'Prime contractors' could run pathways for decade

The DH’s head of provider transition Bob Ricketts told HSJ the NHS standard contract could be changed to allow clinical commissioning groups to buy services for a whole condition or population over a longer period than currently allowed.

The model would free CCGs to appoint the prime contractor who would then organise the best model of care with other providers.

Mr Ricketts said frail older people or those on the end of life care pathway might benefit from this approach.

He said an end of life care pathway could involve a hospital, some element of telehealth, a hospice and community healthcare providers coming together to provide an integrated service.

The prime contractor would be responsible for organising and paying other providers, dividing an agreed outcome-linked payment between them.

This would mean CCGs and commissioning support units organise a single contract for the sub-population rather than a series of contracts for each separate part of a care pathway.

Mr Ricketts, who is leading the development of the contract, said: “We want to get across to CCGs that you don’t have to do what primary care trusts did - don’t think more of the same, think service transformation.

“This is something we are trying to enable in the new standard contract. It’s not something CCGs will have to do, but it will allow them to do it.”

He added: “This is a way of reducing the amount of hospital-provided care through partnership, not a confrontational approach. It’s about helping CCGs and CSUs to grow into really innovative institutions.”

The new standard contract and guidance will be published in the new year.