At a time when GPs are facing unprecedented pressure from challenging workloads, increasing running costs and a recruitment crisis, are the new emerging models of care being promoted by NHS England and others the answer to your challenges?

Although each model is different, all involve changes to the organisation of services, payments and contracting systems designed to create new opportunities to improve services. The aim is to increase collaboration between primary, community, mental health, acute and social care to achieve economies of scale and reduce hospital admissions.

Well organised primary care has a vital role to play in this and arguably, is best placed to take a leading role. Practices should review their internal organisational arrangements and their partnerships with other organisations to ensure they are best placed to take advantage of any new models being introduced in their area.

In the table below, we summarise the main emerging new models of care are and bust some myths around the language used to describe them, which can be confusing.

Model Key Features
PCH

Primary Care Home (Designed by National Association of Primary Care)

NAPC reports that there are more than 200 sites across England covering more than 8 million patients¹

An integrated workforce of GPs, acute, mental health and community health and social care professionals collaborating as a complete care community to provide enhanced personalised and preventative care for a list of 30,000 to 50,000 patients.

They share a unified and capitated budget with shared risk and reward There is no specified organisational form. Parties could come together under a simple collaboration agreement or form a new organisation together.

PCHs should have a plan through which they:

  • Adopt a proactive whole population health management approach
  • Deal with total care needs, costs and outcomes of the population
  • Give staff freedom to act, encourage innovation, improve staff satisfaction and in turn recruitment and retention
MCP

Multi-specialty Community Provider (designed by NHS England)

Example: West Wakefield “Connecting Care Hubs”²

Population-based community and primary care scheme delivered to a registered list of at least 100,000 patients

Schemes can be:

  • Virtual (contracting arrangements remain as is, but there is an additional contract between all the care providers called an “alliance contract”)
  • Partially integrated (certain services will be re-procured under a single contract with a combined budget held by a single organisation), or
  • Fully integrated (all services are re-procured under a single contract with a combined budget held by a single organisation).

The organisations likely to hold the contracts for partially and fully integrated schemes are likely to be NHS FTs, Federations, GP Super-practices and joint venture companies.

To participate in partially or fully integrated schemes, primary care providers must suspend their GMS/PMS contracts. Regulations will be published later this month to describe how this will work.

Other key issues still to be resolved for this model include:

  • Pensions – will all income earned be pensionable?
  • Clinical negligence cover – will medical defence organisations, or the Clinical Negligence Scheme for Trusts (CNST) provide cover?
  • VAT treatment of income – GP Practices will need to retain the right to reclaim VAT
  • Regulation – will MCP require a single CQC registration, or will each practice involved need to maintain its individual CQWC registration

MCPs are currently being designed to change types of intervention (e.g. to strengthen preventative medicine), change who does what (e.g. to make more effective use of GPs, nurses etc), change where care is delivered (e.g. out of acute settings), and improve care co-ordination across services.

PACS

Primary and Acute Care System (designed by NHS England) Example: Symphony Healthcare Services (a subsidiary owned by Yeovil District Hospital NHS FT)³

Population based primary and acute care delivered to a registered list of at least 250,000 patients

As with the MCP model, schemes can be:

  • Virtual
  • Partially integrated
  • Fully integrated

Please see MCP model above. PACS face similar issues. PACS are currently being designed to transform the care workforce and the roles of clinicians and carers in it to allow for more co-ordinated care. In some cases, this means the NHS FT taking on the primary care contracts and employing GPs who were once partners Practices.

ICS

(Integrated Care System, a concept from the USA adopted by NHS England) Previously called Accountable Care Systems/Organisations – ICS is the new collective term for shadow accountable care systems Example: Surrey and Berkshire have ICSs and Manchester could be said to be a true ICS since it is a devolved health and care system

Integrated Care System describes health and care organisations across a geography that try to work together to provide integrated services for a defined population.

ICSs have no basis in law. The NHS is split between those who commission services (NHS England and CCGs) and those who provide services (NHS FTs, GPs etc) and commissioners and providers have separate and often different statutory duties that do not enable true integration in a legal sense. Nonetheless some systems are trying to work together under a shared governance arrangement which is not legally binding and is based on a high degree of trust and an understanding that they will be mutually accountable for each other’s actions.

ICSs are supposed to:

  • Create more robust cross-organisational arrangements to tackle the systemic challenges facing the NHS;
  • Support population health management;
  • Deliver more care through re-designed community-based and home-based services

The new models may help to alleviate some of the problems faced in primary care, but are not a panacea. What is key is that you ensure your practice is in the best shape it can be in order to play a full role in and take full advantage of collaborating in your area.