Introduction to the New Care Models – Vanguard Sites

In January 2015 the NHS invited individual organisations and partnerships, including those with the voluntary sector to apply to become Vanguard sites for the New Care Models Programme.

In March 2015 the first wave of 29 vanguard sites were chosen and in July a second wave of eight vanguards was announced, known as urgent and emergency care vanguards followed by a third wave of 13 Acute care collaboration vanguards sites In September 2015

The  Vanguard sites are part of what is known as the New Care Models Programme, a new initiative by NHS England to support the implementation of its The Five Year Forward View (5YFV), which sets out the future vision of the NHS.

Chapter three of the Five Year Forward View sets out what these new models of care might look like based on a number of emerging models.

Each vanguard site will take a lead on the development new care models:

Integrated Primary and Acute Care Systems – will join up GP, community, mental health and hospital services.

Under this new care model, primary and acute care systems (PACS) would provide list-based GP and hospital services, together with mental health and community care, in single NHS organisations for the first time. They could evolve in different ways, for example, by hospital trusts opening their own GP surgeries. Under some circumstances, PACS could become accountable for the whole health needs of a registered list of patients.

Multispecialty Community Providers – So what are the Multispecialty community providers vanguard sites going to be doing?

Well, in a nutshell ……. multispecialty community vanguards are all about  moving specialist care out of hospitals into the community – an often talked about aspiration that these 14 Vanguard sites will be making a reality

Under this new care model, GP group practices would expand, bringing in nurses and community health services, hospital specialists and others to provide integrated out-of-hospital care. These practices would shift the majority of outpatient consultations and ambulatory care to out-of-hospital settings. Over time, these providers might take on delegated responsibility for managing NHS budgets (or combined health and social care budgets) for their registered patients. 

Enhanced health in care homes – will aim to improve services for older people, joining up health, care and rehabilitation.

Under this new care model, the NHS will work in partnership with care home providers and local authority social services departments to develop new shared models of care and  support, including medical reviews, medication reviews and rehabilitation services. These should build on work being done locally through the Better Care Fund and will draw on models that have been shown to improve quality of life, to reduce hospital bed use and to yield significant cost savings.

Urgent and emergency care – will look at new approaches to improve the coordination of services and reduce pressure on A&E departments.

These new models will see care delivered by GPs, pharmacists, community teams, ambulance services, NHS 111, and social care. Six of the programmes will cover smaller areas including GP practices and social care, with two larger network vanguards integrating across larger populations.

Acute care collaboration vanguards  - The 13 acute care collaboration vanguards will link together local hospitals to improve their clinical and financial viability.

You can find out more about the East and East Midlands Vanguard sites here or please contact Jayne Quantrill - Health and Wellbeing Coordinator Wellbeing East and East Midlands at 

There are a few things are worth noting about the vanguard sites:

  • The projects' ambitions range from organising a broader range of community and specialist care services around groups of GP practices to the development of fully integrated care organisations delivering a wide range of services under a capitated budget.

  • The proposals are led, variously, by CCGs, hospital trusts, community trusts or in some cases large GP practices or GP provider organisations. 

  • Some proposals are built on a genuine broad collaboration of commissioning and provider organisations, others have a clear lead provider around which other services will be structured.

However the aim is not just to improve services in the Vanguard areas, but to also develop models that can be replicated elsewhere, drawing on recent lessons from other leading edge areas, such as the integrated care pioneers which will act as the blue prints for the NHS moving forward

What does this mean for patients?

According to NHS England ‘this is all about making health services more accessible and more effective for patients, improving their experiences and their outcomes. This could mean fewer trips to hospitals as cancer and dementia specialists hold clinics in local surgeries, one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home’.

What does this mean for the voluntary and community sector?

Many of the new care models are focused on existing emerging models, some of which seek to make better use of voluntary and community services which can support people with long term conditions to meet their health and wellbeing needs.

An example of this is social prescribing – NHE England cites the Rotherham model whereby GPs and community matrons work alongside voluntary sector advisors who know what voluntary services are available for patients with long term conditions

Resources - New Care Models Vanguards

New Care Models: Vanguards – a blueprint for the future of NHS and care services

Vanguards Support Directory This directory outlines the support currently available from the Five Year Forward View arm’s length bodies and some of the voluntary sector strategic partners.

Other useful resource collections:

King’s Fund – Integrated Care: Commentary and resources focusing on the widespread adoption of integrated care to meet the needs of frail older people and others with complex health and social care needs.

Local Government Association – Integration and the Better Care Fund: The LGA works with councils to support, promote and improve local government.

Public Service Transformation Network: The role of the Transformation Network is to support and enable the transition to ‘better local services for people’ by developing, identifying and spreading evidence of what works.