Bulletin for CCGs: issue 44, 18 October 2013



Letter from the Chief Executive

Commissioning Assembly News

Strategic issues:

Operational issues:

Other news:

Letters to CCGs:

About this bulletin

Gateway reference number: 00554

Planning for a sustainable NHS: responding to the ‘call to action’

NHS England will issue its planning guidance in December. However, there is a great deal of critical work that needs to happen before that. A letter from Sir David Nicholson, Chief Executive, to commissioners highlighting the key challenges facing the NHS should help focus attention and thinking regarding the crucial work that needs to start so that bold and ambitious plans can be developed for the future.

New Working Groups


A new research working group of the Assembly has been established with the focus of engaging all aspects of the commissioning system.

The aim of the group is to promote research through the development of strong partnerships. This work will contribute to encouraging evidence based decision making in service system redesign as well as supporting the aim of research offered to patients as part of their treatment option.

If you are interested in becoming a member of the working group or would like details about the new group please contact

  • Further information about the Commissioning Assembly is available here.

Parity of Esteem Working Group – get involved

By valuing mental health and physical health equally, and delivering integrated services which are capable of tackling both these aspects of health, commissioners can improve the outcomes of their populations and achieve parity of esteem.

But how can we commission services that achieve parity of esteem? Is there a shared understanding of what this means, or looks like? How do we do this amidst the current financial challenges? Are there areas of good practice that already exist?

A new working group of the Commissioning Assembly is being set up to address these key questions and to identify what support, enablers or frameworks are needed to enable commissioners to successfully commission for parity of esteem.

We are seeking CCG colleagues to join the working group, and a clinical co-chair.  If you are interested, please contact

Securing excellent commissioning support

To get the best outcomes and experience for patients, commissioners need to be able to secure quality today and lead the transformation of services for tomorrow. This means clinically-led, local commissioning and professional, high quality commissioning support.

CCGs have asked for practical help and support become in becoming informed, demanding customers of commissioning support services, to; encourage innovative solutions, be able to shape and influence the support on offer, and work through the procurement and contracting aspects of the relationships with their support providers.

A project has been set up under the NHS Commissioning Assembly CCG Development and Commissioning Support Working Groups to help CCGs secure excellent commissioning support. It includes a number of products that will assist both CCGs and support providers moving forward, including:

  • Joint narrative: NHS England will publish a short joint narrative setting out the tools that will be available to CCGs to assist in making informed decisions to secure the best commissioning support for their local area and the communities they serve in the short and long term.
  • Checklist guidance: Guidance that will include a checklist of questions CCGs can pose to assess the skills set needed to commission for service transformation.
  • Make, share, buy tool: A toolkit that will guide CCGs through the process of deciding where and how to access commissioning support and which builds on the approaches and lessons learnt from CCGs and other stakeholders across the country.
  • Value for Money business case requirements: Documents to support CCGs in robustly demonstrating value for money where there is a significant change to provision.
  • SLA renegotiation: a series of regional workshops in November to support CCGs in understanding the areas for improvement in their SLAs, best practice for Service Specifications/KPIs, model wording and guidance.
  • Lead provider framework: Starting in early November, NHS England is running a number of events across England on the development of the criteria and standards that will be used to assess lead providers of commissioning support services.

Commissioning Assembly Steering Group meeting

The Commissioning Assembly Steering Group meeting will take place this month following highly successful Commissioning Assembly event on 25 September.

This group was established to set the strategic direction for the Assembly, oversee its work and ensure this is taken forward in line with the Assembly principles. It comprises eleven CCG clinical leaders and five NHS England leaders.

In addition to updates on key issues pertinent to the commissioning community the agenda will include evaluation of the event, discussion about the key strategic themes raised and how this will inform the strategic agenda for the Assembly for 2013/14 and beyond. Members can log on to the Commissioning Assembly website here to contribute to the discussion and debate, post hot topics and access material from the working groups.

Your chance to set the bar for Commissioning Support Lead Providers

During November, NHS England will be running a series of local workshops to give CCGs and other key stakeholders an opportunity to feed into the development of the criteria and standards that will be used to assess lead providers of commissioning support services. The workshops will include sessions on supporting the development of high quality SLAs and simple steps to support effective renegotiation with commissioning support suppliers. The events are aimed at CCG chairs, accountable officers, directors of commissioning, directors of operations and directors of finance.

For more information and to book a place please click on the event you would like to attend:

Keogh Quality Note

The Keogh Quality Note sets out the roles, responsibilities and accountability of each of the organisations that are expected to play a part in enabling improvements in the hospitals involved in the Keogh Review, ensuring each part of the system understands the extent and limit of what it is meant to achieve.

