Integrating care: contracting for accountable models by NHS England

Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

Possible knowledge management opportunities whilst working with managers, commissioners, transformation teams and other healthcare leaders to support organisations and staff whilst undergoing these changes.

Current awareness / linking into other organisations and disseminating that information- condensing the amount of information available/ do once and share.

Source: NHS England

Link to main document

Publication format: PDF

Date of publication: August 2017

Summary of driver: 

The Five-Year Forward View and the Next Steps update published in March 2017 described a movement towards integrated care delivered through collaboration across health and care systems. It also introduced the concept of Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards.

Key features of driver

  • Sustainability and Transformation Programmes (STPs) are a way of facilitating this collaboration among local leaders and clinicians
  • Eight areas are ready to go further and become Accountable Care Systems (ACSs) – they will have greater freedom and control over the operation of their local health system and how funding is deployed More ACSs will be added later as STPs mature
  • Some areas also want to establish Accountable Care Organisations (ACOs). ACOs are where the commissioners in that area have a contract with a single organisation for the great majority of health and social-care services. This is a long and complex process and most places are looking to become ACSs first
  • A few areas – particularly some of the Multispecialty Community Providers (MCP) and Primary and Acute Care System (PACS) vanguards – are on the road to establishing an ACO. An ACO model simplifies governance and decision making, brings together funding streams and allows a single provider organisation to make most decisions about how to allocate resources and design care for its local population.
  • ACOs will need to demonstrate a number of features viz:
    • A focus on delivering concrete service improvements
    • A compelling vision of the benefits to be delivered
    • A robust and sustainable financial model
    • Consistency with STP/ACS plans for the future
    • High levels of engagement and support among health-and-social-care leaders
    • Sufficient commitment from primary-care providers
    • Robust system plans to commission, procure, fund, establish and oversee the ACO
    • Clear plans to identify, mitigate and manage risk
  • Three main contractual approaches through with accountable models can be established in practice:
    • Virtual. Practices, local community service providers and commissioners enter into an “alliance agreement,” which would overlay existing commissioning contracts
    • Partially-integrated. Commissioners re-procure, under a single contract, all services that would be within the scope of a fully-integrated model except for core General Practice
    • Fully-integrated. Commissioners re-procure, under a single contract, all of the ‘in scope,’ services including core General Practice

Primary audience: Clinical commissioning groups, local community service providers and other commissioners, health and social care staff.

Date last updated: September 2017

Due for review: September 2018

Group member responsible: LK

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