“Payment mechanisms and incentives will need to be aligned across providers” says King’s Fund report

Butterfly emerging from a chrysalis to reflect transformation

Aimed at commissioners, clinical commissioning groups, commissioning support units, this evidence-based paper aims to bring some clarity to the current and future contractual models, as “many clinical commissioning groups (CCGs) have started to develop novel contracting and commissioning tools”. This is an important opportunity for CCGs to share good practice and learn from each other and support increased integrated care, by removing barriers.

It is written in four important sections:

  1. Emergence of new contractual models
  2. Contract principles: terms of the contract
  3. Designing the contract
  4. Lessons for commissioners
Two people shaking hands with a contract on the table

There are three types of contract that are currently being explored in England

Types of contract

There are three types of contract that are currently being explored in England, and these are described in great depth, including advantages and disadvantages of each of the following:

  1. Prime contractor model – the CCG works with one organisation who manage the other care providers.
  2. Prime provider model – there is one contract awarded to one provider who delivers the services directly.
  3. Alliance contract model – brings together a group of individual providers who sign one contract with a CCG.

Both of these support integrated service delivery and have three core aims:

  1. Provider accountability
  2. Provider responsibility for streamlining services and bridging gaps by working together
  3. Smooth payments between providers
Cartoon people standing on jigsaw pieces and reaching out to pull another into the fold

Facilitate the development of strong provider partnerships by building trust

Collaborative working

This document is very practical and has been designed to improve commissioning and contracting for integrated care by providing commissioners and providers with the necessary tools to ensure that relevant parties take appropriate responsibility for any outcomes. Together with five case studies, from Staffordshire, Bedfordshire, Cambridgeshire, Lambeth, and Salford, It recommends that CCGs, commissioners, and providers need to bear the following lessons in mind:

  1. Maintain continuous engagement and communication with all stakeholders, including patients
  2. Facilitate the development of strong provider partnerships by building trust
  3. Align payment systems across all providers
  4. Make sure that providers are appropriately organised with governance in place

The authors describe the risks involved with developing new approaches to contracting, but say that the risks are worth the final outcome, with financial targets and public health needs being met. Section 4 clearly describes a set of principles that should be considered when developing integrated care contracting models, ensuring that outcomes are “few, clear, concise and readily communicated”, and providing examples of appropriate outcomes.

The word "skills" magnified

One of the key messages in this document is that “commissioners will need to develop a new range of competencies”.


One of the key messages in this document is that “commissioners will need to develop a new range of competencies”. Fortunately, along with this report, The King’s Fund have provided case studies and a summary of each model, to help put them in perspective and help you think about which model is best suited to your organisation.

All support integrated care, so all will improve service delivery, but your organisation may have preferences with how they work with CCGs and other providers, and how much responsibility they want to take.

Work through each section and see how and why the different case studies have implemented their model and choose which one would be most suitable for your locality and capacity, e.g. could your organisation agree to deliver all services directly, or do you already work together with other providers? Each section includes relevant guidance and examples, so that you will be able to choose the best design for your population.


Addicott R. Commissioning and contracting for integrated care (PDF). The King’s Fund, Nov 2014.

Related links

Joined-up care in action: integrated care map – containing case studies from the report

Summary of the three contractual frameworks

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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