Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: Integrated care systems—yet another NHS re-disorganisation

BMJ 2019; 367 doi: (Published 08 October 2019) Cite this as: BMJ 2019;367:l5822
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

I’ve heard recently that the days of our local clinical commissioning group (CCG) are numbered, as it’s about to be swallowed up into a larger body covering the area of three previous CCGs. This will be part of a new integrated care system (ICS), which aims to draw together local council services, hospitals, and community services to provide an efficient and seamless service for patients.

Our CCG has its critics, but what we have works well enough for local GPs and their patients. In the six years since the last NHS reorganisation we’ve built relationships and trust. It took time, but now if I have a question I know the best person to ask, and if my patients aren’t getting the service they need I know where and how I can raise that concern.

Now it looks likely that we’ll start again from scratch, with different people (or the same ones shuffled around after expensive redundancies, if previous experience is anything to go by1). I’m not here to blow the trumpet for CCGs—but for stability, rather than disruption. If any evidence showed that these changes would help us tackle the major healthcare problems, underfunding,23 staff shortages,4 faltering life expectancy,5 and growing health inequalities,6 I’d welcome them. But I’ve yet to be convinced.

We also need to ask who will represent GPs in the planned new structures and how our voices will be heard. The area covered by our proposed ICS will have 45 primary care networks, so clearly it would be impractical for all clinical directors in these networks to have a seat at the table. Should it perhaps be our local GP federation or the local medical committee? Maybe there’s a plan about how the bits of this jigsaw will fit together, but, if there is, it’s a closely guarded secret. My concern is that organisational changes, which may have a fundamental impact on patient care, are happening at speed, behind closed doors, without adequate consultation with patients or staff.

Some of the proposed collaborative processes of the ICSs are at odds with the last big reorganisation, the 2012 Health and Social Care Act, which has ensured that every contract is put out for competitive tendering. NHS England has suggested new legislative changes to overcome this.78 But we should perhaps be wary before we celebrate the end of wasteful competition and privatisation, as there seems to be nothing in this proposed deregulation to stop large scale contracting out by ICSs.

The risk is that, rather than losing our NHS one small service at a time, we’ll lose huge chunks of it to the private sector, and we won’t know about it until it’s too late.



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