHS providers. Systems are increasingly taking responsibility for financial and operational performance across the whole system, supported by new governance arrangements.
  • streamline commissioning arrangements with CCGs to become leader, more strategic organisations (typoically one CCG per system)
  • collaboration between acute providers and the development of group models
  • appoint partnership board and independent chair
  • develop sufficient clinical and managerial capacity

Community pharmacy’s voice need to be heard at each level, with engagement at PCN level needing to take place multiple times in each LPC area, through to multiple LPCs needing to collaborate to influence planning at system level.

PSNC resources
STPs and ICS are central to local health and care planning, so it it important that community pharmacy effectively engages with them; LPCs have worked hard at a local level to engage in the work of STPs and ICS and PSNC has developed a range of resources to support this work.

Sustainability and Transformation Partnerships – a summary of areas for potential community pharmacy involvement (January 2018) This document summarises the areas that PSNC has identified in STP plans which have the potential for community pharmacy involvement. LPCs that have additional information to add, should contact Zainab Al-Kharsan, Service Development Pharmacist.

Information and background detail:

Progress and case studies:

Communication materials: PSNC Briefing 017/18: What can pharmacy do to help transform local care? – a leaflet for STPs (March 2018)

Integrating NHS pharmacy and medicines optimisation into STPs and ICS

In August 2018, NHS England and NHS Improvement announced the launch of a new programme, supported by the Pharmacy Integration Fund, to test how NHS pharmacy and medicines optimisation/safety can be integrated into Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICS) .

The Integrating NHS Pharmacy and Medicines Optimisation (IPMO) programme aimed to develop a framework which set out how to systematically tackle the medicines optimisation priorities for the local population in an STP/ICS footprint and use the expertise of pharmacy professionals in the strategic transformation of systems in order to deliver the best patient outcomes from medicines and value to the taxpayer.

A briefing was published which describes the approach for ‘testing’ the principles of framework for NHS pharmacy and medicines integration within the pilot areas.

Programme objectives

For 2018/19, the programme sought to “test and confirm” the principles of the framework to integrate pharmacy and medicines optimisation into STP/ICSs and primary care network level. In order to do this, NHS England and NHS Improvement identified one pilot STP or ICS in each of the seven NHS regions to operationalise the principles and address key questions, to act as case studies for future roll-out.

The objectives of the programme were:

  • To develop and test a core set of principles that set out how NHS pharmacy and medicines optimisation can be best integrated into STPs and ICSs;
  • To define the functions of leadership for NHS pharmacy and medicines that should be undertaken at system level and describe how these would be delivered;
  • To ensure visible professional expertise and leadership in NHS pharmacy and medicines at system level;
  • To identify and accelerate strategies to achieve medicines optimisation at scale to improve patient outcomes and value for money across primary and secondary care;
  • To explore the approach to developing an integrated, flexible, clinical pharmacy workforce that can deliver high quality and sustainable medicines optimisation at scale, across a local system; and
  • To inform the national priorities on how best to support systems in unblocking the barriers that will increase opportunities for effective medicines optimisation in STPs/ICSs.

Pilot regions

The seven pilot regions were:

  1. Black Country STP (Midlands);
  2. Cumbria and North East STP (North East);
  3. Dorset ICS (South West);
  4. Hertfordshire & West Essex STP (Central & East);
  5. Lancashire & South Cumbria ICS (North West);
  6. South East London STP (London); and
  7. Surrey Heartlands ICS (South East)

Pilot STP/ICS areas had to agree to:

  • identify a dedicated senior NHS pharmacy and medicines optimisation programme manager who would facilitate the necessary processes on an STP/ICS level to deliver the outputs required;
  • establish an NHS pharmacy and medicines optimisation leadership groups (with appropriate time and recourse) that reported into the STP/ICS structure and had board level sponsorship;
  • demonstrate the process for identifying a professional lead for pharmacy and medicines, ideally already working at clinical director level;
  • develop and implement an NHS Pharmacy and Medicines Optimisation Transformation Plan addressing key national and local priorities ensuring it was fully integrated into wider STP/ICS plans; and
  • involve stakeholders.

Rollout of pharmacy and medicines optimisation system leadership

In September 2020, NHS England and NHS Improvement published Leading integrated pharmacy and medicines optimisation – Guidance for ICSs and STPs on transformation and improvement opportunities to benefit patients through integrated pharmacy and medicines optimisation via the Future NHS platform (login required).

This document sets the future direction for system leadership for pharmacy and it summarises the learning from the IPMO pilots. The following PSNC Briefing is aimed at Local Pharmaceutical Committee (LPC) members and officers and it highlights the key points in the NHSE&I document relevant to community pharmacy and suggests actions which LPCs may want to take.

PSNC Briefing 034/20 IPMO guidance and the development of system leadership

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