The publication of the Five Year Forward View resulted in a push towards integrated working across the NHS. The development of ACS and ACO models encourages primary and secondary care providers to join together, coordinate care and share responsibility for the quality and costs of that care. ACOs are intended to capture collective responsibility from all member organisations for the provision of local healthcare needs. The reality is that to capture all local healthcare needs the support of primary care providers, predominately GPs, is required.
Over the last few years many GP practices across the country have become open to the idea of collaborating but mainly by federating or merging with each other. The Primary Care Homes model has become the most common form of collaboration by GP practices with other providers, but these tend to be small collaborations with local mental health and community trusts, CCGs and local councils. GP collaboration at the grander scale of an ACO remains a fundamental issue to be addressed.
The GMS/PMS contracts held by GPs have been highlighted as part of the reason, at least, that GPs are reluctant to fully integrate with an ACO model. The new ACO draft contracts issued by NHS England this year attempt a compromise by offering partially or fully integrated models for an ACO. ‘Partially integrated’ means primary care services are not provided directly by the ACO. GPs still hold their GMS/PMS contract, under which the services are provided and sign a separate Integration Agreement to ensure they are signed up to the same protocols as the other providers within the ACO. This model allows GPs to retain an element of autonomy, which may be more enticing to some. However, it stops short of the full collaboration in relation to all local healthcare needs that lies at the heart of the ACO concept.
An additional attempt at integrating GPs more fully into an ACO model has just taken place. A consultation on possible amendments to the GMS and PMS regulations has just closed. It introduced the concept of GPs suspending their GMS or PMS contract and reactivating it at a later date if desired, rather than completely giving it up. It remains to be seen how many GPs would take up this option. It will remain a daunting option for some as full integration will still convert them into employees or sub-contractors of the ACO, even if only for a few years. For the reason the process is entirely voluntary on behalf of the GPs and they cannot be forced to take this route.
All this means that full collaboration will still be dependent upon strong relationships and strong relationships take time to develop. GP engagement is vital for emerging ACOs and all parties involved. ACO members shouldn’t lose sight of the fact that many GPs have been providing primary care services from their practices for years and the push towards collaboration is a totally new concept for them. Those engaging with GPs should expect questions and concerns to be raised. Many such questions are easy to anticipate: how will they be paid; what effect could this have on their primary care contract; what will they be required to do; will this impact their workforce and work load; where will they be required to provide the services from etc. If responses to these types of questions are available early on it can help to establish meaningful engagement from which a strong relationship can develop.