Drawing on decades of experience, Nigel Edwards and Paul Corrigan reflect on what commissioning has taught us, why strategic commissioning matters now, and what ICBs will need to do differently to make this next phase count. 

ICBs are operating in a difficult context. Capacity is stretched, expectations are rising, and systems are balancing immediate operational pressures with the need to take on a more strategic commissioning role. That is exactly why clarity about the purpose and practice of strategic commissioning matters now.

For 30 years the NHS has talked about commissioning but – apart from the investment in World Class Commissioning – there has rarely been a serious attempt to give it the skills, authority and backing it needs. That does not mean commissioning failed. It means we need to be honest about where it worked, where it struggled, and what that tells us now.

At its best, commissioning brought partners together around shared goals, backed clinical leadership and improved outcomes for pathways and populations. It was strongest when it worked collaboratively with providers and local partners, and weakest when it tried to do too much with too little leverage, capacity or political support, or became distant from patients and services.

That history matters because strategic commissioning is returning in a different context. The 10 Year Health Plan gives it renewed importance as a driver of change at scale, not just to support isolated innovation, but to spread and embed new models of care across whole systems.

What is different this time is the context. As neighbourhood models, stronger place partnerships and more integrated provider arrangements develop, there is a real opportunity to make commissioning more effective than some previous versions. Its role is not to do everything itself, but to set direction, define outcomes, align resources, manage risk and create the conditions for better care to grow and spread.

That means being clearer about the difference between strategic commissioning and provider development. Providers, neighbourhood teams and place partnerships will lead much of the redesign of care and day-to-day improvement. Strategic commissioning has a different job: focusing the system on outcomes, clarifying accountabilities and making it easier for partners to deliver change.

It is also important to recognise the pressure commissioners are under. The lesson from the past is not that commissioning is unnecessary, but that strategic commissioning must be focused, realistic and properly supported.

So what comes next? If strategic commissioning is to succeed, ICBs will need to combine technical skill with strong relationships, confident leadership and a compelling case for change. In practice, that means focusing on a few things that matter most:

Set clear goals for population health and equity – strategic commissioning has to define the outcomes the system is trying to achieve, while leaving room for local ownership, co-design and practical delivery.

Create clarity about accountability and improvement – outcome-based approaches matter, but they need to be matched with realistic measures, balanced scorecards and a shared understanding of how progress will be judged across systems, places and providers.

Be explicit about what should be standardised and what should be locally shaped – if the aim is to reduce fragmentation and improve coordination, commissioners have to make clearer choices about where consistency matters and where flexibility should be preserved.

Develop financial frameworks that support real change – one of the hardest lessons from the past is that strategic shifts in care do not happen unless money can move over time, stranded costs are addressed, and transformation is backed by credible multi-year planning.

Build a public, partner and provider narrative for change – strategic commissioning will often involve asking people to do things differently. That means commissioners must be ready to explain why change is needed, why the status quo also carries risk, and how proposed changes will improve care for patients and communities.

This is not just technical work on contracts, governance and data – it also needs strong relationships, a shared culture and collaboration between ICBs, providers, local government, VCSE organisations and communities.

The task now? Work together and offer the right support to build our understanding on how to get this right. We need to be clear about what strategic commissioning is for, give ICBs the support they need, and to back them from the centre as they take on this role.

The NHS is set to launch a new Strategic Commissioning Development Programme later this year. Designed with systems for systems, it will be developmental – helping ICBs and partners to build the capabilities needed to deliver strategic commissioning in practical ways; sharing tools, learning and support that can be applied day to day .