quality, innovation, productivity and prevention (qipp) programme – management process v1.4[56]

Quality, Innovation, Productivity and Prevention (QIPP) Programme

Management Process

Quality, Innovation, Productivity and Prevention (QIPP) Programme – Management Process

Document Control Sheet

Name of Document: Quality, Innovation, Productivity and Prevention (QIPP) Programme – Management Process

Version: 1.4Owner: Jo Smithson, Chief OfficerFile Location / File Name: G:\QIPP\Governance\QIPP

Management Process

Quality, Innovation, Productivity and Prevention (QIPP) Programme – Management Process V1.4

Date of this version: 12.08.2016Produced by: Chris Bean, QIPP Programme ManagerSynopsis and outcomes of consultation undertaken:

Not Applicable

Synopsis and outcomes of Equality and Diversity Impact Assessment:

Not Applicable

Approved by (Committee): Executive CommitteeDate ratified:Copyholders: Chris Bean, QIPP Programme ManagerNext review due: 30.05.2017Enquiries to: Chris Bean

QIPP Programme ManagerNHS Norwich CCGCity Hall, St Peters Street, Norwich, NR2 1NH

DD. 01603 [email protected]

Revision Date

Summary of Changes Author Version Number

06/03/2015 Initial Draft Chris Bean, QIPP Programme Manager, Norwich CCG

1.0

14/04/2015 Revisions following circulation to QIPP Group include: enhancement of quality, expansion of long list, and revision to terms of reference

Chris Bean, QIPP Programme Manager, Norwich CCG

1.1

19/05/2015 Revisions following circulation to Finance Committee and Clinical Reference Group

Chris Bean, QIPP

1.2

of 20

mailto:[email protected]


Revision Date

Summary of Changes Author Version Number

include: Three Stage Process, reordering of text, addition of templates and meeting schedule in appendix, revisions to QIPP Group terms of reference.

Programme Manager, Norwich CCG

24/06/2015 Redrafting of text for consistency, revision to figures, and inclusion of additional templates.


1.3

12.08.2016 Inclusion of revised Ideas Template, Business Case Template, Work Book, Status Report, and Terms of Reference for QIPP Group. Addition of text for STP.


1.4

of 20


Contents

Section Page Number

1 Introduction 5

2 Aim, Principles and Approach 6

3 Stage One – Idea Generation, Development and Approval 7

4 Stage Two – Delivery of Initiatives 9

5 Stage Three – Monitoring and Control of Initiatives 11

6 Governance Arrangements for QIPP Programme 12

Appendix

A Idea Template 13

B Business Case Template 13

C Project Initiative Document (PID) 13

D Work Book 13

E Status Report Template 13

F Change Request Template 13

G Closure Report Template 13

H Lessons Learnt Template 13

I QIPP Programme Tracker Template 13

J QIPP Programme Dashboard Template 13

K QIPP Programme Report Template 13

L QIPP Group’s Terms of Reference 13

M QIPP Programme Management Process on a page 14

N Role Outline – Senior Responsible Officer (SRO) Project

O Role Outline – Clinical Lead

P Role Outline – Clinical Advisor

of 20


Q Role Outline – Project Manager

of 20


1. IntroductionThe purpose of the National Programme for Quality, Innovation, Productivity, and Prevention (QIPP) is to deliver efficiency savings, whilst at the same time improving the quality of care. Every NHS Commissioning Body is required to deliver QIPP, which starts with a target ‘QIPP Challenge’ being identified as part of the annual financial planning cycle. This target put simply is the difference between the ‘do nothing scenario’ and the financial allocation, as illustrated by Figure 1. Responding to the QIPP Challenge is achieved through changes to how the CCG commissions services, and the services commissioned.

Figure 1: Purpose of QIPP Programme

QIPP schemes fall into two categories: transactional or transformational. The former is broadly categorised as changes in the way providers charge for services delivered, through the removal of a proportion of the providers’ income. The savings are achieved through contractual variations either during the annual contract negotiation or in-year using the variation processes. The latter involve a programme / project-based approach, such as where savings are achieved through the reform of pathways used, or in commissioning more efficient services, these schemes must be based on evidence, with scrutiny and approval of business cases.

