What is a group model?
Like provider collaboratives, a group is an organisational model which has no legal definition and can take various legal organisational forms. It isn't defined by NHSE in their collaborative guidance but is recognised as a way of governing a provider collaborative.
Nonetheless, groups do tend to share common characteristics, which include:
- A central leadership body responsible for the strategic direction, and governance, of the group.
- Discrete, locally managed 'units' which are responsible for operational leadership and management and may have varying degrees of autonomy from the central leadership.
- Some element of standardisation of systems, policies and procedures across the respective units and perhaps a shared set of values.
What are the options for group models?
The term 'group model' can be applied to a range of different organisational forms. It can be applied to a single provider that creates internal divisional or management units, for example to manage several sites or services, such as Barts Health NHS Trust operating a group model for its four major hospital sites. It can also be applied to two or more providers which are jointly governed but operationally led at individual trust level, for example recent joint working between Barts Health NHS Trust and neighbouring trust Barking, Havering and Redbridge University Hospitals NHS Trust establishing a group structure, utilising a group executive board to manage both trusts. Using Barts Health NHS Trust as an example demonstrates how the term group can apply to a number of different arrangements, whether they are uni-trust or multi-trust groups. In fact, many groups are also provider collaboratives, and equally provider collaboratives that don't currently call themselves groups could choose to do so.
Each group arrangement has its own merits and the 'best' model in one locality or organisation will not necessarily be right for another.
Group models can be achieved through the options for collaboration outlined in this section of this guide. Most commonly, group models involve joint leadership and some form of committee for strategic decision-making. In existing group models where the providers remain sovereign entities, this committee is usually advisory but the additional powers introduced by the 2022 Act enable a shift to joint committees with decision-making powers if group members so wish.
Considerations
- The governance considerations when setting up and maintaining a group model will depend on the specific arrangement and local circumstances and so we haven't included specific considerations here.
- Clearly the benefits and risks of operating at scale must be evaluated in forming the arrangement.
- It is worth noting that NED involvement in decision-making can sometimes be minimised where executive structures are the focus for 'managing' divisional units. Ensuring adequate independent scrutiny of decision making and the ability to effectively manage risk will remain key in groups.
What is an example of a group model (which is also described as a provider collaborative)?
The Foundation Group is a collaborative of four partner trusts: South Warwickshire University Foundation Trust, Wye Valley NHS Trust, Worcestershire Acute Hospitals NHS Trust and George Eliot Hospital NHS Trust. These trusts share a chief executive and chair, and each trust has appointed a managing director to support the group chief executive.
The group uses an advisory committee approach, establishing a Foundation Group Strategy Sub-Committee which includes each medical director alongside the group chair and chief executive. Each trust retains its board and organisational distinctiveness. The group has invested in key leadership roles including a group financial advisor, group digital advisor and a group improvement lead.