Exclusive: NHS integration scheme to build in contract escape route for GPs

Practices that form integrated care organisations with hospitals under the new care model vanguard programme could be given the right to revert to GMS or PMS contracts if the collaborations fail.

Dr Berge Balian: integrated care model
Dr Berge Balian: integrated care model

To make integration less risky and more attractive to GPs, health service leaders in Somerset are working on plans to allow practices that integrate with hospitals to revert to their previous G/PMS contract.

The plans are being discussed by leaders of the South Somerset Symphony Programme and the national primary and acute care systems (PACS) vanguards programme.

GPs and secondary care clinicians in Somerset are developing plans for an integrated accountable care organisation bringing a merged group of practices into partnership with a hospital trust. An integrated provider arm could employ clinicians including GPs and consultants.

Symphony programme board chairman GP Dr Berge Balian told GPonline the programme wanted to guarantee practices joining the new integrated organisation partnership the right to return to their previous contract.

New models of care

‘The model we envisage is that we develop an integrated care provider organisation that will have the ability to hold GMS and PMS contracts,' Dr Balian said.

‘Some practices might choose to take their GMS and PMS contracts and integrate with that provider organisation. But what we are working on at the moment is how to do that and still allow those partners to in effect hand over their GMS or PMS contracts to that provider organisation, [but] then take that back in the event that the PACS-vanguard fails for whatever reason.’

Somerset CCG is developing a new outcomes-based commissioning model to work with the integrated provider organisation. The deal is likely to involve longer contracts - around 10 years - with break clauses at the five-year mark that would allow practices to return to G/PMS at specific trigger points.

Integrated contracts being developed will be similar to current GP capitated contracts, moving away from the item of service contracts for hospitals.

Independent contractor GPs

Meanwhile, practices in the area that choose not to join the integrated organisation could be able to retain their independent contract and work with it on specific elements of care, said Dr Balian.

Nine PACS vanguards have been set up across England to date. NHS England national lead for PACS Jacob West said there was a 'range of thinking' on how integration would work in practice. ‘We are reasonably governance agnostic about the approach. First and foremost is doing the design work on the care model then finding a governance vehicle that locally helps you deliver that.'

He rejected the view that PACS are a hospital-led integration model, while multispecialty community providers (MCPs) are more practice-led. ‘It is very much about primary and secondary care being in partnership,' he said.

GP partnerships

The Somerset programme board has a majority of GPs and had LMC representation on its working groups. Mr West added that new care models could only be successful if they are based on local voluntary partnerships, rather than compulsion.

Somerset, he added, was a ‘good example of how they are working through quite tricky technical issues’.

‘Part of what we are trying to do as a national team is to offer support around those technical issues. Whether it be contracting or payment mechanisms or organisational form, through to workforce redesign, and the role of technology and so on. That is emblematic of the way we are trying to make this a locally owned programme with national support.’

The South Somerset Symphony programme brings together South Somerset Healthcare GP Federation, Yeovil District Hospital Foundation Trust, Somerset CCG, and Somerset County Council.

The integration programme will initially focus on 1,500 patients with multiple long-term conditions, while practices will increasingly provided enhanced services including health coaching, or lifestyle advice.

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