Proposals for the final key elements of the authorisation governance process for CCGs, including the decision-making, moderation, conditions and support processes within the NHS Commissioning Board (NHS CB), have been published today.

The information is in a paper to the NHS Commissioning Board Authority which will be asked to approve the proposals at its board meeting on 19 July 2012.
The report to the Board identifies four key governance issues and the recommended approaches to each:

• The appointment of panel chairs and the make-up of authorisation panels
• Establishing the governance arrangements, including a new sub-committee of the NHS CB which would meet from October 2012 and make all the authorisation decisions
• The design of the moderation process for the outcomes of authorisation assessments
• The approach to applying conditions to authorisation, the support that will be made available to CCGs, and the design of the corresponding rectification plans.

The authorisation decision-making and governance process will be overseen by two national directors at the NHS Commissioning Board: Dame Barbara Hakin, National Director of Commissioning Development, and Ian Dalton, Chief Operating Officer.

Dame Barbara Hakin said: “I’m very pleased to propose further arrangements for providing support to CCG authorisation in accordance with the process we previously set out in the CCG applicants’ guide. The overall aim of the authorisation process is to ensure that as many CCGs as possible are authorised and given the support they need to set themselves up by April 2013.

“The process was developed by working with CCGs, national primary care organisations and other stakeholders and has been designed to be fair, transparent, rigorous and efficient. It must be robust enough to ensure CCGs meet the legal requirements for the establishment of new statutory organisations and are safe to proceed. But at the same time it must also balance rigour with a developmental approach.”

It is proposed that a Moderation Panel, chaired by Dame Barbara Hakin, is set up to ensure consistency. It would meet after the assessments for each wave had been completed.

There are 119 authorisation criteria and it is proposed that each unmet criteria would have a standard condition applied to it and, if appropriate, one of a range of support options for that CCG. Following the Moderation Panel, the support would be decided by a Conditions Panel, chaired by Ian Dalton, which would also decide if a CCG is to be established without authorisation (shadow CCG). There would be seven types of support including: making advice and expertise available; providing a specific team or individual; appointing an alternative accountable officer; and removing functions.

Having considered the recommendations of the moderation and conditions panels, Ian Dalton would make the final recommendations to the Board sub-committee regarding the authorisation status for each CCG – fully authorised or authorised with conditions (which includes established without authorisation).

A rectification plan for each CCG would be agreed between the local area team director and the CCG after the sub-committee’s final decision. This would set out the CCG’s proposed response to achieve the threshold for each unmet criteria, allowing the conditions to be discharged.

The purpose of the support and the rectification plan would be to ensure that a CCG is enabled to discharge its conditions as soon as possible before April 2013.
As part of the initial authorisation assessment process, the site visit panels – which assess CCGs – will be led by experienced senior NHS directors and involve senior clinicians, local government, finance and commissioning experts, and patient/public representatives. Site visit panel chairs will be selected by Ian Dalton and will include regional directors, local area team directors and other directors of the Board Authority, and other senior commissioning leaders.

All those taking part in the site visit panels will receive training to ensure a consistent and rigorous approach and the first group will do their training in July, ready for the first panels in September. It is proposed that each site visit panel chair does as many panels as possible to ensure that expertise is accumulated.

The full paper – and all the papers for next week’s board meeting – can be seen here: Board papers for 19th July

Further details about the process will be made available in September.