KINGSTON COMMISSIONING COMMITTEE papers/10 January 2012/Att … · Version:Final 3J - Date: 05 01 12 6. CSO prospectus The latest iteration of Cluster’s CSO prospectus was received

Version:Final J - 1 Date: 05 01 12

KINGSTON COMMISSIONING COMMITTEE LEAD:

Tonia Michaelides

ATTACHMENT:

REPORT AUTHOR:

Phil Chapman

AGENDA ITEM:

RECOMMENDATION: For information

KINGSTON COMMISSIONING COMMITTEE MEETING:

10th January 2012

TITLE OF DOCUMENT:

Workplan Towards Authorisation

EXECUTIVE SUMMARY: The attached summarises activities and progress against a number of the development areas required for the CCG authorisation process. The paper will be supplemented at the KCC meeting with presentation and discussion of the “Full Shadow” framework now adopted across SWL, and of the developing OD Plan.

KEY SECTIONS FOR PARTICULAR NOTE:

RECOMMENDATIONS:

RISKS IDENTIFIED: Substantial amount of diverse work required over relatively short period Leadership and ownership of the work programme to drive it forward (OD Group) Lack of guidance in key areas Completeness of the work programme Clarity re ownership of certain key tasks and processes for delivery

FINANCIAL IMPLICATIONS:

OTHER IMPLICATIONS: (including patient and public involvement/Legal/Governance/ Risk/Diversity/Staffing)

EQUALITY IMPACT ASSESSMENT:

PRIVACY IMPACT ASSESSMENT:

J

Kingston Borough Team


Kingston Clinical Commissioning Group - Workplan Towards Authorisation

1. Latest guidance

Towards Establishment (Dec 11). Includes sections on relationship with member practices,

constitution, governance, accountability, conflicts of interest, leadership roles; includes annexes

on monitoring conflicts of interest, supporting materials for CCGs (forthcoming guidance etc).

Role Outlines (16/12/11). Early draft for discussion. Summarises governing body members,

roles, attributes, competencies etc.

NHS & Local Government as partners in commissioning for health and wellbeing

2. Recruitment to governing body

Vote for GP members of the governing body complete. Elected GP members are Drs Grippaudo,

Iqbal, Jivani, Moore, Smith, Syed. Thanks to Julius Parker and the LMC for running the election

on our behalf.

We have received conflicting guidance re the nurse role and process and are seeking clarification,

but currently still have the aim of recruiting a primary care nurse to the governing body.

We await further guidance re the other posts and also on the process of electing a Chair.

The covering letter from NHSL with the above Role Outlines document indicates that it is

expected that the NHS Commissioning Board will use assessment centres to determine the

suitability of Chairs, Accountable Officers and Chief Finance Officers. Details to be advised.

3. “Full Shadow” CCGs – A framework for April 2012

David Smith and Graham Mackenzie from Wandsworth undertook work on behalf of the emerging SWL CCGs to describe how we want CCGs to look from April 2012, to ensure that in all the debate (particularly at Cluster) about the CSO and the NHS Commissioning Board, the crucial role of CCGs is also progressed. At a SWL management team awayday on 5/12/11 the approach they set out was agreed.

The bullet points from the slide presentation of the approach are included as attachment 1.

David Smith will talk through the slides at the KCC meeting on 10/1/12.

4. Status report for Cluster

Various information were requested by Cluster in preparation for a meeting on 11 th Jan with Ann

Radmore to review progress towards establishing Kingston CCG.

The report included a timeline and short term workplan, notes around CCG structures and

mandate, thinking to date on constitution, OD plan, modelling the use of the £25 per head funding.

The timeline and short term workplan are included as attachment 2. The work has been related

to the key areas established in the above “full shadow” proposal. There are gaps, we need to be

clear about all responsibilities and delivery dates. The timetable will be regularly amended and

updated, but this initial version helps to identify the main activities which need to be tackled in the

short term

Also provided to Cluster were the Agilisys report and a 1st draft OD Plan – see below

5. Agilisys model

Further work is planned to review and refine the model during January.

The Local Commissioning Team has reviewed the model and provided comments to David.

Cluster too have indicated that they wish to discuss further.


6. CSO prospectus

The latest iteration of Cluster’s CSO prospectus was received on 23/12/11. It has been copied to

KCC members separately.

