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Operating Plan 2012 - 2013

March 2012 V Dutchburn



References : To Include

Forward Executive Summary Introduction

Plan on a Page A strategic assurance

1. Clinical Focus and Added Value

1.1 Vision 1.2 Strategic direction 1.3 Understanding population health needs 1.4 Engagement from all member practices 1.5 Engagement with Providers 2.1 Engagement plan 2.2 Engagement with patients, public and the population 2.3 Engaging with communities and stakeholders 2.4 Enabling Access & Offering Choice

2. Engagement with Patients and Communities

3. Clear and Credible Plans: QIPP, Activity, Finance, 3.1 Delivery of Outcomes Workforce, 3.2 QIPP (Transformational & Transactional) Contracts & CQUINS 3.3 Activity 3.4 Finance 3.5 Workforce including Providers 3.6 Contracts & CQUINS Delegation and CCG 3.7 Budget setting and scope Development Plans 3.8 Statutory accountabilities 3.9 CCG development plan 3.10 Risk management arrangements 3.11 Quality and patient care 3.12 OD support 3.13 Equality and diversity 3.14 Communications 4. Capacity and Capability 4.1 Build, share, buy model of service provision 4.2 CCG capacity and capability timetable 4.3 Training and development plan 4.4 Plans for good governance and managing conflict of interest 5. Leadership Capacity and Capability

5.1 Terms of reference 5.2 Board structure and governance 5.3 CCG committee governance: evidence of assurance 6. Collaborative arrangements 6.1 Memorandum of understanding 6.2 Constitution and interim arrangements 6.3 Partnership arrangements 6.4 Health and Well-being Board 1. Transformational programme plan & Mental Health Plan Appendices 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.


CCG Structure Statement of Intent Draft Public & Patient Engagement strategy Stakeholder Map QIPP plan Activity Plans Finance Plans and Narrative Workforce details Organisational Development Plan Risk Management Strategy Operating Plan Equality Impact assessment CCG Authorisation Plan CCE Terms of Reference

Foreword Greater Huddersfield CCG is passionate about making a difference to the health of the people in our area; using a needs-led and evidence-based approach to commission high quality, accessible services that make a real difference to our patients and population. This is enshrined in our vision and values The NHS budget has increased over the last decade by over 6% a year, in real terms. This increased funding has enabled the NHS to expand the workforce, improve and update its equipment and deliver more care to more people more quickly. As a result of the financial situation of the country, the NHS will face very difficult financial circumstances over the next few years. The funding for the NHS is set to increase by 0.1% per year in real terms for the next 3 years. This increase will be easily swallowed by rising costs from factors such as obesity, the ageing population and dementia. Greater Huddersfield Clinical Commissioning Group will have to make ÂŁ16.8 million productivity improvements over the next 3 years. This is going to be difficult but can be achieved by the partnership of patients, members of the public, clinicians, managers and Kirklees Council. This Operating Plan from the Greater Huddersfield Clinical Commissioning Group sets out how the group intends to face this challenge in a time of great transformation within NHS. Our specific objectives moving forward into 2012/13 are: 1. Taking ownership of QIPP in our geographical area 2. Work with other health and social care professionals, to develop and pilot re-design ideas 3. Work more closely with the Kirklees Council to deliver more integrated services 4. As a sub-committee of the PCT take on a delegated budget and commissioning responsibility for population served 5. Work with other local GP commissioning groups and colleagues to form models based on collaboration, that will be more able to share the risks involved in commissioning 6. To work with our public health specialists to ensure we deliver high quality care which focuses on prevention, reduces inequalities and makes efficient use of available resources 7. To work with the local NHS leads on public involvement and patient engagement and with the Health and Wellbeing Board to identify the best model for patient involvement and engagement with the commissioning group. 8. For the CCG to continue to develop to attain full authorisation as a statutory body by April 2013 Dr S Ollerton Chair Greater Huddersfield CCG March 2012


Executive Summary This Operating Plan for the Greater Huddersfield Clinical Commissioning Group (GHCCG) reflects the aspirations and intentions of a committed collaboration between like-minded clinicians and practices to learn, understand and take responsibility for the commissioning of health services on behalf of its registered patient population. It is firmly based on our vision and values: The vision for Greater Huddersfield CCG is „that by being informed by our local population and clinicians, we will drive improvement of healthcare services through leadership, innovation and excellence.‟ Values of GHCCG: Listening, Learning, Leading and Enabling Listening to health professionals, local people and those who support the CCG, in the commissioning of high quality healthcare in the most appropriate setting. Learning from other CCGs, service providers, the local authority and the NHS commissioning Board to inform a strategic long term vision for change. Leading through enthusiasm and cohesiveness to reduce health inequalities in Greater Huddersfield. Enabling local people and clinicians to transform and improve Greater Huddersfield‘s health and healthcare. The key performance indicators and outcomes are designed to reflect the right balance of current capability of CCG practices alongside challenging intentions. Achieving financial balance of the devolved budget is expected with the intention to go further and realise efficiency gains of £5.4 million by March 2013. As well as financial efficiencies, the QIPP contribution includes clinical commissioning intentions specifically on urgent care, mental health and long-term conditions to improve quality and productivity. Our patients and population will have the opportunity to fully integrate with the commissioning business processes of the CCG. The CCG intends to define engagement by our patients as, ownership, responsibility and commitment. All CCG practices will have practice-level patient representative groups and a Patient Engagement Committee will be drawn from the practice groups and wider population groups. In order to support the effective delivery of commissioning, the CCG will address five key challenges; making the NHS patient centred; reinforcing the multidisciplinary approach; working closely with the Local Authority; creating a seamless service and expanding primary healthcare teams. GHCCG recognises the need for robust risk management. As a developing CCG the CCG will vigorously acquire knowledge and expertise in the full range of risk management aspects, especially insurance risk and associated risk-pooling via models of collaboration. The service risk associated with healthcare budgets is better understood currently by CCG practices; however, greater emphasis will be placed upon demand management tools and techniques during 2012/13 to support the intention of realising efficiency gains. This first full year as a new CCG offers challenges and opportunities. As a sub-committee of NHS Calderdale, Kirklees and Wakefield District Board, the responsibility and accountability placed on the CCG provides the means by which the continuing improvement in local health services can be measured against the identified demands of our population.


Greater Huddersfield Clinical Commissioning Group: key facts

40 GP Practices There are 40 GP Practices within the CCG

243,600 Will inherit responsibility for commissioning health services for a total population of 243,600

£458.5 million Total budget £458.5 million per year

£5.4 million QIPP and CIP £5.4 million for 2012/13


GPs as Commissioners

No expected financial growth

Increase in elderly population

High demand for secondary care services

High levels of chronic illness

6 • •

Health & Social Care bill 2011

The Operating Framework 2012/13

Public Health Outcomes Framework

Urgent Care

Planned Care

Unscheduled Care

Mental Health, Learning Disabilities & Continuing Care


Managing capacity & demand and remodelling workforce (build, share buy model)

Partnership, Public & Patient Engagement

Health informatics & performance Monitoring

JSNA & Wellbeing Strategy

CCG Transformation Areas

CCG Organisational & practice Development & staffing resources within primary care


Finance - Managing devolved budgets Total budget £458.5 million per year – devlivering - QIPP and CIP £5.4 million for 2012/13 – 3yr total £16.8 million


NHS Outcome Framework

Listening to health professionals, local people and those who support the CCG, in the commissioning of high quality healthcare in the most appropriate setting. Learning from other CCGs, service providers, the local authority and the NHS commissioning Board to inform a strategic long term vision for change. Leading through enthusiasm and cohesiveness to reduce health inequalities in Greater Huddersfield. Enabling local people and clinicians to transform and improve Greater Huddersfield‘s health and healthcare.

NHS Reform

The vision for Greater Huddersfield CCG is ‘that by being informed by our local population and clinicians, we will drive improvement of healthcare services through leadership, innovation and excellence

Context Cross Cutting Themes Programmes & Work streams

Medicines Management

Long Term Conditions & Intermediate Care Long Term Conditions End of Life Assistive Technology Older People & Dementia Pain Oxygen Services

Planned Care Virtual Referrals Folder Ophthalmology MSK & Dermatology redesign Diagnostics

Women & Children Review of Maternity strategy Children‘s Continuing Care Looked After Children Health Visiting Provision

Urgent Care OOH 111 procurement Reduce inappropriate A & E attendances & Emergency admissions

Local Authority & Health & wellbeing

Mental Health Re-specification of community & Primary care services

GHCCG Development Finalise 12/13 business plan Develop 5 yr strategic plan Establish CCG structures Implement & Consolidate governance structure Establish & implement engagement strategy Achieve authorisation CSO Development

Introduction The transition agenda first set out in the 2010 White Paper, Equity and Excellence: Liberating the NHS describes a new ‗architecture‘ for the NHS where: ‗…power will be given to the front-line clinicians and patients. The headquarters will be in the consulting room and clinic. The Government will liberate the NHS from excessive bureaucratic and political control, and make it easier for professionals to do the right things for and with patients, to innovate and improve outcomes.‘ The Health Bill 2011 proposes major reform to the health system management approach with the intended establishment of statutory Clinical Commissioning Groups (CCG) by 2013. Clinical commissioning groups sit at the heart of the national transition proposals. Based on the membership of member practices, but involving a broad range of clinical professionals, these organisations are designed to unleash the potential of clinical leadership. Greater Huddersfield Clinical Commissioning Group (GHCCG) is a newly formed organisation (see interim structure attached at Appendix 1) and will continue its organisational evolution during 2012/13 by acquiring the appropriate health system management knowledge and expertise to inform its preparation for the Clinical commissioning Group authorisation process. It is intended that Greater Huddersfield will become fully authorised between October 2012 and March 2013. The CCG will be responsible for devolved healthcare budgets of approximately £458.5 million on behalf of 243,600 registered patients and people within the geographical patch. The proportion for NHS contracts of which £135.7 million is included in the Calderdale and Huddersfield NHS Foundation Trust contract, £1.3 million per contract included for Mid Yorkshire NHS Trust, and £22 million for Southwest Yorkshire Partnership Foundation Trust (mental health). The remaining balance relates to NHS prescribing and other commissioned services. The Health and Social Care Bill enshrines an explicit duty for CCGs to have regard to the need to reduce inequalities in the benefits which can be obtained from health services. GHCCG have made a commitment to its population that the agreed plans and priorities which have commenced implementation will continue. As GHCCG develop their strategies for forthcoming years, the plan will be updated to reflect any changes. The CCG is committed to developing a health market consisting of a plurality of providers offering good access, good quality and good value services. A strong working relationship with the local acute Foundation Trust, Calderdale and Huddersfield Foundation Trust (CHFT) based upon clinician to clinician engagement is a priority for the CCG and will be actively developed during 2012/13 as part of the CCGs organisational evolution. At the time of finalising this plan, CHFT, is going through a period of Strategic refresh, which will lead to a programmed transformational change which will have an impact on the priorities for this CCG.


