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Perfecting Accountable Care Organisations must not delay progress on integration

NHS England has announced plans for a 12-week consultation on the contracting arrangements for Accountable Care Organisations (ACOs). Mutual Ventures Senior Consultant Jamie McMahon argues that whilst ACOs offer an important vehicle for joined-up care, other initiatives that promote integration must continue in the meantime.

The development of integrated care is a universally agreed priority across NHS and Social Care services in England. Getting it right is important for patient outcomes, as well as the financial future of our NHS and local authorities.

NHS England’s focus on Integrated Care Systems, including ACOs, and the launch of this consultation, is one of many steps in the right direction. However, four years since the NHS Five Year Forward View was published, a fundamental shift in services is yet to be achieved.

ACOs present an exciting opportunity to reset the landscape and bring services together. Through the award of a single contract for all services in a local area, they have the potential to be the catalyst for a step change towards a system that truly wraps around a patient, rather than one limited by organisational boundaries.

But for ACOs to succeed, and to achieve integration on a large scale, there are significant challenges to overcome. Current structures of contracting and commissioning act as a barrier, not an enabler, of more integrated public services. Added to this, there is no a consistent understanding of what a ACO should be and the risks of still aren’t fully understood.

My own experience working on an innovative programme to integrate GPs practices into an acute trust, showed the complexities of NHS financial and contracting arrangements. Restrictions on funding for utilities, the minefield of data sharing and the inability for an acute trust to hold a General Medical Services (GMS) Contract meant the need for convoluted work-arounds and compromise. Despite that, progress was made in the joining up of data to identify those patients most at risk of hospital admission and to get services, such as physiotherapy, into local GP Practices.

Stepping back from the detail, we need to remember that ACOs aren’t the only option. Even if they were, we cannot wait for the ‘silver bullet’ to be fully designed and implemented. Integration is urgent and we need it now.

We know that smaller scale integration can achieve a lot. For example, Greater Manchester’s work to change contracts to reward improved joining up of services and better outcomes, which includes a trend way from Payment by Results. Elsewhere, The Health and Wellbeing Limited Liability Partnership, comprised of nine social enterprises and charities, has been created to offer commissioners in the north of England a single entity to provide services along entire service pathways and across a wide geographical area.

With all this in mind, Mutual Ventures welcomes the NHS England consultation and its ongoing focus on integration. But we shouldn’t put all our eggs in one basket and wait for ACOs – the NHS should continue to invest in other approaches too. The journey to integrated care is one that has many routes.

For more information about Mutual Ventures’ work in integrated care and how we could help you, contact Senior Consultant Jamie McMahon on or 07875 304911