Further discussion now required to explore how the proposed offering aligns with our

requirements, particularly given the Agilisys model and our preference for a local integrated

commissioning function with RBK.

7. OD Plan

Work is progressing with our commissioning development provider the KPMG Alliance

A draft OD Plan has been developed based on our original statement of works and subsequent

diagnostic activities including group and individual discussions.

The draft OD Plan is to be tabled at the KCC meeting on 10/1/12 for discussion

Specific work is already being taken forward around Patient and Public Engagement, Clinical

Governance and our planned “New Entrants” scheme

Individual 360 degree assessments and provision of coaching for governing body members will

begin in February

Also planned for February are a 2 day session for the new governing body (or as much of it as we

have been able to establish by then) and a launch session for the New Entrants scheme

8. OD Group

The OD Group has not met since the last KCC meeting due primarily to the Christmas break and

GP workload.

We are looking for dates to meet in January and to establish a schedule of meetings to oversee

this substantial work programme on behalf of the KCC (CCG from April)

9. Configuration risk assessment

NHS London’s Director of Strategy and Commissioning Development wrote to Naz Jivani to

confirm that NHSL has submitted a green configuration risk assessment rating for Kingston CCG

to the Department of Health.

She goes on to say that this rating means that our emerging CCG will receive a shadow resource

allocation from the DH [for 2012/13] which will be an important enabler on the road towards

authorisation.

10. Collection and collation of evidence to support authorisation

The diagram below has been discussed previously as a way of representing the activities and

responsibilities of KCC and the Kingston Borough Team now and going forward, and linking them

to the London development roadmap and the national domains for authorisation

We need to progress work to agree the nature and processes for capturing evidence of

achievement in these areas. It is suggested that Leads be identified in each key area with

responsibility, supported by PC, to develop an evidence base

This will potentially need to be incorporated into the workplan


Vision and

Strategy

Corporate Governance – prospectus, constitution, local accountability incl

transparency, decision making structures, audit committee, scheme of

delegation, committee structures and ToRs, governing body

Clinical focus –

demonstrably

adding value

GP Practices

involvement and

engagement

Patient and public

involvement and

engagement

Local Authority joint

working incl

- - planning

- - joint commissioning

- - safeguarding

Needs Assessment

Commissioning

Plan

QIPP Plan

Service redesign and

improvement

Commissioning

Support

arrangements

Contracts

Performance

management

NHS London Roadmap - Organisational and Leadership Development Plan

Pt & public

engagement

Vision &

strategy

Finance

Leadership Governance clinical & corporate

Plan Agree Monitor People

& skills

Processes IM&T

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Capacity &

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Quality/safety

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Plan

Agree

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Record

11. Forthcoming meetings

Review progress on commissioning development (ie programme with KPMG alliance) with Cluster

Pete Smith, Phil Chapman Anne Tofts Jocelyn Fisher, Jacqui Harvey

3/1

Preliminary discussions re delegation and decision making – to inform constitution

Naz Jivani, David Smith, Phil Chapman Anne Tofts, Bruce Potter (legal)

6/1

Discussion of draft OD Plan KCC 10/1

Review Agilisys model David Smith, Naz Jivani, Phil Moore, Tonia Michaelides, Yarlini Roberts, Simon Pearce

10/1

Progress towards CCG – review meeting with Cluster

Naz Jivani, David Smith, Phil Chapman, Anne Tofts Ann Radmore and team

11/1

Cluster Pathfinder transition meeting Naz Jivani, Phil Chapman 12/1

CCG governance, role of governing body and members – development and to inform constitution

Elected GP members of CCG governing body

17/1

OD Group Pete Smith, Phil Moore, Naeem Iqbal, Junaid Syed, Phil Chapman

24/1? 31/1?

Shadow governing body away-2-days CCG governing body 23 + 24 Feb

New entrants programme launch 27, 28 or 29 Feb

PC, 5/1/12


Attachment 1 “Full Shadow” CCGs – A framework for April 2012

Characteristics:

• As “arm’s length” from NHS SWL as permissible under legislation;

• Organisational identity;

• Clarity of scope, role and responsibilities;

• Takes own decisions within agreed parameters, e.g. a performance, finance and delivery plan;

• Defined, clear relationships with other parts of the system;

• Rules of engagement with wider system are transparent and consistently observed.

