The strategic commissioning framework: what you need to know

Overview

In May 2025, ICB leaders worked with NHS England to develop the Model ICB Blueprint, which set out a new role for the ICB: that of strategic commissioner. Developed at pace, the blueprint provided a useful direction of travel but left questions about what exactly strategic commissioning meant, the roles and responsibilities of other parts of the system, and the functions that ICBs would retain.

The 10 Year Health Plan outlined a commitment to publish a strategic commissioning framework to answer these questions. The framework further defines the role of ICBs as strategic commissioners and articulates what this means in practice. It provides an updated commissioning cycle that makes better use of new technologies and prioritises longer-term, proactive care. It outlines how ICBs should be working with their system partners: providers (including integrated health organisations), local government, neighbourhoods, places, and primary care. It also outlines the enablers ICBs will need to develop to be do all this well. 

What is strategic commissioning?

The framework defines strategic commissioning as ‘a continuous evidence-based process to plan, purchase, monitor and evaluate services over the longer term and with this improve population health, reduce health inequalities and improve equitable access to consistently high-quality healthcare.’ 

Strategic commissioning is the key to enabling the government’s three shifts for the NHS and improving both allocative and technical efficiency. The framework also includes an expectation that ICBs should be working with government, including local government, to address the wider determinants of health and wider socioeconomic development, while delivering value for money.

The four stages of the strategic commissioning cycle

The framework outlines an updated commissioning cycle, which ICBs are expected to deliver for all NHS services. ICBs are expected to work with local government in using this approach. There are four stages: 

1. Understanding the context.
2. Developing long-term population health strategy.
3. Delivering through payor function and resource allocation.
4. Evaluating impact.

1. Understanding the context 

By March 2026, each ICB should produce an integrated needs assessment that reflects a detailed understanding of the population served, shared with providers and partners and updated annually. The integrated needs assessment should be broken down by local places and neighbourhoods, typically aligned with health and wellbeing boards.

The information and data sets gathered must come from a range of sources, including a fully linked and costed person-level data set across their geography. This will require robust data-sharing agreements and governance to support re-identification of at-risk cohorts in clinical settings and integration into the NHS Federated Data Platform (FDP). They will also need to develop an ‘adequately resourced’ co-production methodology to work with patients and staff. ICBs should also consider population projections, housing developments and local growth plans to anticipate future healthcare demand. They will need to surface inequalities and population segmentation to generate actionable insights, inform service design and monitor progress toward equity. There is an expectation that each ICB will develop its own intelligence function capable of undertaking this sort of analytical activity. 

ICBs will also be expected to carry out an annual baseline mapping exercise to risk stratify the healthcare services they commission, undertaking reviews where necessary. They will work alongside providers, local government, the voluntary, community and social enterprise (VCSE) sector when appropriate, and those with lived experience to do so. Taken with the integrated needs assessment, this understanding should inform strategies to close the gap between current provision and the desired future population health improvement plan.

2. Developing long-term population health strategy

ICBs are expected to set an overall five-year strategy by January 2026, which, like the integrated needs assessment, will be updated annually. The strategy should describe the ICB’s vision for improving health and healthcare and clearly define outcomes, sub-outcomes, outputs, actions and key performance indicators. To develop the strategy, ICBs will need to draw from the integrated needs assessment and the baseline exercise of current performance, the existing ICS strategy, the health and wellbeing board strategies within the ICB geography, and the three strategic shifts in the 10 Year Health Plan. 

ICBs will then need to use a ‘clear and transparent approach’ to prioritise current and potential commissioning intentions into a five-year population health improvement plan. The improvement plan should draw on neighbourhood health plans in the ICB geography, the three strategic shifts in the 10 Year Health Plan and national planning commitments. The first plans are due in January 2026, and will also need to be updated annually, taking account of the Medium Term Planning Framework and changes to local priorities.  

ICBs can determine the number of intentions to include, but each should include defined outcomes and metrics, clear milestones and timescales, the scale at which delivery will happen, and governance arrangements. The plan should also set out where the ICB intends to commission jointly with local government or delegate commissioning to providers and identify where reconfiguration may be required. 

3. Delivering through payor function and resource allocation

Delivery of each ICB’s strategy and implementation plan will be achieved through their allocation of resources. This could include ceasing services, changing existing services or adding new services. In making these decisions, ICBs are expected to consider:

• scale (eg. multi ICB, system, place, or neighbourhood)
• payment mechanisms (eg. the Provider Selection Regime, or joint procurement with local government)
• local constraints (eg. estates or workforce)
• contractual models (eg. lead provider models or delegation of commissioning)
• financial models (to incentivise partnership working across providers).

