Since 2015, Dudley CCG has led work with local providers and other stakeholders to develop a new model for integrated primary, community and mental health services. It is currently commissioning the new service, with the aim of selecting a provider in April 2017 and establishing the new system by April 2018.
Under the plans, a single provider will hold the budget for and manage a broad range of primary and community services, including core primary care, out-of-hours and urgent-care centre services, community physical health services, community mental health and learning disability services, some outpatient services, intermediate care and end-of-life care. It will also hold the budget for some hospital-based emergency services so that it has an incentive to reduce usage.
Commissioners envisage that the new model should improve access to care, continuity of care and care co-ordination. It should improve the population’s health status, improve access to urgent care, ensure joined-up care for patients with long-term conditions, and provide more proactive care for patients with the most complex needs.
Commissioners have specified a number of features of the new model. For example, the new provider must put in place a new urgent care centre, specialist triage service, community hubs, a single patient portal, community-based consultants for people with long-term conditions, and extensive services for people who are frail or reaching the end of life. However, the intention is also that the organisation will have the flexibility to manage the budget and re-organise services to deliver agreed outcomes.
Commissioners want to ensure close integration between existing primary care services and other community services in the new system. They have specified that general practice should take overall responsibility for the care provided by other services, including multidisciplinary teams and other community services. They envisage that individual practices will join the MCP and take on an ‘MCP contract’, which will replace their GMS or PMS contracts. The MCP will hold a single population budget for all patients registered at those practices.
Commissioners intend to contract with a single legal entity rather than a partnership, which will both manage the budget and deliver the services, although some may need to be sub-contracted initially.
Commissioners plan to hold a competitive dialogue before entering a 15-year contract. The CCG will hold the contract with and be responsible for overseeing the provider. However, the MCP will also report to Dudley Metropolitan Borough Council’s health and wellbeing board on progress in improving population health.
The plan is not to include adult social services within the contract. However, the CCG and the council have agreed to develop a plan for integrating health and care services by 2020. The council might, in time, use a Section 75 agreement to second social care staff into the MCP.