NHS 5 year forward view - New Care Models update

NHS Five Year Forward View
New care models - update
Jones, Director - New Care Models
Update on New Care Models
New care models: our aims, values and design principles
Co-designing the support package
Eight key enablers of transformation delivered through ten joint
Summary of the national support package
Timeline for delivery and next steps
Triple aims of the programme
Health and wellbeing
Care and quality
New care models programme: four core values
Four core values underpin the new care models programme and the way we work.
They are fundamental to the way that we have co-produced the support package
and the way in which we will deliver it
Each of the vanguards will be rooted in its
own local community, but supported at a
national level to ensure that common
opportunities for replicable care redesign
are exploited, and common barriers to
change addressed
Strong clinical engagement and patient
involvement underpin the design and
delivery of the programme
Four key design principles have emerged which frame the support package
1. We solve problems through joint national and local leadership
• The eight key enablers will be delivered through ten joint workstreams , jointly led by a
vanguard leader and national subject matter expert working to decide how it will be taken
2. We create simple replicable frameworks, built for spread
• The principle of replicability is integral to the design of what all vanguards do. The success of
the programme and the value delivered for taxpayers will be defined by the extent to which
learning is easily spread across the country
3. We encourage and support radical innovation
• We want to encourage vanguards to become more revolutionary in their thinking. We will
enable existing silos to be dissolved – for example, through new approaches to commissioning,
contracting, payment and provider forms
4. We work and learn at pace, demonstrating that change and improvement is real
• We know that we need to work at pace. Unless we can start to see demonstrable, quantified
change occurring in 2016/17, it will become harder to justify significant national investment
Five types of new care model will be designed, delivered and replicated
Models of delivery
Already selected
and in set-up phase
– support package is
for these 3 models.
Value propositions
and approval for
funding for some
vanguards are in
Selected on 20th
July – support will
be co-designed and
published by
October 2015
In process of
selection – support
will be co-designed
and published by
October 2015
The 5 types of new care models are:
•1 Multispecialty Community Providers (MCPs) - moving specialist care out of hospitals
into the community
•2 Integrated Primary and Acute Care Systems (PACS) - joining up GP, hospital, community
and mental health services
•3 Enhanced Health in Care Homes - offering older people better, joined up health, care
and rehabilitation services
•4 Urgent and Emergency Care (UEC) - new approaches to improve the coordination of
services and reduce pressure on A&E departments
•5 Acute Care Collaboration (ACC) - local hospitals working together to enhance clinical
and financial viability
37 vanguards developing their visions locally
Integrated primary and acute care systems (PACS)
Wirral Partners
Mid Nottinghamshire Better Together
South Somerset Symphony Programme
Northumberland Accountable Care Organisation
Salford Together
Better Care Together (Morecambe)
North East Hampshire and Farnham Clinical Commissioning
Harrogate and Rural District Clinical Commissioning Group
My Life a Full Life (Isle of Wight)
Multispecialty community providers (MCPs)
Urgent and emergency care (UEC)
South Nottingham System Resilience Group
Cambridgeshire and Peterborough Clinical
Commissioning Group
North East Urgent Care Network
Barking and Dagenham, Havering and
Redbridge System Resilience Group
West Yorkshire Urgent and Emergency Care
Leicester, Leicestershire & Rutland System
Resilience Group
Solihull Together for Better Lives
South Devon and Torbay System Resilience
Calderdale Health and Social Care Economy
Derbyshire Community Health Services NHS Foundation Trust
Fylde Coast Local Health Economy
Vitality (Birmingham and Sandwell)
West Wakefield Health and Wellbeing Ltd
Better Health and Care for Sunderland
Dudley Clinical Commissioning Group
Whitstable Medical Practice
Stockport Together
Tower Hamlets Integrated Provider Partnership
Better Local Care (Southern Hampshire)
Primary Care Cheshire
Lakeside Surgeries (Northamptonshire)
Principia Partners in Health (Southern Nottinghamshire)
Enhanced health in care homes
NHS Wakefield Clinical Commissioning Group
Gateshead Care Home Project
East and North Hertfordshire Clinical Commissioning Group
Nottingham City Clinical Commissioning Group
Sutton Clinical Commissioning Group
Airedale & Partners
Co-designing the support package with and on behalf of vanguards
• Two-day diagnostic site
• We listened to diverse
representatives - from
patients, clinicians, the
voluntary sector and
