Bulletin for proposed CCGs – Issue 23, 09 November 2012

9 November, 2012

Contents

Welcome from Barbara Hakin

Dame Barbara HakinWelcome to the latest bulletin for emerging clinical commissioning groups. This issue contains a number of items which are of absolute importance, both to CCG leaders and others involved in the new clinical commissioning system.

Firstly, the NHS Commissioning Board has today released the running costs allowances for each CCG for 2013/14. These figures are based on the most up to date, accurate population projections from the Office of National Statistics to ensure the maximum degree of consistency and fairness across the country. As you know the running costs allowance for CCGs has been set at a maximum of £25 per head of population per year, and I hope the publication of the figures for 2013/14 will enable you to finalise your staffing structures and your commissioning support for the coming year.

You will see from the figures that the rise in population has led to an increase of £10.5m on the maximum total running costs across England, and most CCGs will receive a higher RCA under these new arrangements. However as some areas of the country have seen a reduction in their populations, they will also have an RCA that is lower than the indicative figures released earlier in the year. Full information about the figures and how they were calculated is included in the bulletin item below.

Next, by the end of November it is essential that CCGs agree and sign service level agreements (SLAs) with the commissioning support units (CSUs) they wish to use from April 2013. Getting SLAs in place to this timescale means that CSUs will be clear about the level of resource they have available and the services they will be able to provide to CCGs. We have recently published a template SLA and guidance on the NHS CB website, so do please access these resources.

As you will also see in the bulletin, last week the NHS Commissioning Board received the final group of authorisation applications from wave 4s CCGs. This marks an important milestone in the work to establish a clinically-led commissioning system inEngland. It is a huge achievement that in all four waves, every CCG submitted its evidence on time. This reflects the hard work and enthusiasm CCG leaders and their teams have shown throughout the process.

Finally, I just want to let you know that we’re expecting the publication next week of the Government’s mandate to the NHS Commissioning Board. This will be an important document in our journey to a clinically-led commissioning system and I urge you to read it. We will make sure that any information within it which is of particular interest to CCGs will be  communicated to you.

There is plenty more to read about in this issue – as always – and I hope you find these bulletins useful. If you have any comments, questions or feedback about the bulletin or about the commissioning development programme in general, please do contact me via pathfinderlearningnetwork@nhs.net.

Thanks again for your continuing commitment and, I look forward to seeing many of you at the launch event of the NHS Commissioning Assembly in Doncaster next week. I’m sure it will be an exciting and thought-provoking day for CCG leaders and NHS CB directors.

Dame Barbara Hakin
National Director: Commissioning Development

CCG running costs allowances 2013/14

The NHS Commissioning Board has today published revised CCG running costs allowances (RCAs) for 2013/14. The figures take into account the latest population projections published by the Office of National Statistics (ONS).

The RCA for a CCG in 2013/14 has been set at a maximum of £25 per head of population per year and this money forms a part of the total allocation which will be communicated to each proposed CCG in December 2012. We anticipate that the restrictions placed on running costs will enable us to deliver a real terms increase in spending on patient care.

In May 2012, the NHS Commissioning Board Authority agreed that CCG running costs allowances would be calculated on the basis of the registered lists for GP practices within each proposed CCG, but moderated at a local authority level to match the latest ONS population projections. This ensures that the aggregate population figures match the current ONS estimate of the England population, while taking account of the unregistered population.

At the end of September 2012, the ONS published the latest version of the 2013 population estimates at a local authority level. These were based, for the first time, on the 2011 census data which projected an increase to the English population from 53.4m people to 53.8m. This therefore leads to the maximum total envelope for CCG running costs rising by £10.5m nationally to £1.34 billion.

The publication of the 2013 population estimates has enabled us to provide a revised, up-to-date set of running costs for CCGs – which ensures they are as accurate as possible and that there is the maximum degree of consistency and fairness nationally. The figures will continue to be revised each year as the ONS revises its population estimates for the following year.

Most CCGs will receive a higher RCA under these new arrangements, although there are some areas where there has been a reduction in the projected population, and consequently local CCGs will receive a lower overall RCA.

The revised RCAs for each of the 211 proposed CCGs are now available in the CCG Resources area along with an information sheet on RCAs for 2013/14 and a document which sets out how the calculations are made.

Wave 4 authorisation applications received

All of the 211 emerging CCGs in England have now submitted their applications for authorisation to take on their clinical commissioning responsibilities.

