Accountable Care Systems
What are they?
May 2017
Accountable Care Systems – what are they?
An evolved version of an STP that is
working as a locally integrated health
system.
Systems where commissioners,
providers and local government
choose to take on collective
responsibility for managing resources
and population health in return for
greater freedoms and flexibilities.
Provide joined up, better coordinated care.
Not a single
organisation
unless we chose for
it to be
Not prescriptive
we can design the
who, the what and
the how
ACSs – What we know…
•
Groups of organisations [within an STP sub area] that
can:
– Agree an accountable performance contract with NHSE/NHSI
– Together manage funding for their defined population,
committing to shared performance goals & a financial system
control total
– Create a collective decision making and governance
structure, aligning statutory accountabilities
– Demonstrate horizontal integration across providers (virtual or
merger)
– Simultaneously operate as a vertically integrated care system,
partnering with local GP practices formed into clinical hubs of
30,000 – 50,000 population
– Deploy rigorous & validated population health management
capabilities
And in return…
•
National leadership bodies will offer ACSs:
– Local commissioners to have delegated decision rights in
respect of commissioning primary care (we already do this
locally) and specialised services
– Devolved transformation funding from 2018, potentially
bundling together national funding for GPFV, mental health
and cancer
– A single ‘one stop shop’ regulatory relationship with NHSE
and NHSI in the form of streamlined oversight arrangements,
an integrated CCG IAF and trust single oversight
– The ability to deploy attributable staff and related funding from
NHSE and NHSI to support the ACS
So what is happening locally?
Three Alliance Boards are in place
We already have established an Alliance Board in each locality in the county – South Worcestershire,
Redditch & Bromsgrove and Wyre forest.
The goal of each Alliance board is to remove boundaries at the point that care is delivered, to create a
system where patient interests come first and resources are collectively focused on improving health
outcomes, supporting people to stay well and to live independently for as long as they wish.
Via the Alliances, the providers work together to deliver this goal by developing a new model of care –
a model of care which delivers a connected system, designed and delivered around local people and
located in natural neighbourhoods.
Chaired by local GPs, the Alliance Boards meet monthly and their role is:

To provide strategic leadership, setting the direction, framework and principles which guide development of a new
model of care across their locality

To support the neighbourhood teams, a key element of the Alliance arrangements, ensuring resources are
identified which allow front line staff and patients to shape local delivery and which ensure delivery through the
development of robust project management arrangements.

To gather and disseminate intelligence and learning from national vanguard sites and other areas

To share learning between neighbourhoods, supporting growth in scale and speed of implementation, where
relevant learning exists
How does this fit with other arrangements
across the county?
The value of partners working
together at a very local level is a
critical element of the developing new
care model. However, partners are
equally concerned to ensure the
benefits of county wide working are
maximised.
As a result, the three Alliance Boards
Wyre
Forest,
Redditch
&
Bromsgrove
and
South
Worcestershire
–
are
working
together and have agreed a common
set of priority focus areas for delivery
within 2017/18, with a key aim of
securing sustainable Primary Care
across the County.
So, what is Worcestershire Alliance?
• Worcestershire Alliance is the term used to describe the process
put in place to support the three Alliances to work collectively at a
county level to deliver the intended patient benefits.
• Led by a multi-agency Programme Board, including the GP chairs of
each local Alliance, representation from the Local Medical
Committee, Worcestershire Acute Hospitals Trust, Worcestershire
Health & Care Trust and Worcestershire County Council, it is chaired
by the CCG.
• The group is focused on supporting the local Alliances by working
together when it makes sense to do so and by jointly tackling some
of the underpinning enablers such as IT, workforce development
and governance
Building on firm foundations
Worcestershire Alliance – not an ACS, but…
•
•
•
•
•
It is a significant step on the journey
It is a pragmatic approach which delivers patient and system
benefits this year
It is the delivery vehicle for the STP Out of Hospital Care
priority
It is a way of engaging us all on the journey in a meaningful
way
It provides the opportunity to:
–
–
–
–
test new behaviour on a smaller scope
learn about & test integrated governance
establish a system wide team
developing knowledge & skills within the county