In 2009, the partners from two GP practices in West Birmingham merged to create Modality Partnership. Since then, the partnership has expanded to become one of England’s largest super-practices. It offers primary care services at 15 practices in Sandwell and Birmingham for a population of 70,000. Its initial objectives were to address variability in the quality of primary care services and achieve other benefits of operating at scale. It has developed a range of extended primary care services including urology, dermatology, rheumatology and x-rays.
Modality has established a partnership board with Birmingham Community Healthcare NHS Foundation Trust and Birmingham and Solihull Mental Health NHS Foundation Trust to oversee the project. The CCG and city council originally participated in the board, but withdrew so that providers could lead development of the new care model.
Modality’s ambition is to use general practice as the foundation for a new community-based health and care system, with primary care providing a single point of access into a broader range of integrated community, mental health and social care services. Its projects focus on moving care into the community and reducing A&E attendance and unplanned hospital admissions.
The project currently includes four workstreams:
- developing extended primary care services, including multidisciplinary teams, for people with complex needs
- putting in place case-management services for groups with the highest need who need more intensive support
- a rolling programme to bring specialist services, including cardiology, respiratory, musculoskeletal, gynaecology and pain management clinics, out of the hospital into the community
- more effective joint working with the hospital system, including to avoid unnecessary A&E attendance and improve discharge planning.
Sandwell and West Birmingham CCG is now considering how it should commission the new model, including which range of budgets and services to bring together into a single contract. It is considering whether to commission a small number of providers to deliver integrated services within three or four local areas, and whether to include some hospital services.
Modality is willing to consider a pooled budget for core primary care services as well as extended primary and community services, providing that it is lead provider and has responsibility for managing the budget. Both the CCG and Modality see advantages in integrating health and social care, but they also see challenges in attempting to pool health and care budgets in the initial phase.
Modality and other local providers are considering how they might come together to manage the budget and deliver services. Modality is open either to establishing a corporate joint venture with other providers or acting as the lead provider and sub-contracting to others to deliver services. It has established a partnership with the US health services company, Optum, which provides health analytics, actuarial support, data tools, decision-support tools, and other services.