ICBs are still central — but there are now 36 rather than 42
Integrated Care Systems remain the local partnership model for health and care in England, while Integrated Care Boards remain the statutory NHS organisations responsible for much of local planning, resource allocation and commissioning. From 1 April 2026, however, England moved from 42 to 36 ICBs following another round of mergers and boundary changes.
Anyone who has worked around NHS structures for more than a few years will recognise the pattern.
Primary Care Groups became Primary Care Trusts. PCTs merged. Strategic Health Authorities came and went. Clinical Commissioning Groups appeared, consolidated and were then replaced. Sustainability and Transformation Partnerships evolved into Integrated Care Systems. Finally, in July 2022, 42 Integrated Care Boards became statutory organisations across England.
At the time, we wondered whether the structure would remain consistent for a while.
It did — relatively speaking.
What is the difference between an ICS and an ICB?
Integrated Care System (ICS)
The wider partnership across an area. It brings together NHS organisations, upper-tier local authorities and other partners including social care, voluntary-sector and community organisations around shared health and care priorities.
Integrated Care Board (ICB)
The statutory NHS organisation for that footprint. It holds budgets, commissions services, plans NHS provision and carries formal duties for the population it serves.
An ICS is therefore not simply another NHS organisation. It is the system or partnership. The ICB is the legal NHS body operating within that system.
The corresponding Integrated Care Partnership (ICP) brings the NHS and local-government sides together in a formal statutory partnership. NHS England states that the ICB and ICP footprints align and together form the ICS.
If you are trying to understand who buys, funds or commissions something, “the ICS” may be too vague. The budget-holder may be the ICB, an NHS trust, a primary-care organisation, a local authority or a delegated place/neighbourhood structure inside the wider system.
What changed in April 2026?
The first statutory ICB structure established 42 boards in July 2022. The 2026 establishment order changed that footprint.
From 1 April 2026:
- six new ICBs were established;
- twelve previous ICBs were abolished;
- one existing ICB boundary was widened;
- England moved to a total of 36 Integrated Care Boards.
The six newly established organisations are:
- NHS Central East ICB;
- NHS Essex ICB;
- NHS Norfolk and Suffolk ICB;
- NHS Surrey and Sussex ICB;
- NHS Thames Valley ICB;
- NHS West and North London ICB.
36 ICBs now cover England
NHS England's current map lists 36 ICBs across the seven NHS regions. Some boards also operate in clustering arrangements with shared leadership, meaning the legal organisations and the management structure do not always map one-to-one.
So were the 2022 reforms a failure?
Not really. The 2026 changes are better understood as consolidation than wholesale replacement.
The basic model survives: ICBs remain statutory commissioners and system leaders; ICSs remain partnership structures; provider organisations remain responsible for delivering care.
What changed is scale.
Some of the original ICB footprints have been merged into larger boards, reflecting a wider push toward fewer organisations, reduced management cost and more strategic commissioning.
Where does commissioning sit now?
ICBs control the majority of NHS spending allocated geographically in England. NHS England's current allocations cover core services, specialised commissioning, primary medical care, other primary care and running costs for 2026/27 through 2028/29.
That makes ICBs much more than coordination bodies. They are major commissioners with responsibility for deploying resources across a population.
The policy direction in 2026 is also explicit: ICBs are being positioned increasingly as strategic commissioners.
Government proposals published during 2026 envisage more commissioning responsibility moving toward ICBs as NHS England functions are restructured or transferred, with the aim of giving local systems greater control over how resources are used across patient pathways.
What does “strategic commissioner” actually mean?
It means the ICB is expected to spend less of its effort acting as an operational management layer and more of it shaping what the local health system needs to deliver.
That includes:
- understanding population health need;
- allocating resources across services and pathways;
- reducing health inequalities;
- planning service configuration;
- commissioning primary, community, acute and specialised services where responsibilities sit locally;
- working with councils and other partners around prevention and neighbourhood care;
- holding providers to account for outcomes and use of resources.
Does that mean everything is bought by the ICB?
No — and this is where NHS sales intelligence gets difficult.
| Requirement | Responsibility may sit with... | What suppliers need to establish |
|---|---|---|
| System-wide commissioning | ICB | Which commissioning directorate or programme owns the requirement. |
| Hospital operational purchase | NHS Trust / Foundation Trust | Whether the ICB influences the specification or funding but the provider buys directly. |
| Primary care services | ICB, provider, PCN or practice depending on requirement | Where commissioning responsibility ends and practice-level operational purchasing begins. |
| Community or neighbourhood service | ICB, community provider, local authority or partnership | Whether the service is commissioned jointly, delegated or delivered through an existing provider contract. |
| Adult social care | Local authority | How the local authority and ICB work together around shared pathways or pooled budgets. |
| Capital / estates / technology | Could sit at system, provider or national level | The funding source, asset owner and procurement route before assuming the ICB is the buyer. |
Where do Primary Care Networks fit?
One of the useful observations in the original article was that larger regional commissioning structures tend to create demand for smaller local operating structures beneath them.
Primary Care Networks (PCNs) are a good example. They group GP practices together around local populations and support shared workforce and service delivery at neighbourhood scale.
They are not replacements for ICBs. They operate at a much more local level and are one part of the primary-care architecture inside the wider system.
For suppliers, that again means knowing whether the opportunity is strategic, system-wide, neighbourhood-level or practice-specific.
What about “place” and neighbourhoods?
The language below ICB level has never been entirely consistent.
Many systems organise partnerships around place, often aligning roughly with local-authority geographies. Below that, neighbourhood working is becoming increasingly important, especially around primary care, community health, social care and prevention.
The important point is not the label. It is understanding where actual authority has been delegated.
Two ICBs can use similar language but give their place structures very different levels of budget, governance and commissioning responsibility.
A short history of how we got here
Local primary-care commissioning moved through Primary Care Groups and then Primary Care Trusts, followed by significant consolidation.
CCGs replaced PCT commissioning arrangements following the Health and Social Care Act reforms.
Partnership footprints developed across England and gradually evolved into the ICS model.
CCGs were abolished and Integrated Care Boards became the statutory NHS commissioning organisations across England.
A further round of mergers and boundary change reduced the number of ICBs while retaining the overall integrated-care model.
And what happens when NHS England disappears?
This is now one of the more important questions hanging over the system.
Government policy in 2026 is to abolish NHS England and redistribute its functions, with some national responsibilities moving into the Department of Health and Social Care and more commissioning responsibility moving toward ICBs.
The Health Bill fact sheets published this year describe ICBs as the future strategic commissioners of local health services. They also indicate that additional responsibilities — including further primary care and public-health commissioning functions — are expected to move toward ICBs as the reforms progress.
So the next phase is not the replacement of ICBs. It is likely to be an expansion and sharpening of their role.
ICB mergers matter, but the more important question is what moved with them: budget, commissioning responsibility, staff, programmes, contracts and named postholders. Structural change is commercially useful only when it is translated into those practical consequences.
Why Oscar tracks NHS structural history
The NHS is probably the clearest example of why current data without history can be misleading.
A person who once worked for a CCG may now sit in an ICB. A contract first commissioned nationally may now be delegated locally. A geography that once contained three organisations may now sit inside one merged board.
Oscar's NHS research therefore tracks not just current organisations and postholders, but the structural changes that explain how the system arrived there.
That helps users answer more useful questions:
- Which ICB now covers an organisation or location after the 2026 mergers?
- Which previous boards were absorbed into a new ICB?
- Where did named commissioning responsibilities move?
- Which NHS trusts and primary-care structures sit inside the new footprint?
- Who now holds the relevant commissioning or functional role?