{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T02:34:35Z","timestamp":1773887675990,"version":"3.50.1"},"reference-count":32,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Applied Research Collaboration (ARC) Yorkshire and Humberside","award":["NIHR200166"],"award-info":[{"award-number":["NIHR200166"]}]},{"name":"NIHR Applied Research Collaboration (ARC) Greater Manchester","award":["NIHR200174"],"award-info":[{"award-number":["NIHR200174"]}]},{"name":"NIHR Applied Research Collaboration (ARC) North East and North Cumbria","award":["NIHR200173"],"award-info":[{"award-number":["NIHR200173"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,2]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To improve social determinants of health, healthcare organisations can support societal and economic goals in their role as anchor institutions (large organisations with an important presence and ties to a place). In England, the National Health Service (NHS) Long Term Plan highlighted the role of the NHS as an Anchor. Despite a clear policy mandate on this, less is known about specific indicators to measure and benchmark anchor performance. A set of metrics was developed to quantify anchor activity using the Greater Manchester (GM) region in England as a case study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Descriptive cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were received on employment and procurement for the financial year 2022\/2023 from NHS trusts located in GM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Performance against two anchor metrics, local spending and employment, was assessed. \u2018Local\u2019 was defined as the Integrated Care Board (ICB) footprint in which the trusts are located. The proportion of procurement spend to the local economy was derived from procurement data. Employment data was aggregated by ethnicity codes and deprivation levels and compared with ICB-level ethnicity and deprivation profiles using the Index of Multiple Deprivation based on 2021 Census data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The included trusts employed 65\u2009597 residents of GM and spent \u00a3389\u2009million on local procurement, demonstrating their importance as anchor organisations. Considerable variation was observed between trusts in local spending, ranging from 6.4% (95% CI 6.4% to 6.41%)\u2009to 52.7% (95% CI 52.69% to 52.72%) (with the mean at 21%). The percentage of locally employed staff ranged from 82.7% (95% CI 81.45% to 83.90%)\u2009to 89.5% (95% CI 89.12% to 89.95%). All trusts demonstrate strong workforce representation from minoritised ethnic groups, but most employed a lower proportion of staff from the most deprived areas than expected based on the local population profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>It is feasible to quantify aspects of anchor activity using routine NHS data, and meaningful variation exists across trusts, even within a single health system. GM provides a useful case study, but further work is needed to embed anchor metrics in routine reporting and to extend measurement to other domains such as estates and sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111328","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T21:55:48Z","timestamp":1773870948000},"page":"e111328","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How to measure the effectiveness of healthcare providers acting as an \u2018anchor institution\u2019: a case study of the NHS in Greater Manchester, England"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7556-7066","authenticated-orcid":false,"given":"Vasudha","family":"Wattal","sequence":"first","affiliation":[{"name":"Health Organisation, Policy, and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Camacho","sequence":"additional","affiliation":[{"name":"Health Organisation, Policy, and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Gkiouleka","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, London, UK"},{"name":"Department of Social Work and Social Policy, University of Strathclyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8033-7081","authenticated-orcid":false,"given":"John Alexander","family":"Ford","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4540-6744","authenticated-orcid":false,"given":"Luke Aaron","family":"Munford","sequence":"additional","affiliation":[{"name":"Health Organisation, Policy, and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"2026031814552325000_16.3.e111328.1","unstructured":"Centre for Local Economic Strategies (CLES) and The Democracy Collaborative . 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