Bulletin for proposed CCGs – Issue 15, 14 June 2012

Contents

• Welcome from Barbara Hakin
• New web tool signposts learning and development opportunities
• Initiative to help CCGs with commissioning support decisions
• CCG remuneration guidance
• Running costs allowances update
• Authorisation ‘surgeries’ for waves two and three
• Key elements of authorisation process put in place
• The Functions of Clinical Commissioning Groups published
• Next steps for communications and engagement services
• News in brief

Welcome from Barbara Hakin

I know those CCGs in Wave 1 will be only too aware that the date for applications for authorisation is now less than three weeks away, on Monday 2 July. This is a hugely exciting and intense period for us all and certainly feels as if we are stepping up yet another gear.

We are continuing to publish as much information and provide as much support as we can, and as fast as we can, to help those preparing for authorisation. Our website provides currently available information and links, and this will continue to expand over the coming weeks as we update the resources on the pathfinder learning network and move it across to the Board Authority’s website.

I’m pleased that today I’m able to alert you to the newly-published learning and support tool, where you will find in one place the learning and development resources available for all proposed CCGs to access, according to development needs (see story below for details).

Organised by the authorisation domains, it provides direct links through to support available from key national bodies, and the NHS Commissioning Board Authority’s own products.

While PCT and SHA clusters continue to support proposed CCGs to work though their tailored development plans, this new learning and support web tool identifies and brings together those existing areas of support that apply countrywide and will provide an ongoing focal point for future products.

Another piece of good news, we are planning to publish Securing Excellence in Primary Care Commissioning – the new single operating model for primary care commissioning – in the coming week. This will be another important moment as the Board Authority sets out its plans for the new primary care commissioning system which will introduce greater consistency, help to tackle inequalities, improve service quality, increase efficiency, and provide a greater focus on health outcomes. I know you will be very interested to see the new approach which is the result of extensive joint working with the national primary care organisations, CCG leaders and other primary care colleagues.

I know there has been some debate about the model constitution framework and I hope that we have now reached a position where everybody understands how to approach the work. As a model, the framework was designed to be comprehensive in order to support CCGs to make sure they cover the right areas, meet the legal requirements and don’t have to seek out all the relevant parts of legislation. CCGs could then choose tailor it to meet their own needs.

It is up to the member practices to decide how they wish to prepare their constitution, using the model framework as a starting point, and to determine their own sign-off arrangements. We believe it would be helpful for at least one member of each practice to understand the full constitution because it is an important agreement. We welcome and support the proposal that CCGs could, if they wish, develop a shorter document that identifies those elements of the constitution which are critical for all members (such as decision-making and communications arrangements) and delegate responsibility for other elements to their leaders and/or the governing body to work through on their behalf.  I also recognise that a good relationship between CCGs and local medical committees is critical and we would encourage you to build this into your approach.

We are also pleased to be publishing HR guidance for the appointment of senior managers who will undertake the accountable officer role (chief officers) and chief finance officers. Additionally we are publishing a further set of frequently asked questions (see ‘remuneration guidance’ story for details on both).

These documents clarify the CCGs’ clear sovereignty in these processes and in determining the pay, terms and conditions from April 2013. You will be aware though that for the accountable officer role, the CCG identifies whom they wish to see appointed but the NHS Commissioning Board (NHS CB) makes the appointment during authorisation. On this basis, most CCGs are asking their NHS CB regional director to identify a suitable assessor to be on any interview panel.

The documents also describe how these designate appointments can be hosted by a PCT using their terms and conditions for the interim period to 1 April 2013.

As always, if you have any questions, comments or feedback about the commissioning development programme, or you would like to be added to the mailing list to receive this bulletin directly, please email me at pathfinderlearningnetwork@nhs.net

Dame Barbara Hakin
National Director for Commissioning Development

New web tool signposts learning and development opportunities

A comprehensive, new CCG learning and support web tool has been published on the NHS Commissioning Board Authority’s website.

