Protest – Manchester Wed 9th Dec

This Wednesday 9th Dec, protest against the privatisers and cutters of our health service! Outside the ‘Vanguards’ conference in the Manchester Central Convention Centre (formerly known as GMEX), 8am-9pm. More information about the ‘Vanguards’ agenda see below.     Facebook event
CALL OUT TO NHS CAMPAIGNS AND ACTIVISTS – in the northwest and beyond!


Oppose cuts and privatisation!

Demonstrate on Wednesday 9 December 2015 from 8am-9am

outside this event: NHS 5YFV Vanguard: New Care Models – Leading the Way

at Manchester Conference Centre, 78 Sackville Street, Manchester M1 3NJ


Protest called by Greater Manchester Keep Our NHS Public


More information in the attached file about the ‘vanguards’ – the front of the new wave of cuts and privatisation.

Spread the word! Facebook event:



What are ‘Vanguards’?

They are ‘areas for developing new models of care’. NHS England chief executive Simon Stevens convinced the NHS that this isn’t yet another wave of pilots, but…

They are a major step in his Five Year Forward View plans:

dictionary defines of a vanguard: foremost division or

front part of an army or advance guard.



Why have ‘Vanguards’ been created?

Vanguards are the ‘advance guard’ in the battle for the heart and soul of the NHS. Many NHS organisations country-wide, behaving in different ways – is like letting all our schools use their own curriculum. NHS managers have accepted a share of the ‘pump-priming’ £200m government bribe to join this scheme…on top of the £millions spent bringing in consultants from firms eg McKinsey, PriceWaterhouseCoopers and Kaiser Permanente, who are already involved in:

setting up private healthcare systems.



What is the hoped-for outcome?

Each new arrangement makes local services work reorganise: ostensibly to begin a “widespread, patient- centred change”. Look closer: that means cuts in State funding for the NHS, in addition to the savage cuts to Social Services adult care – just when staff at all levels are highlighting chronic

funding shortages – just as winter approaches. Each new organisation can then be linked up with others, ready packaged up – for sale.



Does this link to devolution?

Yes it does, as devolving the budget to an entire area, such as Greater Manchester, is just another way of packaging up an area ready – for sale.



Will our health services – no longer national – remain free?

Most unlikely. Pushing Health services together with Social Services makes it easier to levy charges. The NHS & Community Care Act 1990 forced Local Authorities to ‘commission’ private carer services, so Home Care services are now mostly privatised: – so staff work under much worse conditions (eg zero hour contracts). Due to government cuts, only the frailest people now qualify for care: many now receiving less carer time, eg 15 minute calls only. Services once free from District Nurses,

now performed by Home Carers – are paid for by service users.

The Health & Social Care Act 2012 extends this, as more and

more aspects of health care will occur outside hospitals, and:

health services can utilise Local Authorities systems for charging.




NW campaigners are organising along the lines of the very successful Birmingham July demo which kick-started NAN – Northern Activists Network. We’re sure many people – particularly from round the region – and further afield will want to attend.If you can help to organise this important event, please contact: as soon as possible

Can NHS vanguard areas point the way to new models for care? Richard Vize 13 Mar 2015

Testbed areas must be able to demonstrate that successful reforms can be replicated around the country


NHS England’s announcement of the vanguard areas for developing new models of care means the 5 Year Forward View is now on trial, with many dangers ahead. The goodwill towards the vanguards programme is striking. The scale is impressive, with the potential to improve services for up to 5m people. NHSE chief executive Simon Stevens’ salesmanship has convinced the service that this is the beginning of widespread, patient-centred change – not yet another wave of pilots.


The vanguards need to demonstrate they are viable models for reform in a tough financial climate

The vanguard areas will join up MH, primary care, community nursing, hosps, pharmacy & social care. 9 of the 29 successful bidders are primary & acute care systems; 14 multi-specialty community providers (GP practices coming together with hosp specialists, community services, nurses & pharmacists to offer primary & specialist services). The other 6: aiming to enhance health in social care – provide the most convincing evidence of NHS leaders thinking about the care system as a whole rather than just the NHS.


There’s a good mix of test sites: established system leaders eg Northumbria & Salford alongside areas with chronic problems eg Cumbria. The £200m funding represents a substantial investment to secure in fact modest changes compared with the scale of the health service. NHSE must resist temptation to throw more ££ at the scheme if the programmes struggle, as buying success won’t be an option for other areas. The vanguards need to demonstrate they are viable models for reform in a tough financial climate.


NHS Five Year Forward View will need support from clinical staff to succeed

Two pressing questions are how can NHSE & more importantly, the rest of the NHS help vanguard areas succeed & how can successes be replicated across the country? The programme is attempting a difficult balance; it’s embraces local experimentation & differentiation, but will ultimately be judged by the scale & pace with which innovation in vanguard areas becomes established practice. If the rest of the NHS stands around watching while the vanguards get on with it there’ll be little chance of them triggering something approaching system-wide change in the next 3 or 4 years. Ways need to be found to hitch up other areas with the vanguard sites so that they can learn as the work progresses.


There is a vehicle for this. NHSE has promised tailored support for each area on everything from clinical workforce redesign to digital technology & patient empowerment. This offers opportunities for other NHS staff to simultaneously support the schemes & learn from them, feeding back ideas & lessons to their own areas. This will ensure those following the vanguards won’t be coming from a standing start.


