General practice could be vertically integrated into new accountable care systems, says Stevens

Accountable care organisations (ACOs) being developed in parts of the NHS will see stronger integration of primary and secondary care under unified leaderships, Simon Stevens has said.

NHS England chief executive Simon Stevens

The NHS England chief executive was outlining plans for a up to a quarter or more sustainability and transformation plan (STP) areas to be developed into accountable care arrangements with local health and care organisations given joint responsibility for their populations.

Mr Stevens has said that the move would effectively end the purchaser-provider split in the NHS in those areas for the first time since 1990.

Speaking to a Nuffield Trust policy event on Friday Mr Stevens said one element of the move to accountable care systems would be stronger vertical integration of GP services with the rest of the NHS.

Questioned as to how the NHS would end the purchaser-provider split within the existing legislative framework Mr Stevens said there would be a 'pragmatic' approach. In parts of the country where accountable care systems would be developed, he said, the national bodies would be looking for a number of requirements to be met.

NHS integration

STP systems would have to move away from activity-based 'click of the turnstile' funding flows between local NHS bodies, he said. The ACO systems would instead have population health budgets and trusts will operate as a network of providers.

Additionally, he said, 'there is stronger virtual vertical integration between acute services, GP services, community health services, mental health services and potentially social care services'. There are, he added, a number of parts of the country 'where we are on the cusp of getting this done'.

The new systems will also require shared performance improvement targets across the organisations and a 'unified governance arrangement' to help 'drive change'.

In return, he added, the national NHS bodies, including NHS Improvement and the CQC, will provide a single line of interaction and will delegate local control over various funding pots and over some staffing costs.

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