1. NHS Five Year Forward View
New care models - update
Samantha Jones, Director - New Care Models

2. Update on New Care Models Contents1.
New care models: our aims, values and design principles 2.
Co-designing the support package 3.
Eight key enablers of transformation delivered through ten joint workstreams 4.
Summary of the national support package 5.
Timeline for delivery and next steps

3. Health and wellbeing Efficiency
Triple aims of the programme
Health and wellbeing 1
Care and quality 2
Efficiency 3

4. New care models programme: four core values
Four core values underpin the new care models programme and the way we work. They are fundamental to the way that we have co-produced the support package and the way in which we will deliver it
Clinical engagement
Patient involvement
Local ownership
National support
Each of the vanguards will be rooted in its own local community, but supported at a national level to ensure that common opportunities for replicable care redesign are exploited, and common barriers to change addressed
Strong clinical engagement and patient involvement underpin the design and delivery of the programme

5. Four key design principles have emerged which frame the support package
The eight key enablers will be delivered through ten joint workstreams , jointly led by a vanguard leader and national subject matter expert working to decide how it will be taken forward
1. We solve problems through joint national and local leadership
The principle of replicability is integral to the design of what all vanguards do. The success of the programme and the value delivered for taxpayers will be defined by the extent to which learning is easily spread across the country
2. We create simple replicable frameworks, built for spread
We want to encourage vanguards to become more revolutionary in their thinking. We will enable existing silos to be dissolved – for example, through new approaches to commissioning, contracting, payment and provider forms
3. We encourage and support radical innovation
We know that we need to work at pace. Unless we can start to see demonstrable, quantified change occurring in 2016/17, it will become harder to justify significant national investment
4. We work and learn at pace, demonstrating that change and improvement is real

6. Five types of new care model will be designed, delivered and replicated
Models of delivery
The 5 types of new care models are:
Multispecialty Community Providers (MCPs) - moving specialist care out of hospitals into the community
Integrated Primary and Acute Care Systems (PACS) - joining up GP, hospital, community and mental health services
Enhanced Health in Care Homes - offering older people better, joined up health, care and rehabilitation services
Urgent and Emergency Care (UEC) - new approaches to improve the coordination of services and reduce pressure on A&E departments
Acute Care Collaboration (ACC) - local hospitals working together to enhance clinical and financial viability
Already selected and in set-up phase – support package is for these 3 models. Value propositions and approval for funding for some vanguards are in process
In process of selection – support will be co-designed and published by October 2015 1 2 3
Selected on 20th July – support will be co-designed and published by October 2015 4 5

7. 37 vanguards developing their visions locally
Integrated primary and acute care systems (PACS) 1
Wirral Partners 2
Mid Nottinghamshire Better Together 3
South Somerset Symphony Programme 4
Northumberland Accountable Care Organisation 5
Salford Together 6
Better Care Together (Morecambe) 7
North East Hampshire and Farnham Clinical Commissioning Group 8
Harrogate and Rural District Clinical Commissioning Group 9
My Life a Full Life (Isle of Wight)
Multispecialty community providers (MCPs) 10
Calderdale Health and Social Care Economy 11
Derbyshire Community Health Services NHS Foundation Trust 12
Fylde Coast Local Health Economy 13
Vitality (Birmingham and Sandwell) 14
West Wakefield Health and Wellbeing Ltd 15
Better Health and Care for Sunderland 16
Dudley Clinical Commissioning Group 17
Whitstable Medical Practice 18
Stockport Together 19
Tower Hamlets Integrated Provider Partnership 20
Better Local Care (Southern Hampshire) 21
Primary Care Cheshire 22
Lakeside Surgeries (Northamptonshire) 23
Principia Partners in Health (Southern Nottinghamshire)
Urgent and emergency care (UEC) 30
South Nottingham System Resilience Group 31
Cambridgeshire and Peterborough Clinical Commissioning Group 32
North East Urgent Care Network 33
Barking and Dagenham, Havering and Redbridge System Resilience Group 34
West Yorkshire Urgent and Emergency Care Network 35
Leicester, Leicestershire & Rutland System Resilience Group 36
Solihull Together for Better Lives 37
South Devon and Torbay System Resilience Group
Enhanced health in care homes 24
NHS Wakefield Clinical Commissioning Group 25
Gateshead Care Home Project 26
East and North Hertfordshire Clinical Commissioning Group 27
Nottingham City Clinical Commissioning Group 28
Sutton Clinical Commissioning Group 29
Airedale & Partners

