1. Managing the Transition
Sept 2011

2. Agenda Where are we? Clinical Commissioning Groups (CCGs)
Health and Well Being Boards
Issues

3. Reasons for Change Clinicians at the heart of decision making
Involvement and Empowering Patients
Best outcomes in the world
- Driving up quality

4. New Architecture CCGs SHA Clusters PCT Clusters
Health and Wellbeing Boards

5. CCGs 95% Pathfinders Variable maturity Variable size Governance
Scope of Commissioning
Population based
In addition, it is vital that the needs of homeless and excluded people are fully addressed by commissioning consortia, who must be responsible for meeting the needs of everyone residing in their area, not just those who are registered with GPs. We were encouraged to see an amendment agreed to this effect at the Bill’s committee stage

6. Pre-authorisation
PCTs and SHAs formed clusters
Assignment of staff and delegation of commissioning responsibilities
Shadow Health and Well Being Boards
Issues: End State
NCB Relationship
Authorisation with conditions
Commissioning Support

7. To be authorised consortia will need to demonstrate…
Clinical focus and added value
Engagement with patients and communities
A clear and credible plan to deliver quality improvement within
the allotted financial resource
Capacity and capability to deliver all their responsibilities,
including delivery of financial control
Collaborative arrangements for commissioning with other consortia,
Local Authorities and the NHS CB
Leadership capacity and capability

8. Collaborative arrangements for commissioning
How does the consortium plan to work with other consortia and local authorities?
What commissioning support arrangements do they have in place to help them commission across wider geographies?
Standards
Partnership arrangements e.g. pooled budgets, lead commissioning etc in place with other consortia and local authorities
Effective ways of working with NHS CB in place
Suitable arrangements in place to access the right public health advice.
The consortium is a member of all relevant shadow health and wellbeing boards
Robust commissioning support arrangements in place to support collaboration
Tests
JSNA/Health and Wellbeing strategy
Commissioning Plan
Constitution
Commissioning support arrangements
360 degree input
Face-to-face meeting
Evidence

9. Clinical Focus and Added Value
Plans to assess local need, reduce inequalities, and ensure continual quality improvement, to improve patient experience and outcomes
Demonstrate engagement of constituent GPs, also the involvement of other clinical professionals.
Standards
Are key programmes of work led by clinicians from a range of appropriate disciplines?
Arrangements for effective participation of all the consortium’s practices
Is the consortium engaging with stakeholders
Does the consortium have plans to use peer to peer challenge
Tests
Joint Health and Wellbeing strategy
Commissioning plan
Constitution
Membership agreement
360 degree input
Face-to-face meeting
Evidence

10. Pre Authorisation Risk Assessment
Clinical ownership
Commissioning boundaries
LA boundaries
Size

11. Draft Authorisation Issues Raised
Why?
Accountability and authorised with conditions
NCB Relationship
Support services
Running costs
Sustainability

12. Health and Well Being Boards
Responsible for developing joint strategic needs assessments and a joint health and wellbeing strategy.
Scrutiny powers of local authorities to be restricted; use their power of referral to the Secretary of State only for significant changes to designated services.
Min membership: the Director of children’s services,
the Director of adult social services,
the Director of public health,
at least one elected representative, which may be the elected
mayor or leader of the council, or a councillor nominated by them
The Local Healthwatch,
Relevant GP consortium

13. Post Pause
Stronger role in promoting joint commissioning and can act as lead commissioner for some services.
Stronger role in the development of commissioning plans and will be able to refer plans back to the NCB

14. Post Pause 2
Formal role in the authorisation of clinical commissioning groups and will lead on local public involvement.
Restrictions on scrutiny powers of local authorities lifted.  Consideration to be given to the feasibility of “Citizens right” to challenge poor service
There should be a requirement for every JSNA to assess groups in the community with the poorest health to ensure that the needs of the most excluded are recognised.
Every JSNA must also assess, and take steps to meet the housing needs of the local population. The JSNA should be aligned with the most recent assessment of housing needs.

15. Consortia Support Consortia will succeed or fail by quality of support
Need to identify functions
Need to consider scale
Alternative models
Voluntary sector
Independent sector
January 2011

16. Importance of Housing issues to CCGs
House design
Damp
Specialist housing
Extra care
Aids and adaptions
Care and repair
Housing related support

17. Examples of Different Schemes
Care and repair
Supported
Assisted technology
Step up step down
Enable early discharge prevent readmits and prevent falls

18. Getting housing on the agenda
Health and well being strategy
JSNA
Commissioning plans
Strategic planning
Greater awareness of skills and capabilities of voluntary organisations

19. The King’s Fund 10 High Impact Changes
Self-management
Primary prevention
Secondary prevention
Managing ambulatory conditions
Integrating mental & physical health care
To achieve triad quality cost effectiveness and experience
Self manage diet exercise DESMOND
Primary brief intervention smoke alcohol ……family for child obesity AF
Secondary disease registers Post MI hypertension DM
Core set 19ACS EoE 12% all admits…case management , telephone coaching easy access urgent care….Birmingham Ownhealth telephone coaching case mangers
Angina, asthma , cellulitis,DM Heart failure dehydration COPD
Physical and mental health provision of psychological support for angina in Liverpool reduced cost per pat per year by £ DM and depression; record code IAPT ETC

20. The King’s Fund 10 High Impact Changes
Care coordination & integration
End-of-life care
Medicines management
Managing elective activity
Managing emergency activity
Evi on health outcome limited but highly integrated p care with continuity and co ord better patient experiences = Torbay multi prof teams case manage joint care planning personal health pans
End of life2/3 want to die at home 1/3 do facilitated discharge rapid response co ord 24/7 gold standards framework
Meds reviews decision support script switch pharmacy monitoring
Elective activity comparative info Peer review
Urgent integrated coord whole system clinical dashboard to inform changes

21. Enablers Post Industrial Primary Care Integrated Care
Systematic and proactive management of Long term Conditions
Empowerment of patients
Population management

22. Issue for Clinically Led Commissioning
Size
Patient Voice
Leadership and Ownership
Commissioning “differently”

23. Issues for Clinically Led Commissioning 2
Balance quality, cost effectiveness and experience
Manage risk
Joint commissioning
Time needed to develop to maturity

24. Getting housing on the agenda
Health and well being strategy
JSNA
Commissioning plans
Strategic planning
Greater awareness of skills and capabilities of voluntary organisations