STPs and accountable care roundup w/c 22 January

Hempsons is pleased to bring you the latest in its series of news updates on STPs and an accountable care roundup.

Legal challenges against Accountable Care

There is growing public concern that accountable care systems are outside the current NHS legislative framework and therefore outside the NHS itself. Two separate Judicial Review challenges have been reported against the introduction of Accountable Care Organisations.

Judicial Review is a challenge brought in the High Court which seeks to overturn the decision or action of a public body. The Court is asked to rule on whether the decision or action was lawfully undertaken. These challenges are often very technical, and the information available about the two claims launched suggests this is the case here.

A campaign group, 999 Call for the NHS, has been given permission to bring proceedings on the ground that the proposed payment systems for ACOs, being fixed by population and not set under National Tariff, are not lawful. This case is set to be heard in April this year.

A second proposed Judicial Review has been publically supported by Professor Stephen Hawking. The challenge is reported to be on the grounds that the introduction of ACOs is in breach of the duties to undertake a public consultation. This challenge remains in pre-action stages, although the website for the campaign indicates that it has raised over £150,000 to bring the case.

The ‘right to return’ – where GPs suspend their primary care contracts to participate in an Accountable Care Organisation what are their rights if they want to go back to their practice?

NHS England consulted in the autumn on changes to regulations to support the introduction of Accountable Care Organisations (ACOs). This included consultation on the ‘right to return’, a mechanism designed to provide assurance to GPs considering integrating their services with an ACO.

Under NHS England’s ‘fully integrated’ model commissioners are to procure all services (including core general practice) under a new contract: the Accountable Care Organisation Contract (ACO Contract). A single organisation would be responsible for the provision of community and primary medical services and, in some cases, acute services.

As the ACO would be responsible for the provision of primary care, changes are being proposed to the GMS Contract and the PMS Agreement to allow practitioners to suspend service delivery under their core contracts so they can participate fully in the ACO. Patients will be given the option to transfer to the registered list of the ACO or to register with another practice.

Whilst the ACO Contract is intended to be for 10 years, there is provision for a GP Practice to seek withdrawal from the ACO at regular intervals by reactivating their GMS Contract or PMS Agreement.

The proposed changes pose many questions to which the answers are as yet unclear:

• First, the guidance assumes that withdrawal from the arrangements by GPs and reactivation of core primary care contracts will be possible provided the GP practice is still eligible to enter into a GMS Contract or a PMS Agreement and the commissioners’ right to terminate has not arisen. However, in practice questions remain about how to effect reactivation if there are changes to the GP partnership due to death or retirement or if there is a dispute.
• Secondly, where the patients are registered also depends on the strict notice provisions set out in the draft Regulations:
  • By giving 12 months notice on the 2nd anniversary of the suspension of the contract the patients will revert back to the GP practice and the core contract will be reactivated.
  • By giving notice at any time after the 2nd anniversary of the suspension of the core contract, although the core contract will be reactivated, the patients will stay with the ACO.
    It will be important for GPs to get the timings of the notices right to ensure they do not miss triggering the right to take their patients back.

Neha Shah, Associate at Hempsons, comments: “For a GP practice to become a party to the fully integrated model requires the acceptance of the following risk: the core contract may not be reactivated and, if it is, the patients may remain by default registered with the ACO. These risks will need to be balanced with the potential benefits of a model which fully integrates primary care with other services.”

ACS and STP Development Partner Framework

The development of accountable care models depends on moving to more person and population centred care. NHS England has recognised that to achieve this STPs and ACSs will need to supplement their core capabilities with more advanced innovations and solutions, taking advantage of digital and technological developments.

NHS England is currently tendering for the ACS and STP Development Partner Framework which is designed to provide an easy and supported route to access these capabilities. Users of the framework, including CCGs and Trusts, will be supported to run competitions to select suppliers. Suppliers are currently bidding and the framework is expected to go live in May 2018.

This is a helpful development to allow the NHS to access expertise it does not already have to develop ACSs and STPs.

Accountable care – Getting the narrative straight with clinicians. 8 issues

Greg Fell, Director of Public Health at Sheffield City Council, has been providing some interesting insights via his blog. Here’s one which includes 8 issues that need to be grappled with to deliver accountable care: Click here to see the 8 issues.

Hempsons, NHS Providers and Aldwych Partners launch “An eight step guide to accountable care – the art of the possible”

Alongside NHS Providers and Aldwych Partners, we have launched our new guide identifying eight key steps STPs and their partner organisations should consider to support the evolution to accountable care.

Jamie Foster comments: “The move from STPs to accountable care systems (ACSs) and accountable care organisations (ACOs) is picking up pace. Infrastructure is developing to facilitate delivery of accountable care, including NHS England’s draft ACO contract and framework for technology and support services, but it remains the case that moving from numerous sovereign organisations working together in the current system to ACS models and ACO models is complex and challenging. We have sought to demonstrate the ‘art of the possible’ by setting out 8 steps for STPs and their constituent organisations to think about as they take the first steps towards ACSs and ACOs. We hope organisations find it useful”. The full guide is available here.