Big STP plots 'accountable care organisations' across 2.5m patch

The document, which was submitted to NHS England on 21 October and published last week, sets out how the region proposes close an expected financial gap of £1.07bn by 2021.

The STP, which covers a very large patch with a 2.5 million population, decided to break down into six smaller constituent parts which have drawn up their own plans separately. These are: Wakefield, Bradford district and Craven, Leeds, Kirklees, Calderdale and Harrogate.

The wider West Yorkshire and Harrogate STP will focus on nine specific areas including cancer, urgent and emergency care, specialist services, stroke and mental health as well as standardising commissioning, acute service collaboration, prevention, and community and primary care.

Key planks of the plans include redesigning community care with a focus on prevention, making the region’s hospitals sustainable and changing the way services are commissioned.

Changes to the way services are commissioned fall into three areas:

• Strengthening the region-wide committee of CCGs to commission some specialist services at a West Yorkshire and Harrogate level;
• Bringing together CCGs, councils and NHS England to integrate commissioning in the local authority area; and
• Set up new “accountable care organisations” to manage capitated budgets for their local populations.

The regional joint committee of CCGs will be strengthened to make commissioning decisions on specialist services, creating system-wide outcomes and payment methods and care pathways, while provider-led ACOs will decide how resources are best utilised to meet their population’s needs.

Specifically the STP refers to setting up ACOs in Airedale, Bradford and Craven, and Wakefield; and a primary and acute care system in Harrogate. Leeds is also testing new care models which, HSJ understands, could involve an ACO in the future.

STP lead Rob Webster, chief executive of South West Yorkshire Partnership Foundation Trust, said the ACO model would give providers more capacity to work together and added: “How you transfer some staff or functions into a group of providers to help them work together on a [multispecialty community provider] or [primary and acute care system] will take time, but that’s got to happen for providers to work together in new ways. They have to have different capacity and some of that is in commissioning.”

He said at a regional level plans would focus on services which are either at a West Yorkshire scale, require the spread of good practice, or which cannot be solved at a local level.

But Mr Webster said the key risks to the successful implementation of the plan would be whether it receives the £172m of sustainability and transformation funding it is asking for, and pressure on social care.

He added: “We have got a plan which on paper shows we can close the gap, the big risks are will we receive our share of the STF, if we don’t we cannot achieve the ambition that we have got.

“The pressure on council services, public health and services they are commissioning for children in the NHS and the pressure they have got on social care is a significant risk.”

The STP document says that the planned overall position is to reduce the expected financial to a deficit of £91m, made up of an NHS surplus of £43m, and a gap of £135m in social care.

It also refers to plans for closer collaboration between hospitals through the West Yorkshire Association of Acute Trusts with “centres of excellence” reducing the cost of duplication in higher acuity specialties.