Understanding the role of provider collaboratives

The recent NHS white paper positioned a new set of organisations known as provider collaboratives at the heart of delivering integrated care. But what organisations will form these collaboratives and how they will operate within the reformed landscape?

What are provider collaboratives?

Provider collaboratives are expected to operate within a ‘place’-based footprint of between 250,000 to 500,000 people, where they will assume responsibility for delegated budgets, with the new Integrated Care Systems (ICSs) only taking the lead for work carried out over a larger footprint.

All NHS providers will be expected to join at least one provider collaborative, which will be tasked with driving forward pathway changes and service improvements and making the NHS ‘financially and clinically sustainable.’ This will typically involve hospital trusts, as well as ambulance, mental health, and community care services, coming together to form integrated structures.

Meanwhile, trusts that operate across a large area or are within a small Integrated Care System (ICS) are likely to want to be part of a collaborative that spans “multiple systems”. NHSE/I is expected to set out guidance on how to do this soon.

Where will decision-making sit?

The most immediate implication is that decision-making will span a far wider interest group than before. NHS plans, Key Performance Indicators (KPIs), staffing, and to an extent finance, will be based upon the collaborative rather than individual hospital trusts, and money will need to be spent according to population health needs within ‘places.’

However, prescribing 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. It will, therefore, be important for pharma to identify the lead provider within each collaborative.

How will this affect prescribing?

One effect of Clinical Commissioning Groups (CCGs) being absorbed or merged into ICSs will be a reduction in Area Prescribing Committees (APCs). For example, two or three CCGs that currently have separate APCs may merge to fit the size of an ICS or end up being absorbed into the system.

While certain services, including some specialised commissioning, will go to ICSs, many CCG functions in relation to formularies, medicines and decision-making, will be managed at place level by the provider collaboratives.

Therefore, rather than having individual drug and therapeutic committees serving one hospital, there will be a much wider focus on what should be used across the whole collaborative.

Consequently, territory and account planning, assumptions of who customers and payers are, who controls rebates and how area prescribing committees will operate will all need to be reviewed in light of these changes.

What are some of the likely impacts on care pathways?

Place-based care models will also give rise to innovation and change within services. From a clinical perspective, there will be a focus on using the resources available within a place to change the model of care, as is being developed by the Getting It Right First Time (GIRFT) initiative.

There will also be changes in the geographical location of services. For example, some trusts within a collaborative may specialise in particular clinical areas, while there will also be some rationalization of services within ‘places’ to drive efficiencies – and so expect service reconfiguration to be a key priority for many provider collaboratives.

How can pharma develop an effective proposition?

Under the old financial system, individual trusts were paid for activity and they operated in competition with other providers. However, the new provider collaboratives will be working through block or blended contracts with a focus on achieving outcomes built into those contracts.

In particular, they will be looking at population health – which requires equitable provision across the whole system – and also sustainability, meaning that there will be a much stronger focus on long-term benefits to both a ‘place’ and the wider system.

For pharma, this means thinking about the cost of a pathway within each trust and how a particular drug might impact on the system as a whole by, for example, keeping patients out of hospital or enabling homecare – so the ability to map pathways at system level and look at costs for each part of the system, using real-world data, will be important.

Conclusion

In short, “place” will form the locus of local decision-making under the management of the new provider collaboratives, which will be responsible for driving service improvements and pathway changes, while ICSs take on a wider strategic commissioning role.

These developments will have wide-ranging impact on pharma, from new customers and payers, to changes in prescribing and the introduction of new patient pathways. This, in turn, will impact on pharma’s value proposition, which must take account of population health principles.

It is therefore essential for industry to think widely about illness prevention and management, to ensure that its products are aligned with optimal care pathways and to define how they can help to deliver whole system benefits in line with key NHS priorities.

Ends