ICBs could hand some of their existing functions over to the new ‘neighbourhood teams’ under draft plans shared by NHS England.
A draft ‘model ICB blueprint’, shared with local commissioners this month and first covered by HSJ, outlined areas which could be transferred to other organisations in order to help ICBs achieve a 50% reduction in running costs.
This included ‘primary care operations and transformation’ – covering medicines management, estates and workforce support – which should be transferred to ‘neighbourhood health providers over time’.
However, the Government and NHS England have not yet clarified what form ‘neighbourhood health’ will take, despite repeatedly touting it as the future of the NHS. More details on this are expected in the upcoming 10-year plan for health.
NHSE recognised this lack of clarity, telling ICBs it was sharing the draft blueprint ‘without the corresponding picture of what the future of neighbourhood health will look like or the role of the centre or regional teams’.
Another function ICBs could do away with is general practice IT, which NHSE said they could ‘explore options to transfer out’ while ‘ensuring a consistent offer’.
But based on this draft document, ICBs would retain responsibility for the commissioning of primary medical and general practice services, as well as functions such as population health management and care pathway redesign.
Proposed changes to ICB functions
Grow – functions for ICB to grow/invest in over time to deliver against the purpose and objectives:
- Population health management
- Strategic planning including care pathway redesign
- Health inequalities expertise
- Commissioning neighbourhood health
- Commissioning end-to-end pathways (including those delegated by NHS E: specialised services; primary medical, pharmacy, ophthalmic and dental services (POD); general practice, and further services that will be delegated by NHS England to ICBs over time)
- Vaccinations and screening will be delegated by NHS England to ICBs in April 2026
- All remaining NHS England direct commissioning functions will be reviewed during 2025/26
- Core payer functions – contracting
Review for transfer – functions and activities for ICBs to transfer over time
- Oversight of provider performance under NHS performance assessment framework (finance, quality, operational performance)
- To transfer to regions
- Contract management functions to be retained and grown
- High level strategic workforce planning, development, education and training
- Transfer to regions or national over time
- Local workforce development and training including recruitment and retention
- Transfer to providers over time
- Primary care operations and transformation (including primary care, medicines management, estates and workforce support)
- Transfer to neighbourhood health providers over time
- Medicines optimisation
- Transfer delivery to providers over time, retain strategic commissioning overview as part of strategy function
- General practice IT
- Explore options to transfer out of ICBs ensuring consistent offer
Source: NHS England draft ICB blueprint
NHS England recognised that these changes to ICB functions cannot all be achieved in 2025/26 as ‘some changes will require legislation’ and transfers will need to be ‘carefully managed to ensure safe transition’.
The blueprint also noted that ICBs will need to work closely with partners nationally and within local systems, given the implications on different parts of the system.
However, by the end of this month ICBs will need to set out their plans to reduce running costs to meet a ‘revised running cost envelope of £18.76 per head of population’.
The guidance said: ‘This blueprint document marks the first step in a joint programme of work to reshape the focus, role and functions of ICBs, with a view to laying the foundations for delivery of the 10 Year Health Plan.
‘It is clear that moving forwards, ICBs have a critical role to play as strategic commissioners working to improve population health, reduce inequalities and improve access to more consistently high-quality care and we look forward to shaping the next steps on this together.’
These proposals for ICBs also come in the context of the Government’s plan to abolish NHS England over the next two years in order to ‘reduce duplication’ with the Department of Health and Social Care.
NHS England’s financial reset director and accountability director Glen Burley said: ‘There is still much more work to do but we are sharing the blueprint to help ICBs design their future state and develop their plans to achieve the 50% reduction in running costs.
‘We are seeking to reduce the management costs of the NHS so that more money can be spent on the frontline.
‘This won’t be achieved by simply moving functions to different organisations – instead ICBs need to be working together to merge functions to cut duplication as part of their plans to make significant cost savings.’