There is an expectation for ICBs to work at a strategic level, leaving more prescriptive operational design to providers. This includes undertaking horizon scanning, working with NHS regional teams to develop the workforce, undertaking market shaping and management, prioritising a system shift to prevention, and designing and using new payment mechanisms. 

ICBs are also expected to undertake ongoing, risk-based assessments of their contracts, and tailor contractual monitoring and intervention accordingly. This includes ensuring levels of service set out in national contracts, such as for primary care, are in place. 

4. Evaluating impact

ICBs will need to monitor and evaluate the performance (quality, operational and financial) of the services they commission. Each ICB will set an evaluation approach by March 2027, supported by its intelligence function and other partners. The approach must encompass both quantitative and qualitative data, including feedback from staff, communities and people using services, all of which will require ICBs to have clear ways to capture feedback. NHS England will support this by rolling out an implementation index that will collect data on experience, outcomes and health and care use within priority population groups. 

Because oversight of provider trust performance is shifting from ICBs to NHS regional teams, ICBs will be expected to work closely with them. ICBs will continue to be accountable for the performance of primary care providers and national contract requirements. They will continue to have an agreed governance and monitoring framework in place for quality oversight, but this may change from April 2026 as the role of regional NHS teams changes. 

What do ICBs need to be effective strategic commissioners?

The framework outlines seven enablers that ICBs will need to be effective strategic commissioners. It notes that system partners will need to work together to develop these, and in some areas there may be hosted arrangements within one ICB. 

1. System leadership for population health
   ICB leaders and staff will need to be adept at system thinking, leadership, analytics and collaboration. They will need to work diplomatically and be comfortable driving change and influencing without direct authority, including facilitating improved collaboration across the health and care system.
2. Clinical and care professional leadership and governance
   ICBs need effective, broad multidisciplinary clinical and care professional leadership embedded at each stage of the commissioning cycle, to ensure they understand biological, psychological and social risk and best practice care pathways and can make robust decisions.
3. Healthcare data, analytics and technology
   ICBs will need a single, consistent system-wide population health management (PHM) approach alongside a person-level, longitudinal linked dataset that integrates local and national data sources alongside public and patient feedback. ICBs should develop analytical teams that can analyse and interpret complex data. The NHS FDP should be used to support segmentation, risk stratification, and predictive modelling, and ICBs should collaborate with the national FDP team to enhance this capability. The Model Health System – combined with the FDP – will support strategic commissioning by providing initial metrics on spend cost, and activity volumes up to March 2025. By March 2027, commissioner metrics on cardiovascular, stroke and diabetes will be available on the NHS FDP when full adoption is expected. Digital technology should be embedded within ICB strategies and PHM plans, incorporating genomics, AI, wearables, robotics, and joined-up data. ICBs should refer to the forthcoming Model Digital Blueprint (2026/27) for guidance on digital-first approaches and integration with national tools such as the NHS App, NHS FDP, and the single patient record (from 2028).
4. Intelligent healthcare payor
   ICBs will need to deliver fair and evidence-based resource allocation within constrained budgets and so will need skills in health economics; policy; decision-making and priority-setting; communication and stakeholder engagement. They will also need to take an active role in designing, shaping and managing healthy and resilient provider markets, including strengthening GP leadership in primary care. They will need to work with providers to develop best practice models, reallocate resources and tailor commissioning models as needed. ICBs also need the skills to manage and oversee contracts, including building capacity to model and measure impact and intervene where necessary to support services to turn around.
5. User involvement and co-design
   Each ICB should have a systematic approach to co-production that meaningfully engages patients, service users, carers and community groups in the planning, implementation and review of services. A number of guides and frameworks are listed in section 4.5 of the strategic commissioning framework, including NHS England’s guidance on working with people and communities.
6. Working with local government
   ICBs need to build a shared understanding of their population and work with local government to support improved outcomes, tackle inequalities and develop neighbourhood health. This should be achieved through joint planning, shared accountability and a collective role with local authorities in shaping population health strategies and plans.
7. Supporting ICB competency and capability development
   ICBs need excellent leadership and management skills to implement challenging decisions while building and maintaining effective partnerships. They will also need facilitation skills, contract management skills and robust change management capabilities. 

