Bulletin for CCGs: Issue 34, 14 May 2013


  1. Commissioning Assembly news – Integrated care pioneers
  2. CCG Development Framework 2013/14
  3. CCG Assurance Framework 2013/14 proposals published
  4. Timely diagnosis of dementia and post diagnostic support
  5. NHS111 update
  6. NHS support plan launched to help hospital and A&E departments keep waiting times in check
  7. CCG set up: Guide to good handling of complaints
  8. Quality Premium 2013/14 guidance for CCGs
  9. Enabling data flows for commissioning
  10. GP systems of choice (GPSoC) administration of Schedule A on the Tracking Database
  11. Important changes to national immunisation programme
  12. How can the NHS payment system delivers more for patients? – Joint Monitor/NHS England discussion paper
  13. Sustainable Development Strategy consultation – closes 31 May 2013
  14. Joint Monitor /NHS England review of emergency admissions marginal rate – call for evidence
  15. Scheme to improve homeless discharge – call for bids
  16. Dedicated web pages launched for 74 specialised services Clinical Reference Groups (CRGs)
  17. NHS England releases update to national Cancer Drugs Fund list
  18. NHS England welcomes publishing of medicines optimisation
  19. Health and wellbeing leadership: delivering improved outcomes for local communities
  20. Implementing a ban on age discrimination in the NHS: free learning event for commissioners
  21. Commissioning Show 2013 – 12-13 June 2013, Excel, London

Gateway reference number: 00110

Download the Bulletin for CCGs: Issue 34, 14 May 2013 (PDF, 143KB)


Welcome from Barbara Hakin

Dame Barbara Hakin

Dame Barbara Hakin
Interim Chief Operating Officer and Deputy Chief Executive

Welcome to the latest edition of the CCG Bulletin. In this week’s bulletin we outline a number of strategic issues that you will be considering in your own CCG.

Today sees the launch of Integrated Care Pioneers, a national initiative, which will focus on the role of integration in the health and social care system. Together we recognise that integration is key to improving experience of patients and delivering value and for many of you considering the role integration can play for your patients you will want to be up to date with this new development.

Many of you have been involved in the shaping and refining of the interim CCG Assurance Framework 2013/14 and I am eager to develop this document further with as many stakeholders as possible through a series of engagement events. More information about this can be found in the bulletin.

At the end of last week we published the A&E Improvement Plan setting out a tripartite agreement between NHS England, Monitor and the NHS Trust Development Authority (NHS TDA) which will see local urgent care boards established which will ensure system recovery and improvement plans are in place for each A&E department. As lead commissioners, CCGs should support their providers to ensure that each A&E department, that is not within the NHS Constitution threshold, can recover its position at the earliest possible time. This will require the development of local recovery and improvement plans centred on each A&E department. I have asked each Area Director to facilitate the preparation of these plans by CCGs for each A&E department on their patch.

We hope you will find the inclusion of a number of operational issues in this week’s bulletin helpful. These include issues relating to day to day commissioning, such as the current position on A&E, through to practical information that may help your organisation run effectively such as data flows. This section provides helpful pointers to information that you may wish to action within your own organisation.

Towards the end of the bulletin you will find a number of opportunities to get involved in work related to clinical commissioning. These range from consultations to events and you may like to consider your involvement in any of these.

The bulletin also highlights correspondence that has been sent to CCGs since the last bulletin at the end of April 2013.

Dame Barbara Hakin
Interim Chief Operating Officer and Deputy Chief Executive


1.    Commissioning Assembly news

Integrated care pioneers

A collaboration of national organisations, including NHS England, Local Government Association, Monitor and the Department of Health, have come together to help make integrated care and support happen across the country.

As part of the initiative CCGs will be particularly interested in the opportunity for health economies to bid to become integration “pioneers” running large-scale experiments in integrated care.  Those areas awarded pioneer status will be offered support and advice to help overcome barriers to care.

The collaboration has published three key documents as part of this initiative:

  • ‘Integrated Care and Support – Our Shared Commitment’ ( which sets out clear “statements of commitment” by the national partners to support localities and what we expect in return from local areas. This will be a sustained collaboration to remove national barriers, develop national enablers and support local efforts, with a view to making integrated care and support the norm over the coming years;
  • a definition (referred to as the Narrative) of what good, integrated care and support looks and feels like from the perspective of the individual, co-developed for us by National Voices and aligned with the Making it Real initiative supported by Think Local, Act Personal (TLAP); and
  • a letter and supporting note inviting expressions of interest from CCGs, local authorities, health and wellbeing boards and providers areas to become pioneers in integrated care and support, to receive intensive support from the national partners and contribute to accelerating learning at scale and pace for dissemination, promotion and adoption across England. Expressions of interest should be submitted by the end of June 2013.

