Insider tales and must-read analysis on how integration is reshaping health and care systems, NHS providers, primary care, and commissioning. This week by correspondent Rebecca Thomas 

You heard it here first: The NHS in England is finally making headway in creating new integrated structures in primary care.

This week HSJ revealed that a West Midlands acute trust, the Royal Wolverhampton, is due to become the operator of getting on for half the GP practices in its city.

Numerous hospital trusts have considered taking over practices in the past few years, but generally have made very little headway, for some valid reasons that the Integrator has explored before.

Royal Wolverhampton appears to have cracked the nut. Within just two years of launching its integration scheme it could be running 17 out of 42 practices.

It will mark a radical change in the way primary care in that city is run, and a pretty historic development for the NHS overall. The structural split between general practice (run by private independent contractors) and secondary care (run by employees of NHS organisations and, latterly, some private companies) has gone virtually unchallenged since 1948.

Readers’ comments on my news story about the Wolves development were unusually supportive – reports of similar exercises in the past have been met with far more cynicism.

In scale at least, the Black Country trust looks to be has overtaken a similar model launched in 2015 by Yeovil District Hospital Foundation Trust which, unlike Wolverhampton, had the benefit of national vanguard funding.

Both trusts use a similar contracting model, which involves a named GP partner holding a General Medical Services contract, but subcontracting services and financial risk to the acute trust or, in Yeovil’s case, a trust-owned subsidiary company.

In the race to embrace general practice, Yeovil and Royal Wolverhampton are at this moment neck and neck, running nine practices a piece.

There are only a small number of other hospital trusts in the game, such as Northumbria Healthcare FT, and they run only a small number of practices.

The Somerset trust planned as of May to take on a further five practices this August. However, there are rumours that two of those practices have turned down the offer and will remain independent entities.

Even if all five had signed up, Yeovil would be running just 14 out of 75 GP practices in its wider patch, a much lower share than Wolverhampton.

If Royal Wolverhampton manages to finalise the agreements it is hoping for this year, it will easily be the acute trust with the biggest footprint in general practice across its patch. And it will have proven that, in some areas at least, the barriers to this vertical integration can be jumped.

The NHS’s biggest ‘super practice’

Whilst Wolverhampton is racing ahead with vertical integration, another West Midlands provider is making huge strides in developing horizontal integration in the GP business.

The Modality Partnership, another of NHS England’s new care model vanguards, has recently taken on a clutch of nine GP contracts in Walsall – this is in addition to the practices it already runs in that area.

It was in 2016 that HSJ first reported the super partnership’s intentions to expand across the country. At that time it served 70,000 registered patients across Birmingham, Sandwell and Walsall.

Two and a bit years later and the organisation is operating in six different sustainability and transformation partnership footprints, clocking up a population coverage of almost 400,000.

This, by my estimation, makes it by some way the biggest GP partnership in England, and means it has a clearly established basis to call itself a large scale primary care provider.

Considering the pace at which the provider has spread over the last 18 months, The Integrator anticipates another expansion announcement in the very near future; keep your eyes peeled.

Side note: It has gone unnoted that Vince Sai, previously managing director in the UK for Aetna, the US insurance giant, has taken over as chief executive officer of Modality.

ACO baby steps

Meanwhile, with two judicial reviews lost, the legal barriers are in theory cleared for use of the “accountable care contract”.

Dudley and Manchester have been the frontrunners to try to use this method to create structural integration across primary and secondary services.

The Integrator has heard Dudley Clinical Commissioning Group will seek to race ahead in taking the next steps in procuring its proposed ACO. Commissioners in Manchester, on the other hand, have been non-committal in answer to my questions, saying “assess whether the contract is beneficial for Manchester” ahead of April next year.

It’s nearly four years since the Five Year Forward View and finally we may be seeing big breakthroughs for integrated provider models in primary care, though, of course, these remain isolated examples for now.