The new Strategic Commissioning Framework by NHS England places the pivotal role of Integrated Care Boards (ICBs) in the spotlight, as they will lead long‑term planning, resource allocation and performance evaluation across health and care systems from 2026‑27 onwards
NHS England has unveiled a comprehensive strategic commissioning framework, designed to guide integrated care boards (ICBs) in every aspect of planning, allocating resources, and evaluating performance across health and care systems. The framework sets out a four-stage commissioning cycle and key structural, data, and partnership requirements for implementation by 2026/27.
Purpose of the framework
The Model ICB Blueprint marks the first step to reshape the purpose, role, and functions of ICBs. This follows the announcement of a significant reduction in operating costs for ICBs from 2026/27, including a decrease in the number of ICBs from 42 to approximately 26.
The strategic commissioning framework will support ICBs in commissioning NHS services, update the commissioning cycle, and set out the critical enablers to support effective commissioning.
The framework will cover all NHS-commissioned services, including end-of-life care, mental health, learning disabilities and autism, as well as maternity and neonatal care.
The four-stage commissioning cycle
- Understanding the context – ICBs gather and analyse joined-up data, user feedback, and partner insight to understand local population needs, identify underserved groups, and assess service quality and performance.
- Developing long-term population health strategy – They design long-term strategies and care pathways using evidence-based models and national guidance to improve population health and maximise value.
- Delivering through resource allocation – ICBs allocate funding, manage provider markets, and contract services to achieve outcomes aligned with their health improvement plans.
- Evaluating impact – Continuous evaluation of outcomes, patient and staff experience, and service performance ensures accountability and drives improvement.
Success factors for strategic commissioning
To be effective, ICBs require:
- Strong leadership and collaboration with providers, local government, and communities to co-design services.
- Embedded clinical and professional leadership driving cross-system improvement.
- High-quality data, insight, and technology to inform decisions, target inequalities, and evaluate what works.
- Active community engagement through co-production and inclusive, asset-based approaches.
- Close partnerships with local authorities to align efforts across health, social care, housing, and public health.
- Robust market and contract management ensuring quality, efficiency, and value for money.
- Shared financial understanding with providers to guide sustainable investment and service design.
- A skilled, flexible workforce deployed effectively across the health and care system.
Implementation and Timeline
The Strategic Commissioning Framework presents a clear roadmap for Integrated Care Boards (ICBs) to enhance their commissioning capabilities between now and 2026/27. During this period, ICBs will shift from short-term, transactional commissioning to a strategic, population-focused approach that emphasises prevention, integration, and long-term impact.
NHS England will provide national support through shared guidance, data tools, workforce development, and leadership programs to help ICBs build the necessary capacity. The framework encourages systems to begin embedding new ways of working by developing shared data platforms, fostering local partnerships, and aligning resources to ensure readiness for full implementation.
Expected Outcomes and Impact
The Strategic Commissioning Framework, once fully implemented, is expected to transform the planning and delivery of health and care services across England. By utilising integrated intelligence, evidence-based design, and collaborative commissioning, Integrated Care Boards (ICBs) will be better positioned to improve population health outcomes, reduce inequalities, and provide more efficient, high-quality care.
This shift toward system-wide planning aims to strengthen connections between the NHS, local authorities, and community partners, ensuring that investment decisions maximise value and support sustainable health and wellbeing for local communities.
