Agenda Item 11 Enclosure CKWCB/12/41
Cluster Board meeting on 7 February 2012
Title of Report:
Configuration of CCG’s in South East Wakefield
FOI Exemption Category: Open Ann Ballarini, Executive Director of Commissioning and Service Development Responsible Director:
Report Author and Job Title:
Ann Ballarini, Executive Director of Commissioning and Service Development firstname.lastname@example.org
The Strategic Health Authority (SHA) rated South Elmsall and Rycroft and the Grange emerging Clinical Commissioning Groups (eCCGs) as red and CKW Cluster is supporting practices to agree a new configuration for clinical commissioning. A summary of the proposal for the design of the NHS Commissioning Board describes the proposed role and function of the NHS CB Board across 9 directorates with a single operating model with 4 sectors and 50 local offices. The total workforce will be approx. 3,500 with 800people working in NHS CB centre, around 200 people in the four sectors and 2,500 across 50 local offices. The NHS CB running cost budget for 2014/15 will be £492 million which represents a 50% reduction on current costs. These proposals are to be discussed at next NHS CB’s Board meeting on 2nd February 2012. NHS Property Services Ltd. will be a company set up and owned wholly by the Department of Health. The principle function of the company will be to hold and manage part of the estate that is currently owned by PCTs, SHAs and Arms Length Bodies. The location of such services is expected to mirror NHS CB locations as far as possible. Properties and staff may transfer in a number of waves. Further details expected in the spring.
A risk has been identified on the NHS Wakefield risk register around the development of CCGs.
None at the time of writing the paper.
Not applicable to the content of this paper.
Not applicable to the content of this paper.
Outcome of Equality Impact Assessment:
No assessment completed at the time of reporting.
1. Note the update on resolving the configuration issues in South East Wakefield. 2. Note the update on the design of the NHS CB 3. Note the future arrangements for managing NHS Estate.
Configuration of CCGâ€™s in South East Wakefield February 2012 1.0
Purpose of the Report This paper has three purposes: To give an update on the proposal for White Rose practice and the Grange practice to develop a single emerging Clinical Commissioning Group (eCCG). To update on the design of the NHS Commissioning Board. To update on future arrangements for managing NHS Estate.
Proposals for the Establishment of eCCG South Wakefield Commissioning Partnership
All eCCGs were asked to complete a self assessment as the first phase towards authorisation. All eCCGs across the Calderdale, Kirklees, Wakefield, (CKW) cluster submitted an assessment for consideration by the Strategic Health Authority (SHA) NHS North of England. In the case of both South Elmsall and Rycroft - and the Grange, the SHA has risk rated them as red. This is on the basis of their size and the fact that even more fundamentally the SHA has identified that there is a significant problem with their proposed configuration as a result of very recent confirmation from the Department of Health that the wording in the Health and Social Care Bill precludes a single practice, such as in these two cases, from applying to become authorised as a CCG. It goes on to say that all CCGs must be a group of GP practices, by definition.
In The Operating Framework for the NHS in England 2012/13 published on 24th November, page 27, it makes it clear that SHA clusters need to be confident by 31st January that any outstanding configuration issues can be resolved by the end of March 2012. Discussions have taken place with both practices to look at the options for configuration throughout November and they have expressed a wish to form a new eCCG the South Wakefield Commissioning Partnership. Although this configuration would meet the requirements in the Bill to be a group of practices it still would be considered a risk based on size as it would only cover less than 40,000 population. Discussions have been on going with the practices to support their development and to ensure that they are fully aware of the requirements for Authorisation.
The Director of Commissioning Development has outlined the evidence that would be required to assure the SHA that the new eCCG could be a viable organisation and achieve Authorisation. This includes the process and implementation of forming a board. Gill Galdins is the cluster designated director who is supporting this eCCG and is assisting them with this work.
The Wakefield Local Medical Committee has run the selection/election process during December - January and five GPs have been confirmed as board members, two GPs from the Grange practice and three GPs from White Rose practice, one who has been elected as chair.
However the eCCG has been made aware of the scale of the challenge for what is still a small CCG and is still considering further options before agreeing their final configuration. These issues are to be discussed at their first board meeting on 27 th January. Until this is resolved the eCCG is aware that the CKW cluster board will not be asked to consider a scheme of delegation and governance arrangements for this eCCG
The cluster continues to give whatever support is required by the practices to help them to reach a conclusion.
