2. Deliver timely, accurate and relevant national guidance and tools to ICBs

ICB leaders reflected that some of the challenges they faced in progressing the technical aspects of the mergers were linked to delays or lack of clarity in some national guidance and tools, which should be improved going forward. 

The NHS England merger and boundary guidance was focused on preparing ICBs to close down legacy organisations and launch new ones, rather than the complexities around splitting ICBs across different geographies. For example, there was initially no national guidance on how to change a contract to cover two different geographies.  This was reflected in the original due diligence checklist shared with ICBs, which they were asked to complete to provide the appropriate assurances. While revised since the CCG transition, it did not initially fully meet the requirements of the change process. NHSE should ensure it is as up to date as possible for ICBs undertaking this process in 2026/27, learning from the experience of the first wave. 

ICB leaders also reported delays in receiving the right information and tools or decisions to progress the transition, risking missing important milestones. This included confirmation of how boundary changes would apply to primary care, the national contracting tariff and approaches to GP IT. The launch of a national accounting and finance system during the transition period may have exacerbated these challenges. Some ICBs also experienced delays relating to digital support – for example, having to manage two e-mail addresses and the inability to establish new shared mailboxes. Guidance around branding and website updates were also delayed, creating additional complexity.