As part of the Five Year Forward View, in March 2016, NHS England divided the country into 44 footprints, bringing together NHS, local authority and other health and care organisations to collaboratively determine the future of their health and care system.
These systems were first required to develop five-year, place-based plans for the health and social care within their footprint, then referred to as Sustainability and Transformation Plans.
Subsequently, as NHS England have put greater emphasis on system-wide working and integration, their name and nature have changed. In March 2017, these 44 systems were renamed Sustainability and Transformation Partnerships (STPs) with the launch of Next Steps on the Five Year Forward View, which gave them a greater role in the planning of health and care.
Next steps
Next steps on the Five Year Forward View also introduced two specific evolutions of STPs, Integrated Care Systems (ICSs) and Integrated Care Providers (ICPs) - both of which were suggested as possible next steps in development for the most advanced systems.
Each STP and ICS is now expected to produce new five-year plans for 2019/20 - 2025, which will replace those produced in 2016. These plans are expected to take account of the delayed Long-Term Plan for the NHS and new capital funding settlements, so it will be important that the BMA and local members influence their development. Read the BMA's response to the NHS Long Term Plan consultation.
Influencing and engaging with changes to your local health system
The move towards the integration of health and care services in England is continuing to gather pace, with ICS and STPs taking on greater responsibilities and now developing new five-year plans for the future.
It is therefore essential that ICSs and STPs are shaped by the views and experiences of frontline clinicians – who know the most about what the NHS does and how it should work. The guidance presented here is intended to support frontline doctors to secure and capitalise on local engagement and the questions, tips, and information provided have all been tailored to this purpose.
Download the guidance
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STP plans
In March 2016, each footprint was tasked with producing their own local place-based five-year plan, referred to as an Sustainability and Transformation Plan.
These plans were published in 2016, amid controversy surrounding the transparency of the process and pressure on each area to deliver enormous financial savings. Each plan was expected to show how the health system would achieve financial balance by 2021.
In June 2017 we published a comprehensive analysis of every STP plan, highlighting:
- significant concerns regarding the realism of the proposals
- the level of savings they were expected to deliver, and;
- the transparency of the process.
A 2017 investigation found that nearly £10 million had been spent on STP managers and consultancy firms.
As a result, the original plans are no longer necessarily reliable. However, information on each STP and their leadership is available on the NHS England website.
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BMA view
While the BMA supports the concept of health and social care integration, we have been critical of the introduction and initial development of STPs.
Our major concerns regarding STPs and their original plans include:
- Funding and finance - the enormous pressure on STPs to deliver savings, and of capital funding reinforced concerns that they plans were focused on finances, no care
- Governance - STPs are not statutory bodies and have no bass in legislation
- Transparency - STP plans were produced secretively, and could not be properly scrutinised
- Engagement - STP plans were developed with inadequate engagement with clinicians and the public
A recent all-member survey carried out as part of our Caring, Supportive, Collaborative project showed that BMA members continue to view STPs negatively and were not engaged in their development.
The survey found that:
- 78% of doctors said they have not been involved in or engaged for their views in their STP in the last 12 months
- 80% of doctors believe STP plans are primarily driven by cost pressures
- 51% believe their local STP plans will cut services
- 15% doctors believe that their local STP's plans will improve joint working across the health and care system
- 9% feel they would improve sustainability of services
- 5% believe transformation services for the benefit of patient care
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Integrated Care Systems (ICSs)
ICSs are seen as the next step for the most advanced STPs and represent a more advanced level of integration and system-wide working. 14 ICSs have since emerged from the 44 STP footprints, with more expected to be announced next year. You can find details of each ICS and a map of the 14 in place on the NHS England website.
In an ICS, NHS bodies, local authorities and third sector providers enter into a voluntary agreement to take collective responsibility for the management of resources, delivery of services, and population-health of their area. The creation of an ICS does not require any contractual change.
For more information on ICSs and what they mean for doctors, read the BMA's latest member briefing on ICSs or watch the BMA's webinar.
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Integrated Care Partnerships/ Accountable Care Organisations
Integrated Care Partnerships (ICPs – formerly known as ACOs) are a further evolution of STPs, where a contract is awarded to a single provider for the majority of health and care services in a defined area.
Unlike an ICS, the formation of an ICP would require significant contractual change, particularly for general practice. Under current legislation, ICP contracts are also open to private providers. As a result, they have been highly controversial. However, no ICPs have been formed to date.
Read the BMA briefing to find out more about ICPs/ ACOs.
The BMA has also responded to a recent NHS England consultation on the contractual arrangement for ICPs.
Read the BMA briefing to find out more about ICPs/ACOs.
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Contact your Regional Coordinator
While there is national direction and oversight of STPs, ICS and ICPs, they are being developed locally. Therefore, it is crucial that doctors and other key stakeholders engage in and influence the new STP and ICS plans as they develop.
For more information on what is happening locally, contact your Regional Coordinator:
North East - Adele Heeley, [email protected]
Yorkshire and Humber - Elaine McAvoy, [email protected]
North West - Michael Cheetham, [email protected]
West Midlands - Melanie Sutton, [email protected]
East Midlands - Jim Stronger, [email protected]
East of England - Nigel Mason, [email protected]
South Central - Hugh Townsend, [email protected]
South East Coast -Hugh Townsend, [email protected]
South West - Abigail Moore, [email protected]
London - Andrew Barton, [email protected]