New Models of Care: Vanguard sites
New Models of Care: Vanguard sites
The NHS Five Year Forward View (5YFV) recognised that the traditional divide between primary care, community services and hospitals is an increasing barrier to the personalised and coordinated health services that patients need. The NHS is therefore working to dissolve these traditional boundaries to effectively support people with complex long-term conditions.
The NHS is supporting and stimulating the creation of a number of major new care models that can be deployed in different combinations locally across England; this work is being undertaken via the Vanguard sites. While the 5YFV acknowledges that England is too diverse to pretend that a single new model of care should apply everywhere, it also states that there shouldn’t be an infinite number of new care models. While the answer is not one-size-fits-all, nor is it simply to let ‘a thousand flowers bloom’. That is why the NHS approach will be to identify the characteristics of similar health communities across England, and then jointly work with them to consider which of the new options signalled in the 5YFV constitute viable ways forward for the future.
Phase one – three new models of care
In January 2015, the NHS invited individual organisations and partnerships, including those with the voluntary sector to apply to become vanguard sites for the New Models of Care Programme, one of the first steps towards delivering the 5YFV and supporting improvement and integration of services.
There was an open and well-advertised application process, which saw 269 groups of nurses, doctors and other health and social care staff express their interest in developing a model in one of the three selected models of care, with the aim of transforming delivery of local care. The three models of care were:
- Integrated primary and acute care systems (PACs) which will join up GP, community, mental health and hospital services;
- Multispecialty community providers (MCPs) which will aim to move services out of hospitals and into the community;
- Models of enhanced care in care homes which will aim to improve services for older people, joining up health, care and rehabilitation.
Of the 269 applications, 63 were shortlisted and invited to workshops on 2nd-4th March 2015 to present their ideas and be challenged on their plans by fellow applicants and interested parties. Each applicant was then asked to vote for their three preferred sites (excluding themselves) based on level of ambition and the ones they would most like to be involved with. That vote then informed the recommendations put forward by the observers to the New Care Model Board meeting on 9th March 2015 to decide who would be awarded the vanguard status.
On 10th March 2015, the 29 successful vanguard sites were announced.
From April 2015, with the aid of a new £200m transformation fund, the programme team has been working with each vanguard site to develop and put into place their plans to develop local health and care services. Each of the successful applicants is working with the programme team to develop a bespoke support package, to assist and speed up change, and an intensive evaluation programme will seek evidence on what works so that this can rolled out to other parts of the country.
All areas of the country will benefit from a wider support and learning package, based on the lessons learnt from the vanguard sites. Additionally, as a result of the many examples of excellent models up and down the country, a wider programme of support is being put in place for some of the health and social care systems that applied to be part of the programme. This is being supported by the Kings Fund.
FAQs on the New Care Models can be found on the NHS England website.
Two of the vanguard sites specifically involve community pharmacies, but it is expected that there will be community pharmacy involvement in more of the sites in due course.
LPCs who are located in a vanguard site were invited to participate in a teleconference on 15th June 2015 to share information on pharmacy involvement in the vanguard projects in their area. Vanguard teleconference minutes 15th June 2015.
At the end of July 2015, funding was approved for 2015/16 for three of the first 29 vanguards:
- Better Health and Care for Sunderland – £6.5 million;
- Northumberland Accountable Care Organisation – £8.3 million;
- South Somerset Symphony Programme – £4.9 million.
A further £41m has been approved in principle for the following vanguards: Better Care Together (Morecambe); Better Local Care (Southern Hampshire); My Life a Full Life (Isle of Wight); Salford Together; and, Wirral Partners. This will be finalised in August.
Funding for other vanguards will be approved over the coming months.
Phase two – future models of acute care collaboration
Phase two of the programme was announced on 20th May 2015, with an aim of developing innovative ways of delivering high quality acute care for patients. All providers of acute services, including small hospitals, were invited to become vanguard sites for new models of acute care collaboration. Expressions of interest were sought until 31st July 2015 with applicants being expected to demonstrate how their proposals will help promote the health and well-being of the populations they serve, increasing the quality and person-centredness of care, and improve efficiency for the taxpayer within available resources.
