The NHS commissioning map is being redrawn once again. For those working to engage with the NHS, the challenge is not simply learning the new organisational topography, it is about evolving how you engage to stay part of the conversation.

The changes we’re seeing to healthcare commissioning in England are top to bottom: NHS England (NHSE) is being brought into the Department of Health and Social Care (DHSC); Offices for Pan-Integrated Care Board Commissioning (OPICs) are emerging as regional hubs for commissioning services at scale; Integrated Care Boards (ICBs) are evolving into strategic commissioners alongside clustering and reducing budgets by half; providers are being given greater autonomy; and greater focus and resources are being devolved to Place and Neighbourhood.

The result is not simply a new organisational chart. It is a shift in where decisions are made, how they are made and who is involved in making them. This is perhaps reinforced most clearly in the establishment of ‘No.10 North’ and a new prime minister focused on promoting the idea of Place.

So, if the commissioning world is changing once again, is your engagement strategy keeping up?

Let’s look at how OPICs, as new entities, and ICBs as strategic commissioners, might reshape the landscape.

OPICs have emerged as a necessity to manage the delegation of specialised commissioning from national to local, ensuring there is appropriate expertise in place to continue the effective commissioning of these services.

Delegated services are set to include vaccinations, most screening services, and health and justice services, among others. Importantly, OPICs are intended to support commissioning ‘at scale’ across ICBs to improve patient outcomes.

While in one sense OPICs might simplify industry engagement to a degree, i.e. decisions would cover multiple ICBs, in practice there is a series of potential hurdles to navigate.

To take one example: how will ‘top-down’ commissioned services that span ICBs map against ‘bottom-up’ commissioned services at Place and Neighbourhood level within ICBs? OPICs will also be directly accountable to DHSC for those services that will remain commissioned at a national level, so how does that intersect with local decision-making?

At the same time, we have ICBs now focused on strategic commissioning, with fewer resources at their direct disposal.

While keeping one eye firmly focused on the needs of local populations, ICB leaders will also potentially be exposed to far more direct scrutiny from Ministers than before with NHSE and its regional teams gone. This exposure could bring into focus the interventions that will shift the dial for local populations.

For industry, strategic commissioning means a potential reframing of how conditions are considered. It requires a focus on understanding population need, setting priorities, and commissioning services around the desired outcomes. So, for example, respiratory or cardiometabolic conditions aren’t pathways in isolation, but become priorities around neighbourhood health or health inequalities.

And rather than being involved in the depths of delivery, the ICB is there to create the conditions to deliver, explore contracting models and direct resources. There may no longer be one obvious ‘payer’ or one obvious decision-maker with which to engage.

The formal architecture is changing, but the reality on the ground will not change uniformly across England.

ICBs such as SouthEast and SouthWest London are already working under joint leadership, and the South London Office of Specialised Services (SLOSS) helps to align work across four specialist providers and both ICBs to support pathway transformation in areas such as cardiac, blood-borne viruses, neuroscience and sickle cell disease.

With OPICs on the horizon, localities may be preoccupied with how that is going to change roles and responsibilities again, creating further uncertainty.

South Yorkshire ICB is an example of an ICB on the other side of a restructure, which now has a more streamlined focus on neighbourhood health, health inequalities, prevention and productivity among other areas.

As the ICB now focuses on the vision, the role of partnerships is increasingly important to delivery with a local emphasis on strengthening collaboration, aligning priorities and ‘moving from project-based working towards more consistent collective delivery across organisations and places.’

For industry, this creates a fundamental distinction between understanding the theory of the new NHS and understanding how the new NHS is actually operating in a particular location. The policy architecture is the starting point, but local intelligence is what makes it useful.

Here are few guiding principles that could support your thinking:
Firstly, to help navigate the pathway or problem at hand, ask yourself: ‘Who is shaping the problem, who has the authority to act, who controls the resources and who needs to be involved in implementation?’ The answer may involve several organisations and several levels of the system.

Secondly, understand where the local system actually is in its transformation journey. Do not assume that every ICB, Place or OPIC is at the same stage of development. Some may be looking for a flagship initiative. Others may be seeking practical support to implement an agreed direction. Public board papers can give you a helpful steer.

Thirdly, understand the local ‘worry list’. What is currently keeping NHS leaders awake at night? Is it financial sustainability, waiting lists, workforce capacity, variation in care, hospital demand, implementation of a new pathway or delivering the shift towards prevention and care closer to home?

This may be more important than knowing the formal title of the person you are meeting, so keep your networks warm.

A strong engagement conversation should therefore begin with curiosity. What is the local system trying to achieve? What is getting in the way? Where is there a gap between ambition and delivery? Only then should industry consider where its evidence, expertise, medicines or technologies might contribute.

Life sciences have a great deal to offer these conversations: evidence; data; experience of implementation; and insight into how innovations have supported change in other systems, but the strongest partnerships will begin with the NHS’s priorities rather than the industry’s organisational chart.

The healthcare commissioning world is changing once again and it’s not over yet.

Whilst this can create confusion, change is also an opportunity. What are those partnership forums where you could get involved early to really understand the challenges and potential solutions? If industry isn’t already being consulted, why not?

Staying curious to local needs and having a more dynamic approach to local stakeholder engagement could help you stay on the front foot and evolve alongside the system, rather than waiting for the NHS to re-engage with you.

The one bit of certainty we may have is a continued emphasis on localism from the new prime minister.

Andy Burnham’s experience of health devolution in Greater Manchester has provided a prominent example of the argument that decisions about health and public services can be more effective when taken closer to the communities they affect.

‘Manchesterism’ continues to make the political argument that local progress is best delivered by local leadership.

While the innovation offered by life sciences may not have changed, how you communicate this and to whom has. Although you may need to adapt to the new environment, this could be as much of an opportunity as it is a challenge.

Investing in a dynamic understanding of the subnational commissioning landscape could be the key to unlocking an engagement approach fit for the next ten years.