Understanding the latest round of NHS changes and being ready to respond. PDF Print E-mail
administrator  - 02.11.16

STPs, MCPs, PACS and You! Understanding the latest round of NHS changes and being ready to respond.

The NHS is changing. This time around, the change is not happening as a result of a major new piece of legislation, as with the ‘Lansley Reforms’ (the Health and Social Care Act 2012). Instead, the change is being driven, by a shift in policy brought about by the CEO of the NHS, Simon Stevens. As a result, the NHS Five Year Forward View and related New Care Models programme are less in the public eye than were the Lansley Reforms but, we think, could be more far-reaching in terms of how the NHS works in the future. Amid all this are both opportunities and threats for social enterprises operating in the health and social care. But don’t sit on your hands. These change are already underway and are expected to accelerate very quickly.

So what are the changes?

The ‘Forward View’ sets out plans to meet the well-trailed challenges faced by the NHS (rising demand, ageing population, higher costs etc). In 2014-15, fifty ‘Vanguard’ sites were selected to test new ways of delivering services or ‘New Care Models’. A particular aim of the Vanguards was to ensure better integration or joining-up of various health and care services. The intention is that these fifty sites, now a year or two progressed, will act as the blueprint for the rest of the NHS.

Alongside the ‘New Care Models’ programme, the NHS has adopted the principle of ‘place based systems of care’. To this end, it has divided England into 44 ‘regions’ each with its own healthcare economy. Each of these regions is, as we speak, developing a ‘Sustainability and Transformation Plan’ (STP) setting out a coherent plan for delivery of integrated services across whole areas, often as large as whole counties or city-regions. All STPs are likely to include plans for one or more ‘New Care Models’ in their area, depending on the existing mosaic of healthcare services.


While STPs will inevitably reflect this existing mosaic, the New Care Model approaches they will roll-out have the potential to profoundly alter the way in which health providers deliver services. The reason for this is that in most STP areas plans are afoot to develop either (or both) types of New Care Model:

  • The ‘Multi-Speciality Community Provider’ (MCP) model
  • The Primary and Acute Care System (PACS) model.


MCP and PACS models already cover about 8% of England. Every STP will contain one or both, so it’s important for any social enterprise in health to grasp how they operate.

What are MCPs and PACS and why do they matter?

  • A Multi-Speciality Community Provider (MCP) is intended to be a new type of integrated provider organisation which combines both primary care and community-based health and care services. In some places, the MCP will be the provider of all services which are not hospital-based. The MCP in any given area will be awarded a contract in the form of the forthcoming new ‘MCP Contract’


  • A Primary and Acute Services (PACS) model is also intended to include primary, community, mental health and social care services, but the big difference is it will also include most acute hospital services. In this way, a PACS will become responsible for care for a whole area’s population. The PACS provider will be awarded a new ‘PACS Contract’ 

Now here’s the rub for social enterprises and Public Service Mutuals (PSMs). In response to STPs, commissioners are likely to start awarding MCP Contracts and PACS contracts which encompass many of the community services which have up to now been held through standalone contracts, including many provided by PSMs. These contracts will have to be advertised but may or may not end up being subject to competitive tender processes.

In most areas, it is the local acute trusts (in the case of PACS) and GP federations or ‘super-partnerships’ (in the case of MCPs) competing to hold these contracts whose value may run into billions of pounds over a 5-7 or even 10 year period. The contracts may include a requirement for a lead organisation to coordinate all services under the contract, not just those services the organisation will provide itself. Consequently, it may be difficult for PSMs, even those operating at scale with good track records, to compete as lead contractors for these roles.

Therefore, PSMs may need to accept a different role in the overall picture, reflecting the fact that the lead contractors (whoever they are) are unlikely to want to deliver all of the services themselves - so will be looking for partners and sub-contractors.

This may mean, for example, that a PSM becomes a sub-contractor to an acute trust running a PACS consortium rather than contracting directly with a CCG or local authority. This may sound like profound, in some cases uncomfortable, change.


So what can you do?

Whilst there is no room for complacency in this ‘brave new world’ there are steps you can take NOW to ensure you have a part to play under the new contracting arrangements:

  • Starting participating today (if you already haven’t) in conversations with commissioners to shape the types of new care models to be developed and contracts to be awarded. Don’t miss the boat here, things do get forgotten.


  • Strengthen your businesses’ relationships with other providers, especially acutes / GPs, so you can be a key partner / member of the supply chain 

So what’s happening on the ground? STPs are starting to surface publicly. In response we will see a range of governance groups to deliver their plans and it will be essential that PSMs, as community-based providers, are vocal on those groups, as well as continuing to strengthen relationships on a more informal basis.

Assuming PSMscan get over the initial challenge of getting round the table in the first place then it will be important to have clarity on what is expected from all parties and how this is set out.

In due course, where the main contract bid with the PACS or MCP Lead is successful, there will be a formal contract with sub-contracts in place with all other suppliers – like you. As we all know with contracts, this can take an age to appear! In the meantime, ‘Memorandum of Understanding’ can be helpful which, whilst not necessarily being legally binding, sets out the main roles and responsibilities of parties in the build-up to and submission of bids. As with most documents, it is the content rather than the label which is important. Get in touch if you want to know more about how this all works.

Moving forward

In summary, to help maximise the chances of swimming safely through the rough seas of STPs, PACS, and MCPs, we recommend that you:

  • Get aware – by ensuring you are familiar with the local MCP/PACS frameworks and what is likely to be put forward in your area through the STPs


  • Get talking – by having early conversations with commissioners and other potential providers to try to ensure that you have a seat round the table where plans are being discussed


  • Get things documented- by ensuring that all parties are clear on their roles and responsibilities through a memorandum of understanding or similar.


