1. Purpose:

1.1. This framework sets out the minimum set of deliverables for the function of system co-ordination post-March 2026. It replaces the previously issued System co-ordination centre required operational standards (version 3).

1.2. The function of system co-ordination remains essential to facilitating collaboration within the system to support operational oversight, facilitate decision making between providers and delivery of agreed objectives to ensure patient safety. The scope of the function will cover patient pathways linked to urgent and emergency care.

2. Model of delivery

2.1. Integrated care boards (ICBs) retain responsibility to provide or commission an operational system co-ordination function. This section identifies multiple paths that systems can consider for the model of system co-ordination post March 2026, depending on local priorities and strategic direction. ICBs should collaborate with NHS England regions to ensure consistency and alignment of approaches within the same regional footprint. Models of delivery include:

1. Maintain ICB-led system co-ordination centres: system co-ordination centres (SCCs) remain under the full leadership and operational management of ICBs, continuing to provide co-ordination and flow oversight.
2. System co-ordination centres – clusters: SCC clusters would operate at a greater geographical scale than currently covered and would as a minimum be aligned to national cluster arrangements agreed in 2025.
3. Commissioned service: the function of system co-ordination is commissioned through an external provider.
4. Lead provider model through provider collaboratives: In a lead provider model, one provider organisation within a system’s footprint will take responsibility for the function of system co-ordination on behalf of all organisations within the local system.

3. Expected outcomes for the function of system co-ordination

3.1. Real time visibility of operational pressures and risks across the patient pathway

Senior operational and clinical leaders operating within the system’s footprint  will have an aligned view of the operational pressures, performance and risks, which should support collective action, mutual support and dynamic management of risk to improve patient safety.

3.2. Central co-ordination of capacity and action

A system capacity view of all cross-sector providers in community, mental health and acute care should lead to a collaborative effort to improve performance to benefit patients.

It should also support improved ability to maintain services under pressure, shorter system recovery times after major disruptions and reduced incidents of system escalation. 

3.3. Improved clinical outcomes

The function of system co-ordination supports collaborative working across the system which enables a timely response at a system level, assisting local providers to deliver the right care at the right time.

A consistent single point of contact with agreed protocols for escalation of patient transfer delays is expected to support fewer out of area placements and more patients treated closer to home when clinically appropriate

4. Core deliverables

4.1. The function of system co-ordination within each system, whether directly provided or commissioned, should cover the following:

4.2. Central co-ordination:

1. System convener in line with locally agreed protocol; bringing together senior leadership from across the system to support a system response, use of real-time oversight of the wider patient pathway to support with mutual aid and co-ordination, and act as independent arbiter between providers.
2. Establish and maintain a single point of contact (SPOC) for system stakeholders on correspondence meeting the defined scope of this This will include the availability of a SPOC mailbox. The SPOC will also have the capability to disseminate local and national information to relevant providers within the system, and apply local assurance to returns to national teams.
3. Ensure adherence to OPEL Framework for actions pertaining to system and local providers.

4.3. Escalation and de-escalation:

1. Escalation within the system or to NHS England regional teams as per regional/national operating model, OPEL Frameworks and other locally agreed protocols for the UEC pathway.
2. Assure local operational issues and requests with the aim to ensure all locally required actions exhausted pre-escalation.
3. Support local providers with inter-hospital patient transfers as per locally agreed protocol to providers in England and other home nations.

4.4. System intelligence and risk overview

1. Undertaking risk assessment within the system, modelled on the National Quality Board’s Principles of Assessing and Managing Risks across the system. This would cover changes in OPEL and thresholds for escalation.
2. Proactively identify risks and support earlier intervention through intelligence sharing.
3. Support incident response as needed through provision of intelligence and data.

4.5. Recording and management of notes and the decision-making for all actions in line with NHS England’s Corporate records management policy.

4.6. The function of system co-ordination should be capable of 7-day coverage and in line with the regional/national operational model between 8am and 6pm. The system will ensure that processes are in place to provide suitable cover during out of hours (such as through on-call) to ensure a proportionate response to operational challenges or risk of patient harm.

4.7. Business continuity arrangements which cover events relating to the defined scope of this framework. This includes loss of access to real-time data.

4.8. Identified board-level executive (EO) or senior responsible officer (SRO) with accountability for the implementation of this framework, and with appropriate delegated authority to act across all providers in the system. The EO or SRO will ensure the local operating model for system co-ordination reflects shared planning and decision making, accountability and collective responsibility between system providers.

4.9. Dependent on the local operating model, the size, leadership and skill mix of staff (including clinical oversight) required to support the function of system co-ordination will be determined locally.

4.10. Systems are expected to ensure that the local operating model reflects the interests of all system stakeholders within the patient pathway across urgent and emergency care, community and social care. This also includes the development and ongoing review of arrangements to mitigate against conflict of interest particularly where the function is delivered through a lead provider collaborative or SCC cluster setting.

5. Required operational standards

5.1. Each system, dependant on its chosen operating model, should ensure adherence to the following key standards for system co-ordination:

1. Established protocols for convening system provider SROs to support system response.
2. Identified board-level executive or SRO with responsibility for oversight and delivery of this framework.
3. Operating protocol that covers the interface between providers, system leadership and region – depending on the operating model.
4. Capability for 7-day coverage, between 8am and 6pm, and which can be flexed to accommodate surge mitigation.
5. Access and operational use of the FDP System Co-ordination Dashboard or local digital solution that meets technical requirements as referenced in Section 6.
6. Single point of contact arrangements for system stakeholders.
7. Capability to ensure adherence to OPEL Framework by system and local providers.
8. Periodic reviews of the effectiveness of model of delivery to help inform either continued direct provision or ongoing commissioning of the function. 

6. Appendix: data and digital

6.1. Systems will be expected to ensure that there is appropriate digital enablement to support the function of system co-ordination. This would include ensuring relevant access arrangements are in place for use of the System Co-ordination Dashboard on the Federated Data Platform or local digital solution that meets the technical guidance (for SCCs) issued by NHS England (available on NHS Futures Page).

6.2. The system is expected to support local digital enablement for system co-ordination by ensuring relevant data sharing agreements are in place between provider organisations. The agreement will also cover interoperability between the local and national digital systems to support with flow of relevant data to the national OPEL Dashboard. 

6.3. The system’s local digital enablement, either via the FDP Dashboard or a local digital solution should include access to real time data covering the following metrics across the system as a minimum:

1. OPEL scores, visibility of data for each parameter and scores for the pillars outlined in the Integrated OPEL Framework 2024-2026.
2. Ambulance provider Resource Escalation Action Plan (REAP) level and Clinical Safety Plan or Surge (CSP) level.
3. System level Ambulance Category 1, 2, 3 and 4 response standards.
4. Ambulances enroute, on site including volumes and individual waits to be offloaded and handover intervals/mean. 

7. Further information and contact

7.1. For queries about this framework, please contact the National Integrated Urgent and Emergency Care Operations Team at NHS England: england.uec-operations@nhs.net

Publication reference: PRN00572