Embedding primary care into new accountable care models and the GMS/PMS consultation

NHS England has opened the consultation on changes to a host of primary care regulations to facilitate the better integration of primary care medical services into accountable care models of service delivery. The proposed changes are designed to remove some of the barriers to contracting for primary care through a fully integrated provider. The consultation ends on 3 November 2017 - view the details.

This is one of a number of  proposed  changes to the ‘chassis’ of healthcare legislation  aimed at delivery of the radical proposals in ‘The Five Year Forward View’ (FYFV) which promote a more collaborative approach and reduce boundaries between primary, community, hospital and social care delivery. FYFV also introduced the multi-speciality community provider (MCP) - mainly for out of hospital care integration and an integrated primary and acute care system (PACS) for larger population groups and acute services.

In August 2017 a model accountable care organisation (ACO) contract was published by NHS England which is intended to advance and replace the earlier published model MCP contract. Although currently only required for use with the advanced vanguards, NHS England is actively seeking input and comment on its provisions, with the intention of making it a mandated standard form contract in 2018.

For early adopters of new models of care, the key legal sticking points for integrated delivery of care relate to:

  1. access to the NHS pension scheme: proposed changes will ensure income from new types of ACO or integrated contracts is pensionable and to enable independent providers of NHS services who hold an NHS sub-contract or an MCP sub-contract to apply to become an employing authority
  2. building greater flexibility into NHS Act 2006 section 75 integration agreements to allow for collaboration across a wider spectrum of functions than currently allowed
  3. how to fit primary care within the integrated model of care. The current consultation on the GMS/PMS regulations is to find a solution to this issue

The consultation proposal is to suspend a GP’s primary GMS or PMS contract on entry into an MCP arrangement which can be ‘reactivated’ at two year intervals during the term of the MCP contract should the GP decide to exit the arrangement. The proposed regulations set out some practical steps including notice to NHS England, negotiation and amendment of partnership agreements, and notification to registered patients of the move. At entry, patients are given the choice to transfer to the MCP or to register with another GP if they don’t agree. If they do nothing, the default position is that patients on a list will transfer with their GPs to the MCP. If the GP triggers the right to return after two years (and providing the GP is still eligible), patients can choose to remain with the MCP or return to the patient list of the exiting GP. The default position, if the patient does nothing, is to return to the GP’s list, however the default position if the GP triggers the right to return and exits the ACO at year four and onwards, is that the patient remains with the ACO and must actively opt to move back with the GP. This raises all sorts of practical considerations for GPs and patients, as well as questions around compliance with data protection and consent, especially important with the new General Data Protection Regulations (GDPR) and the Data Protection Bill, the latter very recently put out for consultation. Other proposed changes to regulations are linked to the involvement of primary care in a fully integrated ACO delivery and are designed to ensure that the regulations apply to the ACO as well. For instance, the prohibition on sale of goodwill, provisions relating to complaints handling for NHS bodies, local authorities etc, provisions around performance lists and prescription charges and responsible officer provisions, to name a few.

We are working with GPs and federations, NHS trusts, foundation trusts, CCGs and local authorities, as well as with NHS England, assisting across the spectrum of advice relating to new models of care. We have developed model documents, templates and tools to assist commissioners, providers and GPs working within collaborative groups to set up a robust integrated system of care delivery.

We will have advised on most issues that might arise and would be happy to share learning from our advice on similar programmes.

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