Strategic commissioning is the NHS’s new long-term, evidence-led approach to planning, funding and shaping health and care services. It replaces short-term, transactional contracting with a 5-year, outcomes-focused population health model.
From April 2026, strategic commissioning becomes the core statutory function of Integrated Care Boards (ICBs). It directly determines:
- What services are commissioned
- Who delivers them
- At what scale (neighbourhood, place, system)
- With what outcomes and value for money
It is designed to deliver the NHS’s three major system shifts:
- From treatment to prevention
- From hospital to community
- From analogue to digital
The Four Stages of Strategic Commissioning
- Understanding Population Need
ICBs must carry out annual Integrated Needs Assessments using:
- Linked health, care, housing and social data
- Public health intelligence
- VCSE insight and trusted community intelligence
- Lived experience and co-production
- Risk stratification and population segmentation
This stage explicitly requires understanding:
- Health inequalities
- Underserved and inclusion health groups
- Demand pressures now and into the future
- Developing Long-Term Population Health Strategy
Each ICB must publish a 5-year Population Health Improvement Plan by January 2026, built from:
- Integrated Needs Assessments
- Health & Wellbeing Board strategies
- Neighbourhood Health Plans
- National NHS priorities
Each priority must include:
- Agreed outcomes
- Delivery milestones
- Delivery scale (neighbourhood → system)
- Named leadership and governance
This stage also includes:
- Care pathway redesign
- Joint commissioning with Local Authorities
- Planned service reconfiguration and decommissioning (with consultation)
- Commissioning, Investment & Market Shaping
ICBs will use strategic commissioning to:
- Shift funding toward prevention and early intervention
- Introduce outcome-based contracts
- Shape provider markets across NHS, Local Authorities and VCSE
- Apply Provider Selection Regime (PSR) flexibilities
- Introduce risk-share and longer-term contracting models
Importantly, the framework explicitly requires:
- Investment in community and VCSE-led services
- Active market support for fragile and prevention-focused services
- Social value and neighbourhood delivery models
- Evaluation, Improvement & Decommissioning
All commissioned services will be:
- Continuously evaluated against:
- Outcomes
- Inequalities
- Access
- Productivity
- Reviewed using both data and lived experience
- Scaled if successful
- Decommissioned if they do not demonstrate impact
This represents a major cultural shift from funding “activity” to funding “evidenced impact”.
What This Means for the VCSE
1) The framework positions VCSE organisations as:
- A core system delivery partner, not a peripheral contributor
- Prevention and early intervention providers
- Neighbourhood health delivery partners
- Trusted community intelligence brokers
- Co-designers with lived experience
- System integrators through social value
2) The future commissioning environment will increasingly move away from:
- One-year grants
- Unstable short-term funding
- Fragmented service models
3) And towards:
- Longer-term outcome-based contracts
- Neighbourhood-scale provision
- Consortia and alliance delivery
- Integrated community pathways
4) Key Opportunities for the VCSE
- Stronger formal influence over commissioning priorities
- Greater system investment in prevention
- A guaranteed role within neighbourhood health models
- Longer-term funding stability through commissioning
- Increased recognition of VCSE as anchor organisations
- Expansion of VCSE into pathway leadership roles
5) Key Risks If the VCSE Is Not Ready
- Decommissioning decisions made without VCSE influence
- Smaller organisations excluded from system-scale contracts
- Short-term grant funding disappearing without replacement
- Increased competition from non-VCSE providers
- Marginalisation where outcomes and impact cannot be evidenced
What VCSE Organisations Now Need to Be Ready For
1) VCSE organisations will increasingly need:
- Outcome and impact measurement capability
- Digital and data readiness
- Contract governance and delivery confidence
- Partnership and consortium working
- Neighbourhood-scale operating models
- Strong safeguarding, financial and quality systems
- Clear social value and prevention impact evidence
2) Key Questions the VCS Must Now Be Asking
- How will VCSE be embedded in Integrated Needs Assessments?
- Where does VCSE sit in neighbourhood-level commissioning?
- Will there be VCSE consortia for system contracts?
- How will smaller organisations be protected during market reshaping?
- How is lived experience shaping real commissioning decisions?
- How will prevention funding reach VCSE providers in practice?