ICB Roles
ICBs were established in July 2022, and initially designed to oversee NHS performance, the planning and arranging of health services, and managing specific delivery functions. However, interpretations of these roles differed between each region and individual board, leading to both operational inconsistencies and issues in achieving the objectives of Integrated Care Systems (ICS)s.
Now, NHS England is calling for strategic commissioning to be the primary focus for ICBs going forward, aka, to prioritise contracting and commissioning of local providers over performance management. This approach aims to empower ICBs to close the gap on health inequalities, better utilise resources, improve operational efficiencies and improve population health.
To support these shifts, the blueprint proposes redistributing certain functions:
- Delegation to Providers and Regional Teams: Functions like workforce planning, primary care operations, and digital leadership are earmarked for transfer to neighbourhood providers.
- Board Restructuring: ICBs are advised to streamline their boards and reduce headcount to support more agile, responsive ways of working.
- Financial Targets: ICBs must develop plans by the 30th May 2025 to operate within a cost envelope of £18.76 per head of population.
Implementation and Engagement
NHS England said it will be providing ICBs with a ‘planning template’ to outline how each one intends to reach the £18.76 cost envelope and implement the other blueprint objectives by the end of this month. National support will also be available to ease staff into the transition, along with structural leadership advice to help the delivery of statutory duties and process implementation.
Supporting the Three Shifts
The Model ICB Blueprint marks a significant structural realignment in line with the three major shifts outlined in the forthcoming 10-Year Health Plan: moving from analogue to digital, treatment to prevention and hospital to community. As the number of ICBs is expected to reduce from 42 to around 25, this redefinition of roles and reallocation of functions aims to support a more joined-up, efficient, and outcomes-driven health and social care system across England.
Neighbourhood Health and What It Means for ICBs
ICBs and local authorities are also expected to co-develop neighbourhood-based health and care models that consistently implement the foundational components of integrated working, with a particular focus on people with complex or high-level needs. As part of the Neighbourhood Health Guidelines 2025/26, this will take the form of a dedicated neighbourhood delivery plan made up of the following 6 healthcare components:
1. Population Health Management
Systems are expected to use linked, person-level datasets across health and social care services to understand population needs, segment groups, and support proactive planning. Risk stratification tools and shared intelligence functions will guide commissioning, resource allocation, and care coordination, particularly for populations with complex needs.
2. Modern General Practice
Practices should shift from reactive to proactive care by improving access, continuity, and navigation. This includes streamlining digital and in-person contact routes, supporting online services like prescription ordering, and using structured data to guide triage and prioritise care based on patient need.
3. Standardising Community Health Services
ICBs must ensure community services are consistently commissioned to meet physical, mental, and social care needs in an integrated way. Services should cross traditional boundaries, addressing co-occurring issues and connecting with VCSE partners to deliver inclusive, joined-up care.
4. Neighbourhood Multidisciplinary Teams (MDTs)
Integrated MDTs - comprising professionals from health, social care and the voluntary sector - should support cohorts with complex needs. These teams are responsible for proactive, coordinated care planning, assessments, and case management, with care coordinators providing a clear point of contact for individuals.
5. Integrated Intermediate Care (Home First)
Short-term rehab, reablement and recovery services should follow a ‘Home First’ approach wherever possible. Systems should enable both step-up (community referrals) and step-down (post-discharge) pathways, with therapy-led interventions and consistent outcome tracking.
6. Urgent Neighbourhood Services
Urgent response and Hospital at Home services should be aligned and scaled to local need, using a single point of access to coordinate care and reduce unnecessary hospital use. Services must support timely referrals, avoid admissions, and integrate with emergency and same-day care models.
Conclusion
How Integrated Care Boards respond to the blueprint and how neighbourhood-level model initiatives take shape it yet to be seen, but it’s hoped that the changes will lay the groundwork for a more integrated and locally-responsive health and social care system that delivers. We’ll aim to provide further updates on implementation progress, funding developments, and the real-world impact as more details emerge.