In September 2015 a further 13 vanguards were announced – known as acute care collaborations. These are:
- Salford and Wigan Foundation Chain
- Northumbria Foundation Group
- Royal Free London
Multisite specialty franchises
- Dartford and Gravesham (small District General Hospital making use of specialty franchises)
- Moorfields (Ophthalmology)
- National Orthopaedic Alliance (Orthopaedics)
- The Neuro Network (The Walton, Liverpool) (Neurology and spinal specialty)
Accountable clinical networks
- MERIT (Birmingham and Solihull) (Mental Health Accountable Clinical Network);
- Cheshire and Merseyside Women’s and Children Services (Maternity and Paediatrics Accountable Clinical Network);
- Royal Marsden, Manchester Cancer and UCLH (Cancer)
- East Midlands Radiology Consortium (Radiology)
- Developing ‘One NHS’ in Dorset (Multispecialty)
- Working Together Partnership (South Yorkshire, North Derbyshire and Mid Yorkshire) (multispecialty)
Phase three – urgent and emergency care
On 3rd June 2015 the NHS announced a further new care model focusing on urgent and emergency care (UEC), and invited expressions of interest from organisations and partnerships across England.
Leading-edge systems that are making the strongest progress and those local health systems experiencing the very greatest operational challenges, for example, on the A&E 4 hour standard are to be the focus for this new care model.
On 24th July 2015 NHS England Chief Executive Simon Stevens and the NHS 5YFV partners announced eight new vanguard sites that will launch the transformation of urgent and emergency care for more than nine million people. This comes as NHS England also revealed the success of Regional Major Trauma Networks which, after they were set up just three years ago, have seen a remarkable 50% increase in the odds of survival for trauma patients revealed in a new independent audit by the Trauma Audit and Research Network (TARN).
Building on the recent success in improving trauma survival rates, the urgent and emergency care vanguards are tasked with changing the way in which all organisations work together to provide care in a more joined up way for patients.
Urgent care will be delivered, not just in hospitals but also by GPs, pharmacists, community teams, ambulance services, NHS 111, social care and others, and through patients being given support and education to manage their own conditions. Another aim is to break down boundaries between physical and mental health to improve the quality of care and experience for all.
Six vanguards will cover smaller local systems which may include hospitals and surrounding GP practices and social care, while two network vanguards will be working with much larger populations to integrate care on a greater scale.
The eight sites are:
- South Nottingham System Resilience Group;
- Cambridgeshire and Peterborough CCG;
- North East Urgent Care Network;
- Barking and Dagenham, Havering and Redbridge System Resilience Group;
- West Yorkshire Urgent Emergency Care Network;
- Leicester, Leicestershire and Rutland System Resilience Group;
- Solihull Together for Better Lives; and
- South Devon and Torbay System Resilience Group.
In August 2015 NHS England published Safer, faster, better: good practice in delivering urgent and emergency care a practical summary of the design principles that local health and social care communities need to adopt to deliver safer, faster and better urgent and emergency care. These principles are drawn from good practice, which have been tried, tested and delivered successfully by the NHS in local areas across England. The report highlights the valuable contributions that community pharmacies can make to local health communities’ urgent care programmes and provides examples of community pharmacy services that can reduce pressure on general practice and enhance patient safety.
NAPC’s primary care home model
The National Association of Primary Care (NAPC) launched their new care model style primary care programme at their annual conference in October 2015. The Primary Care Home (PCH) model is designed to support the strengthening of primary care in line with the new care models outlined in the NHS Five Year Forward View.
The programme develops the NAPC’s primary care home model and has been endorsed by NHS England with principles aligned to multispecialty community provider (MCP), one of the types of new care model vanguards.
The main features are:
- provision of care to a defined, registered population of between 30,000 and 50,000;
- aligned clinical financial drivers through a unified, capitated budget with appropriate shared risks and rewards;
- an integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care; and
- a combined focus on personalisation of care with improvements in population health outcomes.
The closing date for formal expressions of interest from organisations wanting to become rapid test sites was 5pm on 25th November 2015. NAPC received almost 70 applications and an evaluation workshop for shortlisted applications took place on 10th December 2015. The successful fifteen rapid test sets were announced on 17th December 2015:
- 1st Care Cumbria
- Beacon Medical Group
- Healthy East Grinstead Partnership
- Larwood & Bawtry
- Luton Primary Care Cluster
- Nottingham North & East Community Alliance
- Rugeley Practices PCH
- South Durham Health CIC
- South Bristol Primary Care Collaborative
- St Austell Healthcare
- Thanet Central CIC
- The Breckland Alliance
- The Winsford Group
- Wolverhampton Total Health Care
In late 2016 additional ‘Community of Practice’ sites joined the programme. Details of these sites and futher information on the programme can be found on the NAPC website.