The CCG is part of the ‘central Norfolk health system’ which is based around patient flows and the ‘unit of planning’ for our 5 Year Strategic Plan. Consequently we work in partnership with North Norfolk CCG and South Norfolk CCG on QIPP schemes (e.g. Continuing Care). The CCG is also part of the ‘Norfolk and Waveney’ footprint for Sustainability and Transformation Plans (STPs). JOINT WORK PLAN

This document describes the management process for QIPP in Norwich CCG. It has, and continues, to evolve to ensure our response is proportionate to the ‘QIPP Challenge’ in any given financial year. Given the QIPP Challenge in 2016/17 this

of 20


document has been produced to collate existing processes, and detail the enhancements to them, to assure the Governing Body that the appropriate management controls are in place. It describes the aim, principles and approach of the QIPP Programme; process for idea generation, development and approval; process to deliver initiatives; process to monitor and control the progress of the initiatives; and governance arrangements.

2. Aim, Principles and ApproachOur aim is:

To improve the quality of care in the most efficient way while delivering the best possible outcomes for patients.

To have a rolling QIPP Plan that is comprised of initiatives that meet the financial year’s target, including a contingency of a further 10%.

A good QIPP programme is more than just the balancing figure between available resources and forecast expenditure. To support the aim our principles for QIPP are:

patient centred

based on evidence (e.g. JSNA, NHS Right Care, and Royal Colleges) and intelligence (e.g. quality, activity and performance returns from Providers)

driven by our 5 Year Strategic Plan and Sustainability & Transformation Plan (STP)

integral part of Two Year Operational Plan

clinically supported by the Clinical Reference Group.

Our approach to QIPP uses a three stage process, as illustrated by Figure 2, which is led by the Chief Officer, managed by the Programme Manager, and supported by all staff. Initiatives will be worked up using these three stages: Idea Generation, Development and Approval Process; Delivery of Initiatives; and Monitoring and Control of Initiatives. Each of three stages can be flexed to reflect the different type, complexity or other aspects of the idea being developed or initiative being delivered. This is important to enable it to be adaptable for local needs and recognise the complexity of the commissioning system.

of 20


Figure 2: Three Stages of QIPP Programme

3. Stage One – Idea Generation, Development and ApprovalIt is essential that we generate, develop and approve ideas to meet the QIPP Challenge. We are not short of sources of information to search. There is a wealth of policy, guidance and best practice. The test comes in identifying and measuring the impact they would have locally; in particular the change in value: patient outcomes, patient safety and spend, as illustrated in Figure 3. We have adopted this concept from the NHS Right Care Programme.

Figure 3: Elements of Value

of 20

Idea Generation,

Development and Approval

Delivery of Initiatives

Monitoring and Control of

Initiatives


The CCG captures ideas using an excel spreadsheet called the ‘Long List’. It records salient information about ideas from the Ideas Template that describes QIPP benefits and links to CCG Strategic Objectives. The Senior Management Team (SMT) owns the Long List and leads the process to generate, develop and approve ideas as described below.

Ideas are encouraged from any source (e.g. clinicians, patients, officers, Governing Body members) with the Idea Template completed to capture salient information.

All ideas must pass through this process, as illustrated in Figure 4, and use the relevant template for an Idea or Business Case.

SMT will discuss and review Idea Templates at their weekly meeting and decide:

o whether to proceed

o whether transactional or transformational

o who is the Senior Responsible Officer

o who to contact for clinical input

o who is the lead officer to draft the Business Case

o who should be involved to develop the Business Case

o timescales.

The Clinical Reference Group (CRG) and QIPP Group will support the development of Business Cases. The former providing clinical knowledge, experience and expertise on ideas that propose changes to clinical services, pathways and processes. The latter will ensure input is received from appropriate functions (e.g. business intelligence, finance, and quality) to describe the change and build a comprehensive business case.