Design of the NHS Commissioning Board
The NHS Commissioning Board Authority has published a key document titled Design of the NHS Commissioning Board (NHS CB, January 2012) setting out its recommendations for the structure of the future NHS Commissioning Board (NHS CB) and a vision for new ways of working, subject to the passage of the Health and Social Care Bill. This document can be found on the following link www.commissioningboard.nhs.uk. This signifies that work on the design of the NHS CB has reached a key stage and this document has been published as part of a series of papers for the public board meeting on 2 February 2012. The context of Design of the NHS Commissioning Board is that the proposals build on the vision set out in Developing the NHS Commissioning Board (NHS CB, July 2012). Initial thinking is on how the new commissioning system could work and the NHS CB’s role within it and describes the culture, style and leadership of the NHS CB’s and the processes that it will need to make sure it achieves maximum health benefit for the nation from available resources.
The document describes the NHS CB’s over-arching role in ensuring that the NHS delivers better outcomes for patients, its main functions, the values and culture it will foster and the key processes for transacting business, operating through a matrix working approach. The Board will be structured into nine directorates: Medical Nursing Operations Commissioning Development Improvement and Transformation Patient Engagement, Insight and Informatics Finance Policy, Partnerships and Corporate Development Chief of Staff. It is anticipated that there will be an overall workforce total of 3,500 people employed in the NHS CB. The NHS CB will have a single operating model with four commissioning sectors and 50 local offices. The staff working in the sectors and local offices will be part of the Operations Directorate, which is the largest of the nine directorates.
The document also describes how NHS CB will work at subnational and local levels with a single operating model through sector and local teams. Of the 3,500 staff around 2,500 people will work across 50 local offices (reflecting current PCT cluster arrangements) and their core role will be to directly commission services such as prison and military health, primary care, and specialised services, support and develop Clinical Commissioning Groups through the authorisation process, and also manage and cultivate local partnerships and stakeholder relationships, including ensuring representation on Health and Wellbeing Boards. Around 200 people will work in the four sectors (reflecting current SHA cluster arrangements) and will have narrow, focused functions and should be seen as effectively part of the central structures. Around 800 people will work in the NHS CB centre, with the corporate base in Leeds and a smaller presence in London.
The NHS CB running costs budget for 2014/15 will be £492 million which represents around a 50% reduction. It is expected that additional transitional funding will be available in 2013/14 which is the NHS CB’s first full year of operation. This will be used non-recurrently and not played out into recurrent directorate budgets.
The next steps for the NHS CB are: NHS CB’s recommendations will be discussed at the next NHS Commissioning Board Authority’s board meeting on 2 February 2012; Work is underway on the HR processes to support and enable recruitment; further guidance will be provided to staff during February and Phase 2 of the People Transition Policy and Recruitment Strategy will be developed; National Directors of the NHS CB are anticipated to be in post by the end of March 2012; and SHAs will undertake further work in discussion with PCT clusters and emerging CCGs to make recommendations to the NHS CB on the location of local offices and commissioning support organisations.
Future of PCT Estate
The Secretary of State for Health Andrew Lansley, issued a statement on Wednesday 25th January 2012 which indicated the intention to create a government owned limited company, NHS Property Services Lt, to own and manage PCT Estate that will not transfer to NHS community care providers, under the plans for healthcare reform set out in the Health and Social Care Bill.
NHS Property Services Ltd will be a property company wholly owned by the Department of Health. The principle function of the company will be to hold and manage part of the estate that is currently owned by Primary Care Trusts (PCT’s), together with surplus Strategic Health Authority (SHA) and Arm’s Length Bodies (ALB) estate. The abolition of PCTs and SHAs and the transfer of their property is however subject to the passage of the Health and Social Care Bill.
The aim is to achieve a seamless transfer of the estate and daytoday management of it to the company prior to abolition of PCTs and SHAs. Over time, the organisation will drive greater efficiency in the management of the estate, with resources freed up to improve properties and invest in frontline services.
The PCT portfolio accounts for c. ÂŁ6.6 billion, of which c. ÂŁ4.6 billion is freehold. Approximately two thirds of the current estate is expected to transfer to NHS Property Services Ltd. The estate that does not transfer to NHS Property Services Ltd. Will be transferring to NHS providers. The list of property for proposed transfer to these organisations are currently under consideration by the Department of Health.
The structure and location of NHS Property Services have not been fully developed as yet. However at a national and sub national level it is intended that it will mirror the NHS Commissioning Board locations as far as possible, with further local resources where required. Work is currently being undertaken to confirm how many people are in scope. This is expected to be completed by the end of February 2012.
Work will begin on the organisational design in the spring and further details will be published when available. Due to the complexities of the Estate, it is envisaged that the properties and staff may transfer from PCTs in a number of waves.
Recommendations The board are asked to note the updates on: 1. Resolving the configuration issues in South East Wakefield; 2. Designing the NHS CB and 3. Future arrangements for managing NHS Estate.