Commissioning of pharmacy, optometry, and dental services

Delegation means that there is an agreement between NHS England and an ICB that enables the ICB to take on the responsibility for delivering NHS England functions. Following final approval and signature by each organisation’s senior leadership team, the function becomes the responsibility of the ICB, meaning they can take commissioning decisions on behalf of its population. The ICB becomes the operational and legal owner of the function, being both responsible and liable for its delivery, with NHSE retaining accountability.

The Health and Social Care Act of 2022 sets out a new way of working for the NHS. The new legislative framework provides the basis for delegation of many of the functions of direct commissioning to Integrated Care Boards. Shifting commissioning services away from regional organisation into ICBs intends to reduce health inequalities, improve health outcomes, and reduce inefficiencies and costs through providing more localised and joined up care.

Some NHS England commissioning functions, such as public health, health and justice, and some specialised commissioning services will remain the responsibility of the regional team.

• To improve outcomes in population and healthcare
• To tackle health inequalities, improve health inequalities and improve patient access
• To support broader social and economic development
• To enhance productivity and value for money
• To give us greater autonomy and control over the delivery of our local priorities
• To make it easier for services to be integrated into wider care pathways, for the benefit of patients

ICBs will manage contracts which are currently held by NHSE for Primary Medical Care, Primary Ophthalmic Services and Dental Services. The contracts will not be replaced with a new contract for ICBs under delegation. The delegation agreement describes how ICBs will be responsible for contracting and provider selection. Pharmaceutical Services currently operate on a contractual framework.

Even where services are delegated to local ICBs, accountability for the services will stay with NHS England. This means that the functions of primary care commissioning become the responsibility of ICBs, NHS England will retain accountability.  This will mean they will implement a framework to ensure the continued safe delivery of the primary care functions. We are working with regional colleagues to establish how this will work in practice.

Hertfordshire & West Essex ICB (HWE) will be hosting the Pharmacy and Optometry (P&O) team for the East of England. This means they will host the team that manage P&O market entry and contract management on behalf of all six East of England ICBs.

Suffolk and North East Essex ICB will lead (in house) management of Suffolk and North East Essex dental contracts (and wider functions), dental transformation, pharmacy transformation and optometry transformation.

As of 28 April 2023, in Suffolk and north east Essex there are:

• 174 Pharmacy contractors
• 160 Optometry services
• 144 primary dental providers

Following delegation of the Pharmacy and Optometry (P&O) function from NHSE to ICBs on 1^st April 2023, NHS Hertfordshire and West Essex (HWE) ICB will host the team delivering the day-to-day operation of the P&O contracting function on behalf of the ICBs in East of England.

NHS Hertfordshire and West Essex ICB will be responsible for:

• Contractual management and regulation of the market
• Contract management
• Community pharmacy services delivery

No. SNEE ICB will retain all approval and decision-making responsibilities.  The commissioning and transformation of any local commissioned services for P&O will be the responsibility SNEE ICB and not to be delivered via the HWE hosted team.

NHS Suffolk and North East Essex ICB will retain all functions for dentistry in house, (there is not a system host arrangement). This means that NHS Suffolk and North East Essex ICB will provide the full dentistry function for Suffolk and north east Essex.

SNEE ICB will commission all dental services which will include:

• Mandatory services (General dental treatment)
• Additional services (Advanced mandatory services, Sedation services, Domiciliary services, Dental Public Health Services, Orthodontic services, Referral services)
• Further services which are not covered by Mandatory services or Additional services. Examples of Further services includes level 2 Intermediate Minor Oral Surgery and level 2 Restorative services.

The ICB is also responsible for planning the provider landscape across SNEE, including considering and taking decisions in relation to:

• Establishing new Dental Services Providers across SNEE
• Managing Dental Services Providers providing inadequate standards of patient care
• The procurement or award of new Dental Services Contracts
• Closure of practices.

The transfer of managing complaints happens on 1 April, although the team members themselves won’t move over from NHS England to ICBs until 1 July.  Currently a TUPE consultation is underway.  The team will be split out between each ICB, with each one getting 1-2 new members of staff, who will join existing ICB complaints teams.  The team deal with formal complaints only. If someone raises a concern – e.g. I can’t get a GP appointment or member of staff was rude to me – it is dealt with by our national contact centre.

The National Customer Contact Centre is a single telephone number for members of the public, patients and their representatives. This National Customer Contact Centre will continue to be hosted by NHS England, calls will be transferred to local ICBs if deemed appropriate.