harrow local medical committee meeting …...harrow local medical committee meeting to be held at...

The professional voice of general practice in Harrow Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. [email protected] www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage

HARROW LOCAL MEDICAL COMMITTEE MEETING

To be held at 2.30 pm on Monday 16 April 2012 in the Sheridan Suite, Harrow Quality Hotel, 12-

22 Pinner Road, Harrow, Middlesex, HA1 4HZ

PART TWO

2.30 – 4.00pm

AGENDA

1.0 Welcome and apologies

2.0 3.0 3.1

Declarations of interest Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate Minutes and Matters arising Minutes of the LMC Meeting Part Two held on Monday 20 February 2012 (paper to follow)

4.0 Report from the Borough Director/other representatives report including: 4.1 Finance and QIPP update (paper attached) 4.2 Integrated Care Pilot (papers attached) 4.3 Premises 4.4 Enhanced Services 5.0 Clinical Commissioning Groups update CCG Assurance Delegation Process (papers attached)

6.0 Date of next meeting: Monday 16 April 2012

7.0 Any other business

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Outer North West London Integrated Care Pilot (ICP) overview

This short paper provides an overview of the proposed Outer North West London (NWL) Integrated Care Pilot (ICP). The ICP is a clinician-led initiative that has been shaped in close collaboration with, among others, Dr Ethie Kong (Brent CCG), Dr Amol Kelshiker (Harrow CCG), Dr Ian Goodman (Hillingdon CCG) and Dr Mohini Parmar (Ealing CCG). The ICP business case is being considered by the Cluster board for a period of one year, with a gateway review at the end of Year 1.

The paper has been prepared for presentation to the Outer NWL LMC and as such the impact of the ICP on GPs’ activities is covered in particular detail. The LMC is asked to review this paper and provide any comments or reactions.

WHAT IS INTEGRATED CARE?

Integrated care aims to provide the best possible quality of care at minimum necessary cost through a new model of people care. The key features of integrated care are:

■ providing more proactive and higher quality care in primary, community and social settings to reduce admissions to hospital;

■ focusing on a clearly distinguishable disease or people group; and

■ effective working of professionals across settings of care and between health and social care.

WHAT IS THE OUTER NWL INTEGRATED CARE PILOT (ICP)?

The Outer NWL ICP is a voluntary opt-in initiative that will be delivered by establishing Multi-Disciplinary Groups (MDGs). MDGs will be responsible for delivering integrated care to people in local areas. MDGs will work in a multi-disciplinary system (Exhibit 1).

Exhibit 1: Components of the multi-disciplinary system

Patient registry1

Know the people who you

care for…

Risk stratification2

… understand their level of

risk and need…

Care delivery5

… ensure that the planned

care happens and is well coordinated across

settings of care…

Case conference6

… use multi-disciplinary

case conferences to

improve the care of a very

small number of people with complex cases…

Performance review7

… and continuously assess and improve

performance through

transparency and cross-

setting discussion…

��

�

Work planning4

… provide people with

integrated, pro-active work

plans that vary according

to risk and need…

Care pathways3

… follow standards that

you and your providers in

other settings of care agree

on and understand…

Within the multi-disciplinary system, GPs will be involved in instituting three key changes in care delivery by:

■ creating tailored patient work plans detailing proactive interventions shared across settings of care to manage each patient’s health and well being and to coordinate care between providers;

■ holding monthly case conferences where expert clinical representatives from all settings of care can discuss complex patient cases; and

■ holding quarterly performance review meetings to evaluate the effectiveness of local care pathways and agree key investments to close gaps in delivery.

The delivery of these activities will be aided by an IT system in place. There is a clinician-led IT working group with participation from a broad range of providers, that is currently evaluating options for both interim and longer-term solutions.

In addition, the ICP will include an “Innovation Fund”, which MDGs can apply for funding from with innovative proposals around enhancing current provision.

