Pathfinder bulletin for emerging CCGs – February 2012

In this month’s issue:


Welcome from Barbara Hakin

Dame Barbara HakinWelcome to the February issue of the Pathfinder bulletin – the regular communication for all emerging clinical commissioning groups. Last month you will have received a special, shorter version of the bulletin which focused on the NHS Commissioning Board Authority; this month we are back to normal with a round-up of the latest news, updates and information from across the commissioning system. Today that includes news about recent publications, the first estimates of funding for CCGs, commissioning support checkpoints, and the consultation on the Commissioning Outcomes Framework.

We are still at the beginning of 2012, but as many people are beginning to remark, we’re getting closer and closer to the new world of post-April 2013 and while I know that so much progress has been made over the last few months, there is still plenty to do to ensure we move towards successful, authorised clinical commissioning groups supported by high quality commissioning support services.

To help you with this journey we have recently published updated versions of a number of guidance documents, with many more materials due to follow in the coming weeks. These will include information around roles within CCG governing bodies and the processes to support you in appointing to them, plus model documents to assist with the creation of a constitution, which I know you have been requesting. I do hope that this guidance material will give you a framework to help in your work towards authorisation and establishment, while still allowing you the flexibility and freedom to make your own decisions as clinically-led organisations.

I know you are already working with other key partners, such as your local authorities and the third sector, to drive forward the positive change that you want to see in your local health communities. One of the ways we will be doing this moving forward is through the joint strategic needs assessments, which will give you all the opportunity to  understand and provide for the needs of your populations. This joint working is a vital part of commissioning and we would love you to be able to have your say at this early stage of developing the guidance. You can see more in the story below or by visiting the health and care website.

Finally, I did enjoy meeting many of you at the four development events we held around the country recently, but if you didn’t manage to get chance to talk to me directly, please do feel free to send any comments or feedback about the commissioning development programme via the pathfinderlearningnetwork@dh.gsi.gov.uk email address. I’m always pleased to receive your news, successes or questions.

Kind regards,
Barbara
Dame Barbara Hakin, National Managing Director of Commissioning Development

Commissioning development documents published
Three key documents related to commissioning development have been ratified at the board meeting of the NHS Commissioning Board Authority. They are:

  • Towards establishment: Creating responsive and accountable clinical commissioning groups. This guidance intends to support GP practices, and all those they work with, to work through the arrangements they need to put in place in order to apply to the NHS Commissioning Board to be established as a clinical commissioning group.
  • Developing commissioning support: Towards service excellence. This guidance is designed to assist the set-up of locally sensitive, customer-focused support services for CCGs and describes the assurance processes required to establish commissioning support organisations.
  • Developing clinical commissioning groups: Towards authorisation. This document was first published in September last year and sets out the thinking to help emerging CCGs consider the steps towards authorisation.

All the documents can be found on the CCG resources page on the NHS Commissioning Board Authority’s website. Thank you to everyone who helped shape these over the last few months.

CCG development events
Thank you to everyone who attended one of the four development events for emerging leaders of clinical commissioning groups (CCGs) which were held in December and January.

The events – which were co-productions between the NHS Commissioning Board Authority and each of the four SHA clusters – took place as part of the wider CCG development programme which gives every CCG clinical leader the opportunity to access a core set of development opportunities in the run up to authorisation and establishment.

The three key objectives for the events were to enable all parties to gain an increased understanding of the current environment; to open a dialogue between emerging CCG leaders and the NHS Commissioning Board Authority; and to provide shared learning opportunities.

Delegates have told us the events were very useful, offered opportunities for sharing and networking and gave them a chance to ask questions and find out the most up to date information aboutCCGdevelopment.

We committed at each of the events to share the feedback from all the workshops and the bite-size sessions, so that those who couldn’t attend everything could see the outputs. All that information can now been seen on the Pathfinder Learning Network.

First estimates of funding in new health structure
Clinical commissioning groups could control almost £65 billion of NHS funding, with the NHS Commissioning Board responsible for around £21 billion of commissioning expenditure, and around £5.2 billion spent on public health services.  Of this, at least £2.2 billion will go direct to local authorities and will, for the first time, be protected.

The estimated figures have been developed by mapping PCT spending in 2010/11 on to the future structure, which is still subject to the passage of the Health and Social Care Bill, and uplifting them to 2012/13 levels.

