Classification: Official
Publication reference: PRN02352

To:

• Integrated care board:
  • chief executive officers
  • chairs
  • chief operating officers

cc.

• Regional directors

Dear colleagues

Direct commissioning update

We are writing to update you on plans for transferring NHS England’s direct commissioning functions to integrated care boards (ICBs) from April 2027. These plans remain subject to Parliament’s approval of changes in primary and secondary legislation.

This letter:

A. Confirms which commissioning functions and services are expected to transfer, via legislation, to ICBs from April 2027 and the full leadership role expected of ICBs, supported by NHS England, for commissioning these services through 2026/27.

B. Sets out the role that 7 offices for pan-ICB commissioning (OPICs) will play in supporting ICBs across each NHS region to efficiently and effectively commission these services, including commissioning ‘at scale’ where appropriate to improve patient outcomes.

C. Explains how we will together shape NHS England’s regional commissioning teams during 2026/27 in preparation for transferring this expert resource to ICBs on a fair shares basis from April 2027. Our aim is to ensure a fully functioning OPIC within each region at the point commissioning functions transfer.

These plans support the government’s 10 Year Health Plan ambition to establish ICBs as strategic commissioners for all but the most specialised services.

A. Transferring commissioning functions

The NHS England Executive and the Department of Health and Social Care (DHSC) have agreed that, subject to parliamentary approval, the following commissioning functions of NHS England will transfer to ICBs from April 2027:

• vaccinations, child health information services (CHIS) and almost all components of screening services
• health and justice services and sexual assault and abuse services, including sexual assault referral centres
• specified specialised services, including all previously delegated services and a small number of additional services identified as suitable
• primary care services, including all previously delegated services

Further detail on each of these functions, including the specific services in question, is provided in the annex.

In preparation for this, from April 2026 we expect all ICBs to be fully engaged with and leading the commissioning of these services, supported by NHS England’s regional commissioning teams. This will mean building on and extending the joint working and governance arrangements already in place for delegated specialised services to cover this broader portfolio. These arrangements will need to reflect that NHS England will remain the legal decision-maker for those services not currently covered by a delegation agreement (for example, screening and vaccination, health and justice and additional specialised services). Our regional commissioning teams will share indicative population commissioning footprints to assist ICBs in determining where multi-ICB collaboration and governance will be necessary to ensure services are planned and commissioned at the right scale.

For the avoidance of doubt, and only at the point NHS England is abolished, DHSC will take over responsibility for commissioning:

• all highly specialised services; high secure mental health services; a small number of other specialised services not currently suitable for ICB commissioning (see annex); and the continued national reimbursement of high-cost tariff excluded drugs and devices
• all services for the armed forces community currently commissioned nationally by NHS England
• certain components of screening services that are already commissioned on a national scale

In addition, DHSC will maintain a national framework of standards, service specifications and clinical commissioning policies to support those services that are set to transfer to ICBs.

B. Offices for pan ICB commissioning

For those services set to transfer to ICBs (excluding primary care for which ICBs are already responsible and staff have already transferred), an OPIC will need to be established in each NHS region.

OPICs will ensure that all ICBs across a region have equal access to the critical mass of expert commissioning knowledge and capability necessary for the effective and efficient commissioning of these important and complex areas of service provision. They will become centres of commissioning excellence, playing a vital role in facilitating multi-ICB collaboration and decision-making, ensuring strong patient and public involvement in the design and delivery of services, and building strong relationships with wider health and care system partners.

ICBs should identify, no later than the end of April 2026, one ICB to host the OPIC for their region from April 2027. Staff currently delivering these functions within NHS England’s 7 regional teams will transfer, subject to consultation, to the identified host ICBs in April 2027 (or when the relevant legislative provisions commence) forming the 7 OPICs.

ICBs are encouraged to think about whether the commissioning of other services could be supported through the OPIC model and develop plans accordingly.

C. Shaping NHS England’s regional commissioning teams during 2026/27

The NHS England Executive has now agreed indicative funding envelopes for its regional commissioning teams, including relevant commissioning support unit functions, in 2026/27. These will then flow to ICBs from April 2027 to fund the OPICs. In doing so, we have taken the opportunity to correct imbalances that have emerged over time in the level of resource available to support these commissioning functions. The funding envelopes have been calculated on a weighted capitation basis, consistent with the calculation of ICB running cost allowances, to ensure that each region receives a fair allocation. Your regional teams will share these funding envelopes with you directly.

