Blog by Flexzo

The ICB Consolidation: What Trust Leaders Need to Know About the New System

Published On: September 19, 2025
The NHS is undergoing its most significant structural change in years.

By Q3 2025/26, the 42 Integrated Care Boards across England will operate as just 26 clusters, with many moving toward full mergers by April 2026.

For Trust leaders, this represents far more than administrative reshuffling – it’s a fundamental shift that will reshape commissioning relationships, workforce planning, and operational priorities.

Understanding what this means for your Trust requires positioning your organisation strategically for a system where larger, leaner ICBs will wield greater influence over resource allocation and service planning.

The Scale of Change

In March 2025, NHS England announced that integrated care boards (ICBs) should reduce their running and programme costs by 50 per cent to become more efficient and reduce duplication, by December 2025. The financial reality is clear: ICBs must reduce their administrative costs by approximately 50%, spending no more than £18.76 per head of the ICS’s population by Q3 2025/26.

Structural reorganisation designed to create commissioning bodies with the scale and resources to tackle systemic challenges. Across the 42 ICBs, 15 clusters have been agreed and 11 ICBs are not clustering, with the remainder continuing as standalone entities primarily in the North East, Yorkshire, and North West regions.

What Clustering Actually Means

The term “clustering” can be misleading. While ICBs remain separate legal entities during this phase, the practical reality involves shared leadership, combined teams, and unified strategic approaches. ‘Clustering’ means that, although both ICBs will continue to exist, we will work as one – with a shared Board and leadership arrangements and staffing structure – ahead of a formal merger, which is expected from either April 2026 or April 2027.

For Trusts, this creates both opportunities and challenges. Larger commissioning footprints mean potentially more coherent strategic direction and resource allocation. But they also mean your Trust may need to engage with new leadership structures and navigate different priorities across merged territories.

The Workforce Challenge Multiplier

The clustering process intersects with the NHS’s most pressing operational challenge: workforce shortages. NHS England’s ICB assessments consistently identify workforce challenges as a key risk across systems, with many areas struggling to maintain safe staffing levels while managing increasing demand.

The scale of the staffing challenge is significant. According to the NHS Long Term Workforce Plan, the NHS directly employs 1.7 million people, with projected demand for staff by 2036/37 in the region of 2.3-2.4 million. Now, as ICBs restructure with efficiency savings of 30% demanded by NHS England, the administrative capacity to support workforce planning and commissioning is simultaneously being reduced.

This creates a compound effect. ICBs are losing experienced commissioning staff just as they need to manage more complex relationships across larger footprints, while Trusts continue to struggle with clinical staffing levels that directly impact service delivery. NHS England’s annual assessment of ICBs highlights ongoing workforce challenges, with many areas reporting difficulties in recruiting sufficient staff for key services.

More concerning are the workforce challenges highlighted in NHS England’s ICB assessments, including reports that “if the significant maternity and neonatal workforce shortages affecting all Trusts across the Surrey Heartlands system are not resolved then there could be risk to life, long-term, reduced place of birth choice and poor experience of clinical care for pregnant people and babies” (NHS England Annual Assessment of ICBs 2023/24).

The clustering of ICBs means these workforce planning challenges will need to be addressed across larger populations with potentially less administrative support. For Trust leaders, this suggests the need for more sophisticated workforce strategies that don’t rely solely on traditional ICB support structures.

The New Commissioning Reality

The Blueprint makes clear that as strategic commissioners, ICBs will focus on providing system leadership for population health, setting evidence based and long-term population health strategy and working as healthcare payers to deliver this, maximising the value that can be created from available resources.

This refined focus on strategic commissioning, combined with larger footprints, changes the game for Trust relationships with ICBs. The days of frequent operational interaction may be ending, replaced by more formal, strategic engagements focused on outcomes and value.

For Trusts, this means demonstrating value becomes even more critical. With fewer administrative resources and larger populations to serve, clustered ICBs will inevitably focus on providers that can demonstrate clear impact on population health outcomes and financial sustainability.

Preparing for the New System

The transition creates both immediate and medium-term planning requirements for Trusts. In the immediate term, understanding your new ICB cluster relationships and their leadership structures is essential. Many clusters are still finalising senior appointments, creating uncertainty about future commissioning priorities.

Medium-term, the fundamental challenge is clear: ICBs will focus on strategic commissioning with reduced administrative capacity, while Trusts face the same workforce pressures that require day-to-day operational solutions. The NHS Long Term Workforce Plan acknowledges that healthcare needs have been growing significantly, driven by ageing and increasing morbidity, and outstripping the growth in workforce numbers.

