Unlocking the potential of provider collaboratives

Provider collaboratives can take many shapes. They can:

• bring together all of the NHS trusts within an ICS footprint
• bring together all of the NHS trusts in the same sector, e.g. all acute trusts with an ICS footprint, or
• bring together all of the NHS trusts other providers across sectors, e.g. voluntary, community and social enterprises, private care homes, GP practices, integrated care boards (ICBs), etc.

The aim of provider collaboratives is to gain the benefits of scale to:

• reduce unwarranted variation and inequality in health outcomes, access to services and experience
• improve resilience by, for example, providing mutual aid
• ensure that specialisation and consolidation occur where this will provide better outcomes and value.

In November 2022, the NHS Confederation and NHS providers conducted a survey of provider collaboratives, in which 70% described themselves as being in the early stages of development.

Much has been written about how to set up provider collaboratives for success. Familiar themes are raised:

• Trusted relationships
• Systems thinking
• Form follows function

In this article, we aim to provide some practical guidance by discussing tangible examples behind each.

Trusted relationships

The following activities have helped provider collaborative and system partners strengthen relationships:

• Tasking chairs, governors and non-executive directors to meet proactively with members of the community, local authorities, voluntary and private sector organisations to understand their needs, constraints and working preferences. Some trusts are actively co-ordinating stakeholder engagements and have established systems for sharing insights. Visits and informal meetings, outside the formal meetings and workshops, significantly boost the development of personal trust. Informal conversations lend themselves to discussions about personal circumstances and motivations, which underpin proposed shared activities and objectives.
• Focusing on new activities, rather than wrapping existing programmes under the new provider collaborative umbrella. This helps build excitement and momentum and counter change fatigue and scepticism.
• Starting to work with the enthusiasts and being willing to build successes that encourage others to join.

Systems thinking

Examples of system thinking from recent work include:

• looking at challenges and opportunities holistically, agnostic of the remit of organisations to which one belongs
• exploring system risk and interdependencies
• focusing on real and practical gains, especially things that really matter to partners, such as releasing resources through back office integration and streamlining pathways to cut waiting times.

Looking at challenges and opportunities holistically

In a recent board development workshop, participants were presented with scenarios, e.g. rising childhood obesity. They were encouraged first to think about the challenge holistically, rather than through the lens of what their organisation can control directly.

This led the discussion to consider what would need to be done (by someone). Examples were wide-ranging and included education and cooking lessons in schools, restrictions on fast food licences, national sugar tax, etc.

Then, as a second step, they were asked to identify who would be best placed to action those ideas (schools, local authorities, national government) and, as a third step, how different organisation could influence, and lend support for, priorities.

Exploring system risk and interdependencies

Many trusts and ICBs have found that discussions on risk and reviews of board assurance frameworks are a helpful platform for discussing system interdependencies and system thinking. Those most affected by risks are often not the same as those in the best position to control and/ or mitigate the risks. These interdependencies were always there – the introduction of integrated care systems have just made them more visible.

Organisations are shifting their focus from what is in their direct control towards thinking about their contribution to shared risks and shared objectives. These discussions typically reveal that the cost across the system of the collapse of fragile services is greater than the cost to secure them.

Form follows function

In the early stages of establishing a provider collaborative, there is a temptation to focus on structures and decision-making processes (form before function). We have observed the following good practice to ensure that form follows function:

• Put impact on people at the centre of everything you do. This goes beyond the ‘patient story’ approach. In one trust board meeting we observed, we noted how each agenda item started with the intended outcomes, i.e. the impact on people’s lives, and all the board members started from this premise when making their points. It was a very powerful example of putting people first.
• Focus on behaviours, not processes, starting with the behaviours you exhibit and the language you use. For example, do you routinely talk about ‘patients’ or ‘people.’ Referring to ‘patients’ has implicit implications, for example a focus on treating illness rather than preventing it, and patients as passive recipients as opposed to experts and co-designers in their own health management. Many trusts are providing coaching for key leaders and executives on collaborative behaviours and operating through influence.
• Focus on what you want to do (the what) not the groups and processes for doing it (the how). Start with very simple governance, e.g. a memorandum of understanding between providers, with some core principles, and don’t set up more evolved governance until the level of activity requires them.

Further reading

If you would like to hear more about our work supporting trusts and provider collaboratives, please get in touch.

We also have useful guides and tools on our website, including a guide to provider collaboratives.