Pathfinder bulletin for emerging CCGs – March 2012

In this month’s issue:

Welcome from Barbara Hakin

Dame Barbara HakinWelcome to the March issue of the Pathfinder bulletin for emerging clinical commissioning groups (CCGs). This month the content reflects the huge amount of work taking place to help emerging CCGs prepare for authorisation and establishment. Included are items about new governance resources, including Clinical commissioning group governing body members: Role outlines, attributes and skills, and news of a forthcoming survey of CCGs’ intentions around commissioning support services.

There is also an item on the independent national diagnostic, assessment and development process for leadership roles in CCGs. I wrote to the SHAs earlier this month to set out the next steps in helping you to identify the leaders for your organisations. We want to support you to secure the right people with the  ability and aptitude to lead your CCG into the future, and we believe that this process will help you have more information and support when you come to undertake the selection processes, either as a candidate yourself or part of the CCG looking to find the right leaders.

I know this has been a busy period across the country in every emerging CCG, and my team and I appreciate the time and effort you are putting into developing your organisation. The coming few weeks will be no exception as we expect the Health and Social Care Bill to become an Act, and all CCGs to have agreed their membership and geographic area and delegated budget arrangements ready to prepare for authorisation following the publication of the draft Clinical commissioning group authorisation: Draft guide for applicants in April.

I’m always interested to hear about your experiences and respond to your concerns and it has been great meeting so many of you on my informal visits to emerging CCGs. So far I’ve been both inspired and enlightened by your progress. Another mechanism I’ve put in place is a series of regular online ‘Web Ex’ teleconferences for emerging clinical leaders, either in the early morning or at lunchtime. By bringing together the clinical community online to discuss key topics, I hope you can help shape the development of the new commissioning system in a time-efficient way, and it gives you the opportunity to ask questions directly. There is more detail about this in this month’s bulletin.

Finally, I want to clear up these points on commissioning support: We are very keen to set up what works best locally for CCGs, but you need to bear a few things in mind. Firstly, the size of the CCG will be a big factor in what CCGs can choose to do in-house and what they might buy in. But the fixed running costs envelope  – which is a maximum allowance you can use from your allocation, not a fixed amount that must be spent, or a separate sum – means that there will be some things, like some of the information analysis, benchmarking and procurement, where in order to get the right quality and  the benefits of the right price, it makes sense for everyone to buy this from expert suppliers who can bring added benefits and provide the basis for carrying out more sophisticated services.

There are other activities, including other parts of the information analysis or contracting and contract monitoring, which a biggerCCGor alliance of two or three CCGs could do.  But even for these it could  make sense for an external  commissioning support service (CSS) to create a team where some staff are embedded  in CCGs but have access to a larger support team which can bring in expert advice when it’s needed.

Secondly, there is a myth that the NHS Commissioning Board Authority will set a higher bar for authorisation for a CCG which puts in place internal capacity, rather than buying in commissioning support, or that they may be delayed. This is not true. The CSSs will go through a parallel assurance process during 2012, so a CCGwhich gets most of its capacity for commissioning from a CSS will not need to have this assessed  through authorisation, but a CCG which has in-house capacity will need it to be assessed. This means more will need to be assessed through authorisation but the total scrutiny of the commissioning support capability will be the same.

If you do have any questions, comments or feedback about the commissioning development programme please email me at

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

CCG leadership and development
The NHS Commissioning Board Authority has set up an independent national diagnostic, assessment and development process for everyone who is interested in the key leadership roles in the governing body – Chair, Accountable Officer (AO), Chief Finance Officer (CFO).

It will give prospective candidates the opportunity to access development support ahead of CCGs taking up their formal responsibilities in April 2013.

The process is separate to the selection and appointment process for CCG leadership roles. This is done by CCGs, except in the case of the AO where it is for CCGs to nominate their proposed AO as part of their application for establishment and for the Board Authority to appoint the person.  The Board Authority is working with the trade unions and emerging CCGs on an HR guide to support CCGs in navigating employment law as they move to make formal appointments.

SHAs have been asked to invite emerging CCGs to identify individuals they would like to ‘sponsor’ into the independent process, which is run by the Hay Group. This could be staff in practices or practice-based commissioning roles, as well as those in PCTs and SHAs. In addition, for the AO and CFO role, SHA clusters will identify other potential interested individuals at ‘Very Senior Manager’ level in SHAs or PCTs.

