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CCG Strategic Commissioning Plan 1 | P a g e

Organisational Development Plan 2014/2016

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CONTENTS Statement from our Chairman and Chief Accountable Officer 3 Introduction 3 Our Journey So Far 3 Our Vision and Values 6 Our Environment 8 Risk Analysis 9 Our Model for Organisational Development 10 Our Internal Development Plan 19 Our External Development Plan 29 Conclusion 35 Implementation Plan 36 2014/15 Corporate Objectives 39 Appendix 1 – 2 Year Operational Plan on a Page 43 Appendix 2 – 5 Year Strategic Plan on a Page 44

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STATEMENT FROM OUR CHAIRMAN AND CHIEF ACCOUNTABLE OFFICER ‘The collective principle asserts that … no society can legitimately call itself civilised if a sick person is denied aid because of lack of means’. Nye Bevan’s statement has perhaps never been more relevant since he first established the NHS, given the increasing demands on health and social care at a time when our resources are ever more constrained. We cannot meet this challenge if we do not develop and adapt – but not just as a CCG – nor even just as a health and social care system – but instead as a whole community working better together. We have to make possible a change in our culture if we are to ensure that every person receives the aid that they need. Our CCG is driven first by our values. This is now embedded in our staff contracts and in how we work together. These values then translate into the wider system and the way we wish to engage our service providers and the public through our approach to mutualist healthcare. Rational approaches which merely deliver structural changes, a drive on performance targets and imposed efficiencies will ultimately be unsuccessful. These may be necessary, but we also need to address the motivations and aspirations of both the public and our staff; and develop an adaptive culture that is more human in its response and always thinks about patients in their context. As the leaders of our local healthcare system, one of the most important things that we do is to ensure that we have an effective Organisational Development plan which will enable us, our GPs and our local providers to meet these challenges - enabling us not only to think differently but also to act differently. This organisational development plan explains how we will make real our values and continue to develop as a CCG; and how we will embed our mutualist approach to healthcare to ensure the population we serve has the best possible care and outcomes that we are able to deliver.

Dr David Hegarty Paul Maubach Chairman Chief Accountable Officer

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INTRODUCTION This version of the CCG Organisational Development Plan replaces the original plan which was produced during authorisation and has been produced as we begin our second official year. This provides us with the opportunity to reflect on the work that has been undertaken so far to bring the organisation to where it is now, and sets out a plan to develop the organisation over the next two years. This plan responds to our 5 year CCG Strategic Plan (approved by the CCG Board in May 2014) and the 2 year Operational Plan (approved by the CCG Board in April 2014) and should be read in conjunction with both of these documents. The challenges facing the NHS over the coming years are significant and in Dudley we are no different; we will all strive to improve patient care and with determination and a drive to succeed we can do this on the reduced resources we are challenged with. This plan outlines the development support that will be put in place to enable these challenges to be overcome and allow mutualist healthcare to be delivered. OUR JOURNEY SO FAR Dudley Clinical Commissioning Group became a fully authorised with no conditions statutory organisation on 1st April 2013, although our life journey began some time before. GPs in Dudley have worked together since October 2006 when Dudley Beacon & Castle and Dudley South PCT merged as one organisation. The GPs within the Dudley borough established themselves as five clusters of GPs and became fully involved in practice based commissioning. The five localities came together as Dudley Commissioning Forum and clinicians held lead roles on the Professional Executive Committee and provided clinical leadership for planned care, urgent care and long term conditions. In August 2010 the Dudley GPs unanimously agreed that to have a stronger influence on commissioning they needed to work more cohesively as one group. This was agreed by all clusters and was shortly followed by the announcement by the Secretary of State that clinicians would be put at the heart of leading the NHS with the establishment of Clinical Commissioning Groups. This commitment to work together prior to the announcement of the reforms has given Dudley strong foundations on which to build the development of the CCG. Dudley has remained consolidated in its configuration and this has enabled the CCG to develop at a consistently fast pace. Dr David Hegarty has chaired and led the CCG since 2010 and this consistent stability has had a profound effect on the CCG’s ability to develop and its sustainability. Dudley was also awarded the HSJ Award for Commissioning Organisation of the year in 2011, which is further recognition of our success. From our conception as a statutory body in April 2013 Dudley CCG has gone from strength to strength. At the heart of our success is the strength of the clinical leadership team. Dudley CCG has always remained focussed on what will make us different to a PCT and that is remaining focussed on being a membership organisation and the strength of our clinical leadership. Clinical Leaders were both

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appointed and elected back in 2011 and this leadership has seen the organisation through authorisation and the appointment of our senior management and staff support team. At every level within the organisation there is clinical leadership working in partnership with management and administration expertise to create the team required to deliver real change and improvement in patient care. As a membership organisation of currently 47 GP member practices, Dudley CCG has responsibility for commissioning the healthcare for the Dudley population of approximately 315,000 people. Our member practices are organised in five localities to enhance their involvement at a local level:

The five localities of GP member practices are at the heart of our decision making and consultation process. Each locality has two elected GPs on the CCG Board (Governing Body) and the localities meet every month to discuss issues or proposals, make recommendations. Every practice is represented at the locality meetings, which provides real opportunity for the CCG to consult with its member practices, and provides a two way communication channel to allow information to flow down from the CCG Board and up from the member practices.

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Our elected members are as follows: • Stourbridge and Wollescote (Dr David Hegarty & Dr Steve Mann) • Halesowen and Quarry Bank (Dr Richard Johnson and Dr Jonathan Darby) • Kingswinford, Amblecote and Brierley Hill (Dr Ruth Edwards and a current

vacancy) • Dudley and Netherton (Dr PD Gupta and Dr Mona Mahfouz) • Sedgley, Gornal and Cosesley (Dr Jas Rathore and Dr Kevin Dawes) The locality meetings are supported by a bi-monthly Membership Event which is a discussion forum where all of our member practices come together to debate current topics and developments. Their purpose is to enhance communication, share information and most importantly to engage practices in debate with regard to the challenges that the CCG faces and how it functions as an organisation. Feedback is collected from each event which is taken and acted on by the CCG Executive Team and Board and presented back to our members as “you said, we did”. We also have our “star of engagement” which is used periodically to test out how our members feel as part of the CCG and the results of which are used to determine how we can improve in our communication and engagement mechanisms. OUR VISION AND VALUES Our vision and values were developed by our clinical leaders at the beginning of our development journey and these will remain with us for the next two years of our journey. Our vision: To promote good health and ensure high quality health services for the people of Dudley. Our values:

We will be a caring organisation We will be a patient centred organisation We will work together as teams within the organisation and with partners Quality and safety will be the foundation of everything we do. We will be an organisation that which leads by example. We will be a learning organisation. We will be an inclusive organisation. We will have a focus on prevention and health promotion. We will be an innovative organisation. We will promote excellent financial management.

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Our vision and values are supported by a number of principles that we consistently adopt in our way of working. Our underlying principles are as follows:

Patient and public involvement Clinically led Primary care at our heart Working with partners in our communities Focus on quality and continuous improvement Live within available resources

Our CCG staff team developed a set of team values that we have committed to in our way of working and in the way we treat others in our team. As a team, we expect to live by our values in the way that we treat others and in the way we can expect to be treated ourselves. We use our team values when we are recruiting to new members of our team and we have developed our performance development review process around proven demonstration of our values. They are as follows:

TRUST one another Be honest.

Focus discussion on real issues and on their resolution, allow differences to be forgotten.

Embrace constructive challenge in a timely manner and use it as a positive way to learn.

RESPECT one another Accept others opinions are valid.

Understand people have individual skills and knowledge. Show determination, tolerance and sensitivity.

Be courteous and respect freedom to speak, disagree or remain silent. Ensure no-one becomes isolated in expressing their view and treat all ideas with

respect.

Be OPEN to receiving feedback from others Embrace constructive feedback.

Listen carefully to all ideas and comments and be tolerant to other points of view. Be sensitive to colleagues needs for support when challenging or being challenged.

Ensure feedback is timely and objective. Celebrate success.

Maintain PROFESSIONAL integrity Show group support and loyalty towards the CCG and each other.

Take personal responsibility for actions.

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Be accessible, visible and CONSISTENT Be supportive of decisions made, even though as individuals we may not always

agree. Demonstrate clear and cohesive leadership.

Take RESPONSIBILITY Look inwardly for continuous improvement. Be clear about roles and responsibilities. Manage own and others time efficiently. Consider the impact of our behaviour.

