Tracking everything that’s new in care models and progress of the Five Year Forward View, by integration reporter David Williams.
Last week I said you’d have to wait a couple more weeks for another briefing from me because I’m on leave for a while.
Although it’s true I have gone away (and will be incommunicado by the time you read this), another story emerged that I wanted to explore quickly before I left.
My colleague Rebecca Thomas (HSJ’s primary care lead) has broken a really important story about multispecialty community providers.
Dudley CCG has set out its plan to procure an MCP.
This is a big moment for the new care models agenda – it is the first time we have seen an outline of the process for making an MCP a legal reality.
The first revelation is that they are going to procure the MCP, via a competitive dialogue process. This has set alarm bells ringing on the story’s comment thread, because the memory of Cambridgeshire’s UnitingCare fiasco is still fresh.
Still, CCG governing body papers suggest there is no choice: a new contract of that size cannot be let without an open procurement process.
What size? Nearly £250m a year for 10-15 years. The deal would cover primary care, mental health, outpatients and community services. Social care isn’t included yet, but might be later. There will be outcomes based incentives. And these will be used to extend the impact of the MCP on the total health spend. So although the MCP won’t provide emergency care, there will be some sort of risk/gain share agreement based on its ability to cut the number of avoidable A&E admissions.
The £244m a year will bite a chunk worth about £80m out of the local acute services contract.
Some of that will be subcontracted back to the local foundation trust, but not all of it.
So will the contract be worth £244m x 10 years? There will have to be more flexibility than that: the CCG can’t contract for 10 years when it only has indicative allocations for three. And there will have to be break clauses for poor performance or if the MCP can’t make the numbers work (as per Circle at Hinchingbrooke).
Dudley has also provided new clarity on what sort of organisation an MCP will be. It has to be a “single legal entity” capable of holding a large contract and managing “significant financial risk”. Dudley is not saying it has to be an NHS trust, or private provider, or that it must be GP led. While it must have transparency and governance arrangements “consistent with” a public body, there are no firm rules about the ownership model.
That open-endedness will be deliberate, and the CCG can expect applications from NHS trusts and big private providers. Plus, potentially, organisations backed by either of the two, possibly including GPs. But it would be surprising if a bid from a recently established GP federation on its own got very far because it would probably struggle to prove it could handle a contract that size.
It certainly won’t be an elaborate alliance contract – it will be a provider organisation, which might subcontract some services to other local providers while directly providing others.
The contract is supposed to be signed by April 2017 and fully mobilised by 2018. That gives us, for the first time, a best case scenario for the adoption of a new model of care in one of the most advanced vanguard sites.
Dudley probably represents “MCP max” – a single provider organisation established as quickly as is feasible. Others may take the alliance contract route, at least to begin with, while some might set up the MCP in stages, beginning with a new contract for all the non-GP services before adding those later.
But Dudley isn’t going to be unique. The point of new care models is that they are widely applicable: so this tells us a significant amount about how the move to MCPs will work nationally.
Look out for NHS England’s board papers this month, where we expect a major policy document on MCP and primary care contracting to be published.
And now I really am going on holiday. See you in August.