The evolution of provider collaboration

Key points

• Strong collaboration between providers forms the bedrock of statutory integrated care systems. While collaboration across NHS providers has existed for many years, collaboratives have become more common in mental health through NHSE’s new care models for specialised services and in other sectors, with trusts coming together to look at streamlining resources, standardising care and offering mutual aid.
• In summer 2021, NHS England formalised the move to collaborative working and set out guidance for how providers should work together at scale in provider collaboratives. These partnership arrangements have been developing across the country, embracing the opportunity to work together at scale to tackle unwarranted variation, make improvements and deliver the best care for patients and communities.
• But since being formally mandated, how have provider collaboratives been progressing, what challenges have they faced and what opportunities lie ahead in the years to come? To discover the answers, the NHS Confederation and NHS Providers joined forces to conduct the first survey on provider collaboratives’ progress.
• This report – based on a survey of provider collaborative leaders – details what we found, including insights on provider collaboratives’ priorities and how they are building relationships with partners and integrated care boards (ICBs). It also highlights their challenges and successes, and where more support might be needed to fully realise their potential. The insights will be of interest to provider collaboratives up and down the country, to ICBs and integrated care systems (ICSs), and to policymakers looking to support their development.
• Many provider collaboratives still consider themselves in the early stages of development, with more than 70 per cent focusing on set up – such as governance arrangements, leadership models and decision-making processes – in the last 12 months. While establishment has been an important focus, a gear shift over the coming year has been signaled, with twothirds intending to focus on clinical pathway redesign or the consolidation of clinical services.
• Despite being at this early stage, collaboratives are already working to make a difference for the populations they serve: even the newer collaboratives are taking their first steps towards improving the quality of care by reducing out-of-area placements, strengthening community services, tackling backlogs and making services more efficient.
• Relationship building has been a key priority, with a positive early picture emerging of collaboratives’ engagement with ICBs, focusing on setting priorities, operational pressures and with involvement of place-based partnerships. This can be dependent on the maturity of the system and the complexity of the number of ICSs that the collaborative covers.
• Collaboratives vary by sector and in maturity. The varied nature highlights that providers are using the deliberately open statutory framework to take approaches that make sense in their local areas. Population needs, NHS priorities and local relationships will inevitably vary from ICS to ICS, but what is evident is that the permissive approach is paying off. NHS England and ministers must make efforts to preserve it.
• As well as time, collaborations need staffing, resource and leadership capacity: these are in short supply given the extreme operational and financial pressures facing the NHS at the moment. As collaboratives mature, it is vital that national leaders are realistic about the impact that external factors will have on their development. This must be reflected in national policy while pressures persist.
• The survey illustrates that trusts are committed to collaboration and realising the benefits they can bring. However, the ability to realise this potential and make a transformational contribution to care in their systems will be underpinned by access to the right support.