WCCG Commissioning Cycle Describing the Process – Part 2

1. WCCG Commissioning CycleDescribing the Process – Part 2

2. Purpose: The Commissioning Cycle Wakefield CCG uses the Commissioning Cycle (CC) as a framework to link internal business processes together across the organisation. This handbook provides the tools to take changes to commissioned services through a standardised approach from concept to delivery.  Key outcomes of this approach are; • A transparent framework which is simple, easy to navigate and understand. • Commitment to streamlining ways of working to enable implementation of the strategic objectives of the organisation. • A live dynamic resource which is regularly updated and reviewed. • Robust consideration and evaluation of the need for change, thorough development of proposals, timely decision-making, efficient tendering and contracting to deliver the change, on to subsequent monitoring of its delivery and impact. Focused on improving the quality of healthcare we are committed to, an evidence-based approach to commissioning, and engaging patients and the public, clinicians and commissioners in strategic planning and service design.

3. What is the commissioning cycle? Commissioning is the continual process of planning, agreeing and monitoring services. Commissioning is not one action but many, ranging from the health-needs assessment for a population, through the clinically based design of patient pathways, to service specification and contract negotiation or procurement, with continuous quality assessment. (NHS website www.england.nhs.uk) There is no single geography across which all services should be commissioned, some local services can be designed and secured for a population of a few thousand, while for rare disorders, services need to be considered and secured nationally. Commissioning comprises a range of activities, including: • Assessing needs • Planning services • Procuring services • Monitoring quality The process, which is repeated typically on an annual basis, is often shown as a cycle: • Two main statutory duties: • How am I securing needs for my users? • Best value for money? Putting services in place to meet the demand

4. WCCG Commissioning Cycle Planning Services Procuring Services How would you monitor Quality Need Meeting the Demand Identify the Need Monitoring of activity and demand

5. Assessing needs Review Demand & Capacity / Identify the need using the sources listed below Explanation This stage is about assessing the health needs of the local population. The starting point for this is the Joint Strategic Needs Assessment (JSNA) carried out by the Health and Wellbeing Board. Other considerations in understanding the population needs are: • Demographics; • Nice Guidelines; • Specific Public health data for the service under review; • Local referral / activity / cost data – by GP and GP practice. Sources WCCG SME: Public Health/ BI • JSNA • Prevalence Data • Benchmarking/ Research • Morbidity & Mortality • Risk Factors and Lifestyle • Local referral/ activity data • Review all local/ national intelligence • Consider WCCG communication and engagement strategy • Health and Wellbeing Strategy

6. Reviewing Service Provision Review Capacity & Demand / What do we need to consider when reviewing service provision? Explanation This stage allows commissioners to understand how services are currently being provided and identify any gaps. Commissioners determine if  the existing level of service provision best meets the local needs in terms of value for money, quality and accessibility.  Consideration should be given to; • Performance & access indicators; • Quality measures (safety / effectiveness / outcomes / experience); • Value for money and benchmarking; • Location; • Cultural and equality appropriateness; • Supporting choice; • Workforce including clinical leadership; • Patient complaints and feedback. Sources WCCG SME: Transformation / Commissioning Team supported by BI, Performance, Contracting, Procurement , Finance and Quality Teams • Engage with service providers • Current service performance • National Indicators including IAF • Review current existing evidence base for this service area • Clinical outcome measures • Finance considerations • NICE Guidelines • Strategy overview • Right care • Consider WCCG communication and engagement strategy • Service user / satisfaction data • Complaints, compliments and concerns • Initial IIA Assessment

7. Deciding Priorities Gap Analysis / Why do we need to decide priorities? Explanation This stage focuses on the importance of planning to close any gaps. Patient and the public views should be considered in developing local plans and strategiesalong with reference to other strategic documents such as Health and Wellbeing / STP / ICS. The local health needs assessment along with an analysis of current provision will help to indicate what (if anything) needs to change. Consideration should be given to: • Communities that have limited choice, either in terms of providers or in the nature of services available; • Areas where there are gaps in existing service provision and those with specific health needs that could benefit from additional investment in services; • Investment in services not targeted on areas of greatest need. Sources WCCG SME: Executive Team – Strategic Objectives • Strategic Objectives • Finance considerations • Planning • Consider local/national strategic context • National Must Do – External Drivers • Practice level data • Incident and prevalence data • Deprivation index • Social markers/ demographics • STP/ICS priority programmes • Service user feedback • Consider WCCG communication and engagement strategy • System Transformation • JSNA • VBC