A strategic assurance A strategy allows plans of action to be designed to achieve particular goals. This operating plan has been prepared from a series of existing papers, including ‗The Operating Framework for the NHS in England 2012/13 and the ‗NHS Kirklees five Year Strategic / Operating Plan 2010/11 – 2014/15‘, refreshed March 2011, in order begin to inform a future single strategic plan that will act as a guide to the Greater Huddersfield Clinical Commissioning Group, and the managers and staff assigned to the clinical commissioning group (CCG). The purpose of this single document is to set out the: Work that has already been undertaken in establishing the emerging Greater Huddersfield Clinical Commissioning Group. The assurance that Greater Huddersfield Clinical Commissioning Group can provide to the Cluster Board to take on a delegated budget and commissioning responsibility for population served The timetable and plan for how Greater Huddersfield Clinical Commissioning Group will continue to develop to attain full authorisation as a statutory body by April 2013. At this stage the outline assurance requires discussion, amendment and approval. However, the significant advantages of achieving an agreed position are that: Our commissioning priorities are clearly stated; There is a framework against which we can show that we are making sensible decisions on early issues; There is an overarching description of how we intend to communicate with all our stakeholders; Limited clinical commissioner time is focused in the right areas; A clear sense of purpose for practices, the Board, and assigned staff is established, thus getting everyone lined-up behind the same objectives;


We are enabled to demonstrate success at the end of our first year i.e. we said it, and then we did it; and that, We ensure that we address the areas that will form part of the NHS Commissioning Board (NHSCB) authorisation process in order to secure authorisation. The document is constructed around the six domains set for CCG authorisation. It is our intention that it should serve as a useful guide for Board members and staff alike; and be an effective medium for developing and strengthening our track record of success. This Operating Plan is designed to reflect the transition nature of a developing consortium with organisational and leadership learning requirements which it will seek to acquire through its core commissioning business during 2012/13. The one page plan details; the drivers, transformational areas and programme areas, agreed as the key clinical and strategic priorities for 12/13. The CCG board has chosen to refocus its leadership, aligning to these six areas and other corporate requirements. The detailed plans moving beyond 2013/14 will be updated within this plan and added, including measures for outcomes and delivery. Details of the agreed transformational work supported and clinically led by GHCCG is available at appendix 2. 1


The White Paper (2010) and the subsequent Health and Social Care Bill (2011) suggest liberation from the bureaucracy that has hindered NHS progress. Alongside this liberation will be a focus on quality and on improving clinical outcomes. The implementation of policy will be the responsibility of Clinical Commissioning Groups. As a Pathfinder CCG, Greater Huddersfield welcomes this opportunity and is ready to take on more responsibility from NHS Kirklees. Work undertaken during the last 6 years during the previous ‗practice based commissioning‘ setup whereby GP Practices had the ability to develop local services, has built a solid foundation of trust amongst practices and staff. This will be very important for Greater Huddersfield in tackling the reform programme and shaping the NHS of the future. The challenge for GHCCG is to realise the government‘s ambition and our vision to improve quality and patient experience over the next few years when growth in resources will not match the needs of an ageing population and growing health needs. GHCCG acknowledge that the task will not be easy, but believe that the CCG is best placed to direct funding most efficiently, based on local needs and evidence of what works. GHCCG is aiming for a fundamental change in the focus of commissioning which includes improved capacity within primary care to bring more care into the community environment. GHCCG are strengthening relationships they are further supporting stronger collaboration across boundaries, with colleagues in other CCGs and sharing resource and service redesign solutions that encompass the knowledge and better patient outcomes. These are particularly important where Secondary Care services cross geographical boundaries. The contact that GPs have with patients‘ means that they receive direct feedback on what works well and what does not and are therefore best placed to drive efficiencies. Clarity over the values of GHCCG will be essential to achieving the best for our patients. GHCCG board members have been identified to undertake a range of clinical leadership positions, this is strengthened and supported by other CCG member colleagues being coopted as required, increasing the level of engagement by individual practice members.


GHCCG is also working with partners across the Cluster, supported by managers and staff within the PCT and providers around larger areas of redesign such as; 111 and Urgent Care, diagnostics and ambulatory care for the aims of achieving positive results and whole system change in relation to QIPP and improving the health for all our population. 1.1 Vision Successful organisations in the public sector possess a common attribute: everyone who works in them is aligned to the organisational vision, values and purpose. GHCCG spent considerable time formulating the vision and values during June 2011 and believe that they reflect the national patient outcomes, as they put patients at the centre of decision-making, whilst focusing on improving dignity and service to patients and meeting essential standards of care whilst reducing inequalities. The result of this work is detailed below and these key components will provide the backdrop against which the success of GHCCG will be measured. These are expanded as follows: The vision for Greater Huddersfield CCG is „that by being informed by our local population and clinicians, we will drive improvement of healthcare services through leadership, innovation and excellence.‟

Values of GHCCG: Listening, Learning, Leading and Enabling Listening to health professionals, local people and those who support the CCG, in the commissioning of high quality healthcare in the most appropriate setting. Learning from other CCGs, service providers, the local authority and the NHS commissioning Board to inform a strategic long term vision for change. Leading through enthusiasm and cohesiveness to reduce health inequalities in Greater Huddersfield. Enabling local people and clinicians to transform and improve Greater Huddersfield‘s health and healthcare.

The GHCCG have agreed that they will abide by principles, values and rights clearly set out in the NHS Constitution to ensure that the NHS in Greater Huddersfield works fairly and effectively. 1.2 Strategic direction The purpose of the Greater Huddersfield Clinical Commissioning Group is to provide leadership to, and coordinate the activities of, member practices and other partners, to enable them to enhance their individual and collective contribution to the CCG‘s vision through their primary aims and aspirations of: Improved patient outcomes and Improved consistency and quality of care Improved patient experience Improved Patient Safety Empowered patients; putting the patient at the centre through better integration with social care, provision of good quality care, improvements in mortality, morbidity, quality of life, staying healthier for longer, listening to patients, focusing on prevention and self care.


Improve access to services for patients; shifting care closer to home when appropriate, better integration with social care and better ways of working more locally with secondary care providers. Reduced costs without compromising patient care; to improve fairness between localities in terms of resources and provision; through targeted funding, fairness of resource allocations locally, keeping within allocated CCG budgets in total per annum. Redesigned pathways with the help of public health, primary and secondary care Clinicians to ensure appropriate patient care is available at the right time, in the right place, with the right person, utilising Improved information to patients to support selfcare and choices including alternatives to hospital treatment; this will be achieved through better ways of working with secondary care, community services and social care providers, ending the fragmentation of patient journeys, using contracts flexibly rather than as a barrier, re-specifying pathways to improve services, changing the way people engage with and receive care, promoting prevention and self care and looking at ways in which everyone needs to do something differently to improve care services – patients, carers, clinicians, health care professionals. Sharing of good ideas and best practice with all Constituent Practices Working with other CCGs to help to share risks and learn from each other: to provide local solutions to local issues including effective targeting based on need rather than universal coverage. Fostering strong partnerships between and within practices to enhance the commissioning of services for the patients of the CCG and the whole health economy; to drive commissioner led service provision and not supply led service provision. Identify and share good practice; Build health alliances with Kirklees Council, the health and wellbeing board and other partners in the wider health economy; and Encourage public and patient participation to enhance service improvements. In terms of identifying and agreeing CCG Commissioning Priorities GHCCG have: Agreed that outcomes needed to be locality specific to encourage ownership of solutions The Joint Strategic Needs Assessment (JSNA) should be locality focused whilst drawing out common themes A prioritisation process has been agreed which gives greater weighting to locality needs/priorities and in relation to opportunities for savings. To support CCG in identifying its commissioning priorities for the next year is the business intelligence provided from the contracting, finance and performance supported by the areas outlined in the JSNA and identified through engagement of the patient population. The challenging financial situation requires a focussed emphasis on delivering QIPP efficiencies. The primary care performance report is produced at both practice and CCG level. The detail provided within the reports, achieved through the joint working with the finance and performance colleagues enables practices to focus local and national performance, through the identification of local variation, the report supports the CCG to identify priority areas,


identify and share best practice and develop improvement programmes to achieve both the national performance targets and reduce locally variations. GHCCG will ensure that systems are established with all providers to provide robust assurance, that the commissioned services will deliver safe services of acceptable quality, through the development of Key Performance Indicators, identified within service specifications. This will be managed through robust contract management. Where the CCG is not directly responsible for commissioning, the strategic aim is to be able to ‗influence‘; the commissioning strategies of the National Commissioning Board, Regional Specialist Commissioning groups and Public Health. Over the next five years, GHCCG will, through co-operation, collaboration and co-production, across the programmes, partner with other organisations, especially where boundaries or providers are common, such as North Kirklees Health Alliance (NKHA), Calderdale CCG or Kirklees Council. Next Steps Greater Huddersfield Commissioning Group has accepted the commissioning support offered from NHS Kirklees. The CCG is committed to utilising and maximising the skills and expertise of the commissioning support offered over the next 12 months. Greater Huddersfield is committed to a trajectory where authorisation commences from Summer 2012. Over the next 6 months it is the intention of the GHCCG to finalise its 5 year strategic direction and priorities to enable ongoing effective planning and contracting to be undertaken; this will include: Strategic priorities to be agreed for wider engagement Engage widely through existing groups Finalise the joint Health & Wellbeing Strategy and priorities for CCG Inform planning round, commissioning intentions for 2012/13 and development of the CCG medium term plan A brief timetable for this exercise is outlined below: Action CCE receives framework for 12/13 CCG plan. Clinical commissioners identify local priorities. CCE reviews and approves first full draft 12/13 CCG plan. Joint drafting of Health and Well-being (HWB) strategy commences.

Timetable December 2011

January 2011

Strategic priorities agreed by CCE for wider engagement inform planning round, contract negotiations and commissioning intentions for 2012/13 and development of the CCG plan. Engage widely as possible through existing groups and networks. CCE reviews and approves updated 12/13 CCG plan. CCE reviews and approves draft HWB strategy.

January to March 2012 February 2012

CCE reviews and approves final 12/13 CCG plan. CCE reviews and approves final draft of local HWB strategy and any further changes to priorities for CCG.


March 2012

CCE receives Communications report on engagement and establishes 2012/13 communications and engagement strategy for Greater Huddersfield Clinical Commissioning Group

April 2012

Develops clinical improvement strategies and continues to consolidate Greater Huddersfield organisational form and its governance structures. Builds track record of success. - Leads planning and decision making in Greater Huddersfield - Utilises increased delegated powers - Builds stronger partnerships, better engagement, and closer collaboration within the district.

April to October 2012

CCE submits application to NHS Commissioning Board for establishment and authorisation

August to September 2012

Enter formal authorisation process. Greater Huddersfield challenged to demonstrate full capability across the six domains.