Earlier this month the NHS Commissioning Board (NHS CB) received submissions from the 46 CCGs in Wave 4 – the final group to present their applications.

The NHS CB is responsible for supporting the development of CCGs, and the authorisation process has been designed to ensure that CCGs are able to commission safely, use their budgets responsibly and exercise their functions to improve quality, reduce inequality and deliver improved outcomes.

The 211 CCGs were divided into waves to help the NHS CB manage the task of assessing each CCG’s evidence against the rigorous criteria set out in regulations which support the Health and Social Care Act. Each CCG will take on its commissioning responsibilities in April 2013, irrespective of which wave it is in. 

Service level agreements between CCGs and CSUs

The NHS Commissioning Board (NHS CB) has now published a template service level agreement (SLA) and guidance on how to complete SLAs for commissioning support services.

The NHS CB has asked CCGs and commissioning support units (CSUs) to agree and sign the SLAs by the end of November. This will enable both CCGs and CSUs to finalise their staffing structures and recruit in line with the national HR transition process.

For an update on wider commissioning support developments, please take a look at the monthly commissioning support bulletin.

VAT status for CCGs

It has been confirmed that clinical commissioning groups and the NHS Commissioning Board will have the same status for VAT purposes as SHAs and PCTs currently do.

CCGs, the NHS CB, NICE and the Health and Social Care Information Centre will all be included in the NHS VAT Division. This means financial transactions between themselves or any other NHS body will not involve having to include, or indeed consider, VAT.

VAT will still need to be considered when dealing with organisations outside the NHS.

Consultation on commissioning specialised services

The NHS CB has agreed a consultation process to look at the future arrangements for specialised commissioning.

Around £12b a year is spent on commissioning for specialised conditions and this is currently being done in a number of different ways around the country. Work has now begun to standardise this with a single operating model being developed in line with the Health and Social Care Act.

Recent recommendations from a Clinical Advisory Group concluded that virtually all those services currently commissioned by specialised commissioning groups and the national specialised commissioning team should be commissioned by the NHS CB. This approach will now be tested through a four week consultation, looking at service specifications and clinical policies.

Further information will be available on the NHS CB website shortly.

2013/14 NHS standard contract

The NHS standard contract, one of the primary levers for commissioners to hold providers of NHS funded care to account, is currently being developed for 2013/14. It provides a robust legal framework, which enables providers to deliver safe, high quality patient care.

For 2013/14, particular emphasis is being placed on developing a simple, easy to use contract. The goal is to develop a contract that supports and promotes safe, innovative and transformational commissioning and supports commissioners and providers in meeting the QIPP challenge.

Commissioners and providers have said that the current contract is not always appropriate for the type of services being commissioned, especially smaller services. For the commissioning of some types of service, the contract can seem to be over complex. One approach being employed to help address this is an ‘e’-contract. This will significantly streamline the final contract by allowing tailoring of specific terms for specific service types to achieve a proportionate approach.

To ensure the smooth introduction and use of the new contract a package of support is being developed with the help of stakeholders. Central to this is How to guidance which is being developed for clinical commissioners and technical contract guidance covering the detailed operation of the contract.

We will continue to provide updates on the development of the 2013/14 standard contract. If you would like to receive the 2013/14 Standard Contract eBulletin, please contact nhsstandardcontractcomms@dh.gsi.gov.uk.

Strategic clinical networks

The NHS CB will be publishing the Single Operating Framework for strategic clinical networks (SCNs) next week. This follows publication of high-level plans for SCNs in The Way Forward: Strategic Clinical Networks in July this year.

Networks will enable local clinicians to come together to raise standards, support easier and faster access to services and spread best practice. The NHS CB will spend £42 million on the new networks, which will include new specialisms of mental health, dementia, neurological conditions, maternity and children in addition to the existing cancer and cardiovascular networks.

The publication of the framework will enable recruitment to begin for the clinical leaders and managerial support for SCNs.

It is also expected that local clinical commissioning groups (CCGs) may choose to invest further in networks that are of particular importance to their locality.

Emergency preparedness, resilience and response

CCGs should be aware of their roles and responsibilities regarding emergency preparedness from next April, and to help with this a suite of documents has now been published.

The NHS needs to be able to plan for – and respond to – a wide range of incidents and emergencies that could impact on health or patient care. NHS organisations, and providers of NHS funded care, need to be able to show that they can deal with such incidents while maintaining services to patients.