  • Read the Keogh Quality Note here

The ‘Integration Transformation Fund’

The Local Government Association and NHS England have published further guidance on how CCGs and councils should work together to develop their plans for the pooling of £3.8 billion of funding, announced by the Government in the June spending round, to ensure a transformation in integrated health and social care.

The ‘Integration Transformation Fund’ is a single pooled budget to support health and social care services to work more closely together in local areas. The publication today provides further advice, ahead of the formal planning guidance in December, on how the Fund will operate. The publication also includes a draft plan submission template.

Publication of National Tariff proposals for 2014/15

Joint proposals from Monitor and NHS England for the 2014/15 National Tariff Payment System have been published for a 28-day consultation period.

It is important that CCGs read this package of documents, as it sets out the payment rules for commissioners and providers of NHS care to use in 2014/15. The proposals seek to balance the need for innovation in service delivery with stability during a time of transition, and introduce new elements to the payment system such as the potential for ‘Local Modifications’ to be made to national prices.

CCG post-authorisation progress

Last week the Authorisation Committee sat to review the progress of CCGs with outstanding conditions and directions imposed.  Those CCGs affected received their individual reports earlier this week.

  • You can view the committee’s summary report here


CCG decision making around commissioning support services

The attached letter from Rosamond Roughton, National Director for Commissioning Development, emphasises the importance of having good governance to ensure that CCGs are making decisions in the right way to secure the best possible services for their local community and that decisions are as transparent as possible in order to demonstrate effective and economical use of taxpayers’ money.

Later this month, NHS England will publish a make, share, buy tool to support CCGs in their decisions. Where CCGs wish to bring a significant proportion of commissioning support services in house from a current provider of commissioning support, this may have consequences on the continuity of supply for other commissioners and incur financial liabilities to the taxpayer. Consequently, NHS England will be asking CCGs to work closely with their area teams to agree in advance a sound business case that demonstrates the basis of the decision.

Commissioning for Value – a comprehensive data pack to support CCGs

Working with Public Health England and NHS Right Care, NHS England will, this week provide every CCG with a comprehensive data pack to support effective ‘commissioning for value’.

They are the first products CCGs will receive as part of the new planning round for commissioners and fit directly with NHS England’s ‘call to action’ and clearly show CCGs ‘where to look’ as a first stage to identify real opportunities to improve outcomes and increase value for local populations. The localised information will help CCGs and their health-economy partners identify areas for change, utilise resources and make improvements in healthcare quality, outcomes and efficiency.

To start the journey there will be two free support-surgery events in London or Manchester where you will:

  • find out more about the process
  • hear from this early adopter who can demonstrate real results – read a case study Warrington CCG and
  • get face-to-face support in surgeries where data can be discussed on an individual CCG basis.

Register here:

  • Tuesday 12 November – London’s Business Design Centre – book now!
  • Wednesday 13 November – Manchester’s Mercure Hotel – book now!

Winter planning 2013/14

A joint letter from NHS England, the NHS Trust Development Authority (NHS TDA) and Monitor has been issued to leaders across the system setting out the next steps around preparation for winter.

In addition to emphasising the crucial need for coordination and for strong and effective leadership of organisations during winter in order to deliver safe and high quality services, the letter includes important information in relation to winter reporting arrangements and also seeks to clarify the role of Urgent Care Boards (UCBs) which, it is proposed, are renamed as Urgent Care Working Groups to better reflect their constitution.

E-learning tool launched for NHS Continuing Healthcare

On Wednesday 9 October NHS England, in conjunction with the Association of Directors of Adult Social Services, launched an electronic training tool for all those involved in assessment and decision making around NHS Continuing Healthcare.

The tool is free to use and is designed to be intuitive and flexible so that health and social care staff can easily register and undertake training at a time and place that suits them. The tool will support local training programmes and support the work undertaken by all CCGs to ensure that there is consistency and legal compliance in the assessment and decision making processes for NHS Continuing Healthcare.

  • The E-Learning tool is available here for NHS staff and here for Local Authority staff.

Latest Information Governance bulletin published

The fifth edition of the Information Governance bulletin from the Information Governance task force is now available. This aims to support all commissioners in working with data. The volume of material is increasing steadily with this issue, which contains the first FAQs. New material will also be posted on the Information Governance webpage and look out for new announcements between bulletins!

NHS 111: Advice to lead commissioners

The attached letters from Dame Barbara Hakin and Tony Yates, NHS 111 Technical Lead, outline steps lead commissioners should take to ensure NHS 111 sites are compliant with latest protocols and to ensure GPs receive the correct messages from NHS 111 sites.

This is of relevance to CCGs that act as lead commissioners of NHS 111.

  • For further information, please contact Tony Yates, NHS 111 Technical Lead at

Clarification on Signatory Responsibility for GPSoC Schedule A and Local Schedule A Services

The contracting of GPSoC Services requires the contracting authority and the supplier to both sign a Schedule A and Local Schedule A.