The NHS Commissioning Assembly Integration Working Group has played a key role in the development of this work, including review of the key documents. As we now move into the implementation phase the Working Group will be focussing on how these guiding principles could be turned into reality at local level.  This will include expanding engagement with CCGs and other key stakeholders.


2.    CCG Development Framework 2013/14

Many of you will have already been involved with shaping our early thinking of NHS England’s CCG Development Framework for 13/14 and beyond, and the initial proposals for supporting CCGs to agree their development plans. We are keen to understand the current approaches in place between CCGs and Area Teams explore the wider development offer to CCGs to achieve their ambition to become great clinical commissioners.

We would like CCGs to help shape the thinking around the organisational health component of the assurance framework, including what a safe threshold for assurance should look like at the end of 2013/14.

To steer this work and ensure that it delivers what CCGs require, we would like to invite you to “save the date” for the first of a series of free events to examine:

  • the current landscape of CCG development;
  • what a great CCG looks like?;
  • the current and future development offers to CCGs; and
  • the organisational health assurance process.

To ensure that we can have the most effective conversation we would like to two representatives from every CCG, one clinical and one non-clinical to the events to enable us to co-produce the work and address these key issues, perhaps your CCG chair and accountable officer. NHS England will be represented by colleagues from the National CCG Development Team, Area Teams and Regions.

The events will be held in five locations across the country to facilitate attendance and encourage as much participation as possible. Please hold the date that is most convenient for you.

  • 20 June – London
  • 9 July – Northampton
  • 10 July – Reading
  • 16 July – York
  • 17 July – Manchester

We are keen to work with you to understand the specific needs of CCGs now, and how we can work together to ensure your organisation realises its full potential.

The events are all free and further details on venues, timings and registration will be issued shortly, along with a final event programme and information.


3.    CCG Assurance Framework 2013/14 proposals published

On 7 May NHS England published proposals for the CCG Assurance Framework 2013/14. These draft proposals cover the interim arrangements for assurance in Q1 and Q2, and an outline of what elements of assurance will be covered on an annual basis.

The proposed CCG Assurance Framework has been developed with colleagues from CCGs and NHS England. The draft was tested with members of the NHS Commissioning Assembly, through Rapid Reference Groups, prior to publication last week.

We are now keen to draw on the views of commissioners and beyond in developing the framework further, ensuring it delivers for us all.  We want to know how these proposals can be refined and developed further to allow the final document, published in the autumn, to be a truly co-produced piece of work. Nationally this work will be led by a CCG leader and Area Director.  We will want to work with all interested parties in local areas to hear views.  More details on how you can put your views forward and arrangements for local engagement will follow shortly and we are very keen that we gather as much feedback as possible on the current proposals over the coming months.

If you have any queries, please email

4.    Timely diagnosis of dementia and post diagnostic support

Dementia is a major and growing challenge for both health and social care. It is increasingly recognised that care and support can be improved for people with dementia, their families and carers. CCGs have taken the first steps to improving diagnosis and care for people with dementia by setting out an ambition for the proportion of people diagnosed as having dementia and receiving care and support by March 2015. The ambitions range from 40 percent to above 70 percent. This level of variation indicates an opportunity for NHS England to support those CCGs with a lower level of ambition by sharing best practice and the experience and lessons from those with a greater ambition in order to aim for an overall national ambition of two thirds of people with dementia receiving a diagnosis and care by March 2015. We have had fascinating feedback from the NHS Commissioning Assembly Rapid Reference Group on the nature of the barriers that will need to be overcome.

To help achieve this NHS England has created a suite of tools to enable individual GPs, practices and CCGs to improve diagnosis, care and support for people with dementia and their families. We will be seeking to support CCGs and practices to meet the challenges presented by the increasing prevalence of dementia and engaging in dialogue to understand the barriers and how to help spread best practice.


5.    NHS111 update

The NHS Commissioning Assembly has established a working group to focus on 111.  Jointly chaired by Dr Peter Melton, CCG Chief Clinical Officer and John McIvor, Area Team Director. The group is considering how it best supports three phases of work related to 111, ‘roll- out’, ‘review’ and ‘the future’.

Updates on this on-going work will be provided in future CCG bulletins.