It provides access to the development resources that meet current learning needs and which every proposed CCG can expect to be able to access during 2012-13. It is designed to support CCGs as they prepare for authorisation, the clinical leadership of commissioning and their development beyond authorisation.

The web tool is designed as an easy-to-use series of web pages organised according to the domains of authorisation. Its development has been informed over a number of months by work with proposed CCGs and national primary care organisations. It aims to draw together in one place the focused learning outcomes for 2012-13 and the key products identified to support these.

As well as resources provided by the Board Authority and Department of Health, it links through to support available from key national bodies, including the NHS Institute for Innovation and Improvement, the Royal College of General Practitioners, the NHS Leadership Academy and the NHS Alliance and National Association of Primary Care. It is designed to complement local opportunities which are supported by SHA and PCT clusters.

In addition, the Self Assessment Diagnostic Tool for proposed CCGs (originally made available in July 2011) has been refreshed to align it with the authorisation process. This is also available through the learning and support web tool, along with links to:

• Developing as an ‘informed customer’ (see story below)
• Effectively engaging member practices
• Supporting aspirant foundation trusts.

Access the learning and support tool.

If you have any questions about additional development support available in your region, please contact:

• North: graham.atkinson@northwest.nhs.uk
• London: nigel.littlewood@london.nhs.uk
• Midlands and East: lynne.bowers@westmidlands.nhs.uk
• South: greg.simpson-horn@southcentral.nhs.uk

If you have any questions or comments about the tool itself, please email ccgdevelopment@nhs.net

Initiative to help CCGs with commissioning support decisions

A new initiative has been set up to help CCGs with the decisions they need to make around commissioning support services (CSSs) to meet the requirements for authorisation.

A series of practical activities is planned and will include:

June/July 2012:

• Revised ‘ready reckoner’ tool to help CCGs calculate the costs and implications of how they will carry out their functions, how they will structure themselves, what additional external support they need.
• Guidance for CSSs on collaboration with local authorities, independent sector or voluntary sector suppliers.
• A quick guide for CCGs to procuring commissioning support.
• Regional CCG procurement of commissioning support master classes.
• Consultation with CCGs and non-NHS suppliers of commissioning support to explore: the potential procurement options; CCGs’ preferences, e.g. through framework arrangements or other procurement vehicles, including collaborative procurements; the timescales; and what support CCGs might need during procurement of commissioning support.

September/October 2012:

• Learning network for CCG leads on commissioning support.
• Regional and national ‘market days’ in which CCGs can meet a range of potential suppliers from the NHS, local authorities, commercial and voluntary sectors.

The development is in response to a recent survey of CCGs which found that CCGs need more information about the range of commissioning support options available and how to procure the services they need in the longer term.  According to an independent report commissioned by NHS Commissioning Board Authority in March 2012, 59% of CCGs want more information about the choice of commissioning support, and a further 64% want more advice about how to procure their support.

* The full report of the independent customer survey with proposed CCGs and NHS commissioning support services (CSSs) has been published on the NHS Commissioning Board Authority’s website. The findings show that over 90% of proposed CCGs are very or quite confident that the arrangements they are putting in place for commissioning support will allow them to achieve authorisation. Just over a half say they expect to source at least 50% of their commissioning support through NHS CSSs, with around a further quarter sourcing 30%-49%. The survey was conducted in March and April 2012 as part of the arrangements to support the second stage in the business review process for CSSs, known as Checkpoint 2.

CCG remuneration guidance

Remuneration guidance and a set of frequently-asked-questions (FAQs) about the roles of chief officer and chief finance officer in a CCG have been published by the NHS Commissioning Board Authority.

‘Chief officer’ is the term used to describe the most senior manager in a CCG when this individual also takes the role of accountable officer.

The Health and Social Care Act 2012 makes clear that a CCG when established may appoint employees as it considers appropriate, and is able to pay its employees and employ them on terms and conditions in accordance with the determinations of its governing body.