The outcome of the assessment centre part of the process will be a short report outlining the participant’s capability and potential for the role in which they are interested. It will identify whether the individual is ready now to take up the leadership role, likely to be ready with some further development or unlikely to be ready within a reasonable timeframe. The assessment process will then provide access to nationally funded programmes of development opportunities for CCG leaders, delivered flexibly to suit different circumstances. The report will be for the individual but progress to appointment will depend on the report and subsequent development plan being shared.

In the case of the Chair, many CCGs will have completed their local selection process before the individual starts this assessment. Thus if the outcome of the assessment suggests that the individual has the right aptitude for the role and the appropriate development plan theCCGwould simply affirm their position.

The Board Authority has asked the NHS Leadership Academy to run the diagnostic and development part of the process. Individuals will be able  to choose whether to access the diagnostic part of the process first, ahead of the assessment centre, or whether to go straight in to the assessment centre.

SHAs will provide those who have been nominated with further details about the process. The assessment centres are likely to start in late April and booking is already open. The process has been aligned with the timescales for recruitment to the leadership roles in the Board Authority (sectors and local offices) and NHS commissioning support services. For further information please contact the Director of Commissioning Development at your SHA.

Governance resources
More draft documents to help CCGs become established are now available. These need to be read in conjunction with Towards establishment: Creating responsible and accountable CCGs which was published in February 2012. The documents are still in draft and subject to final legal clearance. Final versions will be published following Royal Assent of the Health and Social Care Bill.

The resources, which are optional, have been designed to be flexible and to be tailored for local use.  CCGs may choose to use all or certain aspects of each resource, or decide to create their own versions.

  • Model Constitution  Framework including Standing Orders, Prime Financial Policies,  and Scheme of Delegation Templates

This Framework, co-produced with the NHS, provides a template covering the areas CCGs will wish to consider when drawing up a constitution.  It brings together all the elements of the proposed legislation and suggests a format to follow. It also includes three templates for governing body committees .

  • Governing Body Committees: Terms of Reference Templates

These templates for the audit, remuneration and quality committees have been co-produced with the NHS.

  • Clinical commissioning group governing body members: Role outlines, attributes and skills

This resource provides a description of the roles on the governing body and the skills and qualities needed for each. It also includes a role outline for an optional Chief Operating Officer role at Annex 1.

All the materials can be seen and downloaded from the NHS Commissioning Board Authority website.

Alongside this, the independent diagnostic, assessment and development process for three of the specified roles on aCCG’s governing body: Chair to governing body, Accountable Officer and Chief Finance Officer is now in place.

Appointment support for lay members
A web-based toolkit has been published based on best practice developed by the Appointments Commission. It covers all the steps CCGs may wish to consider in the appointment of lay members to governing bodies. The Best Practice Resource/Practical Toolkit for the appointment of lay members to Clinical Commissioning Groups includes practical checklists and points to consider throughout the process from drawing up the role description through shortlisting, interview and appointment, as well as suggested templates for shortlisting, interview records and letters.

It is good practice to include an independent assessor on the appointment panel.  The Appointments Commission has a list of independent assessors which can be accessed by emerging CCGs via the email helpdesk (see below).  Emerging CCGs will be responsible for covering any fees and expenses they incur if they engage an independent assessor from this list.

A template specification has also been provided for CCGs to adapt should they wish to engage a recruitment specialist to assist them with all or some of their appointment process.

A specific email address has been set up at for any queries you might have about the appointment support for lay members.

Draft authorisation guidance nears publication
Work is taking place to finalise the draft guidance on CCG authorisation. Clinical commissioning group authorisation: Draft guide for applicants will be published on 3 April as part of the papers for consideration at the NHS Commissioning Board Authority meeting on 13 April. It will set out the process and criteria the Board Authority envisages that the NHS Commissioning Board will use to assess whether CCGs are ready to be authorised, the thresholds they must meet to be authorised and the evidence sources to be submitted.

There will be four waves of applications, in July, September, October and November 2012, with each wave taking about three months to assess. Over the next few weeks SHAs will be discussing with each aspiring CCG when they think they will be ready to apply. At the end of April, each aspiring CCG will be asked to tell the Board Authority which wave it plans to join.

SHAs are holding eight regional workshops on authorisation withCCG leaders in March and April. At the meetings, they are sharing sections of the draft guidance to help CCGs see how the criteria and evidence are structured around the six domains. SHAs and PCT clusters will continue to support emerging CCGs in their development and in their preparation for authorisation, including identifyingCCG-specific areas for improvement and actions for resolution.

Survey of CCG plans for commissioning support
All CCGs are due to receive a short survey before the end of March about their commissioning support plans.

