Strategic Commissioning In The NHS: What The New Framework Means For Pharma, MedTech And Device Companies

On November 4, 2025, NHS England published the Strategic Commissioning Framework, setting out how Integrated Care Boards (ICBs) will shift from transactional purchasing to genuine population level stewardship.

This document signals a shift in how decisions will be made, how priorities will be set and how resources will be allocated across the NHS in the coming years. This document matters, it is much more than just another policy paper.

For organisations supplying into the NHS; pharmaceuticals, medtech and device companies, diagnostics, digital health innovators and service partners, this  framework marks a fundamental change in where value conversations need to happen.

It moves commercial engagement upstream, into the arena of population health planning, pathway redesign, prevention and multi-year health outcomes.

The NHS is moving firmly toward strategic commissioning, treating the health system as something to shape and improve over time, not merely manage year to year. And the organisations who understand how to align with this shift will be those who become embedded in care pathways and stay there.

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What the strategic commissioning framework really means for industry

The new Strategic Commissioning Framework defines strategic commissioning as a continuous and evidence based process to improve population health outcomes, reduce inequalities and deliver maximum value for every pound spent.

In practice, this means the NHS is:

• Looking at population data, trends, risks and variation.
• Identifying where the biggest gains can be made in health outcomes and system efficiency.
• Planning services around strategic goals, not just historic patterns.
• Allocating funding based on population needs and outcome ambitions.
• Evaluating delivery rigorously, with impact and value as the central tests.

This is not new in concept, but the framework gives it operational clarity, governance requirements and a clear expectation that ICBs must now embed this way of working.

The four stages of strategic commissioning

The framework outlines a structured cycle that ICBs must follow:

1. Understanding the context.

Population intelligence, segmentation, inequalities mapping, demand modelling, capacity analysis, asset mapping. This is where analytics teams, public health teams and planning teams work together.

2. Developing a long term strategy

Setting multi-year health improvement goals, defining priorities and outcomes, deciding how the overall system should shift (e.g., toward prevention, toward out of hospital care, toward digital enablement).

3. Delivering through the commissioning function

Designing pathways, shaping markets, deciding contracting approaches, allocating resources, specifying service expectations, designing incentives.

4. Evaluating impact

Measuring outcomes, analysing variation, capturing learning and feeding this into the next cycle.

This is a multi-year loop, not an annual planning exercise.

Commissioning at multiple scales

The framework is explicit that commissioning decisions should be made at the right spatial level:

• Neighbourhoods (30,000–50,000 people). Community based, personalised and integrated care; primary care neighbourhood teams.
• Places (250,000–500,000 people). Most service delivery and transformation work, this is where the majority of partnership opportunities sit.
• ICB/system level. Service models, large contracts, long term strategy, financial resource decisions.
• Multi-ICB/regional/national level. Highly specialised services, advanced digital and data infrastructure.

This matters because your commercial model, route to decision makers and evidential case may need to vary by level.

The enablers the NHS will invest in

The framework highlights transformational enablers that will shape priorities:

• Data, analytics and intelligence.
• Clinically led governance.
• Local community co-design.
• Stronger primary care and neighbourhood infrastructure.
• Digital, AI and genomic tools to target care more effectively.

Suppliers whose value proposition strengthens one or more of these enablers will be well positioned.

Why this framework matters to industry

This shift has several direct implications for commercial strategy.

For a start, value conversations are moving upstream, and they start with clinicians. The framework reinforces something I emphasise in my book Embedded; to influence system level change, suppliers must engage much earlier in the decision making process, before procurement, before formulary decisions, before business cases are written.

This upstream engagement happens where pathways, models of care and future service flows are shaped, and it involves a different set of conversations with a broader group of system leaders:

• Directors of Strategy and Planning.
• Population Health and Intelligence Leads.
• Primary Care and Community Transformation Teams.
• Place based Partnerships.
• Provider Collaboratives and Clinical Networks.

But critically, those strategic conversations only land if the clinical case is already won.

In Embedded, I describe this as the two-step influence sequence:

• Win the clinical argument first. Clinicians must see your solution as the right thing for patients, pathways and outcomes. That means demonstrating:

o   Clear clinical benefit.

o   Practical pathway fit.

o   Impact on workload, not just outcomes.

o   Real world feasibility in everyday NHS conditions.

If clinicians are not convinced, no amount of commercial or strategic framing will cut through.

• Then get managers to enable and operationalise those clinical decisions. Once clinical leaders are aligned, the role of system managers, transformation teams and commissioners is to:

o   Build the contracting and funding mechanism.

o   Organise workforce and service model changes.

o   Agree evaluation metrics and reporting.

o   Embed the new model across the pathway, not just in isolated settings.

