NHS England has published the latest version of its multispecialty community provider (MCP) contract - now referred to as an ACO contract - designed to integrate out-of-hospital health and care service provision on a population health basis.
Three levels of MCP integration are being developed. Under a 'virtual' MCP practices will co-operate with other providers under an alliance agreement with no contractual changes.
The 'partially integrated' model will see an MCP provider commissioned for all services other than core GP services, which practices will continue to provide under existing contracts with an integration agreement with the MCP.
A 'fully integrated' model will see practices voluntarily suspend their G/PMS contracts and join the MCP - which is commissioned to provide all services - either as subcontractors, co-owners or salaried employees.
Where GPs agree to become employees of an MCP, NHS England guidance published alongside the contract said indemnity costs ‘will need to be covered by the MCP whether that is an NHS or non-NHS body’.
The ACO contract requires that salaried GPs be employed on terms ‘at least as favourable’ as the BMA model contract.
Versions of the new ACO contract, an adapted form of the NHS standard contract, will be used for partially and fully integrated MCPs.
MCPs will be funded through an integrated, whole-population capitated budget - including most GP services under the fully integrated model - as well as an improvement payment scheme - a top slice of the integrated budget - which replaces CQUIN and QOF, and a gain/loss share arrangement of financial incentives to reduce demand in acute care.
New care models
ACO contracts could be held by existing or newly formed provider organisations, which could include GP-owned companies, corporate joint ventures such as a company formed by a foundation trust and GP practices, an existing NHS body, or the contract could be ‘hosted’ by one organisation on behalf of a group of providers.
GP leaders have previously warned GPs that any decision to suspend their G/PMS contract may be effectively a ‘one way street’ despite any right to return.
The new guidance said GPs can suspend their existing contracts for a limited time period and reactivate them either at the expiry of the ACO contract - which could be up to 10 years - or at two-year intervals. This position, NHS England said, is still subject to consultation and negotiation with the GPC.
Practices that suspend their contracts would have the legal right to provide services to their patient list removed for a period of time. Patients would then follow their GP into the MCP and become part of the MCP’s registered list. Partnerships would have to agree together on reactivation.
Patients within the practice’s former boundary would then be offered the right to leave the MCP and join the practice’s list. However if the practice reactivates in the first two years the default will be for all former patients to be re-registered. After two years patients will remain with the MCP unless they request to follow the GP.
Upon reactivation, NHS England said, practices will have to explain to patients how the care they provide will compare to that of the MCP. It admitted GPs would have concerns that ‘reactivation will become less practical as time passes’.
The contract will allow for some practices in a locality to remain outside the MCP as partially integrated, while others become fully integrated.