New care models: Emerging innovations in governance and organisational form

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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).

Key findings

  • 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.

Policy implications

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.


alan dean

from social care and public health
Comment date
14 January 2017
Don,t MCP's offer a vehicle for real integration and investment in community services at a time when the other structures are showing signs of crisis---a new model and structure we could all get behind Whilst governance and accountability may be complex issues don't they require some robust support in order to make a mark. They need for existing provision to work with this is also critical. Views on this would be appreciated

john kapp

Comment date
23 November 2016
This report is disappointing, as it seems to focus on the problems, but is not surprising, as the old block contacts are hard to shift, despite banner headlines in 2006 ending them. I have proposed a solution of NKICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week courses, which teach patients and service users self care, see I am trying to introduce this into Locally Commissioned Services with clusters of GPs in Brighton and Hove, which is the worst CCG in the country, but aims to be the best.

Kelvin Billinghurst

Director of Medical Services,
Western Australian Country Health Services (WACHS)
Comment date
30 October 2016

Daniel Fascia

Consultant Radiologist,
Yorkshire Radiology
Comment date
18 October 2016
It is unfortunate that you chose the acronym PACS which to a large number of doctors means Picture Archiving and Communication System aka the thing that you look at your radiology on!

Andrew Field

GP lead,
City and Vale GP Alliance
Comment date
12 October 2016
interested of york

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