Pathfinder groups bulletin – July 2011

In this month’s issue:

Welcome from Barbara Hakin

Dame Barbara HakinWelcome to the July 2011 edition of the Pathfinder bulletin. This month sees a slight shift in the focus of our newsletter to you. Based on your feedback, we have included more information about the whole of the commissioning development programme, so you can see where your work as pathfinders fits into the wider context of NHS modernisation. Included in this month’s bulletin therefore are updates on the NHS Commissioning Board, news from David Nicholson’s recent meeting with PCT clusters, information about how our work links with Public Health and information about the new service offer for communications and engagement.

Since I last spoke to you a number of documents have been published which have an impact on the commissioning development work and I know that many of you are particularly eager to see the emerging framework for authorising clinical commissioning groups. This has been developed with extensive input from clinicians, commissioning managers and other key stakeholders and at this stage is being shared as ‘work in progress’. As you know, the proposals are subject to change and refinement as the Health and Social Care Bill passes through Parliament, therefore we are extremely keen to hear your views on it and to work with you and other partners to take the proposals forward. The creation of highly effective, high quality authorised clinical commissioning groups is at the heart of driving improvements for our patients in the NHS and delivering value to the taxpayer.

You will have heard that we announced the latest cohort of pathfinders in July. The pathfinders in cohort 5 now bring the total number across the country to 257, covering 97% of the population. We are planning to hold another national pathfinder event for those colleagues in the autumn and will be contacting the relevant leads about this nearer the time.

I would also like to let you know that we are currently making a number of improvements to the online presence of the Pathfinder Learning Network. Over the summer we hope to introduce new features which will enable you to link with and talk to other pathfinders, share your ideas and interact more easily with us here at the Department. I am keen for us to work together to build an animated, active network that’s also informative and useful for its members. We’ll have more information on this shortly.

One section of the Pathfinder Learning Network that I know is well received is the database of case studies. We are always looking for more pathfinders to come forward with examples of good practice so please do let us know if you have something you would like to share with colleagues. Equally we’d like to hear from you if your emerging CCG is interested in being part of some work around the commissioning of maternity services, equality and diversity or health inequalities. Just email the team on

As you know I am always pleased to get out and about and it was enormously encouraging to see and speak to so many of you at the recent NHS Confederation conference in Manchester. I took part in a very well attended session about the future of commissioning with Professor Steve Field and Dr Chaand Nagpaul from the BMA. For those of you who were unable to come along, you can hear the discussion here.

Finally, I’m sure it won’t surprise you to hear me say that the next few months are going to be extremely busy, but critical, in terms of the work we do to set up successful, supportive arrangements for the new commissioning system. You can see an example of some of the documents we hope to produce before the end of the year in the bulletin below. It’s clear there is much to be done and we cannot achieve it in isolation. Your continued input and partnership working as pathfinders ensures that we can take this work forward successfully and learn from each other as we progress.

I do hope you find this bulletin useful, but as always, if you do have any questions or comments please send them to I look forward to hearing from you.

Kind regards,

Dame Barbara Hakin, National Managing Director of Commissioning Development

Authorising clinical commissioning groups

Clinical commissioning groups (CCGs) are at the heart of the Government’s proposals to establish the NHS as the best healthcare system in the world. And to ensure that we create a network of CCGs that are highly effective and have the leadership and confidence to discharge their healthcare and financial responsibilities, a clear process is needed to authorise those emerging organisations.

We have been working with a number of groups including pathfinders, SHAs and patient representatives to discuss how we can move from the current position of vibrant and enthusiastic pathfinders to established CCGs. We have been thinking particularly about the authorisation domains and principles which the NHS Commissioning Board will be working through with the CCGs to enable them to become fully authorised.

The six domains are:

  • A strong clinical and professional focus which brings real added value
  • Meaningful engagement with patients, carers and their communities
  • Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge within financial resources in line with national outcome standards and local joint health and wellbeing strategies
  • Proper constitutional and governance arrangements with the capacity and capability to deliver all their duties and responsibilities including financial control as well as effectively commission all the services for which they are responsible
  • Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support
  • Great leaders who individually and collectively can make a real difference

Many CCGs will have already begun their developmental work and will be keen to ensure they are focusing their resources appropriately. We want to work with you to refine the proposals and would like to hear your thoughts and comments on the document before it is formally published in September. For more information please contact your SHA Director of Commissioning Development.

Diagnostic tool for emerging clinical commissioning groups

A new developmental, self-assessment tool to enable emerging clinical commissioning groups (CCGs) to understand and reflect upon their values, culture, behaviours and wider organisational health has recently been made available.

