Prime contractor model
In a prime contractor model, the CCG contracts with a single organisation (or consortium) which then sub-contracts individual providers to deliver care. The CCG retains overall accountability for the commissioned services, while the prime contractor holds each of the sub-contractors to account individually.
The prime contractor takes responsibility for designing a delivery model and patient pathway that will most effectively meet the terms of the contract. It uses the terms of the sub-contracts to stimulate and incentivise the necessary behaviours and performance it wishes to see across other providers.
|Advantages of prime contractor model||Disadvantages of prime contractor model|
The Commissioning and contracting for integrated care paper contains more on the prime contractor model as well as two case studies describing how it is being used in Staffordshire and Bedfordshire.
Prime provider model
The prime provider model is a significant variation on the prime contractor model in which the contracted organisation also delivers care directly as part of the agreement. The prime provider could be a new or existing provider from within the local health economy, or a consortium of providers and ‘integrators’.
Similar to the prime contractor model, a prime provider would typically receive a capitated budget to provide all care specified in the contract. The prime provider would also use this budget to ‘buy’ additional services (through sub-contracts) that it cannot deliver directly.
|Advantages of prime provider model||Disadvantages of prime provider model|
The Commissioning and contracting for integrated care paper contains more on the prime provider model and a case study describing how it is being in Cambridgeshire.
Alliance contract model
In an alliance contract model a set of providers enters into a single arrangement with a CCG to deliver services. Commissioners and providers are legally bound together to deliver the specific contracted service, and to share risk and responsibility for meeting the agreed outcomes. As such, they should be incentivised to innovate and identify efficiencies across the system, rather than solely within their organisation.
The alliance is reliant on high levels of trust across its relationships. Members collectively govern the alliance through a leadership board with an agreed terms of reference.
|Advantages of alliance contract model||Disadvantages of alliance contract model|
The Commissioning and contracting for integrated care paper contains more about the alliance contract model as well as two case studies describing how it is being used in Lambeth and Salford.