A defining feature of a provider collaborative is that it involves more than one trust. This excludes from the definition those provider collaborations, including group models, that have moved to a single provider structure (and indeed this is often the end point for a group model). However, this section is included here for completeness and because the move to a single provider by some combination of two or more providers can be seen as one end of the spectrum of collaborative forms. We don’t say it is the culmination or apex of collaboration, since for many providers this is not considered a desirable outcome. But it is nonetheless worth considering briefly here.
What are the routes to creating a single provider?
There are several routes by which providers in a collaborative can come together to form a single organisation:
- Statutory merger[1]
- Statutory acquisition[2]
- Dissolution of an NHS trust[3]
- Statutory transfer schemes[4]
- Commercial transfers
Each of these routes has advantages and disadvantages and should be considered in the context of the aims of the organisations involved. With the exception of statutory transfer schemes (section 69A, which was inserted into the NHSA by the 2022 Act) there are examples of all of these routes being used to create a single provider for services.
We have set out in the table below a summary of these routes:
| Summary | Legislative basis | Restrictions | Approvals | Example | |
| Statutory merger | An FT (A) may apply with another FT or NHS trust (B) for both trusts to be dissolved and a new FT (C) to be established. | s.56 NHSA | Must involve at least one FT | Application must be approved by NHS England and the Secretary of State Each FT requires the approval of more than half of its Council of Governors. |
Merger of Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust to form Manchester University NHS Foundation Trust. |
| Statutory acquisition | An FT (D) may apply with another FT or NHS trust (E) for D to acquire E. | s.56A NHSA | D must be an FT |
Application must be approved by NHS England and the Secretary of State. Each FT requires the approval of more than half of its Council of Governors. |
Acquisition of Royal Liverpool and Broadgreen Hospitals NHS Trust by Aintree University Hospital NHS Foundation Trust to form Liverpool University Hospitals NHS Foundation Trust. |
| Dissolution of an NHS trust | Where an NHS trust is dissolved its assets and liabilities may be transferred by order to another NHS body. | Schedule 4 NHSA | Only applies where an NHS trust is dissolved | Order made by NHS England or Secretary of State | Acquisition of Pennine Acute Hospitals NHS Trust by Salford Royal NHS Foundation Trust to form Northern Care Alliance NHS Foundation Trust. |
| Transfer schemes | NHS England can make a transfer scheme to transfer property, rights and liabilities from one NHS body (F) to another NHS body (G). | s.69A NHSA | Note that both F and G are continuing entities and therefore this option is better suited to transfers of individual services. | Order made by NHS England or Secretary of State | N/A |
| Commercial transfers | Parties enter into a business transfer agreement to transfer the assets of one party (H) to the other party (I). | N/A |
Liabilities of H cannot be transferred to I. Note that both H and I are continuing entities and therefore this option is better suited to transfers of individual services. |
May be assessed as a material transaction by NHS England. May require council of governor approval for FTs where trust’s definition of significant transaction is met. |
Acquisition by Manchester University NHS Foundation Trust of North Manchester General Hospital from Pennine Acute Hospitals NHS Trust. |
Considerations
- Where strategic and organisational alignment is significant, the delivery of shared objectives may in some cases be furthered by closer still alignment within a single organisation. Except in the case of mandated dissolutions or statutory transfer schemes, it will be for the provider organisations to discuss and decide. Potential advantages for already-substantially aligned organisations include reduction of duplication, economies of scale and ease of implementation of decisions.
- Structural integrations require considerable internal and external approvals processes, including approval by NHSE, the secretary of state, and the councils of governors of any FTs involved in the process. Such transaction processes therefore tend to be slow and complex to implement.
- NHSE’s transactions guidance was updated in 2022.
[1] section 56 of the NHSA
[2] section 56A of the NHSA
[3] Schedule 4 of the NHSA
[4] section 69A of the NHSA