Key choices when designing new systems

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Part of Supporting new NHS care models

Vanguards are developing a range of new governance and organisational approaches to support their efforts to develop new models of integrated care.

Areas covered by the approaches

  • Approaches to contracting for the new services
    Commissioners are deciding which budgets should be brought together and how they can be transferred to providers under a single contractual framework.
  • Partnerships and organisational forms among providers
    Vanguard sites are considering which providers should hold the budget for services and how they should be organised to deliver more integrated services. They are exploring a range of options, including sub-contractor relationships, joint ventures or mergers.
  • Governance, decision-making and management of providers’ systems
    Providers are starting to consider the governance and decision-making arrangements needed to manage care and quality effectively – for example, how to ensure that each partner delivers their commitments, how to promote effective joint working, and how to motivate teams and individuals to work differently.
  • Roles of commissioners in the new system
    Commissioners are considering their future role in overseeing more integrated systems, including which activities they should continue to carry out and which to share with or transfer to providers.
  • Approaches to measuring and incentivising performance
    As part of the contracting process, commissioners and providers are agreeing objective measures to assess the quality and outcomes of care. They are also considering options for motivating and incentivising performance.

Approaches being taken by some of the vanguard sites

Table showing summary of approaches taken at six of the vanguards