What is needed for it to succeed?

Making these shifts sustainable requires more than ambition. It demands longer-term planning and the freedom and flexibility to plan with local populations in mind. Trust leaders have welcomed the significant shift away from single year planning towards multi-year planning, set out in the medium-term planning framework. Strategic commissioning will only succeed if it enables transformation through multi-year plans, shared outcomes across system partners, and the right incentives. It requires commissioners and providers to be bold, moving beyond incremental tweaks to redesign services around population health needs and tackling inequalities head-on. 

This evolution of commissioning must go beyond funding activity. It should centre on co-designing services tailored to local populations, and the models to deliver them (e.g. integrated health organisation contracts) Trusts are already leading the way, redesigning pathways, integrating care, taking on delegated budgets, and delivering at scale through provider collaboratives. Their leadership, and operational insight will help ICBs as they look to shape the provider landscape in line with priorities, and configure services at the right scale, from neighbourhood to region. Strategic commissioning should amplify and learn from these experiences, not override them.