OUR ENVIRONMENT The external factors within which we work have a significant bearing on both what we are here to do, and whether we will be able to achieve it. If our business is to improve the health and wellbeing of our population then we must improve life expectancy whilst also reducing the variation in life expectancy across the borough. Significant variations occur by geography, registered vs unregistered patients, male vs female, long-term poor mental health and homelessness. We will need to work hard to support primary care to reduce unwarranted variations and have a clear understanding how we will target specific interventions. It can be considered the norm to live with a long term condition, and our strategy recognises the important of enabling patient autonomy. A largely disproportionate level of cost and healthcare interventions are incurred during the last year of life which represents both poor value for money and poor outcomes for patients and is reflected in the high number of frail elderly that are admitted to hospital. We will be engaging in conversations with our public about the last year of life and our integration programme will work to improve the patient journey during this time. The economic context in which we operate means that we are experiencing negative growth in investment, meaning we need to do more with less whilst improving health outcomes. Through our mutualist strategy we will promote individuals to become more autonomous and manage better their own health care. We will need to invest in preventative, lower cost interventions and disinvest in high cost care and maximise the efficiency of front line care to maximise patient contact time. Our supplier market has two extremes; we have two large scale complex secondary care organisations (Dudley Group Foundation NHS Trust and Dudley Walsall Mental Health Partnership Trust) and alongside much smaller scale organisations such as our GPs, Nursing Homes and the voluntary sector. We will need to consider this market and how we should be shaping it to provide more resilience and capability and encouraging research and innovation. NHS England impacts on our organisation in two ways; they operate as our regulator and they have responsibility for commissioning the services from our member practices. We work very hard to manage our performance and assurance relationship with NHS England and we will be working with them to pilot a project on the co-commissioning of primary care.

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We are co-terminous with our Local Authority (Dudley Metropolitan Borough Council) and our relationship operates on many levels. They are the local democratically elected body that provides strategic oversight for local healthcare delivery through the Health and Wellbeing Board, they publically scrutinise our significant service changes and are partners in commissioning services for our local population. Our relationship with them therefore is complex as they are expected to both hold us to account and work in partnership with us. Will be working closely to develop our working relationship, and through the Better Care Fund to integrate health and social care services around our membership practices. RISK ANALYSIS The aim of this plan is to prioritise our investment in development to mitigate the risks that have been outlined below: Internal Our main risk internally within our organisation is having the capacity and capability to deliver the challenging agenda that we have been set. Our CCG operates on an employed team of 50 employees (with others embedded in the organisation from the CSU etc). We need to make sure that we are prioritising the work of our team effectively to ensure we have the ability to deliver the organisational objectives that are described at the end of this plan. Our other key risks are:

That our team do not uphold and work to our values. Not embracing the difference and opportunity that being a membership and

clinically led organisation brings. A lack of engagement on the part of our membership. The size of the problems we are trying to achieve become overwhelming. That we are unable to maintain our current good financial position.

External

Inability to provide sustainable improved health outcomes for our patients. Integration of health and social care does not achieve the system and culture

changes we require. Relationships within the system become fragmented, defensive and

unproductive. There is a breadown in the system we lead. The necessary culture changes are unachievable. The financial viability of our main providers. Depletion of GP workforce (27% over 55 and 10% over 65)

This plan is not intended to be all encompassing as the plan will be embryonic and flexible to change over the next two years. A Succession Plan and Talent Management Strategy will be produced to accompany the plan to ensure we are prioritising our workforce. It is clear that our success will be measured by whether we have the ability to deliver the ambitions we have set.

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OUR MODEL FOR ORGANISATIONAL DEVELOPMENT The model we have adopted to apply our approach to organisational development is the Weisbord Six-Box Model (organisations and systems). Weisbord’s model is a framework developed by Marvin Weisbord to assess the functioning of organisations. It is a generic framework, based on the techniques and assumptions of the field of organisational development. The six-box model is comprised of the following components (boxes): 1. Purposes: What 'businesses' are we in? 2. Structure: How do we divide up the work? 3. Relationships: How do we manage conflict (coordinate) among people? With our

technologies? 4. Rewards: Is there an incentive for doing all that needs doing? 5. Leadership: Is someone keeping the boxes in balance? 6. Helpful mechanisms: Have we adequate coordinating technologies? To use the model properly, we have applied it to our CCG

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Our purpose is the reason we are here (To promote good health and ensure high quality health services for the people of Dudley). Our long term Strategic Plan (2014-2019) outlines what we commit to deliver over the next five years:

Promote good health and wellbeing; reduce inequalities in health; and commission services and interventions that help us achieve those goals.

Privilege services which operate on a population basis and which are designed to support health and wellbeing – particularly primary care prevention services.

Recognise the key role of the individual person, in contributing to their personal health and wellbeing – and the collective engagement of the local population in contributing to their collective health and well-being; so promoting recognition of autonomy for the individual alongside mutual roles and responsibilities.

To do this we will develop our mutualism concept to include the registered population of our member practices encouraging people to take responsibility for their own healthcare; we will develop patient involvement through consent and true participation through our GP Practice Patient Participation Groups; we will implement integrated working including all primary care, community, mental health and social care services at a practice, locality and borough wide level making the changes necessary to provide the efficiency savings to support the Better Care Fund; we will manage our own financial challenges and that of our providers; develop high quality primary care via the implementation of our Primary Care Development Strategy and development of proposals surrounding joint commissioning with the Area Team; redesign urgent care and develop a new Urgent Care Centre for the borough. Our key aims are to improve: healthy life expectancy; health outcomes; quality and safety; and system effectiveness. We will allow variations in the delivery of services to reflect different needs and inequalities in health in our local communities; however we will remove variations in performance and clinical practice which adversely affect the delivery of health outcomes. Our key outcome objectives are:

Effective and efficient care Healthy life expectancy Mutual approach to achieving best possible outcomes High quality care for all

Our organisational development plan responds to our strategy by explaining how our structures, business models, service provision and organisational cultures will be radically reassessed in light of the social, economic, technological, environmental and economic challenges we face. Our strategy describes how we will place the patient at the centre of our networked community. Our organisational development plan delivers our strategy around clinical leadership and putting primary care at the heart of everything that we do. Our structure is the way our organisational is built; currently 47 member practices arranged in five localities with a team of people employed to support our organisation

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to fulfil its duties. Our structure is driven by improving the health and wellbeing of our population and improving the quality of treatment services we purchase on behalf of our registered population. Our governance structure places clinicians and patients at the centre of everything we do. Our Clinical Executives chair our Committees, with vice chairmanship provided by our members. We have ensured that we have clinician and lay members as majority members of our committees. The structure is as follows: Each committee is chaired by a Clinical Executive (with a Lay Member Vice Chair) and meets on a monthly basis reporting to the bi-monthly CCG Board. The table above shows the responsibilities of each committee. We will be undertaking a review of the effectiveness of both our governing body and our committees during 2014. As local leaders of the NHS, our relationships with our patients, partners and providers are critical to our collective success for the registered population of Dudley. Our strategy recognises the importance of mutual engagement which is balanced alongside responsibilities, enabling our registered population to use resources responsibly and to recognise they are part of a community (CCG) and the community is part of them. We ask our population to take responsibility for managing their own health and wellbeing as much as possible. In return we will develop an active membership programme that incorporate a patient portal providing health and wellbeing, access to their own healthcare records and clear mechanisms for access to their local healthcare services through their GP. Our GP membership, arranged around our localities, are the closest we can get to our registered population. Our membership are trusted by our population and they know the needs of our patients the best. Our priorities and decision making is led by our GP membership and we have ensured that we have opportunities for clinical involvement at every level within the organisation. Primary care is at the heart of our

Governing Body (setting strategy and governance)

Finance & Performance Committee

(holding the system to account)

Communications & Engagement Committee

(engaging public and patients)

Audit Committee (governance)

Remuneration Committee

(governance)

Clinical Development

Committee (implementing

change)

Quality and Safety Committee

(holding system to account)

Primary Care Development

Committee (enabling

membership)

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organisation and we are embracing the opportunity to work alongside NHS England to pilot co-commissioning primary care services. One of our key priorities for the next two years is integrating health and social care community services around our GP membership practices. We are working closely with Dudley Metropolitan Borough Council, Dudley Group Foundation NHS Trust, Dudley and Walsall Mental Health Partnership Trust and Dudley Council for the Voluntary Sector to create the mechanisms for teams without walls focussed around the patient. Our CCG Board has recognised its duty to understand the requirements of equality legislation and how this must influence the CCG’s approach to commissioning. To enable this, Dudley CCG was funded by the NHS Institute for Innovation and Improvement, supported by Shapiro Consulting Ltd (specialists in effective diversity management) to work through the Connect Programme. The Connect Programme enabled inclusive leadership in practice and covered the following three objectives: 1. Develop the commitment, confidence and capabilities of the Dudley CCG

Board and senior management team to successfully lead and embed equality, diversity and inclusion into its commissioning system, governance process and organisational culture.