The NHS Commissioning Board Authority has asked the NHS Alliance / NAPC Clinical Commissioning Coalition to lead a brief survey of all CCGs to assess how well commissioning support services are developing and whether they are truly meeting CCGs’ needs. Market research company TNS-BMRB is supporting the Clinical Commissioning Coalition to run the survey.

The results will be used to inform the second stage of the commissioning support assurance process.  The process – known as ‘Checkpoint 2′ – begins on 2 April and runs through to mid-May. The guidance for Checkpoint 2 has already been shared with SHA clusters and they have been asked to brief CCGs on the process.

The objective of Checkpoint 2 is to assess emerging CSSs’ outline business plans and the future viability of eachCSS. As part of this, CSSs will need to demonstrate they are already supporting emerging CCGs as they prepare for authorisation.

The guidance includes an outline of how CCGs will be involved in Checkpoint 2, and how their views will influence the outcome for NHS CSSs. Following the independent survey, during April, eachCSSwill undergo an in-depth review by a panel which includes aCCGrepresentative. SHAs are currently recruiting CCG leaders to the assessment panels, and full training and guidance will be given to those who take part.

Where a CCG wishes to choose alternative commissioning support, then SHA clusters will work with them to agree an approach. More information on how this process will work is being developed. For information on becoming an ‘informed customer’ of commissioning support services, please see the case studies from an event held by the Clinical Commissioning Coalition on 6 March where CCGs andCSS jointly presented their work on developingCSS.

Service level agreements between CCGs and CSSs
More detailed guidance on commissioning support service level agreements (SLAs) in 2012-13 has been issued to CCGs via SHA/PCT clusters.

The guidance says that while CCGs and CSSs are developing in their new roles, and CCGs are refining their commissioning support requirements, the nature of SLAs will vary and arrangements should remain flexible to accommodate this.

In November 2011, the Operating Framework for the NHS in England 2012-13 outlined that SHA and PCT clusters should ensure shadowSLA arrangements were put in place between CCGs and their choice of NHS CSS supplier before the end of March 2012.

The new guidance outlines that some CCGs will be able to put in place detailed SLAs, setting out service lines and activity metrics, and describing a customer/supplier relationship between the parties, by this timescale. Where CCGs have detailed SLAs in place with CSSs from April this will help them to demonstrate that they have identified their ‘do-buy-share’ intentions, that they know their specific commissioning support requirements, that they have established the necessary agreements and that they have the necessary internal capability to manage it.

Where CCGs are less well developed, then theSLAwill be less defined and, says the guidance, might simply aim to set out a statement of intent by the CCG and a description of the service from the CSS, along with statements about how the CCG aims to further develop the detail of the arrangements through the year.

Clinical leadership ‘Web Ex’ teleconferences
Barbara Hakin has led the first of a series of online ‘Web Ex’ teleconferences for clinical leaders. Web Ex technology combines desktop sharing of slides through a web browser with teleconferencing, so everyone who is logged on sees and hears the same presentation live in real-time and is able to contribute.  This enables Barbara Hakin to discuss current issues with CCGs quickly and directly, without the need for participants to travel.

In the first session, Barbara presented the independent diagnostic, assessment and development process for emerging leaders in CCGs and a recording of the first session is available here.

The dates of the next sessions – on CCG authorisation – are:

  • Wednesday 2 May, 12.15-13.00
  • Thursday 3 May, 18.30-19.15

We will be sending invitations and registration details to clinical leaders shortly.

Health Investment Framework
A Health Investment Framework has delivered £11 million of QIPP savings for one commissioning organisation.

NHS Western Cheshire has achieved the savings and improved patient outcomes through using the evidence-based health investment process. Using the data, and working in partnership with primary and secondary care clinicians, commissioners were able to identify a number of disease areas where service improvements could be made.

The QIPP Right Care workstream provides commissioners and GP practices with a framework to enable them to make evidence-based budget decisions where spending is broken down into disease groups (such as cancer) which then links directly with activity and outcomes information.  Based around disease areas, it enables commissioners to map costs across a whole care pathway – from prevention and health promotion to primary care, hospital admissions and community care.

The Health Investment Framework can help CCGs gain best value and patient outcomes from limited resources. The results will help them to develop clear and credible commissioning plans, which are required as part of the authorisation and establishment process.

For more information contact the Health Investment Team at or visit the Health Investment website which provides a range of resources to help commissioners.

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

In Commissioning, Pathfinder Learning Network

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