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
- The past week has been dominated by the planning guidance. New care models marbled the document and its annexes. This piece on primary care tells you all you need to know about NHS England’s intention to expand capacity and GP opening hours. But will the GPs be there to staff those shifts? And can they be compelled to change their opening hours?
- In readiness to set up new care models, clinical commissioning groups will be encouraged to share functions, scale up and merge. Here’s how the planning guidance frames the policy: “As part of the process for setting up new care models, NHS England will work with CCGs to ensure they have the capability and capacity to operate effectively in the changing provider landscape. This will include building on locally led initiatives up and down the country for CCGs to work together across larger geographical footprints, for example through joint appointments, integrated management and governance arrangements.”
- Two sets of CCGs are merging: Manchester’s three CCGs will merge by April 2017, and set up a partnership agreement with the city council for jointly commissioning health and social care. Meanwhile, another three CCGs in Birmingham and Solihull have announced who will lead their joint board ahead of merging in April 2018. Why does it take three CCGs in Birmingham a year longer to merge than three in Manchester?
- The Royal Wolverhampton Trust and Wolverhampton Council and CCG are quite excited about setting up an accountable care organisation. Sounds like a primary and acute care system. I wonder what the local GPs think?
- There’s an NHS England board meeting this week. Will we get the PACS policy framework, and something else on enhanced health in care homes?
MCPs don’t just need assurance - they need a failure regime
For the second time in a row, Dudley Clinical Commissioning Group has helpfully given us an early indication of an important national policy in the works related to new care models.
During the summer it released details of how procuring a multispecialty community provider might work. Now, my colleague Rebecca Thomas reports that Dudley CCG’s September board papers include details of how MCPs might be assured by national leaders.
The vital bit of context here is, as ever, Cambridgeshire and UnitingCare – in which a flawed contract was taken on by a suboptimally constituted new provider entity. The example haunts national leaders and were it repeated for an MCP, it would be a huge blow to the credibility of the new care models programme.
With STPs looking on all over the country, it will be vital to demonstrate that the new care model providers – many of which are likely to be new entities created especially for the occasion – aren’t going to capsize as soon as they leave the dock.
Dudley’s board papers say NHS England, NHS Improvement and the Care Quality Commission are developing a single process to test the case for change, and the capability of the successful MCP bidder to hold the contract.
This assurance process will involve an assessment of how conflicts of interest will be managed – you may remember how Tower Hamlets CCG had to turn itself inside-out to be able to let a contract for community services to a company owned by local GPs. There is no way round this where CCGs are putting out big contracts involving primary care, for MCPs and primary and acute care systems – it just has to be worked around.
There will also be a three stage gateway process, assessing:
- the CCG’s case for change – including why an MCP has been chosen rather than a PACS;
- whether the contract is properly set up, and whether the proposed provider is capable of delivering the care model; and
- whether it is safe to launch the service.
Dudley is going to issue a prior information notice for the contract and undertake some market engagement this month. But an April 2017 launch for the new contract is now unlikely – the timescale for creating a new organisation, procuring it, assuring it and then awarding a contract is looking tight now.
I hear, anecdotally, that some of the new care model vanguards have some reason to be encouraged that what they are doing is right but it is too early to expect incontrovertible evidence that they are definitely going to work.
Fair enough, but that means there is a judgement call to be made about the risk associated with the new provider and new contract: how can you really check whether a new provider is capable of delivering a new care model?
Answer: you can’t, which means the financial (and reputational) risk of something going wrong has to be shared.
People close to UnitingCare – and Circle in Hinchingbrooke, come to think of it – might wonder why loads of NHS providers get bailed out every year when they can’t make the numbers add up, but they didn’t.
MCP or PACS providers will presumably be keen to know whether they are the sole custodian of the financial risk associated with the new model of care. In their position, I’d want to know that. Because running a barely tried new model on an untried contract in a system where there’s no spare money, we have to acknowledge the possibility that things might go wrong even if the model is right and everyone involved is acting in good faith.
That means, once MCP/PACS assurance has been dealt with, we’re going to need to know what the failure regime will be for new providers. Or if you want to be more optimistic, the success regime.