Integrating cancer and end-of-life care in Staffordshire

hands on a walking stick

09 / 09 / 2014


In Staffordshire, four clinical commissioning groups (CCGs), NHS England and Public Health England are working with Macmillan Cancer Support, and with the support of two local authorities, to redesign cancer and end-of-life care services. They are co-designing new care pathways with patients and carers.

How it works

Care is to be managed and contracted through a single provider, which will be held accountable for the entire patient experience and clinical outcomes. Providers will need to demonstrate they have achieved a pre-agreed set of quality measures within a given expenditure target. Involvement of service users and carers is central in determining the outcomes for this contract. The prime-provider contracts will replace around 70 separate sub-contracting arrangements. 

Contracts will be for ten years. In the first two years, the CCGs and Macmillan will support the selected prime providers to improve the currently available data on activity and costs, which is not yet sufficiently sophisticated to enable a purely outcomes-based approach as it is focused on interventions and individual providers, not on the whole pathway.

Therefore, a key element of the prime provider’s work in the first two years will be to improve the data and analytics in order to provide a basis for a truly outcomes-based contract. They will also be expected to demonstrate real improvement in patient and carer experience. During the first two years the contract will be fee based.

Contract responsibility will formally transfer to the prime providers in the third year when the data is robust enough for effective pathway-outcomes performance management. This may then allow for risk and gain share. The prime provider could potentially not be a provider of any of the clinical services involved but rather focus solely on the job of integrator, sub-contracting all service delivery.

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