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Acute provider collaboratives: delivering system impact in a changing NHS landscape
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3. Delivering at scale through mutual aid, productivity and shared capacity

3. Delivering at scale through mutual aid, productivity and shared capacity

Other systems are demonstrating how collaboratives can deliver operational grip at scale, particularly where there is shared ownership of performance and a clear focus on delivery.

The North East and North Cumbria provider collaborative is made up of all 11 foundation trusts in the region, including acute and/or community trusts, mental health trusts and one ambulance trust and it has focused on mutual aid and system-wide visibility of demand with approximately 2,000 patients being moved between providers to address waiting times. This shared approach to waiting lists is enabling better allocation of capacity, with workforce and infrastructure increasingly used as system assets rather than organisational resources.  

Agreement has been reached to develop a shared Patient Tracking List (PTL) through the Federated Data Platform (FDP), creating a single view of waiting lists to support earlier identification of pressures and enable proactive mutual aid across the network.

This has been supported by wider programmes, including:

  • a medicines optimisation programme delivering £19 million of savings in 2025/26
  • shared workforce services such as recruitment, bank and occupational health. These are part of a workforce programme that has contributed to improved workforce stability, with the FT vacancy rate reducing to 4.2 per cent (3,799 WTE vacancies) in 2025/26 from 6 per cent (5,423 WTE vacancies) in 2024/25 and temporary staff spend reduced by £18 million (7.1 per cent) in 2025/26
  • digital diagnostics platforms enabling shared clinical decision-making, such as digital pathology scanning capability with 50 per cent of all histopathology now reported digitally (will be 100 per cent in 2027)
  • a strategic approach to clinical services sustainability framework agreed across all 11 FTs and the ICB
  • leadership development programmes to prepare our next cadres of executive directors for leading at FT- and system-level
  • building one of the largest aseptic medicines manufacturing centres in the country.

Similarly, Cheshire and Merseyside Acute Provider Collaborative (CMPC) brings together all provider trusts across the region, including acute, specialist, mental health and community providers. It has driven significant system performance improvement, particularly in elective recovery.
 
Rather than acting purely as a coordinating forum, the collaborative has established regular system-wide performance forums, bringing together executives across providers to maintain grip on delivery, and taken a proactive role in identifying emerging risks early and intervening before performance deteriorates. The collaborative has also coordinated mutual aid and redistribution of activity, ensuring capacity is used across the system rather than within individual organisations, alongside intensive oversight of the longest waiters.
 
This approach has been underpinned by:

  • strong chief executive engagement and accountability, enabling honest conversations and peer challenge and support across trusts
  • a culture of shared ownership, where performance is seen as a system issue rather than an organisational one
  • a disciplined focus on delivery and outcomes, supported by regular, structured engagement
  • system-wide adoption of innovation, including collaborative procurement and implementation of new technologies where benefits can be realised at scale. 

In 2025/26, the collaborative reduced the number of patients waiting 65 weeks or more by 93 per cent, from 1,003 to 23, while the number of patients waiting 52 weeks or more fell by 39 per cent. Elective performance also improved significantly, with 18-week RTT performance increasing to 65 per cent, helping Cheshire and Merseyside move from quartile 3 to quartile 1 nationally. These improvements were achieved despite ongoing financial and operational pressures.

The collaborative has also been delivering innovation at scale, and following a successful national pilot bid, CMPC coordinated the implementation of Skin Analytics' NICE-recommended AI dermatology technology (DERM) across the system, making Cheshire and Merseyside one of the few ICBs nationally to fully deploy the tool. 

Providers subsequently agreed a single collaborative contract to maximise value and support consistent adoption. In 2025/26 alone, the programme avoided 4,640 unnecessary face-to-face appointments, helping reduce waiting times, release specialist capacity and improve access to skin cancer services. More than 45,000 urgent suspected skin cancer referrals are managed annually across the system, with Cheshire and Merseyside achieving 94.5 per cent of patients treated within 62 days of referral and 91.5 per cent receiving a diagnosis or ruling out of cancer within 28 days. 

Key takeaway

In both case studies, the provider collaborative operates as a core delivery engine, operationally binding the system together rather than simply coordinating it. By enabling mutual aid, transparency, innovation and shared accountability, provider collaboratives can drive productivity and performance improvements that would not be possible through individual organisations acting alone.

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