This is how innovations move from a good idea in a clinic to something written into the pathway to standard practice across a system.

The suppliers who succeed under the new framework will be those who start conversations upstream, lead with clinical value, work with system leaders to design implementation and stay involved long enough to prove impact.

In other words, partners in system redesign, not just product vendors.

The “offer” must now be pathway and population oriented

As strategic commissioning becomes the dominant approach, the NHS is no longer choosing products, it is choosing whole models of care.

Suppliers must present pathway models, workforce considerations, implementation support and measurable outcomes over time.

If you can articulate how your offer improves an entire pathway for a defined population, you will be welcomed as a partner in delivering system outcomes, not just a supplier of tools.

Evidence and economics matter more than ever when pitching to the NHS

To influence strategic commissioning, companies will need to show:

• Return on investment (not only clinical effectiveness).
• Cost avoided over 1–5 years (not just acquisition cost).
• Impact on health inequalities and access.
• Reductions in demand on urgent and emergency care.
• Support for shifting activity from acute to community settings.

Ultimately, companies that can demonstrate real world impact, backed by robust evidence and long-term economic value will be the ones the NHS choose to partner with, because this is where value becomes visible – when clinical benefit is tied to economic return and delivered sustainably across the pathway.

The list of priority conditions is not exhaustive

As I emphasise in my book Embedded, when the conversation moves to pathways, any condition becomes strategically important if variation exists and outcomes can be improved sustainably.

Industries well placed to benefit include:

• Respiratory, where earlier diagnosis and optimal treatment prevent exacerbations and admissions.
• Cardio renal metabolic conditions, where integrated pathways can prevent deterioration and multimorbidity.
• Mental health and neurodegenerative conditions, where stabilising care in the community reduces crisis demand.
• Diagnostics and medtech, where targeted data, testing and devices support earlier intervention and better resource use.

But this is not a closed list. The NHS is not prioritising conditions; it is prioritising partners who can help redesign pathways.

That means if you work in:

• Dry eye disease
• Menopause
• Allergy
• Wound care
• Stoma care
• Dermatology
• Gastroenterology
• Musculoskeletal conditions
• Or any other area where care is variable or demand is rising

…the opportunity is here, and it is now.

The offer the NHS is looking for is a pathway partner, not a product vendor, and those who step into that role will be the ones who become embedded in system strategy, service redesign and sustained delivery over time.

What Companies Should Do Next To Align With The Strategic Commissioning Framework:

1. Re-frame your proposition around population outcomes and long term value.
2. Map the systems where care variation is highest and build case studies there.
3. Engage earlier, with system strategy and transformation leads, not only procurement.
4. Co-design care models with NHS partners, don’t just deploy products.
5. Build in evaluation, offering data, reporting and measurable outcomes.
6. Be prepared to pilot and show results within real NHS conditions.

Help the NHS hit its goals and you’re halfway there

The NHS is making a deliberate and structural shift, from reactive service management to long term, population level strategic planning. Strategic commissioning reframes the purpose of the system, from simply managing today’s pressures to shaping tomorrow’s outcomes.

It changes who is involved in decisions, when conversations happen and what counts as “value.” This shift is not abstract. It will determine how priorities are set, how funding flows and how improvements are measured across systems over the next decade.

For pharma, medtech and device companies, this represents a significant opportunity but only for those prepared to adapt how they engage. Traditional product first messaging and transactional procurement conversations are no longer sufficient.

The successful organisations will be the ones able to demonstrate how their solutions improve an entire pathway, reduce unwarranted variation, support prevention and release capacity in primary, community and hospital services. In other words, those who can show how they help the NHS achieve its strategic commissioning goals.

Doing that requires a shift in approach. Companies must position themselves as partners in pathway redesign, not vendors of products. That means engaging clinical leaders early to co-create the definition of “good care,” generating real world case studies that demonstrate clinical and economic value, and working with managers and commissioners to operationalise change at scale.

Value must be shown not only in outcomes but in sustainability because that is where commissioning decisions are now being made.

This is the foundation of the approach I outline in Embedded: the model for getting innovations not only adopted but embedded in pathways in a way that lasts.

The core message is simple; when you help the system solve a problem, you stay in the system. If you want practical strategies and language for building those relationships, designing pathway aligned offers, and influencing at system level, the book is a useful guide for doing exactly that.

At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners and system leaders to implement real change. We then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.

With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his book Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Embedded shows you how to reframe your offer, align with NHS priorities and make change stick.