NHS Strategic Commissioning Framework: What Primary Care Leader Needs to Know
- 1 day ago
- 5 min read
At THC Primary Care, we create resources for primary care leaders.
In this blog, we are covering the NHS Strategic Commissioning Framework, what's changing and what this means for you.
In this guide, you'll discover:
✅ The six major changes coming to commissioning that will directly impact how your PCN operates
✅ Critical dates you cannot miss - from January 2026 strategy deadlines to March 2027 capability requirements
✅ The 4-stage commissioning process ICBs must follow - and exactly where PCNs fit into each stage
✅ Real opportunities for PCNs - including enhanced roles, greater autonomy, outcomes-based contracts, and delegated commissioning responsibilities
✅ What's expected of you - the new capability bar for population health management, evaluation, and strategic partnerships
✅ Three new contractual models explained - SNPs, MNPs, and delegated commissioning, plus what it takes to succeed with them
✅ The key enablers - from ICB intelligence functions to the NHS Federated Data Platform
The NHS Strategic Commissioning Framework | What's happening?
Here are the headlines.
Keep reading for the details ⬇️
➡️ ICBs consolidating (42 → ~26) with strategic commissioning as their core purpose
➡️ Neighbourhood-level care is officially recognised as "most effective" for coordinating complex patients - that means GP practices, PCNs, and community teams
➡️ New provider models launching: Single Neighbourhood Providers (SNPs) and Multi-Neighbourhood Providers (MNPs)
➡️ Outcomes-based contracts - Focus shifts from activity to what's actually achieved for populations
➡️ Resources moving from acute to community - Gradually, with "double running costs" acknowledged
➡️ Higher capability expectations - Population health management, evaluation, and strategic analysis are now essential
The opportunities:
✅ Primary care shapes local services through neighbourhood health plans
✅ Enhanced roles with greater autonomy (SNP/MNP models)
✅ Outcomes-based contracts with discretion over service design
✅ Potential delegated commissioning responsibilities
✅ Access to ICB intelligence functions and NHS Federated Data Platform
✅ Investment shifting from hospitals to community settings
The expectations:
⚠️ Demonstrate population health impact, not just activity
⚠️ Develop data literacy and evaluation capabilities
⚠️ Manage complex partnerships (social care, mental health, VCSE, local government)
⚠️ Accept accountability for population health outcomes
⚠️ Engage in strategic planning now while decisions are being made
The timeline:
📅 January 2026 - ICBs must have 5-year strategies and population health improvement plans finalised (8 weeks away)
📅 March 2026 - ICB baseline self-assessments
📅 2026/27 - Framework adoption begins, formal NHS England assessments start
📅 March 2027 - Intelligence functions, evaluation approaches, and co-production methodologies must be in place
The four stages ICBs must follow:
1. Understand context (by March 2026) Integrated needs assessments using person-level data, population segmentation, service performance analysis → Primary care contributes local knowledge and patient insights
2. Develop strategy (by January 2026) 5-year ICB strategy, population health improvement plan, neighbourhood health plans → Primary care provides strategic input - these plans cannot succeed without GP and community team leadership
3. Deliver and allocate Resource allocation based on population needs, outcomes-based contracts, lead provider models, potential decommissioning of underperforming services → New contractual opportunities for primary and community care providers
4. Evaluate impact (by March 2027) Monitor quality, operational and financial performance across short/medium/long-term → All providers must demonstrate measurable population health impact
What the framework says about primary care:
"At the heart of successful neighbourhood working"
"Leading role in the development of neighbourhood health"
"Greater collaboration and better outcomes" through primary care networks and at-scale working
ICBs must: Create conditions for resilient primary care | Strengthen GP leadership | Promote collaboration | Support transformation
The new contractual options:
Outcomes-based contracts: Focus on outcomes achieved with provider discretion over how services are delivered
Lead provider models: One organisation drives integration, oversees delivery across multiple providers, has discretion over resource allocation
Delegated commissioning: Providers have formal roles in ICB decision-making through committees or joint committees
Caveat: Success depends on "system maturity, provider skills in commissioning, clear accountabilities, strong relationships and robust case that changes deliver benefits"
The different scales of commissioning:
National/Multi-ICB: Specialised services, ambulance
ICB/System level: Acute care planning, strategic direction, primary care commissioning (GP/pharmacy/dental/optometry)
Place level: Integrated commissioning with local government, neighbourhood health plans
Neighbourhood level (30,000-50,000 population)
Ongoing coordinated care for individuals with complex conditions
Proactive multidisciplinary team-based care
Population health management
Prevention and early intervention
Key statement: "The ongoing co-ordination of long-term care for named individuals living with complex conditions is most effectively undertaken at the neighbourhood level."
The financial reality
"Moving from current models to best practice cannot rely on growth in funding"
Requires reallocation of existing resources, addressing "double running and stranded costs," and may take several years.
Investment will shift to prevention, community and primary care - but providers must demonstrate better outcomes first.
ICBs will:
Develop a clear prioritisation methodology
Provide transparency on resource movement
Undertake provider impact analysis
Use medium-term financial planning
Key enablers coming:
Intelligence functions - ICBs developing analytics and population health management support for neighbourhoods
Co-production - Mandatory, properly resourced community engagement by March 2027 (particularly seldom-heard groups)
Local government partnership - Integration with Directors of Public Health, Adult Social Care, Children's Services, Housing
Multidisciplinary leadership - Clinical input from GPs, nurses, allied health professionals, pharmacists, social workers, psychologists, midwives, dentists, and optometrists embedded throughout
Technology - NHS Federated Data Platform as default by March 2027, AI, wearables, genomics, robotics, joined-up data
Who this affects:
✓ GP practices and PCNs
✓ Community health services
✓ ICB commissioners and planners
✓ Practice managers and administrators
✓ Local authority public health and social care teams
✓ Mental health services working at the neighbourhood level
✓ VCSE organisations delivering health services
✓ Anyone involved in integrated care delivery
What capabilities are needed:
Population health management: Risk stratification, demand projections, understanding cost drivers, and identifying where outcomes can be enhanced
Proactive care: Targeted interventions addressing modifiable risk factors, case-finding across multidisciplinary teams, and care coordination
Service design and delivery: Streamlining access and transitions, facilitating multidisciplinary teams, community engagement, and contract management
Strategic analysis: Understanding current and future delivery costs, evaluating interventions, demonstrating impact, and health economics
NHS England will provide tools and programmes to build these capabilities
Quality and safety
Use contractual levers for improvement
Proactively manage risks
Conduct quality impact assessments for service changes
Work with the Patient Safety Incident Response Framework
In conclusion
This framework explicitly recognises neighbourhood-level primary care as the foundation for integrated, proactive population health management.
Opportunities are intended to exist for enhanced roles, greater autonomy, and investment shifting to community settings.
But expectations are higher: population health outcomes, evaluation capabilities, strategic partnerships, multidisciplinary working, and tight timelines.
The strategies affecting your area are being written now. If primary care isn't engaged in these conversations, decisions get made without the people who know patients best.
For commissioners: This is your roadmap for the next 5 years
For providers: This shapes your contracts, funding, and expectations
For system leaders: This defines how you'll be assessed
For patients and communities: This determines how your local NHS services will be planned and delivered
We hope this helps!
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About Us
THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.
Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.
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