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At least one clinician should sit on each ICS board, say CCG leaders


By James Hacker
1 June 2021

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The Government should strengthen its legislative proposals to guarantee clinical leadership on Integrated Care System (ICS) boards, NHS Clinical Commissioners (NHSCC) and the NHS Confederation has said.

In a joint letter (27 May), the two organisations said that the upcoming legislation should ensure that at least one clinician – who is registered with an appropriate UK professional regulator – sits on the executive team of an NHS ICS body.

Under the Government’s recent proposals, each ICS will be made up of a statutory ICS NHS body with a unitary board and a separate statutory ICS Health and Care Partnership – and will be required to have ‘appropriate clinical advice’ when making decisions.

The White Paper also sets out the minimum structure an ICS board should have.

NHSCC and NHS Confederation said they backed this ‘permissive minimum’ but called for the guarantee of clinical leadership – ‘not just advice’ – to be strengthened before the draft bill goes to Parliament. 

‘While we agree with the Government’s aim for legislation to provide a permissive minimum legal structure which maximises scope for local decision-making informed by evolving guidance, we feel it is very appropriate that the Government guarantees clinical leadership – not just advice – on ICS NHS Bodies as part of the minimum legal structure in the forthcoming Bill given ICS NHS Bodies will have key responsibilities such as the assurance of clinical quality,’ the letter said.

It added that the ‘best practice clinical leadership models’ are those which have multidisciplinary staff leading on ‘specific areas of work according to their expertise and being heard at the highest levels’.

The two organisations also said clinical leadership had been a ‘top priority’ raised by members and needed strengthening to make ICSs ‘a success’.

More GP representation

The White Paper – published in February – outlines that each ICS NHS Body will have a unitary board accountable for the system’s spending and performance.

It also states that the board will include, as a minimum, a chair and a chief executive, representatives from general practice, NHS trusts and local authorities, and others determined locally, such as community health services.

The ICS NHS bodies will be responsible for the ‘day-to-day’ management of the ICS, and NHS planning and allocation decisions, including setting out the strategic direction for the system.

The NHSCC and NHS Confederation letter follows concerns that the reorganisation of CCGs into ICSs could risk losing the advantages of place-based planning and resource management.

Meanwhile, last week, leaders of PCNs and GP federations warned that more work must be done to prevent ‘tokenistic’ GP representation in ICSs, with more than 50% saying they were ‘unclear’ or ‘very unclear’ about their role in an ICS.

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