• Elimination of a projected 2020/21 deficit of £230 million;
• To develop a single contracting and strategic commissioning framework across both clinical commissioning groups in the footprint;
• Development of a new model of urgent and emergency care;
• Development of large-scale GP practices or federations, which will develop into multispeciality community providers.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

The STP contains very little detail of how many of the changes will reduce the deficit and how the capital investment needed for reconfiguration (particularly of acute services) will be obtained.

There are major changes planned in the area of commissioning services and the way services are organised, but few details in the STP of the implications for the STP area population.

The STP board has been criticised for paying private management consultants, McKinsey  £500,000 for “support for development of STP care models” in Northamptonshire. In August 2017, the board lead of the Northamptonshire STP stepped down; the STP had received a "needed most improvement" rating from NHS England.

According to the HSJ, documents show that a single service model for 10 specialities are in the process of being created. The reconfiguration will see the integration of clinical directorates at each site and non-acute care primarily offered “out of hospital [to] enable efficiencies to be unlocked”.

The ten specialities are: cardiology; ophthalmology; ear, nose and throat; gynaecology; urology; radiology; pathology; rheumatology; dermatology; and orthopaedics. For rheumatology, dermatology and orthopaedics there is an emphasis on moving care into the community.

Residents in Northamptonshire will be affected by the downgrade of Horton Hospital, Banbury, in North Oxfordshire, planned by the Buckinghamshire, Oxfordshire and Berkshire West STP. This includes the removal of many services from the hospital and transfer to the John Radcliffe in Oxford; this will move these services a considerable distance away from Northamptonshire residents.

In August 2017 Oxfordshire CCG confirmed the downgrading of Horton Hospital.

During the meeting, the Oxfordshire CCG board members voted to support the following proposals from the consultation:

• Transfer of Level 3 Critical Care from the Horton to the John Radcliffe (JR) in Oxford.
• A complete transfer of immediate care for suspected strokes to the JR.
• To make permanent the temporary downgrade of the Horton maternity unit from an obstetric to a midwife led unit (MLU).
• The permanent closure of 110 acute beds, followed by a further 36 bed closures dependent on approval by the Clinical Senate.
• An increase in Planned Care Services at the Horton, including plans for a new Diagnostic and Outpatient facility.

Five local councils and the Keep the Horton General campaign, however, plan to continue to consult with legal representatives regarding the possibility of further action to prevent the downgrading.

Corby urgent care centre was under threat of closure when the contract with Lakeside+ came to an end. A campaign succeeded in extending the contract to the end of March 2018 and it was initially thought that the service would remain as a walk-in centre. In January 2018, however, the CCG announced that the centre would be changed from a walk-in centre to an appointment only service. The centre will be renamed a same day access hub. Campaigners believe this is a downgrade of the current service and will lead to a worse service for patients.

The STP is suggesting that GP practices will develop into Federations or super-practices covering much larger numbers of patients.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations (ACO).

Four multispeciality community providers (MCP) will be developed in Northamptonshire covering primary and social care; MCPs are precursors to ICSs and to accountable care organisations.

A new model for urgent and emergency care is under development.

However, there are already issues as the current operator of Corby Urgent Care centre Lakeside+ was set to leave the contract in September 2017,  as a result the centre was under threat of closure. A campaign successfully extended the contract until March 2018. The centre is now appointment only, rather then walk in. Campaigners believe this is a downgrade.

The STP outlines changes to the way health services are commissioned, which are related to the changes to new models of care. This includes the development of a single contracting and strategic commissioning framework across both clinical commissioning groups in the footprint – Nene and Corby – which will include primary care commissioning. The framework will support "outcome based contracts". This leads the way to a single contract covering healthcare, such as that needed for an ACO.