In 2015, 50 vanguard organisations were selected by the National Health Service (NHS) in England to pioneer new and improved ways of delivering health care. Vanguards would focus on joining up care provided in different health care settings; moving specialist care from hospitals into the community; enhancing patient health in care homes and linking hospitals to improve clinical care. These new ways of delivering health care will enable patients to receive care earlier and quicker; provide more and better care closer to home, and create more time for general practitioners (GPs) to plan and care for patients with long term or complex needs.
To deliver care in the new ways, general practices have, for example, simplified and provided quicker access to care by introducing online consultations for non-urgent conditions and are working more closely with community teams to reach patients at high risk of hospitalisation.
To understand the potential impact of the Vanguard initiatives on patient outcomes and general practices, this study will use data from general practices to assess GP consultations referral and hospital admissions rates over time, including before and after changes were introduced. Findings will provide evidence, alongside vanguards own local evaluations, to inform continuing service development.
The English NHS is developing new ways of delivering health care through its new care models programme. These are initially being developed and delivered by 50 vanguards organisations and partnerships throughout the country. Vanguards will pilot a range of models including closer joined up working between community, access to health care quicker and closer to home, and interventions to release GP time to manage more complex conditions.
This analysis will feed into a larger mixed-methods evaluation led by the Vanguards Evaluation team and will focus on estimating pre-intervention and post-intervention healthcare utilisation (e.g. GP consultations, hospital referrals and admissions) using general practice data collected by the Clinical Practice Research Datalink (CPRD). Crude annual and quarterly rates per person time, and 95% confidence intervals, will be aggregated across all CPRD contributing practices, all Vanguard and non-Vanguard practices and individual practices. Rates will be stratified by calendar year, age-band and gender, categories of health care professionals and consultation location. Rates of hospital admission among high risk populations and patients with ambulatory care-sensitive conditions (ACSCs) will also be estimated.
These findings will be used alongside other data collected by the Vanguard evaluation teams to assess the potential impact of their programmes.
Puja Myles - Chief Investigator - CPRD
Tarita Murray-Thomas - Corresponding Applicant - CPRD
Charles Tallack - Collaborator - NHS England
Helen Booth - Collaborator - CPRD
Jane Druce - Collaborator - Southern Health NHS Foundation Trust
Rachael Williams - Collaborator - CPRD
HES Admitted Patient Care