• Eliminate a projected 2020/21 financial gap of £628 million;
• Promote wellbeing, prevention, independence and self-care;
• Strengthen primary, community, social care and carer services;
• Simplify and improve urgent and emergency care;
• Deliver technology enabled care;
• Ensure consistent, evidence based pathways in planned care.

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 original STP did not contain detailed information as to how the deficit will be eliminated and standards maintained, nor how the STP's stated aims will be achieved. Following its publication, a consultation exercise took place and in July 2017 an updated STP document was published.

A key component to the redesign of the acute sector in the STP is moving care into the primary/community care sector.

There will be a major push to shift work into primary care on a much wider scale than has been attempted in the area before. The aim is a rise of 10% in primary care and self-care activity.

An extra £14.5 million over five years will be spent on primary prevention. This funding will be ring-fenced.

In December 2016, document leaked to the HSJ outlined 13 services that could be decommissioned from the Nottingham University Hospitals (NUH) Trust and transferred to the community, plus 17 services that could undergo a redesign after review.  In February 2017, it was announced that the following five services will transfer from the NUH to the community from July :

• pain management and back pain service;
• integrated dietetics service across community and acute settings;
• chronic fatigue syndrome service;
• home visiting service for patients with motor-neurone disease; and
• Geriatric day care/medicine day care/complex rehab.

Nineteen other services will remain at the NUH.

Part of the STP is the development of an accountable care system (ACS) in Greater Nottingham with implementation by early 2018/19. In August 2017, the STP awarded a contract, worth £2.7m, to Capita to help support the development of the ACS. As part of the contract Capita has sub-contracted Centene UK, a data analysis and IT software company, to deliver support to the STP. Centene will give leaders advice on the development of new service models, information management and technology.

Centene UK is a subsidiary of Centene Corporation, a major US healthcare insurer that provides plans for the Medicaid and Medicare schemes.

Then in the same month, Nottingham City CCG tendered a contract for community services worth £205m. As part of the contract, the successful bidder must form part of an ACS in Greater Nottingham.

The contract is due to start in July 2018 and will last seven years with the option to extend for a further two.

In contrast to many STP areas, an appendix was published alongside the primary document, in which the STP board outlined plans to change the workforce skill mix over the next five years.

The appendix says the core skills group would have a net reduction of more than 640 posts, with the largest falls in urgent and planned care, which would drop by more than 400 posts. There would also be a drop of 116 mental health and learning disability posts, but an increase of 38 in primary care.

According to an article in HSJ, within the example outlined in the STP there would also be a net reduction of foundation skills staff, typically bands 1-4 staff, which would drop by more than 200. There would be growth in what the STP calls “enhanced” and “advanced” staff, which it defines as bands 6-7 staff and junior doctors and consultants, GPs and advanced nurse practitioners. Bands 6-7 posts would grow by 2% and the other roles by 7%, an increase of almost 300 posts. According to the article, however "across all staff groups, the example suggests there would be a net reduction of 562 staff or 2.7%."

The STP includes 200 acute bed losses over two years at Nottingham University Hospital and 20 beds lost at Sherwood Forest Hospital.

The plan included the merger of two acute trusts: Sherwood Forest Hospitals Foundation Trust (SFH) and Nottingham University Hospitals NHS Trust (NUH). However, a delay was announced in October 2016, soon followed by the cancellation of the merger inNovember 2016. This was attributed to the NUH’s poor A&E performance and financial challenges. However the British Medical Association (BMA) claimed that the deal was mired in practical and financial issues, such as how to transfer liabilities from the dissolved trust into another which was heavily in deficit. The merger was the first attempt to unite a foundation and non-foundation trust. The BMA noted in early November that SFH’s crippling PFI debt for the building of King’s Mill hospital could be too much to overcome.