Integrated care system

Eight Sustainability and transformation plan areas were named by Simon Stevens in June 2017 as a first wave in the development of what were then called Accountable care systems. He said they "will bring together providers and commissioners to help break down barriers between primary, secondary and social care". They will be given up to £450 million between them in transformation funding over the next 4 years:

• Frimley Health. Frimley Health and Care System a consortium of 30 public and private care providers with five Clinical Commissioning Groups, five GP Federations, 10 Local, District and County Authorities, two Ambulance trusts and five mental health and community providers including Virgin Care;
• South Yorkshire and Bassetlaw, seven NHS hospital trusts – covering 15 hospital sites, which employ 45,000 staff and service 2.3 million residents;
• Nottinghamshire, with an initial focus on Greater Nottingham and the southern part of the sustainability and transformation partnership. The Greater Nottingham Transformation Partnership includes seven public bodies and Circle Health;
• Blackpool and Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage;
• Dorset;
• Luton, with Milton Keynes and Bedfordshire;
• West Berkshire;
• Buckinghamshire.

Greater Manchester was not included because it already had more advanced arrangements under its “devolution” deal^[1]

In each area a provider or, more usually, an alliance of providers will collaborate to meet the needs of a defined population with a budget determined by capitation. There will be a contract that specifies the outcomes and other objectives they are required to achieve within the given budget over a period of time. This may extend well beyond health and social care services to encompass public health and other services. In Manchester the objectives are specified over ten years. Keeping people out of hospital by moving services into the community is a common feature. NHS trusts, Clinical Commissioning Groups and local authorities in the new ACSs will ‘take on clear collective responsibility for resources and population health’.^[2]

The process was denounced by John Sinnott, Chief Executive of Leicestershire County Council in September 2017 as lacking any element of public accountability. He said that existing models in other countries were interesting but not relevant to democratic accountabilities in the UK since they had different governance structures and forms of service provision.^[3]

It is proposed that systems employing general practitioners would have to meet the costs of their indemnity insurance.^[4]

In September 2017 NHS England produced a handbook designed to support the creation of new payment models which are intended to remove the direct relationship between NHS activity and payment, improve the alignment of payment for all providers within the care model and better incentivise prevention and wellbeing.^[5]

Integrated care systems

In February 2018 it was announced that these organisations were in future to be called integrated care systems, and that all the 44 Sustainability and transformation plans would be expected to progress in this direction.^[6] The ten pioneer systems were described as nascent and fragile by the Health Select Committee in May 2018.^[7]

Integrated Care Providers

A consultation on the draft contracts for what are now called Integrated Care Providers was launched by NHS England in August 2018 after the failure of two legal challenges to an earlier draft contract. The consultation said that this was not a new type of legal entity, but merely the "provider organisation which is awarded a contract by commissioners for the services which are within scope." Dudley clinical commissioning group is at the ‘forefront’ of this exercise and will be able to implement the draft voluntary contract ‘subject to the outcome of this consultation exercise’. It is proposed that general practitioners will be able to sign ‘fully’ or ‘partially’ integrated contracts. Fully integrated practices would give up their existing contracts to become salaried.^[8]

References