Details of the integrated MCP contracts being developed by NHS England, published on Thursday, revealed how a single whole population budget will work.
NHS England has said it is developing two versions of the MCP contract - a partially integrated contract, which sits alongside retained GMS contracts; and a fully integrated model, with a single whole population budget across all primary and community services.
MCPs will plan, budget and provide primary, community and possibly some secondary care service for populations over 100,000 based on the GP registered list and built around integrated care hubs serving 30-50,000 people.
General practice at scale
Fully integrated MCPs will receive a single budget, called the ‘contract sum’ made up of a capitated whole population budget and a performance payment.
The capitated element will cover the range of primary, community and secondary service provided and managed by the MCP and will be based on the patient lists of participating practices and an estimate for unregistered patients in the area.
The budget will be multi-year and adjusted ‘broadly in line with changes in CCG allocations’.
The whole patient budget will be ‘complemented’ by a risk/gain share mechanism agreement with local acute providers, meaning funding levels could depend on reducing acute admissions.
NHS England said it is working to develop the gain/risk share mechanism but that they would be based on agreed local priorities. ‘An example would be an aim to reduce avoidable activity in secondary care’.
Hospital admissions targets
An MCP performance payment accounting for around 10% of the total contract value will replace the QOF and CQUIN - the current pay for performance scheme for NHS provider organisations - for participating providers.
NHS England's MCP framework document said it intends the performance payment to be ‘simpler and easier to operate than QOF’.
It will focus on population health, drawing on the prevention metrics in the new CCG assessment framework with local and national priorities and will reward care redesign, process and outcomes.
Practices could be able to hold on to their GMS contract rights under the fully integrated model. NHS England said it is discussing with the government an amendment to the regulations to allow G/PMS contracts to be suspended for the duration of an MCP contract, allowing the MCP to take on responsibility for primary medical services for the patient list for that period.
The MCP framework said there would be local flexibility to define MCPs’ relationships with GPs, who could be partners or shareholders in the MCP organisation, subcontractors, independent providers to the MCP, a chambers arrangement, employees, or employees within a staff mutual organisation. ‘ There would be local flexibility for the MCP to agree remuneration and new ways of working to support the integration of services.’
Under the partial-integration model, the framework said new integration arrangements could overlay existing G/PMS contracts or sub-contracting arrangements to change how GPs work.
The framework said: ‘Given the choices for GPs about the nature of their relationship with an emerging or fully fledged MCP, there is no single new ‘contract’ for individual GPs wanting to take part in an MCP arrangement. For example, many GPs will take leadership roles in MCP organisations with the associated decision-making rights, moving decisively away from current contracting arrangements, or suspending them. Others will wish to become employed. This will always be a local, and personal, decision.’