Integrating care: contracting for accountable models by NHS England

A  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

Drug strategy 2017

A 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: 

The strategy will progress with an eye on emerging evidence, to understand current challenge on a global scale. Library teams can help organisations to monitor the evidence, providing current awareness or horizon scanning services for emerging trends and innovative practice. Library services could provide evidence outlining global issues, or provide evidence for local initiatives and commissioning of services.

Source: Home Office

Link to main document

Publication format: PDF

Date of publication: July 2017

Summary of driver: The strategy aims to reduce illicit and other harmful drug use, and increase the rate of individuals recovering from their dependence. Integral to the strategy is partnership working to tackle drug misuse and the harm caused at local, national and international levels. The government will work with partners in education, health, safeguarding, criminal justice, housing and employment to provide a joined up approach to commissioning services which enable people to live free from drugs. The government will also work with global partners to restrict supply and lead global actions to prevent drugs harms.

Key features of driver:

Current situation:

• Social and economic cost estimated at £10.7bn p.a.; £6bn linked to people stealing to buy drugs
• 2015-16 ca. 2.7m people reported using illegal drugs
• Fewer drug users are coming into treatment and reduced number of under 25s being treated for opiate addiction
• More adults are leaving treatment successfully than in 2009-10, but wide variation between the best- and worst-performing local authorities
• The number of deaths increased by 10.3% in 2015, deaths involving heroin more than doubled between 2012 and 2015

The strategy has four key themes:

• Reducing demand for drugs –preventing the onset of drug use through targeting the most vulnerable members of society, e.g. young people, NEET, offenders, families, women at risk of violence/abuse, sex workers, homeless, veterans, older people.
• Restricting the supply of drugs – working in partnership and changing approach to tackle changes in criminal activity. Using new technologies and innovative data collection methods.
• Building recovery – providing treatments for the range of needs, adopting a joined up approach to commissioning services which enable individuals to lives a life free from drugs.
• Global action – take a leading international role to adopt new evidence to prevent drug harms.

The approach will be grounded in the evidence base, monitoring global practice to inform the approach. The strategy was based on a recent evidence review published by Public Health England. Whilst the strategy is focused on drugs, there will be a joined up approach with action on alcohol.

Primary audience: Public health and Commissioners. Also those working in Education, Health, Safeguarding, Criminal justice, Housing and employment.

Date last updated: September 2017

Due for review: September 2018

Group member responsible: TP

 

Provision of community care: who, what, how much?

A 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: 

A large proportion (39%) of the contracts for community provision are held by private providers, with a further proportion held by charities. Library provision to these groups is likely to be difficult to arrange due to the effort required to prepare SLAs with each provider, with many of these providers holding just one contract.

Source: The Health Foundation

Link to main document

Publication format: PDF

Date of publication: May 2017

Summary of driver:

This paper analyses the community care contracts held by clinical commissioning groups (CCGs) in England. NHS providers held more than half of the total annual value of contracts in the sample, while private providers held 5% of the total annual value, but 39% of the total number of contracts issued. Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most held just one contract.

Key features of driver:

• Successive governments have wanted to increase the use of community care relative to acute care
• BUT community care still only accounts for one in every 10 pounds spent by commissioners
• Recently spending on community care delivered by non-NHS providers has increased substantially
• BUT not many people know who are providing these contracts or what size they are
• Investment in community provision is central to the Five year forward view, leading to 14 multispecialty community provider (MCP) vanguards testing new ways of delivering community care.
• NHS providers hold over half (53%) of the total annual value of contracts awarded for community services
• Other contracts are provided by:
  • GPs
  • Local Authorities
  • Charities
  • Private Companies
• Of the contracts studied by the Health Foundation private providers held 39% by number but only 5% by value
• Private providers tend to hold much smaller contracts – most held just one
• The majority of very large contracts were held by the NHS

Primary audience: Commissioners, community healthcare providers

Date last updated: August 2017

Due for review: August 2018

Group member responsible: JC

Implementing the NHS five year forward view: aligning policies with the plan

Source:  Link to main document: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf

Publication format:  PDF (36 pages)

Date of publication: February 2015

Summary of driver: This is the implementation plan for the NHS Five Year Forward View, which was published October 2014 and proposes major change within the NHS over a five year timeframe. The implementation plan describes why the changes need to be made, makes practical proposals to remove barriers to healthcare and how the new implementation models can be supported. The report highlights the levels of funding required to meet this vision and the need for the NHS to have high-quality and consistent leadership.