8. Designing services Explanation Once priorities are identified the design of services should be considered. Consideration should be given to: • Commissioners need to work together with all providers and stakeholders (including patients and the public review) to review and design the service model; • It is essential to develop meaningful and measurable outcomes (Key Performance Indicators) for the services commissioned; • Search for and utilise best practice and evidence; • Complete IIAs and ensure correct sign off; • Service specification is developed at this stage including all relevant information. Sources WCCG SME: Transformation Managers supported by Clinicians, Quality and Contracting • Establish and understand best practice clinical / public health guidelines and link with lead clinician re benchmarking including Rightcare (NHS Evidence base) • Review existing pathways / Pathway development and guideline production/review • Understand and design service specification (clinical effectiveness, outcomes, safety, experience, regulation) • Specifyand agree quality outcomes/ KPIs • Reviewing patient and service user experience and satisfaction questionnaire outcomes • IIA completion and link with Quality • Finance consideration associated • Commsand Engagement • Procurement advice • Contracting • Capacity Planning

9. Shaping structure of supply Implementation of Service / Procurement / risk and challenge – looking forward with a view of what you think may happen Explanation For delivery of strategic commissioning plans the shape and structure needs to be understood and developed. Considerations should be given to: • Developing and implementing market sector procurement strategies, ranging from single deal contracts to longer term regional commodity and service contracts; • Aligning procurement strategies with overall strategy, and maximising the contribution of suppliers; • Understanding the market: its historic, current and future capabilities; supply chains; and carrying out supply and demand analysis; and workforce analysis; • Developing relationships that prevent unnecessary supplier dependencies, with contingency plans for exit that minimises switching costs. Sources WCCG SME: Contracting Understanding the procurementpathway / legislation – European Law and the implications on health utilising specialist support and advice across the CGG • Open Government and National Tenders – E-Tendering and being open and transparent • Market Management / Provider market days – format, feedback, commissioning intensions • Awarding contracts and keeping within the law – Monitoring adherence to contracts and providing feedback to providers, maintaining regular contact • Financial considerations

10. Planning capacity & managing demand Engaging with the market and adhering to rules and regulations Explanation Commissioners need to consider what capacity is needed across the system to meet the strategic objectives of the organisation. Considerations should be given to: • How demand will be managed to ensure best use of resources is necessary; • Managing demand includes consideration of service risk,  workforce planning and on-going assessment of need to inform further capacity planning; • Protocols and thresholds for referral of patients need to be clear and monitored to ensure that those patients most in need are getting the treatment they need. Sources WCCG SME: Planning/ Comms / BI • Capacity and Demand Modelling • Procurementand Contractingroutes - know all of your options and be clear about your choices – evidence this • Communicatingservice change to all stakeholders: Skyline, Newsletter and clear communication strategy including press release, mail shots to existing patients, leaflet for distribution in primary care etc. *link to communication and engagement • Decommissioningof existing service if appropriate • Choiceis a fundamental principle of the NHS and in order to achieve this – there needs to be a choice of provider, location and time to name only three areas. CCGs are required to demonstrate this and evidence delivery against this important agenda when planning services • Financial considerations • VBC tool • Diagnostics

11. Managing performance Explanation This is how commissioners monitor service delivery and provider performance. Considerations should be given to: • Contract discussions linked to KPIs, Budget and overall contract performance; • If a service is falling below the specified and minimum standards, the commissioner should agree a recovery plan with the provider and monitor this to ensure improvement; • Quality Team lead enhanced surveillance where there is a quality concern identified through routine contract monitoring; • Where improvement does not occur, the commissioner may decide to re-evaluate other stages of the Commissioning Cycle i.e. re-design the service; re procure the service; or consider the shape and structure of supply. Sources WCCG SME: Transformation Team supported by BI, Contracting, Performance and Quality teams • Review real-time performance and data • What does a robust evaluation look like? • Contract performance documentation • RAP plan • Decommissioning policy • Proactive management and regular review – learn to look forward and ‘act’ not backwards and ‘react’ • 3 way budgets meeting(s) associated • Governancearrangements – risk and mitigation techniques • Standard NHS Contracts – know the content and use the levers, if necessary • BI diagnostics • Quality