• This gave an insight into
the vanguards’ proposed
models of care
• We built relationships with
vanguards to bring the
national team and local
teams closer together
Site visits
• Outputs from site visits and
further discussions with
vanguards were developed
into thematic analyses for
each type of care model
• There is good consensus
that the thematic analyses
represent the vanguards’
broad proposals for their
care model locally
• The support package
consists of eight enablers
delivered through 10 joint
Thematic analyses
• We are building the
support package with and
for the vanguards
• As we do this, the national
team is testing out each
element of the emerging
support package to ensure
that it responds to the
needs of vanguards
• This brings co-design into
action, creating a strong
partnership between
vanguards and the national
Support package
Summary of support package: eight key enablers of transformation
1. Designing new care models
Vanguards will be supported to design and implement their overarching care model
based on population needs, and to understand the key components of their care
model which add the greatest impact and value for patients
Key elements of support:
1. Local care model design - analytical support segmenting populations and identifying
interventions; access to NHS England’s Right Care programme
2. Ongoing development and implementation - action research to evaluate the impact of new care
model components; clinical expertise and advice from new care model clinical associates, and NHS
England’s medical directorate clinicians
2. Evaluation and metrics
Vanguards will be supported to develop evidence-based interventions. Impact
assessment and continuous improvement will be established from common local
metrics and evaluation which identify the active ingredients of each care model
Key elements of support:
1. Development of logic models as a foundation for development - intensive one-to-one support on
logic model development
2. Evidence-based interventions - evidence summaries produced for the interventions being
implemented through each care model
3. The vanguard approach to evaluating new care models - task and finish groups to focus on areas
of common challenge; a senior responsible officer for evaluation; co-produced evaluation strategies
4. Core metrics across the care models – a core set of metrics for each care model; a standardised
approach to measuring patient experience; a standardised dashboard for each vanguard to show
progress against the metrics
3. Integrated commissioning and provision
New integrated commissioning approaches will allow vanguards to deliver care
collaboratively designed around the whole needs of patients. These will provide
opportunities for capitated payment through new standard contracts
Key elements of support:
1. Capitated pricing - small number of new payment and incentive models that can be implemented
locally; budgetary flexibility of merging separate provider funding streams into single pot; expertise
on implementing new capitation approaches
2. Quality payments – new pay-for-performance schemes developed; co-design of a limited menu of
3. Bundled contracts, integrated commissioning and procurement - new standard MCP contract and
PACS contracts
4. Model provider-to-provider sub-contract - new model sub-contract; non-mandatory model alliance
agreement; access to legal advice provided for existing projects
5. Integrated commissioning – establishment of the new care models commissioning group; practical
support to manage integrated commissioning
6. Options for new integrated organisational forms – support to understand options, risks and
benefits; centrally commission legal advice to cover relevant issues
4. Empowering patients and communities
Vanguards be supported to work in partnership with patients, people and their
community, empowering them and enabling choice through personalised budgets,
care planning and peer support
Key elements of support:
1. Personalised care and empowering choice - support in developing partnerships with voluntary
organisations; advice on personal budgets
2. Expert advice to support vanguards to meet six principles – developed by the Five Year Forward
View People and Communities Board
3. Directory of support – publishing a comprehensive directory of national and local services available
to vanguards
5. Harnessing technology
Vanguards will be supported to develop connected digital solutions and provided
with expertise to unblock information governance barriers, accelerating the use of
data and technology locally
Key elements of support:
1. Connected digital solutions and information systems - dedicated technical support to develop local
integrated care records; interoperability handbook
2. Information governance - practical help to develop information sharing agreements and guidance
on information governance
3. Digital strategy - diagnostic support to map digital resources; expertise to define digital priorities
and strategies; advice to select the right digital solutions
