{"id":1230,"date":"2026-07-20T07:00:34","date_gmt":"2026-07-20T07:00:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1230"},"modified":"2026-07-16T08:50:43","modified_gmt":"2026-07-16T08:50:43","slug":"audit-registry-and-outcomes-data-at-the-heart-of-strategic-commissioning-by-iain-smith","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/07\/20\/audit-registry-and-outcomes-data-at-the-heart-of-strategic-commissioning-by-iain-smith\/","title":{"rendered":"Audit, registry and outcomes data: At the heart of strategic commissioning. By Iain Smith"},"content":{"rendered":"

Integrated Care Boards (ICBs) play a crucial leadership role in the English NHS. They are responsible for managing health systems across large geographical footprints and ensuring services are planned and delivered to meet local population needs.<\/span>1<\/sup><\/span><\/p>\n

The UK government\u2019s new NHS modernisation bill confirms strategic commissioning – the process of planning, purchasing and monitoring services – as the central purpose of newly reconfigured ICBs.<\/span>2-4<\/sup><\/span> As ICBs move towards their role as strategic commissioners, they will focus on optimising resource use to improve population health; reduce inequalities; improve\u202faccess to services; and deliver high quality outcomes for patients.<\/span>2 3<\/sup><\/span><\/p>\n

To support ICBs in this role, is a strategic commissioning framework comprised of four key steps: understanding the local context; developing long-term population health strategy; delivering value-for-money outcomes; and evaluating impact of commissioning decisions.<\/span>3<\/sup><\/span><\/p>\n

Key to success as a strategic commissioner is the need to demonstrate measurable outcomes and improvement. Clinical audit and registry data must therefore play a major role at the heart of strategic commissioning.<\/span><\/p>\n

\u201c<\/span>National clinical audit and outcomes data should be a central part of really fantastic commissioning. They can provide ICBs an evidence base for a data-driven approach to decision making and help providers to drive improvement and demonstrate commissioned outcomes are being delivered.\u201d <\/span><\/i>Sir James Mackey, Chief Executive, NHS England<\/span><\/p>\n

Clinical audit, registries and understanding the local context<\/b><\/p>\n

Strategic commissioners must develop a deep understanding of their local population and its health and care needs.<\/span>3<\/sup><\/span> Clinical audit and registries provide condition and pathway specific data on care processes, outcomes, variation and inequalities across providers and geographies. Audit and registry data contribute benchmarked comparisons between local providers, ICBs, regions and national averages \u2013 helping commissioners identify where outcomes, access or care processes differ from expected standards.<\/span>5 6<\/sup><\/span><\/p>\n

For example, reducing lives lost to cardiovascular disease (CVD) is an identified priority in the NHS ten-year health plan for England.<\/span>7<\/sup><\/span> CVDPREVENT<\/span><\/a> is a national primary care audit using routinely extracted GP data to identify undiagnosed, undertreated or overtreated patients with high-risk cardiovascular conditions.<\/span>8<\/sup><\/span> This can support ICBs to understand population need, inequalities and prevention opportunities at place, neighbourhood and practice level.<\/span><\/p>\n

Clinical audit, registries and developing population health strategy<\/b><\/p>\n

Strategic commissioners need to develop evidence-based population health strategies that link health with broader socioeconomic outcomes to improve equity and support prevention.<\/span>3<\/sup><\/span> Strategies need to translate into outcomes that matter for patients, such as fewer heart attacks or strokes and effective care pathways.<\/span>7<\/sup><\/span><\/p>\n

The National Audit of Cardiac Rehabilitation (<\/span>NACR<\/span><\/a>) supports planning of cardiovascular prevention and rehabilitation services by monitoring access, equity, quality and outcomes.<\/span>9<\/sup><\/span> Whereas, the Sentinel Stroke National Audit Programme (<\/span>SSNAP<\/span><\/a>) captures whole-pathway stroke data supporting long-term strategy for hyperacute stroke, thrombectomy and rehabilitation.<\/span>10<\/sup><\/span><\/p>\n

Audit data and value-based healthcare<\/b><\/p>\n

Strategic commissioners must prioritise funding and maximise value.<\/span>3<\/sup><\/span> Delivery of strategic outcomes will be supported through allocating resources informed by data and population health priorities. Metrics from audits and registries can be included in contracts and transformation programmes. For example: the National Emergency Laparotomy Audit (<\/span>NELA<\/span><\/a>) links improved outcomes with shorter length of stay and potential savings;<\/span>11<\/sup><\/span> The National Hip Fracture Database (<\/span>NHFD<\/span><\/a>) supports the best practice tariff for hip fracture care in England;<\/span>12<\/sup><\/span> and the National Joint Registry (<\/span>NJR<\/span><\/a>) shows continued reduction in revision surgery and improved outcomes.<\/span>13<\/sup><\/span>\u00a0<\/span><\/p>\n

