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An Accountable Care Organisation (ACO) is a model of healthcare provision where a provider, or group of providers, takes responsibility for the healthcare provision of an entire population. There is no fixed definition of an ACO, but the organisation usually receives an annual, capitated budget to deliver contractually agreed health outcomes.

The NHS in England’s Five Year Forward View (2014) agenda focuses largely on the greater integration of healthcare providers to offer a more joined-up service for patients. The current Government views ACOs as a way to help deliver this.

In August 2017, a draft ACO contract was published, which will allow Clinical Commissioning Groups (CCGs) to choose to commission ACOs in their areas. The Government has argued that some regulatory changes will be required in order for the ACO contract to be used. Currently there are only plans to trial the ACO contract in two areas, Dudley and Manchester, before consideration of a wider rollout of the model across England.

It was initially intended that regulatory changes would be introduced by February 2018, but this has since been delayed until NHS England undertakes a wider consultation on the contract. The NHS England consultation has not yet been launched, so as to allow for the publication of the Health and Social Care Committee’s report into ACOs (published in June 2018), and the conclusion of two judicial reviews against the contract (concluded in May and July 2018 respectively, both of which were rejected).

The proposed introduction of ACOs in the NHS in England has generated some commentary as to a potential increase in private sector involvement, in part due to the model’s origin in the American healthcare system. This interpretation has been disputed by the Government and by the Health and Social Care Committee.

This briefing paper explores the above, as well as the future roles of CCGs and GPs in an ACO system.

As health is a devolved area, this briefing looks at England only.

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