david ellcock, programme director future-focused finance · tackling wasteful spending on health. a...

David Ellcock, Programme DirectorFuture-Focused Finance

“Good organisational culture has a direct impact on patient care in terms of patient satisfaction and patient mortality.”

So you could say it’s a matter of life and death.

We all have a responsibility to play our part in creating a good culture despite the challenges we face.

Source and further reading: NHS Staff Management and Health Service Quality, 2011https://www.gov.uk/government/publications/nhs-staff-management-and-health-service-quality

https://www.gov.uk/government/publications/nhs-staff-management-and-health-service-quality

Elizabeth O'Mahony Chief Finance Officer

Paul BaumannChief Finance Officer

Bill GregoryChief Finance Officer & HFMA Representative

David WilliamsDirector General Finance & Commercial

Calum Pallister Director of Finance

Jill Robinson Claire Yarwood Simon Worthington

Adrian Snarr Richard Alexander

Caroline Clarke

good organisational culture is essential in delivering good patient care

• Finance Systems Accreditation for General Practice

• Value Maker Network

programmes and tools to support system-wide talent development

• Behavioural Skills Framework

equitable access to opportunities for all to develop their knowledge of NHS finance

• Primary Care delivery group

• Beginners’ Guide to Primary Care Terminology

• Payments made to practices process map

• General Practice: New Ways of Working

promoting ways of working that improve outcomes or reduce

resources without compromising either

• BPV ‘bitesize’

widening our scope of vision

• Future of NHS Finance report

• Let us know what more you’d like us to do

- In person- Via the feedback form- By email…

SophieRowe

NetworksManager

Courtney Lawrence

Programme & Communications

Co-ordinator

Grace Lovelady

ProgrammeManager

DavidEllcock

Programme Director

CamillaGodfreyAssistant

ProgrammeDirector

KellyHudson

AssistantProgramme

Director

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

Iain Crossley NAPC Tutor and HFMA Mentor

October 2108

NHS Finance and general practice

©Iain Crossley 1

• How NHS finance works• Advantages and issues with the current

system• How it impacts on primary care• Financing general practice in the future

NHS Finance and general practice

©Iain Crossley 2

How NHS finance works

Most GP practices 'operating on the edge of

financial viability', warns BMA GP Magazine 2018

©Iain Crossley 3

International ComparisonNational Economic Policy

4

Healthcare spend as a proportion of GDP, OECD countries 2016

©Iain Crossley

Dept of Health and Scocial Care

Spending in England c£125bn

©Iain Crossley

Healthcare Myths

Healthcare is not failing but succeeding, expensively, and [as a society] we don’t want to pay for it.

Mintzberg (2012)

©Iain Crossley 6

Problem 1

Demand is rising faster than resources• Workforce• Physical space

©Iain Crossley 7

Demand Pressures on GP practices

Source: https://visual.ons.gov.uk/uk-perspectives-the-changing-population/©Iain Crossley 8

Demand Pressures on GP Practices

Long-term Conditions

About 15 million people in England have a long-term condition.

https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity

©Iain Crossley 9

Demand Pressures on Providers

©Iain Crossley 10

NHS England’s Projection of ‘Financial Gap’

Source: NHS England (2016)

£30bnshortfall

11©Iain Crossley

NHS Financial Gap

Source: The Health Foundation 2015

£30bn

£65bn

12©Iain Crossley

Tackling Wasteful Spending on Health.

A significant share of health spending in OECD countries is at best ineffective and at worst, wasteful.

Overall, evidence suggests that up to one-fifth [20%] of health spending could be channelled towards better use.

OECD 2017

We estimate this unwarranted variation is worth £5bn in terms of efficiency opportunity – a potential contribution of at least 9% on the £55.6bn spent by our acute hospitals.

Carter Review (2016)

13©Iain Crossley

Bridging the

Financial Gap

The Solution?

14©Iain Crossley

Problem 2

Where to target Resources for best effect?

