It’s been a very busy start of the new financial year with significant changes announced to how the NHS is organised. Due to the pre-election period, my blog wasn’t published last month, so we have a bit of a bumper issue this time!

I want to take a moment to acknowledge the extraordinary pace and scale of change unfolding across the NHS — nationally, regionally, and locally, then to reflect on what that means for us with an update on clinical leadership locally, and finally some exciting news on our prevention plans.

ICB Leadership News

Following Dame Patricia Hewitt’s recent retirement due to ill health, Professor Will Pope has stepped in as Interim Chair for NHS Norfolk and Waveney ICB. Will lives locally, so knows our system already, and of course he brings with him a wealth of experience as Chair of NHS Suffolk and North East Essex (SNEE) ICB – a role he’ll continue to hold alongside his new responsibilities in Norfolk and Waveney.

Joining him is Ed Garratt OBE, who takes on the role of Interim Chief Executive following Tracey Bleakley’s decision to explore new opportunities within the NHS. Ed also remains Chief Executive of SNEE ICB, balancing both roles as we continue to move forward as a cluster of ICBs at pace. Both appointments take effect immediately and I am excited to welcome Will and Ed to our team and wish them both all the best for their new roles.

NHS Reform

I’m sure that we have all seen the national announcements: NHS England is set to be folded into the Department of Health and Social Care, with staff numbers cut by around 50% over the next two years. An interim executive leadership team has been put in place nationally to oversee this transition period, and while many details remain unclear, the symbolism is striking. The voice of medical and clinical leadership must be central during this transition, and we all have a role to play to ensure that happens, just as we have done so much to grow clinical and care professional leadership locally.

ICBs, too, face a significant reset. On 1 April 2025, NHS England set out a clear and ambitious direction for ICBs and providers, laying the groundwork for how we’ll work together in 2025/26 to deliver on our core priorities and push forward meaningful reform.

To do this well, we’ll need to strip things back – moving towards a leaner, simpler NHS where everyone knows their purpose, what they’re accountable for, and who they’re accountable to.

Over recent weeks, ICB leaders nationwide have been working to co-design a draft Model ICB Blueprint which has now been shared. This sets out what ICBs are here to do and the capabilities they need to build – especially around strategic commissioning.

We have been tasked with creating our plans by the end of May, with implementation expected by the end of Q3 2025/26, with three clear aims: to improve population health, reduce healthcare inequalities and improve access to high quality care.

Cutting ICB costs by 50% will be tough. But it’s a challenge we need to take on – because the future role of ICBs is critical, and this work sets the stage for their place in delivering the upcoming 10 Year Health Plan and the three big shifts: from sickness to prevention, hospital to community, and analogue to digital.

As part of this reform, some functions are expected to shift to regional teams and other providers over time, with ICBs focusing on strategic commissioning. Any change can be unsettling, but – I welcome the renewed emphasis on commissioning services to address population health needs, using healthcare intelligence, and the lived experience of our population to guide our decisions.

Clinical and Care Professional Leadership

Listening, Learning and Leading Together: Stewardship and Clinical Voice in Action

As we continue to reshape and refocus our system, we’re making choices that reflect both our current constraints and our commitment to clinical leadership.

We originally planned to commission 59 stewardship sessions, but in view of the changes above, we’ve had to scale that back. We’ve now appointed stewards into 29 sessions, all on six-month fixed-term contracts. It’s not the outcome any of us had initially planned or hoped for, and we understand this may be disappointing. But we’ve worked hard to retain those in roles where there’s a clear statutory or urgent need. As we increasingly collaborate with our neighbours in SNEE, we’ll be taking stock of what we need – and what we already have – across our cluster so we can make the best use of shared expertise and capacity.

What hasn’t changed is our belief in the power of clinical and care professional (CCP) voices to drive meaningful improvement. Last month, a colleague from East Coast Community Healthcare (ECCH) provided a fantastic example. Their home insulin team spotted a spike in referrals – many of which didn’t seem clinically justified, and several incidents of concern. So, they took swift action: reviewing the service, engaging with local referrers (across primary and secondary care), and delivering targeted education. The result? A better understanding of when referrals are appropriate, a sharp drop in new referrals, and a rapid reduction in incidents. A great example of local clinical leadership improving safety and quality.

We’re also grateful to the 70 colleagues who responded to the recent CCP survey. We heard from a wide range of professionals – mostly from primary and community care, 20 AHPs, 16 nurses, 12 optometrists, 7 doctors, and others from acute, ICB, independent sector, social care and mental health providers. These insights are already shaping change. We’ve revised the CCP Assembly’s Terms of Reference and are reviewing our leadership programmes to ensure they’re better linked to our quality improvement training, and to make them easier to access and more relevant and practical for any CCPs working in our system.

