Practices bid for controlling stake in integrated provider lined-up for £5bn contract

GP practices serving almost 300,000 patients are part of a preferred bidder for what could be the first full multispecialty community provider (MCP) contract.

Dudley CCG has revealed its preferred bidder for the £5bn 15-year new care model contract; a consortium of four NHS trusts and 38 local GP practices.

The MCP provider will manage a single, whole population budget, delivering services including community-based physical health for adults and children, some outpatient services, primary medical services including GMS, PMS and APMS, local enhanced services, mental health services, public health, learning disabilities services, urgent care centres and GP out-of-hours care. Adult social care services will also be phased in.

The consortium is made up of Birmingham Community Healthcare NHS Foundation Trust, The Dudley Group NHS Foundation Trust, Dudley and Walsall Mental Health Partnership NHS Trust, Black Country Partnership NHS Foundation Trust and 38 of Dudley’s 45 local GP practices.

The practices involved will have to decide whether to fully integrate with the MCP provider, suspending their G/PMS contracts, or partially integrate, retaining their existing contracts.

ACO contract

The latest draft contract for MCPs, the accountable care organisation contract, which will also be used for PACS new care models, was published by NHS England earlier this month. 

Three levels of MCP integration with GP practices are being developed. Under a 'virtual' MCP practices will co-operate with other providers under an alliance agreement with no contractual changes.

The 'partially integrated' model will see an MCP provider commissioned for all services other than core GP services, which practices will continue to provide under existing contracts with an integration agreement with the MCP.

A 'fully integrated' model will see practices voluntarily suspend their G/PMS contracts and join the MCP - which is commissioned to provide all services - either as subcontractors, co-owners or salaried employees.

Dudley LMC revealed that the MCP organisation is likely to be set up as a limited liability company and that practices want 51% of voting shares.

LMC secretary Dr Tim Horsburgh told GPonline that practices wanted to esnure the MCP organisation was 'primary and community, clinically led'. 'The only way to guarantee that', he said, 'is to have a majority voting right on the board'.

Dr Horsburgh said practices did not want a 'token representation' for what will be a primary and community focused system. 

'The danger of going in with a large NHS organisation made up of acute and community trusts is they may just want to carry on as they've always done, because their business is elsewhere', he said.

Split loyalties

NHS trusts could have 'split loyalties' that only practices can counteract with a strong voice in the organisation, he said.

'We will pitch for a controlling interest on the board to ensure that', said Dr Horsburgh. 'That is our starting position. We are not going to accept a minority interest in the project that all the GP practices, we hope, in Dudley will sign up to.

'This is GPs' future, primary care is integral to the delivery of this and most of the big changes in the community that are going to happen are going to happen in primary and community care. So we need GPs to feel confident that they have a voice in this and have some say in their future.'

The LMC also revealed that a number of private companies, including an large outsourcing firm, a multinational healthcare provider, and a UK private provider firm, expressed an interest to the GP practice collaboration in joining the MCP at earlier stages of the process. 

Under the MCP a sucessful bid must include general practice, giving practices an effective veto over potential bid partners. 

The next, dialogue phase of the procurement process will begin in early September, and commissioners expect the £363m a year contract to be in place by Spring 2018 with service delivery beginning in 2018/19.

Dudley CCG chief executive Paul Maubach said: ‘We are delighted to have a viable bidder to start the dialogue process with. This process will test out their ideas and see how well they match our vision for an organisation that will be able to deliver better integrated services designed to improve the lives of Dudley people.’

The CCG said it would be inappropriate to comment on other bidders in the process.

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