©Iain Crossley 15

NHS Finance

How to spend this fairly and equitably to maximise health gain?

Dept Health and Social Care

£125bn

Tax & NI

©Iain Crossley 16

Where should we

spend the £125bn

for best health

gain?

17

Health Social Care

Hospitals

Primary Care

Adult Social Care

Nursing Homes

Health Promotion

Wellbeing©Iain Crossley

Problem 3

How to distribute the resources across the country?

©Iain Crossley 18

19

NHS England

£10bn for General

Practice

NHS England

£76bn for CCGs

©Iain Crossley

HFMA

Allocations £/head

©Iain Crossley 20

Carr-Hill FormulaeBMA concerns with the process:

• Per patient weightings vary widely

• Lack of sensitivity to the needs of atypical populations

• Some population needs are inadequately reflected;

particularly in deprived areas

• Staffing and cost allowances are out of sink with real

costs

©Iain Crossley 21

22

How NHS finance worksFair Allocations or Funding Actual Costs?

Advantages: Problems:

• Fits with NHS Values

• Ensures service is

free at the point of

delivery

• Fair and equitable

• Ignores where patients actually

go; it funds where we would like

pateints to go

• Does not increase with Demand

• Insensitive to actual Local costs

• Ignores the providers real costs

• Ignores financial ‘risk’

• No funding for transformation

©Iain Crossley

Current system for Funding Primary Care

GMS Contract• fee/patient• premises costs and other allowances

QOF incentive

Enhanced Services• fee/activity

©Iain Crossley 23

Impact on Primary Care

Most GP practices 'operating on the edge of

financial viability', warns BMA GP Magazine 2018

©Iain Crossley 24

Funding Primary Care

Percentage change in number of contacts with clinical staff and practice list size

15% increase

in activity

3% rise in

funding

©Iain Crossley 25

Real Terms GP Practice Funding NHS England

GP funding is 7.1% of the total NHS England budget for 2018/19 -down from 7.3% in 2017/18.

BMA Estimate£3.4bn shortfall by 2020/21

©Iain Crossley 26

Responsibility for Primary Care

Co-Commissioning• NHS England• Clinical Commissioning Groups

©Iain Crossley 27

Financial Strategy

Increase Income• Attract more patients• QOF• LES/DES

©Iain Crossley 28

Reduce Costs• Improve practice procedures• Review workforce mix

• On-line consultations• Share costs - At Scale working• Mergers and Super-practices

©Iain Crossley 29

Financing general practice in the future

Redefine current GMS contract:

• Define the Core service• Fee for Activity• Patient charges - Access fee?

©Iain Crossley 30

Financing general practice in the future

Change the Primary Care Model:• Integrated Care Systems• Multispecialty Community Provider

• Change the GP practice model• on-line service• Long term conditions service

©Iain Crossley 31

Any questions?

32©Iain Crossley

National Association of Primary CareDiploma in Advanced Primary Care Management

3 Modules:o Leadership and Personal

effectivenesso NHS policy, law and governanceo Healthcare Business and Finance

http://napc.co.uk/primary-care-home/diploma-2/

©Iain Crossley 33


Managing Practice Finances

Katy Drew LLB FCA ALCM

Accounting Systems

Financial Controls

How to track your income streams

1

2

3

Managing Practice Finances

Which hat are you wearing today?

© Nireus | Dreamstime.com

Future proof

Internal controls

What is an Accounting System?

An accounting information system is a system of collecting, storing and processing financial and accounting data that are used by decision makers. An accounting information system is generally a computer-based method for tracking accounting activity in conjunction with information technology resources.

Wikipedia


A financial management system is the methodology and software that an organization uses to oversee and govern its income, expenses, and assets with the objectives of maximizing profits and ensuring sustainability.

