How health services are planned and paid for

It can help to understand how health services operate in South Gloucestershire so that you or someone you care for can access the right support. 

The information below will explain how health services are delivered in South Gloucestershire. 

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How health services are delivered

NHS health services are divided into primary care, secondary care, and tertiary care. Primary care is often the first point of contact for people in need of healthcare, and may be provided by professionals such as GPs, dentists and pharmacists.

Secondary care, which is sometimes referred to as 'hospital and community care', can either be planned (elective) care such as a cataract operation or urgent and emergency care such as treatment for a fracture.

Tertiary care refers to highly specialised treatment such as neurosurgery, transplants and secure forensic mental health services.

Health services can also be divided into:

  • Universal health services
  • Targeted health services

Universal health services

These are open to everyone, such as:

  • GPs (doctors)
  • dentists
  • pharmacists
  • optometrists
  • hospitals

The NHS website has a search function for you to find your local GP Services.

Targeted health services

These are services where you need to meet criteria or have a significant level of need to access them. They can include:

  • community paediatricians
  • occupational therapists
  • speech and language therapists
  • referral to see a specific team within a hospital

The role of the Integrated Care Board (ICB), Integrated Care System and NHS England

Health services in England are planned and paid for by Integrated Care Boards (ICBs) and NHS England on a local, regional and national basis.  

Integrated Care Board

The Bristol, North Somerset and South Gloucestershire Integrated Care Board (BNSSG ICB) is the new organisation responsible for the day-to-day running of the NHS in our area.  The organisation takes account of population needs, arranges for the provision of services and manages the NHS budget.

The ICB is governed by the Integrated Care Board – this is made up of executive members, non-executive members and wider partners. South Gloucestershire Council is represented on the Board. Please see the BNSSG ICB website for more details.

Every area in England has an Integrated Care Board (ICB) which brings together experienced health and care professionals to decide what services are needed in the local area and ensure that they are provided.  Each ICB is accountable to NHS England for NHS spending and performance.

The services commissioned by the ICB include:

  • urgent and emergency care, such as NHS 111, A&E and ambulance services
  • planned (elective) hospital care, such as operations and treatments 
  • general practice (GP)
  • community health services, such as community nursing and physiotherapy
  • rehabilitation for those recovering from operations and certain conditions
  • maternity and new-born services (excluding neonatal intensive care)
  • infertility services 
  • children and young people’s health services 
  • mental health services
  • continuing health care for people with on-going health needs, such as nursing care.

From April 1, 2023 the ICB became responsible for commissioning dentists, optometrists and pharmacists. Prison healthcare and specialised health services will continue to be commissioned by NHS England.

The ICB also has a statutory responsibility to contribute to the safeguarding arrangements alongside the local police force and South Gloucestershire council for both children and adults.

You can find out more about ICBs on the NHS England website.

The Integrated Care System

Healthier Together is the name given to our Bristol, North Somerset and South Gloucestershire Integrated Care System (ICS). Our ICS includes local councils, NHS hospitals, GP practices and community and mental health services.

The Integrated Care Partnership is a statutory committee responsible for bringing together a broad range of partners - including from the local voluntary sector and community groups - and setting a strategy to meet the population's health, care and wellbeing needs at a system level. You can read more about the Integrated Care Partnership on the Healthier Together website

NHS England

NHS England commissions:

Specialised services (such as treatments for rare conditions and secure mental health care).  See the NHS England website for more details.

Military and veteran health services.  See the NHS England website for more details.

Health services for people in prisons (including youth offender institutions).  See the NHS England website for more details.

Some public health services are also directly commissioned by NHS England.  See the NHS England website for more details.

Responsibilities of the ICB if your child or young person (0-25 years) has special educational needs and/or a disability

This section is only relevant if your child has special educational needs and/or a disability (SEND). 

The Children and Families Act 2014 introduced several new duties for ICB to:

  • commission services jointly with the local authority for children and young people (up to age 25) with SEND, including those with Education Health and Care (EHC) plans
  • work with the local authority to contribute to the Local Offer of services available for children and young people with SEND
  • ensure that health providers inform parents and the appropriate local authority where they think that a young child under compulsory school age has, or probably has, SEND
  • have mechanisms in place to ensure practitioners and clinicians will support the integrated EHC needs assessment process
  • agree personal budgets, where they are provided for those with EHC plans.

Joint commissioning arrangements for securing education, health and care provision must include arrangements for:

  • securing EHC needs assessments
  • securing the provision specified in EHC plans
  • agreeing personal budgets.

Most children with special educational needs will not have an EHC plan but will have been identified as needing SEN support. ICBs have to ensure they have services in place to meet the health needs of all these children and young people.

Every ICB must provide a designated medical officer (DMO) or designated clinical officer (DCO). In South Gloucestershire, we have a SEND Consultant Paediatrician and a DCO who play a key part in implementing the SEND reforms and in supporting joined-up working between health services and local authorities. Learn more about the DCO in our directory of services

Further details on children and young people with SEND is available on the NHS England website.