Place-based systems of care: A way forward for the NHS in England

The NHS in England is facing growing financial and service pressures at a time of rising demand. This paper proposes a new approach to tackling these challenges. It argues that NHS organisations need to move away from a ‘fortress mentality’ whereby they act to secure their own individual interests and future, and instead establish place-based ‘systems of care’ in which they collaborate with other NHS organisations and services to address the challenges and improve the health of the populations they serve.

The paper argues that this will require the backing and support of national bodies and policy-makers, and fundamental changes to the role of commissioning in the NHS.

Key findings

• Collaboration through place-based systems of care offers the best opportunity for NHS organisations to tackle the growing challenges that they are faced with.
• Organisations should work together to govern the common resources available for improving health and care in their area.
• The approach taken to developing systems of care should be determined within each area using a common set of design principles, which are outlined in the paper.
• There are different options for collaboration, and work in England, the United States and other places offers examples of how this is being attempted.
• National bodies and policy-makers have an important role to play in removing the obstacles to the development of systems of care and offering advice and support.
• Major changes to the role of commissioners are needed to support the development of systems of care.

Policy implications

• Commissioning in the NHS needs to become both strategic and integrated. This means commissioners focusing on defining and measuring outcomes, putting in place budgets covering the whole of a population’s care, and using long-term contracts with providers linked to the delivery of these outcomes.
• It also means NHS commissioners working together across larger areas than those typically covered by CCGs today, and pooling budgets with local authorities.
• There are many things that national bodies in the NHS and policy-makers can do to facilitate the development of systems of care and these are highlighted in the paper.

It will, however, require organisational leaders to surrender some of their autonomy in pursuit of the greater good of the populations they collectively serve, and national leaders to act urgently to enable systems of care to evolve rapidly.