When considering Business Cases the Executive Committee needs to:

o Ensure it describes in sufficient detail what the proposed change is, why the change should be supported, who is responsible for delivering the change, how the change will be delivered, and when the benefits will be realised.

o Be assured that the impact on equality, quality and privacy of the proposed change has been assessed and the findings taken into consideration. With proportionate and reasonable response(s) to mitigate any adverse impact.

o Be assured that the activity and financial impact is measurable by baselines, forecasts and supporting assumptions.

o Determine, using the scheme of delegation, whether it also needs to be reviewed and approved by Governing Body and Council of Members.

o Identify the delivery route: Business as Usual (BAU) or follow the Project Delivery Process.

of 20


o Confirm the Senior Responsible Officer, Clinical Lead / Advisor, and Project Manager/Lead Officer. (nb. Role outlines are included in the appendix).

o Discuss and approve resources (e.g. staff time, and funding) as detailed in relevant sections of the Business Case.

Business Cases once approved will be allocated a unique reference code using the protocol of financial year (e.g. 201516) followed by letter (e.g. A). It will then be assigned to one of the following work programmes; so that it can be included in the QIPP Programme.

o Acute

o Mental Health

o Community

o Other

o Prescribing

o CHC

Figure 4: Process for Idea Generation, Development and Approval.

4. Stage Two – Delivery of InitiativesThe delivery of initiatives is managed as part of day to day operations within the CCG. Officers are able to escalate risks and issues through the governance arrangements of their initiatives, where necessary to the QIPP Group and if appropriate weekly SMT meeting.

Those initiatives that the Executive Committee have decided need a formal project management framework will follow our Project Delivery Process, as illustrated in Figure 5. This starts once a Business Case has been approved, Project Manager allocated and resources identified.

of 20


Figure 5: Delivery on Initiatives Process

A common project governance framework exists to ensure delivery within a controlled environment. Further details below.

Project BoardThe Project Board is the decision making group responsible for the overall direction and management of the Project. It will meet regularly as determined by members throughout the project and at the end of each stage of the project. The Board will manage the project by exception, and meet only at other times where key decisions are needed to progress.

It will sign off the monthly Status Report drafted by the Project Manager before being sent to the QIPP Programme Management Office (PMO).

Outline Terms of Reference are:

Objectives: Own and be accountable for the project To take ultimate responsibility for all aspects of quality Provide direction to the project manager Control the level of risk exposure Own the resolution of risks and issues Support cross-boundary integration Communicate with stakeholders external to the project Approve Monthly Status Report Produce Change Requests Authorise closure of the project Assist with the post-project evaluation of benefits realisation

Quorum:Meetings will be quorate when the Senior Responsible Officer, Programme Manager and Project Manager are present.

Record Keeping and Administration:

of 20


The Project Manager will provide administrative support and circulate an agenda and relevant papers in advance of the meeting.

Project TeamThe Project Team is responsible for doing the work. It will meet regularly as determined by the Project Manager to review progress, actions, risks and issues.

The Team is collectively responsible for:

o Assisting the Project Manager to deliver the Project’s outcomes/objectives;

o Within their technical expertise carrying out the elements (work packages) of the Project they are tasked with;

o Providing administrative support to the Project Manager & SRO;

o Advising the Project Manager if any risks arise that are likely to affect delivery of the Project’s objectives and to be part of the risk reduction process;

o Providing information for Project documentation as required; and

o Producing the Project’s products as planned to the required level of quality and to timescales.

Outline Terms of Reference are:

The Team is collectively responsible for:

o Assisting the Project Manager to deliver the project’s aim(s) and objectives;

o Within their technical expertise carrying out the elements (work packages) of the Project they are tasked with;

o Providing administrative support to the Project Manager & SRO;

o Advising the Project Manager if any risks arise that are likely to affect delivery of the project’s aim(s) and objectives and to be part of the risk reduction process;

o Providing information for project documentation as required; and

o Delivering the project as planned to the required level of quality and to timescales.

Senior Responsible Officer (SRO)The SRO is ultimately responsible for the project, supported by the Project Manager. The SRO’s role is to ensure that the project is focused throughout its life on achieving its objectives and delivering a product that will achieve the forecast benefits. The SRO has to ensure that the project gives value for money, ensuring a cost-conscious approach to the project, balancing the demands of the business, user and supplier.

