A clinical commissioning group is proposing to hand its budget and nearly all its functions to a provider led ‘accountable care organisation’, in what could be a first in the NHS.

  • Northumberland CCG would hand its budget and most functions to provider led ACO
  • Would be culmination of PACS project covering new emergency hospital and enhanced primary and community services
  • ACO would be substantial move away from commissioner/provider split

Northumberland CCG’s proposal is part of the health economy’s work to overhaul its models of care and contracting. It was one of the 29 national vanguard sites identified in March and is developing a primary and acute care system.

Sources working on the move, which will be the subject of discussion in the area over coming months, told HSJ it would represent a very substantial reduction of the CCG’s functions, and a substantial move away from the current commissioner/provider divide.

They plan to establish a special purpose vehicle (SPV) organisation, which the CCG budget would be delegated to, along with the primary care budget for the area.

Those leading the work said the SPV would be akin to an “accountable care organisation” – provider networks being developed in the US to take on substantial delegated responsibility and risk for planning and funding services for their populations.

Hexham general hospital

Northumbria Healthcare FT will host the special purpose vehicle organisation

Northumbria Healthcare Foundation Trust, a well regarded provider of acute, community, social and some primary care services in Northumberland, has a major role in developing the proposals and would host the SPV.

It would be jointly governed by the FT and representatives of primary care, public health, and probably others in the area. Governance is being designed to ensure it prioritises population health needs and out of hospital care.

Most of what the CCG does at the moment would be carried out by the SPV or providers.

One senior leader said the CCG would have a “significantly diminished role but will still exist, mainly to set high level population based outcomes for the ACO and to pass the budget over, it will have no tactical commissioning functions”.

Several influential NHS figures have in recent years called for an overhaul of the current split between commissioner and provider roles. In February NHS England chief executive Simon Stevens told HSJ CCGs could potentially delegate their responsibilities to providers or councils. There are no other known examples of CCGs signing up to a substantially diminished role.

Those developing the Northumberland changes said they were designed to strengthen providers’ incentive to improve out of hospital care. The most likely start date for the new model is April 2017 but some elements may begin in shadow form next year.

Over the past year, Northumbria FT has attracted attention for taking over the running of several GP practices, and it expects to extend this to others in future. However, healthcare leaders in the area said they wanted to maintain a “mixed model” of primary care provision, with some practices run by the FT, others coming together in federations or merged practices, and some potentially remaining independent. They would all be connected to the PACS network of providers as they will be contracted by the SPV.

Those leading the changes said they saw forming the ACO as the culmination of three earlier phases for their PACs. The first was Northumbria’s “specialised emergency care hospital”, which opened last month and has received praise for centralising major emergency services from three sites to a new purpose-built facility with extended weekend and night medical cover.

The second phase is to create “primary care hubs”, which will “deliver seven day access to primary care at scale”, while “not about asking our current GPs to work longer and harder”.

The third, to happen in parallel with the second, is for clinicians to work together in different ways in new integrated community/primary teams, making better use of technology including a unified patient record.

The health economy has bid for around £10m national funding to help with some of this work, and an announcement is expected about this soon.

First wedge of £200m transformation funding allocated to vanguards