8. Co-designing the support package with and on behalf of vanguards
Two-day diagnostic site visits
We listened to diverse representatives - from patients, clinicians, the voluntary sector and commissioners
This gave an insight into the vanguards’ proposed models of care
We built relationships with vanguards to bring the national team and local teams closer together
Outputs from site visits and further discussions with vanguards were developed into thematic analyses for each type of care model
There is good consensus that the thematic analyses represent the vanguards’ broad proposals for their care model locally
The support package consists of eight enablers delivered through 10 joint workstreams
We are building the support package with and for the vanguards
As we do this, the national team is testing out each element of the emerging support package to ensure that it responds to the needs of vanguards
This brings co-design into action, creating a strong partnership between vanguards and the national team
Site visits
Thematic analyses
Support package

9. Summary of support package: eight key enablers of transformation

10. 1. Designing new care models
Key elements of support:
Local care model design - analytical support segmenting populations and identifying interventions; access to NHS England’s Right Care programme
Ongoing development and implementation - action research to evaluate the impact of new care model components; clinical expertise and advice from new care model clinical associates, and NHS England’s medical directorate clinicians
Vanguards will be supported to design and implement their overarching care model based on population needs, and to understand the key components of their care model which add the greatest impact and value for patients

11. 2. Evaluation and metrics
Key elements of support:
Development of logic models as a foundation for development - intensive one-to-one support on logic model development
Evidence-based interventions - evidence summaries produced for the interventions being implemented through each care model
The vanguard approach to evaluating new care models - task and finish groups to focus on areas of common challenge; a senior responsible officer for evaluation; co-produced evaluation strategies
Core metrics across the care models – a core set of metrics for each care model; a standardised approach to measuring patient experience; a standardised dashboard for each vanguard to show progress against the metrics
Vanguards will be supported to develop evidence-based interventions. Impact assessment and continuous improvement will be established from common local metrics and evaluation which identify the active ingredients of each care model

12. 3. Integrated commissioning and provision
Key elements of support:
Capitated pricing - small number of new payment and incentive models that can be implemented locally; budgetary flexibility of merging separate provider funding streams into single pot; expertise on implementing new capitation approaches
Quality payments – new pay-for-performance schemes developed; co-design of a limited menu of options
Bundled contracts, integrated commissioning and procurement - new standard MCP contract and PACS contracts
Model provider-to-provider sub-contract - new model sub-contract; non-mandatory model alliance agreement; access to legal advice provided for existing projects
Integrated commissioning – establishment of the new care models commissioning group; practical support to manage integrated commissioning
Options for new integrated organisational forms – support to understand options, risks and benefits; centrally commission legal advice to cover relevant issues
New integrated commissioning approaches will allow vanguards to deliver care collaboratively designed around the whole needs of patients. These will provide opportunities for capitated payment through new standard contracts

13. 4. Empowering patients and communities
Key elements of support:
Personalised care and empowering choice - support in developing partnerships with voluntary organisations; advice on personal budgets
Expert advice to support vanguards to meet six principles – developed by the Five Year Forward View People and Communities Board
Directory of support – publishing a comprehensive directory of national and local services available to vanguards
Vanguards be supported to work in partnership with patients, people and their community, empowering them and enabling choice through personalised budgets, care planning and peer support

