Commissioning Support Bulletin – Issue 3, 9 July 2012

9 July, 2012

Welcome to the monthly Commissioning Support Bulletin from the NHS Commissioning Board Authority.

I’m very pleased to say that we have today announced the appointment of the first commissioning support service (CSS) managing directors. Many congratulations to the successful candidates – see item below for full details – most of whom are already in post. I wish to thank all the candidates for their extremely hard work in establishing their CSSs so far, and reassure those CSS teams which are yet to have a permanent leader appointed that we will support them over the coming months to stay on track.

Further reassurance will also be provided by the Board Authority’s decision to host all 23 CSSs through to the point in 2013-14 at which CCGs make their decisions on their choice of commissioning support, and complete their procurements. I am sure this will be welcome news to CSS staff and people in PCTs who wish to apply for jobs in CSSs. More details below.

Later this week, we are planning to feed back the results of the ‘at scale’ tests, and I know some of you are waiting very keenly for these. The bids have been analysed and assessed and the decision-making process is due to be completed this week.

We issued the Checkpoint 3 guidance, including the detailed financial guidance, on 29 June (see below for the full report). This provides detailed information and also some working assumptions which together are intended to guide CSSs as they prepare for the next stage of the assurance process. We have now turned our attentions to developing a guide to hosting which is likely to be ready in the autumn. Of course we will continue to discuss these potential arrangements with CSSs as we progress towards Checkpoint 3 so there is sufficient clarity for the preparation of full business plans. The hosting guide will provide more detailed information on the proposed hosting charge of between 25-50p per head of population – which will be levied by the NHS Commissioning Board from April 2013 – and the governance arrangements that will underpin CSS operations whilst hosted.

We are also beginning to look at what further checks are required beyond checkpoint three so that, in totality, each CSS only has the right number of staff and overheads to match the contracts it has agreed with CCGs. We are currently developing proposals for:

  • Checkpoint four in November, which will review CSS structures and their plans to ‘right size’ and ‘right skill’
  • Checkpoint five in January, which will review the contractual arrangements (including the terms and conditions) that CSS are putting in place with CCGs for 2013/14.

More information on these will be published shortly.

Meanwhile, it’s important to highlight that we’ve been working with local and national stakeholders from local government to reinforce the message that local authorities have a clear role to play alongside and, potentially, in partnership with other CSSs. The evidence that CSSs submitted for the second checkpoint demonstrated that some strong partnerships are emerging, with the majority of CSSs identifying local authorities as potential partners. Particularly strong partnership arrangements are beginning to emerge in several areas including North West London, Merseyside and the North East. In parallel, and on the back of queries from both CSSs and local government, we are also working with lawyers to create some simple guidance for the system around the rules and legal implications for CCGs and CSSs post April 2013 around collaborating with other organisations, including local authorities, the independent sector and the voluntary sector. We plan to release these later this month.

As some of you may already know, I am fortunate to have been appointed to the role of chief executive of Mersey Care Trust in Liverpool and will take up the post from early September. I will be sorry to leave commissioning support and valued colleagues within the Board Authority and wider NHS at such an important time. Dame Barbara Hakin and Richard Jeavons are currently looking at future arrangements for the commissioning support team and we will update you shortly.

Finally, I realise everyone is working very hard within an environment where there are still many unknowns. I wish to thank you all for your continued work and commitment on commissioning support. We are continuing to make good progress.

Please keep in touch and let us know what you think. To send us your comments, or join our mailing list, please contact us at commissioningsupport@dh.gsi.gov.uk

Dr Joe Rafferty
Director of Commissioning Support

Board Authority appoints first CSS managing directors and announces decision to host

The first round of appointments to commissioning support service (CSS) managing director posts has been made by the NHS Commissioning Board Authority. Nine appointments have been made, while discussions are ongoing with others.

The successful appointees, and their current CSSs, are:

  • Robert Bacon – Birmingham, Black Country and Solihull Commissioning Support Service
  • Stephen Childs – North East Commissioning Support
  • Keith Douglas – Commissioning Support South
  • Jan Hull – Best West Commissioning Support
  • Derek Kitchen – Staffordshire Commissioning Support Service
  • Rachel Pearce – Arden Commissioning Support Service
  • Andrew Ridley – North Central and East London Commissioning Support Service
  • Ming Tang – CSS to be confirmed
  • Sarah Whiting – North West London Commissioning Support Service.

At the same time, the Board Authority has announced that all 23 CSSs will now proceed to be hosted by the NHS Commissioning Board from October 2012; a shift in emphasis brought about as a result of Checkpoint 2, where the numbers of CSSs reduced to 23, and subsequent further evaluation which has made it clear that each is viable in terms of scale. In addition, the Board Authority recognises the need for stability for CSSs and their customers to ensure a successful transition to the new clinical commissioning system.

This decision will also ensure:

  • there is stability and continuity for CCGs as they prepare for and progress through the authorisation process, and as they carry out the procurement of their choice of commissioning support post-April 2013
  • the CSS development process is better aligned with the national HR transition process
  • CSSs can ensure they are the ‘right size’ – a process of ensuring their income covers their costs – in time for April 2013.

Clearly, no CSSs will now be stopped at Checkpoint 3, although this does not rule out further size variation or adjustment to management configurations as a result of the assurance process. Instead, building on the outcome of Checkpoint 2 – where all 23 were judged to be viable – the focus will be on making sure all CSSs are as good as they can be by April 2013.

