Redefining patient pathways and trialling new ways of working could have a significant impact on improving care, finds a report looking into the role of NHS Vanguards in the development of new commissioning structures.

The NHS 'Vanguard' programme, an integral part of the NHS Five Year Forward View, was launched last year to encourage creative and innovative solutions to address health and social care needs at a local level, as well as shape plans for long-term investment to boost population health and ease pressure on services.

There are currently 50 vanguards operating throughout England, each tasked with taking a lead on the development of new care models which will act as the blueprints for the NHS moving forward "and the inspiration to the rest of the health and care system," says NHS England.

Now, a report by NHiS Commissioning Excellence, which helps the NHS plan and commission patient services, finds that NHS vanguards are already successfully demonstrating the value of re-jigging patient pathways and assessing new ways of working.

The report is based on a recent advisory panel discussion, organised by NHiS and involving eight different vanguards, including four multi-specialty community providers, a GP super-practice and an acute care collaboration.

It shows, for example, how some vanguards have integrated healthcare and social care services; while others have seen GP practices widen their activities to incorporate more specialist roles, or link with other GP services to create super-practices.

Using modern technologies such as smartphones, Skype, decision support and risk stratification software is also proving key to switching the main focus away from care management towards disease prevention and early diagnosis.

For example, clinicians in one partnership vanguard are striving to provide community outpatient and diagnostic services from a single large practice to help broaden the range of local social, mental and hospital services on offer, and provide a single point of access to community care. 

 Another group has established a multidisciplinary, multi-agency team to look at mental health policy and strategy in order to determine why patients become 'repeat attendees', in an approach that is helping stakeholders understand the relationship between mental and physical health and social standing, the report notes. 

Risk stratification 

Vanguards have also been looking at risk stratification - identifying the potential care requirements of patients by analysing their medical history, to improve the type and quality of care delivered - to help identify those with complex needs and to determine onward specialist referral. 

Elsewhere, a unique cancer vanguard plans to install decision support software in GP surgeries to help them identify the disease in patients who have symptoms that appear vague, which should also help raise awareness of the potential signs of cancer.

"The focus of care needs to shift from managing ill health to preventing it developing in the first place. This will involve investment in care pathway development in order to facilitate earlier diagnosis and intervention, and define the best care pathways," noted Sue Thomas, chief executive of Commissioning Excellence for NHiS and chair of the Advisory Panel.

"Our recent panel advisory discussion shows that vanguards are leading the way in trialling innovative new ways of working that involve redesigning patient pathways and using technology to improve outcomes and patient experience, and to meet local and national targets. The challenge will be finding ways to make these practices the norm rather than a novelty."