HSJ Article – Exclusive: STPs asked for ‘credible implementation plan’

Sustainability and transformation plan areas are being asked for a “credible implementation plan” to turn proposals into action and reconcile them with contracts and financial targets.

A letter sent to STP leaders 27 February said the Five Year Forward View delivery plan, expected to be published in late March, would request that “each area has developed a credible implementation plan now that the contracting round is nearly complete”.

Chris Hopson said the forward view delivery plan needs ‘brutal honesty’

“This plan will need to show how areas will manage activity and achieve the efficiencies in organisations’ contracts. Implementation plans will also need to reconcile these contracts with STPs where this has not been done already,” it said.

The timetable and format for the plans is yet to be decided, but they are expected to be developed over the next few months, and to refine actions that will be taken in the short-to-medium term. More details will be set out when the delivery plan is published.

In many cases, organisations signed contracts for 2017-19 that did not match the activity of financial plans in their area’s STP. Some commissioners and providers have not yet agreed their financial targets or control totals for the next financial year, and need to make large efficiency savings that they have not identified.

The letter to STP leads, from the NHS England and NHS Improvement chief executives, also says:

  • There will be a formal appointment process for STP leaders. This is expected to take place before the summer break.
  • The national bodies will set out a small number of governance models “we see emerging across the country” and help spread them.
  • Stronger STPs will be given “greater control over NHS England staff, together with CCG and trust resources, to enhance their implementation capability”, and “the right to make recommendations to us about local organisational governance, as well as other actions to overcome the inertia or organisational vetoes that are preventing improvements”.

There will be a “relatively small amount of centrally held transformation funding” for some STPs, overseen by STP leaders, to “help create exemplars for elective and emergency care, and get the most advanced accountable care systems off the ground”. There will also be “some additional central funding to support the formation of primary care hubs or networks across the country”.

The national bodies will also grant STPs one-off funding, ranging from £175,000 to £360,000 each depending on size, “as a contribution to operating costs and to help you assemble your teams quickly”.

According to the letter, the forward view delivery plan “will set out what the NHS will deliver in the next two to three years, within the resources available”. It will cover urgent and emergency care, including use of technology, and it will “describe the hard choices we will need to make to live within our means”.

NHS Providers chief executive Chris Hopson, asked to comment on the delivery plan, told HSJ it needed to do three things: “First, it needs to set out with brutal honesty what the NHS can now deliver if the spending review NHS funding levels are fixed. This will involve some very difficult re-prioritisation decisions.

“Second, it needs to set out how we build on the early success of the STP process to get to credible plans and system level organisational and governance structures that comply with the law, take account of local circumstances and build on the structures that are already there, not cut across them.

“Thirdly, the plan needs to chart a realistic 10 year path on how we move from early new care vanguards to systematic introduction of these approaches across the whole country. It would be much better if, unlike the work on the £22bn savings, the plan was honest and realistic and carried the explicit agreement of the NHS frontline who will actually have to deliver it.”