Where there are still gaps in leadership appointments, the Board Authority has said that immediate leadership arrangements will be put in place to ensure that all CCGs receive the support they need for authorisation and transition, and to ensure that all CSSs are capable of continuing to progress at pace. In some cases, existing interim managing directors will continue in post, while in others there will be new interim management arrangements.

Dame Barbara Hakin, National Director of Commissioning Development, said: “I’m very pleased to announce the first CSS managing director appointments. Many congratulations to the nine successful candidates and their teams; it is a very positive step to see the first appointments to these important new units and enables us now to proceed at pace in putting the full senior management teams in place and, following that, the wider staffing structure.

“These are significant new roles, requiring a very broad set of skills and competencies and it is absolutely essential for the future sustainability of CSSs that we get these appointments right.

“I’m also pleased to be able to announce a period of greater stability and continuity both for CSSs and CCGs, and for NHS staff who wish to transfer into CSSs.

“Our key focus now is to ensure that CSS development continues at a rapid pace over the next few months as we continue the recruitment process. I am confident that CSSs will continue to provide a good service to CCGs over the coming months and that, very soon, we will be making further very high calibre appointments.”

The external recruitment search process has already begun and an advert for the roles was placed in HSJ last week.  Potential candidates for these roles will find further information on the CSS Leaders website.

The CSS finance director appointments process is expected to start shortly. As with the managing director roles, it is expected to have an internal phase and, if appropriate, an external phase.

Business review and assurance update

Detailed guidance and a financial model template have been sent to commissioning support services (CSSs) as part of the preparations for ‘Checkpoint 3’ – the next stage of the business review and assurance process – which begins in August 2012.

The Checkpoint 3 guidance outlines to CSSs what they will need to include in their full business plan, while a separate financial planning guide and financial model template cover the financial requirements. CSSs will need to submit their full business plan, a financial model and a balanced scorecard by 31 August.

CSSs have also been sent the dates of their Checkpoint 3 panel site visits.

Checkpoint 3 will take place in September and CSSs will need to demonstrate they are commercially and financially viable and have completed their Checkpoint 2 development commitments.

Key elements of the checkpoint will include: independent financial due diligence process, customer survey of CCGs, survey of CSS staff, and panel visits by the NHS Commissioning Board Authority.

The NHS Commissioning Board is due to consider the outcome of Checkpoint 3 in October 2012 and, at that point, CSSs will be given a ‘licence to operate’ and an updated development plan.

The licence to operate will describe the rules, processes and policies that will underpin the operational arrangements of CSSs during the hosted period – it will be provisional from October and more formal from April 2013. More information on this will be shared in the Autumn. As part of these arrangements there will be two additional checkpoints during hosting – Checkpoint 4 in November and Checkpoint 5 in January – both designed to further assure the CSSs’ business plans.

Full guidance on the balanced scorecard will be issued shortly.

The Board Authority is currently working with CSSs on their development to ensure as much progress as possible is made by the end of August. Progress meetings will be taking place with all CSSs during July and again in August. Development plans will be updated in early July once the results of the ‘at scale’ tests are known and the relevant development needs have been identified from these assessments.

The Checkpoint 3 documents are available on the in the CSS resources section.

CSS ‘externalisation’ work gets underway

The NHS Commissioning Board Authority is shortly to issue an invitation to tender for a company to prepare a report on commissioning support service (CSS) ‘externalisation’.

The report will provide research and analysis on the options which are available to the NHSCB within this three year timescale. It will also provide advice on how to create a successful market for CSSs.

The report is likely to be received in the autumn.

The externalisation of the CSSs by the NHS Commissioning Board must be completed by April 2016 but must be considered alongside CCG plans to formally procure their commissioning support which they must do as soon as they are ready and willing.

HR update

Guidance is due to be published shortly for CSSs, confirming and clarifying the People Transition Policy and processes which need to be implemented. The guidance will cover timelines, pre-transfer selection and consultation arrangements.

Any questions or requests for clarification should be emailed to: commissioningsupport@dh.gsi.gov.uk

Communications and engagement services

Preliminary returns have been received from commissioning support services (CSSs) that are interested in offering local and/or ‘at scale’ communications and engagement services and a number of CSSs have now expressed an interest in offering at scale services through a hub.

Following this:

  • SHA directors of commissioning development and directors of communication are leading local discussions to develop the best local model for these services in future
  • All those who have expressed an interest in becoming a hub for the at scale elements have been sent the communications and engagement commissioning support quality standards. They have been asked to submit their proposals setting out how the hub will operate as part of a wider network by 9 July.

Once the best shape for hub and network arrangements has been agreed, communications and engagement commissioning support functions will be incorporated as part of the over all CSS submission for Checkpoint 3 of the assurance process.

News in brief

  • CCGs in West Mercia have made their decisions about which commissioning support services (CSSs) they will use. CCGs in Shropshire, Telford and Wrekin and Herefordshire have elected to work with Staffordshire CSS, while CCGs in Worcestershire will work with Arden.
  • The authorisation team at the NHS Commissioning Board Authority is producing a guide on the commissioning support tests by which the in-house support services in CCGs will be assessed. It will be available later this month.
  • Further developments in the structure and responsibilities of the local area teams of the NHS Commissioning Board and clinical senates have been published.
  • An updated Commissioning Support Services: Key Facts – a useful briefing tool for wider audiences – has been published on the NHS Commissioning Board Authority’s website.

Information has been released recently about the new single operating model for primary care commissioning, a proposed NHS Commissioning Assembly, involving NHS Commissioning Board directors and CCG clinical leaders, the CCG authorisation process and the CCG Code of Conduct. For these updates and other news, read our latest Bulletin for proposed CCGs.

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