Model ICB Blueprint

Last week NHS England (NHSE) shared the first version of the Model ICB Blueprint with ICB leaders. This document is intended to help ICBs produce plans by the end of May to reduce their running costs by 50%. It sets out an initial vision for ICBs as strategic commissioners, and the role they will play in realising the ambitions of the 10 Year Health Plan. NHSE expects to carry out further engagement over the coming weeks, including with providers to embed local plans.

This briefing provides a summary of the blueprint document, highlighting the aspects most relevant to trusts, and includes NHS Providers’ view. The blueprint document has also been included at the end of the briefing. For any questions about this briefing or feedback on the blueprint, please get in touch with Emily Newton at emily.newton@nhsproviders.org.

The Model ICB Blueprint builds on NHS England’s letter to trust and system leaders issued at the start of the financial year. The letter set out two key expectations for ICBs: a 50% reduction in their running costs, and a shift towards positioning ICBs as strategic commissioners, central to delivering the ambitions of the 10 Year Health Plan. This vision, which is shaped by the government’s three shifts – from hospital to community, treatment to prevention, and analogue to digital – are all set out as the central drivers for how ICBs will be expected to work within their systems.

The blueprint provides an additional level of detail on how ICBs are expected to evolve and sets out which of their functions may in future be transferred to providers. It defines the system leadership role of ICBs in improving population health, reducing inequalities, and ensuring access to high-quality care. While this closely aligns with the well-established four core aims of integrated care systems (ICSs), the slight variation in language signals a renewed emphasis on the commissioning role of ICBs, aligning with the Health and Care Act 2022, which expressed function of ICBs as “arranging for the provision” of various services. The document also emphasises the role of ICBs as “payers” and sets out how they should evolve to fulfil this purpose effectively.

ICB cost reduction

NHS England has asked all ICBs to submit cost reduction plans by the end of May 2025, based on a revised running cost envelope of £18.76 per head of population. These reductions must be delivered by the end of Q3 2025/26 and maintained on a recurrent basis into 2026/27. Local variation is acknowledged, but regional aggregate plans must remain within that envelope. The blueprint makes clear that savings cannot be achieved by shifting costs to providers unless this results in a genuine net saving.

The role of ICBs

The blueprint reframes the core purpose, role and functions of ICBs in line with the government’s three shifts and the forthcoming 10 Year Health Plan, and a refreshed system architecture. ICBs are tasked with improving population health and ensuring access to consistently high-quality services. They will be accountable for ensuring the best use of their available resources, which should be used strategically with long-term population health outcomes in mind. Overall, the blueprint positions ICBs as system leaders, responsible for setting a population health strategy and acting as “healthcare payers” to maximise value from available resources.

The refreshed role for ICBs is set out as part of a refreshed system architecture in which:

• DHSC/NHS England provide national leadership and “do once” functions;
• regional teams provide oversight and performance management of ICBs and providers and take on functions such as strategic workforce planning and digital provision;
• ICBs become strategic commissioners; and
• providers are responsible for the delivery of care.

As strategic commissioners ICBs are expected to fulfil four core functions:

1. Understanding the local context.
2. Dveloping a long-term population health strategy.
3. Delivering the strategy through payer functions and resource allocation.
4. Evaluating impact.

The blueprint does not set out a specific role for providers in carrying out these functions.

The split of functions between ICBs, providers and regions

To support changes, the blueprint sets out which existing functions should be further developed to support a more focused role for ICBs, and which should be transferred to other parts of the system including providers.

It recommends that ICBs keep, and grow functions such as population health management, strategic planning and commissioning, maintenance of governance and quality management.

Functions which could be transferred to regional teams include oversight of provider performance under the NHS performance assessment framework, strategic workforce planning and research development and innovation.

