31 October

Not only is the UK population increasing but it is also ageing, meaning that the demand for health and social care is at the highest it has ever been and is set to continue to rise. With the current model for the NHS becoming progressively dated, there is a real demand for the introduction of a new system.

‘we need to tear-up the design flaw in the 1948 NHS model where family doctors were organised entirely separately from hospital specialists, and where patients… are increasingly passed from pillar to post between different bits of the health and social services.’

Simon Stevens, Chief Executive of NHS England – RCGP annual conference 2014.

From this sentiment the Five Year Forward View was created, depicting an NHS far from its 1948 origins. In order to achieve this plan, Sustainability and Transformation Plans (STPs) have been introduced.

  • The country has been divided into ‘Transformation Footprints’
  • There are 44 in total
  • They are not territories, but ‘umbrella plans’
  • They are based on existing working networks and communities





Footprints vary in size, with some bringing 12 CCGs together, and populations varying from 300,000 to 2.8m. A list of all Footprints can be found here.

NHS Region Total number of STP Footprints Average number of CCGs per footprint Average footprint population (million)
England 44 4.8 1.2
North 9 7.4 1.7
Midlands and East 17 3.6 1.0
London 5 6.4 1.7
South 13 3.8 1.1


STPs seek to introduce ‘place-based planning’, meaning planning by place for local populations which is a departure from the existing organisation-centric model. The plans look to achieve the national target of closing the gaps between health and wellbeing; care and quality, and finance and efficiency.

‘Almost every STP strategy is about an enhancement of out of hospital care… We need to focus on systems such as…primary care hubs and out-of-hours services… these will need investment to ensure STPs are successful.’

Matthew Swindells, National Director NHS England – Health and Care Innovation Expo 2016.

Health organisations simply cannot deliver efficiency savings and care redesign in silos. STPs look to launch a cross-sector working model, similar to the care model found in the United States. Why are these STPs different from previous models? NHS England have stated that additional funding is available based either on the progress and strength of STPs or by using targets.

More information regarding new care models and finance will follow in the coming weeks as STP reports are published and actioned. Reports will begin with the Birmingham and Solihull Footprint, as they are the first Footprint in the country to publish their plan (21st October 2016).

[1] https://www.england.nhs.uk/wp-content/uploads/2016/02/stp-footprints-march-2016.pdf

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