The ICP is expected to drive significant improvements in quality of care and overall financial position, with anticipated gross acute savings of £8.9-10.3m in year 1 ramping up to £38-44m in year 5 across four boroughs.

A similar ICP is currently in progress in Inner NWL having been approved by LMCs and commenced in 2011. (Please see Appendix I for the interim evaluation of the Inner pilot’s performance)

HOW WILL INTEGRATED CARE BE GOVERNED?

The ICP will be governed by an independently chaired Integrated Management Board (IMB) comprising of primary care, acute trust, social care, community health and mental health representatives, as well as patient representatives. The IMB will be supported by four borough-based Integrated Management Groups (IMGs), who will be co-chaired by a borough GP ICP lead and a representative from the relevant Local Authority. IMGs will govern and review performance of Multi-Disciplinary Groups (MDGs), which will be supported on the ground by an operations team who will provide day to day support.

The proposed governance structure for Outer NWL Pilot

SOURCE: Team analysis

Board –Meeting quarterly

Multi-

Disciplinary Groups –Meeting as agreed

Integrated Management Board (IMB)

Operational Team –Meeting daily

Harrow MDGs Brent MDGs

Harrow Integrated Management Group (IMG)

Hillingdon Integrated Mana-gement Group

Brent Integrated Management Group (IMG)

Ealing Integrated Management Group (IMG)

Borough Groups –Meeting monthly

Hillingdon MDGs Ealing MDGs

Chaired by an Independent Chair and comprised of IMG Co-

Chairs, Community Health Services, Mental Health Trusts, Acute Trusts and Patient reps

Co-Chaired by a lead GP

representative and the Local Authority Director of Adult Social Services and comprised of MDG Chairs and relevant local

service providers

Chaired by the MDG Chair and comprised of GPs and local service providers (e.g., Acute, Mental Health,

Community Health Services, Social Services, etc.)

Will meet more frequently in the project phase to determine the performance and financial frameworks

Harrow Co-ordinator

3x MDG Co-ordinator

Brent Co-ordinator

3x MDG Co-ordinator

Hillingdon Co-ordinator

3x MDG Co-ordinator

Ealing Co-ordinator

3x MDG Co-ordinator

Chaired by the Opera-tions Director and

comprised of 4x Borough Co-ordinators, and 8-12x Band 5/7 MDG Co-ordinators and other support staff

Operations Director and support staff

■ Integrated Management Board (IMB): Responsible for defining the overall principles of governance, setting the direction and proposition of the initiative and determining the applicable financial and performance frameworks. IMB will be chaired by a nominated independent chair and will consist of Integrated Management Group co-chairs and representatives from each participating provider as well as patient representatives.

■ Integrated Management Groups (IMGs): Responsible for managing and assessing the performance of the individual MDGs located in their respective boroughs and defining borough-specific tweaks to pathway configuration and roll-out, financial framework or performance framework. IMGs will be co-chaired by a nominated GP ICP lead and a Local Authority representative and consist of all local MDG chairs as well as representatives from each local participating provider.

■ Multi- Disciplinary Groups (MDGs): Responsible for the holistic needs of a defined population and for carrying out and monitoring the delivery of Integrated Care. MGDs will match existing localities or peer groups in most cases. MDGs will be chaired by nominated GPs and consist of representatives from each local participating provider.

WHAT DOES THIS MEAN FOR GENERAL PRACTITIONERS AND HOW WILL THEY BE REIMBURSED?

Integrated Care represents a new model of people care within which GPs will form an integral component. It is recognised that clinicians, including GPs, should be reimbursed for their time during the process of embedding Integrated Care as a new working practice.

The Outer NWL ICP will pay for the same types of activities as the already-approved Inner NWL ICP: creating work plans, attending case conferences, participating in performance reviews and improving local service provision. However, one of the lessons learned from the Inner ICP is the necessity to simplify the reimbursement mechanism and thus reduce administrative complexity for GP practices. The proposed reimbursement mechanism follows the common principle of reimbursing clinicians for the time they provide, and is intended to provide a framework which is more transparent and simpler in its administration. It is also anticipated that central funding from NHS London will provide financing for the pilot.

