England’s most powerful acute trusts are absent from the new care model “vanguard” sites revealed today by NHS England, but will take part in a forthcoming project on how they can work with small hospitals, HSJ has been told.

Of the 23 multispecialty community providers (or MCPs) and primary and acute care system (or PACS) sites announced this afternoon, none include a trust from the Shelford Group, which represents the 10 biggest and most prestigious regional teaching and specialist centres. No Shelford Group trust is leading a PACS, despite an expectation among some that large, leading acute providers may be well placed to start running primary care services.

NHS England’s director for the new care models programme Samantha Jones told HSJ “there was nothing intentional” in the absence of the large teaching trusts from the vanguard, and said that work developing trial sites for a further care model initiative, called “viable smaller hospitals”, had been delayed.

Viable smaller hospitals were one of the categories for new models of care set out in the NHS Five Year Forward View, alongside PACS and MCPs.

“We weren’t very clear about what the exam question was for the viable smaller hospitals [when we asked for vanguard applications],” she said.

Her directorate is undertaking further work with potential trial sites – including large trusts that are working closely with smaller hospital providers – to define what these should aim to achieve.

Some smaller hospitals are currently in “buddying” relationships with Shelford Group trusts. For example, George Eliot Hospital Trust is buddied by University Hospitals Birmingham Foundation Trust, while Guy’s and St Thomas’ FT was revealed today as a new partner for Medway FT.

Ms Jones said that under the recommendations of the Dalton review, small hospitals could be developed as part of a chain, and added that some large teaching hospital trusts would work with smaller hospitals on this option.

NHS England reveals new care model 'vanguard'