Intended for healthcare professionals

Feature Briefing

Accountable care systems and accountable care organisations in the NHS: progress or route to privatisation?

BMJ 2017; 358 doi: (Published 04 September 2017) Cite this as: BMJ 2017;358:j4105
  1. Tom Moberly, UK editor, The BMJ
  1. tmoberly{at}

Sustainability and transformation partnerships are evolving into these new organisations, which will have responsibility for all NHS and social care. Tom Moberly explains what this means

What are accountable care systems and accountable care organisations?

In an accountable care system (ACS) several healthcare organisations agree to provide all health and social care for a given population. An accountable care organisation (ACO) is a body that manages the agreements to establish such a system and is accountable for all care. Distinctions between the two terms are often overlooked, and they are sometimes used interchangeably.

How did the terms originate?

Accountable care organisations began in the US, with groups of healthcare providers coming together to provide care for a given population. Examples include the Group Health Cooperative of Puget Sound, Washington State; the Geisinger Health System, western Pennsylvania; and Intermountain Healthcare in Salt Lake City.1 ACOs are accountable to patients …

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