The benefits of discussing complex cases in case conferences go far beyond the actual patients being discussed, and contribute to the overall improvement in GP’s ability to handle complex cases. This has been recognised by London Deanery which has approved attendance of MDG case conferences as a certifiable professional development programme.

As proposed in the Outer NWL ICP, GPs will be reimbursed for their participation in the following activities1:

■ Attending two case conferences per month: A GP representative from each participating practice will attend two conferences each month (one per pathway) to discuss complex patient cases.

– Initially two separate case conferences for Diabetes and Elderly pathways will be held each month, with a duration of three hours each,

– After six months, COPD and CHD pathways will be included with the monthly allowance of reimbursable time increased to a total of eight hours per practice,

– Each practice will be reimbursed at up to £100 per hour,

1 Rates specified here are maximum reimbursement rates. Each CCG may agree that providers are reimbursed at a lower rate

with the balance spent on additional care provision.

– The pilot will reimburse for exactly 6 hours each month for each MDG they attend, and for 2 additional hours each month after CHD and COPD pathways are be rolled out,

– This equates to up to £7,200 per practice per year for Elderly and Diabetes pathways, and additionally up to £2,400 per practice per year after CHD and COPD pathways are rolled out

■ Attending a quarterly performance review meeting: A GP representative from each participating practice will attend one three-hour quarterly MDG meeting to participate in the review and discussion of MDG performance

– Each practice will be reimbursed at up to £100 per hour (for no more than 3 hours of performance reviews every quarter)

– This equates to up to £1,200 per practice per year

■ Owning the creation of work plans: A 45 minute appointment with each patient to create a work plan of interventions or steps to be carried out over the following 12 months

– Work plans can be created by any professional (including a practice nurse, a GP or another health or social care professional) at the discretion of each GP practice

– The organisation which employs the professional will be reimbursed at a rate of £37.50 per completed work plan (based on 45 minutes of a Nurse’s time at a rate of £50 per hour)

– Total reimbursement will vary based on the prevalence of people who fall into specific pathways, with a phased roll-out approach as described below:

□ Year 1: 50% of people with diabetes, 25% of elderly people, 25% of people with CHD and 25% of people with COPD

□ Year 2: 50% of people with diabetes, 25% of elderly people, 75% of people with CHD and 75% of people with COPD

□ Year 3 and onwards: 100% of people with diabetes, 50% of elderly people, 100% of people with CHD and 100% of people with COPD

Additionally, a GP will chair each MDG. Each MDG chair will represent their MDG on the IMG which in turn will be co-chaired by a lead GP. Each of the IMG co-chairs will also sit on the IMB.

GPs will be paid through the same contractual model used for the Inner NWL ICP, consisting of three main elements:

■ A Memorandum of Understanding (MOU) signed between all parties and the Cluster agreeing the objectives of the pilot, the services to be provided and the funds to be released upon delivery of services.

■ An “Establishment Agreement” signed between all parties to define the role and responsibility of each party in delivering the terms of the MOU.

■ A “Hosting Agreement” which establishes CNWL as the holder of funds and employer of staff for the pilot.

To secure reimbursement GP Practices will submit a quarterly invoice, validated by the IMB, to CNWL. Subsequently, funds will be released to the Practice account. This reimbursement may be counted as NHS income. GP practices that enter the pilot sign the Memorandum of Understanding as a provider (GMS/PMS-contracted practice)

Participation in the Pilot is at the GP practice level and as such reimbursement will be based on the case conferences and performance reviews attended by each Practice. Practices may elect to send several representatives to case conferences and performance reviews but reimbursement will be capped at one representative per practice.

