New Models of Care
New Models of Care
The NHS Five Year Forward View (5YFV) recognised that the traditional divide between primary care, community services and hospitals was 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.
As part of the work to implement the 5YFV, the NHS supported the creation of a number of major new care models that could be deployed in different combinations locally across England; this work was undertaken via Vanguard sites. While the 5YFV acknowledged that England is too diverse to pretend that a single new model of care should apply everywhere, it also stated 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 was 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 constituted viable ways forward for the future.
Phase one – three new models of care
In January 2015, the NHS invited individual organisations and partnerships, 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 would join up GP, community, mental health and hospital services;
- Multispecialty community providers (MCPs) which would aim to move services out of hospitals and into the community;
- Models of enhanced care in care homes which would aim to improve services for older people, joining up health, care and rehabilitation.
On 10th March 2015, the 29 successful vanguard sites were announced.
LPCs who were 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.
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. In September 2015 a further 13 vanguards were announced – known as acute care collaborations.
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 were making the strongest progress and those local health systems experiencing the very greatest operational challenges, for example, on the A&E 4 hour standard were 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 would launch the transformation of urgent and emergency care for more than nine million people. This came 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 were tasked with changing the way in which all organisations worked together to provide care in a more joined up way for patients.
Urgent care would 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 was to break down boundaries between physical and mental health to improve the quality of care and experience for all.
Six vanguards covered smaller local systems which included hospitals and surrounding GP practices and social care, while two network vanguards worked with much larger populations to integrate care on a greater scale.
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 were drawn from good practice, which has been tried, tested and delivered successfully by the NHS in local areas across England. The report highlighted 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 developed the NAPC’s primary care home model and was endorsed by NHS England with principles aligned to multispecialty community provider (MCP), one of the types of new care model vanguards.
The main features of the PCH model 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.
Details of the PCH sites and further 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.
The MCP care model and contract framework
In July 2016, NHS England published the The multispecialty community provider emerging care model and contract framework, which described what being an MCP meant, 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.
The document, Mapping of sites to LPCs, was created to map the Vanguard sites and other 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.