Commissioning is central to the NHS meeting the challenges it faces today and in the future, and in ensuring that the NHS delivers the triple aim of better health for everyone, better care for all and efficient use of NHS resources. In order to deliver the triple aim, commissioning will need to continue to develop as it has since its inception.

Commissioners are working more closely together, aligning their objectives with providers and taking a more strategic, place-based approach to commissioning. Integrated care boards (ICBs), operating within integrated care systems, have a key role in maximising the value of each pound spent in their local area.

Delegation of commissioning functions to integrated care boards

The Health and Care Act 2022 established ICBs and made provision for the delegation of national commissioning responsibilities, supporting our long-term and continuing ambition to put decision-making at as local a level as possible.

Giving ICBs responsibility for commissioning more of the care provided to their population is a key enabler for integrating care and improving population health. It gives the flexibility to join up more pathways of care and better aligns incentives, leading to better outcomes and experiences for patients.

In April 2023, NHS England completed delegation of the commissioning for pharmacy, optometry and dental (POD) services to ICBs, and in July 2023 associated staff were transferred to ICBs.

In April 2024, 59 specialised services were delegated to ICBs in 3 NHS England regions (North West, Midlands and East of England). The final set of specialised services will be delegated to all ICBs from April 2025 and, subject to consultation, associated staff will transfer in July 2025.

NHS England will establish collaborative working arrangements with ICBs for the commissioning of vaccination, screening and child health information services (CHIS) from April 2025. Responsibility for commissioning vaccination services and suitable elements of screening pathways and CHIS will be delegated to ICBs in April 2026, subject to governance and Secretary of State approval.

The plans for the delegation of direct commissioning functions and associated staff transfers are set out in this letter from Steve Russell, Chief Delivery Officer.

Arrangements for delegation and joint exercise of statutory functions

This guidance for ICBs, NHS trusts and foundation trusts provides an overview of the new collaborative working arrangements that are possible between NHS organisations and local government following commencement of the Health and Care Act 2022.

NHS provider selection regime

Find out more about the new set of rules for arranging healthcare services in England.