Indeed, provider collaboratives are the cornerstone of the NHS’s mental health implementation framework and from April this year, provider collaboratives are to become the vehicle for delivering all specialised mental health, learning disability and autism services. And October has seen the first ten fast track provider collaboratives go live - these collaboratives will take on the budgets and the care pathway for their population, commissioning specialised mental health services covering children and young people mental health inpatient services, adult low and medium secure care and adult eating disorder services.
We share insights from our learning and experience of working with provider collaboratives on what makes a successful collaborative – the honeymoon can fade fairly quickly as you get down to the difficult issues.
We have prepared 10 FAQs to guide you through the process of forming a collaborative.
The first step for providers is to work with others who share a similar vision, culture and ethos. Often existing relationships will make for a good partnership as you will have a shared history of other joint working or partnering.
Providers must decide which person at each organisation will have responsibility for developing the provider collaborative. The provider representative must have sufficient delegated authority and seniority to make decisions on behalf of the provider, and ideally, the chosen representatives will attend every workshop in order to ensure continuing progress in the collaborative’s development.
The provider representatives will also need to have sufficient leadership voice and influence within their respective organisations, in order to assure their boards on the adoption of the proposed changes and to encourage people at both grass roots and leadership levels within their organisation to advocate for the model.
Providers will need to consider the overall aims and objectives of the collaborative. This means thinking about the reasons and incentives that organisations have to enter into the collaborative in the first place, their ultimate goals and what they are actually seeking to achieve together. Be clear about your objectives.
For example, is the collaborative merely a vehicle for contracting with NHS England, or are the providers looking to create real change and improvements to the service for patients?
Providers need to be clear and transparent on their chosen governance model. So, providers will need to agree on the voting and decision-making structure of the collaborative, and consider questions like:
- do all the providers have equal voting rights, or does the lead provider get more of a say?
- must the majority vote also include the lead provider, or can the lead provider be bound by a decision it has not agreed to?
- in the event of deadlock, does the lead provider get the casting vote?
- what are the processes for existing providers to leave or new providers to join the collaborative, and how should this be agreed?
Providers will therefore need to work out and be very clear on what exactly the role of the lead provider will be within the collaborative. Just because a provider is the “lead provider” does not necessarily mean it is in charge of the other providers with whom it sub-contracts. The overall purpose of the collaborative should be to work together and spend money in a way that provides the best outcome for patients. Therefore, in many collaboratives the lead provider is aligned equally with the other providers. This helps to create a more open and collaborative environment where all providers feel they can contribute and participate on an equal footing.
The collaborative must also consider carefully the interaction between, and separation of, the lead provider’s dual role as both provider and commissioner. For example, rather than reserving all commissioning decisions to the lead provider, it might be better if these are dealt with by the collaborative as a whole, or even by a separate team instructed by the collaborative.
Providers will also need to plan and agree on how to deal with the financial risk and/or “gain” of the provider collaborative. In many collaboratives, any financial surplus is reinvested into the system in order to improve the service and ultimately benefit patients. This means that individual organisations will not take a portion of any “profits”. Instead, the surplus is a saving that can be used as an opportunity to make improvements, buy equipment, or hire more staff.
It is essential for the collaborative to prepare a clinical model in order to work out how care will be delivered in a better and more cost-effective way, in order to improve the experience of patients and staff. A detailed clinical model should set out exactly how the service will be delivered differently, and will also help providers to see how the collaborative will work in practice.
There are potential difficulties where the collaborative includes independent sector (IS) organisations because they must comply with various competition rules, such as not sharing commercial sensitive information or fixing prices. For multi-site IS providers, this presents a risk in terms of having to share patient and staff data or information with other organisations. Integrated care relies on sharing patient data, so providers will need to be aware of the issues associated with competition and sharing information.
Providers will also need to think about the IP position, such as what will happen where a provider leaves the collaborative after developing or contributing to new ideas or concepts. Will the provider be able to take this IP with them or does it remain with the collaborative?
Providers will need to bear in mind how different types of provider organisation operate, and take this into account when deciding how they will be treated within the collaborative and how this might affect the contractual structure. For example, IS organisations might be restricted by their banking covenants from underwriting another organisation’s risk. Providers should therefore be mindful of these differences and work together to develop equity within the collaborative. This means giving each provider what it needs in order to reach a place of equality within the collaborative, as each provider is not necessarily starting from the same position.