APPENDIX 1: INTERIM EVALUATION OF INNER PILOT

Early indications from the Inner ICP pilot already show a clear statistically significant distinction, most likely driven by the pilot: participating practices have seen their NEL medical specialty admissions decrease by -6.6% for Elderly year over year (for a period of Jul-Jan 2011/12 compared to Jul-Jan 2010/11), while non-participating practices in these boroughs saw their NEL medical specialty admissions grow by 0.3% for the same cohort over the same period:

Trend in non-elective medical specialty admissions

Participating practices

Non-participating practices

By acute providerBy ICP borough

Non-elective medical specialty admissions for patients aged 75 and over, resident in INWL

Growth rate, percent, 11/12 vs 10/11 seven months (Jul-Jan) each year

1 Not statistically significant due to small sample size

SOURCE: SUS data Apr 2009- Jan 2012

Westminster

Kensington

& Chelsea

Imperial

Chelsea &

Westminster

Other

Total Total

0.8

-4.8

-0.3

-10.1

-5.0

-1.61

0.3

-6.6

Hammersmith

& Fulham

-2.7

-9.6

7.4

-6.1

3.7

3.4

0.3

-6.6

Statistically

not significant

The whole premise of the pilot is to move from reactive to proactive mode of care, and we expect this reduction in exacerbations to lead to lower number of urgent GP appointments in the future, freeing up GP capacity to do more proactive care such as attending case conferences.

While these indications are positive, it is recognised that it is too early to tell the story definitively. For this reason, there is an evaluation framework in place to evaluate the full effects of the Inner pilot, currently being conducted by Nuffield College and Imperial College.

Chief Executive: Dr Anne Rainsberry Chair: Jeff Zitron

NHS NORTH WEST LONDON CLUSTER BOARD

10th APRIL 2012

Title CCG Delegation and Authorisation Update

Agenda Item 9.1

Senior Responsible Officer (SRO)

Daniel Elkeles Director of Strategy

Summary

This paper is in 2 parts: Part A: Delegation of medium and high complexity budgets to CCGs Summarises the process for and outcomes from each of the recent applications and formal discussions between members of the executive team and each CCG Board to provide assurance prior to the delegation of commissioning budgets. Board members are asked to endorse the recommended delegation of budgets.

Part B: Update on the Authorisation Programme

The paper provides information to the Board on the national programme for CCG authorisation and the plans in place across the cluster to support each CCG through the authorisation process

Recommendations PART A: Delegation of medium and high complexity budgets to CCGs

Rated green and recommended for full delegation without conditions:

Brent CCG

Central London Healthcare CCG

Hammersmith and Fulham CCG

West London CCG

Rated red and recommended for full delegation with conditions:

Hillingdon CCG

Great West CCG

Ealing CCG

Harrow CCG

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Cluster Board April 2012 Agenda item 9.2

(Please note: the points highlighted in this paper on each CCG specifically

relate to the delega�on process for medium/high budgets and are not a

general overview of the CCG).

PART B: Update on CCG Authorisastion

The Board are asked to note progress on:

The national process of authorisation

The plans in NWL to support the authorisation of CCGs

This report cross references:

Board Assurance Framework

CA09

Fit with Integrated Strategy Plan (ISP)

Fully aligned with the plan

Risk/s report identifies

Identified in Strategy Risk Register

Risk Register discipline

Strategy Risk Register

Implications

(including statutory or legal references)

Previous forum Migration Board meeting 30th March 2012

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PART A: Delegation of medium and high complexity budgets to CCGs

1. Background

Early in 2011/12 NHS North West London ran an exercise with CCGs to assess their readiness to take on responsibility for a variety of low complexity commissioning budgets with the intention that CCGs move to seek full delegation of eligible budgets by year end to enable CCG shadow operation through 2012/13. Following this first round of delegation of budgets, in October 2011 guidance was circulated to all emerging CCGs in NWL about how to apply to take on delegated responsibilities for medium and high complexity budgets.

