As the NHS faces increasing financial pressures and rising demand, provider collaboratives and shared service models offer a pathway to sustainability. But while strategy documents typically emphasise structure and cost, they frequently neglect a critical element: the people.
The success of shared services isn’t just about model design or platform choice but it’s about how the change is experienced by the workforce. In today’s NHS, with staff burnout, retention challenges, and widespread organisational change fatigue, transformation must be delivered through a people-first lens.
Why one model doesn’t fit all
From finance and HR to procurement and diagnostics, each service function in the NHS operates with different levels of maturity, risk appetite, and operational nuance. This means that applying a “one-size-fits-all” model is not only unworkable but potentially damaging.
Instead, organisations are increasingly adopting hybrid approaches. These typically combine:
- Single Shared Services Organisations (SSSO) for transactional, standardised functions like finance, payroll, or digital—where scale, automation, and consistency offer value.
- Hub-and-spoke models for functions requiring central expertise with spoke organisations retaining specialist delivery components — such as diagnostics, IT, and procurement.
- Collaborative federative structures for areas where local accountability and cultural continuity are important.
- And outsourcing, where specialist skills or technologies can be efficiently provided by third-party partners, carefully balanced against retention of NHS values and workforce protections.
The People Lens: Essential, Not Optional
The real differentiator isn’t which model is chosen but how it affects the workforce.
Organisations can assess people impact across five key areas using a structured approach:
- Workforce Costs – What is the cost of change, from consultation to realignment?
- Employee Relations – Will TUPE apply? How complex is the change journey?
- HR Integration – What systems, policies, and governance will need harmonising?
- Talent Management – Will this model support skills development and retention?
- Service Culture – Will teams still feel connected to the purpose of their work?
This approach brings workforce voices into the heart of strategic decision-making and highlights areas where culture, morale, or team knowledge may be at risk.
Hybrid models: Balancing standardisation with flexibility
No model is perfect. However, hybrid solutions allow NHS organisations to align the right model to the right service.
For example, this could mean:
- Implementing SSSO for finance and digital functions, enabling automation, career pathways, and achieve economies of scale.
- Using hub-and-spoke for diagnostics or IT support, ensuring local accountability with expert oversight.
- Maintaining federative structures in governance, risk, or communications, where shared goals but local delivery matters most.
Theory is great, but practice is essential
The best-designed model fails without effective execution. Transformation must be well-managed, with pilot programmes, strong stakeholder engagement, and transparent change support for staff.
What works best is:
- Phased delivery – starting with lower-risk areas to build confidence
- Change and HR readiness assessments before transition
- Clear career pathways and job security for affected staff
- Leadership alignment and governance frameworks established early on
Conclusion
The NHS doesn’t need more generic transformation plans. It needs human-centred operating models that balance efficiency with empathy.
When shared service strategies are co-designed with staff, grounded in operational reality, and delivered with care, the benefits aren’t just financial. There are cultural, organisational, and sustainable benefits too.
Because at the end of the day, shared services don’t work unless people do.
