New models:

what is the thinking?

Alison Turner, Abeda Mulla, Robin Miller

strategy_unit

#mcpsynthesis

Multispecialty Community Providers

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“The MCP care model operates at four different levels:

• at the whole population level, the MCP aims to bend the curve of future

healthcare demand. It aims to address the wider determinants of health and

tackle inequalities. It builds social capital by mobilising citizens, local employers

and the voluntary sector;

• for people with self-limiting conditions, the MCP helps build and forms part of a

more coherent and effective local network of urgent care;

• for people with ongoing care needs, it provides a broader range of services in the

community that are more joined-up between primary, community, social and acute

care services, and between physical and mental health, including for some,

integrated personal commissioning (IPC) and personal health budgets; and

• for small numbers of patients with very high needs and costs, it delivers an

‘extensive care’ service.”

https://www.england.nhs.uk/wp-content/uploads/2016/07/mcp-care-model-frmwrk.pdf

About the project

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Objectives :

• articulate programme theories by

mapping logic models/key documents,

prioritising theories for investigation;

• identify sources of evidence to test

programme theories;

• appraise, extract and analyse evidence;

• develop the synthesis, producing a

“blueprint”;

• consult with key stakeholders to validate

findings and test applicability to different

contexts;

• finalise the synthesis, incorporating

stakeholder feedback;

• disseminate findings.

Aims:

• To provide decision makers in health and

social care with a practical evidence base

relating to the MCP model of care.

• To develop a “blueprint” which articulates

how and why MCP models work.

• To support decision makers in a range of

settings, by:

Supporting the required local

evaluation of the MCP sites;

Enabling shared learning for the

design and delivery of the MCPs in a

timely way;

Informing policymakers of the “active

ingredients” for successful new

models of care.

Review questions

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What are the foremost theories of

change inherent within the MCP model of

care?

What seem to be the “active ingredients”

which should inform design of MCP models

of care?

What are the social and cultural

conditions which influence (enabling and

blocking) change within MCP models of

care and how do these mechanisms operate

in different contexts?

What are the key knowledge gaps and

uncertainties in relation to the design,

implementation and evaluation of MCP

models of care?

Our approach

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A realist review seeks to understand and explain what works for whom under

what circumstances

Specifically, we are looking at a New Model of Care (MCP) to identify under what

circumstances MCPs are more or less likely to deliver the benefits that are

claimed for them (the Quadruple Aim)

Our research will help to improve future health service delivery and lessons

learned may also apply to other new models of care

Our approach will help us to understand why an intervention or model seems to

work (or not) in different contexts

Realist methods are being increasingly used…

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Example

Improving skills and care standards in the support workforce for older people:

a realist synthesis of workforce development interventions

‘What works’ in workforce development for the older persons’ support workforce:

• Making it real to the work of the support worker.

• Paying attention to the individual

• Tapping into support workers’ motivations

• Joining things up around workforce

• Co-design

• Journeying together

• Taking a planned approach in workforce

• Spreading the impacts of workforce development across organisations

https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr04120/#/abstract

Discussion on tables

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What works for whom under what circumstances

Considering the perspectives of: patients, communities,

practitioners, providers, commissioners

What aspects of the MCP model might work? Why?

Conversely, what aspects of the MCP model might not

work? Why?

A framework for understanding whole system

change

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a. NHS England 2015. The 10 enablers of

transformation in “THE FORWARD VIEW INTO

ACTION. New Care Models: support for the

vanguards” https://www.england.nhs.uk/wp-

content/uploads/2015/12/acc-uec-support-

package.pdf

b. NHS England 2016. MCP Framework: working

document shared in confidence June 2016

c. WHO 2016. Framework on integrated, people-

centred health services

http://apps.who.int/gb/ebwha/pdf_files/WHA69

/A69_39-en.pdf?ua=1

d. Fillingham and Weir 2014 System leadership:

Lessons and learning from AQuA’s Integrated

Care Discovery Communities. Figure 2:

Framework AQuA’s Integration System

http://www.kingsfund.org.uk/publications/syste

m-leadership

e. NHS England 2016. The multispecialty

community provider (MCP) emerging care

model and contract framework

https://www.england.nhs.uk/wp-

content/uploads/2016/07/mcp-care-model-

frmwrk.pdf

Programme theory components

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Programme theory reviews Programme theory maps

R1 Community based coordinated care is

more accessible

R2 Place-based contracting and payment

systems incentivise shared accountability

R3 Fostering relational behaviours builds

resilience within communities

M1 Collective responsibility improves quality

and safety outcomes

M2 Multidisciplinary teams provide

continuity for patients with LTCs/complex

needs

M3 Engaged and trained staff expedite

cultural change

M4 System learning embeds and sustains

transformational change

M5: Proactive population health is

dependent on shared and linked data

More information

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Project information:

https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/157715/#/

Wordpress site:

https://mcpsynthesis.wordpress.com/

Protocol:

https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0346-x

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This project is funded by the National Institute for Health Research, Health Services

and Delivery Research Programme (project number 15/77/15).

The views and opinions expressed therein are those of the authors and do not

necessarily reflect those of the Health Services and Delivery Research Programme,

NIHR, NHS or the Department of Health.