Intended for healthcare professionals

Feature STPs

Wanted: clinicians to avert NHS transformation failure

BMJ 2017; 359 doi: (Published 09 November 2017) Cite this as: BMJ 2017;359:j5130
  1. Jennifer Richardson, features editor, The BMJ
  1. jrichardson{at}

The partnerships charged with overhauling services will fail spectacularly without clinical engagement and scrutiny, say hospital doctors—the very things the new groups most lack, according to a new research. Jennifer Richardson reports

The latest vehicle for overhauling NHS services is either “progress on the road to better care” or “destined to fail,” senior hospital doctors say. Either “an opportunity to introduce major improvements to the quality and effectiveness of NHS services” or “a fundamental threat to services.”

A report published on 9 November by the Hospital Consultants and Specialists Association (HCSA) finds little prospect of middle ground for the outcome of sustainability and transformation partnerships (STPs),1 the 44 collaborations of local NHS organisations charged with improving care and financial stability in their geographical areas by 2021.

There is still opportunity and time, says the HCSA, a professional body and trade union for hospital doctors, to ensure that the positive of the two extremes prevails. However, that will depend extensively on one thing largely missing so far: clinician input.

The report is damning on this front. In a survey of members with 454 respondents, 95% thought that they had not been consulted on or had sufficient involvement in STPs, which have each set out a five year plan to meet local challenges and needs. This lack of clinical scrutiny is “condemning [STPs] to be another damaging and short lived reorganisation,” says HCSA chief executive and general secretary, Eddie Saville.

Some respondents said that they had not heard of STPs before the survey despite, as the HCSA points out, the partnerships representing an important change in the way that the NHS in England will plan and run its services.

Others felt that what clinician involvement existed was mere “window dressing,” with “no intention of genuine consultation.” This …

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