Commissioning for innovation at scale: A practical playbook for ICBs
By Chris Garner, Associate Director, NHS North Central London ICB
Most innovations in the NHS fail to scale not because they don’t work, but because they’re commissioned in ways that set them up to fail. Too often, promising solutions are procured through short-term pilots, fragmented funding pots, or narrowly defined service specifications that cannot deliver the conditions needed for real-world impact. At the same time, the NHS faces rising demand, workforce shortages, and constrained budgets. Delivering the 10-Year Plan and sustaining the health service for future generations will require commissioning approaches that actively enable, not unintentionally inhibit, innovation that shifts care closer to home and maximises workforce capacity.
Innovation is not a “nice-to-have”; it is essential. But it is also more than adopting new technology. It depends on commissioning models that support providers to redesign pathways, embed new ways of working, and deliver: better outcomes for patients, empowered staff, financial sustainability, equity and consistency.
This article sets out a playbook for Integrated Care Boards (ICBs) to commission innovation at scale, illustrated through North Central London’s (NCL) experience with Doc Abode, and outlines how regional and national partners can support replication across the country.
Why ICBs should lead the revolution
ICBs are accountable for improving population health and delivering value for money and a renewed mandate for strategic commissioning. Therefore, they must drive innovation as a core system function.
Even as the operating model for the NHS changes, ICBs remain essential in enabling innovation to be delivered at scale. They sit in a unique position where they can see the system challenges and bring together multiple providers and stakeholders to implement solutions that no single provider could achieve alone. Importantly, they hold the financial levers to redirect investment across settings and commission at scale rather than within fragmented contracts.
NCL ICB has shown what this looks like in practice with the roll-out of urgent community response (UCR) and virtual ward workforce coordination software across four community services providers.
Learning from Doc Abode in North Central London
Challenge
Across NCL, manual coordination for UCR teams across four community providers was creating inefficiencies, wasting staff time, and delaying patient care. Coordinators spent hours each day matching available clinicians to urgent referrals using phone calls, spreadsheets, and fragmented systems. The result was slower responses for patients, frustrated staff unable to work efficiently, and poor visibility of community capacity across the system.
Solution
To address this problem, NCL ICB commissioned Doc Abode – a real-time workforce coordination platform that matches the right clinician to the right patient at the right time. The rollout followed a structured evaluation of potential solutions and was co-designed with providers and frontline staff to ensure it reflected operational realities and built confidence and ownership. This investment formed part of a wider £3 million shift from acute to community services, within a £50 million Core Offer Transformation Programme designed to strengthen community care and demonstrate the value of strategic commissioning.
Implementation
The programme began with a staff-first approach, identifying provider champions and deploying hands-on rollout support to build trust and encourage adoption. Implementation was phased across four providers, shaped by active feedback loops and continuous engagement.
As the solution scaled, NCL established real-time data dashboards and peer-learning networks to drive continuous improvement and sustain benefits over time. This collaborative approach ensured integration into daily workflows and alignment with the Single Point of Access and Integrated Care Coordination Hubs, giving operational teams a unified view of capacity across boroughs.
Impact
The results show what strategic commissioning can achieve when innovation is implemented at scale with proper support.
The service has avoided thousands of hospital admissions, with providers moving from variable performance to consistently achieving over 90% 2-hour UCR responsiveness. This included some sites reaching this level for the first time. Since implementation, NCL has seen a 32% increase in total visits and a 37% increase in visits per shift, demonstrating both efficiency and workforce optimisation. Patients now receive faster responses and more care at home, reducing unnecessary emergency-department attendances.
Staff report spending less time on administration and more on patient care, while built-in lone-worker protection and fairer work allocation with protected breaks have improved safety, morale, and retention. System-wide coordination has also improved markedly: coordinators now have a single, real-time view of community capacity, enabling quicker adjustments during the day and reducing duplication.
Together, these outcomes show how targeted investment, co-design, and system-level commissioning can deliver measurable, sustained improvements for patients, staff, and the wider health system.
A playbook for commissioning innovation
From NCL’s experience, a repeatable framework is emerging as a practical playbook for ICBs to commission innovation at scale.
This process is iterative, not linear. Each step informs the others, and ICBs will need to adapt as circumstances change. But the principle remains constant: ICBs must lead innovation deliberately and systematically.
