Somerset STP plots 'accountable care system'

The plan, which was published yesterday, proposes consolidating services across Somerset’s two acute providers, and warns that without change the county will face a cumulative funding shortfall of £596m by 2020-21.

Somerset’s STP footprint includes Somerset Clinical Commissioning Group, Taunton and Somerset Foundation Trust, Somerset Partnership FT, Yeovil District Hospital FT and Somerset county council.

The plan says that an accountable care system will be achieved by April 2019, comprising of two parts: a “strategic commissioning function” will be created with NHS and social care working together “under a single commissioning arrangement to secure outcomes and pool budgets”. This will be accompanied by an “accountable provider organisation”, where services are “delivered by a provider, or group of providers” through a single governance structure to the Somerset population through an outcome based contract.

It is not clear whether the accountable provider organisation could result in providers merging, but the STP states that moving to the accountable care system will result in a “reduction in management overheads and organisations”.

On the subject of acute services, the STP states that workforce challenges and rising demand are making it “increasingly difficult to maintain the full provision of services” across Taunton and Somerset and Yeovil District Hospital.

The plan says “alternative models of delivery” will be developed for “vulnerable services”, including consolidation and introduction of “single site, single workforce solutions” if appropriate.

Paediatrics, maternity, dermatology, oral maxillofacial surgery, urology and oncology have been prioritised for redesign this year.

For maternity and paediatrics, a joint approach to redesign is being taken with Dorset, with the possibility that services at Yeovil District Hospital could be networked with Dorset County Hospital FT.

The STP also includes plans to improve prevention and beef up out of hospital services.

Somerset CCG chair and STP lead Matthew Dolman, said: “The health and care system in Somerset needs real change which puts prevention at its heart.”

“We haven’t kept pace with the changing demands and this is the opportunity to address that and focus on keeping people healthy, independent and in their own homes and communities for as long as possible.”