1st May kick off for Scarborough and Ryedale’s cost-cutting, out-of-hospital services contract

Scarborough and Ryedale Clinical Commissioning Group recently awarded an £80.6m, 7 year Multispecialty Community Provider contract to Humber NHS Foundation Trust, to deliver an Integrated Prevention, Community Care and Support service for Adults. Now in its “mobilisation” phase, this Accountable Care Organisation contract was due to go live on 3rd April 2018.

However, in a Freedom of Information response on 23rd March the Clinical Commissioning Group stated that, pending NHS England’s Accountable Care Organisation contract consultation, they had reverted to the standard NHS contract. The new service start date is 1 May 2018. However, very oddly,  the CCG said that

“all materially relevant sections of the ACO contract have been incorporated into the standard version.”

So what’s the point of the ACO contract consultation? Or indeed, of the ACO contract?

Other Clinical Commissioning Groups and Councils have also rowed back from using Accountable Care Organisation contracts, in the face of upcoming 2 Judicial Reviews and NHS England’s public consultation.

Slash, Trash and Privatise

Why does all this dry as dust contracting stuff matter? Because it is the means of slashing, privatising and dismantling the NHS into a number of local health and social care services that are run on inadequate funding, and designed to restrict patients’ access to care (the bean counters call this “flattening” or “managing” “demand”.)

There are huge problems of deliberately fostered public ignorance about what’s going on. Central government, their quangos and local councils have not informed or consulted us and our elected representatives seem not to know or care what’s going on. Instead, in general Councillors nod through these huge changes and MPs turn a blind eye.

So we need to wise up and call a halt.

A Multispecialty Community Provider is the vehicle (hearse?) for one of the Accountable Care Models identified in NHE England’s August 2017 draft Accountable Care Organisation contract.  This contract is the subject of two forthcoming Judicial Reviews that challenge its lawfulness under existing NHS and social care legislation.

First it was Care Closer to Home, now it’s out of hospital care

According to the Scarborough and Ryedale Multispecialty Community Provider/Primary Care Integration Agreement pack, the Multispecialty Community Provider is:

“a new care model for provision of out-of-hospital care…”

This “new care model”  until recently went under the name of Care Closer to Home. This name seems to vanished after the public started pointing out that in fact it would mostly mean Care Further From Home.

Moving hospital services “into the community” is a euphemism for a functional merging of (increasingly privatised) NHS community care services with cash-strapped, means tested, largely privatised local authority social care and leisure services, and a wide range of other local authority and central government public services.

It is also seen as a “massive market opportunity” by private health company Totally Ltd – which provides the new Integrated Urgent Care Service in Scarborough and Ryedale through its recent acquisition, Vocare Ltd.

It is unclear how the NHS principle of providing a comprehensive health service for everyone who needs it, free at the point of need, is going to survive when merged into this cash-strapped, means tested, largely privatised system. Particularly come 2020, when it is predicted that central government core funding  to local authorities will be almost entirely phased out.

GPs are not signed up to this out of hospital services contract

In procuring this Integrated Service for Adults, Scarborough and Ryedale Clinical Commissioning Group announced themselves as

“an early adopter of NHS England’s partially integrated Multi Speciality Community Provider model”.

The partially-integrated Multispeciality Community Provider contract does NOT cover core general practice services – although they fall within the scope of the Multispeciality Community Provider care model.

Integration Agreements with GPs and Council

Instead, GPs would retain their existing GMS, PMS or APMS contracts while their “crucial contribution to the care model” is spelt out in an Integration Agreement that each of the area’s 15 GP practices sign with the MCP provider – in this case, Humber NHS Foundation Trust.

There is also supposed to be an Integration Agreement with North Yorkshire County Council.

The original NHS England Multispeciality Community Provider Integration Agreement is no longer available on NHS England’s website. It seems to have been replaced by this , which explains that the Integration Agreement sets out how the MCP provider and GPs “will work together in a collaborative and integrated way” – while the service contracts set out how services will be delivered.

Scarborough and Ryedale Clinical Commissioning Group’s November 2017 press release said they began the process of commissioning a new integrated community service for adults in April that year.

In partnership with North Yorkshire County Council, a local GP federation, East Coast Health Options Community Interest Company,  made an unsuccessful bid for the Multispecialty Community Provider contract.

The £80.6 million contract includes community nursing, physiotherapy and occupational therapy, plus specialist nursing and other therapies in the first year (from April 2018), and continuing healthcare assessments, frailty, and elderly medicine outpatients from year two (starting April 2019).

Is this contract lawful?

The tender document specifies that:

“Contract will be the NHS Accountable Care Model Contract…Financial payment package is based on: Whole Population Payment; Improvement Payment Scheme; Gain/Loss Share and KPI [Key Performance Indicator] performance.

Integration agreements with CCG’s GP practices & local social care provider are required.”

And Scarborough and Ryedale CCG’s June 2016 Draft Briefing Document – ‘Procurement of a Partial Multi-specialty Community Provider Contract: What does it mean for GPs and Practices?’ explains that the Multi-specialty Community Provider is responsible for:

“managing new capitated contracts for population health and care.”

Whole Population Payments are the subject of the 999 Call for the NHS Judicial Review of the NHS England draft Accountable Care Organisation/Models contract, on the grounds that they are unlawful under current NHS and social care legislation.

The Scarborough and Ryedale Multispeciality Community Provider contract award has been subject to NHS England’s new Integrated Support and Assurance Process (ISAP). This sets out checkpoints for agreement throughout the procurement process. NHS England has introduced this process because of

“well publicised problems in letting contracts to support new models of care elsewhere in the country”.

The 3rd and final Integrated Support and Assurance Process checkpoint was due between 15th February- 2nd April 2018, during the “mobilisation” stage which runs between 1st Jan 2018 and 2nd April 2018.

However, since Scarborough and Ryedale Clinical Commissioning Group have reverted to the standard NHS contract for out-of-hospital community services, it is no longer subject to NHS England’s Integrated Support and Assurance Process.

Updated 23rd March with information from the Freedom of Information response.

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