The way the NHS plans and pays for healthcare in England is undergoing its biggest shake-up in decades, with a fundamental shift away from the old system of competition between different providers towards a new model focused on collaboration and keeping entire communities healthy.
For years, Clinical Commissioning Groups (CCGs) acted as the NHS's shoppers, assessing what healthcare their local areas needed and then buying services from hospitals, mental health trusts, GP practices, and even private companies. This "purchaser-provider split" was designed to drive competition and efficiency, but often left patients navigating fragmented services that didn't always talk to each other.
That's all changed with the Health and Care Act 2022, which has formally established Integrated Care Systems (ICSs) across England. These bring together NHS organisations, councils, and community partners to work as a team rather than competitors. At the heart of each system sits an Integrated Care Board (ICB), which has now taken over the responsibilities previously held by CCGs.
According to a new analysis by The King's Fund, this represents a fundamental shift in thinking. Rather than simply treating people when they fall ill, the focus is now on "population health management" – keeping entire communities healthier and tackling the root causes of poor health before problems arise.
The new ICBs work alongside Integrated Care Partnerships – committees that bring NHS and council leaders together – to develop joined-up strategies for their areas. This means more emphasis on partnership working, shared decision-making, and tackling health inequalities, rather than the old system of competitive tendering for individual services.
For patients, this should mean smoother journeys through the healthcare system, with better coordination between your GP, local hospital, mental health services, and social care. Services should also be more tailored to local needs and priorities, rather than following a one-size-fits-all approach.
The transformation is still in its early stages, and The King's Fund emphasises that success will depend on how well these new partnerships can work together, manage complex budgets, and deliver real improvements in health outcomes. But for the first time in years, the NHS is moving away from an internal market towards a model that puts collaboration and prevention at its heart.
Source: The King's Fund