Primary care, New Care Models and STPs roundup
Hempsons is pleased to bring you the latest in its series of news updates on new care models, STPs and integration.
The Government’s Mandate to NHS England for 2017/18 has now been published. It states that “2017-18 should be the year in which we see concrete progress on local Sustainability and Transformation Plans”.
This is consistent with news that STP areas are being asked for a “credible implementation plan” to turn proposals into action and reconcile them with contracts and financial targets. HSJ reports that a letter sent to STP leaders said the Five Year Forward View delivery plan, expected to be published in late March, would request that “each area has developed a credible implementation plan now that the contracting round is nearly complete”. The timetable and format for the plans is yet to be decided, but they are expected to be developed over the next few months, and to refine actions that will be taken in the short-to-medium term.
Christian Dingwall, partner at Hempsons, comments: “This represents the next phase for STPs: moving from vision to implementation. STP partner organisations will need to work together to look at the detail of how they can implement their plans, addressing often difficult issues such as organisational form, accountability, conflicts of interest and how they will comply with legal requirements including procurement law”.
Northamptonshire Healthcare Foundation Trust has established a corporate joint venture arrangement with 3Sixty Care, an “at scale” GP federation. The partners have set up 3Sixty Care Partnership – a new, jointly owned company – which will offer NHS health and care to a population of 272,000 across Kettering, Corby, Wellingborough, east Northamptonshire and surrounding areas. The company plans to bid for contracts and are keen to bid for an MCP contract.
The 3Sixty Care Partnership is part of a formal “primary care home” pilot for the National Association of Primary Care. Hempsons is pleased to have advised on this innovative project, building on other work bringing Trusts and GPs together including The Royal Wolverhampton NHS Trust’s Vertical Integration project. (Read more about this project here and here.)
Alongside his headline commitment to provide additional social care funding, the chancellor Philip Hammond’s spring budget announced new capital funding for the “strongest” STPs.
Mr Hammond said the investment will be spread over three years, with further funding expected to be announced in the autumn budget for more STPs. Investment decisions will consider whether an area is “playing its part in raising proceeds from unused land, to reinvest in the health service”.
Some experts have described the amount as “modest” (for example, HSJ reports that analysis of all 44 STP documents suggests they will require more than £10bn of new capital investment over five years). In light of this it is likely that Trusts will need to continue to explore innovative funding solutions and estates rationalisation. Strategic estates partnerships are being explored by a number of Trusts (read more here).
The budget also included a commitment for capital investment of £100m specifically for accident and emergency departments was also announced, with the intention that it enables trusts to invest in “onsite GP facilities”. This is further evidence of the direction of travel towards increasing collaboration between Trusts and GPs (see story 2).
Accountable care is rapidly becoming the most talked about aspect of new care models and STPs. Simon Stevens recently told the Commons public accounts committee that six to 10 STPs were set to become “accountable care organisations or systems… bringing about integrated funding and delivery for a given geographical population”. He went on to say that accountable care structures ”will for the first time since 1990 effectively end the purchaser provider split”.
Jamie Foster, partner at Hempsons, comments: “The concept of accountable care is relatively new to the NHS and it has no set definition. STPs looking at accountable care models will need to consider what form their models will take, ranging from loose alliances in which organisations retain their own autonomy but agree to collaborate to fully integrated networks of hospitals and other providers. Accountable care models are likely to be complex and time-consuming to establish given they will be dependent on the award of capitated budgets under long term contracts, so an accountable care model might be the end goal of a new care model rather than something that can be established immediately.”
5. Alliance contracting
Alliance contracting is becoming increasingly popular as new care models and STP implementation plans take shape. The model, as applied to the NHS, involves multiple organisations, both commissioners and/or providers, agreeing to work collaboratively to deliver integrated services, typically involving collective accountability, aligned objectives and incentives and sharing of risk and reward. There is much flexibility in the way alliance contracting can be used: as a contracting arrangement to help partners put their model in place or as part of the model itself.
For more information on alliance contracting please see:
Hempsons’ Integration Resource Centre contains a series of articles and in-depth reports on new care models, integration, STPs and governance.
Have a browse through the available topics and contact us if you have any questions.