Tracking everything that’s new in care models and progress of the Five Year Forward View. By integration reporter David Williams.

The week in new care models

  • We may yet avoid a massive increase in public procurement activity, in spite of a new set of rules handed down from the European Union and more recent Department of Health guidance spelling out that they really do apply to the NHS. Taken literally the rules would cause NHS commissioners to advertise pretty much everything, or risk legal challenge from disgruntled providers. But NHS Clinical Commissioners has told clinical commissioning groups there is little appetite for this, because it would create large amounts of extra work to be completed in a “ridiculous timeline” for advertising and letting contracts. This year’s contracting round timetable is indeed very tight. CCGs are apparently not going to get a hard time from NHS England about it – but it’s at their own risk, as CCGs are legally responsible for their own contracts. So it looks like CCGs are taking a calculated risk based on the likelihood of being challenged in the courts. That makes sense for services such as general acute hospitals, where there is little evidence of a contestable market. But new care models focused on GP services and community care might still be a different matter.
  • UnitingCare latest: MPs have had their say. The Commons public accounts committee didn’t uncover anything new, but it has put it better than anyone else: there was “a failure of business acumen that would embarrass a child in a sweet shop” from “incompetent, grossly irresponsible” NHS bodies. Services are likely to suffer as a result. Until or unless we see anything about NHS England’s own failure to stop things going wrong, or Monitor’s role in the fiasco, or indeed how on earth the Department of Health’s gateway review process missed the risks that now appear so obvious, the book on this sorry episode is now closed.
  • The Royal Free London Foundation Trust is looking to vertically integrate with primary care. So far Salford Royal is the most notable example of a trust integrating in both directions at the same time via its hospital chains and tie-ups with GPs and social care. Now it has emerged that the Royal Free, which is developing a hospital chain, has also been talking to Yeovil and Northumbria trusts about how to work more closely with primary care. Yeovil and Northumbria are two of the primary and acute care systems sites that look most likely to progress quickly. An email sent from the Royal Free to GPs in its patch said: “From what we have heard, [Yeovil’s] approach to working with local GP practices has helped to develop the relationships, resources and skill sets required to deliver better integrated services for their patients, whilst also helping to manage workloads of staff in primary care. We think there may be some aspects of this approach that could work well in this part of London.”
  • I had been terribly excited about sustainability and transformation plans, having been led to believe that they were the national rollout and delivery mechanism for new models of care. However, a few are turning out to contain the interesting indications of how MCPs and PACS might be extended. In Sussex and East Surrey there is a fairly nuanced proposal to roll out around a set of MCPs. Primary care will be organised (corralled?) into 20 “hubs”, each serving a 30,000-50,000 population, and the idea is to scale these up into a string of MCPs. Discussions are already under way for early shadow budgets. As with all things STP, there’s a saving attached: £92m by 2021. But the final form of the MCPs won’t be known for another couple of years. Another important but unanswered question: will the MCPs have a joint governance or ownership structure, or will they be completely standalone?
  • More interesting STP news: in the Black Country the CCGs and trusts are thinking about merging their back office functions. We’ve heard before that under a fully developed “accountable care organisation”, the commissioner and provider functions would blur at the edges, with the commissioner taking on a higher level, more strategic role. So here’s an early example of a commitment to actually doing that. There’s just one problem: the CCGs have recently reprocured their commissioning support services. They were told to do this by NHS England, which has for some years been developing and promoting the use of its “lead provider framework” procurement tool for commissioning support. Getting out of that contract in order to consolidate with the local providers would cost the CCGs, in turn “degrading the value for money case”. This is likely to be an issue wherever people are trying to slim down the commissioner function in the name of greater integration. Oops.