Commissioning in the NHS – first as tragedy, then as farce?
The framework for strategic commissioning could be our chance to end the ritual of plans that never move money. It asks ICBs to be intelligent payors, segment populations, commission across pathways, and evaluate impact. The music is right. Doing the dance is going to be damn difficult.
Here is what I would do as a chair, chief exec, or director across health and local government.
– Name two cohorts where avoidable utilisation is high and modifiable.
– Commission integrated neighbourhood teams around them with clear outcomes, a theory of change, and contractual discretion for providers within guardrails.
– Use a short Strategic Commissioning Options Appraisal to sequence resource shifts over two to three years. Be explicit about stranded costs, double-running, mitigations, and what decommissioning actually means for people and staff. Publish the decision criteria and the provider impact analysis.
– Create a VCSE stabilisation and growth line, with alliance-style agreements where appropriate. Fund community capacity as an outcome driver, not a decorative add-on.
– Run the Commissioning Compass across the partnership to show where capability needs to move next, then report progress quarterly alongside outcomes and equity gaps.
None of this is exotic. It is the sober craft of commissioning. It is also the only way to turn frameworks into better outcomes for people.
chosen path 