Assumptions:

• All CCGs ready for “full shadow” by 1st April 2012; alternative model required for any CCG not

ready;

• The whole system moves into full shadow roles at the same time. New

relationships/dependencies of CCGs, CSO, SWL Cluster/Commissioning Board, Councils/Public

Health develop in parallel;

• Borough Teams and Borough MD roles end. The CCG is the local commissioning NHS

organisation, working with partner agencies;

• Full shadow CCG responsibilities deliverable within £25 per head running costs target.

Leadership • Board/Senior leadership team in place as defined in guidance;

• “Designate” senior roles if not appointed through due process;

• Accountable Officer (AO) model locally agreed and in place (GP Chair or Chief Officer);

• AO reports to SWL CEO for 2012/13;

• Clinical lead roles appointed/elected through transparent local process and carry support of

constituent practices;

• Nurse, Consultant, Lay Member appointments subject to national guidance;

• Locally designed management structure (beyond statutory roles) in place - staff seconded into

CCG from PCT for 12/13.

Governance: • Established CCG Board, Sub-Committees and Management Team;

• Programme of meetings;

• CCG Written Constitution in place;

• A Delivery Agreement for 2012/13 with NHS SWL/Shadow Commissioning Board (strengthened

version of Delegation Agreement);

• All local commissioning decisions, within parameters of the Delivery Agreement, taken by CCG

Board;

• Formal performance management reporting to NHS SWL/Commissioning Board;

• Risk register, assurance and corporate governance processes in place.

Finance: • Defined and formally delegated financial allocation for 2012/13;

• Financial assumptions and business rules transparent and consistently observed;

• If required, changes to financial plans by negotiation not direction;

• CCG Finance Director (Designate) appointed and strategic finance team established in CCG

structure;

• Revised SFIs and Scheme of Delegation in place appropriate for an “arm’s length” body;

• CCGs have agreed risk sharing arrangements in place.


Strategy & Planning:

• CCG Commissioning Strategy Plan, 2012/13 Operating Plan and QIPP programme in place;

• Structure, process and people in place to deliver all elements of commissioning cycle including

annualised planning process;

• CCG engagement and commitment to BSBV (Location of BSBV team and resources?);

• CCG engagement with Councils/Public Health for JSNAs and Health & Wellbeing Strategies.

Commissioning support:

• Demonstrate all functions required of CCG are covered by internal structure, local partnerships or

external commissioning support;

• Commissioning support into/on behalf of the CCG is:

• Fully specified and costed;

• Subject to an SLA and formal transaction processes;

• Performance managed by the CCG.

• CCG-CSO relationship is established as a customer-supplier model;

• Commissioning support local arrangements between CCGs or with local authorities (Joint

Commissioning) subject to SLAs/Partnership Agreements.

Provider relationships:

• CCGs review and define future lead/host arrangements for individual Trusts. Reflect in a written

agreement by April 2012;

• CCGs clarify and establish consistent working relationships with CCGs and Trusts outside SWL

delivering significant services for SWL patients;

• FT pipeline process led by NHS SWL/Commissioning Board with CCG engagement.

Partnerships:

• Local partnerships are core business of CCG;

• Parameters of CCG-led/NHS SWL-led partnership activities clearly defined (e.g. interaction with

Local Authorities, MPs, LINks/Healthwatch);

• CCG full participation in local Health & Wellbeing Board;

• Partnership Agreement or MoU for Public Health input into CCG;

• PPI initiatives and resources deployed locally through CCG.

Summary:

• Localise where possible, centralise only where required;

• Radical redesign of whole commissioning system;

• Be permissive about scope of CCG role within shadow status;

• Clarity on accountabilities and authority to act essential for all parts of new “shadow system” –

need to be formalised and consistently observed;

• Culture and behaviours as important as structures and process;

• Enable the pathway for CCGs to authorisation.


