Newsflash: NHS England and NHS Improvement publish long awaited Integrated Support and Assurance Process Guidance


NHS England (NHSE) and NHS Improvement (NHSI) published an introduction to the Integrated Support and Assurance Process (ISAP) in November 2016.  This somewhat sparse guidance gave an initial outline to the process and what could be expected but left emerging accountable care systems guessing as to the detail of the process.

This latest guidance provides more detail on the ISAP review process that NHSE and NHSI will undertake, focusing on Key Lines of Enquiry (KLOEs) and with examples of what good looks like.

The process, split into three checkpoints, will involve both commissioners and providers.  NHSE and NHSI will use the checkpoints to “support the commissioner and provider(s) to identify, understand and mitigate as far as possible the risks of the complex contract.” Feedback and recommendations are provided after each checkpoint.  The checkpoints under the ISAP are:

  • Early engagement during the commissioner’s strategy development, usually before market engagement takes place;
  • Checkpoint 1 just before the formal competitive procurement or other selection process begins;
  • Checkpoint 2 when the preferred bidder has been identified but before the contract is signed; and
  • Checkpoint 3 just before the service commences.

NHSE and NHSI intend to “provide a ‘system view’ of the proposals, focusing on what is required to support the successful delivery of complex contracts. Applying the ISAP will help mitigate but not eliminate the risk that is inevitable if a complex contract is to be utilised. It is not about creating barriers to implementation.”

Further detail on the ISAP

The ISAP asks four key questions:

  • Will the service model produce net benefits?
  • Are the provider and commissioner capable of managing the contract and the risk allocated to them?
  • Have the consequences for other providers been thought through?
  • Does the proposed service model merit considering adjustments to the regulatory approach, including the approach to failure?

The ISAP was developed as a result of the failure of the Uniting Care Partnerships contract and therefore testing the robustness of the arrangements with regard to risk and contingency planning in the event of failure will be particularly important.

The ISAP is more likely to apply where:

  • Over 40% of one or more of the commissioners’ allocations is committed to the new contract
  • The contract is longer than the current allocation period set by NHSE
  • There are well established and evidenced shortcomings regarding one or more of the commissioners’ financial or operational performance
  • Performance-based income is greater than 4% of total contract value

Whether to apply the ISAP is ultimately at the discretion of NHSE and NHSI and CCGs will need to ensure that they engage with NHSE at an early stage in their planning.

Important take away points

  • Proposals will be given a rating of “red” “amber” or “green”.
  • The Checkpoints 1 and 3 are anticipated to take 1 month, with Checkpoint 2 taking up to 3 months.  The guidance anticipates that procurements will take between 15 to 18 months in total.
  • The ISAP does not apply to alliance arrangements where no new contracting arrangements are being established through a procurement process.
  • NHSI’s transaction review process will apply to both NHS trusts and NHS foundation trusts.  NHSI will continue to apply its Transactions Guidance and carry out any reviews as part of the ISAP.
  • To receive a “green” or “amber” rating at checkpoint 2 of the ISAP an NHS trust or foundation trust must receive an appropriate risk rating under the Transactions Guidance.
  • CCGs moving to a strategic role will need to assure NHSE that their future arrangements are robust and viable and that they continue to deliver their statutory functions effectively.
  • NHSI will not be making an assessment under the ISAP of whether the relevant procurement law has been complied with.

Even where an ISAP rating of green is given, this does not mean that there are no risks, legal or otherwise, and the guidance is clear that commissioners and providers will need to take legal advice.

Hempsons are already advising many emerging accountable care systems nationally and can provide expert advice on contracting, procurement and transactions to commissioners and providers looking to put in place novel and complex arrangements to which the ISAP applies.