1. Define the problem with providers and citizens
Start with one clear, measurable problem that you have co-designed with providers and citizens, including seldom heard groups, and keep it scoped to a specific pathway and place. Agree the baselines, a small set of metrics and data access upfront, name the owners and set a simple review rhythm. Note the non-negotiables, the Electronic Patient Record (EPR) stays the record of care, no duplicate entry, safety and accessibility protected, then map the key handoffs and set a few hypotheses for the first 100 days. Capture it all in a one page problem brief and a short benefits pact so success, equity checks and course corrections are clear from day one.
2. Prioritise by importance and solvability
Once the problem is clear, prioritisation becomes critical. ICBs face multiple competing demands, and dispersing effort across numerous small pilots means lots of activity generated but with little sustained impact. Assessing challenges by both their scale of impact and their feasibility of resolution helps focus energy where it can make the most difference. Not every problem is equally solvable, and not every innovation is equally ready. Challenges that affect multiple providers, have clear operational metrics, and can be addressed with mature solutions should be prioritised over those requiring significant R&D or single-organisation fixes.
3. Scan the market and test the evidence
With priorities established, understanding the market through mapping available solutions, exploring their integration potential, and scrutinising return on investment evidence with healthy scepticism. Engaging providers in the shortlisting process builds confidence and ownership early, reducing resistance when implementation begins. The goal is not finding the perfect solution but finding one that is sufficiently proven and feasible to back. Use the NHS Innovation Accelerator and your Health Innovation Network to identify innovations with independent real-world evaluations and verified return on investment (ROI) evidence. Visit live sites and speak with staff who use the product every day to understand what really works.
Your check list for choosing a solution should include whether it can:
- Align with a national priority
- Have real world evidence you can verify
- Integrate into existing workflows without friction
- Start to demonstrate in year return on investment
- Reduce steps in the care pathway
- Save time for frontline staff
- Demonstrate a track record of implementation.
4. Secure buy-in and investment
Aligning system partners requires transparency and shared metrics. Develop investment criteria focused on system impact and deliverability. Where innovation shifts care upstream, funding should follow.
This requires honest conversations about risk and trade-offs, particularly when diverting resources from immediate operational pressures to longer-term transformation. NCL secured system commitment to shift funding from acutes to community services by using modelling of avoided non-elective occupied bed-days as the key metric to demonstrate system impact and financial ROI.
5. Procurement at scale
ICBs can make their most tangible difference through strategic, system-wide procurement. Coordinating across multiple providers reduces duplication, avoids fragmented contracts, and creates leverage with suppliers. Commission services, not products, ensuring suppliers are accountable for adoption, operationalisation, and outcomes. Standardise requirements where possible, especially around integration and data. Structure contracts around measurable results, service performance, and phased scaling.
6. Information governance and data security
Addressing IG and data security early prevents them from derailing implementation later. Using system-wide templates for Digital Technology Assessment Criteria (DTAC)s, Data Protection Impact Assessments (DPIA)s and information governance (IG) checklists reduces the burden on individual providers and prevents each trust from starting from scratch. Consider pooling Trust and ICB resources and subject matter experts such as Data Protection Officers, Chief Security Officers, Chief Clinical Informatics Officers, Cyber and IG experts to agree processes and provide assurances –‘do it once’.
7. System integration
Innovations that require duplicate data entry or new workflows tend to fail. Integration must be treated as a design principle.
The Health Innovation Network’s 2025 London survey found that over 60% of community staff lacked access to key patient information, such as GP records and test results, undermining productivity, safety, and joined-up care.
ICBs should prioritise interoperability and open standards, ensuring solutions integrate with local EPRs and shared care platforms. While London benefits from the London Care Record, other regions can develop equivalent shared-access models. Integration governance should be streamlined so providers aren’t solving the same problem repeatedly.
8. Implement strategically
Technical rollout alone does not guarantee success. Sustainable change depends on early engagement, co-design with staff, and clear ownership across suppliers, providers, and the ICB. Implementation must be run as a joint endeavour between these partners, not delegated to one organisation. Appointing clinical and operational champions with protected time ensures credibility on the ground and supports consistent adoption. Equally, it is vital to fund change capacity explicitly. If clinical time is used, backfill it to avoid adding pressure to frontline teams. A phased approach – testing in one area, refining through feedback, and then scaling – reduces risk and builds confidence. Simple metrics, rapid feedback loops, and visible action on user input builds trust with the team using the solution.
