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.
- 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
- 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
- King's Fund: Governance of new care models: approaches being taken in the vanguards in developing a range of governance and organisational approaches
- Kings Fund: South Devon and Torbay proactive case management using a community virtual ward and ‘the Devon Predictive Model'
- King's Fund: Northumberland's accountable care organisation a case study
- King's Fund: Intentional whole health system redesign Southcentral Foundation's 'Nuka' system of care Looking at he redesign of the health care system in Alaska
- Dudley CCG board papers (p.111) Dudley vanguard is one of the first localities to procure a multispecialty community provider (MCP).
Around older people
- The King's Fund: Providing integrated care for older people with complex needs lessons from seven international case studies
LGA support and resources
- Integrated care value case toolkit looks at the evidence and impact of different integrated care models
- LGA: The journey to integration: Learning from seven leading localities care model chapter, p28, including a review of the most common interventions, p.33.
Selected tools and resources from our partners
NHS New Care Models
- NHS England: The multispecialty community provider (MCP) emerging care model and contract framework describes its emerging common characteristics
- NHS England: Integrated primary and acute care (PACS) framework outlines its key characterises and next steps required to set up the model
- NHS England: Enhanced health in care homes framework based on a suite of evidence-based interventions, which are designed to be delivered within and around a care home
- NHS England: Urgent and Emergency Care (UEC): Supporting the vanguards summary of the support package
- King's Fund: New Care Models: Emerging innovations in governance and organisational form explores the different approaches being taken by MCP and PACS vanguards to contracting, governance and other organisational infrastructure
- The Nuffield Trust: Evaluating integrated and community-based care: How do we know what works? Evaluation of community-based interventions and their impact, and what may help those designing, implementing and evaluating such interventions in future
- King's fund: Accountable Care Models explained a guide to ACOs
- The King's Fund: Clinical and service integration: The route to improved outcomes evidence about high-profile integrated systems and outlining examples of integrated care for particular care groups or people with the same diseases or condition
- NHS Providers: Right time, right place commission into transfers of care: Evidence review analysis of the existing evidence on the problem of delayed transfers of care, its causes and impact. Also brings together an overview of attempts to solve it, drawing on both published literature and information submitted to the commission.
- The King's Fund: Transforming our health care system: Ten priorities for our commissioners supporting commissioners to meet key challenges by transforming the health care system
Around population groups
- NHS Confed: Growing old together: Sharing new ways to support older people guidance for people involved in designing care for older people
- The King's Fund: Making our health and care systems fit for an ageing population a high-level resource and reference guide for local service leaders who want to improve care for older people
- The King's Fund: Coordinated care for people with complex chronic conditions key lessons and markers for success.