Clinical audit, registries and evaluating impact<\/b><\/p>\n

Strategic commissioners need to monitor whether decisions improved outcomes, reduced inequalities, improved access and delivered value.<\/span>3<\/sup><\/span> Clinical audits and registries are designed to identify where care meets standards and where improvement is needed. They enable repeated measurement and can support quality improvement cycles.<\/span>14 15<\/sup><\/span> Registries capture longitudinal data, and many audits publish periodic data, allowing commissioned changes to be tracked over time.<\/span>5<\/sup><\/span> By using audit and registry data, commissioners can evaluate the impact before and after pathway redesign, investment or service reconfiguration.<\/span><\/p>\n

Making it happen \u2013 access to data and linkage across datasets<\/b><\/p>\n

Audit and registry data offer meaningful clinical process and outcome metrics. The data however can sit in different places \u2013 such as individual audit provider websites. Furthermore, for strategic commissioning, ICBs must consider activity, workforce and finance data \u2013 which can also sit in separate places.<\/span><\/p>\n

Bringing datasets together supports a more rounded view of outcomes, safety, variation, equity, and value – not just lower cost. This points to an enhanced role for digital tools such as secure data environments (SDEs) and open access platforms such as National Clinical Audit Benchmarking (<\/span>NCAB<\/span><\/a>) and NHS Open Model Health System (<\/span>OMHS<\/span><\/a>).\u00a0<\/span><\/p>\n

NCAB provides benchmarked results from the National Clinical Audit and Patient Outcomes Programme (<\/span>NCAPOP<\/span><\/a>).<\/span>16<\/sup><\/span> OMHS provides benchmarked data on quality, productivity and outcomes, including from selected national clinical audits.<\/span>17<\/sup><\/span> Both NCAB and OMHS are open platforms providing benchmarked public data.<\/span>17 18<\/sup><\/span> This matters for strategic commissioning because ICBs are expected to make evidence-based, transparent decisions.<\/span><\/p>\n

SDEs are platforms that control who can access data, what they can access, and what they can do with it. They allow approved users to work securely with de-identified data and enable access to health and care data for research and analysis.<\/span>19 20<\/sup><\/span> SDEs reduce the need for ICBs to negotiate bespoke data flows and make evaluation of commissioning decisions easier.<\/span><\/p>\n

National clinical audits and registries can help ICBs move from broad strategic intent to measurable commissioning action – showing where need is greatest, where variation exists, and whether commissioned changes are improving outcomes equitably over time. Making audit and registry data available through SDEs and open access platforms would help ICBs use national audit and registry data as core strategic commissioning assets.<\/span><\/p>\n

