In July 2025, NHS England published Fit for the Future: the NHS 10 Year Health Plan, a document built around three shifts: from hospital to community, from analogue to digital, and from treating sickness to preventing it. Read narrowly, it is a plan for GP surgeries and hospital trusts. Read carefully, the nhs 10 year plan is really a rewrite of the integrated care board’s job description — the statutory body responsible for planning, commissioning, and funding care across each of London’s local health systems. For a city whose health debate has spent over a decade arguing that care needs to move closer to where people live, the plan reads as an instruction to finish that argument in practice.
From Block Contracts to Population-Based Commissioning
The plan’s most concrete change for commissioners is financial. Under the current system, many providers are paid through block contracts — a fixed sum regardless of how many patients are actually seen or how well they are treated. The 10 Year Plan sets out to dismantle that model. In its place, integrated care boards are expected to commission and pay for effective care, with payment withheld where care quality is poor and bonuses available where it is high. This is a deliberate move away from transactional, service-by-service commissioning and towards population-based approaches that follow a patient’s whole pathway, not just the single service they happen to be using that day.
For an ICB, that is a different kind of job. Instead of negotiating and monitoring dozens of separate contracts, commissioners are expected to act as system leaders for population health — building long-term, evidence-based strategies aimed at prevention and early intervention, and reducing the unwarranted variation in care that has long been a feature of London’s borough-by-borough health landscape.
Money Follows the Neighbourhood, Not the Hospital
The plan commits to higher investment growth in primary and community services relative to hospitals over the following three to four years, funding the shift of care out of acute settings and into neighbourhood-level provision. Multi-year budgets and financial incentives are intended to reward investment in preventative services rather than treatment after the fact. A new payment mechanism — “year of care” payments — is due to be tested from the 2026 to 2027 financial year, moving away from paying per appointment or per admission and towards paying for a person’s care needs across a full year.
The centrepiece of the neighbourhood ambition is a national rollout of Neighbourhood Health Centres: 50 are planned by 2029, rising to as many as 300 by 2035, with deprived areas prioritised for the earliest sites. These are designed as single locations offering a broad range of local services, open at least 12 hours a day, six days a week — a very different commissioning unit to a GP practice list or a hospital outpatient department, and one that requires ICBs to plan estate, workforce, and contracts around a place rather than a single provider.
New Provider Models, New Governance Questions
Alongside the neighbourhood centres, the plan introduces new provider structures, including Single Neighbourhood Providers covering populations of around 50,000 people, which may in time replace the traditional General Medical Services and Personal Medical Services contracts that most GP practices currently hold. Multi-provider commissioning arrangements are also being introduced, which means ICBs will need new governance and accountability frameworks to manage care delivered jointly across several organisations rather than by one named provider.
None of this is optional paperwork. Providers judged to be performing well are promised “earned autonomy” — greater independence and financial flexibility — while NHS England itself is being merged into the Department of Health and Social Care, with a commitment to cut central headcount by half. The practical effect is that more of the day-to-day judgement about what gets commissioned, and how it is paid for, moves down to ICB level, even as the centre becomes smaller.
What This Could Mean Across London’s Boroughs
London’s integrated care boards already sit at the sharp end of exactly the tension the plan is trying to resolve: a city with world-class acute hospitals and, in many boroughs, patchy access to the community and preventative services that are supposed to stop people needing those hospitals in the first place. The plan’s ambition to make ICBs coterminous with local government boundaries “wherever feasible” is a direct nod to that geography — London’s health system does not map cleanly onto a single administrative footprint, and commissioning decisions have long had to be negotiated across borough lines.
Two commitments are worth tracking closely for anyone following commissioning decisions in the capital. First, the plan expects 95% of people with complex needs to have an agreed care plan by 2027 — a target that depends entirely on community and primary care capacity existing where it is needed, not just where it currently happens to be strongest. Second, the number of people offered a personal health budget is expected to at least double by 2028 to 2029, with universal availability targeted by 2035. Both depend on ICBs actively commissioning for it, not simply administering what already exists.
| When | What changes |
|---|---|
| 2025/26 | National Quality Board relaunched with a new quality strategy; larger-geography GP contracts begin rollout |
| 2026/27 | “Year of care” payments tested as an alternative to block contracts |
| By 2027 | 95% of people with complex needs expected to have an agreed care plan |
| By 2028 | Single patient record system mandated across providers |
| By 2029 | 50 Neighbourhood Health Centres open, deprived areas prioritised |
| By 2035 | Up to 300 Neighbourhood Health Centres; universal personal health budgets targeted |
Why the Detail Matters More Than the Headline
It is easy to read a document like the nhs 10 year plan as a statement of intent and move on. But commissioning is where intent becomes budget, and budget is where a hospital, a GP practice, or a community clinic either gets the resources to change how it works or does not. The shift from block contracts to outcomes-linked payment, the multi-year budgets, and the new neighbourhood provider models are not abstractions for an integrated care board — they are the mechanics it now has to build. For London, a city of enormous variation in health outcomes across relatively short distances, how thoroughly each ICB translates this plan into local commissioning decisions will matter more than the plan’s own headline ambitions.
The direction is clear even where the local detail is still being worked out: less money tied to activity in a building, more money tied to a person’s outcomes wherever they are treated. That is a genuinely different commissioning task, and one London’s ICBs are only at the beginning of taking on.