It’s no secret that the NHS loves an abbreviation. But in a world with more and more of them, it can be hard to keep track.

This year, ICSs were established as part of the Health and Social Care Act 2022, effectively replacing the clinical commissioning groups (CCGs) in which many pharmacists were employed.

Read more: What is community pharmacy’s place in integrated care systems?

CCGs had been around for 10 years after being established as part of the Health and Social Care Act 2012.

CCG pharmacists worked proactively with partners and stakeholders, implementing medicine optimisation, strategy, audits, provided expert medicine information and prescribing advice to GPs – among a host of other responsibilities.

Now those CCGs are no more.

But what is the function of its successor the ICS, what on earth are ICPs and ICBs and, crucially, where do pharmacists fit in?

 

What is an ICS?

 

Put simply, the ICS is the umbrella overseeing local healthcare commissioning and there are now 42 of them across England. Much larger than CCGs, they cover wider areas and have bigger budgets.

The ICS is there to remove boundaries that existed between services so people can access the support they need from the NHS and social care when needed.

Each ICS covers a geographical area, with its name reflecting the area it serves.

Beneath that umbrella are two other groups: ICBs and an ICPs.

 

What is an ICB?

 

The ICB is a statutory organisation that brings the NHS together locally to "improve population health and establish shared strategic priorities within the NHS".

They are responsible for planning and funding, taking local health needs into account.

Read more: ‘The ICS rollout delay is welcome, but we must change decision makers’ views on pharmacy’

With so much at stake, pharmacy leaders including the Association of Independent Multiple pharmacies CEO Leyla Hannbeck have urged for pharmacy to have a voice in these "decision-making forums".

 

What is an ICP?

 

On the other side is an ICP, the statutory committee of the ICS.

They are made up of partners from across the local area including healthcare providers and people across public health and social care.

Service providers including GPs, nurses, social workers, hospital specialists and, you guessed it, pharmacists can all have a seat at the table.

Read more: How one LPC became 'vital' to its integrated care system

 

What does this mean for pharmacies?

 

ICSs have delegated responsibility for direct commissioning in sectors such as general practice, dental, ophthalmic – and pharmacy.

This gives pharmacists more responsibility for things such as screening and immunisations. But each ICS is different, with different needs.

So what next for pharmacies? Well, the most obviously affected will be pharmacists employed by the now-defunct CCGs.

Indeed, Paul Day at the Pharmacists' Defence Association (PDA) says that the union's immediate concern is "for the employment impact for pharmacists previously employed by the now-closed CCGs who find themselves in changed roles and now employed by the new ICB or in some cases potentially redundant".

There may also be repercussions for pharmacists working across different areas.

The details are yet unknown but the PDA says that there will likely be different decisions on certain issues handed down by various ICSs or else national decisions would just be "implemented 42 times".

Therefore, in this "new reality", relief pharmacists and locums working in large pharmacy chains with branches across different ICSs "will need to adapt" to these differences whenever they appear, Mr Day warns. 

He goes on to say: “Similarly, some patients may visit pharmacies in different ICS areas, [if] for example they live in one ICS area but work in another. So again, if differences are material, patients will need to adapt to that also.”

For its part, the Royal Pharmaceutical Society has said it hopes that ICSs will “consider how they best use the pharmacy workforce to deliver population health and support people with long-term conditions". It hopes this will include giving pharmacists "access and input into" patients' shared care records.