NHS Cheshire and Merseyside Commissioning Intentions 2027-28

• Develop and implement a system-wide Integrated Neighbourhood Team (INT) service specification in all 58 neighbourhoods.
• Commission the Beyond Programme to develop with partners a children and young people multidisciplinary team model across Cheshire and Merseyside focusing on lung health, neurodiversity, and mental health.
• Work with General Practice (through a collaborative approach), NHS providers, and wider system partners in the development of a Women's Integrated Neighbourhood Service.
• Through a Primary Care Network (PCN) Neighbourhood Direct Enhanced Service, neighbourhood delivery plans will support implementation of the proactive care model. Informed by intelligence, neighbourhoods will prioritise the highest-need 1% of the population, using multidisciplinary and proactive approaches to improve outcomes, reduce inequalities and prevent avoidable deterioration.
• Improve access, coordination, and pathways of care through an Integrated Referral Model and Single Point of Access for Tier 2 services for elective referrals, including ENT, Dermatology and Gynaecology.
• Deliver community musculoskeletal (MSK) interface services covering Orthopaedics, Rheumatology, Spinal Conditions and Chronic Pain.
• Work with system partners to redesign diagnostic and community-based services, including Point of Care Testing (POCT) and phlebotomy, to improve efficiency, access, and patient experience. We will use the Deconstructing the Block Contract programme and Provider Collaborative Community Mapping work as enablers.
• Implementation of best practice models in relation to Urgent Care Single Point of Access, Crisis Response, and Intermediate Care pathways.
• Enable integrated neighbourhood delivery through estates, digital infrastructure and co-location, supporting multidisciplinary working and seamless patient care.
• Work with partners to ensure our agreed capital programme plans deliver the expected benefits, including in activity and productivity.

See sections below on other priority areas.

• Enhance access to neighbourhood-based women’s health services and commission community-based Tier 2 women’s health services through an integrated referral management model to improve access, reduce variation and support earlier intervention (see Neighbourhood Health Models above).
• Undertake a comprehensive review of maternity and neonatal services to ensure commissioned services deliver safe, high-quality care, meet national standards and are clinically and financially sustainable.
• Update the Fertility Commissioning Policy to ensure alignment with current clinical guidance.
• Review and implement future commissioning arrangements for termination of pregnancy services.

• Population Health and Prevention: improve lung health, healthy weight, oral health, and vaccination uptake, including expanded oral health programmes and obesity prevention services.
• Develop neighbourhood multidisciplinary teams and deliver a single paediatric model of care with standardised pathways and more services closer to home.
• Improve access to neurodiversity support, reduce waiting times and variation, and establish a single point of access for support.
• Improve timely access to mental health support, reduce inequalities and waiting times, and align school-based provision.
• Implement the Regional Care Cooperative and integrated pathways for children and young people with complex needs.
• Deliver a consistent Cheshire and Merseyside care model, integrated pathways, and a single care package approach for Children in Care and Care Experienced Young People, including improving access to Initial Health Assessments (IHAs).
• Development of alternative interventions for children and young people in crisis.
• The Integrated Care Board (ICB) will deliver on its statutory responsibility for SEND reform with local councils to commission specialist support (including Experts at Hand), deliver local strategic reform plans and drive multi-agency inclusion.

• Implement the nationally mandated roll-out of Neighbourhood Mental Health Centres.
• Implement the nationally mandated roll-out of Mental Health Emergency Departments.
• Improve acute mental health care flow by working collaboratively to reduce delayed discharges by ensuring timely access to appropriate accommodation and housing solutions.
• Develop a consistent mental health rehabilitation pathway, including improved placement oversight, bed planning, referral processes, and community provision.
• Implement a consistent pathway for personality disorder and complex emotional needs to improve outcomes and eliminate out-of-area placements.
• Develop plans to implement the SMI Modern Service Framework (MSF) when published.
• Deliver national workforce expansion targets for Individual Placement and Support (IPS) and Talking Therapies.

A whole pathway/partnership approach to improving outcomes and reducing inequalities through implementation of the Cardiovascular Kidney Metabolic Modern Service Framework.

