Guess who?

The latest reforms hang on the principle of collaborative decision-making led by clinicians – and almost by definition, therefore, clinical networks are becoming an increasingly powerful force for change.

An integrated care system (ICS) will tend to have some clinical networks mandated by NHS England and aligned to national clinical priorities, as well as locally determined (and often less formal) networks. Most will give clinical committees and networks a formal role in their governance structures, offering them top-of-the-table influence over decisions such as managing pathway redesign, tackling health inequalities and supporting innovation.

Within this, the Clinical Network Lead is the chief orchestrator, helping to establish the agenda and priorities that the network seeks to take forward in its discussions with the ICS.

Cancer Alliances are the most sophisticated and well-established type of clinical network and deserve a special mention. They exist to ‘bring providers and commissioners together with patients to co-design services to optimise pathways, ensure effective integration and address variation.’

As with other networks, members of Cancer Alliances will be particularly interested in value propositions that show:

• How the workforce might be managed or redeployed to make better use of available time and resources
• How clinical efficiencies could be found, including through prevention, preoperative care and post-operative recovery
• What contributions can be made to reduce the backlog and surgical waiting times, for example by reducing the number of appointments necessary
• How a drug might be better used at a population health level to tackle health inequalities and support under served populations.

With responsibility for commissioning many specialised services shifting to ICSs from April 2023, industry also needs to pay attention to the membership and behaviours of clinical reference groups (CRGs). These currently exist to guide specialised commissioning decisions taken by NHS England and its regional offices.

With NHSE retaining overall accountability for specialised commissioning beyond April, CRGs are likely to remain highly active in terms of shaping service specifications, influencing decision-making and reviewing the progress made by systems as they take on devolved responsibility.

All ICSs are working to a five-year service plan comprising a number of broad programmes of work (typical examples might include cancer, mental health, urgent care, medicines optimisation and so on), each supporting the ICS’s overall strategic objectives.

The ICS Programme Lead is the Senior Responsible Officer for these programmes and will report directly into the board on their performance against the plan – which will also incorporate all disease area strategies. Underneath them, the day-to-day work of leading individual workstreams will be done by a Programme Manager working with a cross-functional team involving clinicians, nurses and others drawn from wider ICS organisations.

If the Programme Leads are the ‘heads’, then the Service Leads are the ‘hands’ in terms of the delivery of service plans. Working within Trusts, they are responsible for the operational budget and play a pivotal role in terms of workforce planning and resourcing across the system to ensure services operate effectively.

They are particularly important if a value proposition has an impact on resourcing or workforce – for instance, if a drug no longer requires infusion, or can be administered and managed remotely via a telehealth solution or by a primary or community health team. Service Leads will also be heavily involved in multi-disciplinary team discussions about the staffing of the pathway.

ICSs are typically appointing designated ‘Transformation Leads’, whose role is focused on ‘the mobilisation and co-ordination of change’ across the system – in other words, they are responsible for fast-tracking, facilitating and mainstreaming innovative practice within the NHS.

Their teams will tend to work on a project-by-project basis to support system needs, working with clinicians and Service Leads to shape, deliver and embed a specific pilot or change programme before handing it over to expand out and run as a mainstream proposition.

From an industry perspective, these professionals are ambassadors for innovative practice. They tend to work on ‘enabler’ programmes, such as digital or workforce development, but could be potentially valuable advocates if a proposition supports their efforts to encourage new ways of working.

Systems are also starting to bolster their medicines management capability. Key to this is the emerging role of the ICS Chief Pharmacist – which NHSEI’s outgoing Chief Pharmaceutical Officer Keith Ridge has described as ‘crucial’ for delivering the government’s medicines optimisation programme.

To give an idea of the roles, one of the first appointments was made in North East London, where the Group Chief Pharmacist is in charge of developing ‘a system-wide vision’ for medicines optimisation and pharmacy, leading the medicines management teams within the new integrated care board. Most ICS chief pharmacists are now in post across the country, and can be tracked through our new System 360 strategic account management tool.

The folding of clinical commissioning groups into ICSs has also led to an equivalent shift in the organisation of area prescribing committees (APCs). In most cases, these now operate at a system level, making collective decisions on formularies across a wider geographical area.

While the workings of APCs will be reasonably familiar to industry, it is important companies understand the membership and power dynamic within these reconfigured committees, and can provide targeted information about product launches to support their discussions.

At provider level, the presence of High Cost Drug Pharmacists working within hospitals is also significant. As my colleague Jyotika Singh has shown, their specialist knowledge can help create the conditions necessary to make changes happen on the ground.

High Cost Drug Pharmacists tend to be linked to specific departments that use a range of high cost drugs (HCDs). Part of their role is to support their seamless integration into homecare delivery, as well as being part of the clinical multidisciplinary team. They also liaise with the ICS High Cost Drug Pharmacist Lead, who manages, audits and reports on the 400-plus HCDs used across the NHS.

Finally, within primary care, the role of the PCN Clinical Pharmacist Team Lead is crucial. The lead is responsible for: delivering medicines reconciliation for discharge meds, annual medicines reviews, rationalising or optimising medicines of patients on polypharmacy, supporting priority medicines programmes (like sustainable inhaler use), overseeing the medicines cost-effectiveness schemes and leading chronic disease clinics where they have specialised training.

They also get involved in supporting the introduction of innovative practices where it can support workforce optimisation (for instance, by reducing GP time) and, as such, play a fundamental part in scaling up and embedding change on the ground. 

Oli Hudson is Content Director at Wilmington Healthcare.
Go to wilmingtonhealthcare.com