The different scales of commissioning

The framework outlines the need for services to be commissioned at different levels, from multi-ICB down to neighbourhood. As part of the ongoing delegation of responsibility for commissioning from NHS England to ICBs, an Office of Pan-ICB Commissioning is being established in each region.  

The framework suggests ICBs should consider ‘devolving where possible and aggregating where necessary’, and gives the following guide for where services should sit, recognising some variation will be necessary:

• Neighbourhood: Ongoing co-ordination of long-term care for named individuals living with complex conditions.
• Place: Tailored service planning and co-ordination to meet local community needs.
• System: Planning and improvement of acute care (physical and mental health).
• Multi-system: Planning and improvement of specialised and ambulance care.

Primary care

ICBs play an important role in creating a resilient and sustainable primary care sector that can support neighbourhood working and underpin the shift of care from hospital to community. ICBs must both ensure contractual requirements are met and promote a culture of collaboration. The new strategic commissioning development programme will support ICB commissioners of GP services to create the right conditions for improving general practice – and potentially the commissioning of pharmacy, optometry and dentistry in future.

Neighbourhood

The development of single neighbourhood providers (SNPs) and multi-neighbourhood providers (MNPs) has the potential to shift the majority of NHS provision to a population-based model. ICBs should work in partnership with local government and other partners to determine the neighbourhoods and places in their local systems, identify their needs, and shape the development of providers and the use of contract models to create the right provider landscape. Further information about the new contractual models, including the integrated health organisation contract, will be included in an upcoming neighbourhood system archetype document expected in late 2025. 

Place

The 10 Year Health Plan strengthens the role of place partners through their role in the development of neighbourhood health plans, which set out shared objectives across place partners and how commissioners and providers will deliver services in an integrated way, and by defining the optimal delivery models for their populations, including for neighbourhood delivery and, in some parts of the country, integrated health organisations (IHOs). ICBs can use contracting arrangements to allow providers greater freedom and flexibility in achieving agreed objectives, allowing them to drive transformation. ICBs may wish to commission lead providers to drive greater integration, or choose to give providers a formal role in commissioning decision-making. ICBs will need to support the development of skills and capability within providers to do this and consider how they can balance economies of scale to support access to scarce skills. In particular, ICBs will need to ensure they have robust oversight over new arrangements for provider IHO contracts and enhance the incentives for population-based outcome measures and the shift towards primary and community care and prevention. 

Analysis

The strategic commissioning framework comes at a crucial time – offering some clarity and direction for ICBs as they undergo significant changes to their role and structure. 

There is much to welcome in the framework. In our annual report on the state of integrated care systems (ICSs) , ICB leaders told us that they feel optimistic about the potential for strategic commissioning to improve the health of patients and residents. The framework offers a direction of travel that chimes with what many NHS leaders told us in earlier this year, that strategic commissioning is about collaborating with local government and wider system partners, looking over longer-term time horizons, prioritising transformation and left shift, and engaging meaningfully with patients and communities to drive the shift to new integrated models of neighbourhood care. We’re pleased to see that many of our proposals have been included in the framework, such as payment mechanisms that support shared commitment to improved outcomes, a heightened focus on data analysis and evidence-based decision-making, and more collaborative and diplomatic leadership. The framework offers a vision for ICBs in which they are freed from the minutiae and freed up to make the sort of transformational change that is needed to achieve the government’s three shifts.  

The problem, of course, is that there is little ‘freeing up’ to be had. As with the model region blueprint, released in September, the strategic commissioning framework instead operates as a sort of catch-all: ICBs are to do almost everything. ICB leaders have already told us that they’re concerned about how they can build strategic commissioning capability while retaining the capacity needed to maintain their existing functions. As they go through significant headcount reductions while still holding onto a range of statutory duties they can’t shed until a future NHS bill passes, the glaring question for most ICB leaders will be how to deliver on their new responsibilities from April 2026. 

One of the most significant opportunities in the framework is the prospect of closer working between ICBs and local government. It’s positive that the framework references both the fourth purpose of ICBs to support broader social and economic development, which has been notably missing from other policy documents published this year, and the significant work already underway by ICBs on the work and health agenda. However, there are questions about how ICBs can effectively do this. The integrated needs assessment, five-year strategy and five-year implementation plan are all expected to draw on the work of local government public health teams and health and wellbeing boards, with little detail on how to avoid duplication or whether this supersedes the Joint Forward Plan – the current five-year strategy for ICBs and their partners. 

