Why New ICBs Must Embrace Local Negotiating Committees as Key Partners

As the NHS enters another period of structural reform, the re-imagination of Integrated Care Boards (ICBs) presents both risk and opportunity. One of the most critical decisions ICBs will face is whom they treat as partners in shaping services and policy. In particular, it is time to recognise the central and irreplaceable role of local negotiating committees

Historically, these bodies have been sidelined or actively excluded from strategic NHS planning. This exclusion has been to the detriment of patient outcomes, workforce morale, and system efficiency. ICBs now have an opportunity—and a responsibility—to change that.

Anchors of Stability in a Sea of Reorganisation

Local Medical Committees (LMCs), Local Dental Committees (LDCs), Local Optical Committees (LOCs), and Local Pharmaceutical Committees (LPCs) are not new. Many pre-date the NHS itself, having served as trusted, democratic, and statutory representatives of their professions for over 75 years. During that time, NHS organisational structures have come and gone at an astonishing rate. Since 1998 alone, there have been more than 20 major NHS restructures, each one redrawing local boundaries, redefining roles, and disrupting relationships.

In contrast, local negotiating committees have provided unbroken continuity, deeply rooted in local professional networks and communities. They have institutional memory, long-term trust, and legitimacy.  These are qualities no newly minted organisation can claim.

The Cost of Exclusion

In previous structures, whether Primary Care Trusts (PCTs), Strategic Health Authorities (SHAs), or Clinical Commissioning Groups (CCGs), there were frequent attempts to bypass or neutralise the role of negotiating committees. This was not only short-sighted but harmful. The consequences of this exclusion include:

• Flawed service design: When LDCs and LPCs are left out of commissioning discussions, the result is often services that fail to work on the ground.
• Lost trust: When systems ignore LMC input, they often lose the support of general practice entirely—leading to disengagement and resistance.
• Inefficient implementation: Without LOC involvement, for example, community eye care pathways often collapse under operational misalignment.

A New Era, A New Relationship

ICBs were created to break silos, improve integration, and strengthen community-based care. To do that, they must engage the right partners—and local negotiating committees are uniquely equipped to help.

They offer:

• Professional insight, rooted in daily practice and shared across every contractor.
• A trusted channel for communication, problem-solving, and co-design.
• The ability to negotiate, not just comply—turning aspiration into something operationally deliverable.

These committees have deep knowledge of what works in real settings, and can help ICBs navigate complexity with local legitimacy.

Why Federated Providers and PCNs Are Not Substitutes

A common misconception among Integrated Care Boards (ICBs) is that Primary Care Networks (PCNs) and federated provider organisations can replace the role of local negotiating committees in engagement and strategy. This is incorrect and potentially damaging.

While federated providers and PCNs have a valuable role in delivering services, they are fundamentally different from representative committees.

Relying on federated providers or PCNs to represent an entire profession risks excluding voices, introducing conflicts of interest, and blurring governance. It also erodes trust in decision-making and undermines transparency.

A 2022 NHS Confederation survey found that only 42% of GPs felt represented by their PCN, compared to over 80% who felt represented by their LMC. A similar pattern has been seen in pharmacy and dentistry, where provider groups often reflect organisational interests—not professional breadth.

Data Alone Is Not Enough: Why Committees Are Critical Interpreters

Reformed ICBs are rightly embracing data-driven decision-making. But data needs interpretation—and that requires local knowledge.

For example:

• A spike in antibiotic prescribing might stem from limited appointment capacity, not poor prescribing habits.
• Low uptake of a community pharmacy service could reflect accessibility barriers, not lack of demand.
• A dip in dental check-ups might relate to workforce shortages, not patient disengagement.

Local negotiating committees are vital for contextualising numbers and explaining patterns, turning data into actionable insight. Without their voice, data risks being misread—leading to flawed strategies and punitive responses.

Partnership That Delivers Outcomes

Evidence shows that systems with strong, professional engagement get better results:

• The Nuffield Trust has linked high primary care engagement with lower emergency admissions and better chronic disease control.
• The Health Foundation found that services co-designed with LPCs and LDCs had higher uptake and better continuity.
• Leeds Health and Care Partnership, which included LMCs and LOCs in its early planning, saw measurable improvements in access and prevention.

In short, engagement works and negotiating committees are the right partners to deliver it.

What ICBs Must Do Now

To realise the ambitions of integrated care, ICBs should:

1. Embed LMCs, LDCs, LOCs, and LPCs as strategic partners, not optional consultees.
2. Avoid confusing delivery organisations with representative ones.
3. Include local negotiating committees in planning, policy shaping, service redesign, and evaluation.
4. Recognise the independence, expertise, and legitimacy these committees bring.

Not Just a Seat at the Table, But A Voice in the Room

LMCs, LDCs, LOCs, and LPCs are not relics of the past. They are pillars of professionalism, interpreters of system complexity, and critical friends of good governance. They have outlasted the rise and fall of countless NHS bodies because they meet a need no one else can.

If ICBs are serious about localism, trust, workforce engagement, and better patient care, then the inclusion of local negotiating committees must not just be encouraged, it must be expected.

The NHS doesn’t need more reinvention. It needs better relationships. And that begins with listening to those who have been here all along.