Attachment 2 Kingston Clinical Commissioning Group (KCCG) - Summary timeline and period activity

Period: A. Present to March 2012 B. April 2012 to Sept 2012 C. Oct 2012 to March 2013 D. April 2013 onwards

Description Development and preparation

Full shadow

Established full shadow

Established, authorised operation

Summary of activities Put all necessary building blocks in place as per detailed plan below; progress OD; enable full shadow operation from 1/4/12 More detailed short term work provided in following pages, linked to “full shadow” framework

Full shadow operation as described; continuing OD; intention to submit application at earliest opportunity – likely to be July 2012; work effectively as a shadow CCG through this period; clarify and build evidence of effectiveness required for application

Indication that earliest establishment from initial applications likely to be October 2012; established as legal entity together with level of authorisation (shadow, with conditions, fully authorised); likely limitations on ability to act independently until April 2013 (in particular commissioning budget remains responsibility of NHS SWL);

Fully, independently operational to authorised level; performance mgt arrgts in place with NHSCB


Detailed activities in Period A – Development and preparation period – Linked to “full shadow” framework

Present to March 2012 Actions Who By

Development and preparation period

1. Leadership

Establish governing body

GPs selected, elected by end Dec11 Voting period 1/12/11 – 21/12/11; LMC count and report in confidence to DS; DS discuss with unsuccessful candidate; DS arrange list of successful candidates to be sent to all practices by end Dec11

End Dec11

Nurse selected by end Jan12 Note guidance received 20/12/11; review process and timing in light of guidance; note KCCG original objective of this being primary care nurse to maintain primary care majority

Consultant, Lay Members subject to guidance Awaiting guidance; PC discuss with JF re KPCT lay members;

Accountable Officer - agree model and process; nominate preferred candidate (TEp38); designate in short term

Clarify process for designation in short term Clarify model (i.e. managerial / clinical, dedicated / shared, if shared – with whom …); process for nomination; process for formal agreement locally (note if Agilisys adopted = managerial, joint with RBK); awaiting guidance on any national assessment process

Chief finance officer - guidance? Designate in short term

NHSSWL identify suitable candidates in short term who can be designated; clarify process for designation in short term Awaiting guidance on appropriate longer term process + details of national assessment process

Chair - selected by gov body (TEp39)or by GP electorate (?)

Noted TE says governing body will select individual to take on the role; local process says GP electorate will vote; clarify. Seek guidance – should we make interim arrangement while national process defining competencies, assessment being clarified (due Jan12)

Locally designed management structure

Further review of Agilisys model Jan11; final decision on arrgts from 1/4/12; Clarity re posts required and hosting arrgts (CSO, RBK, other) (i)

Critical area of work = review, refine and final decision re Agilisys model, or alternative arrangements … Complete by end Jan12 Meeting 10/1/12 to further review Agilisys model Awaiting DH confirmation that £25 / hd is capitation, not weighted Confirm process for final agreement of management structure, posts etc incl sign-off with RBK

DS/NJ PC SWL DS

Jan12

Staff secondment arrangements developed SWL develop secondment documentation PC liaise with JF to confirm staffing list and roles from 1/4/12


2. Governance

Governing body

established, together with sub-committees (esp audit, remuneration); clarity re role / scope of gov body + delegation and decision making; programme of meetings for year

Key area of work = firming up processes and timetable for all governing body members; gov body scope / responsibilities; mtg and committee structures; need for / role of Exec committee etc 6/1/12 dev mtg (NJ, DS, AT, PC, legal specialist) re gov body / committees / exec team delegation and decision making Aiming for 17/1/12 mtg of GP members re scope of gov body – governance role vs other roles … Away-2-days for as many governing body members as have been identified in Feb12 Arrangements needs to iterate with / be reflected in Constitution

Esp DS/NJ + AT

Exec / management team established

Clarity re role / scope + extent of decision making authority; clear membership; programme of meetings

Key area of work, as above

Constitution Important to make progress in Jan12 to ensure member-driven in a timely way Outline proposed content by 21/12/11 Link to DH team developing CCG constitution (draft likely end Jan12) Inter-practice agreement developed and signed off by members Dec11 Draft CCG constitution to members by mid Jan12; discuss at Jan12 GP forum Incorporate changes; final review by members; aim for approval at KCC mtg Feb12 (enables emerging national model to be taken into account)

