Bulletin for CCGs: issue 47, 28 November 2013


Commissioning Assembly news:

Strategic issues:

Operational issues:

Events and campaigns:

Other news:

Letters to CCGs:

About this bulletin

NHS Commissioning Assembly news

Join the NHS Commissioning Assembly strategy working group

The NHS Commissioning Assembly strategy working group is looking for new members so please get involved!

The aim of the working group is to generate and share ideas which will support the development and implementation of the NHS 10 year strategy.

All contributions and ideas from the working group will help co-produce CCG engagement tools, signposting of research, case studies and discussion material with a clear timeline as to how the engagement will support the national planning round for the NHS. Key outputs from the monthly meetings will be used to inform the requirement for 3-5 year strategic plans for CCGs.

If you are interested in becoming involved in the strategy group, or would like further information on working groups of the Assembly, please contact us.

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Supporting best practice in CCG organisational development

Overseen by the NHS Commissioning Assembly’s CCG Development Working Group, a project group has been established to explore how to support best practice in CCG organisational development. The group agreed some specific actions to produce a range of helpful support resources, including some diagnostic tools that also incorporate elements of the recently published Framework of Excellence. This is being led by CCGs, working collaboratively with some partner organisations on a ‘do once and share’ basis. The group would like to have some ‘critical friend’ CCGs who are willing to test these OD tools as they are developed.

By the early spring, we will have a range of case studies developed with CCGs who have different characteristics and approaches to their OD planning.

If you would like to shape OD resources or think your CCG might have some interesting perspectives and shared learning on OD and would be interested in becoming one of the national case study sites please contact Sarah Briggs.


Walking the service- “looking and seeing”

 In June 2013, the Quality Working Group of the NHS Commissioning Assembly held a workshop with the twin aims of:

  • Considering what support CCGs may need to help them fulfil their role in assuring the quality of care they commission.
  • Developing strategic approaches to improving quality and outcomes across each of the 5 domains of the NHS Outcomes Framework.

Following this workshop, CCG members requested support in improving their approaches to assuring the quality of the services commissioned. A Commissioning for Quality Framework is currently being developed in co-production with the working group and others. The aim is to publish this in early to mid-January 2014.

As part of the process of developing the Commissioning for Quality Framework, we are aware of a number of CCGs who have developed methodologies for visiting commissioned services to see them in action. CCG colleagues have expressed an interest in learning from these processes and are keen to see what is involved in such visits.

If your CCG has developed such a methodology for visits to providers, we would like to hear from you.

  • Please send information to Caroline Humphreys, Service Transformation Lead, NHS England –Telephone: 07827 903664


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Strategic issues

2014/15 NHS Mandate from the Government

Sir Malcolm Grant, Chair of NHS England, has welcomed the refreshed Mandate from the Government on behalf of the organisation.  Read more here

In response to the publication of the refreshed mandate, Sir Malcolm Grant has written to the Secretary of State, Rt Hon Jeremy Hunt MP, setting out NHS England’s commitments, objectives and principles for securing the outcomes proposed in the Mandate.

  • Read the letter here


Assurance Framework published

NHS England has published the first assurance frameworks for both CCG and direct commissioning. Both frameworks are based on six identical assurance domains which enable a broad assessment of delivery, capability and organisational health to be made.

The CCG Assurance Framework sets out how NHS England will meet its statutory responsibility to conduct a performance assessment of each CCG. Alongside the framework, an operational guide sets out how assurance should be delivered in 2013/14, including the key sources of evidence required, which will inform the assessment.

Although the two frameworks are being published together, assurance of services directly commissioned by NHS England’s area teams is at an earlier stage.   While CCGs had an established, consistent baseline of expected performance through the authorisation process, assurance of direct commissioning will begin with a comprehensive baseline exercise using the CCG authorisation criteria.  This will establish the existing stage of development for NHS England as a direct commissioner of services at local, regional and national level.

The framework which supports both documents has been the subject of extensive engagement over summer 2013 and represents a co-produced approach between all areas of NHS England as well as CCG representatives and other key national stakeholders.

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Strategic Framework for Commissioning of General Practice

In August this year, NHS England published “Improving General Practice – A Call to Action” as part of the series of papers to support the wider work on a Call to Action. Many people and organisations have contributed to the debate about how we can work together to maximise the contribution that general practice can make to improving outcomes and tackling inequalities as part of wider local strategies. On 5 December, we will be testing the emerging ideas with a wide range of public and patient groups. The strategic framework, to be published early next year, will set out the vision for commissioning general practice in the future, and describe some of the work that will be taken forward nationally to support and enable local strategies.  It is not too late to get involved.  If you would like to share your views, then please get in touch with the NHS Commissioning Assembly working group on primary care through

Local engagement between Area Teams and CCGs, patient groups and community organisations will continue once the framework has been published to agree how best to implement local strategies

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Integration Transformation Fund Planning

As per the Local Government Association (LGA) letter of 30th October, forwarded to Regions and Area Teams, the regional discussions around Integration Transformation Fund (ITF) planning should hopefully have commenced, including identifying local areas which may need additional support. We are trying to coordinate a package of support for CCGs and Local Authorities to help with their ITF plans.

