• Elimination of a projected 2020/21 deficit of £897 million;
• Strengthening of primary care to manage patients in the community more proactively;
• Increased integration of primary, community, social and secondary care;
• Increase in prevention services;
• Overall, the STP aims to move care from the acute sector to the community/primary care sector, reducing hospital visits and admissions.

Like other areas, the major aims are 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.

Greater Manchester had already compiled a five-year plan by 2016 and this was put forward and accepted as the STP. This means that the changes in Manchester are further ahead than in most other areas.

There are now a number of primary care hubs offering seven day additional access across Greater Manchester.

NHS England and the 12 CCGs of Greater Manchester have collaborated to develop nine Greater Manchester primary care medical standards, which will be implemented by December 2017.

Programmes are in development to improve the population's health incorporating dentists, optometrists and pharmacists, as well as primary care.

The plans include the development of fully integrated Locality Care Organisations (LCOs), which include all health and social care providers in a locality who will work together to provide care to a defined population with primary care at the centre. The establishment of LCOs should enable conditions to be managed at home and in the community.

In March 2017, a partnership between Manchester City Council and a newly formed CCG that incorporates much of Manchester advertised a contract seeking a provider for “out of hospital” health and care services across the city. The 10 year contract is worth nearly £6bn. The winner of the contract will be known as a local care organisation.

The LCO will provide services for a population of around 600,000 across the city – but not the entire Greater Manchester devolution region. A single bid was made for the contract in June 2017 by the Manchester Provider Board, which is a consortium made up of Manchester City Council, local GP federations, the city’s three acute trusts, community service providers and Greater Manchester Mental Health Trust.

Eight clinical areas have been identified - paediatrics, maternity and obstetrics, respiratory and cardiology, MSK and Orthopaedics, breast, urology, neuro-rehabilitation and vascular - and service redesign is being investigated.

In August 2017, the Competition and Markets Authority cleared the planned merger of two major teaching trusts in Manchester - Central Manchester University Hospitals Foundation Trust and University Hospital of South Manchester FT.

A reconfiguration of urgent and emergency care is underway, which could lead to closures of some urgent care centres.

Two walk-in centres in Bury and Prestwich are due to shut. This decision has prompted widespread condemnation from local citizens: 2,000 people signed a petition to save Moorgate Primary Care Centre and Prestwich Walk In Centre. 83% of people disagreed with the plans in the CCG's survey on the closures.

These two walk in centres have since been saved from closure until beyond March 2018 after extensive petitioning by the local community.

Greater Manchester is one of four sustainability and transformation plan areas which will lead plans for regional back office mergers across the NHS.

Trafford CCG is considering plans to introduce a minimum waiting time for certain elective surgery in order to save money, according to a report in the HSJ and The Guardian in November 2017. The minimum wait time is likely to be three months for conditions such as cataract surgery and joint  replacements.

Greater Manchester and Stockport have been leading the way in the development of new models of care.

The STP plans included the development of fully integrated Locality Care Organisations (LCOs), which was to include all health and social care providers in a locality who will work together to provide care to a defined population with primary care at the centre.

In March 2017, a partnership between Manchester City Council and a newly formed CCG that incorporates much of Manchester advertised a contract seeking a provider for “out of hospital” health and care services across the city. The 10 year contract is worth nearly £6bn. The winner of the contract will be known as a local care organisation.

The LCO will provide services for a population of around 600,000 across the city – but not the entire Greater Manchester devolution region. A single bid was made for the contract in June 2017 by the Manchester Provider Board, which is a consortium made up of Manchester City Council, local GP federations, the city’s three acute trusts, community service providers and Greater Manchester Mental Health Trust.

However, in October 2017, leaders in Greater Manchester said initial plans for the £6 million contract to be given to a consortium of existing providers will not be possible because legislation means the new provider could incur additional VAT charges.

In the Stockport area, a vanguard had already been developed prior to publication of the STP.

Known as Stockport Together it incorporated the following organisations:

• Stockport NHS Foundation Trust (for hospital and community services)
• NHS Stockport Clinical Commissioning Group
• Pennine Care NHS Foundation Trust (for mental health services)
• Stockport Metropolitan Borough Council
• Viaduct Health (the GP federation which represents Stockport’s 45 practices
• and third sector voluntary organisations

The plan was to develop an accountable care organisation based on the Stockport Together vanguard. To enable this a new 'care trust' was to be developed capable of holding a multi-speciality community provider contract. These plans were put on hold in mid-2017 due to contract difficulties. Providers in Stockport have since agreed to pursue an alliance model to pursue the integration plans.

In early January 2018, however, unions involved with the Stockport project reported concerns over the plans. Unison, which represents 230 NHS council and NHS staff in Stockport Together, raised several questions, including the reduction in qualified staff and increase in non-qualified staff, a reduction in availability of services at peak times, and assumptions made in the Stockport Together business case. Unison launched a ballot to determine if the staff were prepared to take industrial action. In April 2018 Unison announced industrial action for 27 April 2018.