Managing the Transition Sept 2011

1. Managing the Transition Sept 2011

2. Agenda • Where are we? • Clinical Commissioning Groups (CCGs) • Health and Well Being Boards • Issues

3. Reasons for Change • Clinicians at the heart of decision making • Involvement and Empowering Patients • Best outcomes in the world - Driving up quality

4. New Architecture CCGs SHA Clusters PCT Clusters Health and Wellbeing Boards

5. CCGs • 95% Pathfinders • Variable maturity • Variable size • Governance • Scope of Commissioning • Population based

6. Pre-authorisation PCTs and SHAs formed clusters Assignment of staff and delegation of commissioning responsibilities Shadow Health and Well Being Boards Issues: End State NCB Relationship Authorisation with conditions Commissioning Support

7. To be authorised consortia will need to demonstrate… Clinical focus and added value Engagement with patients and communities A clear and credible plan to deliver quality improvement within the allotted financial resource Capacity and capability to deliver all their responsibilities, including delivery of financial control Collaborative arrangements for commissioning with other consortia, Local Authorities and the NHS CB Leadership capacity and capability

8. Collaborative arrangements for commissioning • How does the consortium plan to work with other consortia and local authorities? • What commissioning support arrangements do they have in place to help them commission across wider geographies? Standards • Partnership arrangements e.g. pooled budgets, lead commissioning etc in place with other consortia and local authorities • Effective ways of working with NHS CB in place • Suitable arrangements in place to access the right public health advice. • The consortium is a member of all relevant shadow health and wellbeing boards • Robust commissioning support arrangements in place to support collaboration Tests • JSNA/Health and Wellbeing strategy • Commissioning Plan • Constitution • Commissioning support arrangements • 360 degree input • Face-to-face meeting Evidence

9. Clinical Focus and Added Value Plans to assess local need, reduce inequalities, and ensure continual quality improvement, to improve patient experience and outcomes Demonstrate engagement of constituent GPs, also the involvement of other clinical professionals. Standards • Are key programmes of work led by clinicians from a range of appropriate disciplines? • Arrangements for effective participation of all the consortium’s practices • Is the consortium engaging with stakeholders • Does the consortium have plans to use peer to peer challenge Tests • Joint Health and Wellbeing strategy • Commissioning plan • Constitution • Membership agreement • 360 degree input • Face-to-face meeting Evidence

10. Pre Authorisation Risk Assessment • Clinical ownership • Commissioning boundaries • LA boundaries • Size

11. Draft AuthorisationIssues Raised • Why? • Accountability and authorised with conditions • NCB Relationship • Support services • Running costs • Sustainability

12. Health and Well Being Boards • Responsible for developing joint strategic needs assessments and a joint health and wellbeing strategy. • Scrutiny powers of local authorities to be restricted; use their power of referral to the Secretary of State only for significant changes to designated services.

13. Post Pause • Stronger role in promoting joint commissioning and can act as lead commissioner for some services. • Stronger role in the development of commissioning plans and will be able to refer plans back to the NCB

14. Post Pause 2 • Formal role in the authorisation of clinical commissioning groups and will lead on local public involvement. • Restrictions on scrutiny powers of local authorities lifted.  Consideration to be given to the feasibility of “Citizens right” to challenge poor service

15. Consortia Support • Consortia will succeed or fail by quality of support • Need to identify functions • Need to consider scale • Alternative models • Voluntary sector • Independent sector

16. Importance of Housing issues to CCGs • House design • Damp • Specialist housing • Extra care • Aids and adaptions • Care and repair • Housing related support

17. Examples of Different Schemes • Care and repair • Supported • Assisted technology • Step up step down

18. Getting housing on the agenda • Health and well being strategy • JSNA • Commissioning plans • Strategic planning • Greater awareness of skills and capabilities of voluntary organisations

19. The King’s Fund 10 High Impact Changes • Self-management • Primary prevention • Secondary prevention • Managing ambulatory conditions • Integrating mental & physical health care

20. The King’s Fund 10 High Impact Changes • Care coordination & integration • End-of-life care • Medicines management • Managing elective activity • Managing emergency activity

21. Enablers • Post Industrial Primary Care • Integrated Care • Systematic and proactive management of Long term Conditions • Empowerment of patients • Population management

22. Issue for Clinically Led Commissioning • Size • Patient Voice • Leadership and Ownership • Commissioning “differently”

23. Issues for Clinically Led Commissioning 2 • Balance quality, cost effectiveness and experience • Manage risk • Joint commissioning • Time needed to develop to maturity

24. Getting housing on the agenda • Health and well being strategy • JSNA • Commissioning plans • Strategic planning • Greater awareness of skills and capabilities of voluntary organisations