Functions which could be transferred to providers are listed as:

• local workforce development and training;
• green plans and sustainability;
• digital leadership (enabled by national data and digital infrastructure);
• development of neighbourhood and place-based partnerships (with ICBs retaining their commissioning role for neighbourhood health services);
• medicines optimisation (with ICBs retaining overview as part of their commissioning role);
• pathway and service development programmes (ICBs retaining strategic overview); and
• estates and infrastructure strategy.

Infection prevention and control, safeguarding, SEND, NHS Continuing Healthcare and General Practice IT will also be considered for transfer, although detail about where these will go are not shared at this point.

Key enablers

To support ICBs to carry out these functions, the blueprint sets out key enablers that need to be in place, including population health management capability, strategic planning, clinical leadership and governance, user involvement and co-design, and partnership working with local government.

ICBs are also asked to develop into ‘sophisticated and intelligent healthcare payers’. This is set out as a requirement for ICBs to ensure they understand their costs, design payment mechanisms and incentives which support their plans, and the need to ensure effective use of public resources so investment decisions are made based on relative value rather than demand or precedent.

Next steps and further engagement

This document is set out as a first step and has been published to enable ICBs to produce plans by the end of May to reduce their running costs by 50%. Engagement will take place over the coming weeks to advance and add detail to the role of ICBs in their systems. NHSE acknowledge that further engagement is needed with partners, including providers, and expect regional and system teams to work with organisations across their systems to inform the development of the final local model. It is also proposed that ICBs will be supported to develop in line with this revised role and functions through a national support offer which will include a new commissioning framework and maturity assessment.

This document helpfully begins to clarify announcements and statements made by the Secretary of State and the previous NHS England chief executive on the role of ICBs as strategic commissioners. We strongly welcome this clarification, which responds to some of the concerns we had previously raised about the development of system working since the passing of the 2022 Health and Care Act. The blueprint provides a welcome articulation and clarification of the value of commissioning to the NHS, including how it needs to change to support the delivery of ICS aims and the government’s three shifts. It also rightly places quality of care, equity and improvement at the heart of the approach. It is vital that the experiences of patients and outcomes for local communities are at the heart of ICBs’ decision-making.  

Noting the current context for the publication of this document is important ICBs will be developing their cost reduction plans amid wider changes to the NHS architecture and ahead of the publication of the 10 Year Health Plan. This will be challenging and require a huge amount of work. We therefore recognise the need for this document to be published quickly to enable planning to happen at pace.

The description of strategic commissioning provides an appropriate formulation of ICBs as system leaders. More detail will be needed to understand how providers can best support them in the four core functions set out in this document, particularly in building a full picture of population health need, reviewing and evaluating services, and crucially as a key partner in designing new models of care.

The focus on the shift to community and developing neighbourhood health and place-based partnerships is helpful, and trusts will play a fundamental role in how services are integrated locally, including how they are commissioned. More detail will be welcomed about the enablers to support innovative and new ways of working, and providers will need to work closely with their system leaders and partners to establish clear accountabilities and responsibilities.

To support the ‘leaner and simpler way of working’, the blueprint sets out the functions that will be transferred out of ICBs to regional teams and providers. This could address concerns around duplication within systems. However, providers will need to be closely involved with the next phase of engagement on these proposals. ICBs will want to work with the providers in their systems to establish the most suitable transfer of functions, to ensure that risks are mitigated, and all parties are clear on accountability and responsibility.

In future iterations it would be helpful to understand how ICBs will work more closely with local government, including to commission services jointly, and how services which have historically been commissioned over a larger geographical footprint (e.g. ambulance services and specialised services) will be considered under the new commissioning approach.

In summary, we are supportive of NHS England setting out detail as and when they can, understanding the complex work underway to finalise the 10 Year Health Plan. We were grateful for the opportunity to engage on behalf of trusts with NHS England’s work on strategic commissioning earlier this year. As engagement continues and the approach is refined, we look forward to continuing our work with NHS England and with members to help ensure that the role of ICBs and the wider system architecture supports providers to deliver high quality care for patients.