Understanding baseline spend is the first step in establishing future budgets and further analysis will now be done to build on this.  These figures will help CCGs to plan for the distribution of resources in the new system in a way that meets the needs of local populations.  They will also support PCTs to plan for the transfer of public health responsibilities to local authorities and of commissioning to CCGs.

The figures have been prepared to help emerging CCGs start working on managing their budgets, developing relationships with local partners and playing an active role in planning services for 2012/13, taking ownership for the areas which they will inherit when they become legally responsible for commissioning.

The Advisory Committee on Resource Allocation will publish its formula for allocating resources to clinical commissioning groups and to local authorities for their new public health responsibilities in due course.

Health and Social Care Bill in the Lords
The Health and Social Care Bill returned to the Lords for its Report stage on 8 February 2012. This is the penultimate stage in the Lords, before the Third Reading, following which the Bill – as amended by the Lords – will return to the Commons for MPs to consider any amendments that have been made.

The Government is tabling a number of amendments in Report designed to strengthen the Bill, and meet some of the concerns which Peers and stakeholders have raised. A full list, and a briefing note explaining the intention behind the amendments, is available here.

The latest draft of the Bill is available on the Parliament website and Hansard reports of each Report session can also be found on this page.

CCG risk assessments
Each emerging CCG was invited to participate in an initial risk assessment of their proposed configuration with their SHA in autumn 2011. This was designed to help emerging CCGs understand whether their current proposed arrangements were likely to meet the criteria defined in the Health and Social Care Bill, plus a number of other factors. The areas for consideration were sign up from member practices, appropriate geographical area, the relationship with local authority boundaries and the likely impact of size on each CCG’s organisational viability.

The process aimed to let emerging CCGs understand any risks associated with their proposed arrangements and to give them time to consider how to manage those risks to become statutory organisations, compliant with the proposed legislation.

The vast majority of CCGs are now well on the way to confirming their configuration, with only a very small handful remaining with major risks to resolve.

Authorisation next steps
Emerging CCG leads are being invited to events to help them shape the next steps in planning for the authorisation process.

The events will be run by the four SHA clusters and will involve key national speakers such as Barbara Hakin and Authorisation Director John Bewick.

The aim is to help emerging CCGs prepare for the release of the next version of the Towards Authorisation guidance which is due out at the end of March 2012. Its publication will be supported by an applicant’s guide which will incorporate a list of the tools and development support that will be available.

The guidance is currently being updated following a stakeholder consultation event on 31 January in Birmingham. The event brought together emerging CCG leads, PCT directors of commissioning development and Department of Health policy leads to work on the co-production of the criteria, thresholds and the evidence that will be required in authorisation.

If you are interested in attending one of the forthcoming events, please contact your SHA commissioning development team.

Commissioning support checkpoint one
Over the past year staff in PCT clusters have been working closely with CCGs to develop responsive and customer-focused commissioning support services (CSSs) that will support CCGs through authorisation and beyond. The document ‘Developing commissioning support: Towards service excellence’ describes the business review process for assuring commissioning support to give confidence to both the NHS Commissioning Board and CCGs that the emerging CSSs are customer focused, effective and efficient and likely to be viable in the medium to long term.

The first checkpoint of this review took place during January 2012 and aimed to assess the quality of the emerging commissioning support offers and how responsive they are to CCGs’ needs. NHS CSSs were asked to develop a ‘prospectus’ that begins to describe the ‘offer’ to CCGs. These early prospectuses will develop over time as CCGs develop a clearer view of the needs and expectations from commissioning support.

Feedback from checkpoint one shows that there has been real and tangible progress with many CSSs developing effective business relationships with their customers, and also working together to explore collaborative models that maximise value for money.  The findings of the checkpoint also helped to highlight the development needs of emerging CSSs, including where work needs to be done to establish more customer focused and viable commissioning support in the future.

These are different for eachCSS, but specific themes were the need for CSSs to develop and operate separately from PCT; the need for good leadership; for them to develop sound and viable business models; and importantly, the critical need to work closely with CCGs to make sure that services are really delivered in ways that are responsive to their customers’ needs. To take this last point forward, a number of ‘informed customer’ workshops are taking place across the country in March. The dates and locations are:

  • Tuesday 6 March, Birmingham
  • Wednesday 14 March, London
  • Thursday 15 March, Leeds
  • 21 March, Bristol

More information and details of how to book will be available at www.pcc.nhs.uk from next week.