October 2012 to March 2013

The importance to have good integrated governance with the right level of leadership and clinical skill mix, has not been underestimated by the CCG, an immediate priority is to ensure that the shadow Accountable Officer and shadow Chief Finance Officer are appointed to positions by the end of March 2012 and that an appropriately skilled and quality senior management team are recruited, to take responsibility that all duties are appropriately discharged. 1.3 Understanding population health needs GHCCG will commission health and care services which have an impact on the 243,600 registered patients within 40 GP practices and on the wider population living in the area served by GHCCG. The area is diverse in its geography and it operates within both rural and urban locations and is partially co-terminus with Kirklees Council. Of population just over 1 in 5 are aged under 19 and nearly 1 in 7 aged over 65 years. There are pockets of relative deprivation for both children and older people; the Joint Strategic Needs Assessment (JSNA) for 2010 tells us that 30% of children aged 0-15 years were living in income deprived households in Huddersfield, and 20% of 11-16 year olds were eligible for free school meals. Of all those households in the north of Huddersfield with dependent children living in them 35% of houses were perceived by the family as not being adequate for the household‘s needs. There is a diverse mixture of communities, including diversity of cultures and faiths; there is a higher proportion of our population from ethnic minorities than for England as a whole. Ethnicities present in Kirklees include those of Pakistani origin, Indian origin and AfricanCaribbean origin, however, the largest group remains of white origin. The population‘s health needs therefore vary, with different health issues in urban Huddersfield than in the surrounding areas. Obesity and smoking rates are high and physical activity rates are low in some areas and communities. Long term conditions and deaths from heart disease and cancer are issues for older people, whilst relatively high levels of anxiety and depression are a concern among all age groups, but particularly teenage girls in some


areas. The teenage conception rate remains higher than Kirklees and nationally in Huddersfield. Across Greater Huddersfield the infant mortality rate is falling but is still significantly above the national rate. The (JSNA) is a key document to inform planning and commissioning in Kirklees. The process for developing the JSNA has enabled us to identify key issues for specific populations such as for people with disabilities, women of child bearing age and older people. It also looks at key conditions such as heart disease, stroke, obesity, diabetes and dementia; wider living and working factors such as employment, housing and educational attainment and personal behaviours such as smoking, alcohol, food and nutrition. ( GHCCG are working closely with Public Health in relation to the health challenges. The JSNA will inform the Health and Wellbeing Board in developing their Joint Health and Wellbeing Strategy. The information within the document is presented under each of the localities that make up the Kirklees CCGs. This locality focus supports the CCGs priority setting by drawing out common themes. These priorities were presented and discussed by the CCG in July 2011 and the planning sessions, supported by public health to define the priorities for 12/13 and QIPP will be updated annually. Details of the agreed Commissioning Priorities, including both the specific GHCCG and Kirklees wide priorities, which include transformation, service redesign, decommissioning of services and Key Performance Indicators to measure the delivery and outcome success can be read within the attached activity, QIPP, transformation programme, mental health programme appendices. Specialist areas, which will led by the NHS Calderdale, Kirklees and Wakefield district cluster (CK&W), supported by the CCG are included within the CK&W 2012/15 operating plan, which should be read along side this document. 1.4 Engagement from all Member Practices The Greater Huddersfield Clinical Commissioning Group operates as a consortium constituted of member practices operating on behalf of the populations served by those practices, to deliver and implement GP commissioning under delegated authority by NHS Kirklees. The CCG operates within the geographical boundaries of Kirklees council, serving the resident population and has 40 practices in its membership. As a large CCG, ensuring that all practices are abreast of developments during this period of rapid change is a challenge. GHCCG have established a single commissioning structure for the Greater Huddersfield area, bringing together a diverse range of former PBC groupings. This has been facilitated and achieved by building on the recognised well established collaborative model of working, with practices seeing this structure as essential in ensuring engagement of all practices in the new commissioning agenda. GHCCG have developed as a ‗bottom up‘ organisation which listens to opinions across all member practices. This has been achieved by: Sending a regular newsletter to all practices, giving the latest updates on CCG developments across the patch, sharing good work and giving feedback to practices. Using plenary sessions to ensure face to face discussions with all GP clinical leads from each practice. There is a structured communication channel between the locality meetings and the CCG Board. A team of GP board members look after 5 practices each to discuss the impact of the government reforms and the development of the CCG. Practice protected time is held bi-monthly with Practice Managers, Practice Nurses and GPs from each practice. Meeting minutes are widely distributed


GHCCG website has been developed, accessed via GP Link This Operating Plan is the product of a high degree of involvement and engagement by Greater Huddersfield Clinical Commissioning Group practices. The formulation of the CCGs key priorities and Operating Plan has been managed through the CCG which has ensured that all practices are represented. GP leads for each practice had the opportunity to share the developing plan with their own practice colleagues in order to gather wider insight and views on the content of the plan. Greater Huddersfield CCG is fully committed to working with its member practices and their staff teams to unleash their potential and to lead and deliver health services commissioning in different ways, and in doing so develop a clear record of success that will support our authorisation as a statutory organisation before April 2103. GHCCG has drawn up a ‗statement of intent‘, which sets out arrangements and procedures which the CCG must adhere to. The statement of intent‘ also sets out clear expectations about the behaviours and values of GHCCG and its member practices. The statement of intent‘ as set out in Appendix 3 has been agreed with member practices 1.5 Engagement with Providers GHCCG recognizes the size and complexity of the challenges facing the local health economy in the coming years in seeking to promote transformational change in the NHS. The development of new clinically led care pathways whilst at the same time achieving efficiency savings, improvements in quality and best value for money in services provided requires careful negotiation and co-ordination with our major service providers if the best outcomes are to be achieved. During 2012/13, GHCCG intends to work closely with NHS Kirklees, the Local Authority and local acute (Calderdale and Huddersfield Foundation Trust), mental health (Southwest Yorkshire partnership Foundation Trust) hospitals and community (Locala) provider organisations to ensure that the CCG commission a cohesive network of services. GHCCG is one of two clinical commissioning groups in Kirklees. Whilst each have distinctive identities and focus which reflects the needs of their populations, GHCCG are in close dialogue with North Kirklees Health Alliance CCG. GHCCG are working closely with Calderdale CCG; as a key commissioning partner with CHFT as the main acute contract. Over the coming year, GHCCG will be exploring options for one consortium to ‗host‘ certain commissioning functions across the geographical patch in order to work efficiently and minimise management costs. The CCG have developed a series of transformational groups with acute trust providers, comprising Senior Clinicians and Managers from both parties to explore clinical innovations and promote efficiency and quality in service provision. During the course of 2012/13 our other major service providers will be contacted and invited to form similar transformational groups; Southwest Yorkshire Partnership Foundation Trust have indicated their willingness to meet in pursuit of joint aims. These well established and ongoing processes for dialogue and negotiation with providers help to ensure that plans are aligned across the health economy. GHCCG have involved main local providers in the development of the Local Operating Plan for 2012/13. However, the Operating Framework has significant implications for both commissioning and provider organisations and these will take time to fully understand and work through. Consequently, this plan will continue to develop and be refined with partner organisations. GHCCG will maintain and build further relationships with all providers, this will include testing the market with new providers to GHCCG, to build strength and competition, develop and stimulate a range of choice in care and support services in the local area.


1.5.1 Our Providers Calderdale and Huddersfield Foundation Trust (CHFT) is the main provider of acute health services for GHCCG. The Trust runs two hospitals and a range of community services. GHCCG are fully engaged with the Calderdale and Kirklees Transformational Board. The Board leads transformational change across the CHFT footprint, particularly in relation to elective and non-elective work areas. The Transformational Board brings together representatives from health and social care organisations across the footprint, including Calderdale CCG, Kirklees and Calderdale councils and Southwest Yorkshire Partnership Foundation Trust (SWYPFT) and facilitates collaboration and coproduction. Following events in December and January 2012, GHCCG has confirmed its support for the development of a Clinical Services Strategy for the CHFT footprint, and is signed-up to the principles agreed. The CCG will continue to ensure alignment between the emerging clinical services strategy and delivery of this Operating Plan. To support this, a new programme structure is being proposed for the CHFT footprint. Its main features are: Its total focus on the CHFT footprint; The strength of it clinical leadership (potential for chairmanship by CCG Chairs); It brings together clinical leaders from Calderdale and Greater Huddersfield in a formal structure; It brings together delivery of QIPP and CIPs under one programme; and It will have dedicated leads to deliver the programme. Mid-Yorkshire Hospitals Trust (MYHT), provide a small percentage of acute health services for the population of GHCCG, however MYHT is the main acute health service provider, for our neighbouring NKHA CCG. GHCCG are supportive of the ongoing developments in relation to the Mid-Yorkshire Health Economy Foundation Trust programme and Clinical Services Strategy. South West Yorkshire Partnership Foundation Trust (SWYPFT), is one of the largest specialist mental health and learning disability Trusts in the country and provides a range of mental health and learning disability services to the people of Calderdale, Kirklees and Wakefield. They also provide some regional specialist medium-secure services. The Trust has recently acquired all community and mental health services in the Barnsley district. GHCCG have set out plans to work with the Trust on: Transforming acute and community mental health care pathways to improve patient experience and increase service efficiency; Improving dementia care for local people; The effective introduction of a new national payment tariff (Payment by Results) for mental health. Locala Community Partnership, previously known as Kirklees Community Health Services, provides community services, mainly for the populations of GHCCG and NKHA. GHCCG board members attend both the Contract Management Group and the Provider Quality Group; they are also represented on the members‘ council. As part of ongoing engagement plans, Locala, through a joint community partnership programme are restructuring their team to reflect practice units, during 2012/13 this will enable the level of engagement to grow. Yorkshire Ambulance Service (YAS), NHS Airedale, Bradford and Leeds (ABL) are the lead commissioner for the YAS Emergency & Urgent Ambulance Services contract. YAS


plans to achieve Foundation Trust (FT) Status by December 2012; GHCCG are supportive of this important organisational change for YAS, which is been led by the lead commissioner. The underpinning issue will be achieving and maintaining identified efficiencies, particularly around reducing conveyance and altering the skill level balance (and cost), including securing 111 and retaining the PTS operation. The re-structuring and re-focussing of the YAS executive team indicates a commitment to achieve the organisational structure and ethos to support effective financial management. Practices as Providers, It is important that GHCCG recognises our primary care practices as providers of services locally, in addition to their core primary care GMS or PMS contracts. GHCCG has a wide selection of services that are performance managed through the CCG, these will undergo further evaluation during 2012/2013 and annually thereafter. The list below details the services commissioned through Practice Based Commissioning that will continue to be monitored and performance managed. Additionally new services implemented by GHCCG during 2011/12 these services are performance managed by CCG assigned staff to prevent any conflict of interest risk. Originating PBC/ CCG The Grange Group Practice Oaklands Health Centre Oaklands Health Centre Slaithwaite Health Centre Oaklands Health Centre Elmwood Health Centre Slaithwaite Health Centre Oaklands Health Centre Elmwood Health Centre University Health Centre Oaklands Health Centre Slaithwaite Health Centre Newsome Surgery Oaklands Health Centre Slaithwaite Health Centre Oaklands Health Centre Meltham Road Doctors Oaklands Health Centre University Health Centre Elmwood Health Centre Oaklands Health Centre Oaklands Health Centre Meltham Road Doctors The Grange Group Practice Waterloo Practice Almondbury Surgery Shepley Health Centre Oaklands Health Centre Kirkburton Health Centre Newsome Surgery University Health Centre Kirkburton Health Centre University Health Centre University Health Centre University Health Centre Meltham Road Doctors University Health Centre


Scheme D Dimer Case Management Ophthalmology



Rhuematology Accupuncture MSK Diabetic podiatry In house pharmacist Orthopaedics Dermatology Diabetes clinics Gynaecology (Ring Pessary service) Long Term Conditions Teenage Advice Clinic 24 hour BP monitoring Patch Testing Pain self management clinic Sexual health Minor Ailments Psychotherapy Camoflage Audiology


Scheme D Dimer LES 24 hour BP monitoring Intermediate pain service Pathway management tool Rheumatology LES Inter-practice referrals

