Because the vanguards have shown just how important is to build collaborative relationships between the organisations and leaders involved in developing new care models as well as the technical elements; This report looks at the different approaches being taken by MCP (multispecialty community provider) and PACS (primary and acute care system) vanguards to contracting, governance and other organisational infrastructure. It focuses on development at five sites: Dudley, Sandwell and West Birmingham, Salford; Northumberland; and South Somerset.