2. Increase the effectiveness of Dudley CCG and the Health and Wellbeing Board to work in partnership to advance equality, diversity and inclusion across the local healthcare system.

3. Build the capacity of Dudley CCG to help ensure that it meets statutory equality requirements and build on the potential opportunities offered by diversity and inclusion to achieve critical outcomes including improvements in QIPP and patient safety.

The outcome of this work will be a refreshed CCG Equality and Diversity Strategy that recognises best practice and reflects our strategic and operational plans. The Equality Delivery System described within the new legislation sets out two clear objectives for staffing and leadership, which are used as a guide to the organisations development. These are: For staff – increase the diversity and quality of the working lives of the paid and non-paid workforce, supporting all staff to respond better to patients’ and communities’ needs. The desired outcomes are: • Recruitment and selection processes are fair, inclusive and transparent so that

the workforce becomes as diverse as it can be within all occupations and grades. • Levels of pay and related terms and conditions are fairly determined for all posts,

with staff doing the same work in the same job being remunerated equally. • Through support, training, personal development and performance appraisal,

staff are confident and competent to do their work, so that services are commissioned or provided appropriately.

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• Staff are free from abuse, harassment, bullying, violence from both patients and patients’ relatives, and from their colleagues, with redress being open and fair to all.

• Flexible working options are made available to all staff, consistent with the needs of patients, and the way that people lead their lives.

• The workforce is supported to remain healthy, with a focus on addressing major health and lifestyle issues that affect individual staff and the wider population.

For the Board – ensure that equality is everyone’s business, and everyone is expected to take an active part, supported by the work of specialist equality leaders and champions. The desired outcomes are: • The CCG Board and senior leaders conduct and plan business so that equality is

advanced, and good relations fostered, within the organisation and beyond. • Middle managers and other line managers support and motivate staff to work in

culturally competent ways within a work environment free from discrimination. • Use the NHS Equality and Diversity Competency Framework to recruit, develop

and support strategic leaders to advance equality outcomes. To achieve these outcomes, the CCG will need to have good quality information about the workforce, disaggregated by race, disability, gender, age, sexual orientation and religion or belief. This information is provided to our Remuneration Committee on a regular basis. We will seek to use our influence as leaders and commissioners of local healthcare services to ensure that provider organisations and commissioning support services adopt a similar approach to equality and diversity through our contractual arrangements. To be an inclusive organisation as set out in our values, our workforce will be supported and feel confident in their ability to challenge discrimination, advance equal opportunities, foster good relations and safeguard human rights, as directed by the NHS Constitution. How we co-ordinate technology to enable our mechanisms will be a key enabler to the development of our organisation. Our IT Strategy sets out our intentions over the next two years and by the end of June 2014 we will have every one of our member practices on the same IT system (Emis web). This will enable records to be shared, increase the opportunities for patients to be treated at other surgeries for special services, and will mean that the GP systems will be connected to our out of hours and urgent care primary care services (our Urgent Care Strategy outlined in our Operational Plan). With primary care at the heart of what we do, we must ensure that we are creating opportunity for improving our primary care estate through our Primary Care Estate Strategy. We have already undertaken a tabletop analysis of our estate, and will commit to a further indepth review to identify estate that is in need of improvement or replacement over the next five years. This will be translated into a priority plan for investment that is developed and agreed by our membership.

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We clearly articulated to our providers at our Commissioning Conference in September 2013 that we will be moving away from activity driven performance monitoring and will only commission services from providers who are able to demonstrate the value they have made to a patient’s life. By participating in the Building Healthy Partnership project we have worked closely with one of our voluntary sector providers (Summit House) to develop a tool to measure social value (PSIAMS). We will be expanding the use of this tool across our providers. We are committed to “thinking differently” and have a culture that embraces innovation and ideas on how we can work to achieve different outcomes. We commit resource every year to enable innovation and this resource is split equally across our five localities. Ideas will be generated from our membership each year, and in future we plan to introduce a “Dragons Den” style approach to encouraging new ideas to come forward from our GP members and CCG teams. Our rewards describe the way we recognise staff for the contribution to our organisation and their achievements. The culture of our organisation is set by our values and behaviours; the values that are set by our own team:

The values are embedded in the staff contract and we use the values to recruit to new members of the team and over the coming months every member of our organisation will be trained in how to recruit staff on the same value set as our own. We have also revised our process for appraising our staff and have designed a process for performance development and appraisal that is based on our values. This is supported by a 360 degree appraisal (again based on our values and obligatory for any member of our team who has management responsibility).

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Successful completion of our performance review will see staff rewarded by pay progression through the incremental ranges of their band. This will be rolled out for all staff within the CCG during 2014/15. Our teams are also rewarded by the training and development that is offered to them. For our CCG staff team, training and development needs and opportunities will be developed through their performance development review. We recognise our staff are our strongest asset, and wholeheartedly commit to providing staff with opportunities to develop both within and outside our organisation. We are an active participant with the national CCG development team and have strong connections with the Leadership Academy. These relationships enable us to both shape and participate in development for staff in CCGs across the country. We support coaching for staff, commit to fund organisation wide development (such as the HFMA finance modules for all staff) and are keen to enable every member of our team to reach their full potential. The development of staff within our membership practices is of equal importance. We have a budget dedicated specifically to practice staff training and will create plans for development for Practice staff, Practice Managers and Practice Nurses. This is alongside the educational programme we also run for our GP members. We recognise the contribution of our staff each week with our CCG “Star” of the week. This is awarded to an individual who has gone above and beyond the call of duty and shone to their peers. It is peer nominated and is awarded by the Chief Officer at the weekly staff briefing. We are also celebrating our first year with an award ceremony that recognises and rewards its members and staff. The award categories are as follows:

Innovation of the Year Thinking and Doing Differently Working in Partnership Improving Patient Care GP of the Year Practice Manager of the Year Practice Nurse of the Year CCG Star of the Year Dr Liz Pope Award for Outstanding Contribution (in memory of one of our

inspirational leaders) These awards will be given at the same time as our Long Service Awards, and will follow our Annual General Meeting. The rewards for our patients will be through our commitment to commission services that add value to their lives, our promise to only commission services of high quality and our dedication to empowering the patient voice to have more influence over decisions that are made about their healthcare and increase the opportunity for engagement. Our Operational Plan describes how we will ensure the best possible outcomes for our registered population by improving the patient experience and value added outcomes of healthcare, increase early detection of dementia, improving individual autonomy and improving access and choice of services. A

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number of specific initiatives have been agreed that will enable commissioning for value added outcomes:

Citizen empowerment and engagement (active citizenship leading to social prescriptions)

Elective pathway modernisation (streamlined pathways leading to a reduction in outpatient attendances)

Integrated care (aligned health and social care teams providing proactive care leading to a reduction in emergency admissions)

Community rapid response (alternative to ambulance conveyance leading to a reduction in appropriate hospital admissions)

Integrated urgent care (providing a single point of access to reduction A&E attendances)

Systematic management of long term conditions (service delivered that respond to health inequalities leading to modelled prevalence for heart failure and chronic kidney disease)

Quality programme (implementation of CQUINs and quality initiatives that lead to 7 day working across acute and community services)

Primary Care Strategy (delivering primary care at scale leading to higher quality services and federated localities)

Market shaping and development (creating responsive integrated community services by subjecting some services to AQP)

All of the above initiatives will be delivered within the next two years. Our strategy demonstrates how we will commit to removing unwarranted variation in care and evaluating individual clinical performance to inform patient choice. We will commission a specific piece of work that analyses the performance and outcomes of our clinical providers of care best value in both financial and outcomes. Patient and public engagement has been and will remain of vital importance in the development of our organisation. We are creating a mutualist based relationship with member practices and their registered membership by development of our Patient Participation Groups. The majority of our practices have a Patient Participation Group, and our aim is for every practice within the borough to have an active Patient Participation Group by end of March 2015. We will continue the work that we have started to develop these groups, enabling them to develop at their own pace with a bespoke toolkit that will help them develop the skills they require to be effective. We are currently working with the groups to look at a structure that would enable them to have a locality influence and a stronger voice at Board with the possibility of a member of the public having a place at the Board. We have engaged our PPG representatives in a development workshop with our Board and will be repeated this over the next two years to test whether patient engagement is as influential as it can be. Our mutualist approach will endeavour to create a more engaged relationship with our registered population, enabling them to have a clear share in how services are shaped and developed; as well as a more personalised service which encourages more autonomous self management. Most importantly our members will know, value and understand the benefits of being a member of our CCG. We work closely with

