How will STPs change the face of the NHS in 2017?

New Sustainability and Transformation Plans (STPs) are set to launch across the NHS in England in April, introducing 44 geographical ‘footprints’ to deliver local care services. Sue Thomas and Paul Midgley assess the changes that STPs will bring and what they could mean for pharma.

After months of speculation, 2017 will see a fundamental shift in the way that the NHS is organised, with the launch of local, place-based care in the form of Sustainability and Transformation Plans (STPs) in April.

sue-thomas-wilmington-200 paul-midgley-wilmington-200

Sue Thomas and Paul Midgley

STPs will require all NHS healthcare providers – from primary to specialist and social care – to work together in geographical areas or ‘footprints’, and will provide a framework for how services are delivered in each local area.

One of their key objectives is to help the NHS deal with an expected £22 billion hole in its budget by 2020 by identifying and delivering savings, and increasing efficiency.  To meet their financial targets, STPs will be making cuts to the numbers of beds, A&E departments and other services they deem ‘unnecessary’.

Some STPs are morphing GPs and hospitals into single organisations and centralising specialist treatments, such as heart surgery and cancer care. For example, Darlington & Tees STP plans to consolidate specialist hospital services into two sites, while SW London will cut acute hospitals from five to four.

STPs will also bring major commissioning changes, including a reduction in the number of commissioners. For example, the Birmingham and Solihull STP plans to merge its three Clinical Commissioning Groups (CCGs), while Lancashire and South Cumbria propose a single health and wellbeing board.

The remaining CCGs will be empowered to commission services across the entire care pathway – from primary to secondary care – following new co-commissioning arrangements between NHS England and CCGs. These changes are designed to help STPs adapt to the pathway approach to commissioning laid out in the Five Year Forward View.

Financial changes brought about by STPs will include longer-term, outcomes-based contracts and the use of budgets that cover the health care needs of a defined population (capitated budgets) rather than payment according to the number of patients seen or treated (payment by results).

What do STPs mean for pharma?

Longer-term, outcomes-based contracts could create opportunities for pharma to sell more expensive, innovative drugs if it can prove that these products will help the NHS to realise savings in the long term.

However, as budgets tighten, it will be increasingly difficult for pharma to get new, more expensive products taken up and more important than ever for it to demonstrate value across the board. This means the industry must be more opportunistic in identifying gaps in service provision and working with clinicians and other stakeholders to fill them.

Pharma also needs to demonstrate how its products and services can aid service integration. So, rather than thinking of its products in isolation, the industry must define where they fit along the patient pathway.

How can pharma work with STPs?

In order to work with STPs, pharma needs to get to grips with the priorities and primary objectives of the 44 individual footprints. One of the best ways to do this is to keep abreast of local STP plans and board meeting reports from stakeholders, such as CCG chief officers, which keep members up to date with local developments and priorities.

Armed with the latest knowledge, the industry should look to offer tailored solutions that fit with the aspirations of individual STPs and will help them to fulfil the needs of their local patient populations. Joint projects with these stakeholders could include new research and existing NHS Digital data analysis, as well as educational campaigns.

Securing appointments with senior STP figures isn’t essential, since they will not be doing all the groundwork. Indeed, it would be equally valuable to work with clinicians to help them develop a business case for an idea that they can present to payers.

For example, if a group of clinicians wants to use a new drug but it keeps getting blocked by the prescribing committee, pharma could help doctors develop the business case by researching and supplying a variety of data, including the results of clinical trials, impact on the population and amount of money that could be saved across the whole patient journey.

Pharma can also empower clinicians to work with other stakeholders to introduce new ways of working. For example, we are working with the NHS, academia, key third sector healthcare organisations and innovators, as well as patients, to develop a free toolkit to help clinicians provide the best treatment for dementia patients. The toolkit maps out the care pathway a dementia patient will follow and contains a comprehensive roadmap and resources for the care of people with dementia.


2017 promises to be a year of immense upheaval for the NHS when STPs are introduced. In this new commissioning environment, where budgets will be even tighter and service cuts inevitable, pharma must prove the efficacy of its products and show how, and where, they will add value in the patient pathway. Pharma must also get to grips with the aims and objectives of the individual STPs and be opportunistic in looking for ways to work with clinicians and other stakeholders to help them tailor and deliver services that best suit their local populations.

About the authors:

Sue Thomas is CEO of the Commissioning Excellence Directorate and Paul Midgley is director of NHS insight, both at Wilmington Healthcare.

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