Strategic Commissioning: From Evidence to Impact – A Whole-System Imperative

At the 2025 NHS Confederation ICS Network Conference, over coffee and pastries at the breakfast session, we discussed an important challenge: how do we move commissioning from aspiration to action and make evidence the backbone of decision-making across the system? Hosted by IQVIA, the breakfast panel explored “Strategic Commissioning: Delivering Impact Through Evidence”.

It’s Everyone’s Business

Strategic commissioning isn’t just an ICB issue. It’s a whole-system responsibility. Commissioners, providers, and partners all have a role. If we want better population health outcomes and financial sustainability, we need to stop thinking and acting as silos and start pulling in the same direction.

Commissioning and Decommissioning

One theme that stood out: commissioning isn’t just about adding shiny new services. Sometimes it’s about making tough calls and stopping things that don’t deliver value. That takes courage and clarity. Whilst we could continue to debate about vertical versus horizontal commissioning, the truth is, we need both and must recognise that “we’re all in it together”.

Evidence isn’t Optional

If commissioning is the engine, evidence is the fuel. Three principles came through loud and clear:

Build a strong evidence base to understand population need.
Align incentives and avoid duplication through smart logic modelling.
Agree on a single version of the truth and that the data ‘is enough’ – because endless arguments over conflicting data, or the need to constantly seek 100%, helps no one.

Without these, we risk never moving forward with effective commissioning, and we’ll never be able to share and scale when we experience/see something great.

Managing Expectations

We all want to deliver for population need, that’s non-negotiable, but we also need to manage expectations, whether from patients, politicians, or professionals. That means resisting distractions, focusing on what works, and making decisions based on evidence, not just anecdotes. Whilst aligning finances and incentives is hard, it’s clear that this marks the difference between good intentions and real impact.

The Leadership Challenge

So where did we finish the discussion? Strategic commissioning isn’t just technical, it’s about leadership and working together – something we saw resonating throughout the rest of the conference. We kept hearing that ‘there isn’t time to wait for everything to be sorted’, we need people to be courageous in making tough decisions, to seek clarity in order to set priorities, and be relentless about collaboration to turn evidence into impact. If we can get this right then we’ll stop just tweaking the system, we will have what we need to transform it for the populations we serve.

NHS Solutions

Fueling transformation to increase value and improve patient outcomes

It’s Everyone’s Business

Commissioning and Decommissioning

Evidence isn’t Optional

Managing Expectations

The Leadership Challenge

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