Kirklees wide procurement In Progress Potential

Scheme Kirklees Pain Services – led by Public Health Intermediate care service



2.1 Engagement plan GHCCG is keen to promote its role within the local community and to build sustainable and effective relationships with its member practices, staff, local politicians, the Local Authority, Local Involvement Network/HealthWatch, NHS organisations, the media and other partners as well as patients and the public. GHCCG has developed a draft patient and public engagement strategy which has been developed with the input of Kirklees Local Involvement Network(LiNK). The CCG recognises that for some of its engagement activities it will be more effective and appropriate for the wider public to conduct engagement in partnership with other NHS organisations within the Cluster and beyond. The draft patient and public engagement strategy is attached at Appendix 4 and clearly outlines the CCG intentions for engagement, although recognising that this will be updated as plans develop and reflecting further stakeholder input. GHCCG have established a Patient and Public Engagement Operational Group to further develop plans for engagement, ensuring that the patient voice is represented in the decisions made by the CCG. GHCCG will be an active partner on the ‗Health and Wellbeing Board‘ (HWB), established (in shadow form at present) to improve the commissioning and delivery of services across NHS and local government, leading to improved health and wellbeing for people in Kirklees. Health and Well-being Boards will bring together those who buy services across the NHS, public health, social care and children‘s services, elected representatives and representatives from HealthWatch to plan the right services for their area. They will look at all health and care needs together, and be required to create health and well-being strategies. GHCC will play an active role in developing the Joint Health and Wellbeing Strategy (JHAWS) for Kirklees. The CCG will also support the development of Local HealthWatch, both through participation within the consultation initiatives and by active membership on the HealthWatch Task and Finish Group. It is recognised that the transition between the current LINk and HealthWatch will take place during 2012/13 and the CCG will maintain strong relationships with the LINk. GHCCG holds a seat at the LINks steering group and nominated members have agreed to work with the CCG to further develop its engagement. GHCCG will build upon the existing mature relationships and strong track-record of collaboration between health and social care agencies, to develop and implement the vision for joint commissioning and seeking to improve the:


Integration of health and social care; Efficiency of commissioning functions and teams; Planning and prioritisation process across health and social care Efficiency of in cost spending across health and social care. There are clear statutory duties and accountabilities placed on current and forming NHS organisations in relation to informing and engaging patients and the public. The CCG is aware that Section 242 of the NHS Act 2006 established a statutory duty for NHS bodies to involve and consult the public on: The planning of the provision of services, The development and consideration of proposals for changes in the way those services are provided, and Decisions affecting the operation of those services. Subject to parliamentary approval, the Health and Social Care Bill 2011 will place duties upon commissioning groups in relation to engagement, including the following: Public involvement and consultation by clinical commissioning groups (1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (―commissioning arrangements‖). (2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)— (a) in the planning of the commissioning arrangements by the group, (b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them, and (c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. (3) The clinical commissioning group must include in its constitution— (a) a description of the arrangements made by it under subsection (2), and (b) a statement of the principles which it will follow in implementing those arrangements. (4) The Board may publish guidance for clinical commissioning groups on the discharge of their functions under this section. (5) A clinical commissioning group must have regard to any guidance published by the Board under subsection (4). 2.2 Engagement with patients, public and the population (6) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users. (The Health and Social Care bill 2011 – January 2012 revision)


2.2 Engagement with patients, public and the population Legal duties are not the only reason to involve patients and the public. Sustained, mature engagement with communities around their needs and preferences has been shown to deliver improved health and wellbeing outcomes, allowing local people to have more trust in their local NHS and increased satisfaction. Engaging with vulnerable groups and seldom heard communities, and responding to their needs, also helps to tackle health inequalities by giving these groups a sense of ownership around health services and adopting an assetbased approach to involving them. GHCCG recognises that engagement with patients and the public is not a one off activity, but an ongoing, two-way dialogue. The overall approach detailed within this Operating Plan is that patient and public involvement is an enabling strategy for the achievement of the CCGs commissioning vision. The CCG is committed to support the vision of ‗no decision about me without me’ and representing the patient voice in its commissioning decisions. To enable this, a clear governance structure will be established to ensure that engagement is represented within its operating structure. 2.3 Engaging with communities and stakeholders With current and emerging structures, commissioners will be required to maintain and develop the relationships they have with the NHS Commissioning Board, Public Health, local authorities and voluntary and community sector organisations. These relationships and the impact of stakeholder involvement and engagement are increasingly important for the new commissioning bodies. The main structures for ensuring that patients and the public are effectively represented are: Overview and Scrutiny Committees Health and Wellbeing Boards Local Involvement Networks / HealthWatch As part of the ongoing development of the overarching engagement strategy GHCCG have carried out stakeholder mapping and analysis to ensure that we communicate appropriately with all relevant individuals and organisations. Appendix 5 Greater Huddersfield Clinical Commissioning Group recognises the importance of working collaboratively with other partners to achieve whole health economy service improvements and addressing the wider health inequalities within a local population. As the CCG continues to evolve and develop as an organisation so will the local Health & Wellbeing Board and the GHCCG is committed to contributing to the successful establishment of the Board and fostering strong, positive links on a common aim – the continuous improvement in health and social care of people living in Kirklees. Involvement between GHCCG and the local authority is pivotal in order to ensure a clinical link between the children and adult commissioning agenda and provide demonstrable CCG engagement with partners and the voluntary sector in providing efficient health and care services across GHCCG. GHCCG recognises the importance of working closely with Public Health to support the joint commissioning of services between Public Health and CCG where collaborative working is required to facilitate this; to keep informed of the progress of Public Health services commissioned for GHCCG patients; and to utilise Public Health expertise to inform future


commissioning decisions as appropriate, to achieve measurable outcomes in terms of health improvement and reducing inequalities. By engaging with local communities and using this knowledge to inform commissioning decisions, GHCCG will be able to offer services which are responsive and accountable. 2.4 Enabling access and offering choice GHCCG will ensure that the patient ‗voice‘ is at the heart of commissioning decisions, embedding it within the commissioning cycle. Patient choice, through initiatives such as the Any Qualified Provider, Choose and Book, summary care record will incorporate engagement of patients and the public ensuring their views are represented in the decisions the CCG takes in respect of services. Choose and Book GHCCG are engaged with the Choose and Book team and are actively leading/supporting this work. The ‗Optimising Electronic Referrals', West Yorkshire wide project, sponsored by WYCOM aims to help make further improvements. Active engagement with CHFT has proved successful as CHFT now offers advice and guidance, currently at no cost. Advice and Guidance allows one clinician to seek advice from another. The GP can attach documents to the advice request - diagnostic results, scanned images (e.g. ECGs) or correspondence related to the patient. The CHFT clinician is then able to review the request, add attachments if required and send a response back to the GP. This model supports the CCG priority areas of ‗reducing inappropriate referrals‘ and ‗providing care closer to home.‘ Summary Care Record (SCR) The SCR provides healthcare staff treating patients with faster access to their patients' key health information, ensuring joined-up care and better health interventions and outcomes, in a manner which ensures secure access on a consent and need to know basis. In support of patient access to information GHCCG will bring forward plans in 2012/13 to enable our member practices to deliver against the target requirement of delivering patients‘ ability to access their primary care records. There are five key elements to this: Access to view/request medication; Access to test results and letters; Access to a summary or subset of the full medical record; Access to a full medical record; and Book/Cancel GP appointments. Any Qualified Provider (AQP) The approach to choice for the population of GHCCG area will be supplemented through the AQP process. GHCCG will consider the application of this approach to future service procurement through consideration of the following: The service is discrete and capable of being chosen individually by patients and/or referrers; There is no unacceptable clinical risk associated with a multiple and potentially diverse provider landscape; There is no strong interdependence between the service and any other clinical services that would make it advantageous to have them provided by the same provider; The overall activity levels versus fixed costs mean that an AQP model is likely to be commercially viable for providers;


Initially that the services are all on the national menu. That patient safety issues are fully considered as part of the process and the services do not have significant associated patient safety issues. Further assessment of patient safety issues and any required mitigation will be considered before signing off detailed specifications and accreditation requirements. GHCCG have agreed to support the NHS CKW cluster plan to undertake a phased implementation of patient choice of AQP, the final choice includes: 1. 2. 3.

Adult hearing services in the community (to cover GHCCG, CCCG, NKHA and WHA); Diagnostic tests closer to home (to cover GHCCG, CCCG, NKHA and WHA); and Primary care psychological therapies (adults) (to cover Calderdale CCG).

3. CLEAR AND CREDIBLE PLANS: GHCCG have worked with the current NHS Kirklees, management teams to develop the plans for finance, demand / activity and workforce plans, and our QIPP programme, during Q4 2011/2012 the triangulation of those four areas of Information has been undertaken to provide assurance that any increase in activity is supported by appropriate funding and is deliverable through the known workforce plans. Any area identified as a potential risk to delivery is described in full with mitigating actions where relevant, in the following sections and supporting appendices. Where the CCG will not be responsible for delivery post April 2013, for example Primary Care Contracting, GHCCGs strategy is to ‗influence‘ the decisions in these areas and support, where agreeable those strategies that are not in their level of responsibility. 3.1 Delivery of Outcomes The NHS Outcomes Framework sets out the improvements against which the NHS Commissioning Board will be held to account from 2013/14. Greater Huddersfield Clinical Commissioning Group will be ready and able to take on statutory responsibilities from April 2013. To support this, it has created its own vision and supporting set of values and principles (Section 1). GHCCG plans are aligned to government priorities specified in ‗The Operating Framework for the NHS in England 2012/13 and the ‗NHS Kirklees Four Year Strategic / Operating Plan 2011/12 – 2014/15‘. In 2010 NHS Kirklees published a Five Year Strategic Plan; the strategic plan went through a robust and rigorous process to develop the priorities/programmes with full involvement of patients, the public and other stakeholders. This Strategic Plan has since been refreshed March 2011, ‗NHS Kirklees Four Year Strategic / Operating Plan 2011/12 – 2014/15‘, building on the plan previously submitted and reflecting key contextual changes and key programmes changes required to ensure greater efficiency and value for money. It is recognised that NHS Kirklees has continued to make sustained progress in implementing the Strategic Plan during 2011-12, with the majority of projects now implemented or underway. NHS Kirklees and the GHCCG have confirmed their commitment to the delivery of the Strategic Plan to 2013. For 2012-13, the GHCCG will monitor Strategic Plan programme


performance closely. The CCG is clear what its priorities are for 2012/13, and its plans incorporate both NHS Kirklees and new outcomes. These plans include matching its clinical improvement strategies and internal structures to address each of the five domains within the Framework in order that high-quality care and pathways of care are secured for local people. Key amongst these local outcomes will be improving services and patient experiences of those services. To support the on-going delivery of the Strategic Plan to 2013, GHCCG will work closely with member practices to ensure the successful implementation and delivery of projects/initiatives, particularly with regards to those underperforming as highlighted in quarterly Performance Reports. Understanding these challenges and current capabilities, along with the CCG primary goals, can generate effective fixes. Creative applications of CCG programme based reporting, can help effectively integrate the clinical actions required and regulate the contribution of professional groups along a system of care. To establish future quality metrics, the CCG will draw on skills of the business intelligence workforce and task them to look at best practice models for using the CCG programme based reporting to gather data and generate reports. GHCCG are then intending to integrate benchmarking data for achievable and real-life quality outcomes. GHCCG recognise that an important aspect of their proposed new commissioning business model will be the way in which they as commissioning leaders will design, direct and ensure delivery of outcomes for clinical programmes, working alongside their partners in acute and community services. They will elevate the levels of clinical leadership and strategic grip within priority clinical programme areas 3.2 QIPP (Quality, Innovation, Productivity and Prevention) (Transformational & Transactional) Nationally it is recognised that there is a clear correlation between improving quality (by using evidence based practice) and care pathways (to reduce waste and achieve productivity gains). The current economic climate has created an additional impetus for health economies to prioritise Quality, Innovation, Productivity and Prevention (QIPP). The focus on quality improvement (in the current economic climate) is providing a powerful lever for radical change. It is recognised that clear evidence of quality improvement in the three domains of patient safety, clinical effectiveness and patient experience together with the use of innovation to achieve tangible productivity gains is required. There is a requirement for the NHS Kirklees/CCGs to deliver just under ÂŁ30m of QIPP efficiencies over the next 3 years, GHCCGs share of this is ÂŁ16.8 million. In the previous 2 years we have successfully delivered ÂŁ28m of QIPP efficiencies. This provides us with a strong base to work on. However, the task of delivering Qipp is becoming increasingly more challenging due to the increasing financial constraints facing the NHS and the wider health and social care sector. There is also an increasing need to focus on transformational change as a way of delivering long term, sustainable efficiencies and being able to deliver modern services to meet the ever increasing demand facing the NHS and social care. As identified within the 2012/13 operating framework 50% of the programme should be transformational. So, whilst it remains important to continue to improve underlying cost efficiency, we have deliberately placed more emphasis on working towards transformational change over a 3 year period.


