Large ICS to hand billions to acute ‘provider collaborative’

The joint body made up of local trusts, which is already operating in shadow form, would be able to receive and hold the funding as it would be a legal entity of the integrated care system.

Currently, funding is allocated to 10 clinical commissioning groups in Greater Manchester, which then agree a contract with local trusts to provide services for their population. Assigning money straight to a collaborative board of providers would bypass any “place”/borough-level structures, while also aiming to foster greater collaboration between the six acute trusts.

The annual income of the patch’s acute trusts is around £4.8bn, although some of that is likely to be excluded. 

ICSs are in the process of being created under new government legislation. They will subsume CCGs’ responsibilities, with some of those functions expected to be delegated to providers, or provider collaboratives, to varying degrees within different systems.

The national legislative proposals have so far lacked detail on collaboratives’ role, however, with NHS England suggesting there could be room for some local flexibility.

The Greater Manchester collaborative, currently known as the “provider federation board”, is relatively advanced compared to those in other parts of the country, and will seemingly play a pivotal role.

Sir Richard Leese, chair of the region’s ICS, said the proportion of funding held by the joint body is still being debated, but there was recognition it would need to be substantial in the short-term, as providers need to lead the recovery of elective care.

He told HSJ: “There is still a discussion about the extent to which all of the acute funding would go to the provider collaborative…

“There isn’t an argument about where the financial flows should go to — what the argument will be about is how much, the quantum rather than direction of travel.

“What we don’t want to do is have money that goes from the ICS NHS board to a locality that then goes to the provider collaborative, that then goes to trusts. We don’t want to be putting in additional layers. That would be inefficient.

“I think broadly there’s a recognition in the system that in any given year the extent you can move money from one area to another is marginal because a lot of it is pretty much in fixed costs, in people and buildings.

“There’s also a realistic recognition that this will probably lead to certainly the bulk of acute funding going to the provider collaborative for the next two to three years.

“Some of that resource will go direct to the providers — that’s got to be the case — but some of it will be held by the provider collaborative. The white paper does allow the ICS board to delegate to various NHS structures beneath it… and provider collaboratives are identified in the white paper.”

A paper to the ICS board last Friday, by interim chief officer Sarah Price, said the provider collaborative “will require formal governance, the ability to manage a shared budget and take on formal accountability for delivery”.

The response to the coronavirus pandemic has encouraged further collaboration between providers, with the provider collaborative/federation board playing a leading role.

It is chaired by Manchester University Foundation Trust chief executive Sir Mike Deegan, with former Trafford commissioner Martyn Pritchard recently appointed as managing director.

Handing a significant portion of the ICS’ funding to the collaborative could prove controversial among some in the region, as there have been calls for each borough to have full control over its own share of funding.

Sir Richard, who is also leader of Manchester City Council, said he anticipates all primary and community funding would go to borough-level “locality boards”, while mental health funds would be organised across the system.

In an article for HSJ,  Sir Richard said Greater Manchester’s ICS will benefit from “long-standing relationships, which we have invested in deeply in recent years”.