The first and most important step in the development of any new care model is clarity of purpose about the population health and care outcomes partners wish to achieve and the preferred care model.  Experience to date suggests that many local economies, whether vanguards or not, have made a lot of progress on this front.

So what happens once everyone has signed up to agreed outcomes and a care model? That is the stage at which partners need to work through the detail required to make the new care model happen.

For providers, that means looking at organisational form.

For commissioners – CCGs, NHS England and local authorities – that means considering the steps needed to commission the model.  It is important to be aware that commissioners will remain accountable for commissioning  the model, whatever new care model is being adopted.

Key steps for commissioners will be:

Step 1: Being clear about the services to be included in the new care model, whether primary care, community, mental health, social care services or any combination of them.  A lesson from recent projects is the need to consider the role that existing core primary care services will play in the new model

Step 2: Deciding whether the model will result in service changes, both in respect of the way services are  delivered or the range of services available if so, early consideration will  need  to be given to complying with statutory duties to involve service users and other stakeholders in the development and consideration of proposals for changes to services

Step 3: Mapping existing contracts against the contracting arrangements that will be needed to commission the new care model where commissioners want to award a new contract, for example a long-term outcomes based contract, they may not be able to do so without terminating existing contracts which in some cases may require  the consent of providers

Step 4: Determining the form of any contract to be awarded and its key terms the form of contract will depend on the services which are to be bundled in it and key terms will  be duration and payment, in relation to which NHS contracting mechanisms offer increasing flexibility

Step 5: Deciding on a procurement strategy for any contracts to be awarded, including considering whether the award of contracts without running competitive tenders is compliant with procurement law an early understanding of the market, the likely level of interest in the contract opportunity and commissioners’ key drivers will help shape  decision making about the strategy.

Engaging early has allowed us to consider our strategy in line with the relevant procurement law position, taking advantage of additional flexibilities that were available.  We have been able to build relationships right from the beginning of the project to support our new care model proposal.” – NHS Stockport CCG, participant in Stockport Together Multispecialty Community Provider vanguard

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