1. 10 principles
1. Focus on function
2. Robust governance and integrated management
3. Aligned incentives essential to bring docs together
4. Integrate the data (and IT)
5. Preserve choice
6. Many ways to keep ICOs ‘honest’
7. Scale is essential
8. It’s the relationships stupid
9. It takes time for success
10. Evaluation design is critical

2. Tolerances
• Pilots should be allowed to evolve and
grow
• Impact on PCT targets (eg inequalities)
• Slower start to build necessary
relationships
• Data governance (within limits of public
acceptance)
• Specialist employment conflicts (??)

3. Blind spots
• Inconsistent on scale
• Aligning incentives and unbundling tariffs,
• Data and IT linkages and timescales
• Limited ability to define/measure outcomes
• GP willingness to take risk
• Start up costs and financial management
• Nature of political cover may change
• Skills deficits (Mx, IT, clinical leadership)

4. Friday discussion points (1)
Managing consultants and conflicts of
interest with acute trusts
– Develop ICO in consultation with acute trust.
‘Adapt’ (?) ICO proposal to fit with strategic
development/viability of acute trust
– Enthuse consultants/GPs by focusing on/
emphasising service improvement
– Ensure proposals come from GPs & specialists
‘10 care focus’ in US includes specialists

5. Friday discussion points (2)
Interprofessional relationships
– Need to re-kindle GP- consultant relationships
– No burning platform/external incentive for this
– Needs internal processes
– Professional incentives are important
• Quality improvement
• Outcome measures and benchmarking data
• IT/data dissemination for ‘incentivising’ information
• Caution needed re profit motive and Dr-Pt relations

6. Friday discussion points (3)
Interorganisational relationships
– Will need high trust between PCTs and ICOs
backed up by clear metrics
– Avoid over-specification of contracts
– ICO plans need to developed in discussion
with acute trusts but avoid collusion
– Need relationship developments and regulat-
ory tolerances & new financial freedoms -
between health and local govt

7. Friday discussion points (4)
Getting the ICO programme off the ground:
– Difference of opinions between: Start from where
we are/Build on and grow existing initiatives &
Smaller number of radical pilots
– Either way, set selection bar high with evidence
of existing relationships.? Board 2 Board process
– Recognise initial need for double running costs
– Reliable political cover will be essential
– Tolerance needed of novel approaches to IT;
flexible £ arrangements, workforce changes

8. Friday discussion points (5)
Governance & accountability
– Learn from example of joint governance of
BEN/HEFT services
– Ensure clinician leaders and well embedded in
governance structures
– Need single primary outcome measure across
all participating orgs – ulitisation = good option
– Good commissioning as the key to good
governance (sue R)
– Need user involvement at all stages

9. Friday discussion points (6)
Support needed for pilots
– Support with data and IT integration to support
risk stratification and outcomes monitoring
– Time to build relationships/shared goals/
strategic visions in key groups/organisations
– Tolerances and political cover outlined above
– Evaluation that does not constrain
development of the pilots
– Learning network to disseminate early learning