Whatis.com


What are the common elements of an accounting system for a GP practice?• Source records• Software• Financial controls• Financial statements• Cashflow

Source Records

• Practice Records sent to your accountant

Source Records

Other examples of source records:• Bank Reconciliations• PPA returns• Funding bids• Clinical searches

Software

Advantages of specialised software

• Automates and streamlines reporting

• Can pull data easily

• Can process data and produce a summary

Internal Controls

Transaction authorisationSegregation of dutiesSupervisionAccess ControlAccounting recordsIndependent verification

Internal Controls

1.Safeguard the assets of the business

2.Ensure financial information is accurate and reliable

3.Encourage good management

Finance Partner

Finance Partner

1. Authorise payments

2. Review payroll monthly

3. Review finance monthly reports

4. Have control access to all bank accounts

5. Monitor the financial position

Bank Income

Purchasing Payroll

Internal Controls

Purchasing Controls

1.Placing of orders – purchase order form

2.Checking of items received

3.Payment of order

Review

• What additional controls do you need to put in place?

• What could you delegate to other staff?

Payroll Controls

1.HMRC and NHS pensions

2.Overtime

3.Monthly summary

4.Payment

5.Hourly rates

Bank Account Controls

1.All income paid in promptly

2.Cheque controls

3.Online banking

4.Bank reconciliation

5.Finance partner

Income Controls

Tracking your ‘Open Exeter’ Income

• Global sum• QOF achievement• GP Indemnity reimbursement• Electronic referrals system• Vaccinations• Drugs Income• Extended access• Rent and rates

Tracking Superannuation…….

Global Sum 2018/19

• Value per weighted patient £87.92 2018/19£85.35 2017/18£80.59 2016/17

Check against Global sum and correction factor details statement

QOF CPI Adjustments

2018/19 - An increase in the value of QOF point by £8.06 or 4.7% from £171.20 to £179.26

(2016/17 £165.18)

Average practice list size (CPI) has risen from 7,732 as at 1 Jan 2017 to 8,096 as at 1 Jan 2018

GP Indemnity costs 2018/19

Reimbursement will be based on unweighted patient numbers – £1.017 per patient for 2017/18 (was 51.6p for 2016/17)

Paid before end of March 2018

GPC expects partners to ensure that salaried and locums receive their fair share of this

Electronic Referrals System

Non-recurrent payment made directly to practices based on number of weighted patients at £0.170 per patient

Locum Reimbursement

Sickness payments:Maximum payable per week 1% increase to £1,751.52 from £1,734.18

Parental leave payments:£1,143.06 for the first 2 weeks£1,751.52 for subsequent weeks

V&I Changes 2018/19

• Uplift in IoS (Item of Service) Fee for 9 V&I programmes from £9.80 to £10.06 from 1 April 2018

• Hepatitis B at-risk (new-born babies)• HPV completing dose• Men ACWY freshers• Men B• Men completing dose• MMR• Rotavirus• Shingles routine and catch-up

V&I Changes 2018/19

IoS Fee is unchanged at £9.80 for:

• Childhood seasonal influenza• Pertussis• Seasonal influenza and pneumococcal

polysaccharide

Payment for pneumococcal PCV remains at £15.02

Income Controls

‘Open Exeter’ income

• Drugs Income• Extended access• Rent and rates

Also• Superannuation

Other Income

• Sales ledger

• Overview of amounts claimed

• Medical Reports and Copy Records

• Invoice calendar

Sundry Other Income

Sundry income – eg meeting attendance; cremation fees

Cash received from patients

Review

• Anything to add to your action plan?

• What could you delegate or share with other staff?

Other Financial Controls

1.Cashflow forecast

2.Budget

3.Monthly financial reports

4.Backups

5.Paper documentation

Review

• What controls are already in place?

• What could you delegate or share with other staff or partners?

CQC

Documenting Processes

• Internal Controls

• How to….

• Do you have a Finance Processes Policy?

Source records

Internal controls

Action plan

Documentation of Financial Processes

1

2

3

4

Accounting Systems

Financial Planning

Understanding Accounts…..

