Primary care to move from ICB control under new NHS England blueprint

Primary care ‘operations and transformation’ will move out of integrated care board (ICB) control, an NHS England blueprint has stated.

The Model ICB Blueprint, shared with ICB leaders last week, noted 18 functions that will be transferred out of ICBs “over time.”

Primary care functions to be moved include medicine management, workforce support, and estates.

Pathway and service development, development of neighbourhood partnerships, medicines optimisation, sustainability, research, local workforce training and development, and digital transformation, will also move to new ‘neighbourhood health providers.’

‘Neighbourhood health providers’ will sit underneath ICBs and will include some primary care, mental health, community and voluntary services, working closely with acute services, the blueprint outlined.

Workforce planning and education and training are expected to move from local ICBs to regional teams.

The blueprint noted that “there are no specific timeframes [for the change] at this stage.”

A wider reorganisation of healthcare

Moving care from ‘hospital to community’ is one of the Government’s three key health shifts.

“These shifts set the direction for how ICBs need to operate going forward,” the blueprint said.

It is hoped that moving certain functions out of ICBs will allow them to focus on “strategic commissioning,” in the neighbourhood health service context.

“The NHS needs strong commissioners who can better understand the health and care needs of their local populations, who can work with users and wider communities to develop strategies to improve health and tackle inequalities and who can contract with providers to ensure consistently high-quality and efficient care, in line with best practice,” the document noted.

It also emphasised that ICBs should look to grow their focus on population health and inequalities, partnerships within public health and the voluntary sector, sickness prevention, and pathway redesign.

One aspect that ICBs should look to “retain and adapt” is their existing commissioning, including decisions on local funding, the document said.

It comes after a letter to ICBs on 1 April, which “set out the critical role ICBs will play in the future as strategic commissioners, and in realising the ambitions that will be set out in the 10-Year Health Plan.”

The document also notes that ICB leaders have worked with NHS England on the development of the plan.

“Discussion and refinement” are expected over the coming weeks, the document added.

It also emphasised that the Darzi review, published in September 2024, noted a need for the role of ICBs to be further clarified.

Speaking to the Health Service Journal, Glen Burley, NHS England’s financial reset and accountability director, said that the reorganisation seeks to reduce NHS management costs so that “more money can be spent on the frontline.”

ICBs are required to make 50% cuts to their overheads by December 2025.

Burley emphasised, however, that 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.”

The news on ICBs comes as part of a wider reorganisation of healthcare, which is expected to culminate when the Government’s 10-Year Health Plan, currently stated for June, is published.

It also comes after Sir Keir Starmer’s announcement in March that NHS England itself will be abolished.

Importance of collaboration emphasised

Sarah Walter, director of the NHS Confederation’s Integrated Care Systems Network, welcomed the blueprint, calling it “a helpful overview of the future role of integrated care boards” that “provides leaders with much-needed clarity about the proposed future functions in the context of a changing health and care landscape.”

“ICBs will perform a crucial role as strategic commissioners in delivering the government’s plans for the future as they drive reform and deliver against the ambitions set out in the forthcoming 10-Year Health Plan,” Walter said.

However, Walter added that “as the NHS undergoes significant changes, we cannot forget the importance of collaborating with broader partners, including local government, voluntary, community, and social enterprise organisations, and others.

“An integrated approach is needed to deliver a more proactive and preventative model of care, wrapped around patients, which is crucial for achieving the government’s long-term ambitions.”

Walter added: “It is vital to ensure that the progress made by integrated care systems in fostering a collaborative approach to supporting the health of the population is preserved amidst these changes.”

The Independent Healthcare Providers Network (IHPN) has also noted that its members will expect to see more information on how they will work with the NHS in the future.

“These changes leave a number of big questions outstanding for independent providers and the way that they work with NHS organisations, which may not be fully answered until the publication of the 10-year plan,” the IHPN’s statement said.

The organisation added: “For these changes to be successfully delivered, it is vital that on one hand, the transfer of some responsibilities to NHS trusts doesn’t lead to some of the siloed behaviours that integrated care services have sought to move away from, while on the other that the development of neighbourhood health teams, and the role of lead providers, creates opportunity for providers of all types to exercise leadership and help shape the healthcare in their areas based on their understanding and expertise.

“Independent healthcare providers stand ready to help contribute to these changes and ensure that the NHS is able to deliver on improving patient outcomes and experiences.”