2. Process for full delegation

For this round, we asked each CCG to submit an evidence-based application against a set of robust and clear criteria. We conducted a detailed assessment of the evidence our CCGs provided which was then considered by a panel of NHS NWL Directors including Daniel Elkeles, Simon Weldon, Mark Spencer, Richard Jeffery (Cluster Head of Finance) and our Sub-Cluster CEOs as independent assessors. The process was designed for NHS NWL to support our CCGs to be the best they can be and to ensure that they have the capacity and capability to take on full delegation. It is also an important foundation for the work we anticipate they will need to do to apply for authorisation later in the year. We gave feedback to each CCG on their application and, following this, they gave a presentation to Dr Anne Rainsberry, as the Accountable Officer for the Cluster, and the review panel. The table below describes this process in more detail. Full documentation for each CCG, including application, our assessment of each application, and their consequent

presentation are available upon request. We have attached as an appendix, an anonymous example of a CCG application (appendix 1) and our assessment (appendix 2) to demonstrate the rigour of the process.

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Table: Overview of process for full delegation of responsibilities to CCGs in NHS NWL

CCG completes detailed application form with further

information and evidence to support the CCG's track record on:

a clinical and professional focus

meaningful engagement

clear and credible plans to deliver within financial

resources

proper constitutional and governance arrangements

collaborative arrangements with key stakeholders

leadership

their performance and risk management and planning for

proposed delegated responsibilities

Cluster review of each application, comprising a number of

reviews which are assessed by NHS NWL Directors of Strategy,

Finance, Quality and Performance

Agreed assurance summary outlines a RAG rating against each

criteria and, for each CCG, a summary of:

strengths

development areas

key lines of enquiry

Feedback given to each CCG to respond to at presentation

CCG Chair, accountable officer and finance director equivalents,

the quality lead present their application

Each CCG asked to present their application, taking into account

the feedback at the previous stage with common questions to

all CCGs around:

Operational delivery

Finance and QIPP

Leadership and organisational development

Collaboration and commissioning support

A summary of each CCGs application and presentation

produced

Recommendations, including proposals for delegated

responsibility, tabled at NHS NWL Cluster Board on 10 April

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4. Recommendations

The final output of the delegation process is a paper that outlines our assessment at the presentation panel of each CCG s capability across finance, performance, leadership, quality and strategy. The eight summary reports are attached in full as appendix 3.

Please note: the points highlighted in the summary for each CCG specifically relate to the delegation process for medium/high budgets and are not a general overview of the CCG

The decision was taken with the Finance team on whether each CCG will have full delegation or whether the delegation will have conditions applied. These conditions are set out below and further information on this is in the Cluster Board paper 11.3.

Rated green and recommended for full delegation without conditions:

Brent CCG

Central London Healthcare CCG

Hammersmith and Fulham CCG

West London CCG

Rated red and recommended for full delegation with conditions:

Hillingdon CCG - The PCT and CCG are unlikely to set a balanced budget without

delegation. The CCG will be required to produce an agreed recovery plan by 30th June 2012.

Great West CCG - The PCT and CCG will require external support to set a balanced budget

The CCG will be required to produce an agreed recovery plan by 30th June 2012.

Ealing CCG - The PCT and CCG will require external support to set a balanced budget in 20

The CCG will be required to produce and agreed recovery plan by 30th June 2012.

Harrow CCG - The PCT and CCG will require external support to set a balanced budget in 2012/13 and will ther

The CCG will be required to produce an agreed recovery plan by 30th June 2012.

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PART B: Update on CCG Authorisation Programme

1. Introduction

In order to become a statutory body in April 2013 Clinical Commissioning Groups (CCGs) will be required to demonstrate compliance with the requirements of the Authorisation Process as set out by the Department of Health. This process will include a SHA pre-assessment; an application to the NHS Commissioning Board (NHSCB); and a NHSCB assessment.

Key to the authorisation of CCGs will be our plans, processes and activities to ensure the CCGs across North West London Cluster are in the strongest position possible for the authorisation process. This paper updates the Board on:

the information on the national authorisation process and

the plans in place across NWL to ensure CCGs have the most effective support in place throughout their preparations for a successful authorisation process and subsequent outcome.

