NHS England is in the process of developing what it is calling an MCP contract. The contract, which NHS England says will be available ‘shortly’, was first announced at last year’s Conservative Party conference with an emphasis on seven-day opening and integrated care.
The GP Forward View says NHS England is aiming for the contract to go live on a voluntary basis in April 2017.
The contract is being developed as part of NHS England’s new care models vanguard programme. Six of the multispecialty community provider (MCP) vanguard sites are currently piloting the contract.
These are Southern Hampshire, Dudley, Manchester, West Wakefield, Modality in Birmingham and Whitstable in Kent.
The new contract will be for populations of 30,000-plus and based on a registered patient list.
The GP Forward View says that the MCP model is about creating a new clinical and business model ‘for the integrated provision of primary and community services, based on the GP registered list’. It will also integrate a wider range of services, including specialists, where appropriate.
Speaking at this month’s annual LMC conference in London, Dr Nigel Watson, chief executive of Wessex LMC and head of the Southern Hampshire MCP said that practices that do elect to take on the MCP contract will be given a population budget and be held to account against a range of outcomes measures.
Seven-day, 8am-8pm working appeared to have become less of a priority under the MCP contract since the plans were first announced, Dr Watson added.
‘I wouldn’t say it has totally disappeared Access is an issue the contract is seeking to address, but seven-day working is less prominent in the discussions now,’ he said.
With a larger population budget and the flexibility to deploy it, the MCP should focus on better population health, says the GP Forward View. This could involve moving away from the ‘one-size-fits-all’ 10-minute consultation.
MCPs will have a stronger focus on prevention and supporting patients, more integrated urgent care and integrated community-based teams of GPs, specialists, nurses, pharmacists and therapists, with access to ‘step-up and step-down beds’.
The Forward View also says that a new payment model will combine all the existing relevant budgets that fall within the MCP scope. This will presumably include some, if not all, of practices’ funding streams.
It is also likely that a new quality and performance scheme that replaces CQUIN and QOF will form part of the contract.
Who will hold the contract?
The contract will have to be held by a ‘legal entity’ and pilots are currently looking at what form this might take. For super-practices, such as the Modality partnership in Birmingham that is piloting the contract, this would probably be more straightforward than for smaller practices that decide to group together to take on the contract.
However, a separate legal entity that sits above existing practices would mean that individual practices would not have to take on the risks of budgets for services that they don’t currently provide, or that they will potentially be delivering with other providers.
The GP Forward View says that there will be a choice of organisational forms, for example a community interest company, LLP or even a joint venture with the local trust.
The Forward View also says that there will be ‘new employment and independent contractor options for MCPs to offer clinicians’, including equity partnership or salaried roles, which could be ‘instead of existing PMS or GMS’.
This suggests the MCP contract will, in some cases, replace practices’ existing contract. However, the Forward View does say that ‘moving off’ GMS or PMS contracts to new arrangements will be entirely voluntary.
Dr Watson told the LMC conference that the MCP contract would ‘sit on top’ of practices’ PMS or GMS contracts rather than replacing them. Until the actual contract is available it is not entirely clear how this option would work, particularly if elements of practices’ funding are pooled into the funding for the MCP contract.
However, even if practices retain their existing contracts, Dr Watson said that one of the problems with the MCP contract would be that ‘if you develop [the MCP model] too far you will come to a point where you can’t return because you are so integrated into the system’ that it would be hard to re-establish former funding streams.