Indicative Activity Plan
An Indicative Activity Plan (IAP) is a funding mechanism used by Integrated Care Boards (ICBs) to commission NHS services from private providers. These services are delivered on behalf of the NHS through private contracts and are intended to support patient access to care.
Under an Indicative Activity Plan, the ICB applies a financial cap on the level of activity a provider can deliver within a single financial year. This cap limits the total amount the ICB is willing to pay, regardless of ongoing patient demand or existing referrals.
While this approach is intended to provide financial control, it can have significant unintended consequences for patients, general practice, and the wider NHS—particularly towards the end of the financial year.
Impact of reaching an Indicative Activity Plan Cap
When a provider reaches its Indicative Activity Plan Cap, it may no longer be funded to continue treating patients under that contract. At this point, a number of actions may occur, including:
- Patients being placed on a waiting list until the next financial year begins
- The provider referring the patient directly to another NHS provider to continue their care
- Patients being discharged back to their GP and advised to seek a new referral to an alternative provider – this final option should NOT happen!
These scenarios can result in delays to treatment, confusion for patients, and fragmented care pathways.
LMC position and GP workload concerns
Wessex LMCs is particularly concerned about the impact of Indicative Activity Caps on general practice. Discharging patients back to their GP solely because a provider has reached its financial limit represents an inappropriate transfer of administrative and clinical workload.
GPs should never be asked to carry out onward referrals, re-refer patients, or take any additional action as a result of a provider reaching its Indicative Activity Cap.
Where onward referral or transfer of care is required due to contractual or financial limits, responsibility must remain with the provider and the commissioning ICB and not with general practice.
What GPs should do if this happens
If a GP practice is contacted by a provider stating that a patient cannot be treated because the provider has reached its Indicative Activity Cap, practices should:
- Not accept the patient back onto the practice workload for administrative reasons related to funding limits
- Go back to the provider informing them of this outcome
- Contact your ICB Primary Care Team, providing the patient’s NHS number, so the issue can be resolved directly by the ICB on the practice’s behalf
The ICB is responsible for managing commissioned activity and ensuring appropriate patient pathways remain in place when contractual limits are reached.
Wessex LMCs encourages practices to escalate these issues promptly so they can be addressed at a system level and to help prevent inappropriate workload being passed to general practice.