Three factors were vital to the success of Alzira: long-term contracts of at least 15 years duration; capitated budgets and aligned incentives for primary care practitioners. In the UK things are a little more complex. We’re moving to captitated budgets but the Five Year Forward View does not commit to long-term contracts, so it’s not as easy for organisations that might be investing in integration now and making savings, to be the long-term beneficiaries.
Workforce flexibilities are not as well developed here. Some Vanguard sites are keen to employ staff in different ways but we have many employment models, some staff are subject to national contract frameworks such as Agenda For Change, GMS or others. These may be insufficiently aligned to the goals of the local emerging population health management organisations such as MCPs or PACS.
The company that runs Alzira, Ribera Salud, secured an injection of capital, in their case from the private sector to redesign services, but would there be the same injection from the public purse here, or from a private partner? It’s more likely that new organisations will need to be created to deliver integrated care within the existing spending parameters.
Commissioners will need to have long-term contracts so providers get much longer times to redesign the service. In Alzira, GPs were brought in as direct employees with incentives schemes designed around the success of the system rather than the success of small practices, as is more the case in the UK. At an early stage in their journey, Ribera Salud benefitted significantly from a cash injection from a US insurance company Centene. The injection of capital allowed them to redesign services and align incentives and contracts with GPs.
This article was originally published here.