Source · Select Committees · Health and Social Care Committee
Recommendation 36
36
Accepted in Part
Paragraph: 119
NHS England's role supporting ICSs to implement gain sharing for reduced secondary care.
Recommendation
NHS England should support Integrated Care Systems to implement gain sharing so that Primary Care Networks and individual practices that support the reduction of secondary care expenditure, such as through reducing unplanned admissions, are able to share in the financial gains.
Government Response Summary
The government partially accepts, committing to provide "light touch support" like sharing case studies for gain sharing, but notes difficulties in proving causality for direct financial transfers. They also state work is ongoing to explore additional opportunities to reward primary care.
Paragraph Reference:
119
Government Response
Accepted in Part
HM Government
Accepted in Part
Partially accept. The Department partially accepts this recommendation. We appreciate the sentiment of sharing the rewards of cost reductions where primary care has had a part to play. NHS England can provide light touch support for Integrated Care Systems (ICSs) to implement gain sharing, for example by way of sharing appropriate case studies. The difficulties in proving causality of reduction in expenditure mean that a gain sharing agreement where funds are taken from secondary care and given to primary care would not always be suitable. In addition, whether savings can be extracted and redistributed depends on the nature of provider contracts locally as well as the underlying fixed and variable costs. However, there are already mechanisms in place which reward primary care where it supports the reduction of secondary care expenditure. ICSs have been designed to have an overview of the whole system so that resources are used most effectively across primary, secondary, community and social care. Within an ICS, savings made in one area typically contribute towards overall system control totals. Work is ongoing to consider additional opportunities to reward primary care for actions taken to relieve pressure on secondary care. The recovery plans sets out that NHS England will explore alternative approaches that can work alongside the partnership model and explore additional opportunities to better align clinical and financial responsibilities in primary care, enabling primary care teams to shape NHS services in their area and reinvest savings in frontline services.