The last vestige of practice control of health services could be scrapped within 18 months with the abolition of clinical commissioning groups, it has been revealed.

The move could roll back 30 years of reorganisations that have attempted to use primary care knowledge to improve allocation of resources in the NHS. The CCGs would be replaced by the new Integrated Care Systems, which would oversee resources for populations of a million or more, the Health Service Journal reported.

The IC Systems were developed as a way of creating single organisations to run all services – but, under the proposals, they may run alongside NHS trusts or in some cases trusts may become ICS organisations. NHS England faced a protracted legal challenge to the creation of the integrated care organisations amid concerns they could be handed over to private companies. The cases were settled when NHS England promised this would not happen.

According to the journal, NHS England wants the systems to become “statutory corporate NHS bodies” taking in clinical commissioning groups. This would happen by April 2022. An alternative approach is that the Integrated Care Systems would have a board, running alongside CCGS but NHS England has said this has downsides – while giving them full powers would “offer great long-term clarity” in leadership and accountability. The proposals could take NHS organisation back three to four decades when single health authorities managed budgets and ran services – with practices running in parallel. In the present health service, practices would continue with joint working and managing some services through primary care networks – although in some cases the integrated care systems would own and run practices as some NHS trusts already do.

Practices were first given budgets to purchase services in the 1980s and then the 1997 Labour government created primary care groups, which rapidly evolved into large primary care trusts. The 2010 coalition government attempted to bring control of services back under the control of practices through the creation of clinical commissioning groups in 2013 – but its rules over the outsourcing of services provoked controversy and small CCGs soon began merging into larger organisations.

NHS Clinical Commissioners chief executive Lou Patten said: “These proposals signal a really significant moment for clinical commissioners. CCGs have been hugely successful in developing the vitally important partnership between clinicians, managers and lay members. It has been enlightening over the past few years to have a strong united clinical view about major service changes, patient pathways and the principle of primary care being the cornerstone of patient-centred care. This sets a really strong legacy for Integrated Care Systems.

“Whilst recognising that the majority of commissioning functions will continue at ICS level in what is being proposed, the great work at neighbourhood and place, enhanced by the focus on the pandemic must continue. The local stewardship role of CCGs and their joint working with local authorities must not be lost – we cannot throw the baby out with the bathwater. There is a huge amount of organisational memory within CCGs, and we must ensure staff are retained to continue the current and future commissioning responsibilities.”

The proposals were welcomed by the NHS Confederation, which described them as “measured but important.” Chief executive Danny Mortimer said: “There is often anxiety about another NHS reorganisation, but the NHS and the partners we work with across social care and other public services have been on this journey now for several years. In many ways, NHS and care organisations have worked in spite of the existing legal framework to foster better ways of working locally. But the current legal and regulatory restrictions will only take us so far.

“As such, we believe it is the logical next step to establish these partnerships as statutory bodies and build on the progress that has been made in recent years bringing together service provision, strategic commissioning and clinical leaders, all of whom will have an obligation to collaborate to improve the health of the communities they serve.”