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NHS England releases contract framework for PACS vanguards

12 October 2016

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The NHS will be offering integrated primary and acute care services (PACS) vanguards the same three voluntary contract options as multi-speciality community provider (MCP) vanguards.

NHS England is offering a “virtual” PACS contract through an alliance agreement; a “partially integrated” PACS contract, where the contract covers the majority of healthcare services with a single budget; and a “fully integrated” model with a single contact for all healthcare services, operating under a whole-population budget.

The framework adds that the PACS contract could be held by GPs – the first time a framework has made clear that GPs are able to run a vanguard, including acute services.

The contract could be held “by a new entity, formed for example through a joint venture between a group of GPs, an acute trust, and other local health and care providers, or held by an existing NHS provider,” the framework says.

Ian Dodge, national director for commissioning strategy, said at the NHS England board meeting that PACS and MCP care delivery models are “almost identical”.

“They differ mainly in the breadth of services in the PACS, which includes the direct delivery of core hospital services,” he said. “Both take the registered GP list as a starting point and neither can work without the full engagement of primary care.”

However, David Roberts, chair of the commissioning committee, expressed concern over balancing the “joint working that exists between local GPs, local health systems and trusts”, with transparency and avoiding conflicts of interest.

The report acknowledges “some of the people driving the development of a PACS may currently work in CCGs” and “that is entirely understandable and legitimate”.

Dodge added that a protocol is being established to determine “when people should excuse themselves from conversations around procurement because they have interest potentially in part of the provider.

“But in such a way that it doesn’t harm the necessary collaboration between the GPs and the other potential providers.”

Professor Sir Malcolm Grant, chair of the NHS England board and a Task and Finish group looking at managing conflicts of interest, said the NHS is responsible for putting people in situations where there is an “institutionalised conflict of interest”.

He said: “There is a good reason for doing that, but there is every good reason for not going over the top and being punctilious.”

Guidance surrounding conflicts of interest in PACS vanguards will be published later this year.