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Large-scale health system transformation in the United Kingdom: Implementing the new care models in the NHS

Lookup NU author(s): Dr Gregory Maniatopoulos, Emeritus Professor David Hunter



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020, Gregory Maniatopoulos, David J. Hunter, Jonathan Erskine and Bob Hudson. Purpose: Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England. Design/methodology/approach: Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign. Findings: It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes. Originality/value: Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

Publication metadata

Author(s): Maniatopoulos G, Hunter DJ, Erskine J, Hudson B

Publication type: Article

Publication status: Published

Journal: Journal of Health Organization and Management

Year: 2020

Volume: 34

Issue: 3

Pages: 325-344

Print publication date: 04/05/2020

Online publication date: 18/03/2020

Acceptance date: 25/11/2019

Date deposited: 06/04/2020

ISSN (print): 1477-7266

ISSN (electronic): 1758-7247

Publisher: Emerald Group Publishing Ltd


DOI: 10.1108/JHOM-05-2019-0144

PubMed id: 32181995


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