14. 5. Harnessing technology
Key elements of support:
Connected digital solutions and information systems - dedicated technical support to develop local integrated care records; interoperability handbook
Information governance - practical help to develop information sharing agreements and guidance on information governance
Digital strategy - diagnostic support to map digital resources; expertise to define digital priorities and strategies; advice to select the right digital solutions
Managing system vendors - support to collate technology requirements and enable collective market engagement and procurement at scale
Vanguards will be supported to develop connected digital solutions and provided with expertise to unblock information governance barriers, accelerating the use of data and technology locally

15. 6. Workforce redesign
Key elements of support:
Local workforce strategy - self-assessment tool on capacity and capability for workforce redesign; support to develop plans for delivering local strategies
New and extended roles, skills and training - common skill descriptors and job descriptions developed for new and extended roles; support to develop specific roles; training resources
New ways of working - resources to support multi-disciplinary working, mental health crisis care transformation and person-centred community care; facilitated simulation exercises to understand the challenges of multi-professional working; peer learning sets
Vanguards will be supported to map and profile their existing workforce, develop new and extended roles and new ways of working which support multi-disciplinary team working and shared responsibility

16. 7. Local leadership and delivery
Key elements of support:
System leadership - “Community of Practice” leadership programmes; learning on system leadership from international partners
Integrated and flexible leadership - leadership programmes to support specific needs; learning community for primary care and community professionals; multi-disciplinary learning sets
Leadership at all levels - exploration of ways to access leadership schemes for clinical and non-clinical staff
Supporting local delivery - programme planning and project management approaches; dedicated account manager for each vanguard; access to funding for set-up via the Transformation Fund
Use of local health and social care assets - best practice roadmap for estates management; surgery sessions; framework on how to rationalise estate across partners; advice and legal support to deal with financial legacy of Private Finance Initiative deals
Vanguards will be supported to strengthen system leadership across all organisations, distributing and empowering leadership at the frontline and creating clinical and professional leadership which embraces integration

17. 8. Communications and engagement
Key elements of support:
Communications and engagement strategy - expertise to develop communication and engagement strategies; new evaluation tool to enable vanguards to assess and compare the impact of their strategy
Sharing best practice and methods - range of tools to share the learning as part of a detailed collaboration plan; online tool to enable rapid dissemination of learning across the vanguards
Vanguards want to develop effective local communications and engagement which strengthens local collaboration of partners where staff, local people and other stakeholders. Vanguards will be provided with expertise and resources to deliver local best practice which allow local people and staff to champion their emerging model

18. 8 key enablers delivered through 10 joint workstreams
New care model joint workstreams
Leadership and system development
Workforce redesign
Empowering, patients and communities
Evaluation and metrics
Harnessing technology
Commissioning, contracting and procurement
Payment design and pricing
Organisational form
Estates
Communications and engagement
Each workstream will be led by a local vanguard and national subject matter expert
The joint workstream leads will:
Decide together how the work should be taken forward – including what problems need to be fixed, and how to ensure national replication.
Identify the support they require from national bodies, commission it from us and hold us to account for delivering it
The primary role of the national bodies is to align behind the vanguards, and remove blocks and reduce burdens

19. Transformation funding
The vanguards have access to the £200 million Transformation Fund. Each vanguard has been given the opportunity to submit value propositions demonstrating delivery against the triple aims of the programme.
Efficiency requirements are core to this, and vanguards are demonstrating through these propositions how they will deliver the requirements of additional efficiencies by the end of 2017/18.
Following consideration by NHS England’s Finance and Investment Committee, approval has been given in principle to the initial £61m requests for funding, subject to some clarification, including of savings.
Those vanguards that chose not to submit a value proposition at this time are actively working on them over the summer with the NCM team.

20. Timeline for delivery and next steps
Support package design
March – July 2015
Support package delivery
August – March 2016
Continual refinement to support package as delivery progresses
March 2016 onwards
Publication of initial support by 31 July - developed in collaboration with vanguards, national bodies and partner organisations
Sites for two further care models selected
Local and national evaluation
Support programme evolves and develops to optimise local delivery and national replication
Delivery of support commences
Support package for two further care models developed and published