System design, governance & accountability

Provider Collaboratives: What are the purposes and aims of provider collaboratives?

Examining the scale of collaboration and the models through which provider collaboratives are governed, as well as how decisions are taken in practice

Shot of a group of medical professionals having a meeting together inside a boardroom at a hospital
April 2024 -

Background

Since 2015, health care policy in England has shifted towards more collaborative and integrated ways of working among health and social care providers. This change of approach started with the introduction of Sustainability and Transformation Partnerships (STPs), which were later succeeded by Integrated Care Systems (ICSs). STPs were collaborations between commissioners or purchasers of health care and providers of health and social care which covered defined geographical areas across the country. ICSs are collaborations among NHS organisations (for example hospitals or general practices), local authorities, and voluntary services, and are meant to be responsible for planning and delivering joined up health and social care services in England. There are 42 ICSs, covering populations from one to three million people. When they were introduced, ICSs were voluntary partnerships, with decisions taken collectively by consensus. Their main functions were to agree priorities for their local area and plan collectively how to improve the health of their population.

Until July 2022, ICSs had functioned as loose and informal networks and did not have any legal grounding. In 2022, new legislation in the form of the Health and Care Act 2022 (HCA 2022), which came into effect on 1st July 2022, made collaborative working in ICSs legally binding, by establishing Integrated Care Boards (ICBs) as statutory, independent and accountable bodies. ICBs have replaced Clinical Commissioning Groups (CCGs), the old commissioners of NHS health care. They have taken on the functions of planning and buying health care services for acute, primary and mental health services in their local areas. Their membership has to include a chair, a chief executive officer, and representatives from NHS hospitals, general practice, and local authorities. They also have to make sure that at least one board member has knowledge and experience of mental health services.

From 2024, ICBs are expected to delegate functions and resources to other partnerships within the ICSs, like for example to provider collaboratives. From July 2022, all NHS hospitals and mental health service providers are required to be part of a provider collaborative. Other NHS providers, for example, community and ambulance trusts, voluntary organisations and private providers, will have the option to join a provider collaborative. Provider collaboratives can be collaborations between organisations providing similar services (for example, mental health or acute care providers) or they may include providers of different types of care (for example, primary care, community care, and mental health, or acute and community care providers).

Provider collaboratives have many purposes, for example, to improve health outcomes, to use efficiently public funds , to reduce inequalities in access and experience of patients across different providers, to change the organization of health care services, and to eliminate the long waits for hospital treatment which resulted from the COVID pandemic. They have the potential to play a key role in the use of NHS funds and the structure and delivery of health care services and health outcomes for their local populations.

  • In this study, we aim to examine how provider collaboratives are developing, and the processes they put in place to deliver their goals.

    In particular, our aims are to examine:

    • The scale of collaboration and the models through which provider collaboratives are governed, as well as how decisions are taken in practice.
    • The degree of delegation of functions and budgets from ICBs to provider collaboratives and the mechanisms by which provider collaboratives are held to account, and how they hold their own members to account.
    • The processes by which the provider collaboratives contribute to improve sustainability of services, efficiency of NHS resources and quality of care.
    • How provider collaboratives reconcile their roles as collaboratives external to ICSs when at the same time they are part of ICSs through their individual partner organisations.

    Our specific research questions are:

    1. What are the purpose and aims of provider collaboratives?
    2. What type of organisations are members of different provider collaboratives?
    3. How are provider collaboratives governed, both internally and externally in terms of being held accountable for their actions?
    4. Do provider collaboratives hold NHS contracts and if so, how are these structured in terms of the responsibilities of their individual member organisations?
    5. How do provider collaboratives coordinate their long term plans and strategies for service delivery with those of their related ICBs?
    6. Do provider collaboratives contribute to the improvement of quality of care, efficiency and sustainability of services?

  • This is a three year study (2024 – 2026) in which we will examine the provider collaboratives in three ICSs. This research builds on earlier projects in which we investigated the development of ICSs before and after the HCA 2022. We intend to use the same ICSs we used in our previous studies in order to trace their development throughout the years.

    First we will contact the ICSs to give us permission to carry out the study in their locality. We will then analyse national and local policy documents, for example, policy guidance, board meeting papers from the ICBs and provider collaboratives. We will then compile a list of participants (members of staff) from the ICBs and the provider collaboratives that we think are relevant to be interviewed. We will then contact those members of staff, sending them a summary of the project, and ask them to sign a consent form if they agree to be interviewed. We will then conduct semi-structured interviews with each participant at a time that suits them. During the interviews we will have a list of questions to ask the participants but we will make sure that our questions allow the participants to express their views about the way provider collaboratives are developing, their structures, what works well and what still needs to be improved. We will also ask to sit as non-participant observers in a limited number of meetings in order to observe the working relationships of participants, the challenges they face, and the way decisions are being taken. Our overall aim in doing the interviews and the observation of meetings is to collect rich information from managers of provider collaboratives and ICBs about what works well and the areas in which they think they need further help and guidance.

    The study includes a small component of quantitative analysis in which we will use routine data about provider collaboratives, their activities and associated health outcomes to assess how effective and efficient they are.

  • Our previous studies produced several publications and important lessons were fed to the Department of Health and Social Care and to our case study sites. In this project we also intend to collect information that will be useful to national policy makers in guiding the further development of provider collaboratives and also the development of the national regulatory framework in respect of these collaborations.

    At the end of the study we will produce a final report. However, we will be happy to work with policy colleagues in the Department of Health and Social Care to identify opportunities for informal feedback during the study. We will also write papers for publication in peer reviewed journals.