Western Berkshire likely Candidate for Accountable Care System Status

Western Berkshire, covering Reading, Wokingham and Newbury areas, has been selected as one of 9 areas (most others are STP areas) to have early Accountable Care Systems status. This gives the area full control over more of its funding, including primary care and specialist care and delivers more freedom for the commissioners. NHS providers in the
area will integrate horizontally to improve patient treatment pathways. GP practices are expected to integrate into units serving 30,000 to 50,000 patients which can deliver a wide variety of services to their population. The emphasis will be more on integration and cooperation than on competitive tendering.

The requirements for areas to become Accountable Care Systems are the following demands which make a radical shift away from terndering individual services or practices to the management of population health over a wide area:

  • Agree an accountable performance contract with NHS England and NHS Improvement that can credibly commit to make faster improvements in the key deliverables set out in this Plan for 2017/18 and 2018/19.
  • Together manage funding for their defined population, committing to shared performance goals and a financial system ‘control total’ across CCGs and providers. Thereby moving beyond ‘click of the turnstile’ tariff payments where appropriate, more assertively moderating demand growth, deploying their shared workforce and facilities, and effectively abolishing the annual transactional contractual purchaser/provider negotiations within their area.
  • Create an effective collective decision making and governance structure, aligning the ongoing and continuing individual statutory accountabilities of their constituent bodies.
  • Demonstrate how their provider organisations will operate on a horizontally integrated basis, whether virtually or through actual mergers, for example, having ‘one hospital on several sites’ through clinically networked service delivery.
  • Demonstrate how they will simultaneously also operate as a vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,000-50,000 populations. In every case this will also mean a new relationship with local community and mental health providers as well as health and mental health providers and social services.
  • Deploy (or partner with third party experts to access) rigorous and validated population health management capabilities that improve prevention, enhance patient activation and supported self- management for long term conditions, manage avoidable demand, and reduce unwarranted variation in line with the RightCare programme.
  • Establish clear mechanisms by which residents within the ACS’ defined local population will still be able to exercise patient choice over where they are treated for elective care, and increasingly using their personal health budgets where these are coming into operation. To support patient choice, payment is made to the third-party provider from the ACS’ budget.