Financial Planning

Cash-flow forecasting…..

Accounts Vs Cash flow forecast

• Financial accounts- A record of HISTORIC performance

• Cash flow forecast- A predictive tool for forecasting future cash flows

Follow us on:

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Katy Drew – Primary Care Development ManagerT: 01625 527 351E: [email protected]

INTERFACE CLINICAL SERVICES

Understanding QOF and Maximising Income

Jack BirchallHead of Service Development

Agenda

› Quality and Outcomes Framework› The Relevance of Prevalence› Clinical Impact of Inaccurate Prevalence› Budget setting methodology› Potential Issues with Prevalence Reporting› Factors Affecting QOF Income› How QOF Income is Calculated› Financial Impact of Static Prevalence› Future of QOF› What can I do?› How Interface can help?› Questions

Quality and Outcomes Framework

› Quality and outcomes framework (QOF) is part of the General Medical Services (GMS) contract for general practices

› Introduced on 1 April 2004 › The QOF is a voluntary reward and incentive programme› It rewards GP practices for the quality of care they provide

to their patients


Clinical Domain Public Health Domains

Total Available 77 Indicators and 559 Points


19 Clinical Domains 1 Public Health Domain


Average Practice

£100,206


› The QOF gives an indication of the overall performance through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. Put simply, the higher the score, the higher the financial reward for the practice.

› The final payment is adjusted to take account of practice list size and the prevalence of chronic conditions in the practice's local area.

› The QOF helps practices compare the delivery and quality of care currently provided against the achievements of previous years. Ultimately, the aim is to improve standards of care by assessing and benchmarking the quality of care patients receive.

Clinical Impact of Inaccurate Prevalence?

Patients not recalled for

routine review

Patients experience

deterioration in symptoms

Patients not risk assessed

Patients suffer

avoidable complications

Impact of Inaccurate Prevalence on Patients and Resources

Missing meds review, assessment of condition

Poor quality of life

Inaccurate budget models,under resourced NHS,added pressure on staff

Increasing patient risk and poor outcomes

Increased burden on both primary and secondary care resources

Patients not recalled for

routine review

Patients experience

deterioration in symptoms

Patients not risk assessed

Patients suffer

avoidable complications

Budget Setting Methodology

“Budget-setting methodology (BMA)

Every year, NHS England will set the prescribing budget for each CCG, using a formula that contains a number of factors, including:› population profile and list size of the practice using a weighted capitation unit known as the STAR-PU

prescribing unit › an average spend per patient for the CCG calculated for cardiovascular, respiratory and diabetes prescribing

using QOF prevalence data. This figure is then applied to each CCG as appropriate › consideration of historic spend of the practices in the CCG › high-cost drug spend by the practices in the CCG › adjustments made for deprivation and care home patients, for each practice in the CCG › recent NICE guidance and other national clinical treatment guidance › new medicines.”

Potential Issues with Prevalence reporting

› Prevalence data is only as accurate as the coding within a practice

› Common inaccurate/inadequate codes used› Poor understanding of correct codes› Inherited codes› Scope for inaccurately reported prevalence

Identify patients across all clinical

domains

Identify patients across all clinical

domains

Increases PrevalenceIncreases

Prevalence

Informs more accurately on

True Prevalence

Informs more accurately on

True Prevalence

Increases £ Per Point

Increases £ Per Point

Ensures Patients are Identified for Regular Review

and Ongoing Care

Ensures Patients are Identified for Regular Review

and Ongoing Care

Prevalence

Hitting target missing the point????

