1. Briefing Summary August 2015
CCG Operating Model
Briefing Summary August 2015 JC

2. NEW Devon CCG Operating Model
The new CCG operating model is being implemented in response to our recently commissioned Capability and Capacity review.
Much has changed in the 2 years since the CCG was formed: significant financial challenges, increasing patient activity levels, closer alignment with social care as well as the Five Year Forward View and the service transformation needed across Devon to achieve this.
The new CCG operating model needs to effectively interface with a system that comprises 4 System Resilience Groups (including South Devon), 3 acute providers, 2 local authorities, 2 mental health providers, 2 community providers, 2 children’s services providers, Monitor, TDA and NHS England
There needs to be a step change in both the strategic environment for recovery and the level of collective delivery to close the 5 year forecast gap of £430m
Overall the review concluded the CCG needed to:
Deliver financial recovery
Develop better management & control of system performance
Drive whole system transformation & JC

3. Contents 1. CCG Governance and Accountability Slides 4-15
Planning and Delivery Units
Slides 16-24

4. 1. CCG Governance and AccountabilityJC

5. Strategy and Delivery A single overarching strategy and framework
The CCG will develop strategic, delivery and financial frameworks which will identify the medium and long term objectives of the NEW Devon CCG health economy.
Two detailed place-based strategies and Delivery Units
This will then be delivered through two detailed planning and delivery units, one formed by the Northern and Eastern localities working together and the other formed by the Western Locality
(Illustrated in slides 4-6)
Robust operational control and delivery through providers
Using single CCG control centres and local planning and delivery units Chief Operating Officers are responsible for the delivery of performance, contracts and implementation of strategy.
Mandate and Accountability Agreements
Agreements that define responsibility and ensure single CCG approach . (Detailed in slides 8)
Clear revised governance structures
The CCG has revised its governance & committee structure to enact the new operating model (detailed in slide 6&7)
Revised Executive structure and lead arrangements
The CCG has revised its Executive Team structure and lead arrangements (detailed in slides 9&10). The Director of Strategy is due to start on 1st November 2015.

6. NEW Devon CCG Operating Model
Governing Body
Western
Locality
Northern
Patient
The new model retains the patient and members at the centre but driven through focussed Planning and Delivery Units formed from the Localities and held to account by the CCG Governing Body
Eastern
Locality

7. Accountability Thread
Aligned Committee
Terms of Reference 1
CCG Constitution
Council of members (the membership) delegates responsibility to Governing Body. Governing Body delegates powers to Locality Boards and other committees to achieve objectives and can remove delegation for non-delivery 2
CCG Strategy
The 2-5 year strategic vision developed and held by the Governing Body that describes the outcomes and changes the CCG wants to achieve 3
Annual Operating Plan
Single set of annual organisational objectives describing the elements of the CCG strategy and national requirements that the Governing Body expects the CCG Executive to deliver 4
Annual Accountability Agreement
Annually written agreement by which the Governing Body details the objectives expected to be delivered by the Planning & Delivery Units (thus holding the PDUs to account) and other committees. 5
Mandate
Annually written agreement by which Locality Boards empower Planning & Delivery Units and the Governing Body empowers the Executive Committee & Turnaround Steering to deliver specific parts of the operating plan 6
Executive & Clinical Lead Accountability
Individual objectives set through PDPs incorporating organisational objectives

8. Turnaround
Turnaround will ensure that these structures and process deliver the maximum return for the CCG
In any area where there is potential conflict of structures, Turnaround requirements will be seen as paramount
In this sense, “Turnaround” includes the appropriate balance of finance, safety, quality and performance

9. Governance Delivery Committee structure

10. Locality Functions
These are commissioning functions undertaken by locality boards:
Member engagement and development
Public and patient engagement
Feeding into and commissioning new and innovative service models – Right Care
Develop and agree the mandate with the PDU
Holding the PDU to account
Encourage primary care to work at scale
Developing a future for community hospitals and hubs
Continually improving the quality of primary care

