The involvement of GPs is the most important and most challenging factor facing any area wanting to trial one of the new models of care detailed in the NHS Five Year Forward View, Simon Stevens has said.

The NHS England chief executive told HSJ that more than 100 areas had expressed an interest in becoming part of the “vanguard” implementing new integrated ways of working. The deadline for submissions was yesterday.

The forward view detailed four new models of care that national bodies would support local leaders to implement over the coming years. Two of these – multispecialty community providers, and primary and acute care systems – involve integrating primary care and hospital care in a single provider organisation.

GP taking patient's blood pressure

Bringing primary care in on a large scale will be the most challenging factor for vanguard applicants, Simon Stevens said

Mr Stevens said that although he was willing to consider applicants’ suggestions for how they might diverge from the models set out in the forward view, “there are some tests; one of them is the extent to which you’re bringing list based general practice into the equation”.

He continued: “If when people say [they want to try implementing] a hybrid, and that’s a way of ducking some of the difficult changes that are required locally, that won’t be a strong contender for action in 2015-16.”

Mr Stevens said that bringing primary care in on a large scale would be the single most challenging factor for vanguard applicants.

“A lot of what people have been thinking about is building out from the hospital and integrating the community health services – fine, but there are plenty of parts of the country that are already doing that.

“The issue is combining primary care with a population accountability,” he said, adding that a “relationship of equals” was needed between primary care and hospital providers.

NHS England guidance on new care models published last month for prospective vanguard bidders said a primary and acute care system, or PACS, should cover a population of “at least a small district general hospital”, or 200,000-250,000 people.

The size of the PACS will be determined by the size of the combined GP practice list involved, and “may become much larger” than 250,000, the guidance said. It also recommended multispecialty community providers, or MCPs, operate across a GP list population of at least 30,000-50,000.

Vanguard sites could develop new organisations to run a PACS or MCP, but existing NHS organisations must retain ultimate accountability, Mr Stevens suggested.  

“Where public assets are being vested in one of these new organisational forms, then we do need a safeguard on the use of those public assets,” he said.

“I expect in practice we’re going to see the combination of the foundation trust organisational shell expanding in new ways, we’re going to see some special purpose vehicles that combine sovereignty of existing organisations.

“I think there’s enough flexibility in the current arrangements to enable us to make the movement we need in 2015-16.”

Mr Stevens also said NHS England now had to make a judgment about how many applications should be accepted into the vanguard. He said a balance had to be struck between having few enough vanguard sites for the money available to support each one to be a “meaningful” amount, and backing the enthusiasm that the process has revealed.

He also said applicants will have a role in choosing which sites receive external support, “because the point of them is not just that they do interesting things, but that they also produce learning for the health service as a whole”.