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NHS England has published the first contract for ‘accountable care organisations’ to outline how the integrated systems will operate with commissioners and other providers.
The document supersedes the ‘multispecialty community provider’ (MCP) contract that was released at the end of last year and ‘is now usable for accountable care models generally’.
The document explains a successful ‘accountable care system’ as one that provides ‘NHS, public health and social care services in a joined–up way for its population’.
However, it adds that ‘it is for local commissioners to decide how to achieve this integration’.
The updated contract framework further explains the three contractual approaches: virtual, partially integrated and fully integrated models.
The virtual model does not create an accountable care organisation but sets up an ‘alliance agreement’ that will overlay existing commissioning contracts to establish ‘a shared vision’.
The partially integrated model would create an integrated care system, with commissioners having to re-procure under a single contract, all services except for core general practice, meaning GPs will be able to retain their GMS or PMS contracts.
The fully integrated model is the same as the partially integrated model but includes general practice, with GPs having to give up their GMS or PMS contracts.
However, the document notes that GPs who decide to return to their original contract from a fully integrated model, can only do so every two years and could lose all their patients when they do.
The document said: ‘If the GP reactivated in the first two years of the [c]ontract the default would be that patients previously on their registered list follow the GP to be re-registered with the practice.
‘If they reactivate after these first two years the patients will remain with the MCP unless they request to follow the GP.’
Furthermore, the new guidance states that a GMS or PMS contract can only be reactivated once, meaning all the partners originally under the contract will have to agree that it should be reactivated.
The document said: ‘For example, if half a partnership wished to reactivate and half preferred to stay in the MCP, the partners together would have to agree on their preferred course of action.’