2. National Update - The Authorisation Process

2.1. Principles for Authorisation Until the recent passage of the Health and Social Care Bill, the official documentation setting out the CCG Authorisation Process has been limited. Last September, the Department of Hea sets out the following key

principles with regards the Authorisation Process :

Design for Success Assuming the majority of CCGs will be authorised by April 2013 and expecting that 100% are established with conditions where appropriate

Authorisation as a Journey - Recognising authorisation as a safe threshold on a

journey of continuous improvement, not an end point. A maturity model.

Potential after Authorisation - Seeing authorisation as an assessment of confidence

delegated sub-committees of PCTs

Domains for Authorisation a simple framework which is well understood

Evidence for Authorisation - Minimising the evidence requirement for formal submission of evidence and maximising the use of the pre-authorisation period for informal submission

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With the passage of the Health Bill, we are now expecting the publication by the NHSCB full requirements for authorisation.

2.2. The Steps and Domains for Authorisation Recent guidance from NHS London has set out the process throughout the summer and autumn of 2012 to ensure all CCGs are authorisation by April 2013. Each CCG will apply

All CCGs will be assessed at three stages along the process. Firstly, through an SHA pre-application stage which will provide assurances to the SHA of the readiness of a CCG; Secondly, through a formal application to the NHSCB which will include the submission of evidence across 6 Domains of Authorisations and a 360 stakeholder survey; and thirdly, a NHSCB assessment which it is envisaged includes a site visit by the NHSCB to the CCG.

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The framework for description of the commissioning capability required for CCGS across a range of key areas. They are: 1. A strong clinical and multi-professional focus which brings real added value 2. Meaningful engagement with patients, carer and their communities 3. Clear and credible plans which continue to deliver QIPP Challenge within financial

resources, in line with national requirements (including excellent outcomes and local joint health and well-being strategies.

4. Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commissioning all the services for which they are responsible

5. Collaborative arrangements for commissioning with other CCGs, local authorities and the NHSCB as well as the appropriate commissioning support

6. Great leaders who individually and collectively can make a real difference Each domain is then broken down and has a range of sub-indicators/criteria with each of these areas having associated thresholds and specific evidence requirements. The evidence requirements will be used to demonstrate commissioning capability of a CCG in a specific domain. An example of how a domain, sub-indicator, thresholds, and pieces of evidence are linked is shown below:

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Example: Domain 1: A strong clinical and multi-professional focus which brings real added value

Criteria Threshold for Authorisa�on Evidence for authorisa�on Evidence source and phase for submissions

Domain 1

1.1 Clinical

perspec�ve in

everything it does

1.1a. Shared vision developed by

the CCG and its member

prac�ces

i. Shared vision is included in CCG

cons�tu�on, signed off by its

members

ii. CCG has iden�fied local quality

priority areas, aligned with QIPP

and this is reflected in CCG plans

iii. Example of CCG delivering

measurable improvements in quality and produc�vity

Cons�tu�on and other documents detailing

governance arrangements

Pre applica�on

2012-13 Integrated plan and dra*

commissioning inten�ons for 2013-14

NHSCB led assessment


governance arrangements Pre applica�on

1.1b Structure and processes in

place to enable clinicians to lead the work of the CCG and

demonstrate their public

accountability in doing so.

i. Clinically led process for iden�fying

priori�es, including quality and pa�ent safety

ii. Governance structure established to

monitor quality and safety including

analysis of pa�ent voice and

experience and safety incident

repor�ng

iii. Arrangements in place with a mul�-

professional range of clinicians to

share informa�on and learning

2012-13 Integrated Plan and dra*



Desk top review



Pre-applica�on

Minutes of mul�-professional mee�ngs

NHSCB-led assessment

Desktop review

CCG OrganogramPre applica�on

Criteria Threshold for Authorisa�on Evidence for authorisa�on Evidence source and phase for submissions