The tool is an interactive, computer-based product which allows members of your leadership team to assess the capability of your emerging CCG across the six domains, identify for themselves their development needs and access further resources and examples of good practice.

The tool is intended to encourage conversations about the roles and responsibilities which will be expected of CCGs as statutory bodies and your readiness to take these on.

It will be up to you whether and how you use the tool and the information produced will belong to you, although they may choose to share the outputs with others.

Whilst the tool includes some of the key areas which are likely to be required for authorisation, it also provides insight into how you can create vibrant organisations that can continually improve beyond the point of authorisation.

Initially the tool will be available as an interactive spreadsheet, in response to demand from pathfinders for early access to the tool. By autumn 2011 a fully web-based version should become available. We would commend its use to emerging CCGs early on in their journey to support their organisational development journey over the next 12/18 months.

You can access the tool and supporting information via your PCT cluster or on the Pathfinder Learning Network.

Supporting authorisation

In addition to the initial thinking around authorisation and the diagnostic tool, a number of supplementary documents will be made available over the coming months. These will support the development of clinical commissioning groups to become fully authorised, giving more detail about specific areas of work. Forthcoming documents include:

  • Guidance on the delegation of commissioning responsibilities. This will set out how the process for budget delegation will be tracked in a consistent way across the NHS.
  • Guidance on the legal status of CCG pathfinders and ‘shadow’ CCGs. This will provide clarification about the proposed legislative framework in the Health and Social Care Bill and explain issues such as the employment of staff.
  • An update to ‘The functions of GP commissioning consortia’ (originally published in March 2011) reflecting the changes made to the Health and Social Care Bill as a result of the NHS Future Forum report.

Guidance on governance support

A separate development tool has been produced by the National Leadership Council (NLC), Foresight Partnership Ltd and NIHR King’s Patient Safety and Service Quality Research Centre to inform and support emerging clinical commissioning groups as they consider how to build effective governance arrangements. The tool comprises a suite of three documents including a literature review, a set of case studies (drawn from practice based commissioning) and a discussion paper. The documents have been produced in partnership with the NHS and has been uploaded to the NLC website .

Naming of emerging CCGs

Many emerging clinical commissioning groups (CCGs) have asked how they should be named and branded before authorisation, in the light of the response to the NHS Future Forum report.

The intention is that a governance framework will be made available in the autumn to all emerging CCGs. This will include details of how groups should be named and branded both pre and post authorisation. In the meantime, wherever possible, groups should hold off making naming and branding decisions that may have to be reversed at a later date.

If this is unavoidable, groups should choose an interim name that is clear and descriptive and follows the information set out in paragraph 3.49 of the NHS Future Forum report.  Those wishing to use the NHS identity during this period should follow the branding guidance for non-statutory organisations. Further information on this is available from the NHS brand helpline on 0207 972 5250/5261.

Pathfinder evaluation

The Department has commissioned an independent evaluation of the pathfinder programme, to help share the learning from pathfinders and to advise the NHS Commissioning Board on the key factors which it will need to address in the support it provides to CCGs during 2012/13 to ensure their readiness to assume responsibility for commissioning.

The evaluation will be led by the London School of Hygiene and Tropical Medicine and the University of Manchester via a small number of case studies and a wider survey. The research team will begin contacting potential case study sites over the summer with the survey expected to take place over the autumn. Initial findings are expected in December, with more detail due in June 2012.

We would encourage you to contribute your thoughts when you are contacted, to share your learning with other pathfinders, provide feedback on your experience as a pathfinder and influence the development of commissioning going forward.

Developing the NHS Commissioning Board

Initial thinking on the design of the new NHS Commissioning Board was published in July. Developing the NHS Commissioning Board aims to give a sense of direction to stakeholders, partners, pathfinders and staff who may potentially work for or with the Board.

In the foreword to the document, Sir David Nicholson, Chief Executive of the NHS and Chief Executive designate of the new Board, says,

“Building this new system over the next two years whilst delivering for our patients, increasing productivity and improving the quality of care, is a major challenge. But I firmly believe that the end we are trying to achieve – a stronger, more innovative and more coherent commissioning system – will be critical to sustaining the NHS in the years to come.”

The document describes the Board’s potential culture, style and leadership. It also outlines the processes needed to ensure it achieves maximum health benefit for the nation from the resources invested.

While all of the proposals remain subject to the passage of the Health and Social Care Bill, the publication of this document will allow the design principles to be challenged and tested through co-production.

Read the full document here.