CCGs are being strongly encouraged to follow the guidance, which has been approved by Remuneration and Terms of Service Committee at the Board Authority, to ensure that there is consistency and transparency in the use of public money and that the principles set out in the Will Hutton Fair Pay Review are applied.

The guidance offers flexibility for CCGs to reflect local circumstances and the shape and nature of individual organisations. As with the Clinical commissioning groups HR guide, published in April 2012, it is intended to support CCGs to recruit, retain and motivate high calibre staff, while at the same time helping to minimise redundancies.

The guidance, which will apply from the point CCGs become employing bodies on 1 April 2013, covers: proposed pay rates, joint management arrangements, development pay, recruitment and retention premiums, additional payments for additional responsibilities or complexity factors, the role of CCG remuneration committees, and reporting arrangements.

It outlines three bands of payment for both chief officers and chief finance officers, based on the population sizes of CCGs. It also highlights that legislative regulations are likely to require CCGs to make publicly available annually information on the salaries, fees, pensions, travelling and other allowances and gratuities paid to senior managers and governing body members.

Prior to establishment, the designate chief officer and chief finance officer will be ‘assigned’ to the CCG by their current employing organisation on their current terms and conditions. Any changes made by the PCT to the salaries of the designate chief officer and chief finance officer during this period will be subject to the general principles governing remuneration of staff employed by PCTs.

The guidance is not intended as the basis of remuneration for accountable officers where being a clinician has been deemed an essential requirement. Guidance on the reimbursement of clinicians is included in Clinical commissioning groups governing body members: Role outlines, attributes and skills and further detail is provided in the FAQs.

The remuneration guidance and frequently-asked questions are available on the Board Authority’s website.

Running costs allowances update

A briefing on CCGs’ running costs allowances has been published on the NHS Commissioning Board Authority’s website.

The briefing outlines how running costs allowances have been calculated on the basis of ‘raw’ population without weighting according to the traditional determinants of population need, such as age, sex or deprivation. The population data being used in the calculations is the latest Office of National Statistics’ (ONS) projections for 2013 which is for a total England population of 53.56m.

In contrast to this, the attribution data set (ADS), which is the source of GP list data, gives a patient population of 55.26m for practices in England in April 2011. The starting point for the calculation of running costs is the patient populations for a CCG’s GP practices, as recorded in the ADS. This ensures that the distribution of running costs takes account of cross-boundary patient flows.

These patient populations are then adjusted, using the pre-existing methodology used in PCT financial allocations, so that they match the total ONS England population projection of 53.56m. This is done by matching the total ADS population resident in each district local authority area to the ONS projection for 2013 (after excluding estimated counts of military personnel).

The methodology takes account of factors such as: inaccurate lists, for instance where patients no longer live in the area and are registered with a different practice, but have not yet been removed from their previous GP’s list; and unregistered people, who are included in ONS counts but are not on GPs’ lists.

Overall, running costs allowances have been set at a level which is consistent with the requirement to reduce NHS system wide administration costs by one third.

Authorisation ‘surgeries’ for waves two and three

The authorisation ‘surgeries’ for waves two and three will be held on:

• Wednesday 20 June – London
• Tuesday 26 June – Birmingham
• Thursday 28 June – Leeds
• Wednesday 4 July – London.

CCGs have already been notified of these dates and venues will be confirmed soon.

Each CCG has four places and people should register for places at the workshop of their choice by emailing Joanne Crosby (joanne.crosby@northwest.nhs.uk).

The purpose of the surgeries is to help CCGs prepare their applications and hear more details about both the desktop assessment and site visit by the panel assessors.

Details of workshops for wave 4 applicants will be released in due course.

