Convergence 2.0: Payment systems not the immediate focus

Nottinghamshire was named as one of eight ICSs last year (alongside two devolution areas and joined by four more areas earlier this year). The initial focus was on the Greater Nottingham area, but more recently there have been moves to broaden the scope to the whole county.

Marcus Pratt (pictured), programme director for finance and system efficiencies for Nottinghamshire and Greater Nottingham Sustainability and Transformation Partnership, briefed the Convergence conference on progress towards getting organisations to think in terms of system finance.

An STP finance director group meets regularly, supported by an underpinning technical group, and an initial financial framework has been put in place, committing all organisations to work in a transparent, open book way. ‘We are now talking about how to turn this into a robust accountability framework,’ he said.

In particular, he said it would be important to agree up front how the system would respond when performance went off plan. ‘If you decide these things after the fact, the danger is that organisations will go back to old [organisation focused] behaviours,’ he said.

The ICS has some experience of developing new payment approaches to underpin system working. Last October it launched a capitation budget to support a new musculoskeletal service in mid-Nottinghamshire. This included a core budget with a risk share arrangement involving marginal rates and a risk/reward pool.

However, there have been no moves to expand this approach. ‘We have had long conversations about payment mechanisms and incentives and we do have some good practice in place in some sectors,’ Mr Pratt told the conference. ‘But given our limited capacity at the moment, the focus is on getting cost out of the system based on the relationships we have. Alongside this, we are talking about how payment mechanisms might look in the future as we develop our system architecture.

‘It is not that we don’t think this is important,’ he added. ‘We really do, but we need to develop this in a very considered way.’

Speaking as part of the same session, STP chair David Pearson (pictured below) said the work was challenging. ‘We’ve made fantastic progress delivering some real benefits for people and the system,’ he said.

‘But every week we are furiously paddling beneath the waterline to keep the show on the road because this is a challenging financial and service landscape we are working in.’

He added that that while there were always more issues to address, it was important to celebrate achievements along the way.