Late last week saw the publication of 'Next Steps on the NHS Five Year Forward View', dubbed the ‘Delivery Plan' for the NHS to 2020.

Next Steps sets out the priorities for the NHS in terms of service improvement and development, and forms part of NHS England’s business plan for 2017/18. Key areas of focus include urgent and emergency care, general practice, efficiency and prevention.

Next Steps for STPs and Accountable Care Systems

Sustainability and Transformation Plans are to become Sustainability and Transformation ‘Partnerships’ – to transform fragmented local health economies into population-based integrated health systems. Every NHS organisation in an STP will form an STP ‘board’, to include participation from general practice and local government ‘wherever appropriate’. An STP chair / leader will be appointed (or re-appointed) using a fair process, ratified by NHS England and NHS Improvement. NHS England will now be supportive in principle of CCG organisational changes to match STP boundaries where necessary.

The most advanced STPs could become ACSs – described as an ‘evolved’ version of an STP working locally as an integrated health system – and the ‘likely candidates’ for this status are revealed. It is acknowledged that ACSs will require staged implementation, which could be years in the making. To what extent we will see fully fledged ACSs before 2020 remains to be seen.

New language, same challenges

Although the framework under which STPs will evolve (and some will become ACSs) is itself developing, the actual and perceived ‘barriers’ to forming population based health systems made up of several organisations with different governance structures and legal duties remain. As the frontrunner ‘vanguard’ sites have learned, there is a myriad of complex legal, governance and practical issues to be worked through in order to implement these systems, regardless of scale. The governance and decision-making abilities of STPs in particular is complex: there is seemingly no appetite for primary legislation, so the decision-making powers and duties of the individual bodies will remain and need to be respected.

STPs are likely to have to make significant, contentious decisions on a collective basis, whilst ensuring that participant organisations’ various statutory duties are fulfilled. In particular, the importance of community participation and involvement in STP implementation is emphasised in Next Steps, with the most significant proposals required to meet one of three ‘common sense conditions’.