STPs

Click on the STP regional footprints below for more information.

Five key issues that are likely to affect surgery

1. Reconfiguration of acute services

Most STPs are considering options to reconfigure acute services. A number of plans are proposing centralising or consolidating specialised services, most commonly orthopaedics, neurosurgery, maternity and paediatrics. Some plans are also considering reducing the number of acute sites and community hospitals through mergers, closing hospital beds and downgrading A&E departments. The RCS is concerned that some proposals plan to reduce beds to an unsustainable level although NHS England has recently introduced a “beds test” to ensure any reduction is achievable without causing problems for patient care such as through creating more out-of-hospital support.

2. Split between emergency and planned care

NHS England is encouraging STPs to look for opportunities to split emergency and urgent care beds or facilities to allow more efficient use of beds for planned surgery, and avoid the risk of cancelled operations due to emergency admissions.

3. Optimising elective care pathways

Some plans are proposing to optimise elective pathways with the aim of reducing variation in the delivery of planned care. Some examples of the proposals to improve elective pathways include reducing the number of unnecessary outpatient appointments, optimising the use of staff and theatres and ensuring timely discharge planning.

4. Rationing

Some plans suggest that CCGs might review funding thresholds for procedures of limited clinical value, such as cataract surgery and hip and knee replacements.

5. Workforce

Some of the workforce proposals are aimed at providing staff with a skills mix to deliver the new models of care across organisation boundaries and services. This includes the use of Multi-Disciplinary Teams and the creation of new roles, such as physician associates, general practice pharmacists and advanced clinical practitioners. However, concerns have been raised about reductions in workforce numbers, not only for staff employed in administrative functions, but also for nurses and GPs. This has led to NHS Improvement establishing a taskforce, made up of senior figures from arm’s length bodies, set up to examine and challenge the STPs’ workforce proposals.

In order to develop local plans, the whole of England has been divided into 44 geographical areas grouping health and care organisations. On average, each footprint covers a population of 1.2 million people and counts approximately five Clinical Commissioning Groups (CCGs) and seven NHS Trusts – with variation across different regions.

STP footprints

Local footprints were created using a number of factors, including geography, scale, existing programmes and relationships, the financial sustainability of organisations in an area, the leadership capacity and the capability to support change. However, the NHS England’s Next Steps On The Five Year Forward View, which was published in March 2017, made it clear that STPs will be able to propose adjustments to their geographical boundaries when appropriate.

A number of health and care organisations are members of their local STPs, including CCGs, Local Authorities and NHS Trusts. The structure of governance varies across STPs. However, so far the parternships have not had the powers of a legal entity and STP leads were initially appointed by NHS England for each footprint.

More recently, the update on the Five Year Forward View published last March proposed new governance. For example, all STPs will be able to form a board, establish decision-making mechanisms or reappoint an STP lead through a fair process.