In our state of ICSs report, ICB leaders told us they feel confident in fulfilling their first two new functions: understanding local context and developing a population health strategy. ICBs already have varied and comprehensive ways of understanding their populations and are already responsible for producing five-year strategies and implementation plans. But one of the more significant shifts here is the focus on data and analytics. ICBs will be expected to establish their own intelligence functions to deliver health economics, develop a system-wide, linked person-level dataset (including securing the necessary data sharing agreements), develop their own ‘adequately resourced’ co-production methodologies to work with partners and communities, and annually risk assess all the services they commission. We had previously seen suggestion that ICBs would have access to intelligence support at the pan-ICB level to support them with this new analytical focus, considering their current constraints. Instead, the framework outlines that each ICB will need to develop this function independently, which is likely to be a challenge in the short term. Especially notable is the push for the NHS FDP strategic commissioning tool to be the default tool for analytics. The FDP currently doesn’t incorporate primary care data by default, which is a necessary dataset for ICBs to gather a full population-level view. The timelines set out in the framework for its use by ICBs in March 2027 is ambitious. 

The 10 Year Health Plan introduces a range of new delivery models, which each aim to improve population health outcomes and value for money through greater allocative efficiency. The framework states that place partners will collectively define the optimal delivery model(s) based on local context, with the ICB playing a facilitative role. We are therefore encouraged by the framework’s acknowledgement that ICB capability should form part of the IHO assessment process. The framework also begins to describe the link between the new contractual mechanisms introduced by the 10 Year Health Plan: IHO, single neighbourhood provider (SNP) and multi-neighbourhood provider (MNP) contracts. IHO and SNP/MNP contract holders will be expected to work together to deliver the left shift and transform models of care. However, it is unclear whether they could eventually become the same entity and how this relationship differs according to the scale covered by the contract. We look forward to more detail on this in the forthcoming system archetypes blueprint.

The framework provides some welcome clarity on what happens to ICBs’ role as they increasingly delegate functions and skills, such as population health analytics, to providers. It is worth noting that delegation of commissioning responsibilities from ICBs is currently very limited and the pace at which ICBs delegate their functions will depend on providers’ readiness to assume them. The framework’s acknowledgement that providers will require support from ICBs to develop their commissioning and integrator capabilities is welcome. This will also require support and ‘strategic oversight’ from DHSC/NHS England national and regional teams – something which was mentioned briefly in the Model Region Blueprint – and further clarity on lines of accountability and oversight.

Strategic commissioning of neighbourhood health provides a real opportunity to shift from reactive service delivery to proactive, preventative approaches to health and care. It is welcome that the framework emphasises the importance of embedding partnership working with partners that go beyond the NHS. Local government, the VCSE sector and local communities will be crucial in identifying local populations and their needs and shaping the provider landscape. ICBs should ensure they are creating the enabling conditions for neighbourhood delivery to be locally led, working with their partners to do so. Our new project with Local Trust, the Innovation Unit and Health Innovation South West is currently exploring this, supporting six sites with their efforts to build community-led approaches to health. 

The national development programme outlined in the framework will be critical to developing the skills and capabilities required for ICBs to deliver on their strategic commissioning role. Questions remain about how the development programme will be structured and funded. ICBs have expressed that they wish to be involved in the design and delivery of any improvement programme, supporting a sector-led approach to improvement similar to that seen in local government.

Next steps for ICBs

All ICBs are expected to adopt the approach outlined in the framework in 2026/27 as part of the NHS planning process. In January 2026, a strategic commissioning capability toolkit will be issued, which will set out a number of levels (from ‘starting out’ to ‘mastering’) for each step of the commissioning approach and the enablers. ICBs will be expected to carry out a baseline assessment against the framework in March 2026. 

A strategic commissioning development programme will be launched from April 2026 to support ICBs and others with developing their skills. This will have three strands: ongoing Model ICB implementation support, organisational development, and individual development. The framework suggests this programme will include explicit support for health economics skills and creating the right conditions for improving general practice. 

How we are supporting members

To support our members in their role as strategic commissioners, we have established a Strategic Commissioning Forum. 

Chaired by Hannah Iqbal, chief strategic, digital and transformation officer at Buckinghamshire, Oxfordshire and Berkshire West ICB, and Sarah Mansuralli, chief strategy and population health officer for North Central London ICB, the forum brings together directors of commissioning, strategy, and population health to move towards this new vision of commissioning.  

Each meeting is focused on a step within the strategic commissioning cycle, and features key speakers, examples of good practice, insight from system partners, and opportunities for peer learning to support ICBs move to strategic commissioning.