From delegation to integration: lessons from early delegation of primary pharmacy, ophthalmology and dentistry commissioning to integrated care boards

TRFT Library & Knowledge Service

Apr 3

NHS Confederation - April 3rd 2023

Delegation of POD services supports increased autonomy at a local system level. Find out more about it from experiences of early adopters.

Key points

Delegation of primary pharmacy, ophthalmology and dentistry (POD) from NHS England to integrated care boards (ICBs) on 1 April 2023, provides an opportunity to transform care for patients but will need a realistic timetable and smooth transition if this transformation is to be achieved.
This report provides evidence from nine 'early adopter' ICBs and argues that closer local collaboration between NHS systems and frontline providers can be the single biggest to driver to address local provision challenges.
Early adopter POD commissioners identified immediate transition challenges including ensuring adequate governance is in place, understanding and meeting commissioner and provider data requirements and developing effective engagement mechanisms with local providers.
Access to and capacity to use appropriate data is most urgent to identify unmet patient need and ensure service quality. Meanwhile, clarity over flexibility within national contracting arrangements, particularly for dentistry, is needed and opportunities for further reform considered.
NHS England needs sufficient ICB capacity, particularly in relation to dentistry where there is mounting evidence that some dentists have been reducing their NHS activity or ceasing to offer NHS services. Within its broader workforce planning, the government must develop a clear approach to the dentistry workforce crisis.
Delegation provides an opportunity to support increased autonomy at a local system level, backed up by appropriate regional and national support, which can improve access to services and improve health outcomes. To maximise the potential benefits, support from NHS England needs to avoid risk aversion, permit innovative approaches to improving health outcomes and reducing health inequalities, and not create barriers to implement different approaches.
For ICBs, the immediate task will be to manage the logistical and governance challenges of shifting the management of these contracts and they should invest time and effort in building relationships with POD service providers, as well as wider stakeholders.

Read the Report - From delegation to integration: lessons from early delegation of primary pharmacy, ophthalmology and dentistry commissioning to integrated care boards