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our local Healthwatch, who have a place on our CCG Board. We also have an established Healthcare Forum which meets on a bi monthly basis and discusses items of strategic importance to the CCG. Each Healthcare Forum is chaired by either our Chair or one of our Clinical Executives and is well attended by our membership population. They are an important forum for consultation and their views are taken very seriously when planning services or changes. We require strong, inspirational and motivational leadership to enable our organisation to reach its full potential and ambition. As the local leaders of the NHS we have established the Dudley Leadership Group which includes Chief Officer level membership of our local organisations (CCG, acute trust, mental health trust, local authority and voluntary sector). This group will continue to hold a strategic focus on the development of services in the borough. We also have strong connections through our local Health and Wellbeing Board, who also undertake regular development to ensure they are operating at their optimum effectiveness. We will endeavour to continue to provide influence and drive to our local Health and Wellbeing Board. We established a Collaborative Leadership Team with our main acute provider (Dudley Group Foundation NHS Trust) during the summer of 2013 and this has enabled a deeper understanding of both organisations and enabled the relationship of commissioner and provider to develop in a much more constructive way. We have now established a similar group with our local mental health provider (Dudley and Walsall Mental Health Partnership NHS Trust). We have also established quarterly Board to Board meetings with these organisations to discuss and progress strategic alignment, and we will also be establishing Board to Board meetings with West Midlands Ambulance Trust and Black Country Partnership Trust. We have embedded a network leadership model that enables leadership at every level within the organisation. One of our values is responsibility and we encourage our staff to take responsibility and demonstrate leadership at every level. We are committed to being a learning organisation and embrace opportunities to participate in research through our member practices. We will be appointing to a GP Clinical Lead for Research after which we will review our Research Plan. To support our commitment to education and research we have developed links with the Health Services Management Centre in Birmingham and will be progressing our work in this area over the next two years. We will be also forming alliances with other local academic institutions as we develop our educational programme for our member practices. We have an active interest in publishing the work that we are leading on, and have recently submitted an article to the European Health Management conference on our work with the voluntary sector through Building Healthy Partnerships. We have plans in place to publish our work on our mutualism strategy and will be presenting at a conference in Copenhagen in 2014. Alongside all of the above is the development of our CCG as it matures to a high performing organisation capable of transformation, innovation and commissioning at the most effective level. Our commitment to organisational development is

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demonstrated by our decision to provide our organisational development expertise in-house following appointment to our Organisational Development Practitioner in June 2013. This role sits alongside the Chair and Chief Accountable Officer and whilst holds senior management responsibility (for human resources and CCG administration), sits separately to the remainder of the senior management team to enable an external view. Our Organisational Development Practitioner is supported by external expertise, through strategic partners and organisational/leadership development providers. Our focus on organisational development has been fundamental to the success of our CCG to date and we are committed to participating in research and theoretical studies to underpin the areas suggested within the Strategic and Operational Plans and will publish our work accordingly. OUR INTERNAL DEVELOPMENT PLAN The culture of our CCG has always been clear; our organisation is clinically led and is a membership organisation configured by our local GP practices. We take clinical engagement very seriously and have been recognised nationally for our commitment to the importance of clinical engagement. We invested early in our journey in a GP lead for engagement of our membership. This role is undertaken by a retired Dudley GP who is well respected by all his colleagues within our GP community. He works in partnership with our Head of Membership and their team connect with every practice to help them develop as both commissioners and providers of high quality primary care. The impact of this team on the development of primary care and commissioning has been phenomenal and is a function that the CCG seeks to build on in the future with the recruitment of specific GPs with special interest to develop the clinically led commissioning function. This team is the eyes and ears of primary care and influences at every level in the organisation. Our CCG Constitution was developed in collaboration with our constituent practices, our LMC and the expertise of BMA lawyers. All practices were engaged in its development and have ownership of the constitution, which is reviewed every six months. Our member practices elect two GP representatives (based on a three year term) to represent their locality on the CCG Board (governing body). Each elected locality GP has a specific area that they provide clinical leadership expertise on. Specific development is given to the elected locality GPs to ensure they have the skills and expertise to lead their localities and clinical lead areas. Each elected GP will have their development plan reviewed within 2014/15. We have developed a Clinical Leadership Structure (see overleaf) which is led by four appointed Clinical Executives. This structure includes the clinical lead areas of the GP elected Board members and also other clinical leads. This structure was reviewed in November 2013. Clinical Executive posts are in the first instance ringfenced to GP elected Board members only (as per the CCG Constitution) and if not appointed to from the GPs on the Board they are then open to any GP across Dudley to apply. Clinical Lead roles however are automatically made available to all GPs across the borough. Our Clinical Executives are:

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• Clinical Executive for Finance and Performance (Dr Jas Rathore) • Clinical Executive for Quality and Safety (Dr Ruth Edwards) • Clinical Executive for Acute & Community Commissioning (Dr Steve Mann) • Clinical Executive for Integration and Partnerships (Dr Steve Cartwright) Three of our Clinical Executives are GP elected Board members. The fourth (Clinical Executive for Integration and Partnerships) is by appointment a co-opted member of the Board (non-voting). Each Clinical Executive is appointed for a term of three years. Every Clinical Lead post has been aligned to one of the Clinical Executive portfolios in the structure to strengthen leadership and to provide clear reporting mechanisms and accountability. All of the GPs that have a place on the Board (voting or non voting) participate in our Clinical Forum. Clinical Forum is informal; clinician led and meets monthly to provide an avenue for ideas, innovation, debate, discussion and challenge away from the formal board table. The introduction of Clinical Forum has had a tremendous impact on the engagement of our clinical leaders and the development of localities. It enables ideas to be generated and move forward much quicker than they did before. Clinical Forum is deliberately informal and is a model that the CCG intends to follow when developing all of its locality forums.

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Chair (Dr D Hegarty)

Clinical Executive Integration & Partnerships

(Dr Steve Cartwright)

Clinical Executive Quality and Safety (Dr Ruth Edwards)

Clinical Executive Commissioning (Dr Steve Mann)

Various clinical areas (vacancy)

Meds Management (Dr PD Gupta)

Various clinical areas - vascular (Dr J Darby)

End of Life/Cancer (Dr Lucy Martin)

Diabetes (Vacancy)

Respiratory (Dr Mark Hopkin)

Clinical Executive Finance &

Performance/Primary Care (Dr Jas Rathore)

Primary Care Development/GP Mentorship (Dr K Dawes)

IT & Caldicott Guardian (Dr R Johnson)

Primary Care Engagement (Dr R Gee)

Corporate Systems & Redesign (Dr J Darby)

Safeguarding/Q&S Support (vacancy)

Mental Health (Dr M Mahfouz)

Children’s (Dr T Horsburgh)

Prevention, Older People & Dementia (vacancy)

Pain (Dr Richard Johnson)

GP Education & Research (vacancy)

Innovation (Dr Richard Johnson)

Clinical Leadership Structure

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Development of our CCG Board Our Board began meeting in public in July 2012 and held its first meeting as a statutory organisation in April 2013. The voting members of the Board are as follows: Dr David Hegarty (Chair) Dr PD Gupta & Dr Mona Mahfouz (Dudley and Netherton locality) Dr Richard Johnson & Dr Jonathan Darby (Halesowen and Quarry Bank locality) Dr Jas Rathore & Dr Kevin Dawes (Sedgley, Coseley and Gornal locality) Dr David Hegarty & Dr Steve Mann (Stourbridge, Wollascote and Lye locality) Dr Ruth Edwards and a current vacancy (Kingswinford, Amblecote and Brierley Hill locality) Chief Accountable Officer (Paul Maubach) Chief Finance Officer (Matthew Hartland) Chief Quality and Nursing Officer (Rebecca Bartholomew) Secondary Care Clinician (Mary Heber) Lay member – governance (Steve Wellings) Lay member – patient engagement (Julie Jasper) Lay Member – quality and safety (Chris Handy) Chief Executive of Dudley Metropolitan Borough Council (John Polychranakis) The non-voting members of the Board are: Director of Public Health (Valerie Little) Clinical Executive for Integration and Partnerships (Dr Steve Cartwright) LMC Representative (Dr Tim Horsburgh) Also in attendance are: GP Engagement Lead (Dr Richard Gee) Head of Commissioning (Neill Bucktin) Head of Membership (Daniel King) Head of Communications and Engagement (Laura Broster) Organisational Development Practitioner (Stephanie Cartwright) Healthwatch (Jayne Emery) The Board of the CCG have been involved in a Board Development programme since its appointment in 2011 and this programme will continue over the next two years. This programme has covered the development of the CCG vision and values, understanding what it means to sit on the Board of a public statutory organisation, up skilling Board members in key business areas (eg finance, commissioning, engagement, communications, governance, media, safeguarding and quality) and its function to hold the organisation and local health system to account. In addition to the Board Development Programme, individual Board members also receive additional input to ensure they are upskilled to the level of existing Board members who have more experience. This additional input is delivered by the Chief Finance Officer and Organisational Development Lead and specifically focusses on

