Health and social care professionals are used to working with change, and many of you will already be aware of the latest kid on the block: your local Sustainability and Transformation Plan, or STP. Indeed some of you will be engaged in developing and delivering your local plan.
But for those of you who are new to integrated care models this article aims to provide the key facts to help you understand and engage with the discussions about integration that are taking place in your area.
Sustainability & Transformation Plan (STP)
An STP is a multi-year plan built around the needs of your local population that should drive transformation in patient experience and health outcomes.
To deliver transformational change STPs are meant to:
- build and strengthen local relationships
- present the current situation
- share the ambitions for 2020 and outline the concrete steps needed to achieve them
STPs should show how an area expects to develop and spread new care models, using technology and a reshaped workforce.
Interestingly, each STP should make a sustained effort to improve services offered to care home residents, but there is no such requirement for them to improve end of life care, and whilst a few do make reference to death and dying many more will require end of life and palliative care providers to think creatively about how your services align with STP objectives.
More than a year into their development STPs are becoming more ‘real’, with the ‘P’ increasingly referred to as ‘partnership’ rather than ‘plan’.
To find out more about STP’s and to see what your local plan contains and how it’s progressing follow this link.
Clinical Commissioning Group (CCG)
CCGs will continue as the organisations with the statutory responsibility for commissioning services, but there have been a number of CCG mergers in the last year with more expected as they align to STP footprints.
Accountable Care Organisations (ACOs)
ACOs are a fairly recent American development being adopted in the UK to put new care models in place that integrate services previously provided separately.
An ACO brings NHS organisations and other providers together to collaborate in meeting the needs of the population they serve, taking responsibility for the cost and quality of care they deliver within an agreed budget. ACOs take many forms, from fully integrated systems to looser alliances and networks of hospitals, medical groups and other providers.
An effective ACO depends on:
- strong partnership working between the organisations and clinicians – an ACO outcome is often clinical integration rather than organisational integration
- access to shared electronic patient records and predictive tools
- longer term outcome based contracts
- capitalised budgets that cover the health care needs of a defined population, not payment by results based on activity
There are two UK-specific versions of an integrated ACO; the Primary & Acute Care System (PACS) and the Multi-specialist Community-based Provider (MCP). Both focus on population health management and their delivery models look very similar but the key difference between them is the scope of services involved.
MCPs and PACS both:
- operate on a whole population budget (WPB), with quality incentives for preventive care
- support people to self-manage by working with partners to develop self-management resources, peer-to-peer support and carers’ networks
- join up and streamline:
- – physical and mental health care
- – 111, GP in- and OOH services, minor injury units, walk-in centres, community pharmacies and A&E
- ensure care homes are wired into this system, with their own ‘express’ pathway
PACS embrace all core acute services, integrating them with primary and community services, and serves the population of its local hospital as a minimum and, in some smaller STPs, the whole geography.
PACS will commission other providers to deliver services, paying them and holding them to account in meeting shared goals for population health.
Three PACS contracting models are emerging:
- ‘virtual’ PACS – providers are bound together by an alliance agreement
- ‘partially integrated’ PACS – a single budget contract is let for the vast majority of health and care services
- ‘fully integrated’ PACS – a single contract is let for all local health and care services with a whole-population budget
The acute trust in a PACS may join a hospital group or other Acute Care Collaboration (ACC) – see below for more information – to support sustainability of acute services over a bigger geography. Click on this link for more information.
An MCP includes primary, community and mental health, and social care. MCPs operate at a minimum 30,000-50,000 population scale up to 150,000-300,000.
They focus on prevention and redesign to improve health and wellbeing, achieve better quality, reduce avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care.
MCPs have GPs with their registered lists of patients at their core, offering federations and super-practices the potential to combine with community services to create a broader, more holistic form of general practice.
An MCP does not take on the direct running of most core acute services, but may take on some services traditionally provided in hospitals that do not need to be; e.g. diagnostics and some outpatient services.
MCPs may start off as a loose coalition, but must be established on a sound legal footing under contract eventually. Three broad versions are emerging:
- ‘virtual’ MCP – providers are bound together by an ‘alliance’ agreement
- ‘partially integrated’ MCP – contracts in place between the MCP and GPs to achieve operational integration
- ‘fully integrated’ MCP – a single whole-population budget across all primary medical and community based services
Contract duration will be 10 or 15 years and payment will comprise three parts:
- a whole population budget for the range of services covered
- a performance element that replaces CQUIN and QOF
- a gain/risk share for acute activity
Click here for more information.
Acute Care Collaborations/Systems
Acute Care Collaborations/Systems are made up of hospital groups, franchises or networks. They are built on existing clinical relationships and patient flows with clinicians and providers collaborating to provide hospital services across STP areas; and/or across other parts of the country.
They must develop clinical standards by 2020 that drive out avoidable variations in quality and cost per patient.
The first regions to announce development of an ACS were:
- Frimley Health
- South Yorkshire and Bassetlaw
- Blackpool and Fylde Coast
- Luton, with Milton Keynes and Bedfordshire
- West Berkshire