The Commissioning Support Summit Part One: The macro environment Part Two: Delivering effective commissioning London,

1. The Commissioning Support SummitPart One: The macro environmentPart Two: Delivering effective commissioningLondon, Wednesday 13th June 2012 Roger Hymas Healthcare Commissioning Services Ltd Proprietary to Healthcare Commissioning Services Ltd

2. ‘A re-organisation so big you can see it from outer space’, David Nicholson No organisation at any time in the commercial history of the world has attempted a transformation of this size.

3. NHS commissioning organisation: this is where we’re headed Until 31.03.2013 From 01.04.2013 DH/ NHS Exec NHS CB NHS CB Regional Offices SHAs CCGs CSSs Local Authorities (PH) Third Party Organisations PCTs Practices Practices Patient Support Groups Patients Patients

4. It’s this critical relationship which will be the determinant of future NHS success Until 31.03.2013 From 01.04.2013 DH/ NHS Exec NHS CB NHS CB Regional Offices SHAs CCGs CSSs Local Authorities (PH) Third Party Organisations PCTs Practices Practices Patient Support Groups Patients Patients

5. Above everything, commissioning’s principal requirement is to deliver excellent outcomes The new commissioning phenomenon is the Commissioning Outcomes Framework (COF) beginning April 2013: • An evolution of the NHS Outcomes Framework. • COF to drive local improvements in quality and outcomes. • Focuses on patients’ needs (not central targets). • CCGs accountable for delivering agreed local priorities. • The full list will be published in the Autumn. We estimate that 300 discrete activities have to be managed by CCGs.

6. The DH is organising CCG authorisation around six domains ‘The proposed content of the authorisation process is built around six domains – six areas which are most likely to act as pre-conditions of success for a CCG.’ • Clinical/professional focus. • Patient and Public Engagement. • Delivering QIPP productivity. • Good governance and financial control. • Collaboration with stakeholders. • Great leadership.

7. Right from the outset, our point of view has been that CCGs should achieve ‘Authorisation by doing’ • These are the skill sets which have to be mastered: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_130318.pdf

8. Time is running out for an optimal transfer to be effected to GP-led commissioning • This is how quick countdowns can be: Days to go Working Days to go 1st April 2013 43 199

9. CCGs should be working flat out on achieving authorisation But doesn’t that mean having a quality commissioning support system in place?

10. Commissioning will only be effective and deliver the strategy if commissioning support is in place

11. As of now, commissioning support needs a mountain of work right across the NHS Commissioning Support Bulletin – Issue 2, 28 May 2012

12. We’ve learnt a lot about the market dynamic from this ‘must read’ piece of research

13. In all the circumstances, confidence about the future is high • CSSs must build on this position, quickly solidifying their position of trust. • What will be the initiatives which show confidence is not misplaced? • Are they developing a contact maintenance matrix? • Who in the CSS is being tasked with which responsibility?

14. CSSs’ level of engagement with CCGs needs to be cranked up • Nearly one quarter of the market currently does not feel particularly engaged.

15. At this distance CCGs are forecasting little change of CS providers before and after 1st April 2013 • It’s hard for anyone to predict the outcome in a market which has barely yet formed. • CCGs will be wholly in charge of budgets from next April. Expect attitudes to harden.

16. CCG options for commissioning support Use the CSS exclusively Use CSS, top up with third party help Employ third party exclusively CCG topped up by CSS/ third party CCG goes alone (strong practice participation)

17. Market availability • One way to look at this slide is that 50% of the market is available for non-local CSSs and third parties. • I wonder if this is the high water mark for the local CSS?

18. CSS competence will be evaluated at every stage • What’s important to note is that CCGs want CS to be different and innovative. • This will probably mean that the ‘PCT way’ won’t work. • How does the local CSS differentiate its offer vis-a-vis other CSSs and third party providers? • If you’re a CSS, what will you need to do to install effective marketing?

19. It’s the provider management end of commissioning which is the likely focus of CCG collaboration. • Which is probably right, given the make-up of local health economies. • Back office functions aren’t mentioned, but there are probably many scale benefits.

20. CCGs might benefit from pooling their product sourcing • 200+ organisations doing it may not be optimal. • This would save time, improve purchasing effectiveness. • Potentially there could be lower prices as ‘orders’ are consolidated.

21. We’re not exactly sure how much is going to be spent on commissioning support But there again, is anyone else?

22. Dividing the cake • Exactly how much CS money will go to CCGs/CSSs? • What is the weighted average allocation? • When will the money be available this year to CSSs and particularly the private sector? • Are proper market conventions being followed?

23. Arguably then, increased investment in commissioning costs nothing: it’s paid for by better outcomes, healthier lives and happier people http://www.mckinsey.com/mgi/publications/big_data/pdfs/MGI_big_data_full_report.pdf It’s not about £25 PPPY. It’s about return on investment.

24. If I were a CCG looking for authorisation, I’d • Accelerate the procurement of help. • Trust your gut. • Give successful CSS suppliers a contract until 31.3.2013. • Deal with organisations who can’t help or who will block.

25. CSSs will have to develop strong and continuous contact strategies and display their wares • Personal contacts by the CEO and board are critical. • CSSs would be advised to hone their customer relationship marketing agenda and repertoire. • There are compelling reasons to embed CSS staff in the CCGs. They need to build strong marketing, sales and account management strategies.

26. CSS effectiveness: as with all performance, it’s bound to be a bell shaped curve Right now if you were a CCG, who would you choose?

27. Is it going to be a land grab among CCGs to get the best CSS help? • 212 CCGs: if the bell shaped curve applies that means 7 excellent/good CSSs, 7 average performers. • If it’s 14, that’s 1 per 15 CCGs (212 ÷ 14). • If it’s 7 (more likely?), that’s about 1 per 30 CCGs. • That makes effective support a very scarce resource (given the complexity of the agenda). • If you’re a CCG, we hope you’ve got a good local CSS (but how/when would you know?) All this adds up to a very risky decision for CCGs. Which means practices as well.

28. CCGs will be advised to buy a CSS team which can deliver • ‘The results suggest that working relationships between emerging CCGs and NHS CSSs could be more collaborative.’ • ‘A quarter of all emerging CCGs said they were not confident that leadership within their main NHS CSS would develop the organisation into an entity that could operate confidently in a commercial environment.’ • ‘Only half of emerging CCGs felt confident that [CSS] leadership would deliver support in a new and innovative way.’ • ‘Ultimately, emerging CCGs will be able to source commissioning support from outside the NHS so it is essential that NHS CSSs are seen to offer a robust alternative to the commercial and third sectors as well as in-house sources.’ ‘Emerging NHS Clinical Commissioning Groups and Commissioning Support Services’, May 2012. CCGs are not expecting to see a continuation of PCTs.

29. Conclusion • Thank you for your time. • We’re available to help on commissioning development assignments. • If you need more information on any issue raised, please contact: Roger Hymas rogerhymas@btinternet.com 07801 082879 David Collingbourne david.collingbourne@intelligentmedia.co.uk 07778 667544