4. Managing system vendors - support to collate technology requirements and enable collective
market engagement and procurement at scale
6. Workforce redesign
Vanguards will be supported to map and profile their existing workforce, develop new
and extended roles and new ways of working which support multi-disciplinary team
working and shared responsibility
Key elements of support:
1. Local workforce strategy - self-assessment tool on capacity and capability for workforce redesign;
support to develop plans for delivering local strategies
2. New and extended roles, skills and training - common skill descriptors and job descriptions
developed for new and extended roles; support to develop specific roles; training resources
3. New ways of working - resources to support multi-disciplinary working, mental health crisis care
transformation and person-centred community care; facilitated simulation exercises to understand
the challenges of multi-professional working; peer learning sets
7. Local leadership and delivery
Vanguards will be supported to strengthen system leadership across all organisations,
distributing and empowering leadership at the frontline and creating clinical and
professional leadership which embraces integration
Key elements of support:
1. System leadership - “Community of Practice” leadership programmes; learning on system
leadership from international partners
2. Integrated and flexible leadership - leadership programmes to support specific needs; learning
community for primary care and community professionals; multi-disciplinary learning sets
3. Leadership at all levels - exploration of ways to access leadership schemes for clinical and nonclinical staff
4. Supporting local delivery - programme planning and project management approaches; dedicated
account manager for each vanguard; access to funding for set-up via the Transformation Fund
5. Use of local health and social care assets - best practice roadmap for estates management;
surgery sessions; framework on how to rationalise estate across partners; advice and legal support
to deal with financial legacy of Private Finance Initiative deals
8. Communications and engagement
Vanguards want to develop effective local communications and engagement which
strengthens local collaboration of partners where staff, local people and other
stakeholders. Vanguards will be provided with expertise and resources to deliver local
best practice which allow local people and staff to champion their emerging model
Key elements of support:
1. Communications and engagement strategy - expertise to develop communication and
engagement strategies; new evaluation tool to enable vanguards to assess and compare the impact
of their strategy
2. Sharing best practice and methods - range of tools to share the learning as part of a detailed
collaboration plan; online tool to enable rapid dissemination of learning across the vanguards
8 key enablers delivered through 10 joint workstreams
New care model joint workstreams
Leadership and system development
Workforce redesign
 Each workstream will be led by a local
vanguard and national subject matter
 The joint workstream leads will:
Empowering, patients and communities
Evaluation and metrics
Decide together how the work should be
taken forward – including what problems
need to be fixed, and how to ensure
national replication.
Identify the support they require from
national bodies, commission it from us and
hold us to account for delivering it
Harnessing technology
Commissioning, contracting and procurement
Payment design and pricing
Organisational form
Communications and engagement
 The primary role of the national bodies is
to align behind the vanguards, and remove
blocks and reduce burdens
Transformation funding
The vanguards have access to the £200 million Transformation Fund. Each vanguard has
been given the opportunity to submit value propositions demonstrating delivery against
the triple aims of the programme.
Efficiency requirements are core to this, and vanguards are demonstrating through these
propositions how they will deliver the requirements of additional efficiencies by the end
of 2017/18.
Following consideration by NHS England’s Finance and Investment Committee, approval
has been given in principle to the initial £61m requests for funding, subject to some
clarification, including of savings.
Those vanguards that chose not to submit a value proposition at this time are actively
working on them over the summer with the NCM team.
Timeline for delivery and next steps
Publication of initial support
by 31 July - developed in
collaboration with vanguards,
national bodies and partner
Sites for two further care
models selected
Support package design
March – July 2015
Support package delivery
August – March 2016
Local and national
Delivery of support
Support package for two
further care models
developed and published
Support programme
evolves and develops to
optimise local delivery and
national replication
Continual refinement to
support package as
delivery progresses
March 2016 onwards