Integrated care systems and specialised commissioning of health services

These articles aim to help you better understand recent changes to delivery of healthcare, the role of different bodies that are involved and updates on specialised services and the Immunology and Allergy Clinical Reference Group.  

Integrated Care Systems and Integrated Care Boards  

Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and work to improve the lives of people who live and work in their area.  Following the Health and Care Act (2022), forty-two ICSs were established across England on a statutory basis on 1 July 2022, covering populations of around 500,000 to 3 million people.  You can find your local ICS here.  

ICSs are legal entities and have statutory powers and responsibilities. Their aim is to improve health and health care outcomes, tackle inequalities in outcomes, experience and access and enhance productivity and value for money of health services by considering the needs of local populations. 

Two key parts of an ISC are Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs) with ICBs replacing Clinical Commissioning Groups.  

Integrated care boards (ICBs) are responsible for planning and funding most NHS services in the area. 

Integrated care partnerships (ICPs) are committees that bring together a broad set of system partners (including local government, the voluntary, community and social enterprise sector (VCSE), NHS organisations and others) to develop a health and care strategy for the area.   

This image from The Kings Fund summarises the structure and function of an ICS: 

Specialised commissioning 

Specialised services support people with a range of rare and complex conditions e.g., those services needed to support people with primary and secondary immunodeficiency. ICBs have now taken on some of the commissioning responsibilities (planning and monitoring) by NHS England, including the commissioning of primary care and some specialised services giving local systems a greater say in how budgets for these services are spent in their area.  

In April 2025, 70 specialised services (including Immunology and Allergy) will be delegated in all seven regions.  

Commissioning vaccination services and suitable elements of screening pathways and child health information services will be delegated to ICBs in April 2026, subject to governance and Secretary of State approval.  

NHS England » NHS commissioning: plans to April 2026 

Assessing the performance of ICBs 

NHS England has a legal duty* to annually assess the performance of each ICB in respect of each financial year and publish a summary of its findings. 

*  Section 14Z59 of the National Health Service Act 2006 as amended by the Health and Care Act 2022 

NHS England » Annual assessment of integrated care boards 2023/24 – supporting guidance 

The Clinical Reference Group for Immunology and Allergy  

Clinical Reference Groups (CRGs) are committees that provide clinical advice and leadership on specialised services chaired by a National Specialty Advisor.  As part of an overhaul of CRGs, the Immunology and Allergy (I&A) CRG has been designated as a ‘Lead and Inform’ CRG with a full work programme as agreed by NHS England’s Blood and Infection Programme of Care. The I&A CRG’s remit covers primary immunodeficiencies, autoimmune and auto-inflammatory disease where there is associated immunodeficiency, complex autoimmune and vasculitic conditions, autoinflammatory syndromes and allergic conditions including severe, complex and/or rare sub-groups. 

Dr Claire Bethune, Consultant Immunologist at Derriford Hospital, Plymouth has recently been appointed as the National Specialty Advisor leading a committee comprising of clinicians, nursing, patient representatives and the lead commissioner. Their work will cover the review of, and the development of policy and service specifications. Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care, however, the current specification for immunology services dates from 2013.   

You can find out more about who sits on the I&A CRG and its work here. 

Posted August 2024.