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NHS England’s proposed contractual approaches for accountable care models
Virtual integration: Existing contracting arrangements (including GMS and PMS contracts) would remain in place but be underpinned by an “alliance agreement”. This agreement would set out a vision, a commitment to managing resources together, the delivery of services and clear governance to allow elements of joint decision making. This model gives organisations an opportunity to jointly develop a more collaborative care system rather than an accountable care organisation.
Partially integrated: Commissioners would re-procure through a single contract all relevant services apart from core general practice services. Practices would continue to provide those services under their GMS/PMS contracts. The provider holding the ACO contract would integrate the core primary medical services with those covered by the ACO contract via an integration agreement with the practices. The organisation holding the ACO contract could be an existing organisation, a vehicle such as a joint venture perhaps made up of partners across the system, or any new provider. The contract holder could sub-contract the delivery of some services, which in some cases may mean the partially integrated practices.
Fully integrated: Commissioners re-procure through a single contract all relevant services – including core general practice. The contract holder will be lead provider in many cases for a broad range of community and primary medical services – and, in some cases, hospital-based services. The involvement of core primary care services under the main contract would require GPs to be released from their existing GMS, PMS or APMS contract. GMS and PMS contracts could be suspended with the potential for them to be “reactivated” later. NHS England has worked with the BMA and the Department of Health on the changes in regulations needed to enact this suspension option, and it is expected to be available from 2018/19. As with the partial model, the holder of the ACO contract could sub-contract some service delivery – including primary care services, to practices, where they choose to be sub-contractors.
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