On the day briefing: strategic commissioning framework

On 4 November 2025 NHS England (NHSE) published the Strategic commissioning framework, which aims to support all integrated care boards (ICBs) to adopt a strategic commissioning approach from April 2026. The document sets out the principles of strategic commissioning, clarifies expectations of ICBs as the commissioners of most NHS services, and situates the approach within the emerging NHS operating model and the ambitions of the 10‑year health plan.  

This briefing summarises the framework and gives our view on it. If you have any comments, feedback or questions please contact  Emily Newton, policy advisor.  

The strategic commissioning framework builds on the Model ICB Blueprint, which outlined how ICBs’ role should evolve, and delivers on the commitment in the 10-year health plan to support ICBs in delivering its key ambitions.  

The framework updates the traditional commissioning cycle to align with the emerging NHS operating model and the government’s three shifts. It echoes the principles of 2007’s ‘world class commissioning’ by emphasising outcomes, system leadership, and population health intelligence, and adapting them to today’s integrated care context. 

As signalled in both the Model ICB Blueprint and the 10-year health plan, the framework recognises a growing role for providers in strategic commissioning and encourages ICBs to support providers in developing commissioning and integrator capabilities, including for multi-neighbourhood provider (MNP) and integrated health organisation (IHO) contracts. 

The framework applies across the full range of NHS‑commissioned services, including prevention, primary care, health and justice, community, urgent and emergency care, elective and specialised services, mental health, learning disabilities and autism, maternity and end‑of‑life care. 

Strategic commissioning is positioned as central to delivering improvements aligned with the government’s three shifts. It is defined 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.’ As strategic commissioners, ICBs will be accountable for ‘creating the best value for the public from their NHS budget’. This includes by improving allocative efficiency – directing resources to the most clinically appropriate and cost-effective activities, and by enhancing technical efficiency – enabling providers to deliver care more efficiently and sustainably.  

Strategic commissioning approach 

The framework outlines four key stages of strategic commissioning:  

1. Understanding the context – analysing person-level data to assess population needs and service performance. By January 2026, each ICB must complete an integrated needs assessment covering current and future population health, building on existing joint strategic needs assessments. 
2. Developing a long-term population health strategy – creating a five-year strategy and delivery plan by January 2026 (reviewed annually) that articulates a vision for improving health and healthcare, aligned with both national and local priorities. 
3. Delivering through payor function and resource allocation – managing contracts and allocating resources to shape the provider market and deliver against the population health strategy. 
4. Evaluating impact – assessing service outcomes using clinical data, patient and staff feedback, and performance metrics to inform future commissioning decisions. 

Providers are recognised as key partners at each stage of the commissioning process, in particular in reviewing the quality, performance and productivity of existing service provision, supporting the development of best practice care models, and identifying opportunities for new contractual models (including potential delegation of commissioning to providers).  

Key enablers to support ICBs 

• ICBs will complete a baseline assessment against the framework by February 2026, followed by the launch of a strategic commissioning development programme in April 2026. ICBs are expected to adopt the strategic commissioning approach from 2026/27.  
• Once fully implemented, the NHS federated data platform (FDP) will host key information for commissioning, including metrics on a service-by-service basis. Until then, the Model Health System platform will provide spend and cost to activity metrics (using data to March 2025). 
• ICBs should draw on clinical expertise across the full range of services across their systems and ensure this input is considered at all stage of commissioning. 
• To support their role as intelligent healthcare payors, ICBs will need to work closely with providers to understand service provision, shape resilient local provider markets, and co-develop best practice care models. This includes using patient-level information and costing systems (PLICS), and demand and cost projections to define required activity levels and desired outcomes for populations. Providers will need to translate this into detailed delivery models, covering workforce, estate, training, equipment and digital requirements.  
• Work is ongoing to develop best practice tariffs and year of care tariffs. Once available, ICBs are encouraged to implement these tariffs alongside local payment agreements to align incentives. 

Commissioning footprints  

The framework emphasises that commissioning should take place at different population and geographical footprints (from multi-ICB to neighbourhood), with footprints aligned to service type and opportunities for local integration. 

Multi-ICB level 

• Each NHS region will establish an Office of Pan-ICB Commissioning, which will assume direct commissioning responsibilities previously held by NHSE. 
• Specialised and ambulance services can be commissioned at this footprint. 