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the history and commissioning journey in Dudley, with detailed explanation of the governance and financial reporting and assurance mechanisms and explanation of commissioning processes. It also covers work on behaviours and any specific skills enhancement that may be required. Our Lay Members play a vital role in holding the CCG to account and provide valuable assistance and guidance to those newer members who do not have the same level of experience. Each of our Lay Members has a particular area of focus and are designated committee level representation appropriate to their focus area. The same applies to our clinical board members who have specific lead areas as part of their Board member role. When our Board was first formed, we produced our CCG Code of Conduct which was collectively agreed to adhere to. The Code of Conduct was developed to ensure the CCG Board was upholding high standards of behaviour and etic ate that would set an example to the rest of the organisation. Our Code of Conduct is embedded within the organisation; abided by our Board Members and others and referred to should the need arise. Our CCG Code of Conduct is as follows: The Dudley Clinical Commissioning Group agree to abide by the Nolan Principles of Public Life: Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. Openness Holders of public office should be as open as possible about all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. Honesty

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Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. Leadership Holders of public office should promote and support these principles by leadership and example. The Dudley Clinical Commissioning Group Board members will aim to: • Respect one another as possessing individual and corporate skills, knowledge

and responsibilities. • Show determination, tolerance and sensitivity, posing rigorous and challenging

questions, tempered by respect. • Show group support and loyalty towards the CCG and each other. • Listen carefully to all ideas and comments and be tolerant to other points of view,

being sensitive to colleagues’ needs for support when challenging or being challenged.

• Be honest, open and constructive. • Be courteous and respect freedom to speak, disagree or remain silent. • Embrace challenge and regard challenge as a test of the robustness of decision

making processes. Ensure no one becomes isolated in expressing their view and treat all ideas with respect.

• Read all papers before the meeting and clarify points of detail with the relevant author before the meeting. Arrive punctually, participate wholeheartedly and try where possible to stay for the duration of the meeting.

• Ensure papers are distributed 7 days in advance of the meeting, and avoid where possible tabling papers at meetings.

• Dispose of papers appropriately as confidential waste. • Focus discussion on material issues and on their resolution, allow differences to

be forgotten. • Make the most of time available by supporting the chair, colleagues and guests in

maximising scope and variety of views heard. Individual points should be relevant and concise.

• Ensure mobile phones are on silent if they need to be left on, and leave the room to take a call if the call is urgent.

• Remember that we are representative of the whole of Dudley, not representing localities or individual practices.

• Be supportive of the decisions of the Board, even though as individuals we may not agree.

• Embrace the use of technology that has been made available. • Treat each other as adults, and behave in an adult manner. The Dudley Clinical Commissioning Group will aim to not: • Keep referring to past history or previous disagreements. • Regard any arrangements as unchangeable or unchallengeable. • Adopt territorial attitudes, any member of the team has the right to challenge and

question another.

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• Be offensive or act in an attacking, crushing or dismissive manner, and will be ready to apologise.

• Take offence or take comments personally, and always remain open to discussion.

• Regard papers as being ‘rubber stamped’ without discussion or agreement. • Breach confidentiality. Our Executive Team The CCG Executive Team is a combination of the Chair and Clinical Executives alongside the CCG senior management team. It has been established since April 2011 and meets on a weekly basis. The structure is shown below: The Executive Team is well established and ensures that clinician and management partnership is embedded at the helm of the organisation. It has responsibility for ensuring the smooth day to day running of the CCG, referring items appropriately to relevant CCG Committees or to the Board. This team undertakes specific facilitated team development; as both clinical and management teams and collectively as the Executive Team. We include personality profiling, 360° appraisal and work continuously to develop and enhance the performance of this team and the individuals. We will continue to undertake their team and individual development throughout the life of this organisation to ensure we are developing a leadership team capable of taking our ambitious organisation to where it aspires to be. It is imperative for this team to operate effective and to demonstrate inspirational leadership to all of the staff team and our member practices. Our Executive Team have participated in two strategic retreats, and these will continue every six months for the next two years. These retreats provide an opportunity for reflection on the effectiveness of both the organisation and the team,

Chair

Chief Accountable Officer

Clinical Executive Finance & Performance

Clinical Executive Integration & Partnerships

Clinical Executive Commissioning

Clinical Executive Quality & Safety

Chief Quality and Nursing Officer

Chief Finance Officer

Head of Membership

Head of Commissioning

Head of Communications & Engagement

Organisational Development Practitioner

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the opportunity for blue sky thinking, strategic thought processing and planning for the sustainability of both the organisation and the local health economy. The most challenging area of development for the organisation has been the change of culture from a management led organisation to a clinically led organisation and this has not been underestimated. A membership organisation constituted by its GP Practices; with a clear commitment to clinical leadership partnered with management expertise has been the continual focus of our organisational development plan to date. It has been imperative to ensure that both Clinical Executives and Senior Managers have demonstrated strong, trustworthy and reliable leadership styles and they have been continually supported to do this. This leadership team are responsible for leading and empowering others to work in innovative ways and to think differently to how they have thought before. Chair and Clinical Executives Our Chair (Dr David Hegarty) was appointed in 2010 and elected to the Board in November 2011 for a three year term. Shortly afterwards, our Clinical Executives were appointed following a recruitment process in January 2012 and they are subsequently recruited to as vacancies arise. These appointments are also for a three year term. Development Plans are produced for the Chair and each Clinical Executives which focus on the development needs specific to the particular individual. These include leadership development, skills development, mentoring or coaching and are reviewed on a regular basis. Each Clinical Executive is also expected to undertake a health service recognised senior leadership programme if they haven’t already (eg. Aspiring Directors). The Chair and each Clinical Executive receive regular input from the Organisational Development Practitioner as part of their ongoing development. Lay Members Our CCG has three lay members and a Secondary Care Clinician, who is also considered part of the lay member team. They are as follows: Lay Member for Governance Steve Wellings Lay Member of Patient Engagement Julie Jasper Lay Member for Quality and Safety Chris Handy Secondary Care Clinician Mary Heber Two of our lay members (Lay Members for Governance and Patient Engagement) and our Secondary Care Clinician were appointed prior to authorisation following the national guidelines for roles required on CCG Governing Bodies. Both of Lay Members had previously held Non-Executive Director roles on the Dudley PCT Board and therefore brought with them a wealth of experience. Our Secondary Care Clinician also bought with them significant expertise in secondary care which has had a profound effect our Board and in our committees. Our third Lay Member was appointed last year following recognition that quality and safety was such a significant area of focus for the CCG, and acknowledgement that the demands on our lay members was increasing significantly.

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Our Lay Members provide very valuable input to our organisation. They provide challenge where they should and hold a mirror up to the team enabling us to reflect on our development. Because of their experience, they provide a sense check that enables us to move forward appropriately and their collective experience at Board level provides a necessary balance with more inexperienced members of the Governing Body. They meet regularly with the Chair and Chief Accountable Officer, provide vice chairmanship to our committees and maintain links on national programmes to ensure their own development and that of the organisation are maintained. Senior Management Team Our Chief Accountable Officer (Paul Maubach) was appointed in July 2012, closely followed by our Chief Finance Officer (Matthew Hartland) and Chief Quality and Nursing Officer (Rebecca Bartholomew). These three posts are voting members of the CCG Board and therefore have titles that distinguish their difference within the senior management team. Our Head of Commissioning (Neill Bucktin), Head of Communications and Engagement (Laura Broster) and Head of Membership (Daniel King) are the remaining members of the Senior Management Team. Our Organisational Development Practitioner (Stephanie Cartwright) also has senior management responsibility but as described earlier, this role sits outside of the team to offer reflective input and development support. Regular dedicated team development is crucial to the effectiveness of the senior management team. Each member of the team is encouraged to identify a mentor to enhance their own personal development and performance. Individuals are also encouraged to undertake leadership development (eg Top Leaders, Aspiring Directors, Leadership Academy programmes) to enhance their performance and develop their skills. The Chief Accountable Officer and senior management team receive regular input from the Organisational Development Practitioner as part of their ongoing development. Our Staff Team As part of our authorisation process, we undertook a thorough options appraisal of the make/buy/share arrangements for CCGs and developed an organisational structure for the CCG with designated support functions to be bought from our local Commissioning Support Unit (CSU). This structure was reviewed in April 2014 as part of our assessment of our efficiency and effectiveness and as a result various changes will be made to these arrangements. Our CSU embedded teams will continue to be recognised as important parts of our organisational structure and are included in our team development. The majority of our employed staff were appointed by July 2012 which enabled the organisation to function completely in shadow form for at least six months before formal authorisation and inauguration as a statutory body. Amendments have been made to structures to meet the needs of our changing environment. Significant time and resource has been and will continue to be invested in team development to ensure the team grows and develops as the organisation matures. Particular focus and energy is given to the organisational culture as a membership organisation, a