12. Supporting patient choice and seeking public and patient views Explanation This ensures that patients are supported and involved in decision making and commissioning arrangements. Consideration should be given to: • Choice of service; • Location including timings and travel; • Patient feedback and satisfaction surveys and outcomes; • Evaluation and monitoring including quality; • Raising awareness through engagement. Sources WCCG SME: Communication and Engagement and Quality • True patient involvement - co-production • Commsand Engagement plan • 3 way budgets meeting • Skyline Communications • Patient feedback group • Focus Group • Public facing documents • Public Engagement Team

13. WCCG Commissioning CycleProcess Steps – Part 3

14. Business Process Flowchart for Wakefield Governance Checkpoints – SFI’s (please refer to SFI document) etc.… Contract management and review Monitoring effect on making change Strategic Planning Procuring Services Monitoring & Evaluation

15. Wakefield Step 1Evaluating the proposal/ service/ commissioned services • Understand Impact on workforce • Testing the evidence base • Cost benefit analysis • Test fit with Strategic priorities • Quality testing Public and Patient engagement • Clinical Engagement and decision making linked to commissioning cycle • Consider Information requirements • IIA/ DPIA/ EQIA • Advice from senior colleagues and utilisation of WCCG governance structure • Communications and Engagement consideration • Finance Considerations • Complete Strategic Outline Case (include KPI’s) What is needed? • Completion of PMO documentation • Check Governance routes for decision making • IIA, DPIA, EQIA • Workbook • Strategic Outline Case • Programme Board Movement to next stage The proposal is approved. A commissioning project is initiated, a project manager appointed. Programme Board does not support the proposal and this is reported back to the originator with the rationale for the Board’s decision.

16. Wakefield Step 2Developing a business case/ case to change • Provider / market analysis • Explore Investment/disinvestment opportunities and potential for outsourcing • Developing the service plan and rationale • Understanding workforce implications • Collate intelligence to inform planning – concerns, complaints, incidents, reports • Develop full Service Specification or clinical criteria for approval including minimum datasets (MDS) and KPIS • Public and patient engagement • Clinical engagement/ Meds Pathways • Consider IT Systems and data requirements • IIA/ DPIA/ EQIA • Localised pathways What is needed? • Stakeholder analysis leading to a stakeholder map • Market engagement • Business case – completed • Finance Involvement • Quality link • Workbook update Movement to next stage • If a decision on the Full Business Case by the delegated authority (Programme Board, Executive team or our Board in line with Delegated Limits) is approved then the project moves to phase 3. • The clinical pathway and service specifications approved by Clinical Cabinet? • If decision not to progress. Decisions are reported back to the originator with the rationale for the Board’s decision.

17. Wakefield Step 3 Procurement/ re-procurement and delivery • Procurement – where an approved project includes a pilot project, ensure that procurement rules are followed to avoid legal challenge • Change management plan • Contract with providers / shape structure of supply – plan KPIs/ outcomes • Tender Document in accordance with procurement strategy • Selection Criteria (from business case) – (who?) • Equality Impact Assessment review • Workforce planning • Consider equality issues • Consider workforce issues • Finalise any communications • Agree budgets What is needed? • Completion of workbook • Check progress points with procurement and record outcomes in PMO documentation • IIA/ DPIA/ EQIA review • Plan workforce • Link with contracting • Review communication and engagement plan • Checklist • Exit strategy if relevant/ appropriate • Finance Movement to next stage • Ensure all stages signed off by Exec lead and relevant bodies to progress.

18. Wakefield Step 4Contract Management and review • Regular Contract Monitoring – 3 way budget/ contracting/ commissioner meeting (internal) • Formal contract review meetings with provider(s) • Invoice management and financial requirements • Quality monitoring • Focused intervention when necessary • Patient experience monitoring • Managing demand to understand appropriate access to care • Workforce planning – the contract may specify workforce requirements that must be met • Post Project review and lessons learned What is needed? • Contract review meetings (provider) • Finance meetings • Track data – BI and review KPI performance and outcomes • Contract template (by contracting) • Service specific data set • Review project – lessons learned • Quality • Programme board