6.    NHS support plan launched to help hospital and A&E departments keep waiting times in check

Plans to strengthen performance in urgent and emergency care are being put in place across the country to help hospital A&E departments meet demand and tackle waiting time pressures.

NHS England has joined with the NHS Trust Development Authority (NHS TDA) and Monitor, which are responsible for provider regulation, to ensure coordinated action to ease the immediate pressures.

At the same time, a review will take place to understand the causes of problems, which differ around the country.

We have already had detailed feedback from the NHS Commissioning Assembly Rapid Reference Group on the potential factors which has helped to inform our analysis.


7.    CCG set up: Guide to good handling of complaints

During transition many CCGs asked for support and advice on handling complaints.  In response NHS England has worked in partnership with the Health Service Ombudsman, and with input from CCGs, to develop a Guide to good handling of complaints.

This final part of support to CCGs as they set up, has now concluded and NHS England has this week published a guide to support CCGs to develop good processes for handling of – and responding to – complaints. Ensuring good handling of complaints – and learning from them – are ways in which CCGs can improve quality for their patients.

All NHS organisations, including CCGs, need to comply with the 2009 complaints regulations. ‘Guide to good handling of complaints for CCGs’ provides advice and top tips to CCGs on responding to complaints about the services they commission on behalf of their populations, or about the exercise of any of their own functions. It is intended as a helpful guide to good practice and will help CCGs to ensure they comply with the legal requirements of the 2009 complaints regulations. The document also highlights the importance of monitoring trends and learning from complaints and makes suggestions for CCGs on how to do this.


8.    Quality Premium 2013/14 guidance for CCGs

Please be aware that an error has been found in the Quality Premium guidance for CCGs. A key section implies measures are focused on adults. However, this is incorrect and should include all ages.

The change details are as follows:

Domain 2 enhancing quality of life for people with long term conditions and Domain 3 Helping people to recover from episodes of ill health or following injury is a composite measure of emergency admissions.

On page 7 the elements of the composite measure for Avoidable Emergency Admissions in relation to:

  • unplanned hospitalisation for chronic ambulatory care sensitive conditions and
  • emergency admissions for acute conditions that should not usually require hospital admission

make reference to these measures being focussed on adults. This is incorrect. Paragraph 9 of the technical guidance (page 19) makes clear that, although these items were originally restricted to adults only in the NHS Outcomes Framework, all ages are included for Quality Premium purposes.

CCGs should therefore be aware that for the purposes of the quality premium, performance will be assessed on the basis of progress for all age groups.

The guidance will be amended to reflect this.


9.    Enabling data flows for commissioning

Following Dame Fiona Caldicott’s review into information governance (IG), ‘Information: to share or not to share’, we are reviewing the necessary actions to improve IG arrangements in the new health and social care landscape.

This work will enable better and more transparent sharing of information in the interest of patients. As part of this, we need to ensure we have a lawful basis for disclosure of data for commissioning and the separation of direct and indirect care uses of data is important for this.

NHS England recently secured a 3-month Section 251 (s251) extension until 30 June 2013 to support the flow of Secondary Uses Service (SUS) data from Health and Social Care Information Centre (HSCIC) to commissioning support units (CSUs) and CCGs. A decision from the Confidentiality Advisory Committee (CAG) regarding the outcome of a further application to support SUS and other data flows is expected shortly. If successful, we anticipate, the approval will be subject to a number of conditions that will need to be implemented within a short timeframe.

We recognise that the past couple of months have been difficult as we try to re-align data flows to new organisations and appreciate the patience and professionalism that has been shown by CCGs whilst the necessary approvals are sought.

To offer further support, a series of four workshops are planned for the first two weeks of June in the North, the Midlands and London. These working sessions will provide a view of the changes necessary to comply with the s251 support and opportunities for questions of NHS England and the HSCIC IG and Data Services delivery teams.

Dates and venues for the workshops are:

  • 5 June – London (for London area)
  • 7 June – London (for South)
  • 11 June – Leicester (Midlands and East)
  • 14 June – Leeds (North)


10. GP systems of choice (GPSoC) administration of Schedule A on the Tracking Database

In line with the NHS restructure, various responsibilities associated with the administration and ordering of GPSoC services has transferred from PCTs to CCGs. It is understood that the CCGs would typically defer some of these responsibilities to the commissioning support units (CSUs).

One of the responsibilities is the administration of Schedule A on the Tracking Database which is the central tool the NHS uses to order GPSoC services. Staff who were formerly working for a  PCT, who formerly undertook this task, have had their access downgraded to read only since PCTs have disbanded.

