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Clinical policy and the Triple Aim: Why ICS leaders need to act now

Clinical policy and the Triple Aim: Why ICS leaders need to act now
By Charlotte Nuttley NHS Arden & GEM
23 June 2022

The ‘to do’ list for Integrated Care System (ICS) leaders is understandably long as we head towards formal adoption of the new structures in July 2022.

Among the requirements competing for attention is clinical policy development and harmonisation. It’s crucial to achieving the ICS Triple Aim of better health for everyone, better care for all patients and sustainable NHS services, fundamental to the Covid-19 recovery programme, and provides the robust evidence and governance required when difficult funding decisions need to be made. But the process is complex, which is why commissioners need to act now.

Depending on the complexity and policy development, change will require evidence reviews, engagement with clinicians, patients and other stakeholders, as well as effective implementation across system partners. With most clinical commissioning groups (CCGs) having upwards of 100 clinical policies in place, harmonising these arrangements and addressing any gaps is a significant task. There are steps ICSs can take to make this more manageable, however. The important thing is to make a start, which could simply be developing a plan for addressing your most urgent policy requirements.

Where to start

ICSs are tasked with looking at population health across the system, which includes knowing what is safe and clinically effective for their patients. Every ICS will have a different starting point; some with more policies in place than others. In our work with newly consolidated CCGs, we have found commissioners often benefit from an initial assessment of their current policy landscape. Which policies exist for which conditions and which patient populations. Where are the gaps? These can then be rated based on, for example, priority, need, level of risk or complexity.

Where clinical interventions are highly contentious, or where there has been a significant change in clinical direction, more time will be needed for clinical and patient engagement. These will likely require more urgent action than the more straightforward interventions, where there is low level of need, or significant synergy already exists across different partner policies. Knowing your ‘red flags’ will enable your ICS to focus attention where it is needed most in the early days.

Essential elements

How these policies are developed or adapted directly impacts the likelihood of achieving successful patient outcomes as well as financial sustainability. Getting the process right also reduces the risk of facing costly legal challenges, particularly in the case of treatments where eligibility criteria are often complex, such as fertility treatment or cosmetic surgery.

Some of the challenges for ICSs in facing this growing task will be ensuring appropriate levels of patient, clinical and wider stakeholder engagement during policy development, and that any proposed changes are clearly and comprehensively communicated both to clinicians and their patients. Similarly, sufficient time and resources need to be allocated to conducting meaningful clinical evidence reviews that pick up on timely research and guidelines, particularly in areas where our understanding of what works is changing rapidly.

Supporting COVID-19 recovery

Waiting lists are longer than ever in the wake of the coronavirus pandemic. Up to date clinical policies are an important enabler in making the right decisions to support the best outcomes for patients. This considers both the clinical evidence and the financial implications to ensure ICSs are equipped to make decisions that will improve health outcomes and be sustainable for the NHS.

Policy development and harmonisation is as much about deciding what not to do as about what to do. In decommissioning services that have not been found to deliver the outcomes expected, system leaders will be better able to direct resources to the greatest areas of need, funding interventions which are likely to deliver the most benefit to the greatest number of people.

Driving system-wide consistency

As ICSs become statutory bodies, robustly developing and harmonising clinical policies will provide consistent eligibility and treatment options across the local health and care system. This will help to address health inequalities, tackle the most urgent clinical priorities, and support delivery of the Triple Aim duty of better health for everyone, better care for all patients and sustainable NHS services.

NHS Arden & GEM CSU is running a series of free webinars for NHS organisations looking at policy development and harmonisation. To find out more and register, visit

By Charlotte Nuttley, senior individual funding requests nurse at NHS Arden & GEM commissioning support unit.

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