Domain 1

1.1 Clinical perspec�ve

in everything it does

1.1a. Shared vision developed by

the CCG and its member prac�ces

i. Shared vision is included in CCG

cons�tu�on, signed off by its members

ii. CCG has iden�fied local quality

priority areas, aligned with QIPP

and this is reflected in CCG plans

iii. Example of CCG delivering

measurable improvements in quality and produc�vity



2012-13 Integrated plan and dra*





1.1b Structure and processes in

place to enable clinicians to lead

the work of the CCG and

demonstrate their public

accountability in doing so.

i. Clinically led process for iden�fying

priori�es, including quality and

pa�ent safety

ii. Governance structure established to

monitor quality and safety including

analysis of pa�ent voice and

experience and safety incident

repor�ngiii. Arrangements in place with a mul� -

professional range of clinicians to

share informa�on and learning

2012-13 Integrated Plan and dra*



Desk top review



Pre-applica�on

Minutes of mul�-professional mee�ngsNHSCB-led assessment

Desktop review

CCG Organogram

Pre applica�on

The latest draft guidance provides further detail behind each of the 6 domains and outlines over 16 pieces of evidence for submission by the CCG as part of the authorisation process:

The evidence includes:

CCG authorisation application form CCG constitution and other documents detailing governance arrangements (to be

specified) CCG Organogram Case studies (to be specified estimated to be between 6-8) Draft Joint Strategic Needs Assessment Financial management arrangements compliant with national requirements Health and Wellbeing Board minutes and reports Joint Health and Wellbeing Strategy Letter of support for CCG Chair List of collaborative and joint commissioning arrangements

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Minutes of multi-professional meetings Organisational Development Plan SLA or MoU with assured commissioning support provider 2012-13 contracts 2012-13 Integrated Plan and draft commissioning intentions for 2013-14 360° stakeholder survey report and CCG comment

All CCGs will need to compile the above evidence on time, in a co-ordinated way to the highest quplans, activities and outcome data of the CCG. As authorisation is a national process, there are things that can be done locally at CCG level, at cluster level, regional level and at national level to aid a CCGs preparation for authorisation.

3. Our Approach across North West London

To provide the best possible support to the CCGs to get them through Authorisation, we have recently appointed two new people and reorganised the strategy team. Two additional people have been included in the budget for Q1/2 in 2012/13 in case we need to expand the team further. The team will provide dedicated support to their allocated CCGs. This meets the

ct for each: David Barron: Central London, West London and Ealing Charlie Paterson: Brent , Harrow and Hammersmith & Fulham Matthew Bazeley: Hillingdon

Jacinda Kemps: Great West (Hounslow) The high-level project plan for CCG authorisation support is set out below. In summary, it is proposed that support is provided across 5 key stages:

1) Establishing the baseline: Gap Analysis and Road Map for Authorisation (March to mid-April). Support to help the CCGs understand their current position on authorisation, identify their requirements and setting out what needs to be done when and by whom through the form of a road map.

2) Cluster Support and Quality Assurance (April to June). Support to help CCGs develop their evidence base as required, cross checking against national best practice, providing advice and guidance to the CCGs on the authorisation process and tracking progress.

3) SHA pre-assessment (April to June). Support CCGs in preparations and submissions to the SHA ensuring regional consistency to the highest standards.

4) Application to the NHS Commissioning Board (July to November wave depending). Support CCGs in preparations and application to the NHSCB ensuring the application is to the highest standard.