Factors Affecting QOF Income

› Achievement of QOF points (Registers)

› Contractor Population Index (CPI)

› Adjusted Disease Prevalence factor (ADPF)

Accuracy of Registers

and Coding

CPI ADPF£179.26Your £’s per Point

Standard Point value

2018/19

Contractor Population

Index

Adjusted Disease

Prevalence Factor

Ratio of your list size Vs average (8,279)

Ratio of your Register

Prevalence Vs average

QOF Calculation

Your Disease Register

Prevalence

National Average Disease

Register Prevalence for

specified domain

Your List Size

Average List Size

10%£179.26Your £’s

per Point

Cant Affect

Difficult to Affect

Accuracy Vital

8,279

8,279 5%

QOF Calculation

Practice List Size – Contractor Population Index (CPI)

QOF Points Achievement

Individual Domain Disease Prevalence – Adjusted Disease Prevalence Factor (ADPF)

Practices with the SAME list size and SAME QOF Points achievement can have significantly DIFFERENT QOF Payments!!

An increase in prevalence will always result in an increase in QOF point value

Diabetes Register = 447

Prevalence = 5.4%

Prevalence Factor (5.4/5.4) = 1

QOF Point value = £179.26

DOMAIN VALUE £15,416


Prevalence = 3.6%

Prevalence Factor (3.6/5.4) = 0.67

QOF Point Value = £120.10

DOMAIN VALUE

£10,329


Prevalence = 7.1%

Prevalence Factor (7.1/5.4) = 1.31

QOF Point Value = £234.83

DOMAIN VALUE

£20,195

Practice A

Practice B

Practice C

Diabetes example list size = 8,279

(CPI:1)Available points =

86

How Much Difference Does it Make???How Much Difference Does it Make?

Financial Impact of Static Prevalence

• Average ADPF, 5 yr income £24,149• 10% Increase, 5 yr income £27,094• 20% Increase, 5 yr income £32,992

The Future of QOF

›Snomed›5YFV

› Modifications to indicators› Updates to exception reporting › 3 QI indicators per year

›Potential improvements for this QOF year

What can I do?????

› Understand QOF income is not just about points achieved

› Ensure your prevalence is accurate› Start with highest value domains› Undertake an audit of your clinical registers› Positively challenge beliefs› Identify training and knowledge gaps within your team

(clinical and non-clinical staff)› Training and action where appropriate

What can I do?

How can Interface Help

you?

Enhanced Disease Prevalence Report

• All delegate attendees can access a ‘health check’ report free of charge from

Interface• Report will allow you to benchmark your

prevalence and provides an indication of the number of patients missing from

registers• We can arrange today – please come

and see us on the Interface Stand• Can arrange via email –[email protected]

QOF ‘HealthCheck’

PRACTICE NAME: Interface Clinical Services CLINICAL COMMISSIONING GROUP N/A

PRACTICE NHS ID: XYZ12345 PRACTICE TELEPHONE 0113 2029799

PRACTICE LIST SIZE: 7074 KEY PRACTICE CONTACT Michael Drakard

PRACTICE PATIENTS OVER AGED 16: 5181 CLINICAL SYSTEM Emis Web

PRACTICE PATIENTS OVER AGED 17: 5080 REPORT GENERATED BY (NAME) Louis Miller

PRACTICE PATIENTS OVER AGED 18: 4960 REPORT GENERATED BY (ROLE) Head Of Remote Services

PRACTICE PATIENTS OVER AGED 50: 1497 REPORT DATE 18/05/2016

BASELINE QOF £ PER POINT: £156.63 NATIONAL AVERAGE LIST FOR CPI (FROM NHS SFE 2015) 7460

Clinical Domain

Nat

iona

l pre

vale

nce

(age

ad

just

ed)

Regi

ster

siz

e

Prac

tice

prev

alen

ce (a

ge

adju

sted

)

Avai

labl

e po

ints

Current £ per QOF

point

Pote

ntia

l Pat

ient

s fo

und

Tota

l inc

ludi

ng p

oten

tial

Adju

sted

pra

ctic

e di

seas

e pr

eval

ence Potential £

per QOF point

Value of each additional

register patient (£)

