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Support for Accountable Care Systems

Developing an Accountable Care System is potentially the most complex change management programme that a Clinical Commissioning Group will ever undertake. NHS Shared Business Services is providing procurement and contracting support to 33 CCGs, helping them to develop their approach to contracting their local Accountable Care System to achieve the patient outcomes and financial sustainability they require. Read our 10 tips for success.

In June this year, Simon Stevens, Chief Executive of NHS England, pledged to end the "fractured" health and care system, announcing that nine areas in England - covering some seven million people - would be developing new "Accountable Care Systems" (ACSs).

Bringing together local NHS organisations with social care services and the voluntary sector, the new ACSs are designed to provide better, more joined-up care by breaking down the barriers between primary and secondary care, physical and mental care and social care and the NHS.

NHS Shared Business Services are helping CCGs to develop strategies for contracting the new models of care which help shape the new accountable care systems. The expertise we offer is built on a solid understandingof the relevant procurement law and the political sensitivities which influence stakeholder challenges, recognising no two CCGs have the same factors and considerations at a local level.

For example, in Manchester, our Commissioner Services team have been working with the newly- created Manchester Health and Care Commissioning partnership across the city, which is in the final stages of creating the beginnings of its accountable care system. For health systems such as Manchester, relationships are strong and the vision has been in development for some time. For others, a more incremental process of evolution is preferred - working within existing contract arrangements bolstered by an alliance agreement to test and shape the long term ACS model.

Across South London CCGs, our procurement specialists have been advising CCGs on the 'Light Touch Regime' (specific flexibilities under the Public Contracts Regulations 2015) to procure Multi Speciality Community Providers consisting of Primary Care and Community providers to collaborate on out of hospital care to help improve the overall supply chain with improved innovation and affordability focusing on care closer to home.

By supporting a variety of CCGs who are ultimately working towards implementing an accountable care system, we have been able to identify the following key factors to take into account:

1. Define the scope. Make sure that you have a robust list of current contracts and their expiry dates.  Which are working well, which need improvement and what is the evidence?  Engage your stakeholders early on and consult subject matter experts to agree which services should be in scope for your ACS. Evidence the rationale for the scope to create the case for change.

2. Consider and agree the level of integration required. Explore different models. Working through the service and population cohort scope will help define suitable model options e.g. to what extent primary and acute care services are integrated.

3. Collaborate and co-produce the new model. Work with providers, stakeholders and subject matter experts to understand what needs to change and how it can change so that you develop a specification which is deliverable and will enable the provider(s) to achieve the desired outcomes.

4. Understand the market. Which providers are interested and capable in delivering your ACS services and, importantly, test the core competencies to drive collaboration, integration and transformation.

5. Carefully consider the correct contracting approach. Consider whether a competitive tender or legal variation of existing contracts is the best way to achieve your outcomes whilst bearing in mind the need to be compliant with Public Contract Regulations.  Develop a robust contracting strategy with a clear rationale - does the contracting approach minimise the VAT burden on the providers and the CCG? Don't be a robot following a rigid process - push the boundaries and design the strategy that will deliver your requirements. This may be a roadmap - a journey towards the ultimate vision.

6. Embrace procurement. Don't worry that the Public Contract Regulations will stop you from achieving the best outcome.  Use the Regulations to your advantage to drive best value as well as innovation to ensure that you get the right contract in place with the right provider(s).

7. Engage with providers.  In order to ensure that contracts are deliverable and viable it is vitally important to have dialogue with providers both BEFORE and DURING the procurement and contracting process. With contracts sometimes lasting 10 years or so, communication and negotiation must also continue for the life of the contract as part of an effective contract management regime.

8. Future proof the model.  Even if something is out of scope on day one, it might be in scope tomorrow or five years from now.  Build flexibility in to your contract at the start so that you can future proof your ACS and ensure that it is fit for purpose for the lifetime of the contract whilst remaining compliant with the Public Contract Regulations.

9. Get your approach to governance and assurance right. Develop a clear governance and decision making framework. The scale and change required to deliver requires clear governance, project set up and understanding of the external assurance processes and regulatory involvement e.g. NHS England and NHS Improvement's integrated support and assurance process (ISAP).

10. Securing financial sustainability. The case for change will need to be evidenced at the outset - however ongoing mechanisms will be helpful to track, monitor and agree future investment decisions based on the health economy priorities. Are there processes in place to mitigate the risk of not achieving the anticipated savings?


For an informal chat about developing an accountable care system strategy or if you would like advice on how to approach the NHS England and NHS Improvement Integrated Support and Assurance Process (ISAP) please email Alison Kerfoot, Director of Strategic Procurement & Commissioning Support.

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