Commissioning for integrated care

These examples show how commissioning can align services across primary, community, and secondary care. By creating shared pathways and outcomes, commissioners and providers have reduced duplication, improved patient experience, and embedded prevention into service design. 

Surrey Downs Health and Care

Surrey Downs Health and Care (SDHC) is a partnership between Epsom and St Helier University Hospitals NHS Trust, Surrey County Council, and three local GP federations. Operating through a joint venture, it delivers adult community health services for 300,000 residents, including bedded care in community hospitals, an integrated frailty unit, community nursing and therapies, specialist services, and urgent care through response teams and virtual wards. These services are organised through Integrated Neighbourhood Teams (INTs) across six Primary Care Network (PCN) footprints, embedding multidisciplinary working and prevention locally. 

This approach has delivered measurable improvements. Therapy services were redesigned within INTs, reducing waiting times from 18 weeks to just 3. Overnight hospital admissions have sustained a 30% reduction compared to pre‑pandemic levels, while older residents have seen 35% fewer A&E attendances, 31% fewer non‑elective admissions, and 11% fewer GP contacts. These outcomes show how neighbourhood services can reduce acute demand and support recovery at home. 

The Surrey Downs model also demonstrates how formal joint ventures align governance and strengthen accountability, while involving local people to build legitimacy and sustainability. Together, these features have created a model of holistic, accessible care that provides a blueprint for scaling up community‑based services across wider systems. 

North Central London Health Alliance

The North Central London (NCL) Health Alliance is an ‘all in’ provider collaborative that brings together all NHS trusts and foundation trusts across acute, mental health, community, and specialist services, alongside a GP provider alliance representing every GP in the system. By pooling resources, aligning governance, and jointly commissioning services, the alliance is able to support Integrated Neighbourhood Teams, where health, social care, and voluntary staff are co‑located to deliver joined‑up services. Borough‑level governance structures involve frontline staff and voluntary partners, ensuring decisions reflect the perspectives of those closest to patients. This integration across organisational boundaries secures staff buy‑in, protects quality, and strengthens collaboration. 

The impacts are already clear. Staff report feeling less isolated and better supported, with early evidence of reduced sickness and attrition. Patients benefit from proactive interventions such as joined‑up home visits and improved referral standards, helping to identify deterioration earlier and reduce reliance on crisis care. Activity is shifting into community settings, demonstrating how to embed prevention across services and improve outcomes. 

Oxfordshire home‑based care

Oxfordshire’s place‑based partnership has brought together acute, community, and local authority services to reduce hospital pressures and improve patient outcomes. A key commissioning decision was the creation of a Transfer of Care hub, where nurses, social workers, and therapists jointly plan discharges. This has reduced delays and ensured therapy and social care are delivered more quickly, improving hospital flow. 

Commissioners also expanded home‑based care capacity from 20,000 to 30,000 hours per week, shifting the balance of care towards independence and recovery at home. INTs built around PCNs in Banbury, Bicester, and Oxford, were commissioned to address local priorities such as frailty, child respiratory conditions, and inequalities in deprived areas. These multidisciplinary teams coordinate health, social care, and voluntary support, helping residents avoid unnecessary hospital visits and live independently. 

The impact has been clear: proactive neighbourhood care has lowered demand for acute services, while expanded home‑based provision has enabled more patients to recover at home. By using commissioning to integrate services, Oxfordshire has created a model that combines hospital flow improvements with community‑based prevention. Place‑based commissioning harnesses local authority accountability and NHS expertise, strengthening system ownership and tackling inequalities.

Delegating specialised commissioning from NHS England to ICBs offers real promise, but it’s not without complexity. Done well, this shift can bring some specialised services closer to home, including into neighbourhood settings, improving access and experience for patients. But it also carries risks. Commissioning over smaller footprints can fragment services that rely on consistency and specialist expertise. To avoid this, as strategic commissioners, ICBs must work hand-in-hand with providers striking the right balance between local delivery and national standards.

Alongside these changes, enabling collaboration beyond the health sector is critical. Stronger partnerships with local government are key to moving from a system that treats sickness to one that prevents it. Co-commissioning offers huge potential to wrap care around people with complex needs. Greater Manchester's pooled budgets show what’s possible. Yet, as ICBs consolidate and local authorities undergo restructure, new challenges are emerging. ICBs will need to adopt flexible, place-based approaches that keep public health and social care central to commissioning decisions, ensuring prevention and equity remain at the heart of system design.