Strategic Commissioning Framework: Neighbourhood Care

The framework introduces a four-stage commissioning cycle that ICBs and partners are expected to follow:

1. Understanding the context

Systems must draw on population-level data, local intelligence, lived experience, and community insight to build a detailed picture of needs, inequalities and demand. This includes segmentation at neighbourhood level, mapping assets, and understanding the wider determinants shaping health outcomes.

2. Developing long-term strategy

Commissioning strategy should take a five-year view, aligning with population health priorities, national standards and local transformation goals. Importantly, the framework recognises that strategy must operate at different scales; system, place and neighbourhood, ensuring that the priorities of smaller communities are reflected in wider system plans.

3. Delivering through resource allocation and commissioning activity

Following the release of the Model ICB Blueprint in May 2025, ICBs will now be responsible for commissioning various provider activities, ranging from resource allocation and contract development to revamping approaches to payments. Their role will be heavily focused on outcomes over activities and developing/enabling stronger, long-lasting partnerships.

4. Evaluating impact

Continuous improvement is a central expectation. Systems and their partners are required to keep track of outcomes, service experience, as well as equity and value. Insights will need to be evaluated regularly in order to decide whether services need to be redesigned and decommissioned entirely. The framework also states that partners at every level will need to take shared accountability for these processes and actions.

The framework repeatedly acknowledges neighbourhoods as a critical delivery unit for integrated, preventative care. Several themes stand out for neighbourhood teams, primary care, community providers and VCSE partners.

Neighbourhood-level insight becomes foundational

Understanding the context requires far richer local intelligence than before. Service gaps, monitoring local needs, community patterns, and feeding lived experience will become the responsibility of neighbourhood teams, i.e. PCNs, MDTS, community nurses, plus those that work in social care and the VCSE area will all play a key role in providing and measuring insights.

Stronger alignment between neighbourhood priorities and system strategy

The framework formalises the idea that neighbourhood priorities must influence system plans, not sit beneath them. ICBs will need to co-develop strategies with place and neighbourhood partners and ensure that preventative, community-based interventions are properly reflected in long-term planning.

Commissioning models shift towards prevention and community capacity

The resource-allocation stage gives neighbourhood care a clearer foothold. Systems are encouraged to direct investment towards upstream interventions, local assets and community-based support where evidence shows long-term value. This could include neighbourhood hubs, proactive care models, outreach services and enhanced VCSE collaboration.

Evaluation becomes central to sustaining neighbourhood models

Neighbourhood care teams will also be responsible for demonstrating impactful outcomes. From equity improvements to reduced demand, services will need to be measured continuously and insights fed back to central to establish whether they either need to be decommissioned completely, or adapted to ensure they are delivering value.  

Partnership working is no longer optional

Neighbourhood care is framed as a joint endeavour across health, social care, VCSE organisations, housing, and community partners. The framework reinforces that commissioning must reflect this wider landscape, with neighbourhood teams actively shaping decisions across sectors.

While the Strategic Commissioning Framework sets the direction, much of the practical detail will emerge as systems begin to apply it. Over the next year, we can expect ICBs, places and neighbourhood teams to start reshaping their planning processes around the four-stage cycle. Early changes are likely to centre on strengthening local intelligence, improving the quality of neighbourhood-level data, and building consistent ways for communities to feed insight into commissioning decisions.

There may also be a gradual shift in resource flows as systems look to redirect funding towards prevention, early intervention and community capacity. Neighbourhood teams could see clearer investment in multidisciplinary working, proactive care models and local VCSE partnerships, particularly where these can demonstrate measurable impact on population health.

As evaluation becomes a more formal part of strategic commissioning, we may see systems testing new neighbourhood-care approaches at small scale before expanding them. This could lead to a more iterative, learning-driven model of improvement where neighbourhoods act as real-world testbeds for service redesign.

Finally, the framework’s emphasis on shared accountability suggests that closer alignment between system, place and neighbourhood is on the horizon. Over time, strategic commissioning may help reduce the gap between what communities say they need and the way services are planned, funded and delivered.