Therefore we have requested staff who require Tracking Database full access to contact the Exeter Help Desk at completing the Access Request Form. As part of this process the Help Desk need to verify the request by contacting the Accountable Officer at the CCG to verify the request.

Please contact the with the e-mail address of an Accountable Officer at the CCG who can verify such requests.

  • Useful FAQs related to CCG and CSU responsibilities are available here

11. Important changes to national immunisation programme

A number of important changes to the national immunisation programme will be introduced this year to protect against flu, meningitis C, shingles and diarrhoea.

A letter sent to CCGs and GPs via Area Teams on 30 April 2013 outlined the changes, including more detail on the introduction of a rotavirus vaccination for babies, which will be implemented following a series of recommendations by the Joint Committee on Vaccination and Immunisation (JCVI) to improve the overall level of protection against preventable diseases.

From 1 June 2013 there will be changes to the schedule for administering the meningitis C vaccine as the second priming dose currently given at four months will be replaced by a booster given in adolescence. A second letter announcing these changes sent on 7 May 2013 can be viewed here.

The new rotavirus vaccination programme will start from July this year for children under four months old. In addition a new shingles vaccine will be introduced for people aged 70 years with a catch-up programme for those aged up to, and including, 79.

There are also plans to extend the flu immunisation programme to include all two year olds, which is the first step of the phased introduction for all children aged two to 16 years old over the next couple of years.

Further letters will be sent about the changes in England in relation to shingles and childhood flu programmes prior to their implementation.

It has also been announced that the temporary programme of pertussis (whooping cough) vaccination for pregnant women, which has been in place since October 2012, will continue into 2013/14.

These changes follow the publishing of an update to the detailed agreement between the Department of Health and NHS England on the delivery of certain public health functions, which will drive improvements in the health of England’s population.


12. How can the NHS payment system delivers more for patients? – Joint Monitor/NHS England discussion paper

Monitor and NHS England, working in partnership, need your help to ensure that the future NHS payment system delivers affordable, quality care and better outcomes for patients.

This discussion paper sets out early thinking on designing a comprehensive payment system for NHS services for the long term.

We are particularly interested in hearing your views about:

  • the objectives of the NHS payment system:
    • how can we best support innovation in patterns of care?
    • how can we positively influence provider and commissioner behaviours?
    • how can we support sustainable, risk managed improvements in quality of care?
  • how can the payment system be best designed to include different payment approaches for the different types of patient needs and care?
  • how can we strengthen the foundations of the current payment system in the meantime?

This paper also sets out our approach for the first jointly produced 2014/15 National Tariff document.

There will be additional opportunities to share your views on this important area over the coming months at which we encourage your attendance and contribution.

13. Sustainable Development Strategy consultation – closes 31 May 2013

A major consultation to help shape the future of an environmentally, financially and socially sustainable health system is currently under way and is seeking input from anyone involved in healthcare.

Run by the Sustainable Development Unit the consultation is to help shape the ‘Sustainable Development Strategy for the Health, Public Health and Social Care System 2014-2020’ which will be launched in January 2014. The team are particularly keen to receive input from CCGs because of their core role in commissioning health services.

You can support the consultation in a number of ways:

  • Complete the online response form at Organisational and an individual responses welcomed.
  • Raise awareness of the consultation through your own networks via your regular communication channels. Refer people to
  • Use the consultation as an opportunity to engage with your stakeholders. You will find a suite of supporting materials on the website including presentations, videos and exercises.

14. Joint Monitor /NHS England review of emergency admissions marginal rate – call for evidence

We are gathering evidence to support short and longer term improvements to the payment system. This includes a call for evidence to inform the thinking on a review of the 30 percent marginal rate rule for emergency admissions.

The purpose of the review is to:

  • explore what has happened as a result of the introduction of the marginal rate;
  • assess what impact it has had including whether it has helped to control the numbers of avoidable emergency admissions; and
  • identify whether the approach could be improved.

Our intention is to build a solid base of evidence from a range of stakeholders. We are particularly interested in hearing from commissioners on a range of issues set out in the call for evidence.


15. Scheme to improve homeless discharge – call for bids

Department of Health working with NHS England has launched an application process for voluntary sector bids working in partnership with NHS and local authorities to improve discharge arrangements for homeless patients – to improve health outcomes, reduce ‘revolving door’ admissions and save NHS money.

Homeless people visit A&E six times, and are admitted four times, more than those with a home – with 70 percent discharged back onto the street – estimated to cost NHS £85m/year.