In order to ensure this is as helpful as possible, please let us know if there is anything in particular that would be useful.


Launch of Legislative Reform Order (LRO) Consultation – to allow joint committees

The Department of Health launched the LRO consultation on Thursday 14 November. The proposed LRO will enable (a) two or more CCGs to form joint committees when jointly exercising their functions and (b) for one or more CCGs and NHS England to jointly exercise the functions of a CCG and to form a joint committee when doing so.

The consultation and covering letter were sent directly to all 211 CCGs by the Department of Health. Responses are sought from the Chief Accountable Officer in each CCG. The consultation will close on 7 January 2014

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National Call to Action event on valuing mental and physical health equally

On 25 November, NHS England hosted its second Call to Action stakeholder event, this time focusing on ‘Valuing mental and physical health equally’.

During the event, experts in the room, including invited service users and clinicians, explored how health and care services could be modernised and adapted to address the whole person and not just episodes of ill health. The aim was to have a number of possible solutions that could be used to tackle poor physical health for those with mental health problems, and prevent those with physical health problems developing mental health issues.

Outputs and ideas from this event and the other national events will feed into the Planning Guidance support tools being made available to CCGs to help with 2 and 5 year operational and strategic plans.

  • For more information about the call to action, or to ask a question, email us


Ways of Working survey – results due in December 2013

Since the Ways of Working survey closed earlier this month, Ipsos MORI has been collating and analysing the results for NHS Clinical Commissioners. The independent survey aims to evaluate the extent to which the co-produced Ways of Working are being demonstrated by NHS England. The final report and outcomes will be shared with all CCGs and with NHS England in December 2013


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Operational Issues

How to ensure the right people, with the right skills, are in the right place at the right time

On 19th November, The National Quality Board, sponsored by The Chief Nursing Officer in England, published a ‘How to’ guide to support providers and commissioners in making the right decisions about nursing, midwifery and care staffing.

The guide outlines a number of expectations of providers and commissioners in this area, provides practical steps on how they can be met, and provides examples of good practice.  It highlights the role of commissioners as part of contracting for high quality care in assuring themselves that providers have sufficient staffing capacity and capability. It also outlines the commissioners’ role in working in partnership with providers to address any significant staffing problems.


Commissioning Resources Plan published on NHS England website

The Commissioning Resources Plan (Nov 13) is a summary of all guidance, resources and tools for commissioners that NHS England is planning to produce. It does not include internal policies and procedures at this stage and may not be a complete list.  Guidance we plan to publish, to which CCGs must have regard, is highlighted in green. This plan will be updated monthly to reflect any new resources and or changes to publication dates.

Any feedback on the usefulness of this forward look is very welcome and we intend to continue to develop this product in light of any feedback received.

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Winter Planning

You will be aware that Sir David Nicholson wrote to all CCGs and Local Authorities last week to encourage further joint working.

On Friday 21 November we announced a further £150 million of non-recurrent funding to support the remaining systems and Sir David will be writing to you with further detail shortly.

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National Audit Office report on emergency admissions to hospital: managing the demand

The National Audit Office (NAO) scrutinises public spending for the Parliamentary Public Accounts Committee which holds the Government to account for how it spends taxpayers’ money on public services. NAO has reported on how emergency admissions to hospital were managed in 2012-3. The report recommends action by all parts of the health system to improve management of patient conditions to avoid emergency admission where appropriate and to improve the flow of patients through the system. It recommends action by CCGs to assess and adopt best practice to do this, and to use Urgent Care Working Groups to inform local commissioning.


Commissioning for prevention

The Call to Action, published in July, describes why the health service needs to change fundamentally in order to meet future health needs and to restore its economic sustainability.  CCGs and their partners will shortly embark on developing 5-year strategies, with the first two years at an operational level of detail.

To assist them in identifying transformative options, NHS England will be publishing a series of discussion papers.  The first one, entitled Commissioning for Prevention, outlines how CCGs can prevent premature mortality and chronic disability by allocating their total resources differently.

  • Read the letter about Commissioning for Prevention here

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More than one million Friends and Family Tests completed in just six months

More than one million individual pieces of feedback have now been collected through the Friends and Family Test in just a six month period.

Read about the latest data here, including a letter from Tim Kelsey, NHS England Director for Patients and Information, outlining the next steps on the Friends and Family Test and thanking all involved for their part in continuing to ensure that patients’ voices are both heard and acted upon.


