Care model and organisational form

A local area or ‘place' is clear what improvements it seeks to achieve to improve outcomes and which care model will most likely deliver these improvements.


Care model

  • This describes how services are organised and delivered. There is no single definition of integration or an integrated care model
  • Typically in integrating services, local partners begin around specific localities, such as a neighbourhood, or population group, for example older people

Organisational model

  • This is how organisations work together to plan and deliver the care model; it can range from partnerships or networks, to more formal federations and joint ventures, or even full mergers, largely depending on the scope and scale of the services being integrated
  • The NHS new care models programme is testing different forms, including joining acute provision with primary care, as well as bringing all out-of-hospital provision together around GP practices
  • An accountable care organisation (ACO) is a group of providers which is jointly responsible for the care of a defined population for an agreed budget (often called a capitated budget). A less formal alliance of providers working together to deliver care to a specific population group is often called an accountable care partnership (ACP)
  • An integrated care organisation (ICO) is a formal integration or merger of one or more services or organisations
  • Integrated organisations or partnerships can use a number of mechanisms to align commissioning and/or delivery such as pooled budgets, joint contracting or merging providers.

Frequently asked questions

How do you develop a care model?

  • The model can take many forms, often responding to local circumstances or how organisations already work together
  • Most care models develop over time, often starting on a smaller scale, with fewer services or a smaller spend, and building over time to cover more of the population or services
  • A key design principle for integrated services is investment in preventative and community provision to help keep people well, safe and independent, and so avoid the need for acute health services.

Which interventions are most effective?

  • There is a growing evidence base for the most effective interventions to underpin a preventative, community-based model, for example schemes to reduce hospital admissions, improve recovery post-crisis, or provide more proactive care – see the examples below

Does the government have a preference for the care or organisational model for integration?

  • The Spending Review 2015 does not prescribe the delivery model, noting three possible options of a lead commissioner, an integrated care organisation or integration through a devolution agreement.

Which organisational form works best?

  • Any change in organisational structure should arise from a strong business case to develop models of care for patient benefit and/or to deliver a more efficient service
  • The focus should be on good governance from the outset as a critical factor in determining the success of any delivery vehicle. It is important that there is board assurance on the rationale for change, to ensure that form genuinely follows function.

Case studies and examples

Around older people

LGA support and resources

Selected tools and resources from our partners

NHS New Care Models

Analysis

Around population groups