Next steps for system working: A discussion paper

The views of system leaders on what the asks of government might be to support a step change in system working.

8 September 2020

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COVID-19 has demonstrated the galvanising effect of a national health emergency. Over this period, many system leaders have reported a deepening of collaborative working among clinical and frontline staff, more cooperation among providers and closer joint working with care homes and local authority staff.

While most of the work to develop system working is necessarily led locally, central government controls the policy and legislative framework within which it operates.

As NHS England and NHS Improvement look to strengthen system working through the development of its ‘system by default’ policy, we have produced a discussion paper designed to start a conversation and prompt discussion about what (if any) policy and/or legislative changes would help to deliver more efficient and effective system working.

Written at the request of ICS and STP chairs and leaders, this paper is an attempt to start crystallising the views of system leaders on what the asks of government might be to support a step change in system working.

This document, aimed primarily at ICS leaders, is a part of a process which will draw on the collective experience and expertise to reach a shared view on the way forward, and follows our earlier ICS Network briefing Time to be radical? The view from system leaders on the future of ‘System by Default’.

It will be important to explore these issues with all the partners involved in system working, including primary care networks, trusts, CCGs and local authorities to see whether it is possible to reach a broad consensus on the way forward.

This will be critical to building a firm foundation for system working in the future that commands support, Such a shared view would also provide a strong basis for influencing government and NHSEI on what the ICS of the future needs to look like if we are to make a difference to health and well-being of our local communities.

Your views are invited on the questions set out in this paper. Please send your responses to