• All providers and clinical commissioning groups will be accountable for “overall system control total”
  • Transformation funding and incentive payments will be tied to delivery of system financial target
  • Targets aim to “reduce the incentives for individual organisations to optimise their own financial position at the expense of the wider system”
  • STPs to be assessed against joint performance metrics

NHS England will issue overall financial targets to each regional health system in the coming weeks, in what will be a significant change to the regulation of local organisations.

Planning guidance for the next two financial years, issued by NHS England today, also sets out a range of performance metrics that STPs will be measured against.

On finance, the guidance says all providers and clinical commissioning groups will be “held accountable for delivering both their individual control total and the relevant overall system control total”.

Earlier this year, NHS organisations were split into 44 regional planning areas, which were tasked with developing a “sustainability and transformation plan” for their geographic footprint. Many of these areas have large underlying financial deficits.

The guidance says transformation funding, which is necessary to deliver key service changes and new models of care, will “only be available to systems whose operational plans meet their required control total and performance trajectories”.

There will also be a direct financial incentive for individual providers, with 1 per cent of quality incentive payments linked to the STP process.

Half of this will be “subject to full provider engagement and commitment” to the process, with the remaining 0.5 per cent held as a “reserve to cover risks in delivery of the relevant system control total”.

The guidance says the system-wide targets will “reduce the incentives for individual organisations to optimise their own financial position at the expense of the wider system”.

The targets will initially be derived from the control totals for each provider and CCG in the region, although areas that can demonstrate mature processes and governance may be able to operate a “flexible system” in 2017-18.

This could involve varying an individual organisation’s control totals so long as the system target is met within a given year.

Implementing this arrangement next year would need to be approved by regulators, but it is expected to become the “default” position from 2018-19.

Large STP areas can also apply to split into “subdivisions”, with each working to a separate control total, the planning guidance says.

Introducing flexibility or subdivisions next year will be subject to joint approval by the NHS England and NHS Improvement regional teams, with applications due by the end of October.

NHS providers have been set individual control totals in 2016-17, and the guidance adds that any deterioration in delivery or the opening position for 2017-18 will result in a greater efficiency requirement, because “by definition they will have unrealised and undelivered efficiency opportunity from previous years”.

By extension, an organisation’s failure to meet this year’s target will make the wider STP control total more difficult to meet next year.

STPs to be assessed on joint performance metrics

Health economies will have to achieve progress against a number of new “sustainability and transformation plan metrics”, the NHS planning guidance says.

According to the guidance, “core baseline STP metrics” will be published in in November, covering as a minimum:


  • Performance against organisation and system control totals


  • Accident and emergency performance
  • Referral to treatment performance

Health outcomes and care redesign

  • Progress against cancer taskforce implementation plan
  • Progress against Five Year Forward View for Mental Health implementation plan
  • Progress against the GP Five Year Forward View
  • Hospital total bed days per 1,000 population
  • Emergency hospital admissions per 1,000 population

The guidance states that STP areas will need to agree trajectories against these areas for 2017-19.