Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme

Abstract

ObjectiveTo examine lessons learnt from the implementation of five Vanguard initiatives in the North East of England.DesignData collection comprised semistructured interviews with key informants at each site.SettingThe study took place across six local authority areas in the North East of England and within six clinical commissioning groups responsible for the delivery of each Vanguard’s aims and objectives.ParticipantsSixty-six interviewees with participants from five Vanguard initiatives in the North East of England, including senior clinicians, project leads and directors, commissioners, and healthcare managers.ResultsWhile the context for each Vanguard is separate and distinct, there also exists a set of common issues which have a regional dimension. Participants felt that the national programme helped to raise the profile of local change initiatives and also contributed to the wider understanding of regional service integration issues. At the same time our findings demonstrate that all five sites experienced, and were subject to, unrealistic pressure placed on them to deliver outcomes. Of particular concern among all sites was the sheer scale and pace of change occurring at the same time as the National Health Service was being tasked with making significant, if unrealistic, efficiency savings.ConclusionsIt is too early to conclude with any confidence that a successful outcome for the new care models programme will be forthcoming. While early indications show some encouraging signs of promise, the overall context in which the complex and ambitious changes are being implemented remains both fragile and fluid.

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

“…Although the MAW model may appear to be a Norwegian concern, similar models have been developed in many other Western countries. This supports the transferability of our findings [ 11 , 12 ]. Transferability is also supported by the use of the maximum variation approach, ensuring the participation of PCPs from both rural and central geographical locations variation in the PCPs’ age, gender, work experience as a physician, and experience working in a hospital.…”

“…Many countries are launching primary healthcare models as alternatives to hospitalisation, as well as aiming to increase coordination across healthcare levels to improve patient care, reduce costs and improve public health [ 7 – 10 ]. Community hospitals, observation wards and hospitals-at-home are examples of health service models at the interface between primary and secondary care that provide acute and/or non-acute services and offer a variety of treatment and diagnostic services [ 11 , 12 ].…”

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

“…First, we were not able to account for local contextual factors which might have affected the adoption and implementation of integration processes. Moreover, implemented initiatives were heterogeneous across sites and difficult to describe in detail using interviews and documentary analysis [15,19,[32][33][34][35][36][37]. A recent evidence synthesis of 115 local Vanguard evaluation reports concluded that none of the reports offered "explanations and/or nuanced insights into the Vanguard operation" [38], making crossinitiatives comparisons difficult.…”

“…Hitherto, the Pioneer or Vanguard programmes have been studied separately [15,19,[32][33][34][35][36][37][38], but never in combination. However, a number of Pioneers subsequently applied to become Vanguards, and thus the two programmes overlapped in time and partially in place.…”

Editorial

“…Observations from our own research and recent experience suggest that current policy pressures for health systems to improve outcomes and reduce inequalities at a time of increasing financial stringency and uncertainty combine to create a huge challenge that, if not met successfully, could negatively affect progress (Maniatopoulos et al , 2019; Hunter et al , 2015; Best et al , 2012). In the UK, growing pressures on the National Health Service (NHS) to meet government targets and release efficiencies have highlighted the need to move away from top-down structural approaches to HST towards the development of new care models at the local level where integrated systems and infrastructures to support ongoing and emergent innovation in use can emerge and evolve over time.…”