9. Embed and sustain
Innovations fail when they remain temporary projects rather than becoming routine practice. Establishing peer learning networks spreads insights across providers and prevents knowledge from staying siloed. Contracts, workforce plans, and data flows need to embed the innovation as business as usual. Real-time evaluation demonstrates ongoing value, allows adaptation as context changes, and provides the evidence base for scaling further or adjusting course. Celebrate success at every opportunity. Highlight what worked and be open about what did not go to plan and how you adapted so it did. You can even collaborate with your Health Innovation Network (HIN) to commission robust independent evaluation and share learnings in regional and national forums or in thought leadership (like this!).
Overcoming barriers to successful scaling
We appreciate that delivering innovation at system level is rarely straightforward. NCL’s experience surfaced a series of barriers that are common across the NHS and which must be addressed if other ICBs are to replicate and scale success.
Culture remains the biggest hurdle. NHS organisations are naturally risk-averse, with staff wary of change and leaders hesitant without robust evidence. Change sticks when staff are engaged first and evidence is co-owned. Provider champions and real-world pilots build confidence faster than mandates. The goal isn’t to eliminate risk, but to manage it through iteration and transparency.
Seeing reality clearly. Data quality issues often mask inefficiencies. In NCL, once common definitions and baselines were established, the need for change became obvious. Under pressure, providers often default to requesting more staff rather than addressing productivity barriers yet staffing business cases are held to lower evidence standards than technology investments. Applying the same rigour to both ensures effort turns into more care, not more activity.
Fragmented commissioning wastes energy and money. Short contracting cycles, multiple frameworks, and disjointed procurement mean individual providers often negotiate separately for similar solutions, leading to duplication, inconsistency, and systems that don’t speak to one another. Strategic commissioning at ICB level enables scale, secures better value, and ensures consistent implementation across providers.
Financial constraints are real. Funding for transformation is limited, and short-term budgets discourage longer-term investment even when the case is clear. NCL secured system commitment to redirect £3 million from acute to community services – the advantage you have with commissioning digital innovation is that it has the biggest potential bang for your NHS buck, with the strongest ROI, especially in a sector like community services with a lower levels of digital maturity.
Information governance and integration slow everything down. IG requirements vary by organisation, and achieving interoperability is difficult even when everyone agrees that it’s necessary. NCL addressed this by tackling IG early, using system-wide templates to reduce duplication, and making integration capability a core procurement criterion.
Demonstrating value is complex. Business cases involve uncertainty about ROI, and evaluation capacity is limited. More fundamentally, much of the impact from innovation is realised over the long-term, such as reduced demand on acute services, improved workforce retention, and better population health outcomes. However, these benefits don’t align neatly with short-term annual budgets and planning cycles. NCL focused on a small number of measurable outcomes linked to system priorities – avoidable admissions, workforce efficiency, response times – and built in real-time evaluation to adapt iteratively rather than waiting for perfect evidence. This approach balanced the need for quick evidence with recognition that transformation takes time to embed.
These barriers aren’t insurmountable, but they require deliberate action. Strategic commissioning provides the platform to address them but only if leaders are willing to work differently and tackle the messy reality of system change.
Conclusion
North Central London’s experience shows that strategic commissioning for innovation can deliver measurable benefits for patients, staff, and the wider health system. By adopting this playbook, other ICBs can replicate success, embedding innovation as a core commissioning function rather than an optional extra.
But to achieve transformation at scale, local ICB action needs to be matched by enabling national policy:
- A national DTAC and IG passport – one approval, transferable across trusts to cut through bureaucratic duplication.
- Dedicated innovation funding streams – to support redirection from acute to community services without forcing ICBs to raid already-stretched budgets.
- Regional evaluation support – evidence generation, peer learning, and market scanning via HINs.
- National incubation and scaling – through the NHS Innovation Accelerator (NIA) to accelerate proven solutions like Doc Abode.
Done well, this approach can create an NHS where innovation consistently translates into better outcomes, not as an occasional success story, but as the way the system routinely solves problems and adapts to change.
