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Accountable Care Organisations (ACOs)

St Marys/Hammersmith Hospitals 21-12-16
Hospital doctor taking blood pressure SMH2016
Doctor with patient

In 2017, NHS England published Next Steps on the Five Year Forward View.

This described how its focus was evolving from Sustainability Transformation Partnerships, to ICSs (Integrated Care Systems) formerly known as ACSs (Accountable Care Systems) and ACOs (Accountable Care Organisations).

These are population-based models of care that integrate primary, secondary, community and other health and care services.


What are Accountable Care Organisations (ACOs)?

ACOs have emerged from the MCP (multi-specialty community provider) and PACS (primary and acute care systems) models developed in the Five Year Forward View, and international examples, including from the United States.

An ACO brings together a number of providers to take responsibility for the cost and quality of care for a defined population within an agreed budget.

The key feature of an ACO is that there will be a single contract with a single organisation for the majority of health and care services in the area.

The ACO contract holder would be responsible for the provision of services, but may not necessarily deliver all the services itself; it could instead hold sub-contracts with other providers.


What the BMA thinks of ACOs

While the BMA believes that integration and greater collaboration is needed, we have several concerns regarding ACOs.

These include:

  • the lack of clarity and accountability surrounding their development so far
  • the risk of privatisation they present
  • whether Government will provide the level of NHS funding and investment required for them to work
  • how they will secure the future of general practice.

BMA Council Chair, Chaand Nagpaul, has issued a statement and has written to the Secretary of State for Health and Social Care, Jeremy Hunt, to highlight these concerns.

Read the statement - Mar 2018

Read the letter to the Secretary of State for Health and Social Care - Jan 2018



Accountable Care Organisations: Member briefing

The briefing explains the different models being developed, describes the key contractual and regulatory issue, sets out the BMA's key concerns and provides advice for members.

Read the briefing

Guidance on the ACO contract

This guidance provides a high-level overview on the main terms and conditions which apply to the NHS standard contract for ACOs alongside the proposed system for suspension and reactivation of a GMS or PMS contract under the 'fully-integrated' version of the contract.

Read our guidance


Further information

Accountable care what?

Read our blog and add your comments

Accountable care models contract: proposed changes to regulations

Read our consultation response

Destination integration? Big on inspiration, short on legislation - the 'quiet revolution' in the NHS

Read our digital feature