Supporting ICB Commissioning Through Smarter Project and Programme Management

As Integrated Care Boards (ICBs) continue to take shape and mature, many system leaders are reflecting on a fundamental challenge: how can we better manage complexity, risk, and delivery across a landscape that is more integrated, more ambitious, and more accountable than ever?

This is not a theoretical concern. Effective ICB commissioning is central to this challenge. ICBs are now responsible for commissioning care at scale, improving population health, tackling inequality, and delivering financial balance, all while leading system wide transformation. 

The stakes are high, the pressure is real, and the need for operational clarity has never been greater. 

Commissioning in Complexity: The New Normal

Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022.

The ICB commissioning model is fundamentally different to what came before. It is collaborative by design, requiring coordination across NHS providers, local authorities and third sector organisations. It is outcomes focused, demanding benefits realisation over activity tracking. And it is strategically driven, with priorities often evolving in real time based on need, funding and policy.

Every NHS Integrated Care Board (ICB) is responsible for determining the range and level of clinical/medical services provided to the public it serves. In this environment, traditional approaches to project delivery, often fragmented, inconsistent or overly focused on process, simply are not enough to support effective ICB commissioning.

Instead, what is needed is a shift toward smarter PPM that enables:

• System wide visibility of programmes and interdependencies
• Benefits led planning and commissioning from the outset
• Robust governance that does not stifle flexibility
• Clear prioritisation aligned to strategic goals
• Transparent reporting that enables trust and a clear line of accountability throughout the process

Why Smarter PPM Matters for ICBs

Most ICBs are running large scale transformation portfolios, often with dozens of active projects across multiple workstreams such as digital, estates, workforce, urgent care redesign, and community models.

With this volume and complexity comes risk, including duplication, drift or disconnect between what is planned and what is delivered.

By applying the principles of smarter PPM, system leaders can:

• Create a single version of the truth across programmes
• Understand capacity and capability gaps before they become bottlenecks
• Focus on outcomes not just outputs, embedding benefits into every programme
• Support collaboration, while still maintaining control and clarity
• Tell a coherent story of delivery to regulators, boards and communities

Smarter PPM is not about bureaucracy. It is about enabling ICB commissioning to happen more effectively, more transparently and with greater confidence.

Smarter Local Authority Project Management: a Case Study 

Discover how local authority project management helps councils deliver complex services more efficiently. Including challenges, tools, and a real-world case study.

Key Shifts in PPM Thinking for ICB Leaders

For ICBs looking to evolve their approach, here are five practical mindset shifts that can help:

1. From activity tracking to value tracking
   Make benefits realisation a central thread, not an afterthought
2. From siloed initiatives to portfolio thinking
   Treat transformation as a connected strategic portfolio, not a list of disconnected projects
3. From reactive reporting to proactive insight
   Use live data to make real time adjustments and enable agile governance
4. From delivery at organisation level to system level
   Align delivery mechanisms with the system architecture of integrated care
5. From compliance to collaboration
   Build processes that foster partnership while still meeting governance standards

Tools Are Important but Culture and Capability Matter More

It is easy to focus on tools when thinking about PPM, but the most successful ICBs are focusing first on culture, clarity and capability

• Are project teams clear on how their work contributes to commissioning goals?
• Do system partners feel part of shared delivery plans?
• Are portfolio boards getting timely, meaningful information or long reports with little insight?

The most effective ICBs also regularly update and review their practices over the years to ensure they remain current and effective. This continual improvement is paramount to sustaining high-quality ICB commissioning.

PM3, can support better PPM practices. But the foundation must be built on shared understanding, trusted processes and clear strategic alignment.

Final Thought: Commissioning Smarter, Not Harder

ICBs are under pressure to deliver transformation, show value, and maintain public trust. Smarter PPM is not a silver bullet but it is a critical enabler of delivering more effectively in a complex, high stakes environment.

The future of integrated care depends not just on what gets commissioned but on how well it is delivered.