NHS England has selected 29 ‘vanguard’ areas to develop new models of integrated services which can be replicated across the country. The sites include some of the most challenged health economies in England and well established pioneers of joined up care.

The vanguard areas will be expected to spend the next year establishing three of the new models of care set out in the NHS Five Year Forward View. These are: multispecialty community providers (or MCPs), primary and acute care systems (or PACS), and enhanced health in care homes.

NHS England

‘Being in the vanguard will be quite challenging,’ Samantha Jones said

The expectation is that the MCPs and PACS areas will be ready to run on a single capitated budget to pay for health services for a defined population by the end of 2015-16.

Samantha Jones, NHS England’s director for the new care models programme, told HSJ she did not believe all the vanguard areas would be successful, but added: “That’s OK, because these are new care models.”

“Just because people are approved now doesn’t mean they will be vanguards in six months’ time.”

“We know that some places might not succeed and some places may deliver something different [to what is required of the vanguard areas]. Being in the vanguard will be quite challenging. I suspect there may be some who say, ‘actually this isn’t the right thing for us to be doing at this precise moment in time’.”

The successful bidders will still have to go through a “gateway process” to assure that they are capable of implementing new care models quickly.

The vanguard announced today consists of 14 MCPs, nine PACS and six sites trialling enhanced health in care homes (see box, below).

Vanguard areas will be expected to deliver efficiency gains across the health system for the whole population they cover, although Ms Jones said these will not be required during 2015-16.

However, she added that NHS England did expect vanguards to be able to demonstrate measurable improvements in quality of care. The metrics used will be nominated by the vanguards themselves, subject to agreement by NHS England. They will not necessarily be existing nationally reported indicators, but they must be nationally replicable, and it must be possible to assess progress in close to real time.

Ms Jones said this aspect had been subject to a “significant debate”. “What we’re going to do is have real time improvements on a monthly basis. We’re not going to say ‘in three years’ time we’ll do a full evaluation and see if it has made a difference or not’.”

Successful vanguard sites include well known pioneers of expanded primary care, such as Whitstable, Northamptonshire’s Lakeside Healthcare and Birmingham’s Vitality Partnership. Airedale, Northumbria and Salford are also included.

However, some more challenged health economies have also made the list, such as the Wirral system, and the troubled health economy that surrounds and includes University Hospitals of Morecambe Bay Foundation Trust in Cumbria and North Lancashire.

Not all the PACS and MCP models include social care, although council run care services are an integral part of the offer of some of the vanguard sites such as the Lancashire North and Cumbria, and Nottinghamshire PACS proposals.

Although NHS England’s guidance for vanguard applicants suggested that an MCP would cover a smaller population than a PACS, some of the proposed MCPs have populations as large as many district general hospital catchment areas. MCPs in Dudley, Northamptonshire and West Cheshire all propose to cover populations of 300,000 or more, while the Salford PACS would serve a population of 230,000.

The vanguard programme will be supported by a £200m transformation fund.

How that money will be allocated has not yet been decided, and NHS England says it will agree with each area how much they are given based on what is needed locally. The fund will largely support double running costs.

No governance models have yet been identified for the new care models. These will be developed as the vanguard progresses, meaning it will likely be many months before it emerges how an MCP or a PACS model will be constituted in the long term.

NHS England will offer a programme of support for the vanguard sites, which it says will be tailored to the needs of each local area. This will include helping areas with joining up information systems, devising new contractual models, workforce redesign, and patient and community engagement.

There will also be a programme for “fast followers” – areas which made strong bids but have not been included among the 29, which will be among the first places beyond the vanguard to adopt new care models. The programme will now be developed by NHS England and the King’s Fund.

The 29 vanguard sites are:

Primary and acute care systems

  • Wirral
  • Mid Nottinghamshire
  • Northumbria
  • Yeovil
  • Salford
  • Lancashire North and Cumbria
  • North East Hampshire and Farnham
  • Harrogate
  • Isle of Wight

Multispecialty community providers

  • Fylde Coast
  • Calderdale
  • Erewash
  • North Birmingham and Sandwell
  • West Wakefield
  • Sunderland
  • Stockport
  • Dudley
  • Whitstable
  • Tower Hamlets
  • Southern Hampshire
  • West Cheshire
  • Northamptonshire
  • Rushcliffe

Enhanced health in social care

  • East and North Hertfordshire
  • Nottingham
  • Sutton
  • Airedale
  • Wakefield
  • Gateshead