Delivering this will require sustained and focused efforts over at least this period of time and our plans and approach are designed to achieve this. Detailed plans are being developed for the delivery of 2012/13 plans, appendix 6. These are been worked up in conjunction with the CCG leadership team. Each of the CCG priority programmes has strong clinical input which has informed the development of QIPP priorities. They also make extensive use of benchmarking, programme budgets, and contracting information to identify and help deliver QIPP opportunities. GHCCG also use a prioritisation framework to help make decisions about where to make QIPP improvements. The plans were discussed in detail at the joint CCE Finance and Performance Group in January 2012. Following this meeting it is expected that the detail of the plans will be signed off, and where this is not possible clear actions agreed to ensure that this is possible by March 2012, to allow sign off by CCEs and Cluster Board. Once agreed, the implementation of the plans will be monitored in year by the Finance and Performance Group. Individual plans will be monitored using the existing project monitoring arrangements. GHCCGs productivity target is to improve the utilisation of resources within our devolved commissioning budget to deliver an efficiency gain year on year, with targets set at: Year 1 to March 2013 – £5.4m Year 2 to March 2014 – £5.7m Year 3 to March 2015 – £5.7m The CCG are working on longer than annual plans to deliver transformational QIPP change. They are being developed in conjunction with the Local Authority and provider organisations. The CCG have a Transformational Board covering CHFT acute trust. These plans are being developed over a longer time period as this level of change requires effort over a number of years to scope and deliver. The requirements on the CCG to deliver 50% of its identified QIPP challenge, is dependent upon the acute trust being able to meet its planned efficiencies, cooperation and collaboration of all partners is required to ensure success. In addition there will be other annual plans arising from other work and areas. Whilst individually these may not have the same value and impact, it is important to continue to identify and address areas of inefficiency. Unless the underlying provision of health and social care is cost effective, the ability to delivery meaningful transformational change will be impaired, and its impact diluted. GHCCG envisage that working with Cluster colleagues will create additional synergy across the Calderdale, Kirklees and Wakefield geography which will help deliver some of the more challenging aspects of QIPP in the medium – long term, The continuous development of the clinical QIPP programme will be a critical feature within the transition period and beyond 2013 when the two CCGs within Kirklees will hold corporate accountability for the economic stability of the health care system within the district. Changes to demand plans resulting from QIPP schemes are managed via a formal change control process with CHFT and MYHT, and are also impacted on contracts with other providers; the impacts are routinely costed into cost and activity projections and therefore cross-reference back to finance and QIPP plans.


3.3 Activity There is a strong track record of working closely with the main providers on shared models and assumptions for demand and activity planning. This robust and established demand planning process supports the negotiation and agreement of contracts. This ensures that activity and financial assumptions and plans are closely aligned with both each other and with those of the providers themselves. This process is currently underway and is broadly based on the following approach: Current year forecast out turn positions forming the basis for negotiating 2012/13 contracts with main providers. Required adjustments for delivery of identified developments and growth either as a result of changed national guidance or local agreement. Demographic growth based on ONS information and local modelling. Impact of QIPP schemes As part of this process we are also working with providers to understand the local impact of any PbR tariff changes for 2012/13 and include the changes to CQUIN payments. Our demand planning process is undertaken jointly with our main providers and includes checks against QIPP plans to ensure that activity changes resulting from these plans are built into demand plans and hence into PCT financial plans and contracts. An up-to-date record of these planned deflections is maintained throughout the contract planning process and used as a triangulation point across QIPP, finance plans and contract demand plans with the main providers. Changes to demand plans resulting from QIPP schemes are managed via a formal change control process, the impacts are routinely costed into cost and activity projections and therefore cross-reference back to finance and QIPP plans. During 2012/13 GHCCG have no immediate plans (with partner CCG) to decommission any current services. GHCCG‘s general approach to service provision will be to create a health market of a plurality of providers, financed on a cost per case basis, informed by our patients‘ right of choice thus effectively reducing where appropriate, the need for formal decommissioning and subsequent formal resource intensive tendering processes. NHS Kirklees have submitted to the Strategic Health Authority (SHA) and the Department of Health, in line with technical guidance, plans to support the 2012/13 Annual Planning Process. Please refer to Appendix 7 for 1 Year plans 2012/13 focusing on Improved access to psychological services, MRSA bacteraemia, Incidence of C. Difficile, Smoking quitters and NHS Health Checks. Please refer to Appendix 7 for 3 Year plans 2012/13 – 2014/15 for Activity based measures. The plans submitted have been green lighted by the SHA as a result of passing the initial validation criteria. All plans submitted are on an NHS Kirklees footprint until systems and processes allow these to be calculated using a methodology that would identify a Clinical Commissioning Group weighting.


The activity plans for 2012/13 have been calculated using actual activity from 2010/11 and 2011/12 to model a monthly projected profile and forecast outturn. A population growth and demographic change (ONS ‗2006-based sub national population projections‘) of 0.74% and 0.71% has been applied to the subsequent year‘s plans for 2013/14 and 2014/15 respectively. Activity has been reduced in line with QIPP plans that have been projected again on an NHS Kirklees footprint. QIPP plans suggest a reduction of 1.87% on Unsheduled activity in the first year 2012/13, a 5.5% reduction in the second year 2013/14 and a 12% reduction in the third year 2014/15. 3.4 Finance A joint finance narrative between GHCCG and NKHA is included in appendix 8, assurance has been provided during quarter 4 2011/12 of triangulation between activity, workforce and finance plans. Financial accountability will be enacted through a process of devolved budgetary reporting and management. Monthly budget reports are being provided to the CCG, with an individual practice level content, through the existing finance team who are providing ongoing support. Oversight and scrutiny of financial performance will be undertaken by the Finance & Performance Committee with two lead GPs providing the feedback and assurance to the CCG. GHCCG agrees to review its activity and finances on a monthly and cumulative basis, by CCG and by practice, and will take appropriate action where required: To achieve financial balance of GHCCGs income and expenditure in respect of provider costs, prescribing and management / running costs. To provide a fair allocation of prescribing and secondary care budget to individual practices based on a fair allocation of budget to GHCCG. To allocate funds efficiently across providers in a manner which responds to capacity demands and serves the health needs of the defined population. To allocate funding appropriately to support the engagement of GHCCG member practices. To forecast, monitor and control areas of financial risk and have procedures and mechanisms in place to counteract these risks. To implement and maintain a comprehensive internal and external audit process of finances. As budgets are delegated to the CCG, the Group will be required, in relation to its delegated duties, to operate within the Standing Orders, Scheme of Delegation and Standing Financial Instructions approved by the Cluster Board. 3.5 Workforce, including providers The HR&OD Shared Service (HRODSS) coordinates workforce information, planning and assurance on behalf of its client PCTs and CCGs, including GHCCG. HRODSS is a shared service that since April 2011 has operated as a single HR&OD team across the NHS Calderdale, Kirklees and Wakefield District Partnership.


Regular workforce reports are produced, including; key metrics to ensure that Senior Management Teams at, CCG, PCT and Cluster level are fully appraised of workforce issues, trends and challenges. They will continue to lead the annual cycle of workforce risk assessment across the cluster health economy. The constructive management and engagement of the workforce is always of paramount importance. During time of organisational change, it is perhaps even more critical that we discharge our workforce commitments successfully in order for our workforce to perform successfully, and for our local populations to continue to receive the high standards of care and access that they have the right to expect. GHCCG‘s developing HR Strategy outlines our commitment to the staff pledges laid out in the NHS Constitution. During the period of transition, the CCGs commitment to these four pledges is unwavering: To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities; To provide all staff with personal development, access to appropriate training for their jobs and line management support to succeed; To provide support and opportunities for staff to maintain their health well-being and safety; and To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families. GHCCG are actively engaged with the cluster board in developing planning for the migration of PCT functions to the new emerging structures and are refining CCG plans as detail emerges nationally and regionally. We will work proactively to determine the alignment and assignment of the PCT workforce. GHCCG recognises the need to take a lead role in the health economy workforce. Delivery of the ambitions for the health of the people within the CCG will be through the quality and effectiveness of the people the CCG, and the wider system, employ. As leaders of the local NHS, the CCG will be required to hold a system-wide overview of the workforce implications of our commissioning strategies and workforce-related risks to their delivery. In particular we are keen to assure ourselves of the reliability, affordability and safety of Provider plans, especially in the current climate. In the most recent versions of our main Providers‘ workforce projections (CHFT, Mid Yorkshire and Locala), the overall trajectory is steadily downwards, suggesting an eventual drop in workforce of 8% between 2010/11 and 2015. This is set against a rising activity trajectory, resulting in what appears to be a significant productivity gap requiring to be filled. Whilst Providers are responsible for the design and delivery of their own workforce plans, where risks are identified, GHCCG will have a role in working with relevant partners to ensure that they are comprehensively addressed. An existing successful health economy workforce risk assessment cycle is now in it‘s fourth year and will continue as CCGs continue to develop. The CCG seek to forge and maintain these strong partnerships with providers and partners. GHCCG is represented, as are our two main acute providers, community providers and mental health provider. GHCCG are engaged in a co-ordinated approach to planning to ensure that finance, activity and workforce plans are in alignment. The lead officers for each of these areas are in


