How do they work?
MCPs (multispecialty community provider), one of the new care models outlined in the Five Year Forward View, are a new type of integrated provider that could potentially combine the planning, budgets and delivery of primary and community care services.
MCPs will seek to offer a wide range of community-based care, including shifting some services out of hospital settings. This could also extend to mental health and social care services. They will use integrated, multi-disciplinary teams, working with GPs, and employing a range of health and social care professionals, including specialists from secondary care.
Where do they form?
MCPs will provide care to the whole population, based on the registered lists of participating GP practices. They will be built around groupings of practices (often in federations or networks) that cover 30,000-50,000 people. These groupings are similar in size and concept to the primary care home approach.
This is a model developed by the NAPC (National Association of Primary Care), which has a combined focus on the personalisation of care with improvements in population health, using an integrated multi-disciplinary workforce. It is highlighted by NHS England as one possible way of developing the ‘building blocks’ of an MCP. The overall scale of an MCP will depend on local context, but it is likely to serve a population of at least 100,000.
How are they funded?
The extent of primary care integration within an MCP will be determined by local GPs. Three voluntary contractual options have been developed, enabling different levels of integration between local practices, the MCP and primary and community care services.
Two of the three options (fully and partially integrated) will involve a new contract, held by the MCP. The third option (virtually integrated) involves an alliance agreement, rather than a new contract. MCPs may also operate a new payment model, based on a capitated, whole-population budget. This will include an element of performance related pay and a gain/loss share arrangement. Again, the extent of primary care integration within the payment model will vary according to the contractual option chosen.
What are the risks?
The organisational form of an MCP will need to be capable of bearing financial risk, with appropriate clinical and financial governance and accountability arrangements. Options are likely to include: a limited company or partnership, which could be a GP super-practice, federation, or new organisation formed for the purposes of delivering the MCP contract; a community interest company; or an existing NHS trust or foundation trust, potentially working with GPs.
Back to collaborative working
Working examples of MCPs
Delegates discuss the benefits of MCPs in their own practices at the working together conference.
Hampshire Better Local Care
Dr Tom Bertram from Hampshire Better Local Care, talked about how the MCP Vanguard has started attracting GPs (where previously there were recruitment issues) as the telephone consultation and online consultation and triage tools save GP appointments and allow practices to manage their workload better.
Primary Care Home
Dr Gill Pickavance from Wolverhampton Total Health Ltd, explained how the Primary Care Home model releases time for GPs through greater use of a multi-disciplinary team.
Download the presentation slides (PP)
Fylde Coast Local Health Economy
Dr Tony Naughton from Fylde Coast Local Health Economy, showed how the MCP Vanguard has led to reduced GP consultations, home visits and phone calls, through use of an enhanced primary care team including GPs, therapists, nurses, wellbeing support workers, social carers and mental health workers.
Download the presentation slides (PP)
- Calderdale (West Yorkshire)
- Erewash (Derbyshire)
- Fylde Coast (Lancashire)
- Lakeside (Lincolnshire/Northamptonshire)
- Tower Hamlets (London)
- West Cheshire
- South Nottinghamshire
Six ‘intensive support’ sites which have been helping to develop the MCP contract options:
- Southern Hampshire
- Modality (Birmingham)
- Dudley (West Midlands)
- Wakefield (West Yorkshire)
- Greater Manchester
- Whitstable (Kent)
Primary care home rapid test sites
- 1st Care Cumbria
- Beacon Medical Group
- The Breckland Alliance
- The Healthy East Grinstead Partnership
- Larwood & Bawtry
- Luton Primary Care Cluster
- Nottingham North & East Community Alliance
- Rugeley Practices
- South Bristol Primary Care Collaborative
- South Durham Health
- St. Austell Healthcare
- Thanet Health
- The Winsford Group
- Wolverhampton Total Health Care
Practical, logistical and theoretical issues around MCPs
Delegates at the working together conference gathered in a breakout group to address a variety of practical, logistical and theoretical issues around MCPs. We've provided the notes that emerged from this discussion below:
What is the impetus for working together?
- The impetus for working together varies from area to area.
- In many areas working at scale is a way of developing some resilience to the pressures facing general practice, including with recruitment.
- In some cases, practices who do not have immediate concerns about their sustainability have been proactive in cooperating because they have seem neighbouring practices struggling or can see potential benefits to their practices.
- However, engagement and collaboration doesn’t always happen organically. LMCs can help galvanise practices to talk to each other; once a few practices have kick-started an initiative, this often encourages others to get involved.
- There was a feeling that if GPs aren’t proactive and leading efforts to work together they will be more at risk of top-down, vertical integration.
The different MCP contractual options
- It is important to be clear whether you are referring to the virtual, partially integrated or fully integrated model, as there are important differences between them.
- There also different elements to each model: the clinical model, organisational model, contractual model and the financial model
- The level and type of risk varies according to the model and contractual option pursued.
- The Primary Care Home model has a strong overlap with MCPs, but does not involve contractual change.
- Nobody in the breakout session was keen to pursue the fully integrated model, but those interested in pursuing a form of MCP had different plans and priorities.
- There was clear agreement that MCPs are not the only option for how to work collaboratively (as acknowledged by Simon Stevens in his keynote) and that any move towards one of the MCP options is voluntary.
- There is a risk that when GPs, in whatever organisational form they have developed, may not win the MCP contract after it has gone through the procurement process.
- It may also be challenging for CCGs to procure MCP contracts that include community services, if these services have recently been reprocured.
- While there is currently still a purchaser-provider split, there is a pilot taking place in Greater Manchester, whereby the CCG will be in control of the budget for a particular contract, on a quarterly timeframe.
- There is a need for a new commissioning solution, as payments-by-results does not give you the flexibility to move money around.
- Some areas have developed arrangements with private companies. For example, in an area with a Primary Care Home model a drugs company has funded a diabetes nurse.
- Funding needs to be made available for transformation, as without money to fund leadership and planning time it is very difficult to enact change.
- It can be challenging to get funding to follow activity that is shifted from secondary care into the community.
- A risk-gain share arrangement between the MCP and secondary care could help facilitate this shift, but only if all sides were supportive of the principle.
- Are employed staff eligible for NHS pensions? It depends on the employment arrangements. An example was given on the MCP in Fylde coast, where the local Trust to employ staff, so they will be eligible.
- Sessionals are an increasingly large proportion of the workforce, and they need to be supported and developed within any model of general practice. They would benefit from some tailored information and guidance.
- There is a risk that within a large MCP-type organisation there is less of an incentive to offer sessionals a good contract. Is there scope to make the BMA model contract mandatory in all cases?
Procurement of services
Dr Barbara King, Birmingham CCG clinical accountable officer, provides a presentation on how procurement of services for collaboration works in her CCG.
Download the presentation slides (PP)