What are the barriers to spread?

Through a series of round table discussions, the people in the room gave their views and feedback on the areas which they saw as barriers to spreading the new care models.  Eight themes emerged.

Insufficient time and resources to transform

The pressures of the day job, and insufficient local capacity, mean that there is little room for transformation to take place at the same time.

Regulation that supports old models of care

Planning and regulation need to be aligned with the new care models and not just the maintenance of individual organisations.  Arms-length bodies also need to clearly communicate what flexibility there is in terms of payment.

Too much focus on organisational form

Population health outcomes need to be the focus rather than focussing first, for example, on what an accountable care organisation is.

Lack of commissioner engagement

Local alignment needs commissioners to want to buy the new models of care using longer term contracts.  Currently clinical commissioning groups tender contracts for shorter periods, and not on a population basis.

Information governance and IT systems

There is a strong perception that current information governance restrictions are a barrier to new care models. Existing IT systems reinforce organisational boundaries and practical experience of expensive failures has put some people off implementing changes.

Organisational self-interest

There is a lot of staff and public loyalty to maintain existing organisational forms.  Larger organisations may find it the hardest to change.  This is because their size gives them the belief that they run their local system.  Everyone is trying to do ‘place-based work’ but in very different ways and do not always know what each other is doing.

Inconsistent national messaging and language

Recent years have seen many different ways of describing “the new” in the NHS.  The language of change needs to be unified, simple and for the long term.

Not being part of the vanguard ‘club’

The funding for vanguards will not be available everywhere so adopters know that they will have to do this with less resource. How can non-vanguard sites be given support and profile to help them implement new care models?