constant dialogue and work together to develop plans. This ensures that agreed contracts reflect the commissioning intentions, and that the financial implications of the agreed contracts are reflected in the budgets. In addition, the workforce planning and finance leads work together to ensure that workforce plans and budgets are in alignment and reflect key planning requirements such as management costs reductions. Appendix 9 3.6 Contracts and CQUINS Contracts are still being finalised as this plan is being written, however the assumptions set out in our finance, activity and workforce plans are underpinning our approach to negotiation. Representatives from the GHCCG shadow board have been identified as key leaders, to work with support from the existing management team to negotiate and agree 2012/13 contracts. Appropriate contractual levers are being utilized to secure desired results, including performance and efficiency expectations. At the current time, GHCCG recognise there are risks and challenges in this process, for example: Maintaining a focus on quality, safety and patient experience throughout the transition process. The need to achieve performance in areas such as 18 weeks in a way that is affordable to the health economy. The impact of the 2012 /13 PbR tariff and the degree to which the local application of this will reflect national planning assumptions, from April 2012 Mental health PbR tariffs will begin to be introduced. This remains a potential financial risk. The need to work effectively with both health and social care partners to manage non elective demand, and ensure that re-ablement and related funding is used to maximum effect to manage risks across the health and social care economy. The CQUIN payment framework came into effect in April 2009 and makes a proportion of providers‘ income conditional on achievement of goals around quality and innovation. The value of CQUINs for 2012/13 is 2.5% of the actual contract outturn (an increase of 1% on the current year) and all providers on the NHS standard contract are eligible for a CQUIN scheme including independent sector providers and care homes. The aim of CQUIN framework is to deliver real benefits for patients and improve the quality of patient care, patient experience and equity in healthcare provision. GHCCG recognise that, a successful CCG will use its structure to drive behaviour change with its stakeholders. CCG members working with the various Clinical Programmes leaders must commit to tracking quality outcomes, establishing fair measures of those outcomes and rewarding providers (including GP practices) for achieving them (this could be via CQUIN or other bespoke inventive programmes). It is important for GHCCG to contribute to this process to maintain the local emphasis in line with its strategic priorities and ensure the scheme will contribute to QIPP. Principles for the development of new indicators have been shared with providers and will guide the development of the schemes. Consultation with providers will continue to be through the relevant Quality Board). The schemes will be agreed through the contract negotiations, with quarterly monitoring of performance discharged through the Quality Boards, and exception reported to the Quality Group and Cluster Governance Committee. Future GHCCG Development GHCCG intend to drive forward quality and safety within the performance against the commissioned and contracted services. Commercial skills are relatively new within the NHS,


but are now an essential and integral part of the commissioning processes under the CCG leadership. GHCCG is committed to the development of a healthcare system that contains stronger incentives for organisations to respond to local needs, improving both quality and efficiency. GHCCG intend to seek to balance competition and market levers with cooperation and apply each in an intelligent way to drive up quality, value for money and responsiveness of services. There are 3 areas of commercial input required: Market management and general commercial activity; Procurement; Contracting and provider management. Market Management: GHCCG will understand how markets are working and apply appropriate levers to improve market functioning. This includes: Commercial strategy (incl. levers) Market Analysis (Incl. Barriers to Entry Removal) Provider economics Patient Choice Development Provider development Procurement: GHCCG will ensure that they have access to a set of procurement activities that enable the acquisition of high quality healthcare provision efficiently, effectively and legally. This includes: Procurement strategy and compliance (including identification of appropriate procurement methods) Clinical services procurement Procurement Project Management & Delivery Negotiation Support Development of Key Performance Indicators Helping to shape service specifications Contract management: The management of the relationship with individual providers ensures that they deliver high quality, effective and safe healthcare. This includes maintenance of contracts and Payment by Results compliance and other nationally prescribed outcomes or targets, and includes: Technical Contract Drafting Contract Administration Contract negotiation Contract monitoring Contract management (incl provider relationship management) Contract validation/challenge/reconciliation Contract performance management (incl performance relationship management) 3.7 Budget setting and scope GHCCG are engaging early and influencing the commissioning process by understanding spend, where it is spent, and for what outcome. This is key to success as CCG begins to


slowly accept responsibility for large swathes of commissioning resource and budget responsibility. In June 2011 practices were provided with details of practice level based on a fair shares calculation using the DH model toolkit. This methodology presents practices with their initial budget that actual performance will be monitored against. The following table shows the initial delegation of budgets to GHCCG which has been agreed: Contract Calderdale & Huddersfield Foundation Trust Southwest Yorkshire Partnership Foundation Trust Mid Yorkshire NHS trust Locala Rest – GMS/PMS/Pharmacy Public health TOTAL


NHS Kirklees total

£135.7 million

£139 million

£22.5 million

£40 million

£1.3 million £22 million

£102.5 million £39 million

£277 million

£550 million

£458.5 million

£870.5 million

With delegated budgets the responsibility for meeting financial targets within the current financial plan have been accepted by CCG in relation to operating within the allocated budget and delivering the QIPP programme. GHCCG commissioning budgets will be monitored on a monthly basis. Mitigating action plans will be agreed with CCG member practices as required, to ensure that the GHCCG achieves financial balance and efficiency savings. The CCG managerial team has recently been strengthened to include contractual and financial expertise. This will allow delegated budgets to be actively managed at a CCG level and support individual practices to fully engage with the commissioning of local services and support service change. The local authority will, be taking over the health improvement budget. This means that the CCG will have a duty to work in partnership with local authorities and will see considerably more integrated or co-ordinated commissioning arrangements, particularly in the areas of long term conditions and services to the elderly. 3.8 Statutory Accountabilities During the transition period to April 2013 or GHCCG achieving full authorisation (whichever is the sooner), the CCG is developing its abilities to deliver against its statutory accountabilities for performance, contracting and financial management through the CCE. The joint formal sub groups of the NHS Calderdale, Kirklees and the Wakefield District Cluster Board with NKHA, is enabling GHCCG to function as a formal sub-committee, with delegated responsibilities for financial duties. As budgets are delegated to the Clinical Commissioning Group (CCG), the Group will be expected to operate within the Standing Orders, Scheme of Delegation and Standing Financial Instructions approved by the Cluster Board. In recognition of this, and to support the CCE in its increased responsibilities for financial monitoring and delivery of QIPP, the Finance and Performance Group will:


perform a monthly review of the overall performance of NHS Kirklees PCT; and review performance against the delivery of the financial and operational plan. The CCG will be required, in relation to its delegated duties, to operate within statutory requirements. The CCG will be supported by CCG and or aligned managers who have expertise in the required areas who will advise the Committee on statutory duties 3.9 CCG development plan Initial development of GHCCG began with a recruitment and selection programme against key competencies to select a strong executive CCG with the ability and motivation to deliver and succeed. There have been a number of development sessions open to all CCG staff across the Calderdale, Kirklees and Wakefield cluster. The Cluster has established a CCG Training and Development Group which has a range of work streams, one being Organisational Development and Training. GHCCG recognises its developmental needs both in terms of organisation and individual requirements to support its transition up to 2013. A GHCCG Organisational development plan has been developed to support the CCG to participate in the national self assessment tool and agree actions and timescales to meet its organisational development needs in readiness for authorisation. Individual needs will result in local actions being undertaken but where there are joint needs across the either the CCG or the cluster, it may be appropriate to deliver some actions plans jointly. The CCG have all recognised the necessity of this development and have actively engaged and led its design and delivery. The CCG diagnostic tool has been completed within the CCG and has been discussed at the December Board to board meeting. Results from the tool have been used to identify and develop CCG priority areas for development. Each CCG clinical lead also has a personal development plans to address their individual training and development needs in terms of commissioning and board membership and their personal objectives for year. A more detailed Organisational Development plan has been developed and will be managed through the CCG and its OD sub group structure. Appendix 10. A formal review of the organisational development plan will be undertaken in April 2012 to reflect on learning to date and identify any further priorities against the authorisation action plan. 3.10 Risk management arrangements GHCCG recognises the need for robust risk management. To deliver this new method of commissioning and ownership will come with a degree of risk, including that of failure to develop and execute a strategy and operating plans. As they continue to develop the CCG will vigorously acquire knowledge and expertise in the full range of risk management aspects. The way in which the CCG challenge is taken forward and capabilities start to be built, in relation to commissioning based disciplines, will significantly influence the way in which strategic objectives will be realised. This forms part of the changes in clinical-led commissioning and failure to develop then embed risk management competencies within the organisation will significantly increase the strategic risks the CCG face.


The CCG will utilise the systems and processes identified in the NHS Calderdale, Kirklees and Wakefield District Risk Management Policy and Risk Register guidelines for the identification, assessment, management, reporting and evaluation of risks. A single system has been selected and agreed via the Cluster Governance Committee in December 2011. Appendix 11. The system and processes are currently being rolled out with a plan to have this fully implemented by April 2012. This will enable GHCCG‘s organisational and governance committees to have the ability to measure risk on a standardised system. The CCG audit and governance subgroup will provide assurance to the executive CCG and Cluster Board that all risks in relation to discharging its duties are being appropriately identified, assessed and managed. Progress on the development of this risk assurance framework will also be monitored by the Audit and Governance Committee at Cluster level on behalf of the Cluster Board. All risks associated with the agreed delegated duties will be managed by the CCG who will also be responsible for identifying and assessing new risks and developing associated risk mitigation plans as required. 3.11 Quality and patient care The challenges facing the development and implementation of CCGs are significant; however the benefits of doing it well are considerable. The reforms in the White Paper centre on the GP playing the most important role in improving the health of local people; commissioning a total health system that provides high quality, efficient and effective care for all. The ultimate goal for GHCCG is to design and deliver a health system which is radically different. It will be one where GPs not only understand what is being committed with every decision made and the outcomes that are being delivered, but which provides a personalised, proactive health service for all within the CCG. GHCCG will act with a view to securing continuous quality improvement in all services it commissions and will embed the three dimensions of quality across all commissioned services which are: The effectiveness of the service; The safety of the service; and The quality of the experience undergone by patients. Quality improvement will be secured through the GHCCG Working Group. The work of the Clinical Working Group will include the focus on the quality schedules in provider contracts and monitoring the quality in general practice. The CCG will assist and support NHS Kirklees during 2012/13 and beyond that the future National Commissioning Board, in discharging its duty relating to securing continuous improvement in the quality of primary medical services. The CCG is committed to promoting equality of opportunity and eliminating discrimination through commissioning of local health services for our registered population. The CCG will actively engage with the local Health and Wellbeing Board in order to achieve cohesive, integrated and accountable commissioning of local services, aligned to the priorities identified in the JSNA and in support of the joint health and wellbeing strategy for Kirklees. The CCG will, in the exercise of its functions, have regard to the need to;


Reduce inequalities between patients with respect to their ability to access health services. Reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services. Promote the involvement of patients and their carers in decisions about the provision of health services to them. Enable patients to make choices with respect to aspects of services provided to them as part of the health service. The CCG is committed to the seven key principles of the NHS Constitution and the underpinning core values of respect and dignity; commitment to quality of care; compassion; improving lives; working together for patients and everyone counts. Patient Choice is integral to the CCG‘s commissioning approach and our patients rights will be upheld and supported to ensure delivery of appropriate services, access and quality. There are robust quality governance arrangements in place with main providers through Quality Boards as part of contract management arrangements. These will continue with clinical commissioner input strengthened from the CCG where necessary. These forums exist for a number of contracts, including Calderdale and Huddersfield Foundation Trust, South West Yorkshire Partnership Foundation Trust (SWYPFT), and Locala. All providers (who provide regulated activities) are expected to be complaint with the Essential Standards of Quality and Safety and meet the registration requirements of the Care Quality Commission (CQC). 3.12 OD support Organisational Development has been defined as “a planned, organisational wide approach to increase organisational effectiveness and health through planned interventions in organisational processes, using behavioural science knowledge”. (Bekhard 1967). The CCG is fully supported by a cluster level HROD team, led by a dedicated senior manager who have knowledge of the GHCCG area, priorities and have worked with the members of the CCE during 2011/12 to develop a joint OD plan as is summarised in 3.9 as well as available in appendix 10. The OD Plan is iterative – its purpose is to accelerate the organisation‘s progress, but the plan and OD activity arising from it will be monitored (e.g. through further diagnostic activity), and will adjust and change to reflect the changing development needs of GHCCG as the development journey to authorisation and beyond continues. 3.13 Equality and diversity GHCCG is developing its understanding of current and future statutory responsibilities as outlined in the: The Equality Act 2010, The Public Sector Equality Duty and The Specific Duties (Regulations 2010) Work continues to determine the future model of corporate support of which equality and is a key component. GHCCG will continue to input into this process as the model evolves during 2012, with the board members undertaking basic understanding of duties within the engagement development. NHS CKW Cluster has an Equality and Diversity Action Plan


