Skip to main content
SpringerLink
Log in

Implementing the New Care Models in the NHS: Reconfiguring the Multilevel Nature of Context to Make It Happen

  • Chapter
  • First Online:
Transitions and Boundaries in the Coordination and Reform of Health Services

Part of the book series: Organizational Behaviour in Healthcare ((OBHC))

Abstract

This chapter derives lessons about reform in the UK’s National Health Service through the development of the Vanguard new care models programme. These new models of care proposed changes that are not concerned solely with structures or top-down reform edicts but are seeking new ways of working and joining up care across a whole system driven by those on the front line. Drawing upon recent theoretical developments on the multilevel nature of context, factors shaping the implementation of five Vanguard initiatives in the North East of England are explored. In so doing, this chapter aims to broaden the scope and scale of analysis across the multiple levels of context—at macro-, meso-, and micro-levels—shaping both process and outcomes of health systems transformation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ACC::

Acute Care Collaboration Vanguard

ACO::

Accountable Care Organisations

CCG::

Clinical Commissioning Group

EHCH::

Enhanced Health in Care Homes

GP::

General Practice

ICP::

Integrated Care Partnerships

MCPs::

Multispeciality Community Providers

MDT::

Multidisciplinary Team

NCMs::

New Care Models

NHS::

National Health System

PACS::

Primary and Acute Care Systems

PbR::

Payments by Results

STPs::

Sustainability and Transformation Partnerships

UEC::

Urgent and Emergency Care

UK::

United Kingdom

5YFV::

NHS Five Year Forward View

References

  • Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research,38(1), 4–23.

    Article  Google Scholar 

  • Bate, P. (2014). Context is everything. London: The Health Foundation.

    Google Scholar 

  • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs,27(3), 759–769.

    Article  Google Scholar 

  • Boyatzis, R. E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering, implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science,4, 50.

    Article  Google Scholar 

  • Dopson, S., & Fitzgerald, L. (2005). Knowledge into action: Evidence-based healthcare in context. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Exworthy, M., & Powell, M. (2004). Big windows and little windows: Implementation in the ‘congested state’. Public Administration,82(2), 263–281.

    Article  Google Scholar 

  • Fulop, N., & Robert, G. (2015). Context for successful quality improvement. London: The Health Foundation.

    Google Scholar 

  • Greener, I., Harrington, B. E., Hunter, D. J., Mannion, R., & Powell, M. (2014). Reforming health care: What’s the evidence? Bristol: Policy Press.

    Book  Google Scholar 

  • Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2005). Diffusion of innovations in health service organizations. Oxford: Blackwell.

    Book  Google Scholar 

  • Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly,82(4), 581–629.

    Article  Google Scholar 

  • Greenhalgh, T., Shaw, S., & Wherton, J. (2016). SCALS: A fourth-generation study of assisted living technologies in their organisational, social, political and policy context. British Medical Journal Open,6, e010208.

    Google Scholar 

  • Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A’Court, C., et al. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research,19(11), e367.

    Article  Google Scholar 

  • Hunter, D. J. (2016). The health debate (2nd ed.). Bristol: Policy Press.

    Book  Google Scholar 

  • Hunter, D. J., Erskine, J., Small, A., McGovern, T., Hicks, C., Whitty, P., et al. (2015). Doing transformational change in the English NHS in the context of ‘big bang’ redisorganisation. Journal of Health Organisation and Management,29(1), 10–24.

    Article  Google Scholar 

  • Jones, L. (2017). Sedimented governance in the English NHS. In M. Bevir and J. Waring (Eds.), De-centring health policy: Learning from British experiences in healthcare governance. London: Routledge.

    Google Scholar 

  • Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W. M., Froehle, C. M., et al. (2010). The influence of context on quality improvement success in health care: A systematic review of the literature. Milbank Quarterly,88(4), 500–559.

    Article  Google Scholar 

  • Kyratsis, Y., Ahmad, R., & Holmes, A. (2012). Making sense of evidence in management decisions: The role of research-based knowledge on innovation adoption and implementation in healthcare. Implementation Science,7, 22.

    Article  Google Scholar 

  • Maniatopoulos, G., Procter, R., Llewellyn, S., Harvey, G., & Boyd, A. (2015). Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology. Social Science and Medicine,131, 98–106.

    Article  Google Scholar 

  • May, C. R., Johnson, M., & Finch, T. (2016). Implementation, context and complexity. Implementation Science,11, 141.

    Article  Google Scholar 

  • Navarro, V. (2011). The importance of politics in policy. Australian and New Zealand Journal of Public Health,35(4), 313.

    Article  Google Scholar 

  • NHS England. (2014). Five year forward view. NHSE.

    Google Scholar 

  • NHS England. (2017). Next steps on the NHS five year forward view. NHSE.

    Google Scholar 

  • Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science,10, 53.

    Article  Google Scholar 

  • Peck, E., & 6, P. (2006). Beyond delivery: Policy implementation as sense-making and settlement. Basingstoke: Palgrave Macmillan.

    Google Scholar 

  • Pettigrew, A. M. (1990). Longitudinal field research on change: Theory and practice. Organization Science,1(3), 267–292.

    Article  Google Scholar 

  • Pettigrew, A. M., Ferlie, E., & McKee, L. (1992a). Shaping strategic change. London: Sage.

