The Strategy Unit has developed a local decision-making framework to empower systems as they look to design new contracting approaches aimed at improving outcomes. It is free to use for all NHS and Third Sector organisations.

The NHS Long Term Plan (LTP) calls for a shift to a new service model with patients receiving joined up care, at the right time and in the most optimal care setting. Central to achieving this will be the health and care system working together in alignment and coordinating resources towards these shared goals. The LTP also sets the NHS’s priorities for outcomes and quality improvement for the next 10 years. 

It is unlikely that any single provider will be able to achieve these outcomes alone. Progress will instead be dependent upon the work of a range of organisations across health, social care, local government, the third sector and beyond. Local systems will need to design approaches to contracting and payment that align with their approaches to quality and outcomes improvement, and that reflect the population covered, the scope of services and the associated provider configuration. Without that alignment, the risk of conflicting incentives and ineffectual interventions is high.

In the absence of a nationally-determined approach, each local system should determine how it will proceed. This resource provides a framework, based on relevant national guidance and the international evidence base, to support local decision-makers embarking on a new approach. The framework guides systems in:

  • Confirming system aims and objectives;
  • Determining the scope of populations and services to be included in contracts, and the priority outcomes;
  • Determining the local provider configuration model;
  • Assessing the appropriateness of the mechanisms available for – 
    • Allocating resource to providers, and
    • Generating improvement in quality and outcomes;
  • Understanding the drivers of system behaviours likely to operate as a result of, or independent of, those mechanisms.

If you have any queries about the framework or would like to discuss any aspect of outcome based commissioning, we would be delighted to talk with you.  Please contact