Annex 1. Glossary and research aims

Integrated health organisation: A host provider holding a capitated contract with responsibility for the health outcomes of a geographically defined population, which delivers some care services directly and sub-contracts others to other providers, with appropriate governance that supports shared decision-making.

Capitated contract: An agreement whereby a fixed sum is allocated per patient within a defined geography to cover their care needs, rather than by the volume or type of services provided. The IHO contract is a form of capitated contract commissioned by an ICB to a ‘host provider’. 

Allocative efficiency: Spending money on services which improve health outcomes the most for every pound spent and reducing demand for lower value-adding healthcare services and treatments in hospital. 

Host provider: An organisation holding a contract with a commissioner, typically for a specific service. The host provider is responsible for delivering or coordinating that service on behalf of a collaborative group of providers. Often referred to as a ‘lead provider’.

Year of Care payments: A population-based payment model that provides a risk-weighted per head budget for all patients in a cohort, based on analysis of existing spend. This then enables strategic commissioners and providers to plan and deliver optimal proactive care services to keep these patients healthy and out of hospital. A Year of Care payment could also include a variable, outcomes-based component.

Single neighbourhood provider: A contract for delivering joined-up enhanced neighbourhood services. In many areas, the existing primary care network (PCN) footprint is geographically coherent and maps onto the population footprint of 30,000-50,000

Multi neighbourhood provider: A contract to support the consistent delivery of services across multiple neighbourhoods, covering populations of 250,000 or more. This contract could be held by a number of organisations but will require the support of GPs in the neighbourhood it serves.

Integrator: A function delivered by an existing organisation(s) operating as a host provider, supporting frontline teams by coordinating funding, data, workforce, estates and other enablers. It acts as a delivery partner for services commissioned by the integrated care board (ICB) and local authorities, supporting the development and coordination of integrated neighbourhood teams, hospital at home services, urgent community response, and integrated discharge pathways.

Vertical integration: A model of service integration in which acute hospital trusts assume responsibility for the management and delivery of primary care services, such as general practices, creating a unified structure across different levels of care to enhance coordination, efficiency and patient outcomes.

Our research aims to provide guidance on how best to practically hold IHO contracts and influence national policy. It is intended to uncover the definition, purpose and parameters of an IHO, understanding how exactly they differ from existing structures and what additional benefits they offer, and how they’ll function within the overarching NHS structure and other models of delivery outlined in the 10YHP.

It describes four core components to holding IHO contracts identified throughout our research (contractual, structural, governance, behavioural/leadership) and considers potential barriers and enablers to doing so. The research is intended to provide considerations for IHOs and alternative models of provider integration.

Building on this, it offers guidance to healthcare leaders, based around the four components, on how best to hold IHO contracts. Finally, it seeks to provide a set of recommendations to the centre that are intended to inform the direction of national policy as the development of IHOs progresses over the coming months.

Research questions

This report was developed following a series of structured and in-depth interviews and a roundtable with senior healthcare leaders. In total we engaged with five leaders from primary care, five from acute and community providers, five from acute trusts, five from ICBs, four from standalone community providers, three from mental health providers, one from the ambulance sector and one from a mental health and community trust. Within this, even coverage across the seven NHS regions was ensured.

A total of 20 expert interviews were conducted between August and October 2025. Interviewees were selected to ensure representation across all sectors and NHS regions. The qualitative analysis was supplemented throughout by desk-based research, which focused on understanding the successes and failures of previous attempts at integrated care in England and abroad.

During interviews, all participants were asked similar broad, thematic questions designed to understand thoughts on the form and function of IHOs, assessing the appetite for them and understanding how closely or not delivery models resembled our understanding of IHOs. After each interview a detailed thematic meeting summary was produced, enabling structural analysis.

Intel gathered from interviews and desk research was used to inform a discussion paper, which was shared with roundtable attendees. The roundtable was held in October and was attended by 17 healthcare leaders representing all sectors and NHS regions. Discussion was structured around the four components identified during the interview and desk-research stages.

The roundtable provided valuable material, which was used to inform the analysis, conclusions, guidance and recommendations outlined in this report.