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

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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.


Anita moore

Chief population health officer,
Comment date
16 April 2017
Excellent articles

john kapp

Comment date
15 December 2016
I attended two conferences at the Kings Fund (29.11, and 1.12) about sustainability and place based care, see my write up in paper 9.111 on Michael Dixon spoke at both about social prescribing of drug free interventions in the community is the only way to make the NHS sustainable and improve the health of both patients and doctors

Roy Booth

Comment date
05 July 2016
Your comment may be right but please don't criticise the existence of the CQC. Without their actions the private care home which my wife is In would not have pulled its socks up and brought its standards up to an acceptable level,. The ever present threat of an inspection by the CQC is vital to prevent the Care Home industry putting profit before quality of care.

Jo Thomson

independent living Co-ordinator,
Comment date
24 January 2016
Part of discussing a draft health and well being strategy, this has given me good guidance and discussion points.

Alan Higgins

Director of Public Health,
Oldham Council
Comment date
29 November 2015
Great report and useful to have ten principles proposed for development of systems of care in the NHS. That last part, in the NHS, is a limiting factor and other parts of the report make it clearer that the whole system should include local government responsibilities and services and include patients and carers and voluntary sector services. Also points 4 - 7 are about governance arrangements which are undeniably important but might exhaust the will of all but the most committed before any of the other points are addressed.

Iain Ashworth

Barrowford Surgery
Comment date
24 November 2015
The NHS has too many vested interest groups. That is clear. It also has far too many quangoid organisations, such as CQC, hanging on its coat tails. Formalised individual budgets, with responsibility recognition need to be considered carefully. Kings fund sometimes have some good ideas, but seldom with are they actually put in place.

Sukhvinder Kau…

Comment date
23 November 2015
While I'm sure we have to focus on place, lets not confuse community of interest with community based providers. The support networks around individuals are not all place based - increasingly they are virtual. But that's not my point - it's the relationships that count and the problem with place based solutions is that they prioritise buildings and physical centres rather than the people and their interests.

Stella Tsartsara

Integrated Care expert,
South East Europe Healthcare
Comment date
17 November 2015
A great report without reservations. The Place based systems of care is the future - there is nothing more to day. And it is inevitable. I tried to put myself to the shoes of those who are criticizing and frankly I did not find anything that struck me at least at all.
More implementation results are needed in this direction. Myself I am also implementing exactly the same model in Greece exactly because the resources are scarce.

George Coxon

Independent commissioning advisor,
Comment date
13 November 2015
Good read Certainly one for reference but lack of social care engagement as key theme is disappointing As a long term NHS supporter senior commissioner for many years. 2 x senior roles in health authorities and clinical roles aplenty I still see protectionism and self interest dominating the self perpetuating ' me and mine ' agenda. Fortress mentality must be tackled by real commitment to H&SC integration and collectivism. Was struck by last paragraph on page 6 Not meaning to sound negative here. As said. Good report useful read and one I will recommend. Thank you.

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