STRUCTURE: A pioneering project to improve the integration of care in south Somerset has abandoned its ambition to boost cooperation among providers with an ‘alliance contract’.

HSJ understands the decision by the Symphony Project board to explore alternatives to the alliance approach comes after concern from GPs and legal advice that the approach would be incompatible with “general medical” and “personal medical services” contracts used in general practice.

The project told HSJ last year it wanted to use the alliance model as it sought to adopt a collaborative approach instead of appointing a lead provider.

Under the alliance approach, commissioners hold contracts with boards on which all providers are represented.

While such contracts are widely used in the oil industry to share risk and responsibility, they have yet to be introduced into the NHS despite widespread interest.

Nick Bray, vice chair of the Somerset Local Medical Committee, told HSJ it had been broadly supportive of the project’s principles but that the involvement of an alliance contract had been a “big problem”.

“This has caused considerable concerns among practices,” he said.

Rupert Dunbar-Rees, a GP and chief executive of Outcomes Based Healthcare, said the introduction of alliance contracts in the NHS would be difficult because of the way GP and the NHS Standard contracts were set up.

However, he suggested that the spirit of alliance contracts could be introduced by supplementing existing contracts for activity and processes with an alliance style contract focused on outcomes.

Robert McGough, a partner in commercial law at Capsticks, said an overarching contract of this kind had been used by NHS England to contract for prison health services and that interest in the approach was growing.

“You can build in alliancing principles, financial incentives, reporting controls and how organisations should relate to each other,” he added.

“It’s quite a flexible approach.”

A spokesman for the Symphony Project said it was “essential that a new model of contracting and payment is implemented to enable the [new] model to achieve its full potential”.

“To this end, we have developed a database of health and social care data which has received national recognition, together with a new outcomes based approach to commissioning,” he said.

“This was originally planned to lead to the development of an alliance contract but all local partners have now decided to explore other models to ensure the best fit with our local circumstances.

“This will not delay the pilot and will enable us to deliver the full model as quickly as possible.”

The project’s board, which brings together the Somerset Clinical Commissioning Group, Yeovil District Hospital and Somerset Partnership foundation trusts and Somerset County Council, has attracted national attention for its unique approach to data analysis.

By linking anonymised patient level data for more than 109,000 patients across primary, community, mental health and social care, it found individuals’ care costs were more dependent on the number of longer term conditions they suffered than their age.

The data is being used to identify the first cohort of patients for a pilot of a new service model scheduled to start later this year. 

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