NHS Structure, Function,Policy & Payment Sytems FAQ

 Clear explanation of how ICSs function, who makes decisions, and how organisations should engage effectively. 

The big NHS changes in 2026 (summary)

1. Major structural reform

• NHS England is being reintegrated into DHSC, ending the “arm’s‑length” model and moving toward a single, more centralised health department.
• NHSE regional teams are shifting from performance managers to strategic facilitators, supporting commissioning at scale.

2. ICB mergers and new footprints

• From 1 April 2026, 12 ICBs are being merged into 6 new ICBs, with one boundary change.
• This is Phase 1 of a wider reconfiguration to streamline commissioning and reduce duplication.

3. Medium‑Term Planning Framework (2026/27–2028/29)

• The NHS has launched its most ambitious plan in years, focused on:
  • Cutting waiting times
  • Restoring access to local care
  • Reducing bureaucracy
  • Reinvesting savings into frontline services
• It underpins the wider 10‑Year Health Plan and sets the direction for digital, workforce, and productivity improvements.

4. Shift to the Neighbourhood Health Service model

• 2026 accelerates the move from a hospital‑centric system to:
  • Neighbourhood Health Centres
  • Integrated community diagnostics
  • Single Patient Record and AI‑enabled access
• This supports the “left shift” toward prevention and community‑based care.

5 Pan‑ICB Commissioning

• New Offices for Pan‑ICB Commissioning (OPICs) are emerging across regions.
• They coordinate services too large for one ICB but not national in scale — a key part of the 2026–27 transition.

Healthcare- Acumen works with clients of all sizes, from small businesses to large corporations. We also work with non-profit organizations and government agencies.

1. Treasury → DHSC

• Treasury sets the national health budget.
• DHSC receives the funding and issues financial directions telling NHS England how it must allocate and spend it.

2. DHSC → NHS England (NHSE)

• NHSE gets a single annual budget.
• ICB allocations go to  local services
• Direct commissioning (specialised services, primary care contracts, screening, vaccinations)
• National programmes (digital, workforce, estates, transformation)

3. NHS England → Integrated Care Boards (ICBs)

• ICBs receive a weighted capitation budget based on population need.
• They commission most hospital, community, mental health, and primary care services. 

4. ICBs → NHS Trusts

• Trusts are paid through:
• Contracts (block, blended, or activity‑based)
• Specialised service contracts (some still held by NHSE)

5. NHSE/ICBs → GP Practices

• GP funding comes through:
• Global Sum (capitation)
• QOF (performance)
• Enhanced Services
• PCN funding (workforce, access, DES)

• NHS England remains the accountable commissioner for all specialised services, but delegation to ICBs has expanded significantly. 
• By 2026/27, ICBs have full commissioning responsibility for 70 specialised services, while NHS England continues to directly commission around 104 retained services, including all highly specialised ones (e.g., rare cancers, genetic disorders, complex surgical interventions).
• The system is preparing for a major legislative transfer in April 2027, when most direct commissioning functions — including some specialised services, vaccinations, screening, and health & justice — will formally move to ICBs. 

Healthcare- Acumen works with clients of all sizes, from small businesses to large corporations. We also work with non-profit organizations and government agencies.

1. Treasury → DHSC

• Treasury sets the national health budget.
• DHSC receives the funding and issues financial directions telling NHS England how it must allocate and spend it.

2. DHSC → NHS England (NHSE)

• NHSE gets a single annual budget.
• ICB allocations go to  local services
• Direct commissioning (specialised services, primary care contracts, screening, vaccinations)
• National programmes (digital, workforce, estates, transformation)

3. NHS England → Integrated Care Boards (ICBs)

• ICBs receive a weighted capitation budget based on population need.
• They commission most hospital, community, mental health, and primary care services. 

4. ICBs → NHS Trusts

• Trusts are paid through:
• Contracts (block, blended, or activity‑based)
• Specialised service contracts (some still held by NHSE)

5. NHSE/ICBs → GP Practices

• GP funding comes through:
• Global Sum (capitation)
• QOF (performance)
• Enhanced Services
• PCN funding (workforce, access, DES)

The duration of an engagement with Healthcare- Acumen varies depending on the complexity of the project. We work with clients on both short-term and long-term projects.

• These are skills or knowledge sets that are highly specific to the NHS, or even to a particular ICS, Trust, or national directorate. Engaging with NHS Managers requires an in depth understanding of these skills that by there very nature cannot be  trained or developed for in  economic  timescales

• e.g., System Oversight Framework, Medicines Value Programme governance 

• Deep understanding  of ICB, Systems and Boards

• Medicines Optimisation Committees, ICB governance routes

• VPAG/VPAS, PSR, NHS Commercial standards, NHSE procurement controls

• The Analysis & Insight into how your Brand aligns  with NHS Policies  That NHS Managers  are performance managed to implement e.g. NHS Standard Contract, NHS Outcomes Framework, Medium Term Planning  2026-29,  NHS Payment Scheme 26 / 27, NHS Core List