Throughout the project, the SRO is responsible for the Business Case.

of 20


The Project Board is not a democracy controlled by votes. The SRO is ultimate decision maker and is supported in the decision making by the Clinical Advisor and Project Manager.

Please see the appendix for full role description.

Project ManagerThe Project Manager has the authority to run the project on a day-to-day basis on behalf of the Project Board within the constraints laid down by them.

The Project Manager’s prime responsibility is to ensure that the project produces the required products within the specified tolerances of time, cost, quality, scope, risk and benefits. The Project Manager is also responsible for the project producing a result capable of achieving the benefits defined in the Business Case.

The Project Manager is responsible for drafting the monthly Status Report on behalf of the SRO.


Clinical AdvisorThe post holder will be expected to take a key role in the review and or strategic planning for clinical pathways / services, working with the CCG Officers to improve health outcomes for Norwich patients.


It is important that all projects follow the Project Delivery Process and use the templates for key documentation, as described below.

Project Initiation Document (PID) – is the working document for managing and directing the project. It brings together all of the key information acquired through the early stages of the project, including the Business Case.

Work Book – is the Project Manager’s day-to-day document for describing and recording progress against: milestones, actions, issues, decisions, and risks. The information within is summarised into the Status Report for reporting to the Programme Management Office (PMO).

Status Report – provides the QIPP Group with a summary of the status of an initiative at agreed stages and is used to monitor progress. The Project Manager uses the Status Report to alert the QIPP Group to any potential problems or areas where support is required.

Change Request – produced for the Project Board/QIPP Group when a change (costs and/or timescale) to the project is requested and includes the description of the change, rationale, impact of the change on the project and its deliverables.

of 20


These will be authorised by the QIPP Group, who will maintain a Change Log on behalf of the Executive Committee.

Closure Report – is the final document produced for the project and is used by Executive Committee and QIPP Group to assess the success of the project, identify best practices for future projects, resolve all open issues, and formally close the project.

Lessons Learnt – at the close of a project, the Lessons Learned report provides a summary of any lessons learned during the project that can be usefully applied to other projects.

5. Stage Three – Monitoring and Control of Initiatives The monitoring and control of the QIPP Programme is achieve through three parts, as illustrated by Figure 6.

Figure 6: Monitoring and Control of Initiatives Process

Programme Management Office (PMO)

The Programme Management Office (PMO) manages the QIPP Programme on a day-to-day basis. It achieves this by communicating and liaising with officers developing Business Cases and Project Managers/Lead Officers delivering initiatives. The current status of the QIPP Programme is recorded in the Tracker.

The delivery of initiatives is monitored through Status Reports. The production of Status Reports is the responsibility of Project Managers, including obtaining sign off from Clinical Leads and Senior Responsible Officers. The production of QIPP Dashboard is the responsibility of the QIPP Programme Manager, including obtaining sign off from the Chief Finance Officer. To support reporting a production cycle has been developed, as described in Table 1, with a reminder email issued once the current month’s QIPP Dashboard has been signed off. The cycle timescale is determined by working backwards from the deadline for reporting non-IFSE, as per Table 2.

of 20


Table 1: Production Cycle for QIPP Dashboard and Status Reports

Working Day

Task Outputs

Up to 5 Project Team reviews activity and finance data for initiative updating the Table at bottom of Status Report.

Data Pack

Updated Finance and Activity Table for Status Report

1 to 5Finance Analyst and QIPP Programme Manager meet to review Dashboard.

Notes of Meeting

QIPP Dashboard – Front Sheet

1 to 5Project Manager / Lead Officer presents updated Status Report ready for review and sign off at their respective Project Board.

Project Manager takes notes of meeting, which capture salient points of discussion and actions.

Project Manager adds date signed off by SRO and Clinical Lead and saves Status Report in respective folder in the Purple Folder and emails Programme Manager and Admin to notify completed.

Notes of Project Board

Status Report – Approved and saved in Purple Folder

6 Admin collate Dashboard and Status Reports, saving draft into the relevant month folder in the QIPP Dashboard folder in the Purple Folder.

