The guidance is focused on arrangements between providers and the way that these are intended to integrate with wider healthcare systems, and provides largely principles as opposed to prescription. That said, the headline, as expected, is that all acute and mental health services must be part of a provider collaborative by no later than April 2022. Other providers, including community services, ambulance trusts, and non-NHS providers, should be part of a provider collaborative where this would benefit patients and would make sense for the providers and systems involved. Given what was already known about these arrangements, not least through existing collaborative arrangements between providers, much of the guidance will come as no surprise. This article summarises some of the key points.

What is a provider collaborative and what are they expected to achieve?

According to the guidance, a provider collaborative is an arrangement between at least two trusts working at scale across places aiming to fulfil ambitions including:

  • Reducing unwarranted variations in care, including inequalities in health outcomes, services, and patient experience
  • Improving resilience via arrangements such as mutual aid
  • Better recruitment, retention and development of staff and leadership talent
  • Enabling increased specialisation and consolidation to provide better outcomes and value

In fact, provider collaborative arrangements are not new, and the guidance provides a number of examples of existing arrangements which are already achieving these aims, such as the Greater Manchester Provider Federation Board, the West Yorkshire Association of Acute Trusts, and a number of NHS-led specialist mental health, learning disabilities and autism collaboratives. The suggestion is that these, and others, can provide a road map for how new collaboratives may be established.

How should they achieve this?

The guidance suggests that benefits of scale can be achieved across a wide range of areas including:

  • Clinical services - via standardisation, expanding access to services, development of new models of care, joint demand management, and increased flexibility for staff.
  • Clinical support services - including pharmacy, radiology, pathology, and shared patient records.
  • Corporate services - including human resources, procurement, analytics, data, and joint quality improvement and change management programmes.

The guidance emphasises that providers, and the systems they are part of, will have the flexibility to arrange provider collaboratives as appropriate, the key being that arrangements are driven by purpose so that providers come together in ways that make most sense for those involved. NHSE/I will not prescribe provider collaborative membership, although collaboratives will be expected to work with NHSE/I regional teams to ensure that the proposed membership can deliver the benefits required.

To quote the guidance, provider collaboratives should be 'proportionate to the shared vision and objectives'. Key enablers of this, which the guidance identifies from the experience of existing arrangements, include:

  • Relationships - developing these across leaders, clinical teams, and system partners, via a continuous process. There is recognition that this takes time and consistent energy to develop.
  • Clinical leadership - empowering and engaging clinicians who are best placed to deliver patient-focused solutions
  • People and communities - using community connections to share and build on good practice
  • Data sharing - including an open-book approach to sharing trust performance data and overcoming organisational silos
  • Digital - interoperable digital capabilities to support smoother working across a range of areas

According to the guidance, provider collaboratives should work to a set of guiding principles including being purposeful and benefit-driven, evolutionary, which means building on existing successful collaborations where these exist, and inclusive to ensure that no provider is left less resilient than others, and that no provider whose involvement is important for delivering overall collaborative benefits, should opt out, even if the benefit for that individual provider is minimal.

How will provider collaboratives work within / across systems at all levels?

The guidance suggests that provider collaboratives will be an important vehicle through which systems can deliver. They should align their priorities with their relevant ICS footprint or footprints. Integrated Care Boards are expected to support provider collaboratives to work effectively and cohesively with other local collaborations. It is also noted that the Health and Care Bill, if passed in its current form, will enable further collaboration between systems and provider collaboratives, enabling ICBs to delegate functions and devolve budgets to them.

Provider collaboratives should also be mindful of the subsidiarity principle to when working with the ICS to decide which objectives are best delivered by the collaborative, and which by place-based partnerships. They should also consider how best to link into the voluntary sector, primary care, local authorities, and social care providers. The guidance refers to "areas of mutual support" for provider collaboratives and place-based partnerships which might include work to understand population health indicators or joint engagement programmes.

The guidance summarises the perceived benefits for different types of provider in becoming a member of a provider collaborative, many of which relate to overall system goals. For example, acute trusts are expected to make the most of their opportunity to deliver benefits of scale and deliver resilience across a system; community providers, many of which will work across a single system or even straddling system boundaries, will provide an important link between collaborations; and ambulance trusts could take advantage of their rich local knowledge to lead programmes to reduce variation across places in terms of access to a variety of services.

On a practical level, systems may want to move staff or other resources to a provider collaborative where doing so will deliver benefits.

Form and governance

The guidance does not prescribe any particular form for provider collaboratives, rather members should determine what works best using guiding principles including that the collaborative:

  • is underpinned by shared vision and commitment to collaborate;
  • builds on any existing successful arrangements;
  • enables effective decision making and members holding each other to account;
  • embeds clinical leadership and enables incorporation of local community voices; and
  • streamlines ways of working within / across systems.

A reminder is given of the three existing models typically used - provider leadership board, lead provider, and shared leadership models; and the guidance notes that the Health and Care Bill will enable ICBs to delegate functions, and trusts to form joint committees to take delegated decisions jointly.

What are the next steps?

The initial step is for all providers to review their existing membership of provider collaboratives. If not already a member, acute and mental health services must join a provider collaborative. Other types of provider must consider whether it would be appropriate for them to join one.

During the course of this 'transitional' year, provider collaboratives are expected to work with local partners to agree priorities and where a provider collaborative already exists, it should review its ongoing priorities to make sure that these align with the systems it is part of. Although NHSE/I will not prescribe membership, collaboratives are expected to work with regional teams to ensure that the proposed membership will deliver the benefits being targeted.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.