The care and quality gap

patient being treated

Patients’ health needs are changing and so the way health services are delivered needs to change to meet them.

People are living for longer and with more long-term conditions, meaning people need a wider range of care from different sources over a longer period of time. The traditional divide between primary care, community services and hospitals needs to be removed.

Instead, care must be joined up and provided seamlessly across a range of healthcare organisations, to meet patients’ needs. New technologies and ways of working must be encouraged and harnessed to improve the quality of care and patient experience and reduce unacceptable variations in patient outcomes. 

This goal involves narrowing the gap between the best and worst performing organisations, while raising the overall standard of quality for everyone.

What the 5YFV proposes

Several new models of delivering care have been identified. First and foremost is the need for a new way of delivering general practice (GP) services. 

Primary care has been underfunded compared to hospitals but demand remains high. So, more funding is needed to encourage people to become, and remain, GPs, while training more community nurses and other primary care staff. 

In addition to a new deal for primary care, there are seven other proposed new models of care: 

New model of care  What it involves 
Multi-specialty Community Providers (MCPs) Letting groups of GPs join with nurses and other community health providers to create integrated out-of-hospital care.
Primary and Acute Care Systems (PACS) Bringing hospital and general practice services together.
Urgent and emergency care networks Joining together A&E, GP out-of-hours, urgent care centres, NHS 111 and ambulance services.
Viable smaller hospitals Providing new options to smaller hospitals to ensure they are sustainable, including partnerships with more distant or specialist hospitals to provide local services.
Specialised care Consolidating care into specialist centres, through a programme of three-year rolling reviews.
Modern maternity services Providing the option for midwives to take control of the services they offer.
Enhanced health in care homes Providing more support for older people living in care homes.

37 vanguard sites, who are already testing different ways of working, have been identified to develop these new models of care.

There is no single fix to the NHS’ challenges, so local flexibility is needed to decide how best to help patients. Where these new models of care are successful, they will be replicated in other organisations with similar characteristics and similar requirements. For example, a model of care that works in central Birmingham may not fit well in rural Devon, but a model that works in Devon may also suit Cumbria. 

For those areas where systems are challenged and the conditions to develop new models of care aren’t yet in place, a success regime will provide increased support and direction to improve in the short, medium and long term. 

NHS staff are crucial to delivering these new models, and all aspects of the 5YFV, so there will be investment in new options for the workforce, as well as training and development to make sure staff are fully equipped to support the changes. 

Staying at the forefront of high quality care means adopting new innovations. The NHS will be supported to better share innovative ways of working and technologies that are already happening, and to undertake research to develop new ones.

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