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Next steps on shift to accountable care organisations revealed

A handbook has been released to give practical guidance to support local areas looking to implement an accountable care organisation (ACO) model and a whole population budget (WPB) approach to paying for health and care services.

Developed by NHS England and NHS Improvement, the handbook is to be used by organisations looking to move to an ACO model of care who wish to find out the next steps in going about this plan.

The document is laid out in chapters, explaining how organisations can calculate the WPB baseline for an ACO, estimate WPB values for the duration of the ACO multiyear contract, as well as implementing Improvement Payment Schemes and then deliver gain/loss sharing to better align financial incentives and transfer utilisation risk from commissioner to provider.

“The NHS Five Year Forward View promoted new care models, including multispecialty community providers (MCP) and integrated primary and acute care systems (PACS), to close these gaps,” the handbook states.

Successful implementation of these ACO models requires a new payment approach that will provide financial incentives to facilitate greater co-ordination and integration of care.

“This handbook describes the development of a payment approach for whole population models of integrated provision, centred on integrated budgets derived from current commissioner expenditure. The WPB approach promotes that the whole population is incorporated into the budget, but allows for flexibility of service scope to account for different care models being developed to meet local needs.”

‘Strong equal partnership is essential’

The move supports a number of calls from local authorities to work more closely with NHS trusts and drive towards stronger finances for both councils and NHS organisations.

A blog by David Pearson, director of adult social care in Nottinghamshire County Council and lead for the region’s sustainability and transformation partnership (STP), said that “strong, equal partnership is essential” to the future transformation of health and care in England.

“The sense of shared enterprise is in its early stages in many areas. Local government and the NHS are two different worlds with distinct cultures and (it sometimes seems) languages,” he wrote. “The NHS has historic local quirks and complexities of its own – addressing these was rightly the priority of many STPs and they will take time to solve.

“However, we have seen new partnerships grow and strengthen considerably during the past year, and they are now beginning to yield results for the communities we serve.”

Pearson added that the progress local authorities have made all happened because of a sustained joint effort between colleagues in councils alongside their NHS counterparts, and a shared focus on tangible improvements.

“But this is not a time for criticising from the side,” he argued. “It is crucial that we all take a seat at the table and seize the opportunity to lead conversations that should have been happening for years, if not decades.

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