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5) Formal Authorisation assessment (October to January 2013 wave depending) Support CCGs in preparations and assessment by the NHSCB

31/5 Evidence base compiled and validated for each CCG

3

1. Proposed CCG authorisa�on �melines

Mar Apr May June July Aug Sept Oct Key

Na�onal milestone

NWL milestone

Cri�cal ac�vi�es

Applicants Guide expected mid-April

April

10/ 3 Each CCG has a nominated PCT cluster

lead/contact assigned Sub-Workstreams

Delivery Phase

SHA pre-assessment for Wave 1 CCGs

(1st of July - tbc)

31/5 Development plan produced on each of the 6 domains

and sub-indicators -

30/6 applica�on for

Wave 1 CCGs begin

1/10 authorisa�on for Wave 1 CCGs

Ini�al Phase:

Establishing the

Baseline

Kick off

mee�ngs

Define

resource offer

Commence with Cluster Support and Quality

Assurance

for submission

Prepara�on for Applica�on

Development ac�vity on the

6 domains

SHA pre-assessment

CCG prepara�on/pre-applica�on support

Applica�on to the NHSCB

Formal Authorisa�on

assessment

31/5 all NWL

CCGs to submit

final report on

wave submission

to DH/NHS CB

Notes

Timings of key na�onal

milestones are

indica�ve and not yet

confirmed. Subject to

passage of Health Bill

and NHSCB Applicants

Guide

31/5 All CCGs to set out their dra* applica�on to cluster for review & refinement

We are currently awai�ng for the

confirmed �meframes

A list of the 6 domains and dra* evidence has been shared. Road maps will likely to

Na�onally led - Leadership Selec�on Process (April)

By 31/3 SHA pre-assessment

phase 1 : So* Intelligence By 30/4: SHA pre-

assessment

phase 2 formal assessment

3.1. Update on progress against plan: The Cluster delegation and authorisation cluster team have only recently kicked off the work on the authorisation process with the CCGs. Initial focus for the team has

Establishing the

The aim of this phase is to:

understand the specific support requirements for each CCG

review current positions of CCGs against the 6 domains and their preparation against the draft submission list

match cluster support to CCG development needs where appropriate and define cluster to CCGs

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-April which sets out what roles, responsibilities, activities and milestones are needed to ensure a successful authorisation process - in line with the national timescales.

Early progress has been made. CCGs have -to the proposal of undertaking a gap analysis against the 6 domains and the production of a road map. By mid-April the Cluster team will know the outputs from this work and will assign resources accordingly. We aim to report back on the outputs of the road map exercise with updates against the project plan and the continued progress on the Authorisation Process at the migration board.

4. Risks

The following risks and mitigation have been identified for the CCG authorisation process across the NWL Cluster:

Risks Mitigation Due to the range of dependencies around CCG authorisation (eg governance and financial arrangements) and competing priorities there is a risk this may lead to slippage in timescales

Mitigate through working across cluster transition teams to ensure all areas (inc governance and finance) are integrated and all aware of CCG specific issues

Election of CCGs during the authorisation process may provide a level of instability during preparations for authorisation

Maintain close working relationships with the CCG chairs and their senior teams to ensure preparations for authorisation stay on track

CCGs fail to project manage their preparations for authorisation and fail to compile all the evidence required in time and to a high standard

CCG delegation and authorisation cluster team member assigned to a CCG to provide support and track progress against Road Map

CCGs do not manage their relationships with key stakeholders in advance of the 360 feedback survey

CCG delegation and authorisation team member assigned to a CCG to provide insights on managing the relationships and communications work

CCGs with financial legacy debt that did not make financial balance in 2011/12 and CCGs delivery against 12/13 QIPP and financial plans

Close working relationships between the Cluster, CSS and CCG to ensure all plans are tracked frequently and communicated into the authorisation process. The later the application for authorisation, the more robust the plans will need to be.

Fluidity in staffing during the transition period and authorisation process which may hinder progress.

Maintain strong relationship between CCG, CSS and Cluster to ensure organisational memory and understanding of the authorisation process is maintained.

CCGs compile poorly constructed pieces of evidence that fail to articulate their readiness for authorisation

The Cluster team will work with the CCGs to develop and review key pieces of evidence and cross check against national best practice where appropriate

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5. Action Required for the Cluster Board

The Board are asked to note the work which is underway and the plans in place for CCG authorisation in the Cluster.

harrow local medical committee meeting …...harrow local medical committee meeting to be held at...

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