kingston commissioning committee papers/10 january 2012/att … · version:final 3j - date: 05 01...
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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
Version:Final J - 2 Date: 05 01 12
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.
Version:Final J - 3 Date: 05 01 12
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
Version:Final J - 4 Date: 05 01 12
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
Co
llab
ora
tive
arr
gts
Na
tio
na
l D
om
ain
s f
or
Au
tho
risa
tio
n
Co
nst
itu
tio
n,
gove
rna
nce
,
cap
aci
ty, c
ap
ab
ility
Cle
ar
cre
dib
le
Pla
ns
Pt
& p
ub
lic
en
gage
me
nt
Clin
ica
l
focu
s
Lea
de
rsh
ip
Capacity &
Capability
Systems
Processes
Finance
Quality/safety
Equality
Acr
oss
all
Co
mm
issi
on
ing
fu
nct
ion
s /
act
ivit
ies
Plan
Agree
Monitor
Build
Track
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
Version:Final J - 5 Date: 05 01 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.
Version:Final J - 6 Date: 05 01 12
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.
Version:Final J - 7 Date: 05 01 12
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
Version:Final J - 8 Date: 05 01 12
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
Version:Final J - 9 Date: 05 01 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
Version:Final J - 10 Date: 05 01 12
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
Version:Final J - 11 Date: 05 01 12
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
Version:Final J - 12 Date: 05 01 12
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