Key elements of authorisation process put in place

The NHS Commissioning Board Authority has published Clinical commissioning group authorisation: Draft guide for assessors undertaking desk top review.  It is an accompaniment to Clinical commissioning group authorisation: Draft guide for applicants and covers:

• The overarching principles, approach and methodology of the assessment  process
• The key stages of assessment, and the requisite outputs of each stage;
• The published domain definitions, criteria and authorisation thresholds as set out in the applicants’ guide and how to assess CCG evidence submissions against them.

The recruitment of Wave 1 assessors with the right skills and competencies for the desktop review elements of the CCG authorisation process by the SHA clusters has taken place. The assessors’ role will be to ensure that the evidence submitted by CCGs is assessed transparently, consistently and fairly and assessors will receive training and accreditation before they start work. The recruitment of panel assessors will begin shortly.

A letter and user guide about the new CCG Authorisation Portal will be sent to all CCGs on 15 June 2012 outlining that the new, password-protected website will be available for use by Wave 1 CCG applicants from 18 June 2012 and for all other CCGs from 9 July 2012. Following this letter, each wave one ‘super user’ will receive an email directly from the service provider, GPTeamNet, giving log-in details for the CCG, including passwords. The same process will be followed for ‘super users’ for other waves in due course. The secure authorisation portal is designed to facilitate the submission process for CCGs, from evidence upload to the submission of the application, and a helpdesk will be provided.

The Board Authority has also recently published a self certification information pack to help CCG applicants for authorisation self-certify their compliance on the application form. The pack is designed to help ensure that interim accountable officers and chairs, as well as governing bodies more broadly, understand the intent of compliance with the statements in the application form.

In addition, a financial governance tool has also now been made available to provide support for proposed CCGs on the arrangements they will need to put in place for good financial governance and on the evidence they will need to present as part of their CCG’s application for authorisation. For each main element of financial governance, the tool suggests the characteristics of good financial governance that the NHS Commissioning Board would expect CCGs to be able to demonstrate, both at the point of their application for authorisation and prior to 1 April 2013.

The submission deadlines for applications for each wave have been confirmed and these are:

• Wave 1 – 2 July
• Wave 2 – 3 September
• Wave 3 – 1 October
• Wave 4 – 1 November.

All the authorisation documents are available on the Board Authority’s website.

The Functions of Clinical Commissioning Groups published

An updated guide to the functions of CCGs has been published to reflect the final content of the Health and Social Care Act 2012.

The Functions of Clinical Commissioning Groups sets out:

• The key statutory duties of CCGs – the ‘must dos’
• The key statutory powers – the things that CCGs have the freedom to do, if they wish, to help meet these duties.

The guide is not intended to be a substitute for the Act but to act as a helpful summary to which busy GPs and proposed CCGs can refer when planning for and implementing their responsibilities.

The new document provides an update to The Functions of GP Commissioning Consortia: A Working Document which was published in March 2011.

The guide has been published on the Department of Health’s website.

Next steps for communications and engagement services

Next steps have been agreed which will ensure the development of a revised operating model for communications and engagement services in line with the timescales for the commissioning support business review and assurance process.

A ‘hub and spoke’ model – similar to that of the other ‘at scale’ CSSs – will be developed which links all CSSs and CCGs across England, maps onto local engagement services, ensures staff are based appropriately in relation to local communities, and concentrates at scale work and additional communications expertise in a small number of hubs.

It is envisaged the model will incorporate local delivery teams and ‘at scale’ services delivered to a set of professional and measurable service standards through the commissioning support community.

The work will take place during June and July and a final decision will be made by the NHS Commissioning Board Authority in late July, ahead of the Checkpoint 3 process.

News in brief

• The NHS Commissioning Board Authority has approved the principles of the design of the local area teams as outlined in the last CCG bulletin and determined that there will be 27 teams working from a number of office bases across their geographical area. The detailed shape, geography and responsibilities for these teams will be available shortly.
• For a full update on developments in commissioning support, see the latest Commissioning Support Bulletin on the Board Authority’s website.
• The NHS Commissioning Board Authority has published its business plan for 2012-13.

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