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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 NHS England, working with the other national NHS oversight bodies, will identify areas in two categories, which will move faster than elsewhere to new models as outlined in the NHS Five Year Forward View
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”.
For these areas NHS England, Monitor and the NHS Trust Development Authority 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 and 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 January 2015.
The areas will be identified as part of the planning process for 2015-16 under guidance to be published before Christmas.
For these areas NHS England, Monitor and the NHS Trust Development Authority 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 and 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 January 2015.
The areas will be identified as part of the planning process for 2015-16 under guidance to be published before Christmas.
Funding
During his lecture Simon Stevens indicated CCGs that are behind their target funding allocations will receive greater shares of the additional NHS funding announced by the government. Some £1.5bn is due to be allocated to CCGs and specialised commissioning budgets. He indicated that there would be a “particular emphasis… depending on the decisions that are taken at the NHS England board meeting on 17 December, on helping those places that are furthest away from their fair shares of resources”.
The remaining money will be used to introduce the new care models outlined in the Five Year Forward View and “kick-start transformational change”.
Mr Stevens also spoke about the £22bn efficiency savings he has estimated the NHS will need to make in the coming five years, saying “we don’t have a choice” but to achieve it.
New models of care
Proposals for new models of providing care were outlined in the Five year Forward View. 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.
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.
Multispecialty community providers
The NHS England chief executive has set out requirements that define a ‘multispecialty community provider’ (MCP), one of the key care models in his vision for the future of the NHS. He indicated that were currently no arrangements that met the conditions of an MCP. “This is not just a federation of GP practices and it’s not just a relabelled care trust.”
Features of an MCP included
During his lecture Simon Stevens indicated CCGs that are behind their target funding allocations will receive greater shares of the additional NHS funding announced by the government. Some £1.5bn is due to be allocated to CCGs and specialised commissioning budgets. He indicated that there would be a “particular emphasis… depending on the decisions that are taken at the NHS England board meeting on 17 December, on helping those places that are furthest away from their fair shares of resources”.
The remaining money will be used to introduce the new care models outlined in the Five Year Forward View and “kick-start transformational change”.
Mr Stevens also spoke about the £22bn efficiency savings he has estimated the NHS will need to make in the coming five years, saying “we don’t have a choice” but to achieve it.
New models of care
Proposals for new models of providing care were outlined in the Five year Forward View. 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.
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.
Multispecialty community providers
The NHS England chief executive has set out requirements that define a ‘multispecialty community provider’ (MCP), one of the key care models in his vision for the future of the NHS. He indicated that were currently no arrangements that met the conditions of an MCP. “This is not just a federation of GP practices and it’s not just a relabelled care trust.”
Features of an MCP included
- Blended primary medical services with some specialists in a single organisation, and an expanded multidisciplinary team that includes pharmacists and nurse leaders.
- In-reach work in other care settings, for example care homes
- Development of “sophisticated risk stratification” where the patient list is divided into segments to identify the top 5 or 6 per cent of patients with the most complex conditions.
- They required integration with NHS 111, primary care extended access
- a “clear set of metrics” to measure performance
- a minimum population size of 50,000.
- Adoption of the NHS England emergent urgent and emergency care strategy
- Taking on responsibility for managing some acute medical patients of a district general hospital.
- MCP providers could optionally decide to take on responsibility for a delegated population budget and could take control of some community hospital services, but not acute hospital services.