Payments to GPs for Drug Reimbursements

To ensure GP contractual payments that interface into CCG ledgers are paid on time (i.e. by the first working day of the month), CCGs need to ensure they consider the CCG BACS run timetable.  This may require CCG Finance Teams / their CSUs to process these payments earlier to ensure payments can be made on the CCG calendar month BACS runs.  If necessary, CCGs can ask SBS to process an additional BACS run. Whilst an additional cost to the CCG, CCGs may be able to offset this by replacing one of their existing BACS runs with the new, earlier run.

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CCGs benefit as new accreditation scheme goes from strength to strength

Commissioners are benefitting from the extra peace of mind provided by the Accredited Voluntary Registers scheme from the Professional Standards Authority (PSA). Launched in January, the scheme provides a layer of protection for CCGs commissioning health and social care services that are not regulated by statute. With eight registers already accredited and another seven having applied, CCGs commissioning acupuncture, counselling and psychotherapy, foot health, hypnotherapy, complementary healthcare or play therapy services can now choose a practitioner belonging to a register approved by the PSA.

  • For more information about the AVR scheme or to find a practitioner on an accredited register, click here


Next steps on Winterbourne View

In October, the Winterbourne View Joint Improvement Programme (WVJIP) published the Stocktake of Progress report

This gave the national picture of progress to achieve the commitments in the Winterbourne View Concordat.

On 20 November all Health and Wellbeing Boards were sent an area Status Report highlighting understanding of local area progress against four key priorities: understanding the numbers (including CCG data gathered earlier in the year), funding, commissioning and meeting the June 2014 deadline.

We encourage CCG leads to work with their Health and Wellbeing Boards to respond to this status report by 02 December.

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Changes to central Department of Health support for Any Qualified Provider (AQP) in community services

During 2013/14, DH has continued its central support to help commissioners in qualifying providers where they had decided to extend patient choice of provider (AQP) to new services. DH Central Support will cease on 14 March 2014. To allow for an appropriate transition period, DH will be applying specified cut-off dates for receipt and processing of offers.

  • For more information, click here

From 2014/15 onwards, qualification of providers will be entirely for commissioners to take forward. DH and NHS England will be working with commissioners and providers over the next few months to help the system develop and establish appropriate arrangements.

Updated CCG outcomes tool and explorer

The CCG outcomes tool and explorer which provide interactive access to key data for CCGs have been updated and the latest versions can be found here.

Following publication in December 2012, the main changes in the November 2013 update are:

Functionality – the ONS cluster groups as comparators have been removed in this release, pending the inclusion of specifically developed CCG clusters in the next update.

Data – where possible more timely information has been provided for data and new data has been added for the following indicators:

  • Quality outcome framework prevalence.
  • Potential years of life lost amenable to healthcare for males and females.
  • Under 75 mortality rate from cardiovascular disease, respiratory disease and cancer.
  • Case-mix adjusted health gain following hip and knee replacement, and groin hernia surgery.

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Events and Campaigns

Your chance to influence information outputs to support commissioning

NHS England is leading a programme to bring the NHS data service up to modern standards- known as the programme.

There are a number of events planned, to hear from commissioners about what they need from  We hope to ensure representation from CCGs across the country.

  • Further information on can be found here

Please see dates for events below. Contact us for more information or to book a place.

  • London – 10 December 2013 (12.30 – 15.30) in London. Contact us
  • South – 11 December 2013 (10.00 – 13.30) in Newbury. Contact us
  • North – 16 December 2013 (AM) in Leeds. Contact us
  • Midlands & East – 15 January 2014 (10.00 – 13.30) in Cambridge. Contact us

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Health and Care Innovation Expo 2014- save the date

NHS England will host the most important health and care event of 2014, at the Manchester Central on 3rd and 4th March.

Innovation Expo will bring together more than 10,000 people who want to bring about change to improve NHS and care services; securing high quality care for everyone and sustaining the NHS for the next generation.

The theme for Expo is the ‘House of Care’. Attendees will be immersed in an environment that shows health and care working together and the possibilities this has to improve quality in our health and care services.

The fast-paced and interactive programme will unite people from across health and care, the voluntary sector, commissioners, clinicians, patients, thought leaders and innovators. Expo will provide the inspiration and tools necessary to improve health outcomes.

There will be key note speeches from some of the most influential and experienced people in the health and care economy. Thought provoking seminars will show people how to create positive changes where they work; this is the pop-up NHS University where people will design their own course from the seminars and workshops on offer.

Everyone who wants to be a change agent in health and care is welcome.

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Improving care for dying people –  views are needed

As part of the wide range of work of the Leadership Alliance for the Care of Dying People (LACDP – chaired by NHS England), an engagement  exercise is currently underway (closing 6 January 2014) targeting health and care professionals and the public on proposals to improve care for people in the last days of life, and their families and carers.

