More than half of England should be covered by new models of providing care, such as hospitals running GP practices and elsewhere GP groups taking over hospitals, under a major shift proposed by Simon Stevens and other national NHS leaders.
The NHS Five Year Forward View, published by NHS England, Monitor and the other national NHS bodies, says moving to new forms of providing and contracting services is essential to the NHS being sustainable in future.
It says there will be no “one size fits all approach” but calls on areas to consider adopting one of two leading types of new organisational model.
The first is called a “primary and acute care system” (PACS), in which successful foundation trusts start delivering GP services with patient lists and which, according to the document, is particularly suited to deprived areas where general practice is under strain.
The second, called “multispecialty community provider” (MCP), involves GP practices coming together either as federations or single organisations, and beginning to deliver community, social and potentially acute care services.
The forward view states that both forms of provider could take on capitated budgets for the care of whole populations, which would be a major development in the English NHS, and akin to “accountable care organisation” models developing in the US and elsewhere.
HSJ understands NHS England and the other national bodies envisage more than half, and up two-thirds, of England will be covered by the new organisation models by the end of the next parliament in 2021.
National leaders believe that some areas will quickly move to the new models because there is widespread agreement in them, while national organisations will force a quick pace of change in places that have serious problems with their current services.
However, the models will not be mandated and it will be for leaders in each area to “converge” on their best options, taking account of the forward view, the document says.
Mr Stevens said the NHS needed to “overcome the artificial dichotomy” between change being led centrally or locally.
“This is not one size fits all, not 1,000 flowers blooming, it’s horses for courses,” he added.
He said, as an example of his vision, he could see Birmingham having two large groups of GPs that employ more physiotherapists, community psychiatric nurses, social workers and some hospital specialists; while some smaller independent general practices would continue with their own model; and with major hospital foundation trusts also beginning to provide some primary care.
By contrast, he said, Northumbria would be more likely to have a single integrated provider of primary care, community and hospital services.
Asked where his vision of providers with much expanded roles, holding capitated budgets, left clinical commissioning groups, Mr Stevens insisted they had an important and growing role, citing plans to increase their involvement in primary and specialised services.
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'New care models' to cover half of England