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STPs

What are STPs?

STP stands for Sustainability and Transformation Partnership. In December 2015, NHS England announced that health and care organisations, grouped into 44 regional ‘footprints’, would be tasked with developing local plans - called Sustainability and Transformation Plans - to deliver the Five Year Forward View (5YFV) and show how local services will evolve and become sustainable over the next five years.

The 44 footprints published their plans before January 2017 with the aim of addressing three key gaps set by the 5YFV:

  1. The health and wellbeing gap
  2. The care and quality gap
  3. The funding and efficiency gap

The plans are now going through a process of public and clinical engagement and will be subject to further changes.

In the 2017 Spring Budget the government announced that the strongest STPs will receive £325m of capital funding spread over three years. Further funding is expected to be announced in the Autumn Budget as a multi-year capital programme to support the implementation of approved high quality plans.

Which one is my local STP and what does it say?

Click on the STP regional footprints below for more information.

QGIS
 

html imagemap created with QGIS West Yorkshire Humber, Coast and Vale Humber, Coast and Vale Humber, Coast and Vale Humber, Coast and Vale Humber, Coast and Vale Humber, Coast and Vale Greater Manchester Cheshire and Merseyside Cheshire and Merseyside Cheshire and Merseyside Cheshire and Merseyside Cheshire and Merseyside South Yorkshire and Bassetlaw Staffordshire Shropshire and Telford and Wrekin Derbyshire Lincolnshire Lincolnshire Nottinghamshire Leicester, Leicestershire and Rutland The Black Country Birmingham and Solihull Coventry and Warwickshire Herefordshire and Worcestershire Northamptonshire Cambridgeshire and Peterborough Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Norfolk and Waveney Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Suffolk and North East Essex Milton Keynes, Bedfordshire and Luton Hertfordshire and West Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex Mid and South Essex North West London North West London North West London North Central London North East London South East London South West London South West London Kent and Medway Kent and Medway Kent and Medway Kent and Medway Kent and Medway Kent and Medway Kent and Medway Kent and Medway Kent and Medway Sussex and East Surrey Sussex and East Surrey Sussex and East Surrey Sussex and East Surrey Sussex and East Surrey Sussex and East Surrey Frimley Health Surrey Heartlands Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Cornwall and the Isles of Scilly Devon Devon Devon Devon Devon Somerset Somerset Somerset Bristol, North Somerset and South Gloucestershire Bristol, North Somerset and South Gloucestershire Bath, Swindon and Wiltshire Dorset Dorset Dorset Dorset Dorset Dorset Dorset Dorset Dorset Hampshire and the Isle of Wight Hampshire and the Isle of Wight Hampshire and the Isle of Wight Hampshire and the Isle of Wight Hampshire and the Isle of Wight Hampshire and the Isle of Wight Hampshire and the Isle of Wight Gloucestershire Buckinghamshire, Oxfordshire and Berkshire West Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham Northumberland, Tyne and Wear and North Durham West, North and East Cumbria West, North and East Cumbria Lancashire and South Cumbria Lancashire and South Cumbria Lancashire and South Cumbria Lancashire and South Cumbria Lancashire and South Cumbria Lancashire and South Cumbria Lancashire and South Cumbria

What is the possible impact on my work?

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.

 

What do the footprints look like?

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

  Average  Minimum  Maximum
Population   1.2m  300,000  2.8m
CCGs  4.8  1  12
Local authorities  5.8  1  20
Trusts  6.7  2  18

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.

Who is in charge?

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.

The RCS and STPs

Want to know more about your local STP? Contact us 

If you have any questions about your STP or would like to be put in touch with your RCS regional team, please email us at publicaffairs@rcseng.ac.uk


Is there any more STP information available from the RCS? 


What is the RCS doing? 

The RCS is continuing to monitor the progress of STPs across England. We will champion positive proposals, but also challenge plans which might harm surgical care. We are also encouraging members to contact us about their local plans, so please do get in touch.


I want to know more - what else can I read? 

Below are a few sources you might find useful to read. 

NHS England

The King's Fund

The HSJ

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