Intended for healthcare professionals


The NHS five year forward view: lessons from the United States in developing new care models

BMJ 2015; 350 doi: (Published 21 April 2015) Cite this as: BMJ 2015;350:h2005
  1. Stephen M Shortell, professor1,
  2. Rachael Addicott, senior research fellow2,
  3. Nicola Walsh, assistant director2,
  4. Chris Ham, chief executive2
  1. 1University of California, Berkeley, School of Public Health, Berkeley, California, USA
  2. 2King’s Fund, London, UK
  1. Correspondence to: S M Shortell shortell{at}
  • Accepted 30 March 2015

All political parties have endorsed NHS plans for greater integration of care in the next parliament. Stephen Shortell and colleagues use US experience to suggest what is needed to make it happen

The NHS five year forward view, published by NHS England and other NHS bodies, sets out a shared view on how services need to change and what models of care will be required in the future.1 Its key arguments are that much more attention should be given to prevention and public health; patients should have far greater control of their care; and barriers in how care is provided should be broken down. This means putting in place new models of care in which care is much more integrated than at present.

Similarities exist between the proposed care models and the development of integrated systems in the United States. Here, we outline two of the models proposed by NHS England and discuss how experience from the United States may help inform how they are implemented.

Two of the care models in the forward view have attracted particular attention. The first is called multispecialty community providers, in which general practitioners would work with a wider range of health and social care professionals than at present. These professionals would include some specialists currently working in hospital, such as geriatricians and paediatricians, as well as nurses, therapists, and social workers. The forward view argues that general practices would need to be organised through federations and networks to be able to make multispecialty community providers a reality.

The second model is described as primary and acute care systems. In this model single organisations would provide NHS general practice and hospital services for a listed population, together with mental health and community care services. These vertically integrated care organisations might be led by …

View Full Text

Log in

Log in through your institution


* For online subscription