Establishing Provider Collaboratives: Lessons Learned and Top Tips

NHSEI published its much-awaited guidance on provider collaboratives setting out how trusts can together work effectively at scale to transform services, tackle unwarranted variation and deliver the best care for patients and communities. It is expected that acute (including specialist) and mental health providers, alongside community, ambulance and non-NHS providers if they so wish and it benefits patients, should be in one of more provider collaboratives by April 2022.

The new Health and Care Bill will provide new options for trusts to make joint decisions. However, this guidance recognises that whilst there is a need to provide specificity, it likely that Trusts will want to move towards collaboration at different speeds and under different models – from committees in common through to joint roles or, in some cases, merger. It also clearly states that trusts should not wait until Bill has become law to establish the collaboratives.

Alongside place-based partnerships, the provider collaboratives are set out as the key enabler of the ICS meeting the triple aim of better health for everyone, better care for all and efficient use of NHS resources. By April 2022, it is expected that the ICS will:

·????????Encompass all trusts providing acute and mental health services (and community trusts, ambulance trusts and non-NHS providers when it makes sense).

·????????Identify the shared purpose of each collaborative and the specific opportunities to deliver benefits of scale and mutual aid.

·????????Develop and implement appropriate membership, governance arrangements and programmes (or reflect on this where collaboratives are already in place).

·????????Ensure purpose, benefits and activities are well aligned with ICS priorities.

In the future, there will be greater opportunities and options for ICBs to empower providers to lead transformation and delivery of services. The Health and Care Bill, if enacted, will enable ICBs to delegate functions to providers including, for example, devolving budgets to provider collaboratives. It is noted that specific programmes of work will differ across collaboratives but often include:

·????????Clinical services – i.e., standardising protocols, policies and pathways, expanding access to appropriate and timely health services, delivering service transformation, designing new models of care, jointly managing clinical demand and capacity, and increasing staff flexibility to work between sites.

·????????Clinical support services - i.e., sharing pharmacy, radiology, pathology, imaging services, and patient records.

·????????Corporate services – i.e., co-ordinating and consolidating (HR, procurement etc.), sharing data and information, and deploying joint quality improvement and change management frameworks.

We have been working with ICS and Trusts on the establishment of ICS and provider collaboratives. Takeaways include:

·????????The benefits from collaboration are wide ranging including quality improvements, efficiencies and sustainability and enabling transformation as well as meeting legal and policy requirements. Successful collaboratives are built on a collective view of the benefits and are motivated by an understanding of the benefits that can be unlocked and based upon a shared purpose and accountability.

·????????The provider collaborative guidance should be seen as an ‘enabler’, establishing new connections as well supporting existing collaboration instead of replacing/preventing them. For example, it should not prevent organisations from entering into other collaborations or undertaking other transformation initiatives.

·????????The importance of behaviours and relationships should not be overlooked. Diversity of thought and inclusivity can be embraced by encouraging collaborators to offer and use all their knowledge, skills and experience. Balanced relationships are key such that there is give and take between organisations and parity in decision making is built in from the outset.

·????????The agenda should be focussed on transformation and how best to effectively drive forward change in a manner that enables the co-ordination of activity and actions in support of agreed outcomes. Duplication of effort can be avoided by good management, co-ordination and effective internal communications.

·????????There are a range of governance mechanisms to be considered – from a loose collaboration through to joint posts and mergers. Whilst trust and confidence are being established, looser arrangements or potentially a committees in common approach may be a first step.

·????????Support will be required from the ICS in setting up the provider collaboration and enabling it to function cohesively (providing a dispute resolution channel where needed) and ensuring cohesion between collaborations.

In terms of selecting the transformation programmes to be led by the provider collaborative, the collaborative may wish to initially focus on a small number of programmes that enable the ICS to meet its objectives whilst demonstrating joint working and the benefits of planning at scale and enabling a move towards joint roles over time. The following questions may assist in selecting the programmes to pursue:

·????????Is there alignment with the ICS Board forward plan and capital allocations and a link to inequalities?

·????????Does the initiative bring benefits to patients?

·????????Does the initiative span multiple providers and there is benefit from acting collaboratively?

·????????Is there a clear strategic, operational and / or financial rationale???

·????????Does the initiative pass a cost benefit test?

·????????Is there a clear accountability and governance structure and a project plan including resourcing such that the initiative is likely to be deliverable?

·????????Does the provider collaborative have the capability and capacity to take on the initiative at this time?

Please let me know if you would like to discuss this further, [email protected]