Checkpoints two and three will apply rigorous and robust tests to assess the viability of theCSS and whether it is providing a service that CCGs will want to buy in the future.

There were 36 prospectuses submitted to SHA clusters, but this number is reducing as CSSs continue to work with CCGs and with each other to refine their structures. Early indications suggest there could be between 20-25 CSSs submitting plans at the next checkpoint.

Commissioning support factsheet
A commissioning support key facts sheet and set of frequently-asked questions has been published on the NHS Commissioning Board Authority’s website.

The key facts sheet covers the main points about commissioning support services and is aimed at GP practices and their teams.

It provides information on areas such as: choice of commissioning support, the assurance process, the timeline for implementation, future options for commissioning support when it is no longer hosted by the NHS CBA, and working with local government.

On the timeline for implementation it gives a clear timetable for the establishment process:

  • Service level agreements signed between CCGs and CSS by March 2012
  • CSS to produce an outline business plan by March 2012 and full business plan by September 2012
  • Identification of CSS leaders by the NHS Commissioning Board Authority (NHS CBA) by July 2012
  • An assurance process to be completed by the NHS CBA by September 2012, to test emerging NHS commissioning support prior to NHS Commissioning Board or CCG hosting
  • Final hosting decisions by the NHS CBA by October 2012
  • Transfer of NHS staff from PCTs to CSS from October 2012 onwards
  • Final service level agreements between CCGs and CSS by March 2013.

On choice of commissioning support it states:

  • Choice is being introduced into commissioning support services to ensure that these management support services become more innovative and provide greater value for money to the NHS.
  • CCGs will be free to use their running costs to seek support from whoever they wish.
  • In practice, during 2012-13, while the NHS makes the transition and while statutory responsibilities are changing, it is likely that the vast majority of commissioning support will come from the local PCT cluster/emerging CSS.
  • However, where CCGs feel they can get a better service from an emerging NHS offer elsewhere, the NHS CBA will be working closely with SHA clusters and with CCGs on a case by case basis so that the HR and other operational and financial implications can be worked through.
  • CCGs will be able to call on specific products or services from the independent or voluntary sector and, during 2012/13, PCT clusters will be able to procure these products or services on behalf of prospective CCGs, with a view to transferring the contract once the CCG becomes a statutory body in April 2013.
  • SHA clusters have been asked to aggregate where CCGs wish to call on support from other sectors so that the sourcing of these providers can be undertaken across the most appropriate scale.
  • Once they are established, CCGs will be public bodies and will be required to procure their commissioning support in the open market in line with the EU rules that govern the public sector.

CCG leaders forum
Thanks to everyone who has shared their ideas about how the NHS Commissioning Board Authority can best build relationships with emerging CCG leaders over the coming months.

Some ideas are now in development, including proposals for a broad forum for CCG leaders. In discussions at the regional development events, two key benefits for a forum were identified:

  • Building an effective relationship with the NHS Commissioning Board Authority to shape the culture and ways of working
  • Ensuring the NHS Commissioning Board and CCGs collaborate around commissioning.

This work is being developed by a small design group who are building on the feedback to come up with some more concrete proposals which will be shared later this month.

For further information please contact: gail.richards@dh.gsi.gov.uk

Draft guidance for JSNA / health and wellbeing strategies
From April 2013, CCGs and local authorities will have equal and explicit obligations to prepare a joint strategic needs assessment (JSNA) and this duty will have to be discharged through new health and wellbeing boards.

JSNAs will be the means by which local leaders work together to understand and agree the needs of all local people, with the joint health and wellbeing strategy setting the priorities for collective action. Taken together they will be the pillars of local decision-making, focusing leaders on the priorities for action and providing the evidence base for decisions about local services.

To support these new responsibilities, the Department of Health has published statutory draft guidance on the JSNA and joint health and wellbeing strategies. We’re keen to gather the views of CCGs and GPs prior to a formal consultation in March. You can read the guidance and download a feedback form here. The deadline for comments is17 February 2012.