NHS England and the Health and Social Care Information Centre (HSCIC) would like to clarify that the only NHS organisation with the necessary authority to sign Schedule A and Local Schedule A are CCGs. For the avoidance of doubt, commissioning support units (CSU) do not have the authority necessary to formally contract GPSoC Services.

Any schedules that have been incorrectly signed must be resigned by the correct organisation.

2013/14 Payment by Results Assurance Programme

Arrangements have been made for the PbR Data Assurance Programme, previously funded by PCTs and managed by the Audit Commission, to be sponsored by the Department of Health. The programme will continue to be delivered under contract by Capita CHKS and will include data quality risk profiles for all acute trusts, follow up of previous recommendations, sample audits of reference costs and clinical coding and, in mental health trusts, development of tariff funding. The national data quality bench marker continues to be available free of charge to both providers and commissioners. Commissioners with local providers involved with the audits will be contacted directly.

Pensions Indexation

In 2004 NHS Pension employer contributions increased from 7 per cent to 14 per cent with the Government agreeing that they would cover these costs for voluntary organisations including hospices. The funding was devolved in 2009 to PCTs and therefore is now with CCGs. Ministers requested that this funding continue to be used for what it was intended for – payment of employer pension contributions for voluntary organisations.

Some CCGs have rejected invoices from hospices. It is important to consider the background and the potential relationship implications in coming to a decision.

Outline of Uterine Cancer Report in the UK: Incidence, Mortality and Survival

Published by the National Cancer Intelligence Network (NCIN), the report presents variation in the age-standardised incidence and mortality rates for uterine cancer in the UK. It demonstrates a 43 per cent increase in the incidence of uterine cancer, driven mainly by obesity. As treatment for endometrial cancer is commissioned at local level, these figures should help to understand the burden of uterine cancer, the most common gynaecological cancer in women, on the local population.

Whilst data is currently published by PCT area, the information will be relevant to many CCGs.

Understanding local cancer services – NCIN Service Profiles for Commissioners

To support local understanding of cancer services the NCIN have published 4 more profiles of clinical teams providing care for Head & Neck, Sarcoma, Gynaecology and Oesophago-Gastric (OG) patients. These bring together relevant indicators to provide comparative information between MDTs, which NCIN believes will be of immense value for commissioners. They are in the NCIN Cancer Commissioning Toolkit (CCT). These are the latest addition to a wider suite of cancer profiles available, including Breast, Colorectal, Lung, Radiotherapy, along with local profiles for GP Practices and PCTs.

iRefer – The Royal College of Radiologists’ Radiology Referral Guidelines

We are pleased to announce that the seventh edition of the adult and paediatric imaging referral guidelines from The Royal College of Radiologists (RCR), known as iRefer, is now available via the N3 platform free of charge to all NHS organisations in England. The RCR produced these guidelines to help clinicians, healthcare professionals, radiographers and radiologists to determine the most appropriate imaging procedures for a wide range of clinical problems and these evidence-based radiology referral guidelines have an important role in improving the quality of care for patients.

Electronic Prescription Service (EPS) – Nomination Policy 2013/14

NHS England has published the Electronic Prescription Service Release 2 Nomination Policy. This publication is important to NHS England’s area teams, CCGs and their IT providers and is available here.

This nomination policy has been developed for all users of the Electronic Prescription Service and NHS organisations with EPS responsibilities. It includes background information, responsibilities and guidance at a national level. This replaces all local documents and previously published nomination polices.

For further information please contact:

International prize for grassroots movement to improve healthcare that started with a tweet

It started with a tweet and swelled to a force of 189,000 people taking action to improve healthcare. Now NHS Change Day has received international recognition by winning a global challenge for management innovation prize organised by Harvard Business Review and McKinsey.

GPs and CCGs were instrumental in making NHS Change Day 2013 a success. Examples included Eastern Cheshire Commissioning Consortium pledging to create a weekly opportunity for all staff to ask the question “What have I done to help a patient this week?”, and NHS Coventry and Rugby CCG, NHS South Warwickshire CCG and NHS Warwickshire North CCG, helping a fifty-strong team of staff, lay members and patients to take the message out to communities.

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

Letter to CCG Clinical Leads and Accountable Officers – National System Deployment

Attached is a letter to CCG clinical leads and accountable officers from the Senior Responsible Owners for the Electronic Prescriptions Service (EPS), the GP2GP Service, the NHS e-Referral Service, the successor to Choose and Book, and the Summary Care Record Service.

The letter is a call for help to achieve the goal of full national system deployment and explains the vital role CCGs play in the deployment of these services.

  • Further information about the national systems can be found here.

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