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clinically led organisation and most importantly a learning organisation that we all feel proud to be part of. The working relationships between clinicians and management support and how these relationships are maximised to their full potential has been and will continue to be a key focus, recognising the strengths that this partnership brings. Following the appointment of the Chief Accountable Officer in July 2012, the organisational structure was reviewed, commencing with the senior management team. Communication is key to the success of our CCG. Weekly staff briefings are led by our Chief Accountable Officer or deputy (Chief Finance Officer) and include all members of our staff team. We also hold monthly Staff Development sessions where the staff team come together to discuss development areas of the organisation and ensure staff are involved in decision making and organisation priorities. We have a staff side recognition agreement and two staff side representatives who provide useful advice to all of our staff. We have an established staff forum which is led by our staff side representatives and is attended by a member of staff from each of our teams, on behalf of each team. During 2014 we will be developing a Talent Management Strategy for our workforce. We are lucky enough to have many rising stars within our staff team, and our Talent Management Strategy will outline how these stars can be identified and supported substantially in their development. Our Member Practices Specific development is focussed in enabling our member practices to grow in their role as clinical leaders and commissioners. This is achieved through regular twice yearly visits from our Membership Engagement Team (led by our GP engagement lead) and also an annual visit from our Chief Accountable Officer. Support will continue to be given to the evolving role of our locality meetings and also to our full membership engagement events. We use a star of engagement to plot how engaged member practices feel and whether they feel they have an arena where they can share their views. This is regularly reviewed and acted upon to ensure that we are engaging effectively with our membership.

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OUR EXTERNAL DEVELOPMENT PLAN Development of our Patient Population The development of our registered population is crucial to the implementation of our mutualism strategy. We want to create a patient population that takes responsibility for its own health and wellbeing. To do this we intend to privilege our registered population via our member practices and develop our interaction and engagement through our Patient Participation Groups (PPGs). We currently have 41 practices out of 47 who have a Patient Participation Group and our intention is that by the end of 2014 all practices will have a group established. We want our patients to take more ownership for their own healthcare, and to be actively involved in how we improve the health outcomes of our population. We will do this by developing our PPGs to have a more influential voice within the CCG, through practice, locality and Board level. We have commissioned a project via the Voluntary Sector that will work with these volunteer groups to help them to grow and develop to be more effective and efficient in their operation, particularly around power and influence. We are working on this agenda in partnership with our member practices, therefore the outcome of this work will be shared responsibility for healthcare and wellbeing. Development of our Membership Dudley CCG recognises the importance of sustainable primary care that is fit for purpose. Our Primary Care Development Strategy has been regionally acclaimed by NHS England. It describes the areas of focus in primary care development and will be refreshed following the recent publication of our Strategic and Operational Plans. Senior management from the CCG meet regularly with senior representation from the NHS England Team (responsible for commissioning primary care) through a Primary Care Interface Group. Dudley CCG is ambitious in its plans for co-commissioning of primary care with NHS England, acknowledging the benefits of improving the quality of primary care. We have invested in work with the Primary Care Foundation, who have worked with every one of our GP practices in producing a Practice Development Plan designed to help them improve their efficiency, access and appointment times for our patients. The CCG will use the information within the development plans to produce workforce development and succession plans for our GP workforce. In Dudley 10% of our GPs are over 65 years old and 27% of our GPs are over 55 years old. This is also mirrored in our Practice Nurse workforce therefore plans will need to be developed that set out how will we will continue to attract and recruit to our clinical primary care workforce along with a Succession Plan to outline how we intend to fill vacancies that arise. This will be particularly challenging as GP recruitment is a national problem, not just a local problem. We will work with our local medical schools to ensure newly qualified GPs are aware of the opportunities in Dudley and will work on how we market the Dudley borough as a place to live and work for GPs. Communication with the membership practices is continuously reviewed for improvement and a membership bulletin is distributed on a fortnightly basis. The CCG Communications and Engagement Strategy was approved by the Board in 2013 and will be refreshed during 2014 following the publication of the five year

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Strategic Plan and two year Operational Plan, with particular emphasis on the next stages of the development journey for Patient Participation Groups. GP Education A programme of GP education events has been established that which takes place on alternate months to our Membership Events. The education events have a different emphasis and provide an opportunity for networking and team building alongside enhancing skills and knowledge in particular clinical areas. They are often organised with expertise from the secondary care sector working with GPs to discuss best practice in clinical care and patient pathways. Practice Nurse Development During our authorisation stage, an election process was undertaken for an elected Practice Nurse to represent the views of the workforce at Committee and Board level. A similar process was undertaken to GP election with Practice Nurses nominating themselves for election followed by a ballot to select the individual to take on the role. Due to personal circumstances, our elected Practice Nurse representative resigned from her role during the summer of 2013 and as yet the Practice Nurse workforce have chosen not to replace this role at the current time. This is part due to the appointment of our Chief Quality and Nursing Officer whose responsibility includes leadership and professional support to the Practice Nurse workforce. Regular engagement events have been established with our Practice Nurses to look at how as a workforce they can be more engaged with the CCG, network with each other and share best practice. Attendance can be variable based on personal choice and practice/workload demand. We will continue to work on the development of this part of the workforce and we will be producing a specific Education and Training Plan for Practice Nurses which incorporates the regular clinical updates that the staff need alongside specific development opportunities such as the Practice Nurse Diploma, Advanced Nurse Practitioner or Nurse Prescribing courses. Our intention is to partner with one of our local Universities to provide this development. The Practice Nurse engagement events will continue to ensure that as a group they feel valued and included to increase opportunity for networking with other colleagues. It is anticipated that as our integration work develops, this engagement agenda will spread wider into our community nursing workforce, with the intention of bringing together these groups of staff to work more closely together. Practice staff engagement is very important to Dudley CCG. The teams will strive for continuous improvement in communication and their expertise as they build a workforce sustainable for the future. It is imperative that they have ways to engage with the organisation and to ensure that they have a mechanism of enabling their views to be heard. Practice Management Development (Dudley Practice Managers Alliance) Dudley Practice Managers Alliance (DPMA) is an independent body which has been established for a number of years now. The Alliance brings Practice Managers

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across the borough together as a workforce on a monthly basis to share developments in General Practice, receive updates and to network/group problem solve etc. In addition to the Alliance, we also have an elected Practice Manager who was elected during authorisation to represent the Practice Manager workforce at CCG committee level. Our elected Practice Manager works in partnership with the DPMA to ensure their voice is heard. Their expertise influences debate and decision making particularly through our Primary Care Development and Finance and Performance Committees leading on key areas of work relating to these two areas. A specific budget is allocated to education and training for the Practice Manager workforce and the spend against this budget is agreed by the DPMA and CCG Head of Membership. Plans for 2014-2016 will include regular development updates for all staff and specific support for staff who want to undertake further education or development in specific areas of their role. Practice Managers possess a range of skills that support the efficient and effective running of our member practices. Similarly to many areas across the country, our localities are entering discussions around opportunities gained from federating or partnering with other practices (including the potential for a locally led GP provider company) to potentially share back office functions, develop shared expertise and increase their market potential. This agenda will need particular expertise and development as this develops over the next two years. Practice Staff Development The staff employed within our member practices are a valuable part of our workforce. They are often the first interaction with our patients before they receive any medical advice. They are a powerful source of knowledge and expertise and have the ability to direct our patients to the most appropriate source of medical attention that they need. In some areas however, they have been a part of the workforce that have received minimal development opportunities and we will be improving opportunities for staff over the next few years. A Training Plan will be produced for these staff which will include Amspar training for all staff for example, to bring the workforce to a consistent level across the borough. Development of the System Whilst we have responsibility for leading the local health economy, we cannot achieve fundamental change and improvement to the health and wellbeing of our population on our own. We will be working to develop our relationships with all of our members, providers, partners and patients through a variety of mechanisms to increase awareness, focus our efforts and align our strategies to achieve more through true collaboration.

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Implementation of Integrated Working High on the agenda for the next two years is the implementation of integrated working across the borough. Dudley CCG will be investing in an Organisational Development Programme to support the integration of community services for our registered population. The Integration Plan developed in collaboration with partner organisations (Dudley Group Foundation NHS Trust, Dudley Metropolitan Borough Council, Dudley & Walsall Mental Health NHS Trust and Dudley Council for the Voluntary Sector) outlines the vision of integrating primary and community health services with social care and the voluntary sector around our GP Practices who are organised in five localities across the Dudley borough:

• Halesowen & Quarry Bank • Stourbridge, Wollescote & Lye • Kingswinford and Brierley Hill • Dudley & Netherton • Sedgley, Coseley & Gornal Essentially, teams will be organised at three levels: • A “Practice/Community Integrated Team” directly aligned to the GP practice • A “Locality Integrated Team” combining teams that are only operationally efficient

if organised at locality level and who work closely with the Practice teams. • A “Borough Wide Team” which would consist of services that are of a small and

specialist nature and again only operationally efficient if organised at borough level who work closely with the practice and locality teams.

