www.england.nhs.uk

Primary care co-

commissioning

update webinar

Primary Care

Co-commissioning Team,

NHS England

england.co-commissioning@nhs.net

14 July 2015

Publications Gateway Reference 03839

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Introduction

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Welcome and thank you for joining the latest co-commissioning

webinar. The webinar is supported by the following:

• Primary Care Co-commissioning Programme Director Julia Simon

• Senior Co-commissioning Manager Stefanie Rutherford

• Co-commissioning Project Officer David Peat

• Deputy Director of Organisational Change Rachel Patterson

• NHS England Central Finance Team Maria Murray

• NHS England Legal Team Sally Banham

• Planning and Assurance Manager Tom Houston

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Overview of the webinar

o - Next steps for the co-commissioning programme;

o - Delegated commissioning update;

o - Joint commissioning update;

o - Conflicts of interest management including frequently asked

questions;

o - QOF and DES;

o - Complaints handling;

o - Evaluation work;

o - Assurance and the 15/16 approvals process; and

o - Workforce update.

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Background and context

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• NHS England’s Commissioning Committee has agreed that the priority in 2015/16 should be to support the new general practice co-commissioning arrangements to embed. There are a number of on-going programmes to support implementation and some key challenges to address to ensure arrangements are sustainable long-term.

• The Committee has also recommended that we explore options for strengthening collaborative commissioning of community pharmacy services, with full and proper engagement of primary care teams, CCGs, NHS Clinical Commissioners and the relevant professional groups.

• The timeline for this work is to be confirmed, but it is likely that initial scoping work will take place between now and November. This will focus upon how we can strengthen partnership working between NHS England and CCG commissioners under the current legal framework.

• Scoping of dental and eye health services will be considered later this year.

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• In response to CCGs’ feedback on the delegation agreement and

request for further support in a number of key areas, we published the following last week:

• A set of model staffing documents to support the “assignment” and “secondment” models;

• Advice on information sharing, including person identifiable data;

• Claims and liabilities FAQs.

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Delegated commissioning update

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• One further CCG is taking forward joint commissioning arrangements

with NHS England in quarter two of 2015/16. This brings the total to 87

joint commissioning arrangements. A further 7 CCGs are expected to

take forward joint commissioning arrangements on 1 October 2015.

• Work is on-going to develop a memorandum of understanding for

joint committees, to clarify roles and responsibilities under the new

arrangements. This will be published in August 2015.

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Joint commissioning update

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• We held a pilot conflicts of interest training webinar for the North Region on 7 July, to provide further advice and support on implementing the conflicts of interest guidance. We are aiming to roll out the training to all regions.

• In addition, we will be undertaking a sample audit in the autumn to review how the conflicts of interest safeguards are operating in practice. This will be developmental in focus with an aim to share learning and good practice. It is not a performance management exercise or part of the assurance process.

• The audit will encompass 7 delegated arrangements and 3 joint arrangements and will involve 360 degree interviews with a number of key stakeholders including local Healthwatch.

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Conflicts of interest management

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Conflicts of interest: FAQs

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• Each provider of primary medical services is a member of a CCG. Whilst it is the practice that will need to declare any interests, it would be good practice to maintain a register of all GPs and other relevant staff (e.g., practice nurses and managers who are also partners).

Do all members of the CCG e.g., individual GPs who are not CCG employees, have to be included

on a register of interest?

• It is good practice to ask at the beginning of a meeting for any declarations of interest. Members present at the meeting would be expected to declare any interest at that point but certainly before it is discussed or as soon as it becomes apparent.

At what point in a meeting do we ask for declarations of interest?

• It is not a requirement to keep a register of services that may be procured in the future until the decision is made. However it would be good practice to ensure planned service developments and possible procurements are transparent and available for the public to see.

Do we need to keep a record of procurement decisions we are

planning?

• CCGs should ensure that both registers are available in a prominent place on the CCG’s website; and

• CCGs should make both registers available upon request at their headquarters.

