Accountable Care Contracting

NHS England announced that it will be launching a consultation on the contracting arrangements for Accountable Care Organisations (ACOs).

To date, the draft ACO Contract has been based on the following models:
- Alliance Contracting – the 'virtual' model which overlays existing contracting arrangements by bringing commissioners and providers together to establish shared Objectives, a commitment to work together to deliver shared Outcomes and a governance structure to work together in order to delivery joined-up and integrated services.
- The Accountable Care Models Contract – the 'fully-integrated' model where commissioners procure a single contract for the delivery of a range of integrated 'in-scope' services including the full range of community and primary medical services as well as acute services in some cases. This contract is a modification of the NHS Standard Contract and requires the contract holder to be responsible for and deliver fully integrated care.
- The Accountable Care Models Contract and GP Integration Agreement – the 'partially-integrated' model, which is hybrid of the virtual and fully-integrated models, where commissioners procure a single contract for a range community and acute service but not core primary medical services. The practices providing core primary medical services enter into the integration agreement which is a form of alliance contract. NHS England have said that the consultation will set out how the contract fits within the NHS as a whole, address how the existing statutory duties of NHS commissioners and providers would be performed under it (including how this would work with existing governance arrangements), and will set out how public accountability and patient choice would be preserved. NHS England is expected to hold a 12 week public consultation process.
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We are currently working with a range of commissioners and providers, across the public and private sectors, who are at differing stages in relation to their accountable care contracting needs. We can support you in relation to consultation. In addition, we can:
- Produce briefing/discussion papers
- Facilitate and present at workshops
- Advise on contracting options available including key issues to be aware of and suggested next steps
- Draft contracts including tailoring the Alliance Contract, Accountable Care Models Contract, GP Integration Agreement to suit the parties at a local level and drafting and any other relevant documents such as memorandum of understanding and heads of terms
- Advise on NHS governance arrangements and decision making including advice on conflicts of interest and schemes of delegation
- Advise on the key differences between the NHS Standard Contract and the Accountable Care Models Contract
- Advise on prime/lead contracting and sub-contracting arrangements
- Advise on the implications of the Accountable Care Models Contract
- Advise on NHS England's and NHS Improvement's Integrated Support and Assurance Process (ISAP)
- Advise on risk & reward share arrangements and payment mechanisms
- Advise on social care integration
- Advise on structural options for accountable care organisations
We are working with a range of organisations in relation to their accountable care systems/organisation plans, STP plans and partnership working arrangements. We have set out below a summary of some of the projects we are currently involved with. We can help take the learnings from these projects and introduce best practice based on our experience into your Accountable Care system acting as your 'Best Practice advisors'.

Alliance Contracting/virtual accountable care models structures
- A consortium of seven Coordinating Providers working in Mid Nottinghamshire under the Mid Nottinghamshire’s Better Together Vanguard to create an alliance model for the delivery of integrated primary, community, secondary and urgent and emergency care under NHS England’s New Model of Care Programme (PACS/MCP hybrid and Alliance Vanguard). This project has been selected by NHS England as the national lead Vanguard for testing new pricing models
- West Birmingham Alliance – on the proposals for a range of commissioners and providers to come together and enter into an Alliance Contract in order to deliver a range of integrated in-scope services
Fully-integrated accountable care models structures
- Manchester CCG on the letting of a large scale out of hospital health and social care Accountable Care Contract with partially integrated primary care and the option to progress to full integration. This is currently in the dialogue phase with a view to agreeing the terms of the contract in the near future. The project is one of the first to go through the Integrated Support and Assurance Process run by NHS England and NHS Improvement, and indeed has been instrumental in refining that process
- Solihull CCG – Solihull Together Vanguard - on the establishment of a collaboration arrangement with Heart of England NHS Foundation Trust to procure an urgent care centre and new urgent care provider together with the creation of an integrated model of primary, community, secondary and urgent and emergency care under NHS England’s New Models of Care Programme (Urgent and Emergency Care Vanguard)
Partially-integrated accountable care models structures
- Yeovil District Hospital NHS Foundation Trust on the creation of a new integrated model of care and the creation of an Integrated and Accountable Care Organisation for the implementation of the new care model under NHS England’s New Model of Care Programme (PACS Vanguard). This project has been selected by NHS England as the national lead Vanguard for modelling new organisational forms;
- Yeovil District Hospital NHS Foundation Trust and Symphony Healthcare Services Limited on the creation of a new integrated model of primary and secondary care;