Three key steps for Integrated Care Boards to deliver strategic commissioning across the NHS

Both guidance documents, as well as the 10-year Health Plan, set high expectations for strategic commissioning, and ICBs must grapple with what this means in practical terms, as they translate national ambition into new organisation designs and ways of working.

ICBs are beginning to align around a shared view of strategic commissioning, with capability-building in health economics, analytics, stakeholder engagement, and population insight emerging as top priorities. In our work with ICBs, we have identified three additional factors critical to the success of strategic commissioning, which have not received the same level of attention.

1. Working with the right partners – and knowing who does what

Cultivating strong relationships with organisations that may be better placed than ICBs to make specific contributions to the commissioning process is a vital skill for strategic commissioning teams to develop. These relationships and external contributions will be essential across all parts of the ICB Blueprint’s strategic commissioning cycle. For example:

Leaning on public health and local authority expertise to understand local needs and to shape population health strategy: Local authorities’ community relationships, expertise in the wider determinants of health and illness, and collaboration with Voluntary, Community, and Social Enterprise (VCSE) organisations will be pivotal for future ICBs. This will help them continue to undertake effective needs assessments and develop commissioning plans that genuinely reflect local population needs, despite significant reductions in resources.

Co-designing new care models with partner organisations: Commissioning teams can use their networks and relationships to bring the right voices and perspectives to redesign discussions, bringing clinical expertise, pathway knowledge, and a service-user perspective to inform opportunities for change. Service redesign programmes that are undertaken jointly will benefit from this combined expertise, as well as help ICBs to manage the level of resource needed to successfully deliver major change programmes.

Partnering with academic institutions and local Health Innovation Networks: Test and scale innovations, embed learning from qualitative and quantitative feedback into pathway redesign, and apply rigorous analysis to measure the effectiveness of services together. This will enable ineffective services to change or be de-commissioned – a vital part of the Strategic Commissioning Framework, which our work suggests is currently under-developed in many ICBs.

To maximise the benefits of building effective working relationships with external partners, relationships need to be underpinned by joint working agreements, setting out clear and agreed roles and responsibilities across organisations and teams.

2. Using technology to transform commissioning-specific tasks

The NHS 10-year Health Plan includes a significant focus on the potential of technology to transform healthcare. However, in addition to transforming care itself, it’s valuable for ICBs to consider what technology would be most advantageous in enabling their own strategic commissioning teams to undertake their role within the system. We have identified four key commissioning tasks where technology could play a transformative role:

Dynamic demand modelling: This involves tools that enable accurate, dynamic modelling of healthcare demand across a whole ICB population, and therefore the most accurate picture possible of the needs that the strategic commissioner must meet – similar to the models already in use in the provider sector. This will allow strategic commissioners to model and simulate future trends in health needs and system pressures, and so support a more proactive response to future demands (including scenarios to test the impact of potential service changes across the system). It will also allow strategic commissioners to model and simulate future trends in health needs and system pressures, to support a more proactive response to future demands (including scenarios to test the impact of potential service changes across the system).

Understanding local health priorities and behaviours: Solutions such as social media analytics, large-scale sentiment analysis, and web search behaviour tracking can be used to gain real-time insights into the population’s health priorities, behaviours, and experiences.

Streamlining contract management: Intelligent systems can streamline the management of contracts, including automatic tracking of compliance and surfacing risks. This technology is already transforming ways of working in other sectors, and has huge potential to improve the accuracy and timeliness of contract oversight, enable prioritisation of high-risk or high-value contracts, and reduce administrative costs.

Enhancing administrative efficiency: Strategic commissioners can also use technology to reduce manual workload across other office functions, including document handling, scheduling, reporting, and workflow automation – freeing up staff time for higher-value work, and improving consistency.

Technology’s ability to transform commissioning will play a pivotal role in shaping the future of ICBs, helping commissioners to navigate both very high expectations and significant cost reductions.

3. Embedding new ways of working within organisation design

ICBs should ensure that the design of strategic commissioning structures and teams is fully aligned to new ways of working. If organisational form should follow function, then there is a need for new forms to support the fact that commissioning will need to be done differently in future. For example: 

Organisation of strategic commissioning teams: ICBs can structure commissioning teams around populations rather than service lines provider contracts, thereby embedding a shift toward prevention and community care within the very structures of their organisations. Dedicated teams for prevention, early intervention, and specific population needs (e.g., long-term conditions) will drive integration and keep prevention a priority. 

Commissioning responsibilities at place and system level: The sharp reduction in running costs poses a challenge to ICBs’ desire to work as locally as possible. In most ICBs, place-based teams will need to be streamlined, with commissioning functions consolidated at the ICB level to unlock economies of scale and harness the specialised expertise. However, this shift doesn’t mean disempowering places. ICBs can assign clear responsibilities to places to lead specific service changes locally. A strong working relationship depends on a transparent, agreed framework that defines which changes are managed at place level and which are led by the ICB.

New structures alone are not enough to ensure that commissioning activities are undertaken differently – creating a prevention team doesn’t directly make services more preventative. But it does ensure protection of ICB time and resources for commissioning services that have previously been vulnerable to being de-prioritised when operational pressures bite. It also sends a clear signal about organisational priorities.

Working through these three areas has the potential to make the difference between strategic commissioning arrangements fully integrated within future ICBs and supported and reinforced by everything the organisation does, and those that will struggle with either resource constraints, failure to break away from previous ways of working, or both.

Despite uncertainty about how ICB redesign will play out, acting now to build on these strengths will position ICBs to deliver better outcomes, accelerate integration, ensure resilience, and help prepare for future challenges.