Services will be delivered through the most accessible and localised point. There will be a clear connection (a named individual) who relates between the three team levels. On a day to day basis the fundamental team that a GP Practice will relate to for the majority of support for their patients will be their Practice/Community Integrated Team. For some smaller practices, they may share a Practice/Community team with another practice, but the principle of named individuals will still apply. All teams will function on a 7 day basis eventually.

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Each locality will need to identify a GP lead who will support both the integrated teams at all levels, and also work with other GP locality leads to develop services to work continually on improving the patient journeys. These leads will be identified through the existing locality meetings and will be supported by the Clinical Executive for Integration and Partnerships. It is proposed that as soon as possible after 1st April 2014 the District Nursing and Virtual Ward teams will be working within the new integrated arrangements. These teams will “lead by example” throughout this integration programme and will enable other teams to learn from their experience and allow momentum to be gained. What is described above and within the Integration Plan requires a different way of working for all of the teams within the community providing health and social care. The biggest challenge to these new working arrangements will be the change of culture required. Simply rearranging staff teams will not work; real change will be delivered through hearts and minds. The organisational development process will be delivered by learning through doing. Staff will be engaged using real patient stories that each and every one of them will be able to relate to. The workforce themselves are the best people to advise on how working in different ways to achieve different outcomes can really be achieved. Leaders will inspire others by using these patient stories to reinforce messages to staff. The process will be led by the Organisational Development Lead at Dudley Clinical Commissioning Group but will involve staff from Dudley Group NHS Foundation Trust, Dudley & Walsall Mental Health Partnership NHS Trust, Dudley Metropolitan Borough Council and Dudley Council for Voluntary Services. Whilst each organisation will need to identify their leaders for integration; every member of staff who is involved in the new way of working will participate. The organisational development process will contain elements of the following: System Leadership Support External expertise with experience in integrating health and social care services was sourced during Autumn 2013 and this support has been working closely with the Integration Working Group. This group brings the organisations responsible for delivering this plan together and the external support provides robust challenge and facilitation to ensure this group is working to its optimum effectiveness. This support will continue throughout 2014. Change Management Programme To integrate services properly means radically changing the way that health and social care is delivered to Dudley CCG registered population and this involves a change to the way of working for all of the staff involved. These changes will need to be led by leaders across all of the teams and organisations who have been empowered to facilitate change, removing some of the organisational boundaries that currently exist that can and will hinder true integration, to create real teams without walls. Five change programmes, one in each locality, will be commissioned to develop leaders as change facilitators, empowering them with the skills necessary

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to lead their teams through the changes, to empower individuals in new working practices and to embed a culture that will be led by hearts and minds. Each programme will use the real patient stories that have been described above and will use the expertise of those working within the system to shape the culture. These leaders will need to work within their own and other organisations to enable true partnership working and therefore each programme will contain individuals from across the four organisations. The programme will involve taking the leaders through change methodology, looking at individual strengths and needs and up skilling individuals to facilitate change throughout the health and social care system creating a team of leaders across the health and social care system who can demonstrate real leadership by example. Organisation Wide Team Development Humans can be resistant to change for many reasons; change fatigue, fear of the unknown and not believing the change is necessary to name just three. Any successful leader needs followers who believe in the vision that they are working towards which is real improvement to patient care. This is where the real patient stories come to life and staff involved can shape the new arrangements based on their own experiences and learning. There is significant evidence to prove that the demonstration of the reasons for change is highly effective through theatrical production as it shows issues affecting real people and their lives through a thought provoking performance. Using this type of approach would be a powerful and engaging way of initiating this process with staff. A facilitative process will be implemented that will include every single member of staff that will be working as part of the integrated teams. This is anticipated to be in excess of 1,000 members of staff across all of the organisations. There will be a maximum of 49 practice teams and various other locality and borough wide teams that will all be included. This process will begin with specific inaugural events that will outline the reasons behind the changes and will involve the System Leaders themselves (Paul Maubach, Paula Clarke, Gary Graham, Andrea Pope-Smith and Andy Gray) sharing their thoughts and joint commitment to improving the lives of the patients of our registered population. The development process will continue over the next two years with specific work on culture and team development at GP practice, locality and borough wide levels (and including the staff working in General Practice). Staff will be encouraged to put the patient at the heart of the change and to share their expertise in how teams can work closer together to improve the patient journey ensuring that these changes are evolutionary whilst succinct across the borough. The CCG will work with the teams to agree improvement objectives based upon delivering better outcomes for patients and the better care fund targets. This will then be supported by an integrated performance framework so all staff can see how their work contributes to the whole improvement of the system One of the outcomes of the facilitated work with individual teams will be the identification of skills gaps and additional training needs, for example influencing and negotiating skills,

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assertiveness, team building etc. Therefore a designated allocation of funding will be available to support such training and development that is identified.

System Development By June 2014 all of our member practices will be on Emis web which will allow our registered populations records to be accessed via any surgery where they may be receiving treatment and in our new Urgent Care Centre which will be opening early next year.

Dudley CCG will be investing in the development of mobile IT for all teams to improve the amount of face to face patient time. This will include the establishment of a systems design team to work with the groups to ensure that the IT and software is developed with and involving the front-line staff and will include the connection of mobile systems with GP Practice systems to centralise the patient record. This will be supported by the development of patient consent; which allows patients to consent to sharing their records via their GP practice. Dudley CCG IT Strategy describes the system development in more detail.

Locality links with our Voluntary Sector

We are extended the remit of our integration plans to include the voluntary sector by investing in a project that will see a Link Worker in each locality tasked with being the interface between primary care and the sector. These roles will connect our GPs and community workers with organisations that can help their patients by looking beyond just the medical problem and looking at the patient and their way of life as a whole. There are many services that can help patients by providing interventions that will improve their quality of life and health outcomes without prescriptive medical intervention. We will be working closely with the sector to maximise this opportunity and encourage our population to see help from elsewhere than their GP.

CONCLUSION

We are an ambitious organisation, built on our values, that is determined to make a real difference to our registered population by being clinically led, thinking differently and working in a way that has not been done before. Our Strategic and Operational Plans are ambitions and set real challenge to our CCG; there is a lot to deliver. To realise our ambition and true potential requires dedicated and time and resource in organisational development and the intention of this plan is to demonstrate the priority it holds, and to prioritise where the time and resource will be spent. We will do this by privileging our member practices, our commitment to integration and our patients by making a real difference to their lives.

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OD IMPLEMENTATION PLAN

Model Component

Workstream Lead Deliverables External support required 2014/15 2015/16

Structure Housekeeping and hygiene factors (ensuring we have the basics right)

All Senior Managers

Complete all outstanding transitional work by the end of quarter one.

Professional development for all clinical staff

Rebecca Bartholomew

Ensure professional development and clinical supervision is in place.

Review

OD process to support integration

Steph Cartwright

OD process begins May 14 Tenders for facilitation and change management support

Continue with implementation

Review of Committee effectiveness

Matt Hartland Review by end of quarter 2

Estate Development Plan

Matt Hartland In depth review of CCG estate

tbc

Relationships Development of relationship with HSMC

Neill Bucktin Agree proposal Recruit Research Assistant Evaluation and review

PPG development Helen Ashford/Steph Cartwright

Aspire to establishment of a PPG in each practice. Develop toolkit Continue PPG development programme.

Continue PPG development programme.

Dudley CVS

Relationship with providers

Paul Maubach Board to Board meetings established will all main providers. Continuation of Collaborative Leadership

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Team meetings with DGFT and DWMHPT

Mechanisms All member practices on one system (Emis Web)

Matt Harland Achievement by July 2014.

Research and Innovation

Steph Cartwright

Revise plans Update plans if necessary

Sharing best practice

Paul Maubach Publication of articles key pieces of work

Leadership Recruitment training for all staff

Steph Cartwright & CSU (HR)

Training sessions for all staff

Refresher training via monthly staff development session

CSU HR Team

Equality and Diversity Strategy including refresh of EDS objectives

Steph Cartwright/ Neill Bucktin

Revised Strategy ratified by CCG Board by July 2014

Review

Equal Opportunities Policy

HR CSU/Steph Cartwright

Policy refresh and ratified by Remuneration ommittee

Review CSU HR Team

Succession Plan Steph Cartwright & David Hegarty

Separate plans for staff team, clinical leadership and membership

Review and update

Workforce Development Plan

Steph Cartwright

Production by the end of Quarter 2

Review and update

Communications and Engagement Strategy

Laura Broster Refresh

Primary Care Development Strategy

Dan King Refresh

CCG Board Development Programme

Steph Cartwright

Continuation of programme and review of Governing Body effectiveness.

