5 Year ForwardNew models and new ways of working

Food for thought

HE NHS England October 2014

Future changes in 5 Year Forward some of the key concepts Published October 2014

Multispecialty Community Provider Model (MCPS)

Expert generalist

FederationsNetworks

Single practices

Digital technology

Target people with complex

needs

Provide OPD services in

community & AC

Employ consultants as partners & or

non med senior practitioners

Credentialing GPs direct

admission rights to acute services

OOH inpatient care supervised

by new role resident

hospitalists

Run local comm. hospitals &

expand diagnostics

Expanded Leadership AHP Pharmacy, HCS

nurses

Funding may be delegated NHS

budget & or H&HSC

responsibility

Renewable energy of carers, voluntary,&

service users accessing hard to reach & new

ways to changing behaviours

Primary and Acute Care (PACS)

Single organisation to provide NHS list based GP & hospital

care with MH & community care

Most radical PACS take accountability for whole health

needs of reg. list under capitates budget similar to Accountable Care

Organisations in USA, Spain & Singapore

One option such as indeprived urban areas where

GPs under strain hard to recruit – hospitals will be permitted to open up own GP services with

lists

The leadership required for these vertically IC PACS may

vary in different localities

A range of options will permit a new variant of IC allowing single

organisations to provide NHS list based GP, Hospital Services, MH

and Community Care services

Other circumstances next stage in development of MCSP could

be that it takes over running main DGH

Urgent and Emergency Care networks

Evening & Weekend access to GP’s or nurses in

community bases with increased range of tests &

treatments

Ambulance services able to make more decisions, treating

patients, referrals & greater use of pharmacists

Ensure hospital patients have access to 7 day services where this

makes a clinical impact on outcomes

Develop networks of linked hospitals so most serious

needs get to specialist emergency centres

A strengthened clinical triage & advice service

linking systems together & help patients navigate the

systems

Proper funding of mental health crisis services

including liaison psychiatry

New ways of measuring quality of urgent & emergency

services

New funding arrangements & new responses to workforce requirements to make new

networks possible

Workforce implications – some thoughts

• New accountabilities• New partners• New teams • New skills• New ways of working• New roles• New culture• New concepts• New geographies

• New opportunities – staff, local people

• Generalist & specialist changes• New & or additional knowledge & skills

• Changing public relations• New career options• New ways of learning• A flexible workforce across services

Annual lecture – Simon Steven’s December 2014

• A chance to bring about a vision partly articulated some time ago.

• “Doctors and specialist will move freely from the hospitals to the health centres, to the maternity and child welfare clinics, and from them back to the hospitals and between the medical officers of health…This will be an essential feature of the whole service; between the local government, the specialists, and the hospitals, there must be absolute and complete cooperation, and no jealously between one and the other.

• “They must be able to use each other’s services without any difficulty and hindrance, and the way in which it will be done…will be the right of the individual patient…to use of the  medical service wherever it is. The right of the individual will be the uniting principle in the whole service.” 

• That was Nye Bevan in 1946. Sixty-eight years later, let’s give it a shot.

Five Year Forward - Simon Steven’s December 2014

‘The forward view is a compass, not a map’

Four new dynamics - Simon Steven’s December 2014

•First, we have the opportunity to move away from care geared towards the “median” patient. Personalisation

• Second, and at the same time, we are going to have more standardisation in the way care is provided. Standardisation ‘For the first time we’re drawing back the veil on unjustified variation to have more standardisaton’

• Third, anticipatory care - moving away from healthcare systems that principally rely on people pitching up to see a health professional when they get sick - towards healthcare systems that are much better able at stratifying risk, identifying upstream care opportunities, and targeting interventions accordingly.

• And fourth, getting real about co-production; recognising that it is often the “experts by experience” who bring the assets, insights and commitment that will reshape the way care is provided.

Push and pull factors - Simon Steven’s December 2014