11. Governance & Delivery Turnaround
CCG Governing Body
Turnaround Steering Group
Locality Board
East
North
Western
Planning & Delivery
Northern and Eastern
Planning and Delivery JF

12. Governance & Delivery Turnaround - Team
Turnaround Steering Group
Turnaround Working Group
PMO
Project Manager
Clinical Lead
BI, HR & Finance
Control Centres
Quality
Clinical Effectiveness
Patient Perspective
Planning
Finance JF
Turnaround Working Group will meet weekly

13. Executive Team Structure
Accountable Officer
Chief Finance Officer
Dep AO & COO Western
Director of Turnaround & COO Eastern & Northern
Chief Nursing Officer
Director of Governance
Director of Strategy
RED - Turnaround Accountability
BLUE - Line Management

14. Executive Team Lead Areas
Executive Lead
Area
Jerry Clough
(COO Western)
Deputy AO, Primary care, performance, cancer, end of life & transforming community services
Martin Sheldon
(Turnaround Director & COO Eastern & Northern)
CCG-wide Turnaround, Urgent care (including NHS 111), specialised commissioning, children’s services, mental health, learning disabilities & planned care
Lorna Collingwood-Burke
(CNO)
Continuing healthcare, prevention/public health & Caldicott
Hugh Groves
(CFO)
SIRO & Estates
Janet Fitzgerald
(Director of Governance)
CBS (CCG internal commissioning support services) & Research

15. CCG-wide Functions
These are CCG Functions that are held at Governing Body level. Examples include:
The CCG strategy and financial framework
Developing and regularly reviewing the Accountability Agreements which hold the Planning & Delivery Units to account
Managing relationships with regulators NHS England, Monitor, Trust Development Agency, CQC and other significant external bodies
Collaborative Business Service provision (where the bulk of CCG staff reside)
Governance
Finance & Budgetary Control
Audit and Assurance
Contracting and BI
Communications
Referral Management HR
Leadership and Clinical leadership development
Quality and Safety

16. 2. Planning and Delivery UnitsJC

17. Planning and Delivery Units
Two Units operating under one CCG Strategy and Operating Plan
Western Planning & Delivery Unit and Northern & Eastern PDU which is created under mandate from Eastern and Northern Locality Boards
Delivering the Governing Body’s Accountability Agreement
Each Planning & Delivery Unit will have a written annual accountability agreement with the Governing Body that clearly sets out expectations and objectives which hold the PDUs to account
Robust clinical and managerial leadership
Each Planning & Delivery Unit has a Chief Operating Officer working closely with their respective GP Locality chairs responsible for the local delivery of performance, financial recovery, strategic change and sustainability.
Mandate for collective working
Council of members (the membership) delegates responsibility to Governing Body. Governing Body delegates powers to Locality Boards. The Locality Boards agree an annual mandate setting out the range of programmes and functions that will be undertaken by the PDUs.
Maximising Delivery
The CCG will therefore be able to effectively balance:
Work that is most efficiently and effectively done locally with individual providers, SRGs and systems
Work that is more efficiently and effectively done by single systems and processes, collective effort and control

18. Delegated Budget & Delivery Responsibility
Planning & Delivery Units held to account (through a formal accountability agreement and delegated budget) to:
Develop a localised Service Strategy aligned to the CCG Strategic Framework
Develop an Annual Delivery Plan setting out the accountability agreement and therefore the CCG Operating Plan & commissioning intentions
Plan & negotiate Provider Contracts (exc Primary Care) and manage in-year performance – Quality, Activity & Finance
Manage Primary Care Referrals (supported by the DRSS)
Delivery of attributed Turnaround & QIPP
Ensure any appropriate delegated running costs are deployed effectively
Establish effective partnership arrangements with local authorities and other organisations inc BCF
Establish effective local governance arrangements to effectively discharge the Planning Unit’s responsibilities (including working arrangements with Locality Board(s) JF

19. PDU Functions
These are commissioning functions undertaken by Planning and Delivery Units for their respective systems:
Risk and performance management
Key provider contracts
Local Authority relationships
Integration-interface management
SRG leadership and management
Local System escalation
Activity planning
Primary care development
Commissioning Budgets
Local delivery of key schemes

