NHS Group Structures: Navigating the Shift

Across the NHS, a clear pattern is emerging: the rise of the group structure. Some trusts were early adopters, but we’re now seeing more organisations coming together, whether by uniting corporate functions or pursuing a full merger.

This shift is being driven by real pressures: financial constraints, workforce shortages, duplicated services, and the ongoing drive for efficiency and collaboration. But the key question remains: does it work, and what are the real benefits of bringing different organisations together?

The Benefits

There are some clear advantages:

• Economies of scale: Joint procurement and vendor contracts across EPR, tech, and data give organisations greater buying power.
• Standardisation: Processes, systems, and infrastructure become more consistent across sites.
• Access to talent: Group models can pool scarce specialists (such as in cyber security or data science) and are often seen as NHS “powerhouses” that attract and retain talent.
• Data-driven care: Integrated data sharing enables better service planning and improved patient outcomes.
• Career development: Staff benefit from broader opportunities across the group.

The Challenges

However, the journey is not without its risks:

• Loss of autonomy: Sites may feel restricted by a one-size-fits-all approach.
• Cultural dilution: Local identity can be weakened, leading to disengagement or attrition.
• Bureaucracy: Decision-making can slow under heavier governance structures.
• Technology headaches: Aligning legacy systems is rarely straightforward.
• Workforce impact: Restructuring can cause anxiety around job security, especially where redundancies are introduced.

Avoiding the Pitfalls

To succeed, trusts need to anticipate common stumbling blocks. As Steve Lobley, Programme Manager at GESH (St George’s, Epsom and St Helier Hospital Group), put it:

“All change starts with understanding where we are right now. Getting a clear picture of the current landscape is paramount. Without it, there’s a real danger of missing existing best practices and repeating past mistakes. Leaders are the ones who paint the picture of what’s possible. They inspire teams with a vision of better patient care and drive the cultural shift needed to get there.”

His point is clear: leadership and aligned priorities are essential to successful group models. Without them, even well-intentioned mergers can falter, with a risk to patient care.

Engaging Staff

Staff engagement is everything. People need to clearly understand the vision, the benefits, and most importantly, what the changes mean for them personally.

Early involvement of clinicians and frontline teams is vital. In fact, some of the most successful EPR implementations we’ve supported included clinicians from day one, helping them see the value of the product and ensuring genuine buy-in.

Benefits Realisation

Measuring success is just as important as defining it. Benefits realisation should be built in from the start, covering both quantitative and qualitative measures:

• Reduction in duplicated technology spend
• Improved digital service availability and uptime
• Increase in staff satisfaction and retention across DDaT
• Positive staff feedback on collaboration and knowledge sharing
• Evidence of improved patient experience through integrated services

Regular review ensures transformation delivers real impact, not just on paper, but in practice.

How Keystream Can Help

One of the NHS’s greatest challenges is doing more with less. That’s where Keystream comes in.

• Our consulting teams run free diagnostic workshops to identify what’s working and where improvements can be made
• We design sustainable transformation plans to ensure improvements last long after we’ve left
• We provide both recruitment and consultancy services, working seamlessly to offer bespoke, blended support for each trust
• Most importantly, we don’t embed for longer than necessary. We pride ourselves on enabling effective handover to BAU teams, leaving organisations stronger and more resilient

Exploring or navigating a group structure?
Let’s talk about how we can support your next steps.

Written by Heather Halliday