Oxford dictionaries  give two definitions of vanguard:
- A group of people leading the way in new developments or ideas
- The foremost part of an advancing army or naval force
Either is applicable to the 29 NHS vanguard sites, all charged with developing the new care models outlined in the Five Year Forward View , a partnership between NHS England, the Care Quality Commission, Health Education England, Monitor, the NHS Trust Development Authority, Public Health England, and the National Institute for Health and Care Excellence. Recommendations of the Dalton review  were also considered.
These new care models seek to allow flexibility and creativity in care delivery with partnerships between the NHS and external agencies (for example, social care), thereby eliminating the traditional divide between primary care, community services, and hospitals, a barrier to personalised and coordinated health services . Through the new care models programme, complete redesign of whole health and care systems are being considered; According to NHSE , this could mean:
- Fewer trips to hospitals as cancer and dementia specialists will hold clinics in local surgeries
- Having one point of call for family doctors, community nurses, social and mental health services
- Access to blood tests, dialysis or even chemotherapy closer to home.
It will also join up the often confusing array of A & E, GP out of hours, minor injuries clinics, ambulance services and 111, thus patients will know where to get urgent help easily and effectively, seven days a week .
The models fall into seven categories:
- Multi-specialty Community Providers (MCPs): federations, networks and super partnerships will be developed to enable general practices to operate on the scale required to deliver a wider range of services. Such services would include those provided by some specialists alongside other professionals 
- Primary and Acute Care Systems (PACS): single organisations to provide NHS list-based GP and hospital services, together with mental health and community care services’ 
- Urgent and emergency care networks: more appropriate use of primary care, community mental health teams, ambulance services and community pharmacists and other specialist emergency centres
- Viable smaller hospitals: new organisational models will be explored.
- Specialised care
- Modern maternity services
- Enhanced health in care homes
The initial 29 Vanguard sites are exploring multi-specialty community provider (MCPs) models, aiming to move specialist care out of hospitals into the community, integrated primary and acute care systems (PACS) – joining up GP, hospital, community and mental health services, and models of enhanced health in care homes, offering older people better, joined up health, care and rehabilitation services. More recently, a further eight sites which will explore the urgent and emergency care model have been announced.
The concept of the FYFW and the associated new care models have been largely hailed as a good thing. The King’s Fund however, urges caution as funding is required to implement new care models (after the initial pump-priming of Vanguard sites by the DH); this funding is likely to come from substantial improvements in productivity rather than from government .
Fortuitously, the same document offers suggestions on how to implement the new care models; presumably these will complement the recently published DH support package , as these merely refer to payment options for MCPs and PACS (capitation fees). This package has been developed with the NHS Vanguard sites, based on their experiences to date. The support package covers:
- Designing new care models – working to develop a local model of care, maximising the greatest impact and value for patients
- Evaluation and metrics – understanding the impact the changes are having on patients, staff and the wider population
- Integrated commissioning and provision – breaking down any barriers which prevent their local health system from developing integrated commissioning
- Empowering patients and communities – enhancing the way in which Vanguards work with patients, local people and communities to develop services
- Harnessing technology – rethinking how care is delivered, and helping organisations to share patient information
- Workforce redesign – developing a modern, flexible workforce organised around patients and local populations;
- Local leadership and delivery – developing leadership capability, learning from international experts
- Communications and engagement – demonstrating best practice in the staff, patient and local population engagement
Vanguard sites are in their early infancy. However, the lessons they are learning are being shared across the NHS, so that when the models are rolled-out across England, other organisations will not be working from a ‘standing start’. However, historically, change in the NHS has been difficult to sustain, even where they is a strong will on the part of individuals and organisations for such change.
We can only watch and wait.
If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.
- Oxford University Press. Oxford Dictionaries. 2015. http://www.oxforddictionaries.com/definition/english/vanguard Accessed August 2015
- NHS England. NHS England, Care Quality Commission, Health Education England, Monitor, Public Health England, Trust Development Authority. NHS five year forward view. London: NHS England. 2014 Available at: www.england.nhs.uk/ourwork/futurenhs/
- Dalton D. Examining new options and opportunities for providers of NHS care. The Dalton Review. 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384126/Dalton_Review.pdf Accessed August 2015
- NHS England. New care models – vanguard sites. http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/ Accessed August 2015
- Ham C, Murray R. Implementing the NHS five year forward view: aligning policies with the plan. King’s Fund, 2015. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf Accessed August 2015
- NHS England et al. THE FORWARD VIEW INTO ACTION: New Care Models: update and initial support. 2015. http://www.england.nhs.uk/wp-content/uploads/2015/07/ncm-support-package.pdf Accessed August 2015