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An acute NHS Trust, a mental health and community services NHS Trust and GP Federation ("the Providers") were seeking advice on the development of one of the first alliance contracting regimes in the NHS.
This involved commissioner and provider organisations delivering community based elective care across two large CCG areas, collectively known as the "Alliance Participants" or the "Alliance", which included:
We were instructed to advise the acute NHS Trust, the mental health and community services NHS Trust and GP Federation ("the Providers") on the development of one of the first alliance contracting regimes in the NHS. The key aims of the venture were to:
A collaborative approach was required for this project to complete. To create an alliance contracting model, there is a requirement to remain within the boundaries of the mandatory framework for NHS contracts. It was necessary for the Providers to negotiate the suite of contractual documents presented by the Commissioners within that mandatory framework, whilst also seeking to reflect the alliance arrangements. The contracts included:
The overarching principle of the Alliance is for all Alliance Participants to act in accordance with the 'Best for Project' principle. Clarity on the Alliance's goals, objectives, investment fund and KPIs (including the consequences of succeeding or failing to deliver them) is crucial in order to minimise conflict between them and any Commissioners' rights to override the 'Best for Project' requirement in certain circumstances.
At present, the NHS Standard Contract must be used by CCGs and NHS England when commissioning certain health services. However, this form of contract may only be held by one provider and is not drafted (and cannot be amended) to allow for multiple providers under the same contract. For this reason, the separate Alliance Agreement and Work Allocation Schedule is necessary to promote an alliance approach.
To achieve true integration of the services, the parties would ideally share risk and reward via pooled budgets. However, due to the structure of the NHS Standard Contract, as well as separate funding lines, the Alliance Participants retain some separation under this model and, as consequence, need to consider limitation of liability and indemnity provisions within the Alliance Agreement.
The Providers also had to consider the legal and commercial risks associated with the application of TUPE upon commencement of the contracts and in respect of any future reorganisation of services under the Alliance.
Primary and Acute Care Systems
Multi-speciality Community Providers
Enhanced Health in Care Homes
Urgent and Emergency Care Networks
Acute Hospital Collaborations
Accountable Care Organisations