which has been developed as a framework for meeting cluster wide statutory requirements of the Equality Act 2010; the Public Sector Equality Duty and the specific duties as set out in regulation (1.1.). The NHS Equality Delivery System (EDS) framework will be used by the Cluster as a tool to; Assist NHS CKW and the member CCGs to meet the (evidential) requirements of the statutory public sector equality duty, and to involve patients (NHS Act 2006); and Improve equality performance across the Cluster by embedding equality into its mainstream business as commissioner. The action plan seeks to ensure consistency in both approach and application across the Cluster, and is based on the NHS Equality Delivery System framework (a performance monitoring tool to support the requirements of the Equality Act 2010.) In the interim, GHCCG has adopted to utilise the existing skills within the organisation to direct them to ensure compliance with the appropriate legislation, this includes: CCG undertaking impact equality assessments with each new business case or evaluation for review at CCE; Ensuring CCG assigned staff undertake mandatory training updates Sign up to and support of a joint programme of work with the local authority regarding reducing health inequalities and Provide assurance reports as required for the CCE Board and through to the Cluster Board. An equality impact assessment will be undertaken on this Operating Plan as it is finalised. Appendix 12. 3.14 Communications During 2012 it is the intention of GHCCG to concentrate on putting the foundations in place for a comprehensive communications and engagement strategy. It is intended that by the end of Q1 2013, the CCG will have developed a robust communications and engagement strategy, facilitated by the completed stakeholder map that will allow the identification of appropriate levels of communications, ranging from information giving to active engagement and involvement. The CCG will be supported by the single communications and engagement team, established across the Calderdale, Kirklees and Wakefield Cluster area during 2012/13, to support, manage and coordinate effective actions to support delivery of the CCG Operating Plans as well as providing expertise in reputation and relationship management. Work continues to determine the future model of corporate support of which communications and engagement is a key component. GHCCG will continue to input into this process as the model evolves. GHCCG recognises that as well as its clinical and commissioning responsibilities, the CCG will be responsible for: Managing the reputation of the local NHS Media management Brand and identity management Crisis communications planning and preparedness Information provision for patients


Responding to parliamentary questions and other statutory requests for information Consultation and engagement around service changes and developments. The CCG is keen to promote its role within the local community and to build sustainable and effective relationships with its member practices, staff, local politicians, the Local Authority, Local Involvement Network/Healthwatch, NHS organisations, the media and other partners as well as patients and the public. The CCG is being supported by the communications and engagement team to achieve this objective The media is increasingly taking an interest in the activities of the CCG‘s and GHCCG have identified and will train key media spokespeople, develop media awareness amongst CCG member practices and agree media protocols. GHCCG will ensure that actionable communications and engagements plans are in place to support any significant programmes of work e.g. the development and implementation of the CHFT Clinical Service Refresh Strategy and the Patient and Public Engagement strategy. 4.0 CAPACITY AND CAPABILITY 4.1 Build, Share, Buy Model of service provision to CCG In March 2011 the DOH published a document ‗The Functions of GP Commissioning Consortia: A Working Document’ which sort to set out a clear and straightforward description of the key duties and powers of consortia. While this document has not been updated following the pause to reconsider the Health Bill it is thought to be a useful guide and starting point when considering the likely functions required of the new statutory bodies, now to be known as Clinical commissioning Groups. The functions set out in the Working Documents broadly follow the commissioning cycle and include the following: Planning and evaluating – in terms of vision, strategy, developing an outcomes framework, developing the QIPP programme, engagement. The document also includes managing quality in primary care services within this area. Agreeing and Monitoring services – in terms of specifying service provision, agreeing, monitoring and managing contracts, joint commissioning arrangements, emergency planning, strategic estates and IFRs. Finance – including financial planning, monitoring and managing, IM&T and premises. Governance – including clinical and corporate governance, statutory responsibilities, and risk management. The November 2011 final draft of Developing commissioning support: Towards service excellence defines commissioning support as ‗…assistance that CCGs or the NHS Commissioning Board buy in or share‘. It also states that: There is no prescribed model for commissioning support: CCGs and their populations will have varying needs. The final decisions on the shape of commissioning support will be a matter for CCGs themselves. Some larger CCGs may undertake for themselves some activities that some smaller CCGs may consider more appropriate to either share or else secure from external suppliers. In some instances, CCGs may work together, either with a shared model between them or with one hosting a service provided to others. GHCCG recognises that this guidance suggests that commissioning support will have more time to evolve with the Commissioning Board hosting any CSO structure up to a maximum of


2016; and that Some support functions, including business intelligence and large and complex contracting are best delivered at scale. To date GHCCG has actively participated in a considerable amount of work already undertaken into workforce capacity and capability across the cluster, and is keen to establish structures that will support their development and progression to authorisation. This has included: Working with emerging commissioning support suppliers to help to define and describe the prospectus and service specifications Begin to identify GHCCG‘s commissioning support requirements; Working with other emerging CCGs to understand the commissioning support functions that can best be shared and to agree how to share them; and Financial modelling. GHCCG is supportive of establishing models of Commissioning Support Services and has actively worked closely with the project lead for defining the final offers which were completed February 2012. The CCG and will continue to explore how it can maintain a suitable local presence to support the key priority of local ownership whilst reviewing the best solution under build, buy or share, signalling their intention for 2013/2014 support before August 2012. 4.2 CCG Capacity and Capability Timetable As formal structures of the CCG and CSS are developed, through the next 6 months arrangements will be agreed for approval of financial plans and budgets for 2012/2013 and beyond. In agreeing the delegation of budgets to the CCG it is crucial that PCT resources in terms of contracting, commissioning, and finance are available at CCG level. A transitional arrangement to provide this resource has been put in place to provide assurance to both the CCG and the Cluster that the capacity and capability exists at CCG level to take on the delegated responsibilities. In advance of the finalisation and populating of the structures and to enable the CCG to discharge its responsibilities staff currently undertaking CCG responsible work will continue to be available to the CCG to do so. GHCCG intend to be ready to take on full statutory responsibility from 1 April 2013. Details Full Sub-committee in place for GHCCG and governance structures Leading on local health system including active review of performance, finance and contracting Working with local project manager for CSO offer to ensure reflects the requirements of GHCCG Implement Authorisation development group to oversee authorisation and OD development is implemented Implementation of development sessions for CCG and CCE Revised recruitment and selection of final future leaders for CCG Application for authorisation (subject to passing of the bill) Agree intention for commissioning support to enable SLA‘s to be finalised Finalise SLA with CSO 100 % Delegated authority from NHSK


Date October 2011 October 2011 August 2011 to February 2012 December 2011 July 2011 to March 2013 April 2012 April to July 2012 August 2012 March 2013 April 2013

Recognition is given to the degree of development already achieved by GHCCG. Some areas of accountability and delivery will commence and over the next 3 months and the CCG have planned these activities into the authorisation plan, appendix 13 and OD plan timetable. These include: Finalising the 5 year strategic plans Inputting into the transitional work programmes for the National Commissioning board Input into the public health transition Agreement of all engagement activities with the CKW Cluster NHS CKW Cluster is supportive of GHCCGs development toward Authorisation: eCCG Greater Huddersfield Clinical Commissioning Group RATED GREEN

Population 243,567

Practices 40

The following sets out the critical path for the development of GHCCG in 6 key stages from September 2011 through to October 2012 and progress to date. The next six months are seen as critical in enabling GHCCG to have appropriate evidence to support their application to be authorised. Stage 1 October – December 2011 Configuration of eCCGs: The CCG self assessment was completed and risk assessed as green. The OD plan has been signed off by the Cluster and will be reviewed in April 2012. The diagnostic checklist was completed and a scheme of delegation and new governance arrangements have been put in place This includes being formally established as a sub committee of the Cluster Board. As part of the Cluster assurance framework, Board to Board challenge-and-confirm meetings have commenced. Stage 2 December 2011 – January 2012 CCGs lead the planning process for 2012/13 by developing a clear and credible plan: GHCCG have developed a clear and credible plan. A provisional CCG Budget allocation has been identified and the plan set out a clear approach to delegation. Stage 3 January 2012 – March 2012 Commissioning intentions should be clearly identified as part of the planning process: Within this Operating Plan, GHCCG has identified its commissioning intentions. Recruitment has commenced to the agreed senior management structure, there is also provisional agreement of which commissioning support functions GHCCG would want to buy, build or share and the model of CSO delivery for these services is under development in line with CSO timetable. Representatives of the CCG are on the key contracting groups. Stage 4 March – September 2012 New contracts led by CCGs and signed by 15 March 2012. This would include a block contract between each CCG and the CSU by April 2012.


GHCCG are leading on the agreed QIPP programme and are key to leading the contract negotiations for the main NHS trust contracts. GHCCG are involved in co producing the CSO offer and future service level agreements. Stage 5 September – October 2012 Operational period (this would be for the period April through to September 2012 to enable CCGs to develop their track records.): The NHS CKW cluster have developed a checklist, which will be used as a tool to prepare and support GHCCG for authorisation, this will help identify areas for development, further support required and the collation of an evidence file. Stage 6 October 2012 Commencement of formal authorisation process with the NHSCB: A series of Board-to-Board ‗confirm-and-challenge‘ meetings between GHCCG Board and the Cluster Board have been set up, the first took place in December 2011. 4.3 Training & Development Plan The CCG is participating in the national Pathfinders programme and contributes to regional and local discussions. The CCG is committed to understanding and building on this learning to ensure that where possible best practice is either; identified, adopted and implemented. More locally executive members represent the member practices and the population regularly as leaders of practice cluster groups, as function leads in specialism's, such as ; medicines management and urgent care and also with partners and stakeholders such as the Local Authority and providers. The CCG recognises the importance of training and development to support the implementation of this plan and the work of the CCG as a whole. Training and development issues for the executive and wider group will be assessed and an Organisational Development (OD) plan implemented. Appendix 10 There have been a number of development sessions open to all GPs and practice staff across the CCG tailored to training needs identified by the CCG leadership team. These sessions have included the following themes; Finance, Contracting, Planning Cycle, Joint Strategic Needs Assessment, Joint Working with the Local Authority. The CCG will continue to work with the Cluster sub group for training and development to agree an ongoing detailed training and development plan for all CCG and CSU staff following a gap analysis of skills required. 4.4 Plans for Good Governance and Managing Conflicts of Interest The CCG is established as a Committee of the Cluster Board with a range of delegated duties and responsibilities. The CCG Committee will operate within clear Terms of Reference which have been approved by Calderdale, Kirklees and Wakefield Cluster Board. These detail arrangements for managing conflicts of interest and all CCG members have completed their registration of such items. The CCG will operate within its delegated duties, functions and responsibilities delegated by the Cluster Board. The Committee, and its members, will operate within the Standing Orders, Scheme of Delegation and Standing Financial Instructions of the Cluster Board. The CCG Committee will provide performance and assurance reports to Calderdale, Kirklees and Wakefield Cluster as agreed.