Key features of driver:

The document lists four key drivers, each with recommendations for action and finishes with a summary of recommendations

How services are commissioned and paid for

• Innovations in commissioning and contracting – NHS commissioners to be supported by national bodies in order to achieve this
• Importance of investing in the development of system leaders
• Development of federation/networks/super partnerships (multispecialty community provider) to enable general practices to deliver a wider range of services
• Provision of proactive care in the community
• Integrated commissioning- combining CCG and NHS England funding
• NHS commissioners to work with interested general practices as pilot MCPs.
• Formation of primary and acute care systems- single organisations to provide NHS services (GP/hospital/mental health/community care) running as virtual or physical organisations
• Innovation in payment systems- capitated budgets/pooled budgets/integrated personal commissioning

How the NHS is regulated

• Improvements in quality of health and social care- CQC to survey patients and service users
• Whole-system intervention regime to support challenged health economies
• NHS England and Monitor should review current rules on procurement and tendering to enable creation of new care models
• Opportunity for local areas to have access to central legal advice

How improvements in care are delivered by local leaders

• Development of leaders at all levels in the NHS
• Providing all NHS staff with the skills and support requires to improve patient care
• Every NHS organisation to take responsibility for the development of leaders and providing staff with skills in quality improvement
• National bodies to develop explicit strategy for quality improvement
• Currently most NHS leaders are organisational leaders and the Five Year Forward View is aligned with system leaders
• Provider leadership- outlined in the Dalton review

How might a transformation fund contribute?

• King’s Fund has argued for a transformation fun d to help provide financial support through change
• Prime role is for transformation fun to pump-prime new care models whilst existing models are decommissioned
• Important to recognise that some health economies may gain, some may lose and new organisations may be created
• Looking to how mental health moved from hospital care to community services and lessons learned

Where next?

• Care models set out in the Five Year Forward View are a starting point and not the end of the story
• Commitment to real-time evaluation and learning
• Creation of vanguard sites to fast-track new care models
• Imbalance between the opportunities offered by the Five Year Forward View and the current situation of financial deficits/A&E pressures/waiting time performance
• National bodies have the responsibility to reinforce the idea that the delivery of the Five Year Forward View is as important an operational performance

Primary audience: NHS England, NHS Commissioners, NHS Providers

Impact on library policy/practice:

None of drivers are specifically aimed at libraries but there opportunities for libraries.

• The recommendation for ‘Leadership and improvement expertise’ when referring to the NHS becoming a learning organisation states ‘national support for improvement being provided through small teams of credible experts’. We are the credible experts in our field (p20).
• Vision of NHS becoming a learning organisation (as outlined in Berwick report 2013) is a great opportunity to expand and promote our skill sets and services (p20).
• Providing all NHS staff with the resources required to update their skills – literature search training/critical appraisal training/how to access information online, I order to improve patient care.
• Undertake literature searches on the relevant subjects and promote current awareness on leadership and community topics.
• Possibility of keeping GPs engaged with library and knowledge services.

 

Date last updated: February 2015

Due for review:  December 2016

Group member responsible: LK

Strategic Clinical Networks

Impact on library policy/practice: Strategic Clinical Networks (SCNs) are designed to encourage provision of clinical advice to support local decision making, making it an ideal system for librarians to share their expertise in terms of literature searching, enquiry services and consolidation of information. The challenge may be

Source: NHS England

Link to main document

Publication format: Web site

Date of publication: Various

Summary of driver: Strategic Clinical Networks focus on bringing improvement in the quality and equity of care and outcomes of their population. They bring together providers and commissioners to make improvements to complex patient pathways using an integrated, whole system approach. They work with commissioners, supporting decision making planning; working across the boundaries of commissioner, provider and voluntary organisations as a vehicle for improvement for patients, carers and the public.

Key features of driver:
The networks are divided into 12 regional areas (Senates) and currnetly focus on the following key areas:

• Cardiovascular (including cardiac, stroke, renal and diabetes);
• Maternity, Children and Young People;
• Mental Health, Dementia and Neurological Conditions;
• Cancer

The networks also work on cross-cutting themes aligned to the domains of the NHS Outcomes framework

• Prevention
• Rehabilitation
• Parity of Esteem
• Transition
• Urgent and Emergency Care
• End of Life Care
• Integration

Primary audience: Commissioners and clinical staff.

Date last updated: 6.9.17

Due for review: 6.9.18

Group member responsible: TP