The alliance is keen to hear views and ideas about how care in the last days of life can be improved, focusing specifically on its proposals for a set of desired outcomes for people who are dying which, supported by guiding principles, should be the basis of care in different settings and circumstances.  Please take part or cascade as appropriate.

Further details and the engagement document can be found here

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Commissioning for health improvement – building the views of the patients and the public into evidence

Interested in patient voice?  Why not join our conference – Putting ‘the public’ back into Public Health – on Thursday January 16th 2014 at Leeds Metropolitan University.

There is a great line up of speakers – including Mike Kelly from NICE, Alison Hill from Public Health England, Olivia Butterworth and Pritti Mehta from NHS England – and anticipate having a lively debate on how we build the experience of patients into evidence we can draw on when commissioning  for health improvement.

  • For more information or to book a place, click here



Other news

Role of the voluntary sector in providing commissioning support

NHS England recognises that high quality commissioning requires expert commissioning support which can come from a range of providers including voluntary sector organisations. A new report ‘Role of the voluntary sector in providing commissioning support’ by the Nuffield Trust in conjunction with Macmillan, ACEVO, Neurological Commissioning Support and NHS England, looks at the potential expertise they can bring to this area.  The report sets out key recommendations and action points for VSOs, CCGs, CSUs and NHS England, which we hope will enable all commissioners to access excellent and affordable commissioning support.

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The Institute of Chartered Secretaries and Administrators- CCG code of governance

The Institute of Chartered Secretaries and Administrators (ICSA) has introduced a new code of governance for CCGs. The code has been produced to support clinicians in developing good governance arrangements and to help build and maintain public trust in clinicians and the NHS. The concise code has been prepared with an expert panel, chaired by The Right Hon The Lord Hunt of Wirral, Partner at DAC Beachcroft LLP.

ICSA, a leader in governance and compliance,  also received feedback from those who work in and with CCGs, so that the code represents all the specialities required within the governing body of a CCG and draws upon their, and the panel’s, experience of the NHS and effective governance.

Department of Health 2012-13 Reference Costs Publication

The 2012-13 Reference Costs Publication was published on the Department of Health pages of on 21 November.  Reference costs are the unit costs to the NHS of providing defined services in a given financial year to the NHS patients in England and are collected and published annually. These are the reference costs for the financial year 2012 to 2013. This is the most up to date information about how NHS expenditure was used to provide healthcare by NHS trusts and NHS foundation trusts.

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Support tool for children & young people in contact with Youth Offending Teams

Young people who offend can have complex health needs which remain unrecognised and unsupported.  The Department of Health and Youth Justice Board commissioned the development of a standardised Comprehensive Health Assessment Tool for young people in the Youth Justice System (in contact with Youth Offending Teams).  Its implementation will ensure young people receive a comprehensive assessment of their physical and mental health, substance misuse and neurodisability needs.  A standardised approach to the assessment of health needs can provide better screening, improve continuity of care and prevent duplication during periods of transitions.

  • For further information, click here

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The Children and Families Bill

The Children and Families Bill is currently passing through Parliament and represents the biggest change to the way children with special educational needs and their families are supported for 30 years.  Although the Bill is led by the Department for Education there are significant implications for the NHS.

DfE are currently consulting on the Code of Practice that will sit alongside the legislation and it is important that CCGs and other parts of the health system have their say.  Further information will follow in future bulletins.

  • Watch an interview with Edward Timspon MP and Dan Poulter MP, delivered by young disabled people, outlining the importance of the reforms
  • Access the Code of Practice consultation here





Please note that letters are not routinely sent directly to CCGs unless they are urgent or confidential. Letters are ordinarily distributed via the CGG Bulletin.


Letter to CCG Clinical Leads and Accountable Officers – Liverpool Care Pathway

Attached is a letter to CCG clinical leads and accountable officers from Jane Cummings, Chief Nursing Officer and Rosamond Roughton, National Director Commissioning Development of NHS England on next steps following the report of the Independent Review into the end of life care model – the Liverpool Care Pathway.

One of the areas of the Independent Review that has been highlighted as an ongoing concern is the use of financial incentives linked to the Liverpool Care Pathway.  Recognising that the design of local incentives is entirely for local discretion, the also request CCGs consider how to cease any such financial incentives and provides advice on how to do this.

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Consultation on the Procedures for the Approval of Independent Sector Places for termination of pregnancy

On 22 November, NHS England emailed CCGs, alerting them to the launch of the Department of Health’s Consultation on the Procedures for the Approval of Independent Sector Places for termination of pregnancy.

As CCG’s are commissioners of abortion services DH is interested in your views. If you have any queries, please contact Lisa Westhall

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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 the CCG bulletin mailbox.

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