Commissioning and contracting for integrated care

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Commissioners have been given greater scope to think differently and to experiment with alternative approaches to commissioning and contracting as a way of driving integrated care.

This report describes how clinical commissioning groups (CCGs) in England are innovating with two broad models – the prime contract and alliance contract. It draws on experiences from five geographical areas, covering different population and disease groups (cancer, end-of-life care, musculoskeletal services, mental health rehabilitation, and older people’s services).

It concludes by highlighting four lessons that CCGs, other commissioners and providers should keep in mind as they embark on new models of commissioning and contracting to support integrated care.

Key findings

  • CCGs and other commissioners need to carefully consider whether a contractual solution is appropriate and proportionate for addressing the particular problem they want to solve. The contractual vehicle is merely the ‘scaffolding’; there are no shortcuts to building trust or nurturing the relationships needed to deliver high-quality, cost-effective care. 
  • There are three main ambitions that should underpin contractual developments to deliver service integration: holding providers to account for outcomes; holding providers to account for streamlining the delivery of patient care across the gaps between service providers; and shifting the flow of money between providers.
  • While commissioning and contracting to support integrated care offers many potential benefits, it also brings substantial risks. Some partnerships will be more complex, involving financial interdependencies and flows of money between providers. The costs of developing and operating these contractual approaches can be high, and commissioners should enter into such arrangements with their eyes open. 

Policy implications 

  • Commissioners should continually engage and communicate with providers, patients and the wider community to define the problem and identify appropriate solutions. This process will ensure that all partners develop a shared vision setting out what they want care to look and feel like – and can then work back from that point to build a model that delivers these aspirations.
  • Transactional as well as relational approaches are important. Nurturing trust and building relationships between providers will be just as important (if not more so) to delivering integrated care as the overarching contract or type of partnership. 
  • Payment mechanisms and incentives need to be aligned across providers. Commissioners can take advantage of opportunities for local variation and flexibility to overcome the legacy of fragmentation.
  • Providers need to develop appropriate governance and organisational models. Providers are best placed to develop interorganisational forums and processes for decision-making, risk-sharing and mutual accountability.

Video introduction to the report


Charles Thomson

community worker,
Voice your care Lincolnshire
Comment date
06 November 2015
Lincolnshire county council have given out contracts to prime and secondary care providers and they then have failed to deliver from an agreed date. This has left many people across Lincolnshire limited or even worse, no care at all. This has had a huge impact on carers, young carers and friends picking up the care. Lincs county council's response has been to blame those needing care and not failure in their implemented plans.

alec fraher

serendipitous options
Comment date
17 March 2015
Hi Rachael,

Your work is of interest to me simply because it runs counter to my own findings based on work with vulnerable adult populations and children service's. If you have the time and contined interest I would be good to compare note's. I still have the original detailed work and would be happy to share for research purpose's.

Pearl Baker

Independent Mental Health Advocate and Advisor/Carer,
Comment date
13 November 2014
A system of Health and Social Care 'Integration' is NOT difficult, however it is for those working in the Health and Social Care sector, why is this!
Failure to have any experience in what agencies are involved outside of Health and Social Care is the problem.

Independent Mental Health Advocates and Advisors are left to 'pick' up the pieces of a system that is not asking the right organisation where the problems.

The Citizen Advice Bureau, MIND, 'Rethink' 'Inside Housing' and the Independent Mental Health Advocates like myself, are never included in discussions on where the problems are. Until we are included in
discussions,which appear to only include Health and Social Care professionals, my work will never end.

Integrated Care means exactly that, it is not about the exclusion of other agencies who really could make a valuable contribution, to something that is really not that difficult to achieve.

Speak to the real 'Professionals' who are making a difference by challenging a system that is not working.

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