New guidance on provider collaboratives – time to build

While we wait for the Health and Care Bill to reach Committee stage on 7 September, NHS England and NHS Improvement has published guidance on provider collaboratives (August 2021). The document, Working at scale: guidance on provider collaboratives, sets out the expectations for how providers should work together and the role collaboratives will play within ICSs.

Trusts have been pushing ahead with plans to work together for some time, collaborating with each other in the acute, mental health, community and ambulance sectors and with local partners, locally at place and across systems. But as this guidance explains, they go beyond ‘providers collaborating’ – they have governed arrangements designed to deliver specific benefits as part of the Integrated Care System arrangements.

What is meant by provider collaboratives?

The guidance explains that they are partnership arrangements involving “at least two trusts” working at scale across multiple places, with a shared purpose and effective decision-making to:

• reduce variation and inequality in health outcomes
• improve resilience
• ensure that specialisation and consolidation occur where this will provide better outcomes and value

By April 2022, all trusts providing acute and mental health services, including specialist trusts, are expected to be part of one or more provider collaboratives. Community trusts, ambulance trusts and non-NHS providers (for example, community interest companies) should be part of provider collaboratives “…where this would benefit patients and makes sense for the providers and systems involved.”

According to the guidance, we may see collaboratives:

• Support the work of other collaborations, including clinical networks, Cancer Alliances and clinical support service networks.
• Work with other organisations within place-based partnerships, which are distinct from provider collaboratives. In this case, place-based partnerships would co-ordinate the planning and delivery of integrated services within localities and alongside communities, while provider collaboratives focus on scale and mutual aid across multiple places or systems.

Form and governance

Provider collaboratives are free to determine the ‘right’ form and governance arrangements – with no one model that all collaboratives must adopt. It will be up to members to decide which arrangements will work best for them.

Eight guiding principles are set out in the guidance to support providers with decisions on form and governance arrangements. It also describes three existing collaboration models NHS providers have used to date to form collaboratives under existing legislation. Models include provider leadership boards, lead providers and share leaderships.

In terms of future statutory models for collaboration, the guidance does cover the provisions contained in the Health and Care Bill which if enacted, will give NHS trusts and foundation trusts new ways to jointly exercise their functions and, subject to future regulations and guidance, enable Integrated Care Boards (ICBs) to delegate functions to trusts.

Objective and priorities

Provider collaboratives will need to agree specific objectives and priorities for their collaborative with one or more ICS(s) and be aligned with place-based partnerships within which the collaborative sits, with members agreeing how they will achieve their objectives with defined plans and programmes of delivery.

For those collaboratives which are already established they should ensure their plans align to current system priorities, the guidance explains. This is an important point, as it suggests that as ICBs emerge we are likely to see discussions amongst NHS leaders across systems, places and collaboratives to ensure current plans are aligned – and if not, some unpicking of existing plans. Any changes made to existing plans that impact patient services will need to be considered in the context of providers’ duties of engagement and consultation.

Footprints and membership of provider collaboratives

Membership of individual provider collaboratives will not be prescribed by NHSE/I – it will be up to providers and system partners to decide. So who to partner with? The guidance offers some guiding principles to support with decision-making together with a set of case studies as examples.

We have developed a set of FAQs to guide you through the process of forming a collaborative based on our insights from our learning and experience of working with provider collaboratives.

A view from NHS Providers

So, what’s their take on the guidance? Is it sufficiently flexible for Trust leaders (NHS trusts and foundation trusts) to facilitate collaboration?

Responding to the publication of the new guidance, the director of policy and strategy at NHS Providers Miriam Deakin said:

"The guidance offers much needed flexibility for providers to lead the development of collaborative arrangements, including their membership and shared goals.

"Looking to the future, we are calling on NHS England and NHS Improvement to ensure the ambition of flexibility carries through into implementation. This is vital to ensure existing joint working arrangements are not unnecessarily disrupted.”

However, Deakin explains that outstanding questions remain:

“…over what mutual accountability between providers within each collaborative will look like in practice, how the relationship between the integrated care body and collaboratives will play out, and whether trusts will be sufficiently resourced so that they are able to service ICS, place and provider collaborative arrangements.”

Getting collaborative ready

There is a fair amount to do before April 2022 – and that’s assuming that the Bill has an uneventful passage through both the House of Commons and House of Lords.

Whether you are an established provider collaborative or in the early stages of development our team of health and care lawyers can help you with developing your objectives and priorities and governance models. We have experience of working with a number of providers up and down the country.