Briefing: the NHS now commissions outcomes, not activity

NHS England’s new Strategic Commissioning Framework is a major shift in how the health system will drive improvement. From 2026/27, Integrated Care Boards (ICBs) will move from purchasing services to acting as strategic commissioners responsible for population health, equity, and measurable system value.

This shift changes what gets adopted, how technologies are evaluated, and the type of evidence innovators must generate.

Why this framework matters

ICBs will commission outcomes, not activity, so innovators must evidence pathway impact, reduced avoidable demand, improved equity, and system efficiency. Value will be judged at the system level, meaning technologies must show operational gain, cost avoidance, prevention benefits, and alignment with Population Health Improvement Plans (PHIPs).

Prevention, community-based models, and digital-first care are strategic priorities. Commissioning decisions will increasingly prioritise technologies that reduce inequalities and support underserved populations.

What this means for innovators

The times of theoretical models and pilot-scale data are over. To succeed innovators need to embrace a new approach that’s grounded in the new reality of the NHS:

Real-world return on investment (ROI) must be demonstrated using NHS data, not theoretical models.

Solutions must integrate with system priorities and support population-level outcomes, not isolated organisational goals.

Evidence must align with PHIPs and demonstrate benefit across entire pathways.

Technologies that reduce inequalities or variation in access will have stronger adoption potential.

Innovators will need stronger real-world data, aligned evaluation metrics, and evidence that speaks to whole-system impact.

What this means for ICBs

The shift requires ICBs and innovators to work together differently:

ICBs will need clearer frameworks to assess innovation readiness and system-wide suitability.

Shared data standards and interoperable infrastructure will be essential for fair comparison of technologies.

Workforce impact and readiness will become core commissioning considerations, favouring innovations that reduce pressure or improve capability.

ICBs will increasingly rely on trusted convenors like FCC to align NHS providers, councils, VCSEs, industry, and regulators around shared adoption goals.

The opportunity ahead

Commissioning doors are changing, not closing, and innovators who adapt early will be well positioned. Technologies must support prevention, reduce system pressure, integrate with community-based and digital-first care, and align with PHIP priorities. Evidence must reflect the language and metrics commissioners are now required to use.

Strategic commissioning signals a new era in which innovation is judged on population benefit, measurable value, and contribution to prevention and equity. Organisations that understand system incentives, collaborate effectively, and build aligned evidence will lead the next wave of NHS adoption. FCC is already operating in this space and is well positioned to support both innovators and ICBs navigating this new commissioning landscape.

FCC can help you navigate the new commissioning landscape.

FCC is ideally placed to help both innovators and IBSs reposition their value, build the right evidence, and translate innovation into system-level impact. We act as a system integrator, bringing together NHS, local government, VCSE partners, industry, and regulators — now essential to linking patient outcomes to population impact as required by the NHS.

Our Digital Care Adoption Readiness work supports ICBs and innovators to understand what is required for system-level adoption. FCC also provides real-world adoption support through testbed design, pathway mapping, and workforce readiness, helping innovations move from pilot to practice.

If you’re looking to scale innovation sustainably and responsibly, contact Dr Lauren Evans at lauren@futurecarecapital.org.uk.