How can we prepare staff for the new era of integrated care?

So the Vanguard pilot schemes for 29 areas have been announced, with the expectation that they will transform care models for local people – the first wave of radical reforms aiming to achieve integrated care.

If these reforms have passed you by, basically this will mean that the schemes chosen will operate according to one the following three models:
• Integrated primary and acute care systems (Pacs), which will bring together GP, hospital services, community and mental health services.
• Multispecialty community providers (MCPs) will move specialist services out of the hospital and closer to people’s homes and into the community.
• Models of enhanced care in care homes will aim to improve services for older people, joining up health, care and rehabilitation.

Supporting radical change, which encourages a bottom-up approach is great in theory and some might say 'transformational change' has been happening for a while in their organisations.

But we are familiar with the inertia that can exist in some parts of the NHS and this type of change requires investment, determination and spirit to make it successful.

The criteria for success will not just be whether they can improve patient care but how these models will be adapted and replicated across other organisations.

The basics of what we do is to help our organisations build trusting, functioning relationships in a highly governed setting. But bringing different groups of people with different values, governance, systems and expectations is not easy. Challenging and removing those barriers will be a difficult task. The impact of current funding and workforce pressures makes this even harder.

Surely one of the key things we need to do is think about how we attract, recruit, retain and support our staff so these changes can happen? 'Wrap around care', 'single point of access' and 'teams looking after one patient' should be replicated for staff too. Research tells us (we always knew but it always helps with a business case for funding!) that dedicated, motivated and well supported staff = excellent patient care.

For this to happen we need investment, technology and skills training, and for organisations to have more movement and freedoms that will enable them to adopt innovative ways of working. Even the regulators will need to adapt. But this is a great opportunity for HR to showcase our skill sets, and what we do best.

So what are your thoughts on the workforce implications? We might consider:

• How is this going to change from how we work now?
• What skills do we need to support this change?
• What will 'new' workforce structures look like?
• What about the legal, governance and contractual requirements?
• How will we support and be involved in workforce planning/skill mix for the new patient pathways?
• How do we influence, lead and add value?

It would be good to hear if you have been involved in the proposals for the Vanguards or what your thoughts are on this…

Kelly Abel, Head of Workforce for the Cancer Programme, Guy’s and St Thomas’ NHS Foundation Trust, London


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