Continuation of programme Sourced when required

Executive Team Development

Steph Cartwright

360 degree appraisals Six monthly retreats

360 degree appraisals Six monthly retreats

Simon Western (Privileged Conversations)

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Senior Management Team Development

Steph Cartwright

360 degree appraisals Dedicated time for team building and organisational objectives review

360 degree appraisals Dedicated time for team building and organisational objectives review

Clinical Leadership David Hegarty Appoint to all vacancies. Rewards Staff satisfaction

survey Steph Cartwright

Undertaken each year.

Values Based PDR process in place

Steph Cartwright

Policy ratified Training for managers PDR arranged for all staff

PDRs in place for all staff

Education and Training Plan

Steph Cartwright

Produced following completion of PDPs and consultation with membership Review of education in primary care.

Reviewed following PDPs and consultation with membership

Innovation Steph Cartwright/ Daniel King

Development of “Dragons Den” style process for innovation funding.

Purpose Develop concept of co-commissioning primary care with NHS England

Daniel King

Environment CCG development and leadership

Steph Cartwright

Sit on national group to shape development support to CCGs and design of leadership development opportunities

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Appendix 1 2014/15 CORPORATE OBJECTIVES

Model Component

Workstream Board lead Management Lead

Objectives External support requred

Q1 Q2 Q3&4

Purpose Strategic Plan David Hegarty Paul Maubach Approval of plan Embedding objectives

Board assurance

Operational Plan Clinical Execs Neill Bucktin Establishing PMO & PIDs

Board assurance

Prioritisation for 16/17

OD Plan – external

Clinical Execs Steph Cartwright

Approval of plan Building capacity in the system

Board assurance

For integration facilitation

OD Plan - internal

David Hegarty Paul Maubach

Steph Cartwright

Approval of plan PDRs, PDPs and Board programme

Board assurance

Financial Plan Jas Rathore Matt Hartland Ensure clear budget & QIPP plans for all areas

Board assurance on progress

Compliance with financial and QIPP targets

Commissioning for Quality

Ruth Edwards Rebecca Bartholomew

Proposals to Board for July

Finish restructuring

Board assurance

Trisha Curran

Structure Integrated Care Steve

Cartwright Neill Bucktin Building the

leadership Provider compliance to the model

Projects as per Operating plan

HSMC (on evaluation)

Integrated Care Steve Cartwright

Neill Bucktin Rapid response service

Evaluating performance

Reablement Care

Steve Cartwright

Neill Bucktin Personal budgets

Projects as per Operating plan

Urgent Care Steve Mann Neill Bucktin, Matt Hartland

Specification for UCC

Public Tender, new financial model

Competing tender process

CSU procurement

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Elective Care Steve Mann Neill Bucktin Project plans based on SDIP

Projects as per Operating plan

7-day working and parity of esteem

Steve Mann & Steve Cartwright

Neill Bucktin Schedule of 7-day services

Plan for implementation

Oversee roll-out

Relationships VCSE

Engagement Steve Cartwright

Laura Broster Richard Haynes Neill Bucktin

Consult with VCSE on input to integration

Setting up VCSE link workers

Membership Engagement

Jas Rathore Daniel King Ongoing programme of membership engagement events linked to CCG in-year plans

Patient / Public Engagement

David Hegarty Julie Jasper

Laura Broster Richard Haynes

Developing PPG training

Ongoing programme of public engagement events linked to CCG in-year plans

Dudley CVS

NHSE Co-commissioning

Jas Rathore Daniel King Joint workshop with NHSE

Implement shadow arrangements

DMBC BCF joint governance

Steve Cartwright

Neill Bucktin Establishing Performance Framework

Embedding Shadow arrangements

Prioritisation for 16/17

Patient Consent Jas Rathore Dan King, Richard Haynes

Develop patient consent specification

Test spec. and roll out implementation

Go-live for use of patient consent

Equality Diversity Inclusion

David Hegarty Steph Cartwright

Refresh Strategy

Establish Talent Mgmt plan

Mechanisms Single IT system Richard

Johnson Matt Hartland Complete EMIS

roll-out Agree data sharing protocols

Map out and begin realising benefits

EMIS

Commissioning-led IT

Richard Johnson

Matt Hartland Developing specification for whole community system

Begin tender process

Mobile IT Richard Johnson

Matt Hartland Testing options Begin roll-out Complete implementation

IT contract

PSIAMS Steve Cartwright

Neill Bucktin Tender for App development

Pilot testing Begin phased roll-out

Cloudberry & Dudley CVS

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Estates strategy Jas Rathore Matt Hartland Complete map of estates

Agree vision and rules with NHSE

Develop plans for priority areas

Estates specialists

Primary Care Innovation

Kevin Dawes Dan King Establish 14/15 innovation programme & training resources

Ensure implementation

Performance Framework

Jas Rathore Matt Hartland Single CCG framework

Ensure framework used and escalation process works

Clinical pathway monitoring

Jonathan Darby

Matt Hartland Develop concept

Pilot testing Use for 16/17 prioritisation

Deloitte

Risk Stratification

Steve Cartwright

Neill Bucktin Ensure full implementation

Test outputs with V.Wards

Embed way of working

CSU

Tendering services

Steve Mann Neill Bucktin, Matt Hartland

Tender for smaller scale community services in order to begin testing / shaping market provision

CSU

Medicines Management

PD Gupta Neill Bucktin Review current objectives

Ensure effectiveness in efficiency & quality improvement

Public Health

EPRR Rebecca Bartholomew

Rebecca Bartholomew

Ensure the CCG holds Providers to account for their EPRR role via Contracts

Leadership Governing Body David Hegarty Paul Maubach,

Matt Hartland Review Board effectiveness

Ensuring public accountability and compliance with these plans

Paul Capener

Good Governance

Steve Wellings, Non-Executives

Matt Hartland Audit plan for year

Audit Committee oversight on governance of CCG activities

H&WB Board David Hegarty Paul Maubach Sign-up to CCG strategy

Partnership working on key strategic themes

Primary Care Development

Kevin Dawes Dan King Review benefits of productive practice; develop capacity for a Quality Improvement Support Team

Primary Care Improvement

Richard Gee Dan King Application of the quadrant model in peer / performance meetings

Network Leadership

Steve Cartwright

Steph Cartwright

Network Leadership training and development programme

Simon Western

CCG Locality Leadership

Jas Rathore Dan King Move focus of all CCG engagement to localities

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System Leadership

David Hegarty Paul Maubach Ensuring effectiveness of the Dudley Leadership Group to coordinate partnership agenda

Communications David Hegarty Laura Broster Richard Haynes

Main consultation on care in last years of life

Health Scrutiny David Hegarty Paul Maubach Ensuring effective relationship with HOSC Rewards Values David Hegarty Paul Maubach,

Steph Caretwright

Build values and 360s into PDR process

Promote values within CCG on-going working and development

Better Outcomes Steve Cartwright, Jas Rathore

Neill Bucktin, Dan King, Matt Hartland

Develop shared outcome objectives across primary and community services – linked to BCF, QOF, Quality Premium & our strategic objectives

CSU (new community metrics)

Value commissioning

Jas Rathore Matt Hartland, Dan King

Develop Primary Care quadrant model

Plan on timetable for P.Care / PMS reviews

NHSE input

System efficiency

Jonathan Darby

Matt Hartland Developing systematic approaches to improving efficiency (eg: comms, referrals, invoicing)

Training & Development

Rebecca Bartholomew

Rebecca Bartholomew

Oversee application of ‘Care, Compassion, Competence, Communication, Courage, Commitment’ with primary & community nursing

Training & Development

Ruth Edwards (previous role)

Dan King Ensure we have a comprehensive Primary Care education and development programme

Celebrating success

David Hegarty Steph Cartwright

AGM and annual awards

Contract Performance

Jas Rathore Matt Hartland Ensuring effective contract management and penalty application with providers

Quality Improvement

Ruth Edwards Rebecca Bartholomew

Ensuring assurance on safety, safeguarding & quality improvement of all providers

Urgent Care performance

Steve Mann Neill Bucktin Ensuring efficient system working and performance through the UCWG

NHSE input

Integration performance

Steve Cartwright

Neill Bucktin Ensuring efficient system working and performance through the ICWG

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Appendix 1 Operational Plan on a page

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Appendix 2 Strategic Plan on a page