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Developing new models of care in the PACS vanguards

A new national approach to large-scale change?

The PACS model is an attempt to bring about closer working between GPs, hospitals, community health professionals, social care and others.

As the national new care models programme comes to a close, we invited those who have led the development of the PACS model, nationally and locally, to reflect on the process of being part of the programme, and of trying to bring about complex change in local systems. This report is not an evaluation of the PACS model or of the new care models programme, but it offers a unique set of first-hand perspectives into the experience of those leading a major programme at the national level and those living it at the local level. The insights shared will be invaluable to those constructing future national support programmes intended to facilitate transformation in local health and care systems. The lessons learned will also be highly relevant to those involved in the ongoing implementation of PACS and similar models.

This independent report was commissioned by NHS England as part of a package of support provided to primary and acute care system (PACS) vanguard sites by The King’s Fund. 

Key messages

  • National bodies can support large-scale change in the health and care system by acting as catalysts of locally led innovation. The new care models programme provides a case study of a major national programme that has attempted to put this type of bottom-up, facilitative approach into practice, and shows the value of national bodies working in this way.

  • In the PACS vanguard sites, relatively modest transformation funding has helped to catalyse significant amounts of innovation in terms of both frontline services and wider structures supporting system-wide collaboration. The most important enablers of change have included an infrastructure for sharing learning between sites, access to specific forms of technical expertise, and a supportive relationship with national bodies.

  • Bringing about system-wide change at the local level requires strong relationships, trust and an ethos of mutual interest. Building this takes time, and in many vanguard sites efforts to develop system leadership and a shared local vision began several years before the new care models programme commenced.

  • Relationships were strengthened in vanguard sites through regular communication, creating joint posts across organisations, co-locating teams, and fostering a culture of openness and transparency between partners. This kind of relationship-building needs to happen before making more formal changes to contractual arrangements or organisational structures.

  • Further work is needed at the national level to remove legal, regulatory and financial barriers that inhibit integrated working across organisational boundaries, including issues around VAT, pensions, contractual terms and conditions, information governance, and procurement laws. Without this, progress locally will be frustrated and there is a risk of some of the momentum being lost. Changes to the legislation will be needed to ensure current developments are aligned with the statutory framework.

  • Spreading and scaling-up innovations from the vanguards sites is the challenge to which system leaders are now turning. With funding for the new care models programme coming to an end, it is not clear where the support for this will come from. National leaders cannot rely on passive diffusion of good practice, and should develop a strategy to ensure that insights from vanguard sites are actively applied in sustainability and transformation partnerships and integrated care systems. This is needed to avoid the risk of learning from the new care models programme being lost.