ICBs have been told to ‘prepare for scrutiny’ as NHS England will be carrying out mid-year reviews over the next six weeks.
In a letter to ICBs and trusts dated 19 September, chief executive of NHS England Sir James Mackey said he would personally be carrying out some of these reviews, for a ‘small number’ of systems and providers.
He added that the discussions would focus on where key priorities are, risks that need mitigation and opportunities to be ‘expedited’.
‘You should prepare for this scrutiny, ensuring that, at organisation and system level, you are ready to articulate a clear and credible financial position for the remainder of this year which delivers operational standards,’ he said.
‘Positively, all but one system has confirmed their expectation that they can deliver the operational performance targets set for this year within their financial envelopes, and so, through mid-year reviews, we look forward to exploring assumptions.’
The letter also addressed progress from the first half of the financial year, with Sir Jim saying this had been ‘astonishing’.
‘To move from a predicted end year deficit of £6bn to the system position being in balance in final plans and at Month 5, whilst at the same time, continuing to improve waiting times in electives, cancer and for emergency care, has required a herculean effort for which I am hugely grateful,’ he said.
‘As we look to the rest of this year, the pace, ambition, and determination which you have demonstrated in the first half of the year must continue.’
He called on systems to ‘maintain financial discipline’, and that there should be a continued focus on access to primary care.
‘As part of dealing with the 8am scramble, from 1 October 2025 practices will be required to keep their online consultation tool open for the duration of core hours for non-urgent appointment requests, medication queries and admin requests. ICBs should ensure practices are following these requirements,’ said the letter.
‘In addition, ICBs should also continue to support community pharmacy to meet the thresholds of performance for Pharmacy First.’
Sir Jim added that ICBs should ‘urgently ensure’ that all necessary dentistry capacity was commissioned to meet their share of the government’s manifesto commitment to deliver an extra 700,000 urgent dental care appointments.
The letter also addressed winter, thanking systems for testing their plans over the past two weeks.
Data from the UK Health Security Agency suggests that this winter may be similar to the moderate to severe scenario tested by systems in the winter planning exercise, he added.
‘This means that fine tuning our plans and completing preparation is critical,’ he said.
‘Over the next 2 weeks, plans must be tightened up and any gaps exposed during the exercise need to be closed, with Board Assurance Statement completed and returned by the end of September.’
Looking forward to 2026/27, Sir Jim said that technology and digital solutions were ‘vital’ for longer term transformation and that NHS England is working to build the 10 year workforce plan which will be ready ‘in the coming months’.
It comes as the joint executive team for the Department of Health and Social Care and NHS England has been announced, ahead of the teams starting to combine resources from November.
ICBs were told in March they must cut their running costs by around 50% by October 2025. Plans have now been put in place to go from 42 ICBs to 26, with various clusters and mergers announced over the summer.
The most recent of these being the confirmation of six new ICBs by NHS England, abolishing 12 existing ICBs as of 1 April 2026.
