The NHS Five Year Forward View:

New Care Models Programme

An overviewMarch 2015

NHS Five Year Forward View

• The NHS Five Year Forward View was published on 23 October 2014

• One of its great successes was that it is a shared vision for the future of the NHS across six national NHS bodies

• The challenge is now implementation; we know: • It will not be easy• We need to learn from the past • We’re going to need a different

approach• We’re up for it

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The future NHS

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The core argument made in the Forward View centres around three ‘gaps’:

Radical upgrade in prevention

• Back national action on major health risks• Targeted prevention initiatives e.g. diabetes • Much greater patient control• Harnessing the ‘renewable energy’ of communities

Health & wellbeing

gap1

New care models

• Neither ‘one size fits all’, nor ‘thousand flowers’• A menu of care models for local areas to consider• Investment and flexibilities to support implementation

of new care models

Care & quality gap

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Efficiency & investment

• Implementation of these care models and other actions could deliver significant efficiency gains

• However, there remains an additional funding requirement for the next government

• And the need for upfront, pump-priming investment

Funding gap

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New Care Models

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Initially the new care models programme will focus on:

• Multi-agency support for people in care homes and to help people stay at home

• Using new technologies and telemedicine for specialist input • Support for patients to die in their place of choice

Enhanced health in care homes

• Coordinated care for patients with long-term conditions • Targeting specific areas of interest, such as elective surgery • Considering new organisational forms and joint ventures

New approaches to smaller viable

hospitals

• Integrated primary, hospital and mental health services working as a single integrated network or organisation

• Sharing the risk for the health of a defined population• Flexible use of workforce and wider community assets

Integrated primary and acute care

systems

• Blending primary care and specialist services in one organisation• Multidisciplinary teams providing services in the community • Identifying the patients who will benefit most, across a population of at

least 30,000

Multispecialty Community Providers

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• Greater scale and scope of services that dissolve traditional boundaries between primary and secondary care

• Targeted services for registered patients with complex ongoing needs (e.g. the frail elderly or those with chronic conditions)

• Expanded primary care leadership and new ways of offering care

• Making the most of digital technologies, new skills and roles

• Greater convenience for patients

What they are

• Larger GP practices could bring in a wider range of skills – including hospital consultants, nurses and therapists, employed or as partners

• Shifting outpatient consultations and ambulatory care out of hospital

• Potential to own or run local community hospitals

• Delegated capitated budgets – including for health and social care

• By addressing the barriers to change, enabling access to funding and maximising use of technology

How they could work

Multispecialty Community Providers

Primary and Acute Care Systems

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What they are

• A new way of ‘vertically’ integrating services

• Single organisations providing NHS list-based GP and hospital services, together with mental health and community care services

• In certain circumstances, an opportunity for hospitals to open their own GP surgeries with registered lists

• Could be combined with ‘horizontal’ integration of social and care

How they could work

• Increased flexibility for Foundation Trusts to utilise their surpluses and investment to kick-start the expansion of primary care

• Contractual changes to enable hospitals to provide primary care services in some circumstances

• At their most radical they could take accountability for all health needs for a register list – similar to Accountable Care Organisations

Ambitious visionHighlighting what you want to change in order to meet clear identified needs and preferences of your local population

Strong local relationships & delivery partners

Support from a diverse range of active delivery partners, local commissioners and communities

Credible plan & tangible progress

To allow the programme to move at pace and make rapid change during 2015; including progress toward new ways of working

Strong leadershipEffective managerial and clinical leadership and the capacity and capability to deliver change

The forerunner sites chosen for new care models will need to show:

Principles of New Care Models

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Align NHS leadershipFor example, by moving towards a joint way of assessing and intervening in challenged health economies

Develop a modern workforce

Designing and commissioning new and more flexible roles to support the future NHS

Exploit the Information Revolution

To provide transparent data, develop services that care digitally delivered and use data to improve the NHS

Accelerate innovationDeveloping new methods for innovating such as ‘test beds’, as well as testing innovations through trials and evaluations

To deliver the scale and pace of change required we will also take steps to:

Critical ‘enablers’ to underpin care model change

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Forerunner SitesProviding focused support for a number of leading health areas to rapidly progress prototypes & learning

All health economies

Supporting the establishment of foundations for early adoption making it easier for all local areas to implement change

Challenged Health Economies

For a minority of health economies that have faced significant difficulties a “success regime” will be applied to create the conditions for success

Supporting new models

As health economies are all at different stages we will work will work with them in different ways

What we are trying to achieve

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There are three key elements to the new care models programme

• A need to manage systems of care not just organisations

• Integrated services around the patient giving the patient greater control

• Addressing pre-existing barriers to change

Dissolving traditional barriers

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• Harnessing the ‘renewable energy’ of communities• Targeted prevention initiatives • Investment and flexibilities to support implementation

of new care models• Active patient involvement

Co-designing local services

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• Promote peer learning with similar areas• Fast learning from best practice examples • Applying innovations and learnings across the system

Applying learnings across the health system

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Overall programme principles

Our core values that underpin the New Care Models Programme are:

Clinical Engagement

Patient Involvement

Local Ownership

National Support

As such, the New Care Models programme will ensure that:

• The process will be as transparent as possible

• Patients and clinicians will be engaged throughout

• Regional teams will be invited to provide local insights

• Additional insight will be sought from a wide range of partners, including the national NHS bodies, NHS IQ and Think Tanks

• Final decisions will be value based, taking into account all evidence received throughout the process

What does success look like?

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A range of new care models that are locally delivered across the country and can be replicated across the system

• A need to manage systems of care not just organisations

• Integrated services around the patient giving the patient greater control in their care

New care models1

• A focus on meeting local population health needs

• Support from a diverse range of active delivery partners, local commissioners and communities

• Active patient involvement

Locally delivered2

• Fast learning from best practice examples that can be applied to other areas across the country

• Applying innovations and learnings across the system

National replicability

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