Overview
Trust leaders across all sectors – acute, mental health, specialist, community, and ambulance – are facing an environment of unprecedented challenge as they navigate increasing demand, and continued operational and financial pressures.
Despite this challenging environment, the story of provider collaboration at scale is one of optimism. At a time when trust leaders and staff are doing everything they can to see patients as quickly as possible, while boosting productivity and becoming more efficient, provider collaboratives across all sectors have proven to be an effective way to achieve these goals.
Provider collaboratives were initially formed in mental health settings, following NHS England's (NHSE) new care model for NHS-led specialised mental health, learning disability and autism (MHLDA) services. Provider collaboration is now also common in acute and community settings, alongside 'all in' collaborations across all provider types. There are great examples of providers embracing the opportunity to build relationships and deliver better and more efficient services by working together both locally across systems and regionally. This includes standardisation to improve care and services; addressing unwarranted variation in care quality; realising economies of scale; identifying approaches to support people experiencing inequalities; and developing innovative ways of working with other local partners, such as social care providers and primary care services.
The government has set out 'three shifts' for the NHS which will form the basis of the new 10-year health plan: from hospital to community, analogue to digital and sickness to prevention. Alongside this, the government will set out a model for a new 'neighbourhood NHS'. While there is increasing focus on opportunities to collaborate locally to integrate services, there continues to be significant benefit to collaboration at scale to tackle national priorities such as elective recovery, increasing diagnostic capacity and addressing workforce shortages. It is important that these benefits of providers collaborating at scale are protected. Lessons can also be learned about the experience of successful collaboration between providers at scale and across systems to support collaboration at place and neighbourhood.
This collection of case studies highlights the outcomes, impacts and benefits of system-wide coordination, integration, and innovation. A common theme across these is a focus on improving efficiency and reducing costs while maintaining or enhancing the quality of care for patients and service users. Another theme is the use of data-driven decision-making leading to improved capacity, greater patient choice, and quicker access to necessary treatments, as well as the sharing of best practices and streamlined service delivery delivered closer to home.
Ultimately, the combined achievements of these collaborations and others —improvements in wait times, diagnostic capacity, workforce flexibility, and patient care—have not only enhanced service delivery but also generated efficiencies and economic benefits, ensuring a more sustainable healthcare system.
What are provider collaboratives?
Provider collaboratives are partnership arrangements that bring together two or more trusts to maximise economies of scale and improve care for their local populations. In 2021, NHSE set the expectation that all trusts providing acute and mental health services, should be part of one or more provider collaborative. In the same guidance, community trusts, ambulance trusts and non-NHS providers, such as voluntary sector organisations and social enterprises, were asked to participate in provider collaboratives where it would benefit patients and makes sense locally. National planning guidance in 2024/25 built on 2021 guidance to expect "all NHS trusts and their boards to be working in at least one collaborative, and that these collaboratives focus on fully realising the benefits of scale as well as transforming services for the future".
National guidance set out some minimum expectations for provider collaboratives but left scope for trusts to agree areas of focus and priorities for collaboration at scale. As a result, the roles, functions, and structures of provider collaboratives vary between collaborations and systems and many trust leaders have welcomed this permissive national framework, which has enabled them to develop collaboration based on local contexts, priorities and needs.
While acute, community and non-specialised mental health provider collaboratives vary in role and structure, NHS-led provider collaboratives bring together providers of specialised mental health, learning disability and autism services, to take responsibility for the budget and pathway for their given population. These collaboratives are led by an NHS trust through a lead provider model which involves a single trust holding a contract with a commissioner and sub-contracting with other trusts and independent sector providers in the collaborative to coordinate service delivery and improvement.
NHS-led provider collaboratives were given specific aims to improve care pathways by experts by experience and clinicians, managing resources to invest in community-based services, bringing care closer to home and reduce inappropriate admissions.
Realising the benefits of collaboration
As provider collaboratives have become more established, we are seeing a growing evidence base underpinning the benefits of collaboration at scale and across sectors. Over the last three years, our provider collaboration support programme has highlighted how provider collaboratives are committed to working together to realise the benefits and maximise the opportunities of closer partnerships across a single or multiple integrated care system (ICS) footprint.
A selection of the illustrative examples of provider collaboratives' work in progress is set out below where we explore and share examples of how some collaboratives have worked together to address common problems on various locally defined priorities:
- Reductions in unwarranted variation in outcomes and access to services.
- Reducing health inequalities.
- Delivering efficiencies and economies of scale.
- Improving and bringing care closer to home.
- Greater resilience and supporting elective recovery.
- Better recruitment, retention and development of staff.