Changes to the NHS in Bristol, North Somerset and South Gloucestershire – 12 May update

 

Update as of 12 May 2025

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.

The Model Integrated Care Board (ICB) – blueprint document has four main sections:

  • The purpose of ICBs
  • Core functions (this includes model ICB core functions and activities and assumptions on potential functional changes that ICBs are asked to consider)
  • Enablers and capabilities (what need to be in place to ensure success)
  • Managing transition (supporting ICBs to manage this transition locally and the support and guidance that will become available).

The document does suggest that some primary care operations and support functions are transferred to ‘neighbourhood health providers/providers – over time’. Our priority will be to develop a greater understanding of this and its implications, to ensure that any future decisions result in a consistent and high-quality offer.

More widely, 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 Bristol, North Somerset and South 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 Bristol, North Somerset and South Gloucestershire Integrated Care Board to cluster with Gloucestershire Integrated Care Board.

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 work will be done into this summer on ICB functions and structures working with regional colleagues. We will continue to work with teams as we formulate plans and we will want to ensure we get things right and we have the best possible arrangements in place.

This is a difficult time for ICB staff and their families. At the appropriate time there will be a consultation with colleagues affected by the restructuring, though national discussions about the detail and timing of this are ongoing.

As a leadership team, we will remain focused on delivering the best possible outcomes for our population and for our dedicated staff and teams working in Bristol, North Somerset and South Gloucestershire.

We will continue to publish further developments on our website on a fortnightly basis.