Place 

• ICBs are encouraged to delegate more responsibility to place-based partnerships over time. 
• Place partnerships, working closely with local government, are tasked with co-developing neighbourhood health plans that outline shared objectives, service transformation priorities, and how commissioners and providers will reorganise to deliver integrated care. 
• These partnerships will also help define the optimal delivery model for their population, including the use of new contract forms to support transformation. 

Neighbourhood 

• ICBs will commission neighbourhood-based models of care, using the strategic commissioning approach to better understand local needs and shape services accordingly. 
• This includes implementing new contractual models introduced in the 10-year health plan (single neighbourhood provider and MNP contracts), tailored to neighbourhood and place-level priorities. 

Role for providers 

• ICBs are encouraged to adopt flexible arrangements that give providers greater autonomy in delivery, such as outcomes-based contracts or lead provider models. 
• IHO contracts may be awarded to eligible new foundation trusts, conferring responsibility for planning services and allocating resources to improve population health. 
• ICBs will retain oversight of these contracts, and commissioner capability will be a key consideration in the IHO assessment process. 

One of NHS Providers’ key purposes is to positively influence the environment in which trusts and foundation trusts operate. We shared feedback on two drafts of this guidance, highlighting the role providers can play across the commissioning cycle, as best placed to maximise technical efficiency, and bringing insight, data and local intelligence to understand: 

• patient and population need,
• gaps in provision, and
• outcomes.  

Trust leaders will welcome the strategic commissioning framework’s intention to shift from transactional contracting to a holistic, outcomes‑focused approach. They see real potential in commissioning across care pathways, populations and outcomes to enhance planning, integration and delivery, and to support the ambitions of the 10‑year health plan. The framework also clarifies appropriate roles for commissioners and providers, empowering providers to deliver and be involved in decisions about improving care. 

We welcome the framework’s clear articulation of the strategic commissioning cycle, including its focus on commissioning for improved quality, which is threaded throughout, and its emphasis on lived experience, co-production and partnership working, especially with local government and the VCSE sector. 

The framework’s alignment with the government’s three strategic shifts is important, but given the clear national emphasis on operational performance, ICBs will have to balance focus on longer-term transformation with short- and medium-term service delivery pressures. Both the regional teams and the 2026-27 NHS oversight framework must support ICBs to be strategic, as well as improving access to care. 

Providers have a vital role to play throughout the commissioning cycle. Their insight, data and intelligence are essential for understanding population needs, identifying gaps in provision, and evaluating outcomes and value for money. We support the framework’s recognition of provider involvement, and its commitment to flexible contracting arrangements such as outcomes-based contracts and lead provider models, which allow providers the autonomy to develop the most effective delivery models. 

While a development programme for strategic commissioning has been announced, building capability across ICBs will take time, and ongoing clustering and reorganisation may slow down progress. 

The phasing of ICB and provider planning cycles for 2026-27 is likely to be problematic. Both ICBs and providers are working to very tight planning timescales this year and ensuring appropriate alignment will be challenging. Providers are working to submit indicative plans before Christmas without the benefit of ICB plans, including updated needs assessments, until January 2026. Providers’ capacity to be appropriately involved in ICB planning may be limited during this period, particularly in systems where there are not effective shared forums for planning.  

Clarity is still needed about how ICBs will be assessed in their strategic commissioning role, and we look forward to further detail in the oversight framework. There are also questions around accountability and performance. The framework does not set out how underperformance will be addressed when either commissioners or providers fail to deliver, particularly in cases where insufficient activity is commissioned. A clear accountability regime for managing failure will be essential. 

ICBs must comply with the legal framework established by the provider selection regime (PSR). We welcome the risk-based approach advocated for reviewing existing contracts and recognition of the flexibility of the options afforded under the PSR. Care should be taken that ICBs do not default to repeated tendering where it is unwarranted. 

The relationship between ICB capability and adopting IHO models requires further clarification. We note that the guidance indicates ICBs’ readiness to oversee IHOs will be assessed as part of the IHO assessment process: further thought needs to be given as to whether IHO contracts can be introduced where ICB capability is low, and how ICB contracting decisions will interact with central assessments of provider readiness. 

Finally, while the framework highlights the importance of joint commissioning with local government, more clarity is needed on the mechanisms and forums for collaboration, beyond health and wellbeing boards. Strengthening this interface remains a priority for providers, particularly those leading on neighbourhood and place-based models where local government involvement is key.