MCP Contract Framework
NHS England’s Five Year Forward View set out a number of NMCs (New Models of Care) that NHS England believes represent ways to provide integrated care to patients, and which are being trialled at 50 ‘Vanguard’ sites across England.
MCPs (Multi-speciality Community Providers) are one of these new care models (and there are 14 MCP vanguards): a population based model of care that integrates primary and community health services, built upon the GP registered lists of the practices involved. In order to do this, individual practices will have to combine together, either through a GP network organisation or a super-practice, to create a combined patient list and bid for an MCP contract from their local commissioner. The MCP contract will be aimed at practices who wish to work within this new integrated care model, covering populations of at least 30,000-50,000 patients, and, as currently constructed, will run entirely separately to the national GMS contract.
The MCP contract framework document sets out the way in which MCP the contract is envisaged to work by NHS England, along with how NHS England expect aspirant MCPs to develop towards qualifying for full MCP contractual status, or a partially-integrated MCP.
The framework outlines 3 contractual paths for practices:
- Virtual MCP
- Partially integrated MCP
- Fully integrated MCP
NHSE will develop two model contracts, one for partially integrated MCPs and one for fully integrated MCP.
Providers of services that come within the scope of an MCP would enter into an ‘alliance agreement’ with the commissioning body, which would overlay (but not replace) regular commissioning processes, setting out an agreement to achieve greater integration of these services (e.g.. shared managing of resources, governance arrangements, risk sharing agreements, operational delivery of services). The services themselves would remain governed by the regular commissioning procedures and contracts.
Partially integrated MCPs
This model would provide a single contract for everything that would otherwise be in scope of the full MCP, outside of core general practice. This could include some aspects of local enhanced primary care services, and by agreement could also include QOF and some DESs. Whilst practices may still hold their GMS/PMS contracts, anything beyond that would require them to form a joint legal entity in order to bid for the contract for any services beyond it. The legal agreement between the practice and the MCP would set out the additional obligations to each other, beyond those contained within the practice’s core contract (for example, the MCP could subcontract services to non-member practices). The contract holder would then be required to integrate these services directly with core primary medical services.
Fully integrated MCP
This will see primary care and community services procured in a single contract between a single legal entity and the relevant commissioning bodies, holding a single whole population budget. It is understood that the full MCP contract will take the form of a hybrid of GMS/PMS or APMS and the NHS Standard Contract, held between the legal entity of the MCP and the commissioning bodies relevant to the respective service specification (CCG/NHS England/Local Authority). It is proposed that the contract will run for a limited period of 10-15 years, and include an early break opportunity (e.g. at 2 or 3 years), to allow for a break right or evaluation of the development of the MCP and the services provided under the contract. GPC has continually highlighted the importance of practices being able to maintain their GMS/PMS contracts. NHS England has investigated an amendment to primary care legislation, which, for full members of the MCP, will allow for the existing GMS/PMS contracts of the member practices to be ‘suspended’ for a defined period of time that aligns to the MCP contract term, and with an option to reactivate them at a later date should the respective contractor so wish. This does not address any related practical implications of such a switch which may still exist e.g. estate ownership. Further details on this are awaited.