Exclusive: Pioneering NHS ACO contract set back

Dudley Clinical Commissioning Group is in the process of trying to establish what would be one of a very small number, or perhaps the only example, of an advanced ACO type model, bringing the running of core GP services together with general NHS care.

It had been planning to award the contract by April this year, with services commencing during 2018-19.

However, the CCG today confirmed to HSJ that it was now aiming for a start date in 2019.

A spokesman said: “Following the ISAP [integrated support and assurance process - the national contract approval process] we expect to be in a position to award the contract late October/early November 2018 with a start date of 1 April 2019.”

The contract aims to take forward its “multispecialty community provider” new care model and is worth £5bn, incorporating a capitated budget for much of the healthcare and some social care for the patch.

The news comes amid a growing political row over the introduction of ACOs and “accountable care” more generally. Two judicial reviews have been filed against NHS England’s draft ACO contract, one of which has received approval to be heard in court.

In August 2017, Dudley CCG announced that its preferred provider to operate the contract was a consortium of local GPs, The Dudley Group Foundation Trust, Birmingham Community Trust FT; Dudley and Walsall Mental Health Partnership Trust and the Black Country Partnership FT.

They are exploring creating a new NHS organisation – likely created by an existing foundation trust being “split into two” to create “an empty shell” to hold the MCP contract, according to Dudley Local Medical Committee minutes. If progressed, it would be a first for the NHS.

The minutes added: “The CIC is not considered viable due to the VAT costs and an [existing] FT hosted option is not acceptable to the Dudley GPs.”

HSJ understands that local officials are awaiting direction from NHS England and NHS Improvement on whether and how this model can be pursued.

A significant number of Dudley’s GP practices are proposing to suspend their existing primary medical services contracts in order to integrate with the MCP – which would be another national first.

Dudley CCG chief executive Paul Maubach said in a statement today: “Whilst at the beginning of the process we anticipated the contract award date to be late spring, we have taken the opportunity to lengthen the competitive dialogue stage to ensure adequate clinical engagement and engagement with member practices to support the development of the model and proposed organisational form.”

City of Manchester commissioners are also planning to award an advanced ACO type contract, and today told HSJ that they still plan for this “local care organisation” to become operational from April 2018.