Table 2.

Comparison of significant pilot experiences and outcomes (extracted from publications of the national evaluation teams and selected studies) [1,2,3,4,5,6,7,8,9,10,11,12].

THEME	ICPS	PIONEERS	VANGUARDS
Facilitators	Effective senior leadership Shared values and vision Strong, pre-existing relationships locally Staff engagement Low complexity interventions (compared to high complexity) Specific education/training interventions Co-location of staff Availability of funding and other resources	Effective cross organisation and professional relationships Effective leadership Kudos as part of a pilot programme Shared vision and values Lack of organisational complexity (especially if shared boundaries) History of successful integrated care Availability of resources Staff engagement and ‘ownership’	Development of relationships with national programme team Multi-modal communications Strong local and national leadership Access to expert knowledge and skills Good level of funding Perception of a licence and platform to do things differently as a result of being part of a high-profile national programme
Barriers	Complexity of organisations and interventions IM&T issues and information governance concerns Poor communication Poor professional engagement (especially GPs) Erosion of professional identity ‘Red tape’ Wider NHS financial pressures Lack of resources and high existing workforce pressure Conflicts with new national policy context	Financial constraints and high existing workforce pressure IM&T issues and information governance concerns Limits to local freedom to innovate Limited national support to tackle systemic barriers Difficulty breaking down professional and organisational roles and culture Leadership tensions between organisations Engagement and commitment of GPs Conflicts with new national policy context	Continuation of standard national regulation and oversight Lack of high quality data and issues with information governance, inter-operability of systems and data sharing Short timescales and expectations of rapid progress (especially against government targets)
Impact on hospital activity	Significant increase in unplanned admissions and reductions in elective elective inpatient and outpatient care. More marked increase in unplanned admissions for case management sites. Overall costs of hospital care reduced by 9% (statistically significant) for case management patients.	A modest impact on unplanned admissions to hospital, with Wave 1 pilots experiencing a lower increase than non-Pioneers. However this was only statistically significant in Year 1 and not in Year 2. Significant variation found between pilots and within pilots.	Vanguards slowed the rise in unplanned admissions compared to controls. Over three years a significant 4.2% reduction in those admissions found for Enhanced Care Home pilots (increased over time and became statistically significant in third year and overall). MCP/PACS significant 3.1% reduction in Year 3 but not significant over whole period. No overall reduction in bed-days Sites had higher unplanned admissions and bed days than controls in two years prior to start of pilot. Impacts most visible in sites which had previously been Pioneers
Impact on patient experience	Mixed response. No more likely to have discussions about how to deal with health problems, more likely to have care plans In case management sites: more clarity regarding discharge; less likely to have been given wrong medicine. But also less likely to be able to see clinician of choice and fewer felt opinions and preferences taken into account.	Data are being collected on MDT caseload patients’ experiences of care received, and on the impact of being on an MDT caseload on health and quality of life.	No systematic study of patient experience across the programme. Individual Vanguards procured individual evaluations, but quality mixed.
Impact on staff experience	Staff reported improved team working and communication; increase of breadth and depth of their job; more responsibility; more interesting jobs; improvements to patient care.	Currently completing data collection on strategic level managers’ and operational as well as front line staff perceptions of health and social care integrated, community-based MDT working.	Staff reported increased job satisfaction associated with the feeling that they had licence to innovate and were part of a high-profile national programme.