In England, the 2012 Health and Social Care Act was heralded to be among the most significant changes in policy for the National Health Service (NHS) since its inception in 1948. And indeed, it introduced major structural upheaval, and was followed by an increase in contracting for NHS services with private-sector organisations.1 Yet a key theme of the policy, namely the intensification of competition in service provision, with a pluralisation of providers and increasing choice for patients, has not fully materialised. Even as implementation of the policy began, the focus of NHS governance was already shifting from competition towards collaboration. The 2014 Five Year Forward View outlined visions for a more integrated health and care system in England.2 Subsequent guidance introduced new organisational forms, such as the so-called Sustainability and Transformation Plans and integrated care systems3,4 with their focus on strategic planning within local health care economies, making the purchaser-provider split, introduced in the English NHS in 1991, seem increasingly redundant. The appointment in 2019 of England’s first joint chief executive of a provider of NHS services and its principal ‘customer’ (clinical commissioning group)5 perhaps marks the death knell of the purchaser-provider split; it is now replaced by a more integrated, strategic and system-based approach to local health care planning and provision.