Easy to say, not easy to do. Let us know if we can of any help. 

By Jamie Foster, Simon Lee of Hempsons and Craig Dearden-Phillips of Stepping Out

Jamie is a partner at Hempsons with many years’ experience of complex healthcare projects, including advising on the establishment of public service mutuals and on a range of innovative new care models. Simon is an associate at Hempsons with significant experience of advising on ‘spinout’ projects from both the NHS and local government. Craig is Managing Director of Stepping Out Ltd and a leading UK expert in creating new ventures from the public sector.



Guest Blog - When is Social Investment a Prize? PDF Print E-mail
administrator  - 07.10.15


When I joined the social enterprise sector six years ago, the notion of repayable finance was little understood and perhaps understandably unwelcome! After all, why pay interest when grant funding was reasonably plentiful? What a difference a few years make. Social investment will never be the solution for all charities and social enterprises but it is also no longer only for the biggest and the bravest. Social investment is starting to take its place as another tool in our range of funding options to be carefully considered and to be taken on only when it provides the right solution for your trading activity.


Big Society Capital’s vision is for affordable and accessible investment to be available for all social enterprise and charities with new products, partners and services entering the marketplace all the time. This year alone we have seen the exciting entry of our sister organisation, The Access Foundation,  and the introduction of Social Investment Tax Relief specifically designed for social enterprises and charities to raise money from individual investors.


One of the best ways to encourage learning is for those who have already taken on investment to share their experiences. As a result of this ambition, we are delighted to be sponsoring Social Enterprise Yorkshire and Humber’s Social Investment Award 2015.


Last year’s award winner, Bramley Baths, demonstrated how social investment can help to support a thriving business with huge social impact. Bramley Baths is a community run leisure centre and swimming baths in West Leeds. Situated in a grade 2 listed building, the social enterprise is run as a community benefit society and with over 200 members, it has a community voice and representation at the heart of its governance. It received £75,000 from investment from Yorkshire Venture Philanthropy Fund and the Key Fund which has been used to grow the turnover to around half a million pounds employing 25 people. Whilst also protecting, investing in and growing a service that would otherwise have been closed.


So social investment is alive and well in Yorkshire and Humber. At this year’s Working Capital event, held at Unity Works, we heard from a range of case studies including Fusion Housing about how they had used social finance to grow their impact.


It is worth remembering that at the very heart of social investment, it exists to create jobs, provide services, support communities and I look forward to reading this years’ entries.


So what are you waiting for? To find out more on how to apply go to our awards page






Melanie Mills


Social Sector Engagement Director


Big Society Capital


Increased risks for social enterprise businesses PDF Print E-mail
administrator  - 28.11.11

by Graham Smith, Bluefin Insurance

Charities and other social enterprises should seek specialist advice to protect themselves against the effects of the economic downturn.

Many types of social enterprise organisation have been affected by the current financial turmoil, from charities and not-for-profit to social enterprises. Many have faced an increase in demand for services whilst they struggle to cope with declining income streams.

To protect the services delivered to beneficiaries many enterprise businesses are looking for ways to cut costs while also increasing fundraising and business activities to sustain cash flow.

The Charities Commission  advised all organisations to take a serious look at their financial health, direction and use of resources.  Their  document ‘The Big Board Talk - the conversation all charities need to have’ highlights how restructuring can help by, amongst other things, increasing the pool of volunteers, re-negotiating and terminating contracts, changing the types of services offered to meet the new demand and making best use of property.

Whilst certainly helping enterprises to make improvements to the way they operate, these considerations also have the potential to inadvertently introduce new risks.

One of the ways to address these risks is to consult an insurance broker who can not only help to identify all risks but can advise how to manage them appropriately.

Insurance brokers can visit clients to gain the fullest picture of their exposures. It’s not just about arranging an insurance policy. Once any risk exposures have been identified the first step is to advise how these risks can be minimised and managed before recommending appropriate cover.

The Charities Commission also lists issues charities should consider and review in the current economic climate, such as their obligations as employers, the financial and reputational risks of being unable to meet terms of a contract, reviewing their performance as a trustee body and safeguard against fraud. Again this highlights risks which need to be managed and may require relevant insurance cover.  Aside from Employers Liability and Motor Insurance which are compulsory covers, the risks an enterprise chooses to actually insure is down to personal choice.

However, it is a decision that should be made with professional advice.  All organisations will have some additional liability exposure.  Unrecognised and ignored, these exposures could become very expensive and threaten the viability of the charity.

Many social enterprises will have a higher duty of care expectation due to the nature of their increased responsibilities to vulnerable people.

Insurers also use their expertise to recommend improvements to reduce risk.  Some provide access to specialist care consultancy services and risk surveyors.  A few insurers align their whole business to social enterprises to maximise expertise and services.  Specialist products designed specifically for social enterprise type organisations are available. Value added services, such as access to legal and public relations advice are also included with some policies.

A quality broker and specialist insurer, both with insight of specific activities, will maintain a regular dialogue.  Their advice and support will add value to the enterprise throughout the relationship; invaluable for enterprises in this difficult economic climate.

Find out more
Contact Graham Smith This e-mail address is being protected from spambots. You need JavaScript enabled to view it an Associate Director at Bluefin Insurance Services Limited,  part of the Bluefin Group which is a wholly owned subsidiary of the AXA group. Bluefin are SEYHs Insurance partner provider.



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