NHS England has announced three new options for contracting Multi-Speciality Community Providers (MCPs) through its new MCP Emerging Care Model and Contract Framework (published July 2016).  The development of this model and framework is hailed as a significant milestone in the New Care Models programme and the implementation of the Five Year Forward View.

Three contracting routes

The following routes will be available for contracting an MCP:

  • a "virtual" MCP brought about through an alliance contract between various providers;
  • a "partially integrated" MCP contract which allows GPs to retain their GMS/PMS contracts which will sit alongside the MCP contract; and
  • a "fully integrated" model with a single whole population budget across all primary and community based services.

All three options are voluntary and may be held by a range of delivery vehicles including community interest companies, limited liability partnerships, limited companies, or traditional partnerships.  These could be a GP super-practice or a federation of GPs, as well as newly formed joint venture vehicles for the purposes of delivering the MCP contract.

The MCP contract is designed to last 10 or 15 years and comprises a new performance element that replaces CQUIN and QOF, as well as a gain/risk share for acute activity.  MCP contracts must still be procured in a transparent and fair way,

The virtual and partially integrated contracts allow GPs to keep their current GMS or PMS contracts.  NHS England anticipates that this will open up new options for how GPs and other clinicians could relate to the MCP without compelling them to leave the security of a GMS/PMS contract in perpetuity.  

The fully integrated contract is anticipated to be a simpler hybrid of a standard NHS contract and a contract for primary medical services, setting both national and local service requirements and standards.

Increased funding

In order to support this development, NHS England has also announced a national New Care Models funding stream which will triple current levels of national support (from 8% to 25% national coverage). The next models to receive such attention will be the Primary and Acute Care Systems (PACS), Enhanced Health in Care Homes (EHCH) and Acute Care Collaborations (ACC) and areas will be invited to submit applications for future MCPs, PACs and ACCs in autumn 2016.

How can we help?

Bevan Brittan is at the forefront of supporting organisations to deliver Vanguard and new models of care; we are advising 8 of the 50 Vanguards and we are working with a range of other organisations looking to develop new models of care. We also actively support organisations looking to work collaboratively to deliver services that place the person at the centre of their care by delivering through multi-disciplinary teams working across organisational boundaries often under single budget arrangements.

There is a need to find commercial and governance models to pool budgets and align incentives between primary, community and secondary care, but there is also the need to find more effective ways to deliver health and (in many cases) social care through new models of collaboration between providers and more effective back office functions.

We can support you to help identify a new model of care as well as guide you through the commercial, legal and governance arrangements that are needed to deliver the changes in envisaged in a new model. We can advise on a range of corporate and/or commercial delivery vehicles to facilitate the objectives of the organisations involved and identify and provide strategic advice on the critical issues, such as procurement, competition, regulation and commercial contracting arrangements.

We are also tracking and logging issues and concerns “on the ground” to help provide a more effective framework for the assurance needs of commissioners, regulators and providers, and to facilitate solutions that support the ambitions of the Forward Five Year View.

Our recent experience includes:

  • advising an NHS Foundation Trust on the creation of a new integrated model of care and the creation of an Integrated and Accountable Care Organisation (a corporate joint venture between the FT and 17 GP Practices) for the implementation of the new care model under the PACS Vanguard.
  • advising an NHS Trust on the creation of a new integrated model of primary, community, secondary (physical and mental health) and social care, together with a Strategic Partnership Arrangement between the Trust and the Local Authority to pool and align budgets for the funding of the new care model. This project is a PACS Vanguard.
  • advising a consortium of six providers working in a single local health economy to create a commercial alliance model for the delivery of integrated primary, community, secondary and urgent and emergency care. This is a PACS/MCP hybrid Vanguard.
  • advising a group of GPs on the establishment of a corporate joint venture with an NHS FT for the acquisition of distressed primary care providers and the establishment of a hybrid PACS and MCP Vanguard.
  • advising a private sector provider partnering with a large GP Partnership, on the creation of an Accountable Care Organisation to provide integrated primary and community care, and enhanced primary care. This is an MCP Vanguard.
  • advising a commissioner on the establishment of a collaboration arrangement with an NHS FT to procure an urgent care centre and new urgent care provider together with the creation of an integrated model of primary, community, secondary and urgent and emergency care. This is an Urgent and Emergency Care Vanguard.
  • we are also instructed by two NHS FTs in respect of their Acute Care Collaboration Vanguards.

In addition, we have been advising on various projects which are not Vanguard sites, but the stakeholders in the relevant local health economies recognise that a programme of change is required to deliver a sustainable local health and social care system. Examples of these types of projects include:

  • advising a consortium of commissioners and providers to create an integrated health and social care model which also brings together commissioning and planning, and back office functions.
  • advising an independent multi-national healthcare company on the creation of an accountable care organisation covering multiple local health economies under which provider, commissioning and commissioning support functions will be integrated into a single contracting framework for all health (primary, community, and secondary (including physical and mental health) and social care.
  • advising two NHS Foundation Trusts on the establishment of separate accountable care organisations within a regional health economy with the aim of integrating primary and secondary care.

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