'Success regime' will direct struggling areas to new models, Stevens reveals

The NHS England chief executive set out the first steps for implementing his vision at the inaugural HSJ annual lecture, held in conjunction with advisory firm FTI Consulting.

In coming months his organisation, working with the other national NHS oversight bodies, will identify areas in two categories, which will move faster than elsewhere to new models, he said.

One group, he said, were those where services are under “very substantial pressure” and “struggling both financially and operationally”. They will be put into a new intervention process to be called a “success regime” - as opposed to a “failure regime” - to avoid “demotivation and stigma”, Mr Stevens revealed to an invited audience in London yesterday.

For these areas NHS England, Monitor and the NHS Trust Development Authority will be “directive in terms of the support that will be provided” – indicating they will be instructed where necessary on what changes need to be made. The approach will bring “the regulatory, the funding flexibility [and] the conditionality to chart a course for these places”, he said. They are expected to be identified by the national bodies early in the new year.

The second group of areas to be identified are those which can move quickly to new models because they have the right “conditions for transformation”. They are performing strongly and have good relationships. They will “get motoring” on new care models once national bodies remove a “number of obstacles… from their way”, Mr Stevens said. They will be “invited” to “co-create” the new models. NHS England and partners will ask for areas to express interest in joining this “vanguard” group by the end of next month, he said.

The areas will be identified as part of the planning process for 2015-16 under guidance to be published before Christmas.

Mr Stevens set out proposals for new models of providing care in the forward view in October. The two that have attracted the most attention are the “multispecialty community provider”, led by primary care, and “primary and acute care system”, which would bring together hospitals with general practice.

The NHS England chief warned providers against attempts to “re-spray” their existing services or projects as any of the care models proposed.

He said: “What we’re going to avoid through this whole process is the idea that people can just kind of re-spray something they’ve currently been doing and, hey presto, it emerges in the sunlight as one of these new things.

“Anybody who thinks they’re doing it already or that it’s easy doesn’t understand it. Nobody is doing this right now and it’s not going to be easy.”

Mr Stevens said he believed many GPs were now willing to move into dramatically new models of care. He appeared to indicate that where they were willing to give up independent contractor status, which they are paid through, the NHS may be able to guarantee their future income when they move into new provider forms.

He said: “I think there are legitimate fears… about what the future might hold and so I don’t think its illegitimate to seek to ensure that if GPs become part of new models then their financial circumstances are taken care of, because they’re the only people in the health service for whom their earnings [and] costs are directly tied to the structure of care.”

Financial loss, as well as loss of independence, is seen by GPs as a substantial barrier to moving into new models.