What is ‘Fit for the future: towards population health delivery models‘
The NHS has published a new commissioning guide for Integrated Care Boards called “Fit for the future: towards population health delivery models.” (Read the full article here). This is a guide for NHS commisioners: particularly ICBs on how population health will be commissioned and outlines the upcoming changes to services
The document states the NHS as “undergoing the biggest change process since its inception”.
The NHS has had no shortage of “big shifts”. However, the scale of what is proposed is truly astounding. If followed through every part of the NHS will have changed in form and function.
Because this is not just a structural tweak. It is an attempt to change how commissioning works at a fundamental level. How money flows. What providers do, How people do it. How risk is managed. And what the system is actually trying to achieve.
Table of Contents
The Shift from Activity to Population Health Commissioning
For years, NHS commissioning has been built around activity.
Providers deliver services. Activity is measured. Contracts are agreed. Money rewards activity.
That approach has shaped behaviour across the system. Hospitals fill up. Prevention struggles to secure funding. Services become increasingly specialised and disconnected from each other.
However, this has led to hospitals consuming ever more funding (58%) with little overall impact. As pointed out by the Darzi review.
Whilst funding to the NHS has gone up healthy life expectancy has gone down. (see chart above)
The new model is trying to move away from that. So that funding is used to greater impact and finally shifts away from hospitals into frontline and community services. (Described by Lord Darzi as the left shift)
ICBs are now expected to commission around population health, not just services. That means understanding the needs of defined populations and working with local authorities and partners to design care around those needs.
It sounds obvious.
But it requires a very different way of thinking.
Commissioning becomes less about purchasing services and more about managing outcomes, risk, and long-term value across a whole population.
Why NHS England Is Changing the Commissioning Model
The driver behind this reform is straightforward.
The NHS is dealing with:
- Rising demand
- Increasing long-term conditions
- Widening health inequalities
- Financial pressure across the system
As reported by the NHS 10 Year Plan, care pathways remain fragmented. Patients move between services that are not well connected. Providers are often incentivised to focus on their own performance rather than collective outcomes.
Population health commissioning is meant to address this.
By aligning funding and accountability around populations, the intention is to:
- encourage collaboration between providers
- support earlier intervention and prevention
- reduce avoidable hospital use
- improve outcomes across whole pathways
That is the ambition.
What ICBs Are Now Expected to Do
This reform significantly changes the role of Integrated Care Boards. (ICBs)
ICBs are no longer just planning and funding services. They are expected to actively manage population health.
In practice, that means developing a much deeper understanding of:
- population needs and risk profiles
- demand across services
- the true cost of care across pathways
It also means using data differently.
Real-time data is expected to identify people who need support now, not just report what has already happened. Activity and cost data should be used to identify where interventions increase value and reduce long-term risk.
And then comes the part that will test the system.
ICBs are expected to act on this insight.
That includes reallocating funding between providers and using new contracting approaches to incentivise collaboration and better outcomes.
This is not passive commissioning. It is active system management. Shaping the healthcare system to meet population health needs.
New NHS Provider Models: SNPs, MNPs and IHOs Explained
To support this shift, the NHS is introducing new contracts.
At neighbourhood level, Single Neighbourhood Providers (SNPs) will deliver integrated services for local populations. This is intended to enable primary care to take on a broader role beyond traditional GP contracts.
Across larger areas, Multi-Neighbourhood Providers (MNPs) will coordinate services across several neighbourhoods, (approx 5 or 6) managing demand and working to reduce avoidable hospital admissions through shared risk approaches.
The most significant development is the introduction of Integrated Health Organisations (IHOs).
IHOs will hold a whole population health budget for a defined geography. They will plan care across the entire pathway and allocate resources accordingly. They will also be accountable for outcomes and system performance.
This represents a major shift in how responsibility is structured within the NHS.
Integrated Health Organisations (IHOs): The Most Controversial Change
IHOs are expected to take on a role that extends beyond traditional provider boundaries.
This includes responsibility for areas such as general practice, pharmacy, dentistry and optometry, even though these contracts remain nationally defined.
This creates a clear tension.
Questions around control, accountability and autonomy are likely to become significant as this model develops. How decisions are made locally, and how national frameworks interact with local responsibility, will shape how IHOs operate in practice.
This is likely to be highly controversial as IHOs by their very nature create power imbalances in the system. Meaning that conflict is highly likely.
The Real Challenge: Can the NHS Deliver Population Health?
The direction of travel is hard to argue with.
More prevention. Better coordination. Improved use of data. Stronger focus on outcomes.
The challenge is whether the system can operate in a way that makes this possible.
Because this model depends on:
- organisations working together in genuinely shared ways
- data being used in real time to guide decisions
- resources moving across organisational boundaries
- a willingness to take on shared financial and clinical risk
These are not small changes.
They go directly against many of the behaviours the current system has reinforced over time.
That is why implementation will be difficult.
The Neighbourhood Health Framework
The Neighbourhood Health Framework was published by NHS England on the same day. The two documents are meant to be read side by side. With the Neighbourhood Health Framework outlining the structure of changes in providers. You can read a summary here. And an analysis and insight on how to implement it succefully here.
What This Means for Neighbourhood Health
For those working in neighbourhood health, this shift creates a significant opportunity.
The policy direction now aligns with approaches that focus on:
- prevention
- community-based support
- relational models of care
Work that has often struggled to gain traction within traditional commissioning models is now being positioned as central to how the NHS should operate.
But alignment at policy level is not enough.
Neighbourhood models still need to be understood, funded, and sustained within a system that remains under pressure.
That means being able to:
- demonstrate value clearly
- navigate commissioning processes
- translate local work into system-level outcomes
This is where many teams are currently facing challenges.
And it is why building shared learning, evidence, and practical understanding across systems matters. Supporting teams to design services, navigate commissioning, and develop credible evaluation is becoming increasingly important as these reforms take shape
Neighbourhood Health Business Cases.
The changes to commissioning alongside quotes from head of the NHS Sir Jim Mackay, strongly indicate that there will be no direct funding for neighbourhood health. Instead, providers will likely to have to create business cases to ICBs and within providers to ensure that funding is diverted into neighbourhood health. It is far from an ideal situation as i discuss here. Because of the range of options available it may well mean that those working in neighbourhood health are competing with each for limited funds. If you want personal support with your business case get in touch and book an appointment.
NHS Commissioning Reform: What Happens Next?
The transition to population health commissioning will take time.
Key developments expected include:
- a developmental year for new contracting models in 2026/27
- gradual introduction of outcome-based contracts
- agreement of neighbourhood footprints across systems
- expansion of risk-sharing approaches, particularly in out-of-hospital care
NHS England is also launching a strategic commissioning development programme to build capability within ICBs.
The first wave of Integrated Health Organisations is expected to be announced soon.
Final Thoughts: A Turning Point or Another Reform?
This could mark a genuine shift in how the NHS operates. Moving towards population health, prevention and more local responsibility for health outcomes.
But the NHS has had many reform programmes that promised similar things. What matters now is not the policy.
It is whether this changes how decisions are made in practice, how resources are allocated, and how organisations behave day to day. That is where this will either succeed.
If you want to read about how this may be successfully implemented please read my analysis on the Neighbourhood Health Framework below.
Further Reading
Fit for the future: towards population health delivery models.” (Read the full article here).
Neighbourhood Health Framework Summary (Read the full article here).
Neighbourhood Health Framework Analysis (Read the analysis here)
Help and Support
We have established a community The Neighbourhood Health Academy by neighbourhood health professionals. Please join through this link. If you would like to learn more details are here:
If you want 121 support please book an appointment and get in touch.