Much is riding on the recently submitted sustainability and transformation plans (STPs), but PA Consulting Group and the HSJ’s survey of clinical commissioning group (CCG) leaders revealed an uncertain picture about how effectively they will be implemented.
Changes in services
When we asked about the changes in services CCG leaders expected, we found a clear focus on expanding primary care and reconfiguration of acute providers. However, respondents thought these developments were likely to be hampered by the present payment system and the sustainability and transformation fund process.
Barriers to success
While CCG leaders were fairly confident STPs would be reflected in contracts with providers for the coming year, sixty-five per cent had low or very low confidence their STP will have the planned impact on financial and operational performance in 2017/18.
That lack of confidence reflected concerns about organisational and financial barriers. These included chronic underfunding and the sheer scale of the financial gap over the next five years. However, the respondents were evenly split about whether their own organisations would achieve financial surplus at the end of the year.
There were also concerns about primary care resilience, contracting for new care models and outcome based commissioning but more confidence about designing new models of care.
CCGs leaders recognised the success of STPs would also depend on external stakeholders and they saw politicians (60 per cent), providers (54 per cent) and the public (54 per cent) as the main sources of opposition or resistance. GPs, other clinicians and their own organisations were seen as more likely to be supportive.
CCG leaders had confidence in their own STPs but more than two thirds were worried about a lack of change management capacity and capability in their area and just over half felt they could not control patient demand. This raises real questions about CCGs’ ability to bring about the transformation the STPs need.
Nothing is certain and everything is possible: CCG leaders’ views on their own sustainability and transformation plans
Addressing the challenges
When we asked what STPs were doing to deal with these challenges, the majority said improving local relationships (78 per cent) and introducing STP control totals (70 per cent) were the key actions. However, only a quarter of respondents felt STP leaders would take responsibility for performance and finance across the footprint, undermining their ability to truly drive change.
In terms of the structures CCG leaders want to see, there was a marked preference for the multispecialty community provider model of care. Whatever model emerges, respondents felt there would be more joint decision-making between CCGs (76 per cent). However, few plan to go any further than this into mergers or devolution of functions to local authorities.
The results of our survey show some confusing and contradictory views about STPs. However, they also show CCG leaders have a significant level of insight into the issues they face and the potential solutions. That creates a real possibility that strategic, place- and population-based commissioning can play a vital role in transforming the NHS over the next five years.