ICB mergers on hold: what it means for PCNs and neighbourhoods

10 hours ago

6 min read

Some ICBs aren't merging anymore. I heard it mentioned at the Pharmacy Show this weekend, so I did a bit of digging, and thought it would be helpful to share what I found.

On 6 October 2026, NHS England told integrated care boards (ICBs) that most of the mergers planned for April 2027 will not go ahead. The ICBs that are currently working together in clusters will now stay that way until at least April 2028.

If you have been working in primary care for a while, you will have seen the headlines. If you are new to PCNs or neighbourhood working, it can be hard to follow. So this blog starts with the basics: why ICBs are being reorganised, what has changed, and what it could mean for you.

Why ICBs are being reorganised

If you are new to PCNs or neighbourhood working, this is the background.

The changes started in March 2025. The government announced it would abolish NHS England and bring its work into the Department of Health and Social Care. At the same time, ICBs were told to cut their running costs by 50%. Running costs are what it costs to run the organisation itself, such as staff and offices, rather than the money spent on patient care.

In May 2025, NHS England published the Model ICB Blueprint. This set out a narrower job for ICBs as strategic commissioners. In plain terms, that means working out what their population needs and buying the right services, rather than running services themselves.

Each ICB had to show, by 30 May 2025, how it would run on £18.76 per person in its area. The 10 Year Health Plan followed in July 2025 and set the wider direction, including the focus on neighbourhood health.

Halving running costs is hard for a smaller ICB to do on its own. So the first step was clustering: ICBs pairing up or grouping together to share leaders and teams. In September 2025, the government said this would take the number of ICB leadership teams from 42 to 26 that year. Clustered ICBs stayed as separate organisations, each with its own budget.

The 10 smallest ICBs, serving around 1 million people or fewer, were all clustered or merged with another ICB.

The second step was mergers. The same September 2025 statement named the first merged ICBs, to start in April 2026. It said more mergers would be decided as local government reorganisation moved forward. The aim was for new ICBs to cover the same areas as strategic authorities wherever possible, so the NHS and councils can plan together.

All of this has a cost. A national funding package for ICB redundancy costs, estimated at £1 billion, was agreed so ICBs could complete their staff cuts.

Where we are now

There are two kinds of change in play: mergers and clusters.

On 1 April 2026, 12 ICBs were merged into six new ones, and one ICB's boundary was widened. That took the number of ICBs in England from 42 to 36.

These are the six new ICBs and the ICBs they replaced:

Norfolk and Suffolk: Norfolk and Waveney; Suffolk and North East Essex (North East Essex moved to Essex)
Essex: Mid and South Essex, plus West Essex and North East Essex
Central East: Hertfordshire and West Essex; Bedfordshire, Luton and Milton Keynes; Cambridgeshire and Peterborough
Thames Valley: Buckinghamshire, Oxfordshire and Berkshire West; the East Berkshire part of Frimley
Surrey and Sussex: Surrey Heartlands; Sussex; the Surrey wards of Frimley
West and North London: North Central London; North West London
Frimley ICB was split three ways. East Berkshire went to Thames Valley, its Surrey wards went to Surrey and Sussex, and its Hampshire wards went to Hampshire and Isle of Wight ICB.

That last move is the one boundary change. Hampshire and Isle of Wight ICB was not abolished. It took in extra area.

A cluster is different. Clustered ICBs share leadership and combined teams, but stay as separate legal bodies. Each keeps its own boundary, budget and legal duties. 20 ICBs are clustering.

The next step was meant to be mergers for the clusters. Over the summer, NHS England proposed that from 1 April 2027, clusters would be replaced by merged ICBs serving populations of at least 1.5 million. Clusters were asked to put forward merged footprints, or explain why they could not.

That plan has now been paused for most areas.

Why the 2027 mergers are not going ahead

In short, it comes down to councils.

The government wants ICB boundaries to line up with future strategic authorities. In many areas, those authorities do not exist yet.

Local government reorganisation is the government's plan to change how councils are set up in parts of England. That includes replacing some county and district councils with single councils, and creating more strategic authorities.

In September 2026, the government paused the national reorganisation process. Without settled council boundaries, NHS England has no fixed map to merge ICBs onto.

So the decision has been pushed back. NHS Cornwall and Isles of Scilly and NHS Devon, one of the clusters affected, published a statement on what NHS England told them on 6 October. Future ICB areas are now expected to be agreed by the Secretary of State after further consultation during 2027. Any changes are expected from April 2028. The statement says the extra time allows more local discussion, in response to concerns raised in the consultation.

Three smaller boundary changes will still go ahead on 1 April 2027, to match known or expected strategic authority footprints.

There had already been local concern about merging too early. The Coventry and Warwickshire and Herefordshire and Worcestershire cluster warned in July that changing boundaries before council footprints were confirmed could mean at least two further restructures.

What is a strategic authority?

A strategic authority covers several council areas and takes on region-wide jobs. It sits above local councils, not in place of them.

The term came from the government's English Devolution White Paper in December 2024. It covers:

combined authorities, such as Greater Manchester or the West Midlands
combined county authorities
the Greater London Authority

Most are led by an elected mayor. They handle things like transport, housing, skills, economic growth and some public health duties. The government wants every part of England to be covered by one.

This matters for ICBs because the government wants health and local government to plan across the same patch. An ICB that spans two strategic authorities makes joint planning harder.

Summary of changes

If you only read one part of this blog, this table sums up where things are.

Confirmed	New
Six merged ICBs and one boundary change in place since 1 April 2026	Most cluster mergers will not happen on 1 April 2027
Clustered ICBs keep separate budgets and legal duties	Current clusters expected to stay until April 2028
ICB footprints are meant to align with strategic authorities	Future footprints to be agreed after further consultation during 2027
	Three smaller boundary changes still go ahead on 1 April 2027

What could this mean for PCNs and neighbourhoods?

Day to day, probably little changes

PCNs still hold their contracts and work with their current ICB. The delay changes ICB structures. It does not change the PCN DES or the GP contract. Neighbourhood health work carries on.

More time in transition for commissioners

Clusters now stay in place until 2028. ICB teams in clusters are still going through staff cuts and changing roles. That can mean slower decisions, changing contacts and less capacity to support neighbourhood work.

Local variation stays

Clustered ICBs keep separate budgets and legal duties. Two PCNs in the same cluster may still see different local enhanced services or neighbourhood funding.

Council partners stay the same for now

Neighbourhood health relies on working with councils, especially on social care and public health. With reorganisation paused, PCNs keep the same council partners in the short term.

Plans built around 2027 may stall

Work that assumed a merger in April 2027, such as shared commissioning or new contract routes, may be put on hold.

Areas that have already merged

Areas that merged or changed boundary in April 2026, such as Hampshire and Isle of Wight, are not waiting on a 2027 merger. The delay does not directly change their footprint.

Questions still open

If clusters stay until 2028, how much commissioning capacity will they have for neighbourhood development?
Will cluster footprints become the final ICB footprints, or will they be redrawn around strategic authorities?
Where a cluster crosses a future strategic authority boundary, which partners will neighbourhood plans be built with?
How will the delay affect ICB plans to cut running costs?

My view ( All views are strictly my own)

The Isle of Wight is my patch. Its geography is unique, so not every area will have the same experience.

On the island, we are now part of Hampshire and Isle of Wight ICB due to a merger. That is one ICB now making decisions across both Hampshire and the Isle of Wight. While our local voice still matters, we have less autonomy.

So if you are working in a cluster, from a PCN point of view, I would make the most of it. Enjoy the independence while you still have it!🙂

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