Information about these new arrangements for local health emergency preparedness, resilience and response (EPRR) – including, but not limited to, CCGs – has been published on the EPRR page.

Continuity of services: Consultation workshops for clinical commissioners

Clinical commissioning groups (CCGs) are being invited to attend one of a series of consultation workshops, hosted by Monitor, on the guidance for continuity of services.

CCGs will have a central and statutory role to play in ensuring the continuity of services for patients. It is also their prime responsibility as a CCG to determine which health services should be protected if a provider fails and enters Special Administration.

Monitor is required to publish guidance for commissioners to help CCGs in this task. It has published a draft for consultation and now wishes to get CCGs’ views at workshops being held during November 2012.

It will be CCGs’ responsibility to review the original designation of ‘commissioner requested services’ that determines which services merit this additional regulatory oversight. Monitor’s guidance will also play a key role in helping CCGs in this task. The guidance aims to ensure that, in carrying out their responsibilities towards continuity of services, CCGs have flexibility and can promote innovation in the configuration and the delivery of health care services.

CCGs can register for one of the workshops

For further information please contact libby.metselaar@monitor-nhsft.gov.uk.

Consultation on the NHS Constitution

The Department of Health (DH) has launched a consultation on new proposals to strengthen the NHS Constitution. The main changes proposed cover:

  • a new responsibility for staff to treat patients not only with the highest standards of care, but also with compassion, dignity and respect;
  • a new pledge making it explicit that patients can expect to sleep in single-sex wards; and
  • a new pledge to patients that NHS staff must be open and honest with them if things go wrong or mistakes happen – this ‘duty of candour’ will become a condition in the NHS Standard Contract from April 2013.

The changes also make it clearer that:

  • patients, their families and carers should be fully involved in all discussions and decisions about their care and treatment, including their end of life care;
  • patients who are abusive or violent to NHS staff could be refused treatment; and
  • the NHS is equally concerned about physical and mental health.

The consultation follows work carried out by the NHS Future Forum on how the Constitution could be strengthened. The Government has accepted the Forum’s recommendations in full and the new proposals reflect this.

The closing date for comments is 28 January 2013 and responses to the consultation will feed into a revised version of the NHS Constitution, which will be published by April 2013.

You can find more information on the consultation on the Department of Health website.

New service capable of supporting locally commissioned services

Staff in emerging CCGs are asked to familiarise themselves with the Calculating Quality Reporting Service (CQRS) by checking out the CQRS web pages and signing up for updates on the new service.

CQRS will be in place for the 2013/14 financial year and will record, monitor, report and calculate achievement and payments on quality services delivered by GP practices. These will include the Quality and Outcomes Framework, nationally-commissioned enhanced services and services commissioned locally from GP practices that go beyond the scope of the GP contract.

Importantly, CQRS will also be capable of supporting services commissioned locally by CCGs from their member practices.  Staff in emerging CCGs should bear this in mind if they are currently thinking of procuring a tool or setting up systems to support the services they expect to commission from their practices, as CQRS is likely to be able to meet this need.

Involving people in their health and health services

Involving patients and the public in decisions at all levels of the health care system is essential if we are to secure the best health outcomes for the nation.  The benefits are proven and wide-ranging.

In line with this, the NHS Commissioning Board is developing guidance for CCGs on how they can:

  • promote the involvement of patients in decisions about their care and treatment (individual involvement); and
  • ensure patients and the public are involved in the planning of, and changes to, health services (collective involvement).

The NHS CB would like to work with CCGs and others in December and January, with a view to publishing the guidance in March 2013. If you would be interested in working with us or would like to find out more please contact either Jonathan Leahy jonathan.leahy@dh.gsi.gov.uk or Peter Burgin peter.burgin@dh.gsi.gov.uk.

A replacement for NHSmail: Shape the future NHS email service

A consultation has been launched to find out what the NHS wants from a future email service, which will debut in June 2014 and replace the current NHSmail system.

The NHSmail team wants to hear from users and non-users of the current system on what you would like to see in the new service; what will help you do your job more efficiently, which in turn will lead to improved patient care.

The consultation is taking place throughout November and early December, and you can input in two ways:

NHS Networks: A forum has been set up for NHSmail2 where initial requirements have been posted. Take a look, comment, or add your own requirements.

Email: Submit your thoughts and requirements to the team

More information

NHS Commissioning Board board meeting

The NHS Commissioning Board held its latest board meeting yesterday. Papers and videos of the meeting are available in the Board papers section.

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