Recommendations for phased implementation

Phase 1: Setting out the vision and establishing support infrastructure (0-6 months)

The 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’s forthcoming strategic commissioning framework should reflect the principles and proposals outlined in this report and be accompanied by an implementation plan to drive change. NHS England should establish the structures needed to support transformation and development of skills and capabilities. This includes a national commissioning forum to support and enable peer learning. 

Phase 2: Reforming planning and performance systems (6-12 months)

Reform core processes to support strategic commissioning. This includes redesigning annual planning processes around population outcomes, developing new templates and methodologies for pathway-based commissioning, and creating frameworks for measuring progress on system integration. Early adopter systems can demonstrate how these reforms will drive meaningful change in practice. Systems will need advanced analytical capabilities and standardised tools to strengthen population health management.

Phase 3: Implementing new ways of working (12-24 months)

Resource and roll out pathway-based commissioning models, establish new financial arrangements for risk sharing and create integrated data systems for real-time monitoring. Success depends on balancing the pace of change with maintaining service stability.

Phase 4: Embedding cultural change (Ongoing)

Embed sustainable improvement through learning networks, peer review processes, and formal mechanisms for adopting successful approaches. This cultural transformation represents the most challenging aspect of change, requiring sustained commitment across all levels to create lasting improvements in how systems work together