“Moving towards a culture of joint working” – the role of provider collaboratives in the ICS

We’ve had a look through Social Care Institute for Excellence’s (SCIE) archives and discovered a thought-provoking webinar on system transformation. In October last year, a panel of speakers came together to discuss the origins and role of provider collaboratives in integrated care systems.

As part of the panel, Sondra Roberto, deputy director of provider policy at NHS England, gave a comprehensive guide to the evolution of provider collaborations, their aims and the key benefits expected to emerge as a result.

Background and context

Sharing how she had led the national policy teamwork to promote and support provider collaboration, Sondra said: “We have developed national policies alongside integrated care systems for some time now, and through the years we’ve worked with new models of provider collaboration; testing the benefits that they can bring to patients and communities.

“Interestingly, this was all happening during a framework in which providers were encouraged to compete with each other, because competition was the framework for driving quality of care. Even then, there was a recognition that providers can often do more by working together.” 

“Even then, there was a recognition that providers can often do more by working together.”

Sondra highlighted some of the new care models and the acute care collaboration groups which have allowed systems to test the ways in which providers can work together. She noted that there are NHS-led provider collaboratives in specialised mental health, learning disabilities and autism services which have evolved from the process of testing new care models in the 2000s.

“We then came to the pandemic, and it started to become quite apparent that joint working and approaching services as a system was really important for providers to start to do that,” Sondra continued. “The goal of our provider collaborative national policy has been to encourage and promote that type of joint working and a culture of looking through the lens of integrated care systems, for how we can best support populations.” 

‘Working together at scale’

In August 2021, Sondra said, the ‘Working together at scale’ guidance was published, setting out an expectation that all NHS providers of acute and mental health services would become part of a provider collaborative by July 2022, as part of the launch of integrated care boards and systems.

“We also said that other providers should be part of provider collaboratives, where it makes sense to deliver benefits,” Sondra noted.

She defined a provide collaborative as “partnership arrangements involving at least two trusts, working at scale across multiple places with a shared purpose and effective decision making arrangements, to reduce unwarranted variation in inequalities and health outcomes, access to services and experience.”

“We really wanted to move away from the competitive nature and more towards a culture of joint working.”

Sondra noted that they can improve resilience by providing mutual aid and supporting challenged organisations or fragile services, and said: “The guidance is not exclusive between NHS trusts only – the purpose was that we get the best types of providers working together on the benefits that they think they can do best by working together. We suggested a minimum of two trusts or organisations because we really wanted to move away from the more competitive nature and towards a culture of joint working. So that was where we put the expectation most firmly, but with the acknowledgement and recognition that it will look different in different systems, and that different types of providers will come together depending on the objectives of their ICS.”

The role and benefits of provider collaboratives

“If you think about a broad plan of an ICS, it will be developed by partners across the system, coordinated and led by an ICB, influenced by the ICP that will bring all partners together. When you’ve got that plan in place, you can then start to think: what are the things that providers can best deliver and lead by working jointly as a system?”

The collaboratives should compliment place-based partnerships and other work in neighbourhoods, Sondra commented, along with other partners who may be leading their own kind of programmes of work to improve and transform care. 

Moving on to explore benefits, Sondra said, “A main benefit is reducing unwarranted variation in clinical practice – that’s about sharing and supporting each other to implement best practice.

“Reductions in health inequalities is another key example. We really saw during the pandemic how health inequalities were dramatically exposed and we know that providers can come together to talk about how they can improve that and create better access for communities who may not have equitable access.”

Other benefits include more effective clinical and support services, she continued. “This is about really producing efficiencies and value for money. We know that providers can sometimes come together – instead of everyone doing one thing on their own – and they can pool together and focus on procurement, recruitment, pathology, clinical support services. Through their shared efforts, can dramatically increase efficiency.”

Another key benefit noted by Sondra is the alleviation of workforce pressures and better development of staff and leadership talent. “They can look together to improve staff experience and retention across the ICS workforce, fostering greater resilience to ensure patient safety – which is absolutely vital in ensuring positive and consistent standards of care and health outcomes.”

To watch the webinar in its entirety, click the link here.