20. Mandated Functions
These are commissioning functions mandated by Localities and Planning and Delivery Units, through the accountability with the Governing Body, to be undertaken by the Executive Committee or Turnaround Steering Group:
Activity planning
Primary care development
Turnaround and Programme Management Office
Planning and management of a single programme for QIPP & Turnaround (inc commissioning control centres)
Continuing Healthcare
Medicines Optimisation
Individual Patient Placements & High Cost Panels
Ambulance & PTS commissioning
Primary Care Co-commissioning
Collaborative commissioning for Specialised Services
Assessment & evaluation of new system models
Overall system escalation
NHS 111 & OOH commissioning (inc TCS)
Operational planning process

21. Maximising Delivery
In determining the optimal deliver method for any piece of work or programme, the following principles will apply : 1. Default: One single unit It is clear that the CCG is one statutory unit of accountability with one Governing Body and, as a default position; everything will work on a whole organisational basis unless there is a compelling reason to choose a different approach. 2. Maximise efficiency and effectiveness The overriding principle for design must be on achievement of delivery against agreed plans; the largest scale of delivery for the resources invested. 3. Promotes flexibility and speed of response In certain areas the ability to be flexible to changing needs and have knowledge of an area that allows a speed of response would be key to operational delivery. 4. Maximise key stakeholder relationships and reputation The CCG must ensure that key relationships are managed well in order to secure delivery and that the reputation of the CCG is enhanced. 5. Promote local accountability to populations and members The CCG is a membership organisation and also has a responsibility to local people. Ways of working must maintain local connections and promote local accountability.

22. Integrated Commissioning
The Partnerships Commissioning Programme Board worked effectively to develop relationship with partner commissioners, particularly local authorities and to commission services for significant vulnerable groups including mental health, learning disabilities, individual placements, children and young people and maternity.
The success of integrated commissioning particularly in Plymouth and reflections of the challenges of running a single directorate across two local authorities has led to the decision to place these commissioning functions within the two Planning and Delivery Units. Success will be measured in terms of what is delivered for the CCG.
This creates new line management arrangements and lines up staff and commissioning budgets with the PDUs in accordance with the allocation of programme budgets.
Paul O’Sullivan leads these services in the Northern & Eastern PDU, reporting to Martin Sheldon and will provide the single leadership voice and co-ordination for the CCG when required. Fiona Phelps leads on these services in the Western PDU, reporting to Jerry Clough.
The PDUs will work together on local strategy and delivery where there is a clear benefit, but the key will be driving greater gains through working with local authorities in a joined up and integrated way

23. Worked Example
It is important to harness the potential of the large and capable CCG, whilst capturing the benefits of greater connection with local authority and local system partners, demanding greater joined-up and integrated effort
This would mean we would develop:
Single strategy for the CCG;
Which would contain a summary strategy for a particular issue (for example, CAMHS)
The CCG expects two PDUs to produce detailed work on CAMHS and any action plans, mandating a single person to lead this where appropriate (eg link to specialist commissioning), but with clear first line accountability with PDUs and local authority partners
The CCG would therefore expect two strategies to deliver the same high-level goals, to be similar and draw on single approaches that work, but have differences to reflect local variation and different need
To monitor delivery of the two PDU action plans, using single BI data feeds and reporting and monitoring where appropriate
The PDUs held to account for delivery

24. Maximising Effectiveness – other issues to consider
The operating model described clarifies many ways for working. It is important that the CCG maintains a focus on continuous improvements and questions we should be answering include:
Medicines Optimisation – is this working to the best effect; is there a need for greater PDU ownership/ accountability?
Control Centres – have we got the Control Centres focussed on the right tasks? Have we reviewed effectiveness? What more could they do?
Turnaround – with a single CCG wide approach, are we maximising the input from PDUs and developing/ capturing new local QIPP ideas?
Primary Care – have we got a clear strategy for developing primary care market with a described narrative for balancing risk and QIPP delivery with practices?