The reorganisation of clinical commissioning groups (CCGs) and proposed changes to their functions could threaten the advantages of place-based working, the King’s Fund has warned.
In a report (20 April), the think tank said that as CCGs merge – and if proposed legislative reforms that would see CCG functions taken over by ICSs go ahead – there is ‘a danger that the advantages of place-based planning and resource management could be lost’.
The King’s Fund reviewed existing evidence on place-based working – which involves local health and care organisations collaborating to manage the common resources available to them – and made recommendations to health leaders on how to develop these partnerships.
This included suggesting that ICSs should delegate budgets at geographical place level to avoid loss of place-based planning – and that national NHS bodies should provide guidance and support to enable this.
‘Over time, local partnerships should use these flexibilities to develop a more joined-up approach to resource management that makes best use of the total collective resources available,’ the report added.
ICSs will also need to ensure that expertise previously held by CCGs is used to support effective planning at place-level, the King’s Fund said.
‘Key functions may include data analysis, needs assessment, negotiation and facilitation, and evaluation skills,’ the report said.
ICSs must not undermine local partnerships
The King’s Fund also warned that the Government’s proposal to place ICSs on a statutory footing should be implemented carefully to avoid ‘detracting from or even undermining the efforts of local place-based partnerships’.
ICS should instead build on the work of these partnerships, given that much of the work involved in integrating care will need to happen over smaller geographies, the report said.
It added that ‘some advanced systems have successfully nurtured an approach where the ICS is built up from its constituent places rather than functioning as a separate entity’ – and ICSs should seek to embed this model.
The systems should also make sure their local places are ‘adequately represented’ in formal ICS structures, the report said.
It gave the example of West Yorkshire and Harrogate, where a Patient and Public Involvement Assurance Group sits on the ICS board to ensure patient and public views are informing planning decisions.
A ‘long-term commitment’
The report concluded that these changes will take time to deliver, and that national leaders ‘need to make a long-term commitment’ to their implementation and development.
Doing so would avoid ‘the past mistakes of moving swiftly to the next reorganisation if desired outcomes are not rapidly achieved’, the King’s Fund said, which would risk wasting effort and losing goodwill among organisations.
The focus should instead be on ‘incremental change, progressively strengthening partnerships and delivering tangible improvements in health and wellbeing’, it added.