Do we have to publish the register of interest and decisions

on our website or do we only need to make them available if

asked?

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QOF and DES

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• As set out in the Next Steps document, CCGs with delegated arrangements can develop an alternative scheme to the QOF and DES, without the need for NHS England approval.

• Any proposed new incentive scheme should be subject to consultation with the Local Medical Committee (LMC), and be able to demonstrate improved outcomes, reduced inequalities and value for money

• We are looking at how we can best support commissioners to develop alternative schemes to QOF and DES.

• We are planning to publish some “frequently asked questions” to clarify some technical questions we have received.

• In addition, we are holding a small workshop with CCG and regional representation on 18 August to develop guidance on designing and implementing alternative schemes. Somerset CCG is supporting this workshop and will share their experiences and learning of developing an alternative scheme.

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• Design work has commenced to look at how complaints can be best managed under the new co-commissioning arrangements.

• We need to ensure that any new arrangements are high quality and easy to navigate for the public.

• A workshop with NHS England and CCG representatives is taking place on Wednesday 29 July to develop potential future models.

• Under the current legal framework NHS England cannot delegate complaints management to CCGs, although a management arrangement could be implemented.

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Complaints handling

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Evaluation and development support

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The ultimate measure of success will be how far the new co-commissioning

arrangements improve care and outcomes for local populations.

A three year formal evaluation programme is being led by the Policy Research Unit in Commissioning and the Healthcare System (PruCOMM).

A voluntary survey of co-commissioning arrangements will be shared in July to help inform on-going policy development.

Learning and development webinars are being held with CCGs and local NHS England teams from June onwards to share learning and good practice.

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On-going support for lay members

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• The Lay Member Reference Group was initially convened to co-produce the content and format of the lay member training and development programme. Following the successful conclusion of the programme, the group has reconvened to oversee the development of a suite of resources in support of lay members’ new responsibilities around primary care co-commissioning. These resources will be made widely available to a target audience that includes but is not limited to: lay members; Healthwatch representatives; secondary care advisors; nurse members; and local authority representatives.

• In the first phase of this work, the list of possible resources currently includes:

• A general guide to the commissioning of primary medical care services, including the historical context of primary care, funding arrangements and the various contracting forms;

• Examples of best practice and scenarios describing the management of conflicts of interest and other work which has facilitated local arrangements e.g. exemplar terms of reference, constitutions, etc.

• Links to existing networks which it is hoped will be extended beyond the established lay member networks; and

• A library of supporting documentation with clear sign-posting to other relevant guidance or policy documents.

• Further work is underway to refine and finalise this list. The first phase of the project is planned for delivery in Autumn 2015.

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Timeline and key milestones

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Date Action

July • Further joint commissioning arrangements implemented.

• Proposal for the conflicts of interest audit to be discussed at NHS England’s

Audit Committee.

• Co-commissioning survey shared.

• Further co-commissioning general update webinar held.

• Conflicts of interest management webinar held for the North Region.

• Webinar for local Healthwatch members held.

• Complaints management workshop held.

August • Joint Memorandum of Understanding published.

• QOF and DES workshop held

• Further learning and development webinars held.

September • Sample audit of conflicts of interest management.

• First update from PruComm’s co-commissioning evaluation programme.

October • Deadline for delegated proposals for 16/17

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Primary care co-

commissioning:

assurance and

15/16 approvals

process

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Assurance framework

• The CCG assurance framework for 2015/16 takes account of the need for NHS England to have

specific additional assurances from CCGs that have taken responsibility for delegated functions.

• A light-touch quarterly self-certification will be required to demonstrate compliance against 5 key

areas:

• Outcomes;

• Governance and the management of potential conflicts of interest;

• Procurement;

• Expiry of contracts;

• Availability of services.

• The self-certification will be fully completed for out of hours services, CCGs with delegated

commissioning arrangements, and where CCGs have formed joint committees. CCGs in joint

commissioning arrangements with NHS England will only need to self-certificate against

governance and conflicts of interest.

