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Integrated Care Providers (ICPs)

Integrated Care Providers (ICPs), formerly called Accountable Care Organisations (ACOs), are population-based models of care that integrate primary, secondary, community and other health and care services under one single provider contract. ICPs are distinct from Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs), both of which focus on achieving integration without contractual change. 

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

What are Integrated Care Providers?

An ICP 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 ICP is that there will be a single contract with a single organisation for the majority of health and care services in the area. The ICP 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.

ICPs should not be confused with ICSs (Integrated Care Systems), which emerged from NHS England's Five Year Forward View and are now expected to cover all of England by 2021. Unlike ICPs, ICSs do not necessitate major contractual change and are likely to operate across a larger population. Going forward, ICSs are central to NHS England's plans for the future and will be responsible for integrating care, strategic decision making and delivering funding within their areas.

 

The ICP Contract

NHS England ran a public consultation on the proposed ICP Contract (further information on which can be found on the NHS England website).

Download a summary of our submission
Download the full submission

This follows on from a previous consultation on amendments to various regulations, required for such a contract to operate. The BMA response to this consultation is available on the BMA consultations page.

 

What the BMA thinks of ICPs

The BMA agrees that there is a distinct need to better coordinate and integrate health services, and which will use NHS resources in an equitable and cost-efficient manner. Indeed, we have long called for greater integration and collaboration between different parts of the health and social care systems, and also across different parts of the medical profession. 

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

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

  • The impact of ICPs on GPs

    In a BMA survey 93 per cent of doctors in England want GPs and hospital doctors to work together more directly in a collaborative and co-ordinated manner. Worryingly, the same survey found that in England 73 per cent of doctors are not aware of the plans to establish integrated care providers.

     

    Impact of ICPs on GPs

    • GP practices will be required to sign up to the contract in order for it to operate
    • ICP contracts will undermine the current partnership model

    However, GP practices do not need to enter into this contractual agreement.

     

    BMA concerns

    • ICP contracts will undermine the GMS contract  and the partnership model of general practice, which the recent GP Partnership review found provides practices with the freedom to innovate; provides relative autonomy in decisions relating to patient care; creates a desire amongst GP partners to success as business owners and provides value for money.
    • There is a risk that local commissioning strategies will erode the autonomy and choice of GP practices and other participating providers.
    • Current procurement law means that combining multiple services into one contract risks the potential for non-NHS providers taking over the provision of care for entire health economies, as the contract would be subject to open competition rules.

    BMA position

    • The BMA does not believe that new contractual models are required to achieve service integration and that the same outcomes can be achieved using existing frameworks. ICSs (Integrated Care Systems), for example, are already in operation and operate on the basis of allowing collaboration and integration with local agreements without the need for formal contracts.
    • GPs must have protections in place whereby they reject the proposed models they have a commitment that:

      (i) Their contracts, funding and services are ring fenced

      (ii) They will have the flexibility to agree the contractual arrangement with the ICP to achieve greater integration, and;

      (iii) There will be a mechanism for them to unlock further funding via (potentially) a separately commissioned contract to achieve this integration

    • Whilst the direction for the ICP Contract contain requirements that salaried GPs must be offered terms no less favourable than the BMA model contract, as per GMS regulations, we expect all doctors employed under an ICP to be provided with nationally negotiated terms and conditions.

    Further discussions on this with the BMA must be undertaken before any ICP contract is put into effect.

     

    GP rights

    • GP practices working under ICP contract will have a ‘right to return’ should they agree to suspend their respective GMS/PMS contract and integrate fully into an ICP.

    However, we retain serious doubts over the practicality of these proposals. Whilst it will be technically possible for a practice to return to a ‘suspended’ GMS or PMS contract there is no guarantee that the practice will return to an adequate level of funding.

    An example:

    There would be no guarantee for practices to return to their contracts for services beyond GMS/PMS, for example local enhanced services and previous CCG funding streams. It is likely that these will be contracted to as part of the ICP contract, and so the practice would need to come to a subcontracting arrangement with the ICP if it wished to provide services beyond GMS/PMS.

    As patients stay with the ICP by default at any point beyond the initial two year break point, there is no guarantee that practice returning to GMS/PMS would be able to survive at all.

    Practices that do manage to successfully leave an ICP will find themselves in direct competition for patients from a much larger organisation that would also control the area’s community nursing services.

    Effectively this means that practices entering into a fully integrated model of working should consider it an irreversible process.

     

    What you need to know if you choose to operate under an ICP contract

    If a GP practice chooses to operate under such a contract there are two options or models:

    Partial model: whereby member practices retain their core GMS/PMS contracts but sign a separate ‘Integration Agreement’ to operate under the ICP provider (guidance on the Integration Agreement can be found here).

    Full model: whereby the practice core contract is ‘suspended’ and replaced in their entirety by the ICP contract. 

    Further detail and guidance on these models, including the BMA’s continuing serious concerns regarding the impact of the Contract, are available in previous BMA guidance notes.

     

    ICP contracts: What patients need to know

    It is not only GPs and their practices that will be potentially impacted by the move onto ICP contracts. Increased privatisation and the resulting fragmentation of services, a lack of consultation with the public and concerns over future GP funding all have the potential to impact the care patients receive.

    The way in which general practice in the UK is structured is what gives it its strength and resilience. This independence allows GPs the freedom to innovate and provides relative autonomy in decisions relating to patient care, which makes them uniquely placed to advocate on behalf of their patients.

    It is important that patients understand the risks associated with ICPs and what they mean for them. The BMA have produced a short explainer for you to share with your patients.

     

  • Further resources and information

    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 ICPs 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

    Judicial Review

    On 23 May 2018 a judicial review challenging NHS transformation plans was heard in the High Court. Launched by the group JR4NHS, it challenged the legality of the Government and NHS England’s plans to form ICPs. Read the BMA’s written statement to the court and our news story.

    Read the statement

    Read our news story

    Integrated Care Systems: Member briefing

    ICSs (Integrated Care Systems) are now seen by NHS leaders as the future of health and care integration in England. They offer the opportunity to break down barriers between services, support doctors collaborate, but their success would be dependent on key principles being met.

    Read the briefing 

     

    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