Income based on full QOF

achievement in current register

Income based on full QOF

achievement in adjusted

register

Additional income

Atrial fibrillation (AF) 1.63% 39 0.55% 29 £ 52.95 16 55 0.78% £ 74.68 £ 39.38 £1,535.66 £2,165.68 £630.01

Secondary prevention of coronary heart disease (CHD) 3.25% 159 2.25% 35 £ 108.49 4 163 2.30% £ 111.22 £ 23.88 £3,797.08 £3,892.61 £95.52

Heart failure (HF) 0.72% 39 0.55% 29 £ 119.44 15 54 0.76% £ 165.38 £ 88.82 £3,463.79 £4,796.02 £1,332.23

Any Questions?

Interface Clinical Services, Schofield House, Gate Way Drive, Yeadon, Leeds, LS19 7XY

T: 07540 502773E: [email protected]: www.interface-cs.co.uk

WORKSHOP B: Creating and setting a budget

Caroline Gray, Practice Manager, Mawbey Group Practice

Welcome

What is important

Who are the most important people in general practice

Who is responsible for delivering an excellent service

SO

Where you want to be and where you are now

How

Do you work out the costs of this

How to identify the budget you need

How to set steps in terms of reaching target and how to build the budget

Budget monitoring

How

Why

Where

Who

Reporting

Why set a budgetWhy do you need to change ? What are the key driversAccountabilityClarityTeam work

The three wise monkeys (Japanese: 三猿? Hepburn: san'en or sanzaru, alternatively 三匹の猿 sanbiki no saru, literally "three monkeys"), the phrase is often used to refer to those who deal with impropriety by turning a blind eye.

There are various meanings ascribed to the monkeys and the proverb this most positive being associations with being of good mind, speech and action which is where we want to be.

The road ahead-• How to build in opportunistic growth/ unexpected loss of budget Managing AccountabilityBreaking bad news

• What is Integration in healthcare• What are the benefits• Look at the current NHS Proposals• Implications for GPs and General Practice


©Iain Crossley 2

One of the biggest problems in the delivery of health care is fragmentation: Patients —especially those with complex issues — see a multitude of providers, and all too often nobody is integrating their care.

(Harvard Business Review, 2018)

Integrated Care

©Iain Crossley 3

Integrate services around the patient • Improve outcomes• Make it easier for patients and carers to coordinate

and navigate their care• Enable access to information on treatment and

outcomes• Allow the funding to follow the patient• Break down barriers and Share best practice• Make best use of resources• Reduce pressure on Service providers

(based on NHS Futures Forum paper)©Iain Crossley 4

Integrated Health and Social Care

Broader determinants of health

Source: (Dahlgren and Whitehead,1993) Tackling inequalities in health©Iain Crossley 5

NHS Integration Policy

Our aim is to use the next several years to make the biggest national move to integrated care of any major western country.

(NHS England, 2017)

©Iain Crossley 7

Integration for which Patients?

GP Practice Population

• Locality

• GP practice

Care group

• Elderly

• Children

Disease or condition group

• Long-term conditions, such as Diabetes

Whole population

• Local authority area

©Iain Crossley 9

How best to do it?

10

2012 - 2015Patient Choice and Provider Competition

Efficiency & Innovation

2012 Lansley Reforms

©Iain Crossley

How best to do it?

11

2012 - 2015Patient Choice and Provider Competition

Efficiency & Innovation

2012 Lansley Reforms

2015 onwardsJoined Up CareSingle Public sector provider coordinating care delivery

Equality and Best Value

Pre - 2012 Lansley

©Iain Crossley

Integration• New Models of Care

• Primary Care Home

• Multi-specialty Community Providers

• GP Super practices

• GP Federations

• Sustainability and Transformation Partnerships

• Integrated Care Systems

• Accountable Care Organisations

• Integrated Care Providers

• Integrated Provider Units©Iain Crossley 12

NHS ApproachWhole Population - Joined-Up Care

Provider integration – individual providers are merged to create one providerGP Super practicesHospital GroupsNew Models of Care

Commissioner integration – commissioners merge to form one commissionerSustainability and Transformation PartnershipsIntegrated Care Systems

©Iain Crossley 13

How do we do it now?