The envelopes incorporate funding for the regional resource that currently supports the commissioning of those specialised services that are and will remain commissioned at a national level by DHSC in the future. As far as possible, we expect this support to be provided by the OPICs working on behalf of DHSC via a service-level agreement, with some exceptions where it will be required to sit nationally.

With these funding envelopes now agreed, ICBs should now work in partnership with their respective NHS England regional team to shape the design of these teams during 2026/27 such that a fully functioning OPIC can be transferred to the identified host ICB from April 2027. Permission has been given to fill vacant posts and establish new posts during 2026/27 within the agreed funding envelopes.

We look forward to working with you as we move ahead with the design of these new functions. Regional teams will be in touch to discuss next steps, with further details to follow in the coming weeks.

Yours sincerely,

Matthew Style, Director General for System Development, NHS England/Department of Health and Social Care
Elizabeth O’Mahony, Director General, Finance (Interim), NHS England

Annex: Summary of service portfolio analyses for transferring functions

Vaccinations, screening and child health information services (CHIS)

As public health functions of the Secretary of State for Health and Social Care, commissioning responsibility for the services listed below will be directly delegated to ICBs (in the same way they are currently delegated to NHS England):

• Section 7A vaccination services
• abdominal aortic aneurysm screening service
• breast screening services
• diabetic eye screening services
• bowel cancer screening hubs
• bowel cancer screening centres
• cervical screening HPV cytology laboratory services
• newborn bloodspot screening laboratory services
• CHIS

Local co-ordination of vaccine response to outbreaks is already the responsibility of ICBs and will remain so.

Health and justice services and sexual assault and abuse services

Responsibility and accountability for all health and justice services will transfer from NHS England to ICBs (subject to legislation).

Health and justice is the collective term used to describe NHS England commissioned healthcare services for children and adults throughout the welfare and youth justice and the criminal justice systems in England.

Health and justice services are commissioned to the ‘principle of equivalence’, which means that the health needs of a population constrained by their circumstances are not compromised and that they receive a level of service equal to that offered to the rest of the population. Partnership agreements and memoranda of understanding are in place with stakeholders to facilitate joint working arrangements for pathways of care.

Health and justice can broadly be split into 6 component cohorts or pathways of care:

• custodial adults
• children and young people secure estate
• vanguards commissioned through the framework for integrated care (community)
• non-custodial (pre and post custody services)
• immigration removal centres and migrant health
• sexual assault and abuse services

Specialised services

Where services are already delegated to ICBs, full accountability will transfer from NHS England to ICBs and a further set of specialised services will also transfer from April 2027 (subject to legislation). These additional services are:

• orthopaedic surgery: joint preservation surgery (adults)
• adult specialist pulmonary hypertension services
• Tier 4 CAMHS (children’s service)
• Tier 4 CAMHS (MSU)
• mental health service for deaf children and adolescents
• severe intestinal failure service (adults)
• severe intestinal failure service HPN on-costs (adults)
• specialist burn care services (adults)
• specialist burn care services (children)
• spinal cord injury services (adults and children)
• Infected Blood Psychological Service (IBPS)

Commissioning accountability and responsibility for all ‘highly’ specialised services, high secure mental health services and a small number of specialised services will transfer to DHSC. The national reimbursement of high-cost tariff excluded drugs and devices will also transfer to DHSC.

Primary care services

Primary care is the collective term used for primary medical services, community pharmacy, primary dental services and ophthalmic services. These services were delegated to ICBs in July 2022 and April 2023, and accountability will transfer from NHS England to ICBs (subject to legislation).

The full list of services already delegated can be found in the primary care delegation agreement. It includes aspects such as:

• commissioning general practice, primary dental, community pharmacy and ophthalmic services and contract management
• commissioning enhanced services and local incentive schemes
• managing poorly performing practices
• procuring new contracts and approving mergers, closures (and market entrance and exit in community pharmacy)
• handling complaints
• responding to Freedom of Information Act and subject matter access requests, and whistleblowing

A number of related primary care functions will continue to be managed nationally and will become the responsibility of DHSC:

• Performers List for England
• responsible officers
• controlled drugs
• capital expenditure functions
• national contracts
• national support services (such as pensions and payments)