In a letter to Sir Jim Mackey following publication of the blueprint for ICB changes, Patricia Marquis, director of RCN England, expressed concerns over the 30 May deadline for ICBs to produce their plans.

Marquis said: ‘We are very concerned that the proposals around structural reform at a national and regional level have not been formally consulted on nor essential impact assessments completed.'

The letter expresses concerns the changes will lead to job losses in nursing and calls for chief nursing officers to be protected from demands to streamline ICB boards.

Marquis said the blueprint's call for a reduction in the contractual oversight of the functions of ICBs could weaken mechanisms for holding providers accountable for safe staffing, recruitment, retention and working conditions.

The letter stated fears that the ‘speed of this process has not left time for vital safety and quality risk assessments to be undertaken', adding: ‘The Blueprint is unclear about where responsibility for maintaining professional standards and assuring patient safety will sit in the future system architecture.'

A spokesperson for NHS England said: ‘The new draft Model ICB Blueprint marks the first step in a joint programme of work to reshape the focus, role and functions of ICBs and is linked to the work we're also undertaking to reshape regions, the centre and our broader approach to the operating model – as part of plans to reduce the management costs of the NHS, so that more money can be spent on the frontline.

‘There is still much more work to do but we are sharing the blueprint to help ICBs design their future state and develop their plans to achieve the 50% reduction in running costs.

‘Clinical leadership at all levels of the NHS is essential and local ICB nurse leadership teams are expected to play a key role in developing these plans.'