This creates an opportunity for Trusts to build more direct, technology-enabled approaches to workforce management. Forward-thinking Trusts are already exploring alternative models. The NHS has recognised that traditional approaches to temporary staffing are unsustainable, with growing focus on retention programs that address the root causes of turnover and flexible working arrangements that better meet staff needs. Some are developing direct relationships with professional networks through collaborative platforms that streamline access to qualified healthcare professionals without traditional agency intermediaries, with solutions like Flexzo AI providing the technological infrastructure to support these new approaches.

The combination of reduced ICB administrative capacity and increased workforce challenges makes intelligent automation essential. Digital platforms, like Flexzo AI, are already demonstrating how technology can streamline processes – from credential verification to shift matching – while maintaining rigorous compliance standards. Trusts that invest in these systems will have significant advantages in both operational efficiency and staff satisfaction during the transition period.

Building Resilience in Transition

The ICB clustering process will continue through 2025 and into 2026, creating ongoing uncertainty about commissioning relationships and support structures. For Trust leaders, building organisational resilience during this transition requires focusing on what you can control rather than waiting for external clarity.

This includes developing more direct professional networks through collaborative staff banks, investing in employee value propositions that reduce reliance on external recruitment, and building internal capacity for workforce planning that doesn’t depend on ICB support. Modern workforce platforms that connect Trusts directly with pre-approved professionals can provide the flexibility needed during this transition period.

Trusts that emerge strongest from this transition will be those that use the disruption as an opportunity to build more direct, efficient relationships with the professionals they need to deliver services.

The Road Ahead

The ICB clustering represents a significant shift in how the NHS organises itself strategically. For Trusts, success in this new system requires understanding that the traditional relationships and support structures are changing fundamentally.

Rather than simply adapting to new ICB structures, the most successful Trusts will use this transition as an opportunity to build more resilient, self-reliant approaches to workforce management. This includes developing direct professional relationships through collaborative networks, investing in retention rather than recruitment, and leveraging AI-powered platforms to reduce administrative complexity while maintaining compliance standards.

Strategic Workforce Solutions for the New Era

As the NHS restructures around leaner, more strategic ICBs, Trusts need workforce solutions that provide both immediate relief and long-term sustainability. This is where platforms like Flexzo AI can play a crucial role in helping Trusts navigate the transition.

Our AI-powered workforce platform addresses many of the challenges created by ICB clustering. While ICBs reduce their administrative capacity, Trusts still need efficient ways to access qualified professionals for additional capacity, whether for elective recovery, emergency cover, or strategic service expansion.

Flexzo AI’s collaborative staff bank connects Trusts directly with over 100,000 pre-approved healthcare professionals, eliminating the traditional reliance on multiple agencies and reducing the administrative burden that stretched ICB teams can no longer manage effectively. Our compliance management system ensures professionals are ready to work without the paperwork delays that become more significant when ICB support is reduced.

For Trusts planning insourcing initiatives to tackle waiting lists – particularly important as ICBs focus more on strategic outcomes – our platform provides the workforce access needed to run additional clinics and theatre sessions using existing infrastructure. This alignment with the strategic commissioning focus of clustered ICBs demonstrates clear value in population health improvement.

The transition to clustered ICBs creates an opportunity for Trusts to take more direct control of their workforce challenges. Flexzo AI provides the technology platform and professional network to make that transition successful, supporting Trusts in building the resilience and flexibility needed for the new commissioning system.

If your Trust is ready to build workforce strategies that work effectively with clustered ICBs while maintaining operational flexibility, we’d welcome the opportunity to discuss how our platform can support your objectives during this significant transition.

Get in Touch

Facing workforce challenges during the ICB transition?

Flexzo AI‘s platform helps Trusts maintain operational flexibility while ICBs focus on strategic commissioning. Our team of healthcare staffing specialists can show you how to build sustainable workforce solutions for the new NHS structure. Contact us to discuss your specific requirements.

Flexzo AI: A Collaborative Staff Bank

Flexzo AI is backed by leading healthcare investors and trusted by NHS Trusts across England.

Our platform connects over 100,000 verified healthcare professionals with hospitals nationwide, processing thousands of shift bookings monthly while maintaining 100% compliance standards.

Founded by former NHS executives and healthcare technology specialists, we understand the operational complexities Trusts face. Our AI-powered system has been developed in partnership with NHS leaders and is used by major hospital groups for elective recovery programs, emergency staffing, and strategic workforce planning. With enterprise-grade security and full regulatory compliance, Flexzo AI provides the reliable infrastructure Trusts need during this period of unprecedented change in NHS commissioning structures.