Hospital

MentalHealth

GPPractice

GPFederation

CCG

LOCAL AUTHORITY

GMS CONTRACT

APMS CONTRACT

NHS STANDARD CONTRACT

©Iain Crossley 15

Stage 1: Integrated Care Systems

Hospital

MentalHealth

GPPractice

GPFederation

CCGNHS England

LOCAL AUTHORITY

GMS CONTRACT

APMS CONTRACT

NHS STANDARD CONTRACT

©Iain Crossley 16

Local Health Economy

MentalHealth

GPFederation

Hospital

Neighbourhood

GPPractice Local

Authority

Primary Care Home

GPPractice

Hospital

CommunityServices

Stage 2: Integrated Care Provider

MentalHealth

GPFederation

Hospital

Neighbourhood

GPPractice

Local Authority

Primary Care Home

GPPractice

Hospital

CommunityServices

Care Provider Alliance

MentalHealth

GPFederation

Hospital

Neighbourhood

GPPractice

Local Authority

Primary Care Home

GPPractice

Hospital

CommunityServices

Stage 2: Integrated Care Provider

INTEGRATED CARE SYSTEM

GMS CONTRACT?

APMS CONTRACT?

NHS STANDARD CONTRACT?

INTEGRATED PROVIDER CONTRACT

Hospital

Primary Care Home

CARE PROVIDER ALLIANCE

©Iain Crossley 20

Can any organisation hold the Integrated Care Provider contract?

• NHS Statutory Body

• Trust

• Foundation Trust

• GP Federation

• GP Super practice

• Primary Care Home

• Multispecialty Community Provider

• Independent Sector organisation

©Iain Crossley 21

Integrated Care Provider

GP SuperPractice

GPPractice

GPPractice

Whole Population Budget

• Allocation for whole system; not subdivided by sector (for local determination)

• Payment to Incentivise performance• Gain/loss agreement to compensate

for activity variations.

General practice participation in a Provider Care Alliance

Three options:

• Virtual Integration• Partial Integration• Full Integration

©Iain Crossley 23

Virtual Integration

• Core general practice remains under GMS, PMS or APMS contracts.

• Practices sign an ‘alliance agreement’ with commissioners and Integrated Care Provider to facilitate joint working

• GP federations continue as service providers outside the Integrated Care Provider

©Iain Crossley 24

Partial Integration

• Integrated Care Provider has contract for the services; except core general practice.

• GP practices remain on GMS/ PMS contracts. • Primary care contribution described via an

integration agreement.• Integration agreement negotiate and sign with


©Iain Crossley 25

Full Integration

• Integrated Care Provider covers full range of services including core general practice.

• GP Practices become part of Integrated Care Provider.

• Contracts directly with the Integrated Care Provider • GMS contract relinquished

©Iain Crossley 26


GP SuperPractice

GPPractice

GPPractice

GP Practice ViewWhat is the practice expected to provide?What activity volumes and times of day/week?What work is being passed from other providers?What work can we pass to other providers?

What funding is available?What price will we be paid for the activity?


Public Consultation finishes on 26 OctoberFurther InformationNHS England Publications:

https://www.england.nhs.uk/new-business-models/publications/consultation-contracting-arrangements-for-icps/

©Iain Crossley 28

https://www.england.nhs.uk/new-business-models/publications/consultation-contracting-arrangements-for-icps/

National Association of Primary CareDiploma in Advanced Primary Care Management

3 Modules:o Leadership and Personal

effectivenesso NHS policy, law and governanceo Healthcare Business and Finance


©Iain Crossley 31


david ellcock, programme director future-focused finance · tackling wasteful spending on health. a...

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