Agenda item

The Committee will hear from Dr James Kent, the newly appointed Accountable Officer for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.



Dr J Kent, Accountable Officer, Integrated Care System



Cover report attached

NHS “Integrating Care – next steps for integrating care systems”


The Chairman welcomed Dr James Kent, Accountable Officer, ICS.  Dr Kent explained that the ICS was a system of three Places; Buckinghamshire, Oxfordshire and Berkshire West, and within each Place there were partnership arrangements which were called ICPs.  The change had occurred approximately two years ago.


Dr Kent stated that the Integrated Care document, included in the agenda pack, was published by NHS England (NHSE) in November 2020; it outlined the way forward for the ICS and included two options on how to put each ICS onto a statutory footing.  NHSE’s preferred option was Option 2, whereby the Clinical Commissioning Groups (CCGs) would be subsumed into the statutory ICS.  The purpose of the ICS was to drive forward all elements of the long term plan and Dr Kent emphasised that the Integrated Care document was a managerial and organisational document rather than a strategic document in terms of services and the majority of the paper was in line with the current direction of travel.  Systems started from strong Places and the paper clarified the role of Place, which centred around local services and urgent care services and indicated the services which were likely to be commissioned at a system level; these tended to be some of the more specialised services.  Several areas needed more detail, such the scrutiny process and the governance; these would be worked on between now and March 2022.  If the second option was agreed it would also need to be decided how the voice of Primary Care was heard.  The document provided clarity on the leadership roles to be recruited to in the ICS. 


The following points were raised in discussion with Committee members

  • The Chairman requested the timescale for when further information would be provided.   Dr Kent advised that there was a large amount of work to be carried out before September 2021 but the ICS was currently working in the direction of travel and his personal view was that plans would need to be broadly configured by January 2022; however the timeline of March 2022 was dependent on the operational challenges of the pandemic being over by March/April 2021; if not, the date could slip.
  • It was noted that there was little mention of social care within the report.  In response, Dr Kent agreed that the document was overly health focussed; it started with the need for strong Places in order to ensure good integration between health and social care.  The health and social care services would be commissioned at a local level and would build on work already underway in terms of joint commissioning and governance arrangements.
  • A Member commented that social care was provided by Buckinghamshire Council (BC) and the report discussed pooled funding of resources. When asked if this would also apply to social care; Dr Kent stated that he had no information on social care funding flows but had not seen anything to suggest that it would change.
  • A Member requested an update on how the establishment of the Primary Care Networks (PCNs) was progressing.  Dr Kent advised that the PCNs had been formed and were expanding the number of resources e.g. pharmacists, physios and allied health professionals; some worked well, but others had teething issues.  The Chairman added that the HASC Select Committee had increasing concerns over the development of the PCNs
  • In response to being asked how patients knew which PCN their practice belonged to, Dr Kent explained that it was an organisational construct and the patient’s front door remained their GP practice.  
  • The Chairman raised a concern about how PCNs would work once the CCGs had merged into one.  Dr Kent stated that there would a Lead for each Place who would liaise with the PCNs.
  • A Member asked how budget decisions would be made as currently there were financial differences across the Buckinghamshire, Oxfordshire and Berkshire West (BOB) area; Buckinghamshire traditionally received 12% less funding than the national average.  The Member asked if Buckinghamshire residents would get their full share of funding, whether a scrutiny function would be set up and hoped that GPs would have more time for their patients.  Dr Kent advised that the ICS had been operating under a different financial regime throughout the pandemic and he was unable to say what the financial position would be once the pandemic was over.  The Integrated Care document was clear that funding resources should follow need; it was not known if that would be across the three counties or specific for each county.  The ICS needed to be open and transparent and would welcome scrutiny on funding.  Dr Kent shared the same hope for more GP time for patients.
  • In response to a question on a change to the ownership of Continuing Health Care; Dr Kent stated that he was not expecting any changes; if option 2 was agreed, the CCG functions would be subsumed into the ICS.
  • A member asked if the proposal would come to fruition by March 2022.  Dr Kent advised he was confident the date would be met as the ICS was broadly operating as outlined in the document; it was a case of formalising what was currently carried out.  There had been a huge amount of collaborative working throughout the pandemic and people had seen the benefits; however, getting the health legislation through parliament could be challenging. 
  • The Chairman commented that in previous presentations, it was stated that 30% of activity would be carried out at ICS level and 70% at ICP level but there was no clarity on what the ICS would be responsible for and what would be handled by the ICP.  Dr Kent advised that he was unable to confirm the exact percentage split but confirmed that most urgent and emergency care pathways would be commissioned at Place, apart from the 999 and 111 services.  Additional primary care services to the national contract would be commissioned at Place.    Planned care would be at a system level along with specialised commissioning but there were some grey areas such as mental health services.  The Chairman advised that the HASC Select Committee was concerned about the outcomes for residents if there was to be consolidation of services to Centres of Excellence which would attract more funding and greater expertise but would come at a cost if residents had to travel across three counties in order to access them.
  • One of the Members asked for reassurance that Wycombe and South Bucks would not lose out financially; Dr Kent reiterated that the new financial regime had yet to be published.  Within Buckinghamshire, over time, as the paper outlined, there was a view that there would be Place-based budgets for services, and it would be for the ICP to determine how the budget was spent.  Dr Kent emphasised that the intent was to allocate funding to the areas of greatest need and that would be the goal at system level and Place level.  The Chairman added that she looked forward to seeing more detailed plans in the future. 


The Chairman thanked Dr Kent for his contribution.

Supporting documents: