We are writing to provide an update on organisational development affecting NHS Integrated Care Boards (ICBs) and how this impacts on Gloucestershire.

As you will be aware, over the last few months, both NHS England and the Department of Health and Social Care have been discussing closer working, reducing duplication and reforming the size and functions of NHS organisations to support the Government’s priorities for the health service.

As part of this reform and the stated desire to maximise use of taxpayers’ money to support frontline services, NHS England informed us in March that the running costs of ICBs would also be reduced by around 50% in line with changes to the centre.

Model ICB blueprint  

Last week, we received draft national guidance which is designed to give greater clarity on the purpose, roles and responsibilities of future ICBs as strategic commissioners.

The document is clear that ‘ICBs have a critical, but more focused role to play – working to improve population health, reduce inequalities and improve access to more consistently high-quality care’. They are also described as central to realising the ambitions that will be set out in the 10 Year Health Plan.

The document is a blueprint, described as a first step and an indication of the future state. It is therefore relatively high level and not prescriptive on all functions and how they should be delivered. There is recognition that the detail and implementation will depend on multiple factors, including the parallel development of provider and regional models.

We now have a lot of work to do in the coming weeks on the detail, including on form and functions, to shape an ICB that can deliver its core responsibilities, meet the needs of the population we serve and is affordable.

A transition group has been established with other ICBs in the south west, supported by the regional team at NHS England and our Executive Team has established a Gloucestershire ICB transition group that meets weekly.

ICB cluster arrangements

Discussions have also progressed on the potential for joint working through ICB cluster arrangements.

This is because we will be required to work on larger footprints in the future to meet our strategic commissioning responsibilities set out in the Model ICB blueprint and our running cost reductions.

As an ICB executive transition group, we have been looking at various options, including across different geographies.

Our initial conversations have covered considerations such as population size and needs, patient flows, the need to discharge statutory duties, partnership arrangements (including local government boundaries and the imperative for maintaining strong ‘place’ based geography within any cluster to support development of neighbourhood health in the future) and finances.

At a meeting of south west ICB and regional leaders on Wednesday, further discussions took place on the potential shape of ICBs for the future across the region, using a detailed design criteria to help ensure alignment with the Model ICB blueprint.

We can now confirm that following those discussions, the provisional view is for Gloucestershire to cluster with Bristol, North Somerset and South Gloucestershire Integrated Care Board. This provides the basis for discussions with our staff, our Board and with you, our community partners.

Next steps

Draft high level ICB plans, which also cover proposals for clustering, will need to be submitted to the regional NHS England team by the end of May for onward moderation and decision nationally.

Once given the go-ahead, reshaped ICBs are expected to come together under ‘clustering’ arrangements from later this year, with a view to formal merger from either April 2026 or April 2027, once any changes to local authority boundaries have been settled.

As mentioned, further detailed work will be done into this summer on ICB functions and structures working with regional colleagues. We will continue to work with teams and partners as we formulate plans.

As a leadership team, our priority is to deliver the best possible outcomes for our population and for our dedicated staff and teams working in Gloucestershire. At the same time, we are also focused on delivering operational plan priorities for this year, including bringing down waiting lists, improving access and delivering high-quality patient care for our local population, with as much funding as possible invested into frontline services.