New Managing Director for the NHS Commissioning Board

Sir David Nicholson has asked Bill McCarthy to lead the establishment of the NHS Commissioning Board, subject to legislation, during the transition. Bill’s role as Managing Director – NHS Commissioning Board will involve developing five key areas, including the:

  • policy framework
  • business and operating model
  • mandate with the Department of Health
  • partnership arrangements with other Government departments
  • relationships with Government and other key partners.

Bill will report to David and start this role immediately on a part-time basis. He will become full time by autumn once cover arrangements have been put in place.

Tim Rideout, continuing in his role as Senior Responsible Officer – NHS Commissioning Board Implementation, will work with Bill to build upon the substantial preparatory work and progress on implementation achieved to date. Tim will continue to lead the NHS Commissioning Board Implementation Team, which will remain based within the Commissioning Development Directorate until autumn.

Barbara Hakin will continue in her role as Managing Director for Commissioning Development, which includes the development of the commissioning architecture (CCGs and Commissioning Support) and the NHS Commissioning Board’s commissioning capacity.

PCT Cluster meeting update

Chief executives from many of the newly formed PCT clusters met in mid July to spend the day working together. Sir David Nicholson opened the meeting and talked about three key areas of activity:

  • Delivery: Chief executives discussed the importance of keeping the focus on delivery of patient care while the way in which care is planned and paid for is changing
  • Clinical commissioning groups: In transition, part of the role of PCT clusters is to help and support emerging CCGs to be the best they can be. CCGs are a vital part of the new system because only when commissioners are engaged can the NHS be improved for its patients.
  • Local commissioning support: It was suggested that PCT clusters are well placed to offer support to commissioners, and in doing so develop their role. This support can take place across a number of PCT clusters and would build a system of support that clinical commissioners want to use.

Progress on public health reform

Pathfinders may be interested to read the Government’s plans for public health reform, which have  been set out with the publication of Healthy Lives, Healthy People: Update and way forward.

The document:

  • clarifies that clinical commissioning groups and the NHS Commissioning Board will receive specialist population health commissioning advice from directors of public health
  • sets out more detail on the new role of the director of public health in local authorities
  • confirms the leadership role of local government across the domains of public health, health improvement, health protection and population healthcare
  • updates progress on the commissioning routes for public health, allowing services to plan
  • sets out the high level principles for the new Emergency Preparedness, Resilience and Response system.
  • confirms the vision for Public Health England, to be established in April 2013 as an Executive Agency (subject to the usual approvals)

For more information and to download the document please visit the DH website.

A new service offer for communications and engagement

As future commissioners of NHS services you will be taking on corporate responsibility for leading strategic service change in your area, public accountability for the decisions your clinical commissioning group makes, protecting and managing the reputation of the local NHS (beyond your practice) and the need to really deliver ‘no decision about me without me’ through excellent patient and public involvement and engagement.

There is work going on to develop a locally delivered communications and engagement service, but one linked to specialist expertise and ‘do once’ economies of scale where appropriate through a nationwide network across the NHS.  The service will offer the expertise and understanding of the NHS system, but will be built on and embrace innovation, best practice from within and beyond the NHS, industry-wide quality standards and a drive to offer a local,  personalised service at a competitive price.

The service will continue to work in partnership with local authorities and others in local communities as appropriate, but will also work across and through the NHS system to ensure that perspective and value is given too.

This service, an internal NHS service during the transition period at least, will support current NHS commissioners in PCT and SHA clusters, and emerging clinical commissioning groups through the transition period until 2013 or authorisation.  After 2013 the new clinical commissioning groups will choose where they get their commissioning support.  Working with you to design a service that meets your needs, we hope to be able to offer the communications and engagement service of choice.

The model is simple: locally focused, locally delivered, locally responsive, but with the ability to draw on specialist expertise when required and benefit from the economies of scale of ‘do once’ activity where appropriate.

There will be a period of extensive discussion with current and future commissioners across the country through to the beginning of October.  This has already started but the team want to hear more from you about what service you think you will need and to continue to use your views to shape our service offer and delivery model.

A workshop on the recently published shared operating model for communications and engagement in PCT clusters is being held on Monday 26 September in central London. This is an opportunity to help shape the communications and engagement shared service that will form a part of the shared operating model. The team is looking for Clinical Commissioning Group leads to be represented at this meeting. If you are interested in attending, or would like more information about it, please email Paul Woodham.

Steph Hood is the Interim Director for the NHS Communications and Engagement Shared Service.  For further information please contact her at, or your local SHA or PCT cluster Director of Communications and Engagement.

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