In August 2017, the Nuffield Trust published an evaluation report of the PCH model, which looked at how sites can make early progress with implementing and evaluating their local PCH models and potential challenges.
Support for vanguard sites
On the 10th December 2015 NHS 5YFV partners published an updated national support package for all 50 vanguard sites.
This follows an initial support package published in July 2015 for the initial 29 vanguards. Since then, a further 21 have been selected, eight urgent and emergency care (UEC) vanguards were announced in July 2015 and thirteen acute care collaboration (ACC) vanguards were announced in September 2015.
The revised package has been updated to reflect the needs of the UEC and ACC vanguards and includes the learning to date from the first 29 vanguards. It is the result of extensive engagement with the vanguards including site visits, workshops and discussions.
Based on the feedback, the number of areas of support has been extended from eight to 10 and now includes ‘new operating models’ and ‘governance, accountability and provider regulation’.
The ten areas of support are:
- Designing new care models– working with the vanguards to develop their local model of care, maximising the greatest impact and value for patients;
- Evaluation and metrics– supporting the vanguards to understand – on an ongoing basis – the impact their changes are having on patients, staff and the wider population;
- Integrated commissioning and provision– assisting the vanguards to break down the barriers which prevent their local health system from developing integrated commissioning;
- New operating models – this has been added to support the ACC vanguards, who are linking hospitals together to improve their clinical and financial viability, develop the right operating model. It will also support the UEC vanguards to explore models to ensure they are working effectively as integrated communities;
- Governance, accountability and provider regulation – designed to help the vanguards develop the right organisational form and governance model, as well as understand the impact on how they are regulated.
- Empowering patients and communities– working with the vanguards to enhance the way in which they work with patients, local people and communities to develop services;
- Harnessing technology– supporting the vanguards to rethink how care is delivered, given the potential of digital technology to deliver care in radically different ways. It will also help organisations to more easily share patient information;
- Workforce redesign– supporting the vanguards to develop a modern, flexible workforce which is organised around patients and their local populations;
- Local leadership and delivery– working with the vanguards to develop leadership capability and learn from international experts, and;
- Communications and engagement– supporting the vanguards to demonstrate best practice in the way they engage with staff, patients and local people.
The national package has been developed to enable the vanguards to make the changes they want effectively and at pace. It aims to maximise the sharing of learning across the vanguards and spread good practice nationally across the wider NHS and care system.
Om 15th December 2016, NHS England announced that funding worth £101 million will be awarded to support and spread the progress of the vanguards.
The MCP emerging care model and contract framework
In July 2016, NHS England published the The multispecialty community provider emerging care model and contract framework, which describes what being an MCP means, based on assembling the core features from the 14 MCP vanguards into a common framework. In addition, the document includes proposals for how the new voluntary contract may work. It proposes the contract will be a multi-year contract with payment operating on the basis of a whole population budget, a new pay-for-performance incentive scheme and risk-and gain-share agreement with the hospital sector. NHS England will be publishing further resources later this year to accompany the framework.
Community pharmacy involvement
The document, Mapping of sites to LPCs, has been created to map the Vanguard sites and other current NHS initiatives to LPC areas.
PSNC Briefing 050/16: Integrated primary and acute care systems (PACS) – Describing the care model and the business model (October 2016)
This PSNC Briefing summarises NHS England’s document, Integrated primary and acute care systems (PACS) – Describing the care model and the business model, which describes a framework covering the core elements of the population-based accountable care model and the options for commissioning and providing a PACS. It will be of particular interest to LPC members who have PACS being developed in their area.
PSNC Briefing 045/16: An introduction to multispecialty community providers (MCPs) and the emerging contract framework (September 2016)
This PSNC Briefing summarises NHS England’s document The multispecialty community provider (MCP) emerging care model and contract framework (July 2016), which describes MCPs – a new place-based model of care – and the emerging contract framework which NHS England is currently developing to support the rollout of this approach to health and care provision.