Commissioning is central to how the NHS improves population health, delivers high-quality care and makes best use of resources. Integrated care boards (ICBs), working within integrated care systems, play a key role in leading this at a local level.

The Health and Care Act 2022 established ICBs and enabled the delegation of NHS England’s commissioning functions to local systems. Since then, responsibilities for commissioning primary care and certain specialised services have moved to ICBs.

NHS commissioning is now entering the next phase. Subject to parliamentary approval, from April 2027 most of NHS England’s direct commissioning functions will transfer to ICBs. During 2026/27, ICBs will work in partnership with NHS England to lead the commissioning of these services in preparation for full transfer.

Further detail is set out in this Direct commissioning update (published 2 March 2026).

What is changing

From April 2027, ICBs are expected to take on responsibility for commissioning the following services in addition to their existing responsibilities for secondary care services:

• vaccination, screening and child health services, including most screening programmes and child health information services (CHIS)
• health and justice services, including services for people in secure and custodial settings, and sexual assault and abuse services
• most specialised services, including all those already delegated and additional services identified as suitable for local commissioning
• primary care services, building on existing delegation arrangements.

ICBs will be the strategic commissioners for most NHS services.

What will remain nationally commissioned

Some services will continue to be commissioned nationally by the Department of Health and Social Care (DHSC), including:

• highly specialised services and high secure mental health services
• some specialised services not suitable for ICB commissioning
• services for the armed forces community
• national elements of screening programmes
• national reimbursement of high-cost drugs and devices.

DHSC will continue to set national standards, service specifications and clinical commissioning policies.

The role of NHS England in 2026/27

NHS England will remain the legal commissioner for services not already delegated. ICBs will take on a full leadership role in commissioning, working closely with NHS England regional teams. Joint working arrangements will expand to cover the full range of services transferring in 2027.

Working at scale: pan-ICB commissioning

To support ICBs, offices for pan-ICB commissioning (OPICs) will be established in each NHS region by April 2027. Each region will identify a host ICB during 2026.

OPICs will:

• provide specialist commissioning expertise and capacity
• support collaboration across multiple ICBs
• enable services to be planned and delivered at the right scale
• strengthen patient and public involvement
• build partnerships across the health and care system.

Building the new system

During 2026/27, NHS England and ICBs will work together to:

• design regional commissioning teams that will transfer to ICBs
• allocate resources on a fair, population-based basis
• ensure each region has a fully functioning OPIC in place by April 2027.

This transition supports the government’s ambition for ICBs to act as strategic commissioners, improving outcomes and reducing variation in care.

Arrangements for delegation and joint exercise of statutory functions

Guidance for ICBs, NHS trusts, foundation trusts and local government sets out collaborative working arrangements following the Health and Care Act 2022, including the delegation and joint exercise of statutory functions.

NHS provider selection regime

The NHS provider selection regime sets out the rules for arranging healthcare services in England, supporting commissioners to make decisions that improve quality, integration and value.