Implementing strategic commissioning

The transition to strategic commissioning will require careful implementation through sequencing and sustained focus and relies on building the right skills as described above. The following recommendations span four phases, from establishing core infrastructure to embedding cultural change. While some elements can proceed in parallel, success depends on building foundations systematically and monitoring progress throughout.

Setting out the vision and establishing support infrastructure (0-6 months)

The publication of a ten-year health plan in late spring 2025 will set out a roadmap for change and articulate a clearer vision for neighbourhood health. NHS England should establish the structures needed to support transformation across all levels. NHS England’s forthcoming strategic commissioning framework should reflect the principles and proposals outlined above and be accompanied by an implementation plan to drive change. Alongside this to support delivery, a national commissioning forum should be created to enable structured peer learning and provide rapid feedback on policy implementation. Place-based partnerships need particular support to develop effective governance and delivery mechanisms. 

Reforming planning and performance systems (6-12 months)

The annual planning process requires fundamental revision to support the new approach to strategic commissioning. This includes updating all planning templates to incorporate pathway-based commissioning and collaborative delivery models. The existing ICB scorecard must evolve to measure what matters for population health improvement, moving beyond traditional activity metrics to capture system integration and outcomes.

Systems should be supported to increase the utilisation of existing data and share learning platforms where evidence, good practice and standardised resources for partnerships agreements can be accessed. These practical tools and frameworks will enable systems to implement new approaches while maintaining consistency where appropriate.

NHS England should develop a comprehensive data skills programme, supported by regional implementation networks. This must go beyond basic analytics to include advanced population health management techniques, predictive modelling, and outcome measurement. Standardised tools for population health needs assessment should be developed centrally to avoid duplication of effort across systems.

Implementing new ways of working (12-24 months)

Systems should begin implementing pathway-based commissioning models, starting with services being delegated from NHS England. This provides an opportunity to test and refine new approaches while maintaining service stability. New financial frameworks that enable risk-sharing across systems must be developed and implemented, supported by system-wide outcome measures linked to population health goals.

Integrated data systems enabling real-time performance monitoring should be supported, alongside capability assessment frameworks that track progress in strategic commissioning. These technical developments must be accompanied by cultural change programmes that support new ways of working.

Embedding cultural change (Ongoing)

Sustaining transformation requires embedding new behaviours and ways of working across the system. Learning networks should be established across ICBs, focused specifically on strategic commissioning challenges and solutions. Formal mechanisms for sharing successful approaches between systems should be created, supported by metrics that track cultural change and collaborative working.

Regular peer review processes between systems should be implemented, using evaluation frameworks that capture both quantitative and qualitative progress. This will create a self-reinforcing cycle of improvement and learning across the NHS.

Monitoring progress

Progress monitoring must focus on tracking implementation across all these areas, using a balanced set of metrics that capture both technical and cultural change. Key areas for measurement include:

• implementation of new commissioning approaches
  
  
• development of system capabilities
  
  
• cultural change and collaborative working
  
  
• population health outcomes
  
  
• financial sustainability
  
  
• service integration
  
  
• patient experience and outcomes

Regular assessment against these metrics will enable early identification of challenges and sharing of successful approaches across systems.

The successful implementation of these recommendations will require sustained commitment from all system partners. However, the potential benefits in terms of improved outcomes, better value for money, and more sustainable services, make this investment essential for the NHS's future.