• North east London commissioners considering new type of contract for new build health centre
  • New GP practice will be set up and doctors will be employed or subcontracted by ICP
  • ICP could become primary care network of its own

An “integrated care provider” of a range of services including core general practice is due to be established in a major new housing development.

Commissioners from Barking and Dagenham, Havering, and Redbridge clinical commissioning groups’ primary care commissioning committees last night green-lit a proposal to run an ICP from 2021.

The Barking Riverside project will see more than 10,000 homes built on former industrial land by the River Thames. Some are already built and occupied, and the development should be home to 22,000 people by 2037.

Commissioners want a “community health and wellbeing hub” to “provide an innovative integrated approach to health and wellbeing,” according to a proposal submitted to the 17 April meeting

The proposal was drawn up by the North East London Commissioning Alliance, a body made up of the seven CCGs in the North East London Sustainability and Transformation Partnership. The local commissioners agreed the plan to develop an ICP, pending the outcome of an equalities impact assessment.

The development is one of 10 which were chosen in 2016 to be part of NHS England’s “healthy new town” programme.

ICPs aim to allow commissioners to procure a wide range of health and social care services through a single organisation that either provides the services itself or subcontracts them to others in the health, social care or third sector.

The North East London STP believes an ICP will be the best way to integrate primary care, community services, social care, mental health services “and potentially some acute and public health services”.

The contract model has been “specifically designed to commission services, including primary care, through a single contract, thus building in integration and removing operational barriers, aligning with the vision for service provision at Barking Riverside,” the proposal said.

Commissioning general practice through an ICP can be controversial because, in its most developed form, GPs have to suspend their existing core contracts to take part. 

However, for this proposal, as a large new community, the STP will establish a “brand new practice” which “will negate the need for an existing practice to suspend its contract… and the complexities that would involve”. GPs will be “employed members of the wider team but will have a strong role in leading the service”.

The ICP will initially be part of the local primary care network, working with neighbouring practices, but the paper said it could be a network of its own in due course. This suggests the health care hub could expand its catchment area beyond the Barking Riverside development, as PCNs are intended to cover a population of 30,000 to 50,000.

Next steps

ICP contracts are available in a “controlled and incremental way”, with NHS England and NHS Improvement requiring commissioners to put their plans through a three-stage assurance process.

The plan for delivering the ICP will first go through a task and finish group, including health and care leaders, to develop the new care model and then draft the contract and specification.

This work should take until February 2020 when the plans will go through the first of NHSE and NHSI’s assurance checkpoints. Following approval by the centre, competing bids will then be assessed through a procurement process.

Checkpoint two is mooted for February 2021 when the preferred bidder will be known but before any contracts are signed. Checkpoint three is final sign-off and the commissioners anticipate this coming at some point after April 2021.

Feedback from the centre so far appears encouraging, as “discussions with NHS England’s legal advisor for new models of care indicate that this would be an appropriate contracting mechanism and achievable with the projected timescales,” according to the proposal paper.

The paper outlines a contingency plan if the ICP turns out to “not be viable due to any national delays”. The commissioners would opt for a “standard NHS contract for non-primary medical services” with a primary care contract bolted on.

But, while “a viable option” for services at Barking Riverside, the commissioners believe it “would be more cumbersome than commissioning using an ICP contract”.