ALL SYSTEMS GO: UNDERSTANDING WHO’S WHO IN THE NEW NHS LANDSCAPE

The Health and Care Act became law in April.  But what, in practice, will actually change for industry, and which stakeholders will be the most important commercially? Here are some of the key players the newly reformed NHS.

1. Integrated Care Systems

   The new legislation formalises the structural changes that have already happened, and in particular gives statutory authority to the 42 new Integrated Care Systems (ICSs) within the new landscape. Covering a geographical footprint of around 1 to 3 million people, ICSs will now take on official responsibility for a single budget, and will need to fulfil a ‘triple aim’ duty in the new Act requiring them to “consider the effects of their decisions on the health and wellbeing of the population, quality of care, and the sustainable use of NHS resources”.

2. Integrated Care Board

   Each ICS will be led by an Integrated Care Board (ICB) made up of a Chief Executive, Chair, Finance Director, Medical Director and a Director of Nursing, as well as up to three non-executive directors and partner members representing local authorities, trust providers and general practice. The ICB will be responsible for allocating resource and setting the strategic priorities for their population via a five-year service plan.

3. Integrated Care Partnership

   To help them do so, Integrated Care Partnerships (ICPs) will be responsible for developing an integrated care strategy to inform these system-level plans. ICPs are made up of organisations across local authorities, the NHS and voluntary sector. Their purpose is to bring together organisations involved in health, social care and public health delivery to make shared decisions on behalf of the people they serve, with a particular focus on addressing health inequalities and improving population health.

4. Provider Collaboratives, Primary Care Networks and Place-Based Partnerships

   Beneath them, there are further networks and entities responsible for delivering integrated services at different levels within the ICS. Provider Collaboratives bring secondary care provider organisations together at an operational level to develop more integrated service plans across a system or multi-system footprint.  Primary Care Networks (PCNs) play a similar role for general practice and other primary and community care organisations at a highly localised, “neighbourhood” level, working with local councils and charities.  Place-Based Partnerships (PCPs), meanwhile, are coalitions of NHS organisations, PCNs, local authorities, voluntary and third sector organisations and community interest groups which develop integrated plans at the intermediate “place” level, which is often mapped against a local authority footprint.

5. Clinical networks

   NHS customers will also be increasingly networked and incentivised to act collectively in pursuit of system goals. Clinical networks, most typically organised by disease area of pathway, will therefore hold even greater influence and need to be carefully courted by commercial organisations. Here is a more detailed piece on why clinical networks are set to be “change-makers” in the new NHS and how to connect with them effectively.

6. Area Prescribing Committees

Formulary decision-making is changing too. With CCGs gone, the area prescribing committees (APCs) that were effectively the CCGs ‘medicines management arm’ will now organise themselves at an ICS level. The picture isn’t uniform and in many cases is still evolving, so you may find, for instance, independent decision-making happening at place and neighbourhood level as they develop their own formularies and ways of interpreting overall ICS medicines guidelines to adapt to local care pathways and service nuances.

Conclusion

These reforms are set to profoundly change the way pharma engage with the NHS. The customer landscape will shift, bringing in a new cast list of influencers, and these customers will be moulded by a different corporate environment. Suppliers will need to revisit their stakeholder mapping and be able to make their case on multiple levels, being mindful of both the immediate operational pressures on NHS organisations and the longer-term strategic priorities they are working to within a given system.

Finally, as this excellent long-read from the Health Foundation makes clear, all ICSs are not created equal. Each will have its own starting position, with unique pressure points and limitations, and variable ways of working. Gathering local intelligence, and using it to drive brand planning and sales strategy in a targeted way, will therefore be key to negotiating the new stakeholder environment.

On 29 June, Wilmington Healthcare will host a live webinar describing the new ICS landscape and how to work more effectively with NHS partners in the reformed NHS. To register, visit https://wilmingtonhealthcare.com/live-webinar-going-live-the-ics-landscape/.