The Model Integrated Care Board Blueprint – key insights

The release of NHS England’s Model Integrated Care Board Blueprint (blueprint) marks a significant step in the ongoing transformation of Integrated Care Boards (ICBs) across England. The blueprint has been produced to provide structure to the changes all ICBs need to undergo and builds upon the foundations provided in Sir James Mackey’s letter dated 1 April 2025 (NHS England » Working together in 2025/26 to lay the foundations for reform).

The blueprint will have the most significant impact on ICBs, but the implications are much broader. ICBs are required to produce cost reduction plans which are to be submitted by 5pm on 30 May 2025 to their regional leads. These should establish how each ICB intends to achieve an £18.76 per head of population operating cost envelope by quarter 3 of 2025/26.

The blueprint provides greater clarity on the future focus, role and functions of the ICBs. There is a greater emphasis on developing long-term strategy, establishing population health goals, and instilling collaboration within the broader NHS ecosystem. This will remain a core function of their roles as commissioners within the system. To achieve this there will be a significant departure from existing operating structures, and substantial organisational transitions ahead, for the ICBs, Department of Health and Social Care and providers.

The restructure presents both opportunities and challenges for ICBs as they navigate the practical implementation of these changes. With ambitious saving mandates and a critical shift in functions to both providers and regional teams, ICBs and the eventual recipients of the functions must carefully plan their transition to this redefined operational model.

Limitations within the blueprint

While the blueprint provides further clarity and guidance on the future of ICB operations, several key elements are yet to be clarified. This reflects the rapid pace of change and the complex nature of the reforms being implemented.

The blueprint is not therefore a definitive manual but another stepping stone in managing the transition. Further essential information will be published over the next few months which will inform this system further.

Essential to this will be the Government’s much anticipated 10 Year Health Plan, which the blueprint indicates will define wider system architecture and clarify trust, centre, and regional team responsibility. Similarly, there remains a lack of specific guidance around the envisioned “Neighbourhood Health” concept which is critical to understanding how care will be devolved to local providers.

NHS England does acknowledge this limitation within the blueprint in which they have stated the following:

‘We are sharing this blueprint with you today without the corresponding picture of what the future of neighbourhood health will look like or the role of the centre or regional teams’

This document does therefore underscore the Government’s ambitious agenda of realigning responsibilities, reducing duplication, and better integrating health delivery models but it is not the final picture and there is a reasonable expectation that the cost reduction plans are likely to be subject to further mitigation and development as additional information is provided.

It is therefore important to bear this in mind when looking at what is included in the blueprint.

The aims of the blueprint

The blueprint aspires to achieve a transformative shift in how the NHS functions by focusing on the three strategic goals which have been established by the Government, namely:

• moving from treatment to prevention: prioritising proactive healthcare to address the root causes of ill-health and reduce inequalities
• enhancing community-based care: decreasing reliance on acute hospital settings and building coordinated care solutions closer to home
• leveraging digital transformation: harnessing advanced healthcare analytics, predictive modelling, and technology to improve outcomes and personalise patient experiences

Overall, the blueprint sets out to strengthen commissioning, enable resource optimisation, and improve population health outcomes across England.

Any function which does not directly form part of the commissioning cycle will consequently be reallocated away from ICBs.

The proposed core functions of the ICB

Under the blueprint, ‘model’ ICBs will focus on four key core functions:

1. Understanding Local Context: Analysing population needs and tackling health inequalities through the use of advanced data and predictive modelling techniques
2. Developing Long-Term Strategy: Collaborating with communities, clinical leaders, and stakeholders to design best-practice care pathways and resource allocation models
3. Delivering Strategy Through Strategic Purchasing: Overseeing value-based contracts, working with providers, and shaping markets to ensure the effective delivery of commissioned services
4. Evaluating Impact: Promoting adaptive planning by embedding user feedback and evaluating care outcomes through rigorous data-driven processes

The functional changes to the ICB

A key part of the blueprint is a table which splits the current functions of ICBs into three categories:

1. Grow: functions for ICBs to grow / invest in over time to deliver against the purpose and objectives
2. Selectively retain and adapt: functions for ICBs to retain and adapt including by delivering at scale
3. Review for transfer: functions and activities for ICBs to transfer over time, enabled by flexibilities under the 2022 Act for ICBs to transfer their statutory duties

This table will be subject to significant scrutiny and analysis as it provides an indication as to what functions ICBs will have to continue to provide and what functions will be reallocated. This is where additional clarity will be required over the next few weeks and months.

By way of example, strategic workforce planning and research innovation will transfer to regional teams, which themselves remain subject to development. Operational functions such as digital leadership and local workforce development will move to healthcare providers but it is not clear if this will be a responsibility for individual providers or if they will be expected to work in collaboratives for these services.

General Practice and Primary Care providers will be keeping a careful eye on how this blueprint is implemented especially in relation to the various functions which directly affect them – those which are marked as being transferred to “Neighbourhood Health Providers” and other functions such as General Practice IT which are marked as being for the ICB to ‘[e]xplore options to transfer out of ICBs ensuring consistent offer’.

Further clarity is needed to determine how these transfers will work in practice, but the blueprint reflects a decisive move to streamline operations and reduce duplication across the system.

Practical steps for managing the transition

The blueprint provides a structured framework to ensure the transition is implemented safely and effectively. Key steps include:

• establishing a dedicated Transition Committee within each ICB to oversee risks, governance frameworks, and change implementation
• employing readiness assessments and gateway processes to verify the safe transition of transferred functions
• supporting staff through redeployment, voluntary redundancy schemes, and transparent communication to minimise disruption and retain morale
• leveraging national guidance from NHS England, including moderation processes and financial risk mitigation tools, to ensure a consistent approach

These measures aim to ensure legal compliance while mitigating operational risks during the realignment process.

How we can help

We are closely monitoring the development of the blueprint and its implications for ICBs and providers. We are able to assist by:

• providing legal input and analysis of ICBs’ cost reduction plans,
• advising on legal and governance frameworks to ensure statutory compliance during functional transfers and operational redesign,
• supporting contractual negotiations and innovative payment mechanisms with providers to align with strategic commissioning principles,
• providing employment law advice, including workforce engagement strategies and managing redundancies or redeployment,
• assisting with regulatory compliance, particularly in safeguarding, digital transformation, and care pathway realignment,
• supporting strategic partnerships with providers, voluntary organisations and regional teams,
• advising on mergers and clustering arrangements between ICBs,
• assisting in the interpretation and implementation of the much anticipated 10 Year Health Plan.