CCG to ICB – reflecting on the change

In September 2021, I left a CCG behind to go on maternity leave. In October 2022, I returned to a new organisation – an ICB. There are plenty of dry explanations out there explaining the difference between the two statutory organisations but coming back to something that feels so different has made me reflect on the real differences, day to day, for someone working in an ICB.

This is my experience a few weeks in….

• Our role has definitely changed – immediately I could see that we are working more as an enabler and a collaborator, supporting and co-ordinating developments across a huge range of services and areas, rather than fulfilling the traditional commissioning role.
• This means working with a much wider range of people and groups – I feel like I’m working more closely with clinicians and services than I have in a long time.
• For the finance function, it’s not just a case of carrying on what we were doing with a new name. EVERYTHING has changed! Ledger coding, how we pay invoices, how we get allocations, how we report each month – the bread and butter that underpins the finance function, the stuff I thought I knew inside out – I really don’t anymore!
• I’ve completely lost the scale of the numbers. I knew off the top of my head my CCG’s allocation, our underlying deficit, the size of our contracts – basically what was a big number worth worrying about! The numbers I hear now are so much bigger and its going to take a while to adjust to the new scale of things.
• Coming back from a year away, it’s easy to feel like I don’t have a clue what is going on. But people have readily pointed out that it’s not just me – those who have been around through the whole transition are still getting to grips with everything. It’s been really full on with not enough time in the day to give everything the attention it needs. Be kind to your ICB finance colleagues, they have had a rough ride this past year!
• Planning is going to bring a tricky dynamic as we are working as ‘places’ (similar to the CCG areas) and as an ICB. With this effectively comes two role and two sets of priorities to manage, with a backdrop of huge financial challenge.
• The most positive thing is that which has always made our NHS great – the people. There is lots of positivity and enthusiasm despite the change fatigue. Since I returned people have been helpful, friendly and kind – colleagues I already knew and lots of new ones I have met across our wider footprint. My colleagues have shown some real resilience this year and I’m really proud of them.
• Finally, it’s hard to truly see the benefits of the organisational change just yet. There are lots of benefits of working collaboratively but it feels like we are doubling up on a lot of work such as reporting and planning (doing things at place level and ICB level) and everyone is still in the early stages of getting to grips with new processes. It’ll take a long time yet to settle and I hope we’re given time to allow this to happen then really see some benefits before more re-organisation comes along.

Of course, this reflection is specific to my role, my perception and my organisation. I’d be interested to hear how others reflect on the differences and how it feels to be working in an ICB.