A shop floor view of recent NHS change: “An invitation to the brave and radical”

I work as far away from London – and the dynamics of NHS leadership – as it is possible to be in England. 

When the news broke last week of NHS England’s abolition, it was “carry on regardless”. There is an NHS superstructure and an NHS of delivery, and the latter trundled on as normal in treating patients. NHS England is remarkably remote from the operational service so the focus on the ground is “what happens next?” 

The ICB change was less expected. I work in the largest ICS and communication with us already tends to be transactional and arm’s length. However, the impact of a 50% cut in management costs will be felt more for smaller ICBs. Everyone is dreading the disruption of ICB’s HR processes and the lack of clarity on “who leads on what”.   

The impact of cuts upon smaller ICBs is terminal  

It costs £2-3m per annum to run a statutory body’s board and legal functions. Some will now have £4m management budgets whereas my ICBs, North East and North Cumbria, will be £24m. All ICBs need to rethink their functions and role but many are now simply impractical.  

Important areas of change will become more prominent to the shop floor as transition occurs; digital, prescribing, procurement of clinical tech and premises. Our prescribing systems are clear, long established and coordinated at the ICB.  So, what happens now? We expect major change to NHS supplies and property management.  

These strategic changes matter at patient level  

Every clinician knows patients undergoing specialist care, invariably involving high-cost drugs. The ongoing delegation of specialised services to ICBs is a policy which already had significant risks – these have now increased, especially in terms of the impact of varied per capita budgets and the consequent variation in local access and service delivery.   

What comes next? 

Most ICBs seem to be in a state of shock and grief. Ambitious primary care organisations like my Primary Care Network will be immediately looking to our local Foundation Trusts for clarity, decision making and continuity. We have accelerated Neighbourhood working plans with our main local NHS provider – a Foundation Trust with hospitals, community services and 12 managed GP practices.   

We anticipate the rise of local NHS single leadership, combining planning and delivery at Place level – resembling the Accountable Care Organisations or multi sector providers envisaged by the Vanguard programme of a decade ago. These could integrate social care, Public Health, care homes, hospices and Voluntary, Community and Social Enterprise bodies – possibly headed by the elected Mayors and their combined authorities.  

If we’re correct, our future is to build a local Neighbourhood model and to do so with the permanent partners of the local provider NHS. This is a major opportunity for those able to be constructive, proactive and engaged.  

My lead clinical colleagues are rightly focused on the end in mind. This is not about saving money but a reset of culture and ways of working, which we all hope achieves the ultimate goal of better patient experience of care and outcomes.