Accountable Care Systems

This year’s NHS England’s Five Year Forward View update recently revealed that the direction of travel for STPs is to “evolve” into Accountable CareSystems (ACS). This could mean a massive shift in how services are tendered, planned and delivered. We may see more business cases from existing provider groups instead of tenders; or massive tenders across geographies worth hundreds of millions of pounds annually.


Since 2014/15’s Operating Framework there has been increasing trends towards integrated health systems; learning from Alaska, Canterbury NZ and others. We see the emergence of “pseudo-ACS” contracts already with large scale “older people’s” and MSK contracts where commissioners in an area have a contract with a single organisation heading a multi-partner supply chain. The update also hints that the next step is Accountable Care Organisations; in essence ending the dominance of the provider Trust model. Business Development will need to adapt and fast; very few of us have done integrated service models at scale and, (with the exception of prison health bid managers), the complexity will be a shock whether bidding or business case writing.

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