In January 2023, NHS Arden & GEM was engaged by NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) to facilitate the delegation of commissioning responsibilities for several primary and secondary healthcare services from NHS England to eleven Midlands ICBs.
This nine month project achieved the successful delegation of complex commissioning responsibilities and the seamless transfer of staff within the agreed timescales. As a result, service decision-making is now taking place at a local level with the aim of improving care integration and patient experience. While relationships and collaboration between ICB and NHS England stakeholders have been fostered to support the future delegation process.
The challenge
As part of the NHS’s long term ambition to put decision-making at as local a level as possible – to improve integration and target resources where they are needed most – a number of direct commissioning functions are being delegated to ICBs from NHS England.
On 1 April 2023, ICBs became responsible for commissioning pharmacy, general ophthalmic and dental (POD) services. Supporting the safe delivery of these functions required the transfer of staff, operating models and processes. Within the Midlands region, 11 ICBs would assume responsibility for commissioning POD services along with:
- Secondary care dental services
- General Medical Advice and Support Team (GMAST).
The delegation of these commissioning responsibilities would also include management of associated finances, dealing with complaints and the transfer of staff.
Our approach
Arden & GEM was selected to deliver this project due to its expertise and experience in healthcare service transition and transformation, particularly in primary care. The project team comprised a:
- Programme Director
- Senior Programme Manager
- Programme Manager
- Governance Advisor.
The team possessed a range of relevant skills and knowledge, including programme and project management, risk and issue management, reporting excellence, and fostering collaboration between teams and organisations.
To achieve the project’s aim of successfully delegating commissioning responsibilities within the agreed timescales the following activities were undertaken.
Programme management and governance
With 12 organisations involved, developing robust programme governance structures was key. A monthly programme board and a weekly checkpoint meeting were established to bring together the programme team with representatives from NHS England and host ICBs.
Two ‘host’ ICBs had been selected to represent the region and host transferred staff; these were NHS Nottingham and Nottinghamshire ICB in the East Midlands and NHS Birmingham and Solihull ICB in the West Midlands.
Checkpoint meetings provided a successful forum to review workstream plans, implement risk management systems and resolve challenges, with a weekly highlights report then produced for all stakeholders.
Corporate governance framework
In addition to programme governance, it was also crucial to establish an ongoing framework for corporate governance (at the appropriate tiers) which was in keeping with the delegation agreement and legislation while also reflecting the needs of the region. This included establishing a Clinical Commissioning Committee and Sub-Committees, and approving Specialists to take delegation arrangements into business as usual.
Managing the transfer of staff transfer
The programme team provided oversight of the HR and people workstream and worked closely with HR teams to successfully transfer approximately 400 staff members from NHS England to the two host ICBs under TUPE (Transfer of Undertakings Protection of Employment) arrangements. Transferring staff members also needed to be provided with new equipment (including laptops and phones) and IT accounts for different systems and platforms.
Transferring systems and processes
As well as ensuring the effective transfer of staff, the programme team also needed to manage the transfer of the following systems and processes:
- Finance ledgers needed to be transferred from NHS England to each of the 11 ICBs
- Central data needed to be safely transferred to ICBs, which included millions of files and a review of user access permissions
- All outstanding POD complaints were passed over the two host ICBs along with responsibility for ongoing quality and complaints management.
The outcomes
This nine month project achieved the successful delegation of complex commissioning responsibilities and seamless transfer of staff from NHS England to ICBs in the Midlands region within the agreed timescales.
The project has brought service decision-making closer to the local level with the aim of improving patient care and experience.
Relationships and collaboration between individual ICBs and between ICBs and NHS England were fostered which will support the ongoing successful delivery of POD services as well as supporting the future delegation process.
Next steps
As well as providing ongoing support to assist ICBs in their new responsibilities, as they become business as usual, the programme team will support the next stages of the delegation process which include:
- From April 2024 – specialised services commissioning and cancer alliances staff
- From April 2025 – vaccination and screening services and staff.
"Arden & GEM rapidly mobilised a PMO to support delegation of PODs to ICBs. The Programme Director worked closely with colleagues in ICBs and NHS England to bring the delegation to conclusion, and was highly effective as an embedded member of the ICB teams."
Lucy Dadge, Director of Integration and Accountable Emergency Officer at NHS Nottingham and Nottinghamshire ICB