The health and care system in England continues to grapple with significant challenges, including chronic staff shortages, constrained financial resources and insufficient capacity to meet growing demand. Trust leaders and national policymakers recognise that providers cannot tackle these systemic challenges alone. Provider collaboration has therefore risen up the national policy agenda, in part to capture the benefits seen when trusts and wider partners worked together in response to the COVID-19 pandemic.
Greater collaboration between NHS organisations is enshrined in the Health and Care Act 2022 (the Act), which placed ICSs on a statutory footing in July 2022. Trusts will play a critical role in delivering the key purposes of ICSs* , often through partnership arrangements that will act as delivery vehicles within ICSs including provider collaboratives, place-based partnerships and neighbourhood multi-disciplinary teams.
In this briefing, we:
- provide a brief overview of how provider collaboratives are developing across England
- illustrate some of the emerging benefits that collaboratives are working to realise
- explore how trust leaders see the role of provider collaboratives developing within ICSs
- identify some key enablers and risks trust boards need to consider.
To inform this briefing, we have drawn on insights collected through our regular engagement with trust leaders, our member support offer on provider collaboration (which includes a regular webinar series sharing collaboratives’ progress and peer learning forums), and ongoing influencing work to shape the development and implementation of national policy.
What are provider collaboratives?
NHS England defines provider collaboratives as partnership arrangements that bring together two or more trusts to maximise economies of scale and improve care for their local populations. NHS England has required all trusts providing acute and/or mental health services, including specialist trusts, to join at least one provider collaborative from July 2022. Community trusts, ambulance trusts and non-NHS providers, such as voluntary sector organisations and social enterprises, are expected to participate in provider collaboratives where it makes sense locally and we know that many are actively exploring these opportunities. In this briefing, we also explore how some collaboratives are looking beyond the provider sector and including planning bodies like ICBs in their membership.
Alongside working in provider collaboratives, trusts are collaborating across smaller footprints within systems known as ‘places’, which often align with local authority boundaries or patient flows into hospital services. You can read our recent place case study briefing here, in which we set out how place-based partnerships are developing and the role trusts are playing in them.
Place-based partnerships bring together a range of organisations to improve and integrate care for communities at a more local level. Place-based partnerships can include trusts, commissioners, local authorities, primary care services, voluntary and community sector organisations, local residents and service users, and wider partners such as housing or education providers. Some trusts are also exploring new ways of working with primary and/or social care, such as developing new integrated delivery models which present opportunities to join up care (and bring some challenges).
Although not the main focus of this piece, trusts and their partners will need to work out how place and provider collaborative arrangements interface, especially given that ICBs will be able to delegate functions and budgets to both types of partnership arrangement. Provider collaboratives will need to both agree objectives with ICBs and align priorities with place-based partnerships, as well as develop a shared understanding of their respective roles.
How has provider collaboration developed?
Provider collaboration has been developing organically for many years, with trusts choosing to work together to address common problems. These collaborations have focused on various locally defined priorities, including:
- delivering shared clinical support services such as pathology
- making efficiency savings through joint procurement
- improving clinical quality and patient safety
- reducing unwarranted variation in quality and access
- improving resilience by consolidating clinical services.
National policy has also facilitated particular types of provider collaboration over the years, with mental health collaboratives now further ahead in exploring the benefits of taking responsibility for devolved specialised commissioning budgets. As provider collaboratives become more developed, we would expect to see a growing evidence base underpinning the different types of arrangements.
The response to COVID-19
Trusts have looked to build on the experience of the COVID-19 pandemic which united the health and care system against a common challenge and accelerated collaboration substantially. Mutual aid became widespread, with trusts sharing staff, capacity, equipment and other resources with each other and wider partners in primary and social care. The pandemic also shone a spotlight on – and exacerbated – stark health inequalities in England that long predated COVID-19. Trusts and their partners want to build on the lessons learned from the pandemic, such as the experience of delivering the COVID-19 vaccination campaign through an outreach model, which have opened up new ways of working with partners better able to reduce the impact of inequalities.
What does national policy and guidance say on provider collaboratives?
National guidance from NHS England (August 2021) sets out some minimum expectations for provider collaboratives but leaves scope for trusts to agree areas of focus and priorities for collaboration at scale. As a result, it is likely that the roles and functions of provider collaboratives will vary between systems. Trust leaders welcome this permissive national framework, which enables them to develop collaboration based on local contexts, priorities and needs.
In addition to the original guidance on provider collaboratives, NHS England has published a supplementary toolkit which provides further support on setting up collaboratives, including potential governance models. It also points towards the new opportunities afforded to trusts by the Act to work together in joint committees and take on delegated budgets and functions from ICBs.
Our Provider Collaboration programme focuses on sharing good practice through a range of events, peer learning forums and resources for boards. It covers the full spectrum of collaborative arrangements that providers are forging at scale and aims to support members to maximise the potential of greater provider collaboration to tackle care backlogs, reduce unwarranted variation, address health inequalities, and deliver more efficient and sustainable services.
Visit our website for recordings of our webinars, blogs on provider collaboration, details of our forthcoming events and further resources.
To find out more, contact Bobby Ancil, programme development manager (provider collaboration).
* [National guidance states that ICSs' four key purposes are to: 1) improve health and care outcomes; 2) tackle inequalities in outcomes, experience and access; 3) boost productivity and value for money; and 4) support broader social and economic development].