    Google Scholar 

  • Pettigrew, A. M., Ferlie, E., & McKee, L. (1992b). Shaping strategic change: The case of the NHS in the 1980s. Public Money and Management,12(3), 27–31.

    Article  Google Scholar 

  • Ragin, C. C., & Becker, H. S. (1992). What is a case? Exploring the foundations of social inquiry. Cambridge: University Press.

    Google Scholar 

  • Robert, G., Greenhalgh, T., MacFarlane, F., & Peacock, R. (2010). Adopting and assimilating new Non-pharmaceutical technologies into health care: A systematic review. Journal of Health Services Research & Policy,15(4), 243–250.

    Article  Google Scholar 

  • Squires, J. E., Graham, I. D., Hutchinson, A. M., Michie, S., Francis, J. J., Sales, A., et al. (2015). Identifying the domains of context important to implementation science: A study protocol. Implementation Science,10, 135.

    Article  Google Scholar 

  • Weick, K. E. (1995). Sensemaking in organizations. Thousand Oaks: Sage.

    Google Scholar 

  • World Health Organization. (2016). Health system transformation: Making it happen. In Expert meeting. Madrid, Spain, December 17–18, 2015. http://www.euro.who.int/data/assets/pdf_file/0014/318020/Madrid-Report-HST-making-it-happen.pdf?ua=1. Accessed 12 Dec 2017.

  • World Health Organization. (2018). Leading health system transformation to the next level. In Expert meeting. Durham, UK, July 12–13, 2017. http://www.euro.who.int/en/health-topics/health-systems/health-services-delivery/publications/2017/leading-health-sytem-transformation-to-the-next-level-2017. Accessed 4 July 2018.

Download references

Acknowledgements

This chapter presents independent research that was funded by the National Health ServiceEngland (NHS) through the support of the North East Commissioning Support Unit (NECS). This funding is gratefully acknowledged as is the support received from NECS for the duration of the study. Ethical approval was gained from Newcastle University Research Ethics Committee (ref: 01216/2016). NHS Research Ethics approval was not required for this study.

Author information

Authors and Affiliations

  1. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

    Gregory Maniatopoulos & David J. Hunter

  2. Durham University, Durham, UK

    Jonathan Erskine

  3. Center for Health Services, University of Kent, Canterbury, UK

    Bob Hudson

Authors
  1. Gregory Maniatopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David J. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan Erskine
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bob Hudson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Maniatopoulos .

Editor information

Editors and Affiliations

  1. Institute of Health Sciences Education, McGill University, Montréal, QC, Canada

    Peter Nugus

  2. Department of Family Medicine, McGill University, Montréal, QC, Canada

    Charo Rodriguez

  3. School of Public Health, University of Montreal, Montréal, QC, Canada

    Jean-Louis Denis

  4. Department of Human Resource Management, HEC Montréal, Montréal, QC, Canada

    Denis Chênevert

Appendix A—Vanguard Sites

Appendix A—Vanguard Sites

Vanguard

Aim of programme

Multispecialty Community Providers (MCPs)

The Vanguard aims to move care out of the hospital into the community. It involved the implementation of an out of hospital model of care focusing on people staying independent and well for as long as possible; people living longer with a better quality of life with long-term conditions; people supported to recover from episodes of ill health and following injury; resilient communities; and high levels of public satisfaction. The MCP Vanguard began in April 2015 although pre-Vanguard elements began implementation from 2013

Primary and Acute Care Systems (PACS)

The Vanguard aims to develop a new variant of “vertically integrated” care allowing single organisations to provide joined-up GP, hospital, community, and mental health services. It involved the development of a new Urgent and Emergency Care Hospital and the development of an “enhanced care teams” pilot and new workforce models (Transforming Primary Care). The PACS Vanguard began in June 2015, and the Trust became the first Accountable Care Organisation in the region—effective from April 2017

Acute Care Collaboration Vanguard (ACC)

The Vanguard aims to link local hospitals together to improve their clinical and financial viability, reducing variation in care and efficiency. It aims to widen the support and services (i.e. commercial/contractual services, consultancy/advisory as well as a range of clinical and corporate services) the Trust can provide to other parts of the NHS through acquiring and/or merging with other hospital Trusts. The ACC Vanguard was finalised in January 2016

Enhanced Health in Care Homes Vanguard (EHCH)

The Vanguard aims to offer older people better, joined-up health, care, and rehabilitation services. It aims to develop a sustainable, high-quality new care model for people in community beds and receiving home-based care services across a metropolitan area with a new outcome-based contract and payment system that supports the development of the Provider Alliance Network (PAN) delivery vehicle. The Vanguard started in March 2015 although some features had been implemented pre-Vanguard status

Urgent and Emergency Care Vanguard (UEC)

The Vanguard aims to improve the coordination of urgent and emergency care as a whole system, ensuring people can access the most appropriate service, the first time. The Vanguard status was awarded in July 2015, and the programme has been fully operational since November 2016. Most initiatives went live in December 2016

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Maniatopoulos, G., Hunter, D.J., Erskine, J., Hudson, B. (2020). Implementing the New Care Models in the NHS: Reconfiguring the Multilevel Nature of Context to Make It Happen. In: Nugus, P., Rodriguez, C., Denis, JL., Chênevert, D. (eds) Transitions and Boundaries in the Coordination and Reform of Health Services. Organizational Behaviour in Healthcare. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-26684-4_1

Download citation

Publish with us

Policies and ethics

Search

Navigation