The funding will ensure better services are in place so that no patient is discharged without their housing and medical support needs planned.


16. Dedicated web pages launched for 74 specialised services Clinical Reference Groups (CRGs)

NHS England has launched a series of web pages dedicated to each of the 74 specialised services Clinical Reference Groups (CRGs).

CRGs cover the full range of specialised services and are responsible for providing NHS England with clinical advice regarding these directly commissioned services. The CRGs are made up of clinicians, commissioners, Public Health experts and patients and carers. They are responsible for the delivery of key ‘products’ such as service specifications and commissioning policies, which enable NHS England to commission services from specialist providers through the contracting arrangements overseen by its Area Teams.


17. NHS England releases update to national Cancer Drugs Fund list

NHS England has released an update to the national Cancer Drugs Fund list, further increasing access for patients to an additional three new cancer drugs. The additions to the list have been made following a review of trial data from the drugs by the Chemotherapy Clinical Reference Group (CRG).


18. NHS England welcomes publishing of medicines optimisation

NHS England is supporting the Royal Pharmaceutical Society’s call for health professionals and patients to work together to ensure better use of medicines.

A guide, called Medicines Optimisation: helping patients make the most of medicines, has been published by the Society which provides frontline professionals with four guiding principles to make sure that the right patients get the right choice of medication, at the right time.

This has been developed through collaboration between patients, health professionals, lay representatives and patient groups, so importantly it focuses on patient outcomes rather than processes.

The four principles are to aim to understand the patient’s experience, ensure evidence based choice of medicines, make medicines optimisation part of routine practice and ensure medicines use is as safe as possible.

In their foreword to the guide, Sir Bruce Keogh (Medical Director), Jane Cummings (Director of Nursing) and Dr Keith Ridge (Chief Pharmaceutical Officer) from NHS England encourage everyone to adopt these principles whether prescribing, dispensing, administering or taking medicines.

The report has been endorsed not only by NHS England but also the Academy of Medical Royal Colleges, the Royal College of General Practitioners, the Royal College of Nursing and the Association of the British Pharmaceutical Industry.


19. Health and wellbeing leadership: delivering improved outcomes for local communities

CCGs are invited to attend one of two learning events to hear about and share experiences of work with health and wellbeing partners to improve outcomes for local communities.

NHS England and the Local Government Association (LGA) are hosting two events for Health and Wellbeing leaders, as part of the health and wellbeing system improvement programme.

CCGs have signalled that developing good collaborative relationships across the commissioning landscape is an essential element to improving outcomes; and that ensuring the effective leadership of health and wellbeing boards is crucial to deliver joint challenges for system transformation.

The full day events – one in Leeds and one in London – will bring together representatives of health and wellbeing boards including CCGs, local authorities, public health, NHS England and Healthwatch, to share perspectives on how local health and wellbeing leaders can work together to deliver shared ambitions to improve outcomes for local populations. Attending the sessions will be a valuable opportunity for CCGs to hear local and national perspectives, and participate in workshops and discussions with colleagues and partners.

The events are taking place on:


20. Implementing a ban on age discrimination in the NHS: free learning event for commissioners

From October 2012, all public bodies including CCGs have a duty to eliminate unlawful age discrimination.

The Equality and Human Rights Commission, Age UK and Department of Health are running a free learning event on 6 June 2013, 10.30am – 4.00pm in London.

The event will tell you all you need to know about the ban on age discrimination in goods and services. It will also look at how to take a good practice approach to drive improvements in services, in particular for older people.

You will have the opportunity to hear from a range of high profile speakers including strategic policy makers, as well as participating in workshops looking at the practical approaches to implementing the ban.


21. Commissioning Show 2013 – 12-13 June 2013, Excel, London

This national event for clinical commissioning is aimed at CCGs, CSU, Area Teams, GPs and practice managers to acquire first hand advice and practical training in business and finance management, provision of care, commissioning support, long term conditions and productivity through technology.

Speakers include NHS England’s Chairman, Professor Malcolm Grant along with Rosamond Roughton, Interim National Director: Commissioning Development, who is speaking on ‘From authorisation to transformation – the new focus for CCGs and the commissioning system in 2013’.


Letters to CCGs

NHS England has issued the following letters to CCGs since the last bulletin:


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Future communications to CCGs

We have had feedback from a number of CCGs about preferred methods for communications. We will be putting in place a more systematic methodology to reach all CCGs directly. If you have any comments you would like to make on this, or indeed on the bulletin, please email

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