The 23 vanguard sites chosen to develop the multispecialty community provider (MCP) and primary and acute care system (PACS) new care models have been working to pool budgets and integrate services more closely. Some are continuing to use informal partnerships, but others are opting for more formal governance arrangements. Commissioners are grappling with how to contract for the new systems, while providers are exploring how to work together within emerging partnerships, how to allocate funding, and how to share risk and rewards.
This report looks at the different approaches being taken by MCP and PACS vanguards to contracting, governance and other organisational infrastructure. It focuses on developments at five sites: Dudley; Sandwell and West Birmingham (Modality Partnership); Salford; Northumberland; and South Somerset (Symphony Project).
Many of the vanguard sites would like to bring together the budgets for core primary care services and other local services, but it seems unlikely that GPs will give up their core General Medical Services or Personal Medical Services contracts in the immediate future.
Many of the sites would like to bring together the budgets and contracting for some health and social care services, but only a small number have made substantial progress in incorporating social care.
Many commissioners plan to contract with a single provider or entity to hold the budget and oversee or deliver a broad range of services, although most are still deciding which organisation or partnership should do this.
Commissioning and developing new care models involves risks as well as opportunities, underlining the importance of how these models are governed, their organisational form and how risks are shared.
Building and strengthening collaborative relationships is just as important as focusing on the technical elements of integrated care.
Successful care models are based on trusting relationships and collaborative organisational cultures, often developed over time, which enable clinical teams as well as organisational leaders to work together effectively. The challenge now is how to build clinical collaboration and system leadership in a statutory context that was not designed for this purpose.
The vanguards have shown just how important it is to build collaborative relationships between the organisations and leaders involved in developing new care models. Delivering results will take time, but there needs to be a focus on the relational elements of new care models as well as the technical elements.