Admin update the date column in the QIPP Tracker for relevant month.

Draft QIPP Dashboard

Updated QIPP Tracker

6QIPP Programme Manager reviews Status Reports, adds progress rating and risk to delivery rating to front sheet to finalise the QIPP Dashboard.

Final QIPP Dashboard

7 CFO review QIPP Dashboard as part of signing off monthly non ISFE return to NHS England

Non IFSE Return to NHS England

of 20


Table 2: Deadline for Status Reports and QIPP Dashboard

Month201617

Status Report Deadline

(working day 5)

QIPP Dashboard Deadline

(working day 6)

QIPP Review with CFO

(working day 7)

QIPP included as part of non-IFSE (working day 8)

56789101112

QIPP Group

The QIPP Group is responsible for tracking the financial progress of initiatives within the QIPP Programme on behalf of the Finance Committee. It achieves this by monitoring the Dashboard and Status Reports on a monthly basis to:

Review progress in reporting period and planned activity in next reporting period.

Assess progress in delivery and realisation of benefits against the original or revised Business Case.

Monitor achievement of savings calculated from the activity data.

Evaluate the risk to delivery using the protocol in Table 3, which is based on risk ratings from the CCG’s Risk Management Strategy and Policy Framework.

Table 3: Protocol for Monitoring QIPP Initiatives

Risk Rating

Risk Score

Frequency

Extreme 15 to 25 ASAPSignificant 8 to 12 Every meetingModerate 4 to 6 Every other meetingLow 1 to 3 Rolling quarterly schedule

Review requests for changes to Business Cases on behalf of the Executive Committee.

Finance Committee

The final element is a written report to each bi-monthly meeting of the Finance Committee. This will detail achievement to date supported by the QIPP Programme Dashboard, progress with ideas, and include Status Reports for every initiative. It will also report on a specific work programme, at each meeting of the Committee – dates for 201617 are contained in Table 4. Given the increased QIPP Challenge the Executive

of 20


Committee will receive a written report each month using the same format – dates for 201617 are contained in Table 5.

Table 4: 201617 Dates for Finance Committee

Date of meeting Papers to be reviewed by CFO

Deadline for papers

Papers to be circulated by

Admin23.09.2016 13.09.2016 15.09.2016 16.09.201618.11.2016 08.11.2016 10.11.2016 11.11.2016

Table 5: 201617 Dates for Executive Committee

Date of meeting Papers to be reviewed by CFO

Deadline for papers

Papers to be circulated by

Admin22.09.2016 13.09.2016 15.09.2016 16.09.201627.10.2016 18.10.2016 20.10.2016 21.10.201624.11.2016 15.11.2016 17.11.2016 18.11.201622.12.2016 13.12.2016 15.12.2016 16.12.201626.01.2017 17.01.2017 19.01.2017 20.01.201723.02.2016 14.02.2017 16.02.2017 17.02.201723.03.2017 14.03.2017 16.03.2017 17.03.2017

6. Governance Arrangements for QIPP ProgrammeThe Governing Body will receive a report that details achievement to date, supported by an overview of the QIPP Programme Dashboard; and progress with ideas. The QIPP Programme Manager drafted this report for the Chief Finance Officer to sponsor and present. The schedule for 201617 is detailed in Table 6 overleaf.

of 20


Table 6: 201617 Governing Body Schedule

of 20


Appendix

A. Idea Template

B Business Case Template

C Project Initiation Document (PID)

D Work Book Template

E Status Report Template

F Change Request Template

G Closure Report Template

H Lessons Learnt Template

I QIPP Programme Tracker Template

J QIPP Programme Dashboard Template

K QIPP Programme Report Template

L QIPP Group’s Terms of Reference To be added

of 20


M QIPP Programme Management Process on a page

N Role Outline – Senior Responsible Officer (SRO) Project

O Role Outline – Clinical Lead

P Role Outline – Clinical Advisor

Q Role Outline – Project Manager

of 20

quality, innovation, productivity and prevention (qipp) programme – management process v1.4[56]

Documents