General practitioner England GP practices

Last updated:

New care models – vanguard sites

The GPC have produced this initial guidance to help explain the new care model vanguard sites.

We will be following the development of these models of care very closely and intend to publish further guidance as soon as possible.

If you have any questions or comments about vanguard sites in your area, please contact the GPC office [email protected]

The Five Year Forward View of October 2014 set out several new care models which aim to 'dissolve traditional boundaries' between general practice, community providers, hospitals, health and social care and mental health services.

The document proposed creating a number of major new care models, recognising that England is too diverse for a single model of care to work everywhere.

Download the Five Year Forward View

The new care models outlined in the document were:

  • Multispecialty Community Providers (MCPs) – forming extended primary care group practices through federations, networks or single organisations to provide a wider range of care using a broader range of professionals. The document specifically mentions employing consultants or taking them on as partners, and potentially developing a new cadre of resident 'hospitalists' 'shifting the majority of outpatient consultations and ambulatory care out of hospital settings'.
  • Primary and Acute Care Systems (PACS) – a new variant of 'vertically integrated' care allowing single organisations to provide GP, hospital, community and mental health services.
  • Urgent and emergency care networks
  • Viable smaller hospitals
  • Specialised care
  • Modern maternity services
  • Enhanced health in care homes


What is the purpose?

The first two of these proposed models in particular are intended to redefine the relationship between primary and secondary care and are of significant interest to the GPC and wider BMA. 

It is clear that there is significant overlap between these models and a binary understanding of the models as representing GP-employed specialists or hospital employed GPs is likely to be particularly unhelpful. In fact the Five Year Forward View reflects a movement already underway as a very diverse range of integrated models are already emerging led variously by CCGs, Trusts and proactive GP organisations. 

As part of the Five Year Forward View, NHS England will pump-prime a cross section of new care models, looking at current exemplars, potential benefits, risks and transition costs. National and regional expertise and support will be harnessed to 'implement care model change rapidly and at scale'.

The Five Year Forward View Into Action: Planning for 2015/16 invited local organisations wishing to become 'vanguard' sites to express their interest to a new care models team. On 10 March NHS England announced that 29 sites had been selected from 269 applications to receive funding from a £200 million transformation fund. The projects (9 PACS, 14 MCPs and 6 care home projects) will be intensively evaluated with a view to replicating successful models elsewhere.

Learn more about the Five Year Forward View Into Action: Planning for 2015/16


Key points to know

A few things are worth noting about the vanguard sites:

  • The 269 applications received and the 29 sites chosen for vanguard status represent a very wide range of projects. The scale of the projects' ambition ranges from organising a broader range of community and specialist care services around groups of GP practices to the development of fully integrated care organisations delivering a wide range of services under a capitated budget.
  • The proposals are led, variously, by CCGs, hospital trusts, community trusts or in some cases large GP practices or GP provider organisations. 
  • Some proposals are built on a genuine broad collaboration of commissioning and provider organisations, others have a clear lead provider around which other services will be structured.
  • The proposals demonstrate the somewhat artificial distinction between MCPs and PACS. Some PACS sites are firmly grounded in established primary care and will build up from an MCP type model, whilst in some cases MCP sites state that they aim to evolve to become fully integrated organisations with delegated capitated budgets.
  • Watch presentations from each of the vanguard sites on NHS England's website


Full list of vanguard sites

The full list of vanguard sites from around the country is as follows:

Integrated Primary and Acute Care Systems (PACS) - joining up GP, hospital, community and mental health services

  • Wirral University Teach Hospital NHS Foundation Trust
  • Mansfield and Ashfield and Newark and Sherwood CCGs
  • Yeovil Hospital
  • Northumbria Healthcare NHS Trust
  • Salford Together
  • Lancashire North
  • Hampshire and Farnham CCG
  • Harrogate and Rural District CCG
  • Isle of Wight

Multispeciality Community Providers (MCPs) - moving specialist care out of hospitals into the community

  • Calderdale Health and Social Care Economy
  • Derbyshire Community Health Services NHS Foundation Trust
  • Fylde Coast Local Health Economy
  • Vitality
  • West Wakefield Health and Wellbeing Ltd
  • NHS Sunderland CCG and Sunderland City Council
  • NHS Dudley CCG
  • Whitstable Medical Practice
  • Stockport Together
  • Tower Hamlets Integrated Provider Partnership
  • Southern Hampshire
  • Primary Care Chesire
  • Lakeside Surgeries
  • Principia Partners in Health

Enhanced health in care homes - offering older people better, joined up health, care and rehabilitation services

  • NHS Wakefield CCG
  • Newcastle Gateshead Alliance
  • East and North Hertfordshire CCG
  • Nottingham City CCG
  • Sutton CCG
  • Airedale NHS Foundation


Get in touch with GPC

The GPC will be following the development of these models of care very closely and intends to publish further guidance as soon as possible.

If you have any questions or comments about vanguard sites in your area, please direct them to the GPC office [email protected]

Read our press release

Read the news story