ICBs can scrap chief nurse and medic, says NHSE

NHSE told HSJ it was “for each ICB to determine which specific roles they require at board level to deliver their core functions”, after saying systems should reduce executive headcounts as part of its “model ICB blueprint”.

It comes as North East London ICB announced to staff it was scrapping its chief nurse and chief medical officer roles from its executive management team. It is restructuring in order to cut its costs in half and focus on “strategic commissioning” (see below), as instructed by government and NHSE.

The Royal College of Nursing has criticised NEL ICB’s removal of the chief nurse role – and said other systems may follow suit.

NHSE guidance  from a year ago said director of nursing and medical director roles must be appointed to ICB boards as executive members.

But NHSE has now told HSJ it “will not be further prescribing ICB board size and composition”.

An NHSE spokesperson said: “While it is for each ICB to determine which specific roles they require at board level to deliver their core functions, we are working closely with ICBs in London to ensure a continued focus on clinical quality and patient safety and have received assurance from North East London that clinical leadership will be embedded throughout their new structure.”

Systems have been told, however, that changes to the ICB model constitution – which requires that ICB boards include at least two non-executive board members, a finance director, nursing director and medical director – will need NHSE agreement.

NHSE added that, to remain compliant with the Health and Care Act 2022, every ICB board is required to have a chair, a chief executive, and three partner members (nominated by GPs, trusts, and local authorities), plus one board member with expertise in mental health.

Patricia Marquis, executive director of RCN England, said: “The decision to remove the chief nurse post by the North East London ICB shows poor insight into the importance of nursing in ensuring safe patient care. Worryingly, we are now hearing that other ICBs across England are planning to follow suit. The RCN is monitoring the situation and will be supporting members to challenge decisions locally.

“As the biggest and most trusted profession in the NHS workforce, it is vital that nursing continues to have leaders in place to influence decision-making. Failure to do so risks devaluing the nursing profession and undermining the delivery of the NHS 10-Year Health Plan, which is so heavily dependent on the expertise and leadership of senior nursing staff.”

North East London ICB restructure

NEL is also scrapping its medical director role, but the postholder, Paul Gilluley, will remain in the executive team as “chief clinical and quality commissioning officer (CQCO)”. The posts of “executive director of people and corporate services” and “chief participation and place officer” are also being removed.

The new executive management team will be:

• Chief clinical and quality commissioning officer – Paul Gilluley
• Chief finance officer – Henry Black
• Chief strategic commissioning officer – Charlotte Pomery
• Chief strategy officer – Ralph Coulbeck

In a message to staff seen by HSJ, NEL ICB’s outgoing CEO Zina Etheridge said: “The new [executive management team] structure responds to the requirement for a new operating model, which is much smaller and has a much clearer focus on strategic commissioning, with current functions requiring change and some potentially moving to alternative organisations.”

Ms Etheridge added that NEL ICB’s current chief nurse, Diane Jones, has been “a vocal and tenacious advocate for embedding equity and inclusion into everything we do, a strong champion of staff voice and a supportive and collaborative colleague”. She said Ms Jones “is not going anywhere immediately, nor are we changing any existing line management arrangements yet”.

An ICB spokesperson added: “We are still working through what the new ICB model will mean for our workforce, but ensuring we have multidisciplinary clinical input at a senior level will be a key consideration as we develop our new ways of working. Any changes made to our structures will be in line with relevant guidance.”

The ICB has said that consultation on its planned restructure below the top-team level will not begin “until September at the earliest”, citing “the various steps on the process that NHSE require to sign off our operating changes”.

Updated at 11.23am, 4 August 2025, to clarify NEL ICB is removing its post of ‘executive director of people and corporate services.’ An earlier version said the ’director of people’ is being removed.