PC PC PS PC

Delivery Agreement for 12/13 agreed with NHS SWL

Prepare by NHSSWL; draft doc to be considered at KCC Feb12 Iterate revisions

Performance management - reporting to NHS SWL agreed

NHSSWL develop and describe process

Other governance arrangements in place

risk register

assurance

corporate governance


3. Finance

Financial allocation - defined, formally delegated for 12/13

NHSSWL

Chief finance officer designate appointed Clarify process with NHSSWL

Local finance team established (i) Part of Agilisys review; Secondment arrangements and/or agreements with RBK in place

Mar12

Finance plan for 12/13 developed and finalised – changes to be negotiated (not direction)

Linked to Operating Plan process; NHSL timetable; financial allocations and other emerging financial pressures

Risk sharing arrangements – developed, in place Initial work required to identify potential areas requiring risk share and possible solutions Pursue agreements with risk sharing partners Establish and document risk sharing arrangements

YR

Jan12 Feb12 Mar12

Financial assumptions and business rules clear Establish what is meant by this; written version; undertake any development as reqd

NHSSWL

Revised SFIs and scheme of delegation developed and in place

NHSSWL develop NHSSWL

4. Strategy and planning

Key plans developed and in place

Commissioning strategy plan 12/13 Approved at Dec11 KCC mtg TM

2012/13 operating plan Working in line with NHSL timetable; 1st draft to Jan12 KCC; TM

QIPP programme 12/13 Initial drafts have been reviewed and revised; Iterations in Jan12/Feb12 required to reflect financial allocations and changing financial environment; clear programme of work and project lead responsibilities assigned

TM Mar12

Structure, processes, people in place to deliver all elements of commissioning cycle incl. annualised planning (i)

Part of Agilisys review; Secondment arrangements in place

TM TM

Jan12 Mar12

CCG engagement and commitment to BSBV

CCG engagement with RBK esp for

Public health (iii) Plan for “full shadow” operation of Public Health functions via RBK from 1/4/12 developed Clarity re PH support for CCG commissioning – define in MoU

JH JH

Feb12 Feb12

JSNA Prepare for necessary joint working; clear processes to incorporate JSNA priorities in commissioning intentions

JH, TM

Health and wellbeing board (ii) Clarity re CCG participation in health and wellbeing board PC Jan12


Health and wellbeing strategy Prepare to contribute via CCG strategy and planning arrangements and participation in health and wellbeing board

JH, TM

5. Commissioning support

Demonstrate how all functions reqd are covered by proposed structure (internal (PCT/CCG secondees), local shared (CCGs, RBK), NHS SL CSO, other) (i)

Critical area of work Awaiting guidance on full range of CCG functions, though must progress with what is known Agilisys review in Jan12 to demonstrate and give steer, esp ref CSO reqts, by end Jan12 Test progress in AR mtg Jan12 Work through practicalities (with NHSSWL HR support) to ensure nec arrgts in plce for 1/4/12

DS, NJ Jan12 Jan12 Feb12-Mar12

Commissioning support / CSO input (i)

SLA developed and signed off including – specification, cost, performance mgt arrgts

Commissioning support incl. joint roles with RBK

Clear, agreed, defined SLA / Partnership Agreements

6. Provider relationships

Lead commissioner / host arrangements Test – can full shadow CCG (not statutory) take on associate agreements from PCT This is preferred route for acute provider relationships Work required re mental health

TM TM SF

Review, refine; reflect each in written agreement by apr12

TM, SF

CCGs and Trusts outside SWL

Clarify and establish consistent working relationships

FT pipeline

NHS SWL lead, CCG engaged


7. Partnerships

Define parameters of CCG / NHSSWL led partnership activities e.g. interaction with

Further discussion with NHSSWL to clarify respective roles and arrangements PC Jan12

RBK

MPs

Shadow HealthWatch

Clear arrangements for participation in Health and wellbeing board (ii)

Review and revise if nec. current representation in light of work on roles, governance

Gov body Mar12

Partnership Agreement or MoU for public health input to CCG

Link to PH development timetable JH

Clear arrangements for PPI incl. deployment of initiatives and resources, through CCG

Documents

KINGSTON COMMISSIONING COMMITTEE papers/10 January 2012/Att … · Version:Final 3J - Date: 05 01 12 6. CSO prospectus The latest iteration of Cluster’s CSO prospectus was received