Commissioning Outcomes Framework: have your say
NICE and the Health and Social Care Information Centre (HSCIC) are seeking views this month about the indicators being developed for the NHS Commissioning Board to consider for the Commissioning Outcomes Framework (COF). More information can be found on the NHS Commissioning Board Authority’s website.

The COF will measure the outcomes and quality of care commissioned by CCGs.  Indicators being developed are either derived directly from the NHS Outcomes Framework, based on NICE Quality Standards, or are indicators from other sources to support the NHS Outcomes Framework.

NICE is undertaking a full public consultation on all the indicators being developed.  This will provide an opportunity for CCGs, patients, carers, professional groups and other individuals to comment. More information can be found on the NICE website.

HSCIC is seeking feedback, primarily from CCGs, on the Quality Standards indicators during February and there will be subsequent opportunity for individuals to comment on the other strands. Feedback will be considered by the HSCIC and provided in summary form to NICE.

The NICE COF Advisory Committee will review the results of testing, engagement and public consultation on the proposed new indicators and will recommend in the summer a set of indicators for publication on the NICE website and consideration by the NHS Commissioning Board.

If you would like to comment on any of the indicators, please visit the HSCIC website at www.ic.nhs.uk/work-with-us/consultations and use the online form relating to the indicator(s) most relevant to you.  The closing date is 1 March 2012.

Choice of GP practice: pilot areas selected
Emerging CCGs in three city areas around the country might be interested to know about the new Choice of GP Practice pilot scheme.

On 30 December 2011, the Department of Health announced the three areas that will pilot choice of GP practice.  People who commute into centralLondon,Nottinghamand Manchester/Salford will be able to be seen or can register with practices in these areas, should they choose.

The pilot will be begin in April 2012, run for a year, and will be subject to an evaluation before decisions are made on any further roll out. GP practices in the pilot areas will be invited to volunteer to take part. For more information visit: http://www.dh.gov.uk/health/2011/12/gp-practice-pilot/

Commissioning maternity services: the scope for doing things differently?
At a time when the birth rate continues to rise and demographic trends are increasing complexity and risk, the challenge for CCGs in commissioning maternity services is huge.

Recognising this, the DH has established a project headed by an experienced SHA maternity lead, to work with emerging CCGs to identify and pull together resources and support that will assist local commissioning. We’re now inviting you to get involved.

To become informed commissioners of maternity services, CCGs may need information on their local childbearing population not automatically included within the Joint Strategic Needs Assessment as well as local outcome and performance data on key indicators.  Many of the determinants of good outcomes in maternity care lie in broader social factors and the responsibility of Health and Wellbeing Boards, there could be benefit in providing tools to assist with this.

For both GPs within CCGs and clinicians within acute trusts there can be some confusion about the ‘commissioning’ of the entire maternity pathway and the role of different professionals in providing elements of that pathway.  It may be that some explicit understanding of this would also be helpful.

There’s more information about the project on the Pathfinder Learning Network and your comments, views and contributions would be very welcome.  Please contact suzanne.tyler@dh.gsi.gov.uk with your thoughts.

Mental health commissioning guides
The Joint Commissioning Panel for Mental Health is a new collaboration between 15 leading organisations with an interest in mental health and learning disabilities. The Panel is co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists. It also builds upon the National Mental Health Development Unit’s previous work on commissioning and mental health.

The Joint Commissioning Panel for Mental Health has now published four commissioning guides. These are aimed at commissioners of mental health services and describe what a ‘good’ service configuration should look like, bringing together scientific evidence, service user and carer experience, and case studies of best practice.

The four guides that have been published are:

  • Guidance for commissioners of primary mental health services;
  • Guidance for commissioners of liaison mental health services to acute hospitals;
  • Guidance for commissioners of dementia services; and
  • Guidance for commissioners of mental health services for young people making the transition from child and adolescent to adult services.

To find out more please visit www.jcpmh.info or e-mail jcpmh@rcpsych.ac.uk.

Pathfinder Learning Network
The latest news, information and resources for emerging clinical commissioning groups continues to be published on the Pathfinder Learning Network. Recent updates include:

Also, do remember the new members-only online discussion forum. It has been designed for members of emerging clinical commissioning groups who want to connect with colleagues, share learning and contribute to discussions with the national Commissioning Development team. You can find it here – and if you’re not already a member, just click the button to join. We hope emerging CCG leaders will shape it over time into a vibrant and lively network.

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