NHSE is trying to promote a “learn as we go” approach by pushing vanguards to publish & analyse out-comes data while the programme is running rather than waiting for some long-winded appraisal with lim-ited value at the end. The learning won’t just be re specifics of particular models, but about leadership for system-wide cultural change. The NHS has a lamentable record on spreading innovation; the vanguard programme needs to demonstrate how this inertia can be broken.


Among the potential pitfalls is the risk that so often faces NHS reform – that people will become sidetracked into making the systems work rather than focusing on improving the experience and outcomes for patients. Improving collaboration between hosp & PD Drs may well feel like a triumph in itself, but if there is no measurable benefit to patients the effort will have been wasted.


This is a moment of high risk for NHS England. If the vanguard programme does not demonstrate substantial improvements in outcomes, patient experience & value for money then the Forward View will have failed its first and most important test.


The GPC has produced this initial guidance to help explain the new care model vanguard sites.

We’ll be following development of these models of care v closely & intend to publish further guidance asap. If you’ve any questions/comments about vanguard sites in your area, pls contact GPC office

New care models – vanguard sites


The 5 Year Forward View of Oct 2014 set out new care models aiming to ‘dissolve traditional boundaries’ btw general practice, community providers, hosps, health & social care & MH services. The document proposed creating some of major new care models, recognising that England’s need more than just one.

The new care models outlined in the document were:


Multispecialty Community Providers (MCPs) – forming extended PC grp practices thru federations, net-works or single orgs to provide a wider range of care using a broader range of professionals. The docu-ment specifically mentions employing consultants/taking them on as partners & potentially developing a new cadre of resident ‘hospitalists’ ‘shifting most O/P consultations & ambulatory care out of hosps’.


Primary and Acute Care Systems (PACS) – a new kind of ‘vertically integrated’ care allowing single orgs to provide GP, hosp, community & MH services.


Urgent and emergency care networks; Viable smaller hospitals; Specialised care; Modern maternity services; enhanced health in care homes


What is the purpose?

The 1st 2 of these proposed models in particular are intended to redefine the relationship btw primary & secondary care & are of special interest to the GPC & wider BMA. There’s clearly significant overlap btw these – a binary understanding of the models as representing GP-employed specialists or hosp-employed GPs won’t be helpful. In fact the 5YFV reflects a movement already underway as a v diverse range of int-egrated models are already emerging led variously by CCGs, Trusts & proactive GP orgs.


As part of the 5YFV, NHS England will pump-prime a cross section of new care models, looking at current exemplars, potential benefits, risks & transition costs. National & regional expertise & support will be harnessed to ‘implement care model change rapidly & at scale’.


The 5YFV Into Action: Planning for 2015/16 invited local orgs wishing to become ‘vanguard’ sites to ex-press their interest to a new care models team. On 10 Mar NHSE announced 29 sites had been selected from 269 applications to rcv funding from a £200 million transformation fund. The projects (9 PACS, 14 MCPs and 6 care home projects) to be intensively eval’d & successful models replicated elsewhere.


Learn more about the 5 Yr Forward View Into Action: Planning for 2015/16

Key points to know and worth noting about the vanguard sites:

The 269 applications rcvd & the 29 sites chosen for vanguard status represent a v wide range of projects. The scale of the projects’ ambition ranges from organising a broader range of community & specialist care services around grps of GP practices to developing full ICOs delivering a wide range of services under a capitated budget.

The proposals are led, by CCGs, hosp trusts, community trusts; some lg GP practices/ GP provider orgs.

Some are built on a genuine broad collaboration of commissioning & provider orgs, others have a clear lead provider around which other services will be structured.

They demonstrate the somewhat artificial distinction btw MCPs & PACS. Some PACS sites are firmly grounded in established PC & will build up from an MCP type model; in some cases MCP sites state they aim to evolve to become full ICOs with delegated capitated budgets.


Watch presentations from each of the vanguard sites on NHS England’s website


The full list of vanguard sites from around the country is as follows:


Integrated Primary & Acute Care Systems (PACS) – linking GP, hosp, community & MH services

Wirral University Teach Hosp NHS FT, Mansfield & Ashfield & Newark & Sherwood CCGs, Yeovil Hosp, Northumbria Healthcare NHS Trust, Salford Together, Lancs North, Hampshire & Farnham CCG, Harrogate & Rural District CCG, Isle of Wight (NWx4, Mids, NE, Sx3)


Multispeciality Community Providers (MCPs) – moving specialist care from hosps to community

Calderdale Health & Social Care Economy, Derbys Community Health Services NHS FT, Fylde Coast Local Health Economy, Vitality, W Wakefield Health & Wellbeing Ltd, NHS Sunderland CCG & City Council, NHS Dudley CCG, Whitstable Medical Practice, Stockport Together, Tower Hamlets Integrated Provider Partnership, Southn Hampshire, PC Cheshire, Lakeside Surgeries, Principia Partners in Health

(Mids 2, Fylde, Vitality & Principia??, NW 3, NE, S 2, Lon, Lakeside?)


Enhanced health in care homes – offering older people better, joined up health, care & rehab

NHS Wakefield CCG, Newcastle Gateshead Alliance, East & North Herts CCG, Nottingham City CCG, Sutton CCG, Airedale NHS Foundation (NE 1, NW 1, Mids 2, Lon, Airedale)


The GPC follow development of these models of care v closely &publish further guidance asap.