Integrated Care Model Provider (ICP) Engagement

Get involved to help us make a decision about moving to adopt a lead provider contract model for All together Better in Sunderland




Since 2013 NHS Sunderland Clinical Commissioning Group has been working closely with health and care organisations through the All Together Better (ATB) alliance to help join up community health and care.

All Together Better is an alliance of health and care providers and commissioning organisations in Sunderland who are working together in a collaborative way to design and deliver the most personalised, pro-active and joined-up care possible for people in the City.

This has been done through greater collaboration to help integrate out of hospital services with a shared purpose and agreed ways of working to improve the care we provide to our patients.

Throughout the development of All Together Better we have involved stakeholders, patients and the public in giving their views to help us develop the alliance and improve services and the care we provide. You can read more about this here.

Moving to a new type of contract arrangement


Despite the longstanding aim of the NHS to improve integration of services, previously there has not been a commissioning contract designed specifically to promote an integrated service model.

Recognising this, and the need for a better funding mechanism to allow improved integration of services, NHS England undertook a national consultation in 2018 on contracting arrangements for ‘Integrated Care Providers’. This means that local systems can now consider new ways of contracting services in order to drive improvements in patient care.

In line with the NHS Long Term Plan and our ambition to integrate services, the CCG feels that the time is right to consider if a move to an Integrated Care Provider    arrangement would enable even better joined up decision making and integration of services across Sunderland.

This would mean potentially awarding a single contract to a lead provider on behalf of ATB. That provider would become responsible for the integrated provision of ‘out of hospital’ care across the city.

This is known as a lead provider model.

This takes into account the feedback from the national consultation run by NHS England in 2018 on contracting arrangements for Integrated Care Providers.

It would allow funding to flow directly to the All Together Better alliance via a lead provider contract, giving ATB greater ability to manage and coordinate out of hospital care working collectively with all service providers in the City.

It’s important to note that we are not changing the way services are provided to patients – this is about how contracts are arranged. The aim is to enable even better joined up decision making and integration of services through a new contracting arrangement. Should services need to change in the future, they would be subject to appropriate engagement, and where necessary, consultation processes.

The two different scenarios that the CCG is considering are:

Scenario one


Move to a procurement process to appoint a single contract to a lead provider on behalf of ATB – the Lead Provider Model.


The advantages of this scenario are:


  • Delivers mechanism for stronger integration for out of hospital care whilst maintaining the alliance values and ways of working where no one partner has precedence over others
  • Ensures care redesign is maintained and that the benefits of working together are not lost over time
  • Facilitates a stronger role for providers of primary medical services
  • Designs more integrated services around the needs of the local population and based on the specific needs of different communities across Sunderland
  • Provides ability to better co-ordinate care across separate provider contracts
  • Better supports people with long-term health conditions, rather than each encounter with the NHS seen as a single, unconnected ‘episode’ of care
  • Improves communication between providers and clinicians to facilitate a more holistic approach to patient care focused on the overall needs of the person
  • Defines more clearly who has overall responsibility for integrating and coordinating care and helps staff to do the right thing
  • Clear lines of accountability, including Regulatory accountability and accountability for the delivery of integrated services outside of hospital
  • Speeds up the ability of the lead provider to act and make collaborative decisions
  • Simplifies who stakeholders should approach over issues

The disadvantages of this scenario are:


  • A lead provider contract model could remove some agility and flexibility
  • Possible impact on the independence of providers to act autonomously
  • Alliance approach which many providers value replaced with a more formal contracting and accountability structure.


Scenario two


Keep the current arrangements of an alliance with no lead provider arrangement.


The advantages of this scenario are:


  • Organisations working together in a system acting and behaving as though they are one, whilst maintaining statutory and contractual responsibilities of individual organisations – both commissioners and providers
  • Collaborative leadership built around redesigning care tailored to the needs of the health of the population of Sunderland, irrespective of existing institutional arrangements
  • Formalised by alliance principles and governance arrangements being included in all commissioning contracts led by an All Together Better Alliance Executive Group
  • Collaborative and pro-active management of resources.
  • Delivering, by collaboration, recommendation and agreement, any changes to models of care and integration.

The disadvantages of this scenario are:


  • Complexity of separate contracts which can lead to duplication and lack of coordination of care for patients
  • Working as an alliance without a lead body may slow down the adoption of any changes and improvements in patient care
  • Lack of clarity about who has overall responsibility for integrating and coordinating care in Sunderland
  • Current alliance model has a shared financial and clinical risk, therefore, is reliant on collaboration and agreement of all providers and commissioners
  • Heavily reliant on committing to the principles of openness and transparency between all partners on funding allocation, efficiency plans and service contract information

Our preferred scenario is scenario one. This scenario provides the most effective route to integration, improving health outcomes for the city and improving efficiency, delivering innovative, financially and clinically sustainable services.

Listening to your views


We would like to hear the views from interested stakeholders before any decision is made.

The feedback we gather will:

  • Help us understand your thoughts and views on the two scenarios
  • Inform the decisions we make by helping us to take into account your views

We would like to know


If you support one of the scenarios and why?

Do you have any other suggestions or comments you wish to make?

How to give your views


We welcome views from a range of partners and stakeholders.

You can:

NHS Sunderland Clinical Commissioning Group

Pemberton House

Colima Avenue




We are doing detailed engagement with stakeholders until 11 March in order to feed back to the Governing Body on 20 April. However, we are committed to listening to the public and stakeholders after this deadline.