NHS England launches frameworks to increase integration of health and care services and improve the lives of care home residents

NHS England today (29 September) published details of two more common frameworks for local health and care systems, organisations, communities and patients, wishing to develop and implement new ways of working.

The documents are based on the learning so far from the primary and acute care system (PACS) and enhanced health in care homes vanguards – describing the key ingredients that make up both models.

They demonstrate how the new models can strengthen primary care, improve access, focus on the prevention of ill-health and control costs. They follow on from the multispecialty community provider (MCP) care model framework, which was launched in July.

Like an MCP, a PACS can be defined as a population-based accountable care model, with general practice at its core. It is organised around patients’ needs and aims to improve the physical, mental and social health and wellbeing of its local population.

However, it will also include most hospital based care, as well as primary, community, mental health and social care services. By aligning the goals and incentives of hospitals with other health and care providers, it offers the potential for a radical new approach to population health.

The integrated (PACS) Framework outlines the next steps required to set up the model – including the need to develop new contractual, funding and organisational form. It sets out three contractual options that will help make a phased transition towards a fully-fledged PACS – a single provider with a single contract for all local health and care services.

This puts clinicians in the driving seat by pooling and allocating resources to areas that will have the greatest impact on the health of their local community and creates a shared responsibility towards the most vulnerable patients.

For example, South Somerset Symphony Programme vanguard uses business intelligence systems to identify the most complex four per cent of patients and provides them with intensive, personalised support through care hubs. A joined up approach and single care plan that is accessible to both primary and secondary care can help prevent avoidable hospital attendances and admissions and facilitate early discharge. Early results indicate a 30 per cent fall in emergency admissions and reduced length of stay when patients are admitted.

While, Healthy Wirral vanguard’s shared care record brings together primary, hospital and community care records with mental health and social care information, so that patients no longer need to repeat the same information to different professionals.

The second of the frameworks put forward at the full NHS England board meeting today (29 September) was the enhanced health care homes model.

It lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of in reach services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams – joining up care for residents.

Today’s publication sends out a message across health and social care. By maximising opportunities in clinical care, IT and technology, workforce and commissioning, the care homes framework can support organisations to deliver high quality and financially sustainable care.

Samantha Jones, Director – New Care Models Programme said: “Practical implementation of care redesign is now well under way across 50 areas of England. Learning about what has and hasn’t worked in these Vanguards means we can now set out for the rest of the NHS with greater precision what needs to happen in order to get concrete results – improving the quality of care, preventing ill-health and saving money.”

Nigel Edwards, Chief Executive of the Nuffield Trust said; “The care home vanguards combine a series of evidence based interventions in a very practical way that has direct benefits for care home residents. Work in vanguards, and by others working in a similar area, shows it works. The model has the potential to help local systems contain the growing demand for hospital care in a cost effective way by reducing admissions and the lengths of stay of those that are admitted. It also offers much needed support to the care home sector which is under very significant pressure and recruitment difficulties.”

A further framework for the acute care collaboration model is expected to be published towards the end of the year


  1. Emily Stone says:

    It’s great to see that more development are being made to improve care home facilities, supporting those who need the extra support and care.

  2. Linda Hillman says:

    without reading through all the detail of the activity at each site, I can’t tell whether there has been any work proactively with the dental profession. I would say that frequently this sector is overlooked, being not mainstream CCG business. However there is plenty of evidence to show that oral health maintenance for care home residents is frequently done poorly or neglected and this crucial element requires a radical improvement across the board. It would be great to be able to implement a systematic approach to oral healthcare for care home residents and staff. thank you

  3. MARION LYNCH says:

    Correct email re innovation request below

  4. Marion lynch says:

    Really appreciate the sharing of good practise and seeking of comments and innovations
    How may we share low cost high impact innovations wh Ch are occurring outside of vanguards?

  5. Prof Clive Bowman says:

    Good news in principle but in practice national operators be they charitable or for profit will need standardised operating systems if the efficiencies that are required to make care homes viable. My point is however creative local initiatives are they need to be distilled to a national approach.