Commissioners split on STP leads' roles and responsibility

This is the finding of HSJ’s latest barometer of CCG leaders, which received responses from 100 chairs and accountable officers during March and the first half of April. It is supported by PA Consulting Group.

According to national guidance, sustainability and transformation plan leaders are “responsible for overseeing and coordinating their STP process”. However, many expect the roles to quickly expand.

Asked about the impact of STPs over the next 12-18 months, 35 per cent of CCG leaders who responded to the survey believed that “STP leaders will become responsible for performance and finance across the footprint”.

Their responses also indicate few CCG leaders are expecting any of their peers to step back from setting health system strategy, despite the creation of the STP leader roles.

Sixty-eight per cent said they personally would work to set strategy across the whole STP footprint. Only 20 per cent believed “some CCG leaders will step back from setting strategy across the CCG-area health system, as the STP lead takes this role”.

A small minority of CCG leaders – five per cent – believe the STP process will lead to their CCG completely merging with other CCGs. Fifty-five per cent believe it will lead to their CCG sharing more functions, excluding leadership and governance, with other groups.

Some respondents expressed concern about the impact of STPs on local and clinical leadership.

One chief officer said: “As there is more central control and more is done through the footprints to drive change, there is a danger that we will lose the wealth of clinical involvement and expertise we have in CCGs.” Another chief officer said STPs meant “the rowing back of local and clinical leadership”.

The survey found many commissioning leaders were prioritising strengthening relationships and reshaping services with current providers, rather than applying levers and incentives, tendering services, or promoting patient choice.

Sixty-five per cent of respondents said STPs meant more of their role would be dominated by improving relationships with, and trust among, other NHS organisations and/or councils.

They were asked to rate, independent of STPs, the importance of different methods to their CCG over the next 12-18 months. The responses were:

Some respondents said national bodies needed to change their behaviour to support a whole system approach.

A chief officer in the south of England said: “Increased system working and collaboration requires a changed approach from the regulators not just local organisations.”

Another said: “We need [NHS England and NHS Improvement] to accelerate their working together and to change approach from one that drives ever increasing activity and investment in acute services to enabling the shift of funds to build new models of care. Behaviours and actions need to match the rhetoric.”