Table 1 Explanation of key concepts

National Health Service (NHS)

The National Health Service of the United Kingdom. It is a publicly-funded service that provides universal healthcare and is free at point of use.

Department for Health and Social Care (DHSC)

The DHSC is the government branch responsible for health and social care policy in the United Kingdom, with a primary focus on England.

2012 - Health and Social Care Act

This 2012 Act introduced requirements for competition and competitive tendering in the NHS and created Clinical Commissioning Groups (CCGs) with the stated aim to improve the sensitivity of the commissioning system to the needs of patients. It also introduced other requirements for competition such as the role and ability for Monitor to ensure that any collaborative organisational entities would require review for potential anti-competitive practices and would block proposals if required.

2014 - NHS Five Year Forward View

Published in October 2014, this report set out the plan for the NHS in England for the next five years. This outlined the move towards more collaborative structures such as Multispecialty Community Providers and Primary and Acute Care Systems and was the initial divergence from the 2012 Health and Social Care act only a couple years prior.

2021 - DHSC White Paper “Integration and innovation: working together to improve health and social care for all”

A White Paper released in early 2021 which set out legislative proposals for a future Health and Social Care Bill, setting the future direction for the health system in England.

2022 - Health and Care Bill

The legislative means for achieving what was set out in the DHSC White Paper, to be enacted in 2022 (see Table 2).

Collaboration (inter-organisational)

Organisations coming together with the intention to achieve benefits that they would not be able to achieve alone.

Integration

A form of collaboration which generally results in subsummation of one organisation into the umbrella of another.

Integrated care

Usually refers to horizontal integration, which is when providers of different health services (e.g., mental health and acute care) are brought together.

Competition (in the NHS)

Refers to the use of a market system in the NHS, which was introduced in the 1990s, and a split between provision and commissioning of services intended to drive improved patient choice.. In 2012, this also involved the implementation of anti-competitive laws that could prevent certain collaborative organisational behaviour deemed to limit patient choice as well as collaborations between providers and commissioners that could be seen as unfair. This has also led to a focus on individual organisational performance that might come at the expense of local system performance.

Coopetition

A term used in the organisational science literature to describe an environment whereby “dense collaborative relationships exist in highly competitive markets” [10].

Clinical Commissioning Groups (CCGs)

Introduced in 2012, these are groups of general practices that come together to buy services for their patients and population.

NHS Vanguards

Tests of five different new models of care that were piloted in England in 2015–2018 after which many continued without additional funding in place. The focus was, in most cases, to improve the care pathway through horizontal integration.

Sustainability and Transformation Partnerships

Precursors to Integrated Care Systems, these were introduced in NHS planning guidance in late 2015 and sought to lead to ‘place-based planning’ with the NHS and social care system working more closely together to better manage collective resources. This involved separating England into 44 ‘plan areas’ with leaders appointed for each that were to implement the Five Year Forward View. Many of these have since transformed into Integrated Care Systems.

Integrated Care Systems

New forms of collaboration that seek to build upon the 2022 Health and Care bill to horizontally integrate services as well as bring together providers and commissioners in a way that was not possible under prior competitive law. There are 42 ICSs currently implemented.

Care Quality Commission (CQC)

A public body within the DHSC, this body regulates and inspects health and social care services in England to ensure they provide safe and high quality care.