STPs and ACOs – Brush up on NHS Issues for Your NHS Consultant Interview

Sustainability and Transformation Plans (STP) are all the rage at the moment. In fact your CEO probably has the STP for your region plastered all over his wall.

But, recently arrived on the scene are Accountable Care Organisations (ACOs), which will equally impact on your services just as much. And since you are probably wondering what we are talking about, here are a few facts you need to know.

Sustainability and Transformation Plans (STPs)

STPs are basically a manifesto/policy for your region, setting out the health and care strategy for the next five years (covering the period October 2016 to March 2021). England was divided into 44 regions (so-called footprints) and each of those regions has its own STP; those STPs are usually written by a consortium of local Care Commissioning Groups (CCGs), NHS Trusts and local government.

And because they are jointly developed by a range of local professionals, they enable the development of policies which are suitable for the local population and, most importantly, they enable a better coordination of local health and social care service, for example, by GPs working more closely with hospital specialists, district nurses and social workers to improve care for people with long-term conditions.

As well as trying to improve integration and coordination of care, STPs also aim to rethink the way some aspects of care are provided. Each STP is different, but many of them will propose changes designed to improve efficiency or access, for example, centralisation of pathology or acute services, hub and spoke approaches, etc. In some cases they may also be dealing with closure of services.

Action: if you have an interview, you NEED to read the STP for the region where the trust you are applying for is located. That STP will be the basis for all discussions on service change and any point you make at an interview (or a pre-interview visit) needs to fit within the parameters set out within that STP. STPs are approachable documents and are publicly available. Most of them are actually set out in easily-navigable websites. Simply search online for the STP for your region and read it attentively. It will greatly help you.

Accountable Care Organisations (ACOs)

Accountable Care is an American concept (think Obamacare but with English style state funding) designed to encourage collaboration between different healthcare providers rather than competition (i.e. basically we are moving away from the Blair-era competition-based health system. The aim to optimise the use of resources and adopt a more cooperative approach.

And because we are moving away from competition and a market-based healthcare system, it means that we are moving away from commissioning and so, in due course, it is likely that CCGs will merely focus on strategic planning and funding of care models rather than tendering processes. It also means that Payment by Result is likely to be replaced by longer-term contracts which are outcome based.

At present ten areas in England are being used to pilot the ACO approach. These are:

• South Yorkshire and Bassetlaw
• Frimley Health
• Dorset
• Bedfordshire, Luton and Milton Keynes
• Nottinghamshire
• Blackpool and Fylde Coast
• Berkshire West
• Buckinghamshire
• Greater Manchester and devolution area
• Surrey Heartlands devolution area

And because the NHS just cannot make things simple, there aren’t simply ACOs. There are also ACPs and ACSs. Here is the difference:

• ACPs (Accountable Care Partnerships) are groups of NHS providers (e.g. GPs, hospitals, community services, mental health services, etc) collaborating to deliver a more coordinated approach to care.
• ACOs (Accountable Care Organisations) are a formalised version of ACPs. This may happen for example if commissioners initiate a bidding process and various organisations come together to offer a bundle of care that may integrate a range of services.
• ACSs (Accountable Care Systems a natural evolution from STPs, leading the planning and commissioning of care in local areas. So in particular there will be several ACPs in an ACS. Now obviously you don’t need to know all of that in detail. But it helps to understand the general direction of travel.

If you want to discuss these issues and many more, and have an NHS consultant interview coming up, join one of our NHS consultant interview courses. They run several times a week.