• Prevention and early identification: Working with combined authorities and local authorities, NHS and Voluntary, Community, Faith, and Social Enterprise (VCFSE) partners to embed prevention through a make every contact count (MECC) approach, prioritising smoking cessation, NHS Health Check uptake, scaling community opportunistic testing, and targeted outreach to populations at greatest risk.
• Risk factor management and treatment optimisation: Move from condition-specific pathways to a coordinated cardiovascular kidney metabolic (CVKM) model, ensuring people are identified via a proactive population health management approach and are assessed and receive timely optimisation of CVKM risk factors, treatment and medicines at every appropriate contact across primary, community and specialist services, supported by specialist multidisciplinary teams for those with complex multimorbidity.
• Healthy weight and metabolic health: Implement a financially sustainable, system-wide, all-age healthy weight pathway in partnership with Local Authorities to improve equitable access to prevention, behavioural support, specialist weight management services, and evidence-based therapies, including GLP-1 medicines.
• Timely access to high-quality stroke and cardiac care: Innovation, transformation and service optimisation to improve access to stroke and cardiac care, reduce unwarranted variation, strengthen service resilience, and optimise specialist capacity, including delivering the Cheshire and Merseyside Cardiac Catheterisation Strategic Plan.
• Recovery, rehabilitation and long-term health: Increase equitable access, uptake, and completion of evidence-based cardiac and stroke rehabilitation programmes, including physical and psychological support, while developing the case for and exploring opportunities for prehabilitation. Strengthen secondary prevention through systematic risk factor optimisation, medicines optimisation, supported self-management and long-term follow-up.

Please also refer to the Neighbourhood Health Models section on proactive identification and care planning.

Frailty

• Deliver rapid seven-day community alternatives to hospital admission, including Urgent Community Response, virtual wards, frailty Same Day Emergency Care (SDEC), intermediate care and rapid reablement.
• Review falls services across Cheshire and Merseyside to reduce variation, improve outcomes, and inform future investment in falls prevention and response.
• Strengthen integrated frailty pathways through Care Coordination/Clinical Assessment Service (CAS), ensuring a “no wrong door” approach to step-up and step-down care.
• Expand community wrap-around services and test innovative discharge models to support people at home and reduce avoidable hospital admissions.
• Improve hospital care and discharge through consistent frailty- and dementia-attuned standards, including early assessment, mobility, nutrition, delirium prevention, and Home First approaches.
• Develop a Frailty Academy and roll out system-wide workforce training in frailty care, delirium management, and strengths-based approaches.
• Align delivery with the Cheshire and Merseyside Dementia Strategy and progress system-wide polypharmacy reviews.

End of life care

• We will improve care by making earlier identification of people approaching the end-of-life routine, providing the right care, in the right place at the right time through personalised care planning, strengthened and integrated community and hospice-based support, enabled by consistent processes and use of shared care records, ensuring more people receive care in their preferred place and reducing avoidable hospital admissions. 

In line with national standards, we will commission care that is safe, effective, sustainable, person-centred, timely, efficient, and equitable. We will set clear quality measures and contractual quality schedules, fostering a learning culture with continuous improvement as the default way of working

Improve oversight of areas for improvement following patient safety responses under PSIRF and delivery of associated quality improvement programmes. We will focus on:

• Delivery of the Modern Service Framework (MSF) for Sepsis,
• Healthcare-acquired infections
• Safer maternity care

• Development of a single, system-wide specification for Enhanced Services during 2027/28, with implementation from 1 April 2028.
• Introduce a consistent commissioning approach that reflects population need, reduces funding inequity and supports a life-course model of care.
• Improve access to general practice by reducing unwarranted variation, strengthening same-day urgent access, refreshing existing plans to align with new primary care operating models, and exploring innovative commissioning and contracting approaches.
• Improve access to NHS dentistry through innovative commissioning and contracting models.

• A programme of service specifications “standardisation” to apply best practice.
• Delivery of ongoing priorities commenced in previous years, for example, Learning Disability and Autism, Adult Neurodiversity and ADHD support.
• Delivery of national mandated priorities to be included in the 2027/28 planning guidance.
• Deliver the mandated priorities in the national Cancer Plan.
• Working in collaboration with the Regional Office of Pan ICB Commissioning to deliver improvements in screening and immunisation rates.
• Delivery of our urgent care transformation programme, including a review and realignment of current Walk-In and Urgent Treatment Centre provision against achieving national service specifications, population need, and neighbourhood health plans.
• Addressing identified pathway issues and other service priorities including:
  • Delivering a consistent ARFID (Avoidant/Restrictive Food Intake Disorder) pathway to improve timely access to specialist assessment and treatment.
  • Delivering integrated ABI (Acquired Brain Injury) and FND (Functional Neurological Disorder) pathways to improve patient experience, coordination of care, and outcomes.
  • Review of Sleep CBT-I services to increase access to evidence-based support and improve sleep health outcomes.
• In addition to the areas highlighted above and the pipeline of contract expiry dates and procurement requirements, we will be undertaking Patient Transport Service and Critical Care Transport procurement processes to ensure safe, sustainable, and high-quality transport services.

In support of these intentions, key outcomes and improvement measures have been identified, driven from our Integrated Needs Assessment, and therefore focus on improving and reducing inequalities in outcomes and access across Cheshire and Merseyside.