Search

Additional file 3. Nature of local evaluations for MCP Vanguards

Additional file 4. Local evaluation questions

Additional file 1. Nature of local evaluations for enhanced care home Vanguards

Additional file 2. Nature of local evaluations for PACS Vanguards

Purpose The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the role of national level support in enabling local integration initiatives. Design/methodology/approach A set of 29 interviews were carried out with a variety of respondents at the national level (including current and past programme leads, strategic account managers, advisors to the programme and external regulators) between October 2017 and March 2018, and analysed thematically. Findings A set of facilitative elements of the programme were identified: the development of relationships and alliances, strong local and national leadership, the availability of expert knowledge and skills, and additional funding. Challenges to success included perceived expectations from the national Vanguard programme, oversight and performance monitoring, engagement with regulators, data availability and quality, as well as timetables and timescales. Crucially, the facilitators and challenges were found to interact in dynamic and complex ways, which resulted in significant tensions and ambiguities within the support programme. Research limitations/implications While the sample was drawn from a range of different senior players and the authors ensured a diverse sample associated with the NCM support programme, it inevitably cannot be complete and there may have been valuable perspectives absent. Originality/value The paper demonstrates that the analysis of facilitators and challenges with respect to the national support of implementation of integrated care initiatives should move beyond the focus on separate influencing factors and address the tensions that the complex interplay among these factors create.

This evaluation took place between March and August 2018 and was commissioned by the NHS\ud Leadership Academy on behalf of Kent and Medway Sustainability and Transformation Plan (STP) and\ud delivered by East Kent Community Education Provider Network (EK CEPN). The programme consisted\ud of three development sessions carried out over two sites, or multi-professional teams known as hubs,\ud clusters or primary care networks by an experienced facilitator using the model ‘conversations inviting\ud change’. This model embodies a narrative approach that recognises the domains identified by the\ud National Leadership Academy of individual effectiveness, relationships and connectivity, innovation\ud and improvement, learning and capacity building (NHS Leadership Academy, 2017).

This report details the findings of a service evaluation of the Vanguard Encompass MCP (MultiSpecialty Community Provider) in East Kent. Encompass was awarded Vanguard status in 2015, through the first wave of Vanguards prompted by NHS England’s ‘Five Year Forward View’ strategy. The evaluation was conducted from March 2017 to April 2018 by the Centre for Health Service Studies in partnership with Encompass, who provided and analysed the metric data. The operational model developed and implemented by Encompass is Community Hub Operating Centres (CHOCs). CHOCs are holistic community based models of integrated service delivery aiming to improve user experience of co-ordinated care and self-management at home; contribute to a reduction in A&E demand and onward \ud admission in the short term; and reduce pressure on acute services and long term care home placements in the longer term. Five CHOCs were initiated after an initial pilot period in 2016, which consist of clusters of GP practices serving a total practice population of 180,784 patients. The evaluation focused on the CHOCs, and the evaluation questions were informed by the NHSE local evaluation document (NHS 2015):\ud \ud ? What impact are the CHOCs having on user outcomes and experience?\ud ? What are the components of the care model delivery (or ‘active/successful ingredients’) that\ud are really making a difference?\ud ? What are the influencing contextual factors and how have they affected implementation and\ud outcomes?\ud ? What changes to the use of resources and activity in the local health system have taken place\ud and to what costs?\ud ? What could be improved, replicated and sustained?