To support the Cluster Audit Committee, GHCCG jointly with NKHA has secured an appropriate support structure to provide assurances in relation to finance, quality, performance and for all corporate and authorisation requirements. Initially the CCGs have adopted the supporting committee structures of Kirklees PCT. During 2012 the CCG Committee will review and consider revision of its supporting arrangements. In addition, the Accountable Officer of the CCG Committee attends the Cluster Audit Committee to discuss any areas of CCG business. 5 LEADERSHIP CAPACITY AND CAPABILITY GHCCG is led by the CCE board whose duty it is to ensure that the organisation and its providers are accountable for the assurance of having the capacity and capability to deliver. The standing financial instructions, utilising a scheme of delegation and standing orders are in place to ensure that the leaders deliver their duty for the organisation to ensure performance targets are achieved; healthy outcome achievements and GHCCG deliver its vision and values. In order to assure this, Standard agenda items for the CCE include board reports in relation to: Performance / Quality Finance Contracting Risk Management With the CCE receiving, reviewing and ratifying the minutes from: Clinical Strategy Group Quality and Safety Sub Group Audit and Governance Sub Group Finance and Performance Sub Group Organisational and Development and Authorisation Sub Group Shadow Health and Wellbeing Board These reports are reviewed and increasingly challenged by the leadership team on the CCE, with decisions taken in order to ensure that quality is improving and targets are being met and where not met, action plans with accountability are implemented. 5.1 Terms of reference Clearly defined terms of reference approved by the Calderdale, Kirklees and Wakefield cluster board have been implemented for the GHCCE and sub committees. Appendix 14. All sub groups to the Clinical Strategy Group, also have defined and agreed terms of reference, including: Practice Nursing Development Group Education and Training Steering Group Practice Managers Reference Group Terms of reference are also agreed for the Health and Wellbeing Board 5.2 Board structure and governance Attached at Appendix 1 is a committee structure for the Greater Huddersfield Clinical Commissioning Group, which will allow it to undertake its delegated responsibilities.


The CCE is constituted of the following membership: Up to eight Clinical Commissioning Group (CCG) Board members Two non-GP clinical members (nurse and consultant) Chief Operating Officer Consultant Public Health, NHS Kirklees Chief Finance Officer, NHS Kirklees Quality Lead, NHS Kirklees A Director nominated by Kirklees Council One Non Executive Director from the Cluster Board Two Non Executive Associates 5.3 CCG Committee Governance: evidence of assurance The GHCCE Committees terms of reference have been agreed and include the following duties and responsibilities: Strategy and planning; Finance, performance and delivery; Quality and safety; Partnership and governance; Development of the clinical commissioning group for authorisation Terms of reference are in place for the sub groups which will ensure and assure the CCG that its duties and responsibilities are being managed and discharged effectively. 6


6.1 Memorandum of Understanding Greater Huddersfield Clinical Commissioning Group (GHCCG) has drawn up a statement of intent, which sets out clear expectations about the behaviours and values of GHCCG and its member practices. The statement of intent, as set out in Appendix 14 has been agreed with member practices and outlines the roles and responsibilities of the GHCCG and its member practices with the purpose of providing clarity in moving forwards. A formal memorandum of understanding between practices and GHCCG, underpinned by clear rules of engagement, will be developed in due course, 6.2 Constitution and interim arrangements Applications for authorisation from prospective emerging CCGs to the NHSCB will have to set out a satisfactory constitution which should include as a minimum: CCG‘s name and members; The CCG‘s geographical area; Arrangements for discharging the CCG's statutory functions; The CCG's procedures for decision making and managing conflicts of interest; and, Arrangements for securing effective participation of CCG members. It is noted that the constitution may require revision subject to the passage of the Health Bill and any subsequent Parliamentary process. It is also expected that further national guidance


will be issued to help confirm the constitutional framework as we move closer to authorisation. GHCCG is operating in shadow form until the formation of a statutory body (no later than 1 April 2013) with specific and delegated responsibilities as appointed by the Cluster Board. During the transition period (and with specific and delegated responsibilities as appointed by the Cluster Board) GHCCG has duties and powers related to the following: Planning services - to contribute to the Joint Strategic Needs Assessment (JSNA) and the joint health and well-being strategy, and to have regard to the same in exercising any relevant functions; Agreeing services - to adopt any ‗standing rules‘ that may be required under the Bill in relation to the contracts to be used by the CCG and to comply with any regulations that may be made governing procurement activities; Monitoring services - to exercise functions with a view to securing continuous improvements in the quality of services for patients and in outcomes, with particular regard to clinical effectiveness, safety and patient experience; Improving the quality of primary care - to assist and support the NHS Commissioning Board as regards its duty to exercise its functions with a view to securing continuous improvement in the quality of primary care; Finance - to break-even on the commissioning budget (i.e. ensure expenditure in any financial year does not exceed the allocated budget and any other funding or other sums received). To keep proper accounts and have these audited annually; Governance - to develop systems and processes that will enable the CCG to be authorised as a statutory body. This may include the setting up of sub-committees and an audit function; and Specific duties of co-operation - to work in partnership to improve the wellbeing of children and, where necessary, support local authorities in arranging support for children and families. 6.3 Partnership arrangements

It is assumed that the authorised GHCCG will inherit the legal partnerships and their interagency governance arrangements, as set out in the table: Strategy area


Children and Young People

Children and Young People Partnership Board

Mental Health

Mental Health Partnership Board

Learning Disability

Learning Disability Partnership Board

Older People

Older People Partnership Board


Dementia Strategy Board

Carer Substance Misuse Integrated Community Equipment Service

Carers Strategy Group Joint Commissioning Group Joint Strategic Commissioning Board (Adults) Safeguarding Board (Children, and Adult) Joint Strategic Commissioning

Safeguarding DoLS


Formal agreement Includes aligned budgets for joint contracts Sc 75 integrated provider agreements Sc 75 integrated provider agreements Some Sc 75 integrated provider agreements Also Sc256 agreements Sc 256 for some contract agreements Sc. 256 NHS Act 2006 Sc 75 Pooled treatment budget Sc 75 Pooled budget & Integrated provider agreement None Plans for Sc 256 NHS Act 2006

Re-ablement Continuing Healthcare

Board (Adults) Joint Strategic Commissioning Board (Adults) Joint Strategic Commissioning Board (Adults)

from April 2012 Sc 256 NHS Act 2006 Integrated decision making / funding agreement panels

NHS Kirklees, have historically operated under the auspices of Section 75 lead commissioning or other joint working arrangements with Kirklees Council for health and social care services and also pooled funds and funding transfer arrangements. The White Paper flags up, that local authorities will have an enhanced power to promote partnership working and integrated delivery of public services and the existing legal framework for partnership arrangement will be simplified and extended. CCGs will also have a duty to work in partnership with local authorities. The local authority will, of course, also be taking over the health improvement budget. This means that we will see considerably more integrated or coordinated commissioning arrangements, particularly in the areas of long term conditions and services to the elderly. GHCCG considers that the requirement of the Operating Framework for 2012/13 to continue the transfer of social care funding creates opportunities to influence social care commissioning for the improved benefit of local health services. During 2012/13, GHCCG will commit to work hard to maximise the potential of this situation. This GHCCG Business Plan the future 5 year CCG Strategy and CCG Governance Plan supported by the JSNA, the Health and Wellbeing Board and the developing Health and Wellbeing commissioning strategy and will determine the approach to sustainable partnerships. GHCCG anticipate working in collaboration with other, surrounding CCGs, specifically but not exclusively, from within the PCT cluster, North Kirklees Health Alliance, Calderdale, Wakefield Alliance and South Wakefield Commissioning Partnership. Partnerships are however not just about and between health and social organisations. They include many different stakeholders, and strategic and tactical groups. The style of partnership relationships, particularly with the health system suppliers will shift emphasis over time from a current ‗commercial‘ model to one of co-production. 6.3.1 Public Health There is an understood and agreed set of arrangements for how the local public health system will operate during 2012/13 in readiness for the statutory transfer in 2013. The Public Health team in Kirklees have a draft transition plan and associated work streams that have been developed in partnership with the Local Authority that clearly reflects the components of the Public Health transition checklist. The Public Health functions will continue to be accountable to the NHS Cluster Board during the 2012/13 transition period. Locally the governance of the process will be overseen by the Public Health Transition board with Kirklees council. By April 2013 public health in Kirklees will: Be fully established within the local authority in respect of responsibilities; Have clear structural relationships with Public Health England (PHE) and the NHS commissioning architecture; and Comprise the appropriate organisational forms and relationships to best deliver its responsibilities in the local authority, PHE and NHS commissioning architecture. The scope of the programme is to manage the transition of public health into the local authority and the relationship with PHE and the NHS commissioning architecture to ensure it delivers its responsibilities. This includes: Accountability and governance including performance monitoring;


System design to embed all relevant elements of PH responsibilities as described nationally with local interpretation for the best fit; Influencing the design of NHS commissioning architecture and PHE so that we are able to relate to it effectively in Kirklees and West Yorkshire with the emerging Commissioning Support Organisation (CSO); Budget planning and setting; Alignment of staff and related HR issues, including any staff transfers into PHE; Managing relationships and expectations; Management of delivery and risks during transition; Ensure effective collaboration with the LA, NHS Cluster and CCGs and emerging West Yorkshire PHE unit and West Yorkshire CSO; and Creation of a public health legacy handover document for 2012/13. Ensure key public health functions are managed and are delivering during transition. 6.4 Health and Well-Being Board Kirklees council is GHCCGs Local Authority partner. It provides a full range of local services to a population of 420,000 people in Kirklees, across both GHCCG and NKHACCG. A history of mature partnership working exists between the NHS and Local Authority, particularly in relation to children and young people, mental health, learning disability, and substance misuse. There are strong individual working relationships between senior officers. The new Health and Wellbeing Board is gaining shape and GHCCG are gearing up for the opportunities and challenges of joint planning and joint commissioning. Two Board members and the Accountable Officer from the CCG are members of the established Health and Wellbeing Board, with supporting officers from the CCG senior management team. Including the delivery of public health objectives, engagement with the local authority is seen as a crucial component for future successful commissioning. GHCCGs aim is to ensure that the CCG and Kirklees council‘s Operating Plans will be firmly underpinned by a shared understanding of the needs of the community, through joint strategic needs assessment. The Joint Strategic Needs Assessment (JSNA) published (September 2011) continues to highlight the challenges in the district. GHCCG will continue through active participation on the health and wellbeing board, to work to achieve a strong alignment between the strategic priorities developed by the CCG and presented within this plan, to those included within the joint health and wellbeing strategy. Development of the Joint Health and Wellbeing strategy is advanced and addresses those identified needs, within the collective resources available. The Kirklees joint health and wellbeing strategy will be out for consultation during Q1 2012. Discussions will continue to develop a proposed model for GHCCG, working with Kirklees Council. This will be in line with defined functions and accountabilities for CCG and health and social care joint commissioning.



transformation programme.docx


FEB priority updates.docx

2. CCG membership structure JG

Statement of intent between Greater Huddersfield Commissioning Consortium and Consortium member practices.docx


Engagement with Patients & Communities.docx


GHCCG stakeholder GHCCG stakeholder mapping exercise Feb 2012 analyses DRAFT March v1.doc 2012 v1.docx


Qipp 1.doc

Qipp Worksheet.xlsx


12-13 activity plans.xls




Financiall Plan 2012-13 Tech Finance Comentary (Jan Draft Plans).doc

Workforce_section_o perating_plan_V1 0 15Mar12.docx



12-13 activity plan 2.xls

GHCCE OD Plan Final 29 Nov 2011.docx


CCG Risk Management Policy 29.12.11.doc

12.add EIA




GHCCG authorisation plan draft version 1.doc

EC-11-53 (1)-GHCC CCE TORs.docx


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