Oli Hudson, content director at Wilmington Healthcare, looks into one of the headline points of the new NHS White Paper, and explores what this might mean for the industry.
'Integrating care: Next steps to building strong and effective integrated care systems across England', the White Paper released by NHS England and NHS Improvement in February, had as a central conceit the increased importance of ‘place’ and the role played by providers.
Place is considered in the White Paper to be a locale with a population of 250,000 to 500,000 and is roughly coterminous with a local authority boundary.
‘Places’ are expected to take on delegated budgets, with the ICS (integrated care system) only taking the lead where it is clear that work needs to be carried out over a larger footprint.
Each place would typically have up to five hospital trusts, as well as ambulance, mental health, and community care services, which are now all expected to form integrated structures.
These providers, working in groupings, collaboratively, seem to hold the future of the NHS in their hands, if this document is enacted as is; driving forward pathway change and service improvement and making the NHS ‘financially and clinically sustainable’.
Every NHS provider will be expected to join at least one provider collaborative.
It seems clear these collaboratives will take an 'active and strong' leadership role in places. This will not be a totally smooth process, and some will struggle more than others to establish a new way of working after a near quarter century of competition with each other. However, written into this script is a need for provider collaboratives to challenge and hold each other to account.
And ultimately the trauma of coping with the post-COVID backlog and having thinly spread workforce and resources may just force the process here. Collaboratives will need to enact mutual aid arrangements such as collective waiting list management and look at their combined and individual spend to see how they can enhance productivity and improve value for money.
This could affect medtech in a variety of ways.
Firstly, who is the decision-making unit that medtech is effectively selling to? In the old model, an account might be a large hospital with its own clinical directorate and its own procurement department. While there would be some aggregate purchasing and plenty of use of the NHS Supply Chain, with provider collaboratives new governance will be in place. Clinical decision making, including an influence on purchasing, will not sit at individual hospital level. What will this mean for a standard medtech account?
Secondly, procurement decisions could well end up in the hands of the so-called ‘lead provider’ a trust within a place that will sign the contract with the regional NHS. In fact, taking on this function is one of the marks of a provider collaborative having gone ‘live’.
It will be important to establish who this lead provider is. For example, in the Nottinghamshire provider collaborative codenamed IMPACT, the lead provider is Nottinghamshire Healthcare NHS Foundation Trust.
The place model will undoubtedly give rise to new pathways, too; both in a clinical sense, in terms of using the resources available within a place to change the model of care, as is being developed by the GIRFT initiative; and in the geographical location of services – in terms of some trusts specialising in particular clinical areas; and rationalisations within place, meaning some service reconfiguration, which could affect what some of your customers are actually carrying out. One of the main priorities of many provider collaboratives, for example, will be to keep patients out of hospital as far as possible.
Lastly, the value proposition could change. Under the old financial system, individual trusts paid on activity and in competition with other providers were effectively incentivised to perform as many procedures as possible, thereby increasing trust revenue. With the new contract-based system, the focus is much more on provider collaboratives achieving outcomes – built into the contract – population health – dependent on equitable provision across the whole system, not just by the individual organisation – and sustainability, meaning a stronger focus on long-term benefits to the place, and system. This last point – perhaps usefully for medtech – could result in less of a focus on short-term cost cutting if those longer-term outcomes are clearly evident from the use of a particular device, technique or product.
This is clearly a space to watch – the next important release from NHSE/I will be its forthcoming publication on provider collaborative models. This is likely to include hospital groups, where trusts will band together in more formal organisations. Could they be medtech’s customers of the future?
