A financially troubled clinical commissioning group may pass many of its responsibilities to Northumbria’s emerging ‘accountable care organisation’, HSJ has learned.

Minutes suggest North Tyneside CCG, which is forecasting a £14.3m deficit this year, has been “advised by NHS England to enter accountable care organisation negotiations with Northumbria Healthcare Foundation Trust”.

Both NHS England and the CCG have confirmed the idea is under consideration but declined to say whether the national body had advised it should happen.

A CCG paper on the proposals seen by HSJ, entitled North Tyneside CCG – ‘Visualising the Unicorn’, says its integration work already includes “a commitment to deliver new models of care… based on examples from successful USA ACO approaches”.

It says the CCG’s current “speed of financial recovery does not meet its statutory duties in an acceptable timeframe” and adds: “Whilst the CCG would ideally want more time to consider its direction and obtain further evidence of its successful commissioning of integrated health and social care, it has concluded that it should now develop the concept of commissioning services through an [ACO].” This would mean substantial CCG functions moving to the ACO.

Northumbria Healthcare Foundation Trust

The CCG has been advised to start ACO negotiations with Northumbria Healthcare FT

The paper says “key partner endorsement [of the work] is vital both to [success] and to minimise the very real risk of challenge” and notes that “the ACO approach is new to the UK, has had mixed success internationally (including, for example, early cost containment followed by overheat) and is untested for challenge by other bodies as anticompetitive/monopolistic”. This means risk assessment and mitigation are “imperative”.

The leaked paper, written in the summer, does not say which provider would lead the ACO. However, public committee minutes of neighbouring Northumberland CCG state: “North Tyneside has been advised by NHS England to enter [ACO] negotiations with Northumbria Healthcare Foundation Trust.”

Northumbria Healthcare is already developing an ACO-type arrangement for Northumberland CCG, its other main local commissioner. North Tyneside’s other big acute provider is Newcastle upon Tyne Hospitals FT.

North Tyneside chief officer Maurya Cushlow said in a statement: ”These discussions are at a very early stage and whilst no final decision has been made, we are keen to explore the opportunities that an [ACO] may offer [and] are collaborating with our close neighbours Northumberland CCG and Northumbria [FT].”

Tim Rideout, NHS England’s director of commissioning operations for Cumbria and the North East, said the CCG was “working hard to establish financial balance and NHS England is working closely with them”. He said Northumbria Healthcare was “a potential partner” for ACO arrangements, but added: “The CCG has to take the final decision about the most appropriate organisation to work with.”

A Northumbria Healthcare spokesman said it was “in positive talks with North Tyneside CCG” but these were “very much in their infancy”.