Horses for Courses

When Simon Stevens wrote in the Five Year Forward View that ‘England is too diverse for a “one size fits all” care model to apply everywhere’ he was absolutely correct. Different local communities will have different needs and priorities, which will require different solutions.

Some of these will require the re-imagining of local organisations and structures, whether multi‑specialty community providers, integrated hospital and primary care providers, or something even more radical. In other cases, closer collaborative working and innovative commissioning may prove the right way forward.

What will become more and more important is that local communities have the right tools for understanding what is happening within their populations. This is not just a retrospective consideration of historic activity; there must be a predictive element, and – importantly – the impact of multi-morbidity needs to be understood.

At the same time, when making changes and delivering transformation, monitoring and benefits realisation will become key. We suspect different communities will look at different baskets of measures. Clinicians – and GPs in particular – will be central to designing and sustaining local change.

This will be a real challenge for those CSUs and other bodies that have just made it on to the Lead Provider Framework, and also for those who may not be on the LPF but who still have skills and products that CCGs may want to buy. It won’t be just about offering a diversity of tools – over time that will prove less than cost-effective. Rather, it means building real, local flexibility into every service those bodies offer.