Tracking everything that’s new in care models and progress of the Five Year Forward View. By integration reporter David Williams.
The week in new care models
- Is a new hospital chain being formed on the south coast? Brighton and Sussex University Hospitals Trust is the latest acute provider to have its chair and chief executive replaced by the leaders of another nearby provider, amid longstanding cultural problems and a more recent loss of financial control. As is customary, the move is being described as anything but a merger. In reality these things go one of two ways: towards a merger as per Heart of England and UH Birmingham, or in the direction of a chain as we saw with Wye Valley and South Warwickshire a couple of weeks ago.
- Earlier this month NHS England published its framework for assuring major contracts. It’s called the “integrated support and assurance process”. A year on from the collapse of Cambridgeshire’s UnitingCare contract, this series of tests is intended to stop similarly catastrophic failures happening in the future – which new service models and new contractual forms make more likely to happen, at least to begin with. National bodies will expect to be engaged with early, before procurement begins or preferred providers are identified – and the service will be checked against the aims of the Five Year Forward View and the local sustainability and transformation plan. Maybe that makes big ACO type models more likely to get approved than single-specialism carve-outs? The publication also states: “The decision about whether to procure and award a contract must be one for local commissioners, and the ISAP should not and cannot remove this decision to the national bodies. However, the view of the national bodies should form a key consideration for local commissioners.” Indeed, it will be a brave CCG that goes to procurement against the advice of NHS England.
- Delayed transfers of care – the most convenient proxy performance indicator for integrated care continues to get worse.
- Somerset’s sustainability and transformation plan is out: they’re planning an “accountable care system”, merging health and social care commissioning functions and appointing a single governance structure on the provider side. South Somerset is already quite a long way towards establishing a primary and acute care system – so will it expand to cover the whole county, or will the model be replicated several times across the wider population? More on Somerset below.
- The increasingly vanguard-esque Royal Wolverhampton Trust is going to take over some more GP practices. It already has three, and expects to expand this to five in the next couple of months. That will bring the total population covered by the fully vertically integrated model to the magic 30,000 to 50,000 range. Separately, Wolverhampton CCG is scaling up GP services via the Primary Care Home model and a 26-practice GP federation. If vertical integration for the whole population is a going to be a goer, the primary care home bit will need to work out how to click into the rest of the system.
- Leeds CCGs are working on a string of MCPs that they hope could eventually morph into an accountable care organisation for the whole city. Plans are at a very early stage compared to Wolverhampton and probably better reflect where most STPs are on the subject.
Mobile apps and the vanguard
Nobody really knows how the vanguards will end up changing how care is provided in this country – but an even greater unknown is the possible impact of new technologies being developed outside the NHS.
It’s not the purpose of this newsletter to enthuse about highly disruptive but potentially transformative tech-based forms of care. But a recent story by my colleague James Illman has highlighted their possible relevance to vanguards.
Because I work in the media I’ve seen first hand how new tech can change the behaviour of the people you serve, how that can disrupt your business model without asking for your permission first, and how rapidly a longstanding institution can become obsolete if it fails to respond.
There is a big difference between that kind of unplanned tech-driven earthquake and the painstaking work under way in the vanguards to change people’s roles, reinvent the mix of treatments available in each care setting, and shift to new types of organisations, regulations, contractual forms and all the rest of it.
So will new care models be swept away by a tech tsunami or can they ride the wave?
And: how significant is the development of mobile primary care apps?
Anyone who tells you they know the answer to either of those questions is over-confident and probably has skin in the game. But we should watch the deal between Babylon and Yeovil District General Hospital closely.
To recap: Yeovil is a key player in the South Somerset “Symphony” primary and acute care system vanguard, which is one of the more advanced of the type.
Babylon is a mobile service offering unlimited rapid remote access to a GP for £5 a month. It’s partnering with a couple of NHS GP practices in Essex, and was (we think) the first app based service to be inspected by the Care Quality Commission. It was launched by serial disruptor Ali Parsa, of Circle fame.
At this stage Babylon is only being offered to the acute trust’s staff for their personal use. It hasn’t been offered to patients as part of the new model of care, although extending it in that way hasn’t been ruled out.
What’s going on here? Well, the trust hasn’t had to pay a penny so this is a good old fashioned loss leader from Babylon. It will probably be part of a campaign to build “brand awareness” and establish themselves as being safe and useful. In this case they’re experimenting with being an employee perk – this approach could easily apply outside the NHS and if employers like the idea that will represent dependable, annual bulk income for them.
Yeovil is only a small trust (turnover: £130m-ish) but its vanguard work has demonstrated it doesn’t want to leave cutting edge healthcare to the big boys in university towns. It has also partnered with Optum on business intelligence – its work on population segmentation has won the attention of national leaders. Its workforce totals about 2,500, including administrative staff, nurses and doctors on the full span of pay grades, providing a pretty good cross-section of working people.
If you think technology might form part of the offer for your population – particularly for those who aren’t old, frail or chronically ill – your own staff might be a good place to start if you want to find out who is interested enough in the model to sign up and download the app, and what the actual usage is like.
As I always end up saying, new care models can only be brought about once you’ve won the hearts and minds of your staff: particularly the GPs.
There is a fair amount of scepticism in primary care about app-based care and Babylon in particular. Once the year’s free trial expires, Yeovil leaders will know whether clinicians think it is any good and something they can work with.
At this stage it is not obvious to many practices whether apps are an existential threat, completely useless, an indulgence for the worried well, actively harmful, or a labour-saving boon.
Yeovil chief Paul Mears has admitted that the pilot was causing “anxiety” among GPs. If Babylon is worth incorporating into the Symphony programme, perhaps it will help if doctors and nurses are making the argument for it, rather than hospital bosses or NHS commissioners who many GPs are a bit suspicious of.