But we also know who we didn’t hear from in this survey: there were very few respondents from pharmacy, social care, resident doctors and some other key voices. That matters. We’ll be thinking carefully about how we improve our reach, ensure inclusion, and plan for succession – not just for Assembly members but also for how we design and communicate our future CCP programmes.

Next steps? We’ll publish the survey results on our website soon to keep the conversation open and transparent.

This is how we build a stronger system: by listening, responding, and growing together.

Provider Group Models

Community Health and Care Services (CCS and NCH&C) have now formally come together as the NCH&C and CCS NHS Group — a change that, while understandably unsettling for some staff, also brings new opportunities. The new Group Board executive and non-executives have taken up their roles leading both organisations, and the first Board meeting has taken place to agree the governance that underpins this model.  

The James Paget University Hospital, Norfolk and Norwich University Hospitals, and The Queen Elizabeth Hospital King’s Lynn are also coming together. They have announced the appointments of Mark Friend as Interim Group Chair and Professor Lesley Dwyer as Group Chief Executive (CEO) of the newly formed Norfolk and Waveney University Hospitals Group. The appointments follow a decision by the Boards of all three Trusts to establish a group model which will deliver better outcomes for the population we serve.

Planning for 2025/26

Despite the headwinds, we’ve submitted our plan for the year ahead, committing to break even. Identifying our full Cost Improvement Programme (CIP) remains a huge challenge — but we are not without optimism. So, I want to highlight one particularly exciting area: prevention.

Prevention

This year, we’ve taken a different approach to how we allocate funding to our largest providers. Traditionally, we’ve passed on the same overall allocation with an annual uplift to reflect population growth and demographic changes. But, in truth, we’ve not always been as strong at diverting money away from established patterns, even when there’s a better way to use it.

So, this year, we pressed pause. Instead of automatically handing over this “growth funding”, we asked our providers to make the case for where additional investment could deliver real impact—and ideally lead to long-term savings. That lead to some successful proposals like changing intermediate care bed arrangements, expanding the Virtual Ward model, and evolving the IV antibiotic service in Great Yarmouth and Waveney.

We also held back £3 million to spend specifically on prevention.

Why prevention? Well obviously, as doctors we all want to reduce avoidable illness, morbidity and death! But it’s also one of the best ways to ease pressure on our services, and we specifically wanted to reduce demand for same-day GP appointments, emergency admissions and A&E attendances.

Where did we target the funding? Using our Population Health Management strategy and local data, we pinpointed areas with the biggest potential return: cardiovascular disease, diabetes, COPD, asthma, and smoking in pregnancy.

How did we design the interventions? We leaned on high-impact NHS interventions and published evidence, while also building on successful work already happening in our patch.

The goal? To create focused, non-recurrent projects that can demonstrate measurable benefits—whether that’s improving quality, reducing activity, or driving down costs—within three years.

So, over the next few months, look out for changes to further improve case finding and management of people with increased CVD risks. We want to prevent as many heart attacks and strokes as we can. There’ll also be expanded access to the diabetes pathway to remission and diabetes prevention programmes, and a huge programme of work to improve diagnosis in COPD and to optimise the treatment of people with the most severe COPD and asthma including children.  I am so proud and excited by this programme and I can’t wait to track the impacts of it over the next few years.

This shift in how we invest our resources is about thinking smarter, acting earlier, and focusing on outcomes that matter to patients and the system.

Primary Care, Diagnostics, and Digital

• Repeat Prescribing Toolkit: A vital new resource has launched to support safer repeat prescribing, which now accounts for 77% of all prescriptions. Please take time to review it — the toolkit is built around patient safety and supports structured medication reviews.
• Cloud Telephony: Now implemented across 100% of our practices — enabling future digital improvements including Robotic Process Automation (RPA) and better demand management.
• Dental Contracting: We’re seeing huge pressures across NHS dental services. Our dental commissioning team is actively working with practices to explore innovative models and supporting them with digital and estates challenges. More to come on this in future updates.

I know that with all the challenges ahead and changes being made to the NHS – many of which are outside of our control – it can feel like an unsettling time. But I remain optimistic. We are working hard to preserve what matters: clinical leadership, population health, strategic commissioning, and our shared ambition to improve care. In the meantime, I want to thank you all for your continued resilience and commitment.

Let’s keep talking, keep challenging, and above all, keep focused on doing what’s right for our communities.

Best wishes,

Frankie