STPs and integrated care roundup w/c 16 April

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

Integrated care and the ACO contract – update

The Department of Health & Social Care has published its response to the consultation on changes to regulations required to facilitate the operation of an NHS Standard Accountable Care Contract

The key proposed changes are:

• Definitions of ‘ACO’ – the various definitions of ACO and related terms used in the draft amendments to regulations will be simplified to refer to integrated services provider ‘and’ integrated services provider contracts (ISPC). The term ISPC will be used for provision of integrated health and care services regardless of whether primary medical services are included. It is also proposed that terms clarify that an ACO contract does not create a new legal entity and that an ACO will not commission services.

• Right to Return – the notice period which is required for GPs who have ‘fully integrated’ their primary medical services with other services to reactivate their suspended GMS/PMS contract will be reduced from 12 months to 6 months. Suspended GMS/PMS contracts can also be reactivated by agreement.

In responding to the consultation, DHSC has also published a brief guide to explain ACOs.

Jamie Foster comments “the Government’s response to the consultation is not unexpected given the sift away from accountable care to integrated care as set out in the NHS Refreshing Plans 2018/19 Guidance. Nor is it a surprise that the Government plans to wait until NHS England’s wider consultation on the ACO contract is complete before trying any proposed amendments to regulations. So far now, commissioners and providers need to continue to work within existing contracting arrangements to implement integrated care.”

Integration – where are we now?

It is clear from both the Government’s revised mandate to NHS England for 2017-18 and the Refreshing NHS Plans 2018/19 guidance that integrating care remains a key policy initiative. Indeed, the Mandate says: ‘We want to see more services provided out of hospitals, a larger primary care workforce and greater integration with social care, so that care is more joined up to meet people’s physical health, mental health and social care needs.’

More specifically, the move towards Integrated Care Systems continues. The Refreshing NHS Plans 2018/19 guidance states that “‘Integrated Care System’ is now being used as a collective term for both devolved health and care systems and for those areas previously designated as ‘shadow accountable care systems’…[and that] an Integrated Care System is where health and care organisations voluntarily come together to provide integrated services for a defined population.” The first wave of integrated care systems are already assuming accountability for local operational and financial performance. From April 2018, they will begin to gain new financial flexibilities and to use new tools for better understanding local health data. Further integrated care systems will be confirmed by NHS England and NHS Improvement in 2018. To become one, a local system must show its partnership is advanced enough to make shared decisions, improve services for the public and manage resources collectively.

The King’s Fund has published a useful summary to help make sense of these exchanges which can be found here.

In addition, Ross Clark, Partner at Hempsons has produced the following article to summarising the changes for GPs, which can be found here.

Alliance contracting – is it the way forward for commissioning?

There is increasing interest in Alliance Contracting as a helpful starting point for integrated care. We have produced a guide about this which considers:

• What is alliance contracting?
• What are the key features?
• What are the benefits?
• What should be included in an alliance contract?

Please click here for a link here to the guide.

Commissioning – how does it fit into integrated care?

The term ‘Commissioning’ encompasses a large number of different activities: from detailed transactional activities associated with service planning and contracting, right through to strategic oversight and system leadership. Within each of those broad descriptions lie many separate functions undertaken at different levels in the system. Regular reorganisations of commissioning in the NHS have added to the lack of clarity about what the functions are and where in the system they sit.

Nigel Edwards, Chief Executive of the Nuffield Trust has written an excellent article on the risks and opportunities for commissioning as we move towards integrated care.

Read the full article here.

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 created a guide identifying eight key steps STPs and their partner organisations should consider to support the evolution to accountable care. Although the term accountable care has now been replaced by integrated care, the practical steps set out in this guide remain as relevant as ever for STPs, commissioners and providers developing integrated care systems. Click here to get the full guide.