References<\/strong><\/p>\n

    \n
  1. NHS England. What is integrated care? London, UK: NHS England; n.d. [Available from: <\/span>https:\/\/www.england.nhs.uk\/integratedcare\/what-is-integrated-care\/<\/span><\/a>.<\/span><\/li>\n
  2. Department of Health & Social Care. Health Bill: ICBs as strategic commissioners – fact sheet London, UK: UK Government; 2026 [Available from: <\/span>https:\/\/www.gov.uk\/government\/publications\/health-bill-icbs-as-strategic-commissioners-fact-sheet\/health-bill-icbs-as-strategic-commissioners-fact-sheet<\/span><\/a>.]<\/span><\/li>\n
  3. NHS England. Strategic commissioning framework London, UK: NHS England; 2026 [Available from: <\/span>https:\/\/www.england.nhs.uk\/long-read\/strategic-commissioning-framework\/<\/span><\/a>.]<\/span><\/li>\n
  4. NHS England. Commissioning: NHS England; n.d. [Available from: <\/span>https:\/\/www.england.nhs.uk\/commissioning\/<\/span><\/a>.]<\/span><\/li>\n
  5. NHS England. Clinical audits and registries: A best practice guide. London: NHS England (Available at <\/span>https:\/\/future.nhs.uk<\/span><\/a> ), 2026.<\/span><\/li>\n
  6. NHS England. Clinical Audit London, UK; NHS England ;n.d. [Available from: <\/span>https:\/\/www.england.nhs.uk\/clinaudit\/<\/span><\/a>.]<\/span><\/li>\n
  7. Department of Health & Social Care and NHS England. Fit for the future: 10 Year Health Plan for England. London: UK Government, 2025.<\/span><\/li>\n
  8. CVDPREVENT. The Cardiovascular Disease Prevention Audit Derby, UK: NHS Arden and Greater East Midlands Commissioning Support Unit; n.d [Available from: <\/span>https:\/\/www.cvdprevent.nhs.uk<\/span><\/a>.]<\/span><\/li>\n
  9. NHS England. National Audit of Cardiac Rehabilitation n.d. [Available from: <\/span>https:\/\/digital.nhs.uk\/data-and-information\/clinical-audits-and-registries\/national-audit-of-cardiac-rehabilitation<\/span><\/a>.]<\/span><\/li>\n
  10. Royal College of Physicians. Sentinel Stroke National Audit Programme (SSNAP) London, UK: Royal College of Physicians; 2017 [Available from: <\/span>https:\/\/www.rcp.ac.uk\/resources\/sentinel-stroke-national-audit-programme-ssnap\/<\/span><\/a>.]<\/span><\/li>\n
  11. Royal College of Anaesthetists. National Emergency Laparotomy Audit (NELA) London, UK: Royal College of Anaesthetists; n.d. [Available from: <\/span>https:\/\/www.rcoa.ac.uk\/research\/research-projects\/national-emergency-laparotomy-audit-nela<\/span><\/a>.]<\/span><\/li>\n
  12. Royal College of Physicians. The Fragility Fracture and Falls Audit Programme (FFFAP) n.d. [Available from: <\/span>https:\/\/www.fffap.org.uk\/FFFAP\/Resources.nsf\/<\/span><\/a>.]<\/span><\/li>\n
  13. NJR. National Joint Registry, London, UK: NJR; n.d. [Available from: <\/span>https:\/\/www.njrcentre.org.uk<\/span><\/a> accessed 29 Jun 2026.<\/span><\/li>\n
  14. Smith I. Quality management and clinical audit: Integrating clinical audit and quality improvement to deliver impact for patients London, UK: BMJ Leader; 2026 [Available from: <\/span>https:\/\/blogs.bmj.com\/bmjleader\/2026\/02\/09\/quality-management-and-clinical-audit-integrating-clinical-audit-and-quality-improvement-to-deliver-impact-for-patients-by-iain-smith\/<\/span><\/a>.]<\/span><\/li>\n
  15. Davey N, Shearer H, Matthew D, et al. Clinical audit and quality improvement: rivals, partners, or one and the same? <\/span>Frontiers in Health Services<\/span><\/i> 2026;Volume 6 – 2026 doi: <\/span>https:\/\/doi.org\/10.3389\/frhs.2026.1768450<\/span><\/a><\/li>\n
  16. HQIP. National Clinical Audit Benchmarking (NCAB) London, UK: Heathcare Quality Improvement Partnership; n.d. [Available from: <\/span>https:\/\/www.hqip.org.uk\/programmes-data\/benchmarking\/<\/span><\/a>.]<\/span><\/li>\n
  17. NHS England. Model Health System London, UK: NHS England; n.d. [Available from: <\/span>https:\/\/open.model.nhs.uk<\/span><\/a>.]<\/span><\/li>\n
  18. HQIP. National clinical audit data features in open access NHS Model Health System London, UK: Healthcare Quality Improvement Partnership; 2026 [Available from: <\/span>https:\/\/www.hqip.org.uk\/news\/open-mhs-launch\/<\/span><\/a>.]<\/span><\/li>\n
  19. Department of Health & Social Care. Secure data environment for NHS health and social care data – policy guidelines London, UK: Department of health & Social Care; 2022 [Available from: <\/span>https:\/\/www.gov.uk\/government\/publications\/secure-data-environment-policy-guidelines\/secure-data-environment-for-nhs-health-and-social-care-data-policy-guidelines<\/span><\/a>.]<\/span><\/li>\n
  20. NHS Digital. Secure Data Environments London, UK: NHS England; 2026 [Available from: <\/span>https:\/\/digital.nhs.uk\/data-and-information\/research-powered-by-data\/support-and-resources\/background\/secure-data-environments<\/span><\/a>.]<\/span><\/li>\n<\/ol>\n

    Author<\/strong><\/p>\n

    \"Iain<\/p>\n

    Iain Smith<\/strong><\/p>\n

    Iain is an Associate Director for the <\/span>Association for Clinical Audit and Registries<\/span><\/a> at HQIP the Healthcare Quality Improvement Partnership. With over 25 years of experience in the English NHS in national, regional and local roles, Iain is an experienced senior leader with a nationally established reputation in the field of healthcare quality improvement. Iain is a mathematics graduate and holds postgraduate qualifications in research methods and transformational change as well as a PhD in healthcare quality improvement. Iain also undertakes visiting academic work and is an Associate Editor for the BMJ Leader journal.<\/span><\/p>\n

    Declaration of interests<\/b><\/p>\n

    I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am an Associate Director with HQIP and a member of the Editorial Board of BMJ Leader.<\/span><\/p>\n

    HQIP<\/span><\/a> is an independent, not-for-profit long-term partner of the NHS responsible for commissioning and managing the <\/span>National Clinical Audit and Patient Outcomes Programme (NCAPOP)<\/span><\/a>.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Integrated Care Boards (ICBs) play a crucial leadership role in the English NHS. They are responsible for managing health systems across large geographical footprints and ensuring services are planned and delivered to meet local population needs.1 The UK government\u2019s new NHS modernisation bill confirms strategic commissioning – the process of planning, purchasing and monitoring services […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":525,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1230","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1230","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/users\/525"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/comments?post=1230"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1230\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/media?parent=1230"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/categories?post=1230"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/tags?post=1230"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}