Milton Keynes was the first area to develop a capitated outcomes- based contract in England, delivered initially for substance misuse services.
- The contract was let to a third-sector organisation, acting as prime contractor for the complete substance misuse service.
- The service was transformed quickly, with improved outcomes for service users and financial savings for commissioners.
- Overall spend on the service was reduced by 20 per cent in the first year.
What the area did and why
Prior to letting the new contract, Milton Keynes substance misuse services were provided by a number of providers across the care economy. As a result, the service was characterised by fragmentation, with users failing to effectively navigate the service and often dropping out of treatment. The large number of contracts, and lack of collaboration between the multiple providers involved in providing services, severely impacted upon the efficiency and effectiveness of the system.
To facilitate and incentivise integration between providers, and deliver value through better clinical and financial outcomes, Milton Keynes PCT and the Milton Keynes local authority worked in partnership to jointly develop an outcomes- based approach to commissioning the substance misuse service.
They initially worked together, and with service users and partner agencies, to understand the outcomes that they wanted to see from the contract. A contract was offered to providers which combined capitation and rewards for improved outcomes; providers were also able to keep money generated from delivering care more efficiently, cutting waste in the system. Both the detail of the contract and the right provider to deliver the service, were selected through a competitive dialogue process.