As part of the NHS’ strategic plan, the Five-Year Forward View, last year NHS organisations and partnerships were invited to trial new ways of running primary and secondary care services by becoming ‘vanguard’ sites.
This move has significant implications for pharma and other healthcare organisations since NHS England envisages that the new care models developed by vanguards will provide a blueprint for the future of the NHS.
Vanguards have been tasked with making health services more accessible and more effective for patients by dismantling NHS care pathways that are no longer working well and taking a fresh approach to service design. Better communication and joined-up working between different parts of the NHS, including GP and hospital services, emergency services and community-based organisations, are integral to this new approach.
For example, vanguards will join up the often confusing array of services – A&E, GP out-of-hours, minor injuries clinics, ambulance services and 111 – so that patients know where they can get urgent help easily and effectively, seven days a week.
The new ways of working proposed by vanguards could also result in fewer trips to hospitals as cancer and dementia specialists hold clinics in local surgeries; one point of call for family doctors, community nurses, social and mental health services, or access to blood tests, dialysis or even chemotherapy closer to home.
What are vanguards?
NHS England and its national partners announced the first of 29 vanguards in March 2015 and, to date, a total of 50 vanguards have been created across five key areas:
- Integrated primary and acute care systems – joining up GP, hospital, community and mental health services
- Enhanced health in care homes – offering older people better, joined-up health, care and rehabilitation services
- Multi-specialty community provider – moving specialist care out of hospitals and into the community
- Urgent and emergency vanguards – improving the coordination of urgent and emergency care services and reduce the pressure on A&E departments
- Acute care vanguards – linking local hospitals to improve their clinical and financial viability.
In the vanguard of change
In the year-and-a-half since the first vanguard was announced, it is clear that they are already redefining patient pathways and trialling new ways of working.
While many emergency departments are struggling to meet waiting time targets, one GP super-practice has placed senior primary care clinicians in its emergency departments to provide a triage system that redirects non-emergency patients to appropriate services – for example, a pharmacy or GP. This has cut down average waiting times to an hour and is minimising waiting time breaches.
In another vanguard, new pathways have offered children and elderly people – the biggest drivers of attendance at emergency departments – a community or home-based care package rather than being admitted to hospital. In another, clearly structured pathways for stroke patients have led to significant reductions in length of stay.
With a target to bring care closer to the patient, many vanguards are shifting acute care away from hospitals and into the community. Some GP practices and clinical commissioning groups are introducing specialised services through greater cooperation in their local areas. For example, one partnership aims to provide community outpatient and diagnostic services from a single large practice, expanding a range of local social, mental and hospital services to provide a single point of access to community care, including nursing, dialysis and chemotherapy in the home.
With so many people affected by preventable conditions such as diabetes and obesity, the focus of care in vanguards is shifting to prevention. This will require investment to identify patients at risk and to facilitate earlier diagnosis and intervention, and may involve joint working with employers and the third sector.
Technology is also playing a role with some GP practices using telephone appointments, Skype and online booking, introducing triage approaches involving telephone consultations with the option of a face-to-face after an initial assessment. In one GP super-practice, low-risk patients with simple problems are assigned the usual 5-10 minute appointment while those at high risk, vulnerable or with complex care needs are offered hour-long appointments, reducing unnecessary follow-ups and increasing the number of people seen in a risk-targeted manner.
How can pharma get involved?
Vanguards are designed to replace old models of health and social care that are no longer working, as well as showing the way for service changes within local Sustainability and Transformation Plans footprints. Getting involved early on could bring huge commercial advantage to pharma companies, a fact that has not been overlooked. In fact, competition is fierce, with vanguards bombarded with offers of help from industry.
Consequently, rather than asking a vanguard how it can help, pharma should offer tailored solutions that fill clearly identified needs. If a vanguard is working in a disease area of interest, find out what you can do to help but take a generic approach, as many vanguards want to tackle wider issues. For example, pharma might offer to identify the people with epilepsy who use A&E following a seizure while the wider vanguard perspective might be to risk-stratify why patients generally, including those with epilepsy, attend A&E.
Pharma can also identify new issues; for example, we recently identified a huge number of emergency hospital admissions for urinary tract infections in several NHS Clinical Networks, which led to a review of how these are managed in primary care.
All the vanguards that have been running for at least a year so are quite advanced, plus their plans are tightly monitored by NHS England. They will not be interested in proposals that would require them to deviate from agreed plans. What they want is help to achieve their goals more quickly.
With technology such as Skype and decision-support software so key to the transformation of the NHS, pharma could develop digital tools, phone apps and other IT services like remote diagnostic or review tools.
The vanguards space is a fast-moving one, so it is vital to keep abreast of developments by attending key national conferences – to listen, not sell. We recommend the Health and Care Innovation Expo 2016, NHS Confederation Conference and Exhibition, Best Practice Show, Commissioning Live events and the Health and Care Commissioning Show.
Opportunity knocks
A key area of opportunity is mental health, which has rapidly moved up the policy agenda across government and improved outcomes have become a major commissioning priority. The Five-Year Forward View for Mental Health was a call to action to accelerate the pace of transformational change in both services and attitude.
NHS vanguards are rapidly gathering momentum to transform and integrate mental healthcare. Nine integrated primary and acute care system vanguards are working on joining up GP, hospital, community and mental health services to place mental and physical health care on an equal footing.
In conclusion, the NHS needs an extra £30bn to deliver the Five-Year Forward View – £8bn was promised by the Treasury pre-Brexit and the remainder will come from doing things differently.
Vanguards are leading the way by developing new models of care that will become a blueprint for the entire NHS. The commercial benefits of getting involved with vanguards early could be immense but the onus on pharma is to work out where it can plug gaps and propose joint working initiatives to help vanguards achieve
their goals.
The authors: Sue Thomas is CEO of commissioning excellence and Paul Midgley is director of NHS insight at local healthcare intelligence provider NHiS
