ICBs paid management consultants millions for primary care strategies

Exclusive ICBs have paid management consultants at least £9m over the last six years to develop strategies for GP practices and primary care. 

Freedom of Information (FOI) data from ICBs, obtained by Pulse, revealed that Surrey Heartlands and South Yorkshire spent the most on consultancy work, with both spending over £1m each.

Surrey Heartlands paid the consulting firm Moorhouse over £960,000 between 2022 and 2024 to help with projects such as implementing the Fuller stocktake and ‘workforce development’. 

Out of the 42 ICBs in England, 39 provided a response to Pulse’s FOI request, with over a third (14) spending nothing at all on management consultants between 2019/20 and the first quarter of 2024/25. 

Birmingham and Solihull, Derby and Derbyshire, and North Central London refused the request or did not respond directly to Pulse’s questions. 

For the remaining ICBs, management consultants were paid for primary care projects such as developing strategies, advising on procurement, and supporting with digital transformation or with estates.

In total, responses to Pulse’s FOI revealed that ICBs spent £9,016,913 on private consultancy work for primary care.

Pulse has previously reported on well-known projects where consultancy work has led to proposals of major change for general practice, such as overhauling same-day care. 

In North West London, the ICB commissioned KPMG to work on a strategy to effectively mandate the use of ‘same-day access hubs’, which has since been shelved due to backlash from GPs and patients.

Pulse’s FOI revealed that primary care commissioners in this area paid KPMG £652,000 for this work, while Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB paid the consultancy firm almost £230,000 for the same purposes.

The data also showed that Black Country spent £416,000 over the last two financial years for PwC to develop a ‘primary care transformation programme’ including a new strategy for general practice.

Pulse analysis of the FOI data indicated that expenditure was highest in 2023/24, at £2.9m, compared to £1.9m in the previous year.

However, it is not possible to directly compare each year as some ICBs were not able to provide financial data pre-2022 from CCGs, while others did not provide data for the current financial year.

Four out of the five London ICBs responded to Pulse’s request and their total spend over six years amounted to £2.3m. 

This makes up a quarter of the total expenditure across all ICBs in England, which goes beyond London’s share of the nation's population or share of GP practices.

In response to Pulse's exclusive data, Londonwide LMCs deputy CEO Dr Lisa Harrod-Rothwell said this could have paid for tens of thousands of additional GP appointments in London, which is where GPs ‘would rather see the funding go, if they had a say in it’. 

She continued: ‘Spending NHS money on management consultants at a time of such financial shortage is perverse. In most cases GPs and their LMC representatives, who see patients day-in, day-out, while living in the same communities, can offer accurate analysis of how systems can meet the needs of their patients.’

The Doctors' Association UK (DAUK) said it has 'a lot of concern' about the use of private consultancy firms by ICBs, particularly when those consultants do not have 'an understanding of the complexity of patient care in the community'.

DAUK GP spokesperson Dr Steve Taylor told Pulse: 'The evidence is clear that this lack of experience and understanding is leading to poor management and decisions. One of the most recent is the North West London approach to same day access.

'Sadly ICB leaders are not always speaking to the very people who have the knowledge and experience of community care provision. Often these are experienced GPs or those who have a greater knowledge of community services.'

He said DAUK's 'advice' to ICBs would be to work in 'clear collaboration' with GPs, and for management consultants to speak to healthcare professionals 'before influencing ideas and policy'.

NHS Surrey Heartlands, which, at £1.5m, had the highest spend of all ICBs who responded, said that it commissioned management consultancy work in a range of different areas including 'workforce modelling post Covid-19' and 'ongoing PCN development work' as well as projects on digital services in primary care.

A spokesperson said: 'As an ICB we are committed to supporting, and investing in, primary care and, from time to time, we bring in specialist support to facilitate specific programmes of work that would benefit from more specialist expertise to improve how we work and how care is delivered.'

'Through these programmes we have worked with practices to introduce a range of positive changes – including embedding new working practices, improving access and significantly increasing use of online and digital services – that make it even easier for people to get the help and support they need,' they added.

But Surrey GP partner Dr Dave Triska told Pulse that he had not seen any 'significant' difference from this consultancy spend, and that the 'biggest change' the ICB could make is by simply 'investing in the primary care system itself and stabilising it'.

'During that [six-year] period of time we've seen things like our locally commissioned services cut, and spend on primary care go down,' he said.

Dr Triska also pointed out that there is already 'plenty of expertise' among Surrey GPs and that 'perhaps those are the people who should be getting the consultancy fees for this sort of thing'.

'There are plenty of things that GPs are asked to be involved with, or might want to get involved with, but none of the time is reimbursed for it - that would make much more sense to me,' he added.

Black Country ICB was also among the highest spenders, with projects worth £647,300 commissioned to private consultancy firms.

The ICB told Pulse that it is committed to working with primary care to achieve transformation and that focused resource was needed to help develop the five-year primary care transformation strategy.

West Yorkshire ICB, which commissioned management consultants at a cost £187,663 over the six-year period, said the external advice was focused on developing local estates plans and strategies.

A spokesperson said: 'This has been with a key focus on developing a clear understanding of future service delivery models, with consideration of population health, workforce and digital opportunities to inform and support delivery of our ambition of developing modern and fit-for-purposes premises.'

Pulse contacted all other ICBs who spent any money on management consultants or refused to respond to the FOI request.

In response to Pulse's findings, NHS England said all ICBs are expected to 'abide' by the 'strict rules around spending' which apply to all NHS organisations.

'ICBs need to ensure that any spending on management consultants is done so with careful consideration so that it represents necessary spending that ultimately improves services for patients and is good value for taxpayers,' a spokesperson said.