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Provider collaboratives – should primary care be involved?

Much has been said and written about the importance provider collaboration as part of the new integrated care system (ICS) arrangements in the NHS. Far less has been said about the role of primary care within what could be viewed, as a structure designed exclusively for the larger providers within the NHS.

What has changed with the introduction of ICSs?

The 2022 Health and Care Act, made ICSs legal entities with statutory powers and responsibilities, creating integrated care boards (ICB) to plan and fund NHS services within its boundaries, and absorb the previous responsibilities from clinical commissioning groups.

The legislation has also changed procurement and competition requirements, taking away the requirement for competitive retendering. The division between commissioning and provision of services is becoming increasingly blurred with the expectation that the ICB and providers within its footprint will work increasingly more collaboratively.

The national direction of travel is that commissioners and providers should increasingly be working hand in hand to plan care for their populations. NHS providers are expected to look beyond their organisational priorities to focus on system-wide objectives, improving outcomes and reducing inequalities for the communities they serve. Increasingly the vehicle chosen to deliver system objectives is via the provider collaborative route, building upon learning and greater collaboration during the COVID-19 pandemic.

What are provider collaboratives?

Provider collaboratives are partnership arrangements involving at least two trusts working at scale across multiple places, with a shared purpose and effective decision-making arrangements.

In many systems, provider collaboratives – alongside place-based partnerships – will play a key role in leading service and pathway improvements, recovering backlogs of care, and delivering NHS long-term plan objectives and system-wide clinical strategies.

My experience as a senior executive involved at the start of one of the largest integrated care systems in the country and then latterly setting up one of the smallest has shown there is a great deal of scope for provider collaboration to improve services for patients which is being fully exploited in some systems, and barely at the starting point in others.

Formalised provider collaborative arrangements tend to fall into three broad categories:

  • Lead provider arrangements – usually focussed on improving specific services with one provider in a system taking contractual responsibility for delivery in partnership with others. Mental health services often utilise lead provider models.
  • Provider boards – a formal board within a system where chief executives or other directors from participating trusts come together, with common delegated responsibilities from their respective boards, so that they can tackle areas of common concern and deliver a shared agenda on behalf of the collaborative. Lancashire and South Cumbria have a well-regarded provider board which is beginning to tackle some long standing challenges in that area.
  • Shared leadership model: the same person or people lead each of the providers involved, with at least a joint chief executive and/or chair. This model can be achieved by NHS trust or foundation trust boards appointing the same person or people to leadership posts. This is often seen as a quick route to achieving common aims, without the complexity of a merger, and has become a very popular model in the Midlands and in London.

What should be the role of primary care?

There is an obvious and defined role for primary care within place based partnerships in a system as distinct from provider collaboratives. Place based partnerships co-ordinate the planning and delivery of integrated services within localities, while provider collaboratives are partnership arrangements spanning several places, with the aim of effective decision making focusing on scale and mutual aid across multiple places or systems.

Provider collaboratives do however need to consider how to work best with primary care. Collaboratives also offer an opportunity for trusts to consider how they can better support primary care, including working with primary care networks, to support priorities relating to prevention, access to urgent and emergency care and whole pathway developments.

In my experience, the more mature ICSs already do this, and often have well established mechanisms for primary care to have a real voice in how the system is run. In Greater Manchester there is a strong primary care board, ensuring the views of colleagues feed into the decisions of the ICB. In Staffordshire and Stoke on Trent, GPs are involved in collaborations improving mental health pathways, long term conditions and end of life care.

Provider collaboratives should not just be about NHS trusts and foundation trusts. There is a real opportunity for primary care to be involved, to help some of those bigger institutions think out of the box and to support real improvements in patient care.

Understanding the purpose and role of provider collaboratives can be confusing and then appreciating how primary care can be key in the decision-making processes may need some debate, negotiation and support. I can offer support to primary care colleagues by demystifying some of this through short workshops and engaging with acute sector colleagues to find the right roles for primary care partners.

Nicky O’Connor, Director – Nicky OConnor Developments Ltd

Contact enquiries@pcc-cic.org.uk to discuss how Nicky can support your provider collaborative to develop.

Last Updated on 29 March 2023