ICS Design Framework: key points on the employment commitment

Rebecca Pallot walks through the key points from NHS England and NHS Improvement’s recently published guidance document on supporting the NHS workforce throughout the development and transition towards statutory Integrated Care Systems.

The commitment to staff

The original "employment commitment" was set out in NHSEI’s February 2021 consultation paper: Integrating care: next steps to building strong and effective integrated care systems, which included a commitment to:

  • “not to make significant changes to roles below the most senior leadership roles";
  • "minimise the impact of organisational change on current staff by focusing on the continuation of existing good work through the transition and not amending terms and conditions"; and
  • "offer opportunities for continued employment for all those who wish to play a part in the future”.

The new 17-page employment commitment guidance document published on 16 June 2021 sets out a core set of principles to support staff and guides them through the transition approach, ensuring consistency whilst recognising the differences between ICSs across the country. The principles of commitment and support include:

  • adopting a people centred approach
  • being compassionate and inclusive
  • minimising disruption

Appendix A of the document sets out the core principles in more detail together with some statements which illustrate a commitment to employment stability and the intention to minimise uncertainty. One such statement is: “My employer will change but my contractual terms and conditions will remain the same”.  

No commitment for those in senior leadership positions

It is worth noting that the new guidance and the commitment to staff does not apply to those employed in senior leadership roles, where there are likely to be significant redundancies.

The new guidance explains that those in senior leadership/board-level roles are likely to be affected by the need to establish designated executive/board level roles in the new ICSs ahead of their establishment in April 2022.

Again, Appendix A sets out some statements for board level employees in an attempt to minimise uncertainty. An example of one of those statements is: “I have access to coaching support to enable me to understand what I need and want from this change for my own personal career”. The support which will be offered to senior leaders and board-level post holders is set out in Appendix B of the document and includes initiatives such as mentoring. Whilst emphasising the need for a co-ordinated process, it recognises the need to "take a talent approach" to the recruitment and appointment process so that the NHS retains "our talented leaders and their experience and knowledge".

NHSEI had previously extended the commitment to CCGs who will be subsumed into ICSs but has extended the commitment to NHSEI itself and to some senior posts within provider collaboratives. A list of those staff most likely to be affected is set out at pages 5 and 6 of the document, including those not covered by the "employment commitment", such as lay members or non-executive directors.

Transfer of staff

The guidance confirms that staff are expected to transfer by TUPE or under the Cabinet Office Statement of Practice on Workforce Matters, and so will retain their continuity of service and entitlement to their existing terms and conditions. Looking ahead, the guidance recognises that as new ICSs evolve they will ‘want to review their operating model’ to deliver their new statutory requirements in the most effective way. Consequently, ICSs will be expected to follow their own organisational policies on managing organisational change but they will need to establish a robust economic, technical or organisational reason before changing the terms and conditions of any transferred staff. The guidance states that only at that point will the principles in the guidance cease to apply.


While the employment commitment is welcomed and looks to protect most commissioning roles, the creation of new ICSs across the country inevitably risks job losses, particularly at senior leadership level. The guidance goes only some way to provide support and resources for senior staff who find themselves in this position and inevitably more guidance will be issued on the subject.  

If you would like to discuss the implications of NHSEI’s employment commitment do get in touch with us.

Our content explained

Every piece of content we create is correct on the date it’s published but please don’t rely on it as legal advice. If you’d like to speak to us about your own legal requirements, please contact one of our expert lawyers.

Mills & Reeve Sites navigation
A tabbed collection of Mills & Reeve sites.
My Mills & Reeve navigation
Subscribe to, or manage your My Mills & Reeve account.
My M&R


Register for My M&R to stay up-to-date with legal news and events, create brochures and bookmark pages.

Existing clients

Log in to your client extranet for free matter information, know-how and documents.


Mills & Reeve system for employees.