• Sign off is required from the audit committee chair and AO or chair of the joint committee.

• Timescale for completion, in the quarter following that which is being self-certificated, will be agreed

locally with the CCG’s DCO team to align with their assurance cycle.

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Future opportunities to implement

joint arrangements

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There will be two further opportunities this year for CCGs to implement new joint commissioning arrangements with NHS England.

• CCGs will not be required to formally submit an application for joint commissioning arrangements, but should work with their local NHS England team in the region to ensure all agreements and documentation are in place by their agreed go-live date. Full details of the requirements will be made available shortly.

• Regions will continue to support submissions from all CCGs who have the greater involvement co-commissioning model in place throughout 2015/16, except in cases where the assurance process has raised significant concerns in respect of current capacity and capability to enter into joint commissioning arrangements.

• Regions will work with CCGs who wish to implement joint arrangements to have all the necessary pre-requisites in place by the quarterly implementation date (i.e. ToR, constitution amendment, governance structure, membership and governing body approval). Full details of these requirements will be made available shortly.

“Go live” implementation Dates

1 July 2015 For CCGs who applied to assume joint arrangements in 2014/15 but

chose to defer implementation to 1 July 2015

1 October 2015 Open to CCGs not currently with joint/delegated arrangements

1 January 2016 Open to all CCGs not currently with joint/delegated arrangements

1 April 2016 Open to all CCGs

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Future opportunities to implement

delegated arrangements

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CCGs who do not currently have delegated arrangements in place can apply to assume delegated responsibility from 1 April 2016. The submission template with list of requirements and supporting information will be made available here shortly.

CCGs will need to submit their proposal by midday Friday 2 October 2015 to england.co-commissioning@nhs.net

Regions will work with CCGs prior to submission to ensure the submissions provide all the necessary information and documentation. The paperwork required will be reviewed to simplify the process as much as possible.

As during the 2014/15 process, regional panels will meet to review the proposals and make recommendations to a national panel on which proposals to take forward. National moderation will be provided by the Primary Care Oversight Group, who will make recommendations to an Executive Scrutiny Group. All CCGs will then be notified of the outcome of their application in early November.

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Primary care co-

commissioning:

workforce

update

Rachel Patterson

Deputy Director of Organisational

Change,

NHS England

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• Two supporting model staffing documents have been finalised and issued as part of the pack for the CCGs:

• Model 1 (Assignment) – set of standard insert relating to workforce for inclusion in Memoranda of Understanding. These aim to provide some clear references to how the workforce is organised to deliver the service, whilst being flexible enough to recognise changes in resource available and different needs of both parties.

• Model 2 (Secondment) – standard secondment agreement for use if staff are seconded from NHS England to a CCG.

Employment Models – Progress to

date

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• Work continues to finalise the document to support Employment

Model 3 (Direct Employment) principles. Completion and sign off

date by end of July.

• Based on feedback received through the HR Working Group we

are aiming to ensure the right balance is achieved to ensure

NHS England staff get prior consideration for CCG roles, whilst

ensuring skills and capacity are retained within NHS England

teams.

Employment Models – Remaining

Work

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• The workforce data collection exercise initially undertaken between March and May indicated that more than 750 staff are involved in roles supporting primary care commissioning regionally, with 42% of time being spent covering primary care medical services.

• Further workforce data analysis work is due to be undertaken to support the scoping of community pharmacy, dental and eye health services and develop the understanding of the current design of roles and how they are organised within regions.

• HR Working Group to explore different ways of working developing in regions e.g., establishment of hubs.

Further Workforce Analysis

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Q&As

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Thank you and close

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• Further information on primary care co-commissioning can be found at: https://www.england.nhs.uk/commissioning/pc-co-comms/

• If you have any further questions, please email: england.co-commissioning@nhs.net

• We would appreciate your views on the webinars and how they can be improved in the future to best meet your needs.