The new NHS landscape
Author: Debbie Kennedy, Programme
and Project Manager, with thanks to
Lawrence Tyler, Commissioning
Development, NHS South of England
13/09/2012
Two systems
1. Overview of the new commissioning system;
– Clinical Commissioning Groups (CCGs)
– Commissioning Support Units (CSUs)
– NHS Commissioning Board /
2. Overview of new Provider system;
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National Provider Development Authority
Clinical Networks
Clinical Senates
Academic Health Science Networks
Foundation Trusts
Monitor
HEALTH WARNING: This is a 29 slide
presentation but please stick with it as it
describes most of the NHS organisations that
inhabit the new landscape!
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NHS commissioner landscape (before
Health and Social Care Act 2012)
Department of Health
10 Strategic Health Authorities
152 Primary Care Trusts
Healthcare providers
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NHS commissioner landscape from 1st
April 2013
Department of Health
NHS Commissioning Board
23 Commissioning
Support Services
212 Clinical Commissioning
Groups (£25/head)
Healthcare providers
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Commissioner System
– Clinical Commissioning Groups
(CCGs)
– Commissioning Support Units (CSUs)
– NHS Commissioning Board, Regional
Offices & Local Area Teams (LATs)
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Clinical Commissioning Groups (CCGs)
• Clinical Commissioning Groups are groups of
clinicians that will, from 1 April 2013, be responsible
for commissioning local health services across
England.
• These services include planned and emergency
hospital care, rehabilitation, most community
services and mental health and learning disability
services.
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Clinical Commissioning Groups (CCGs)
They must have governing bodies in place:
• Chair of the governing body
• Accountable officer and Chief finance officer
• Lay member (lead role in overseeing key elements
of governance)
• Lay member (lead role in championing patient and
public involvement) and;
• Secondary care doctor and registered nurse.
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Clinical Commissioning Groups (CCGs)
There is a national authorisation process that will test
Clinical Commissioning Groups to ensure that they
have the capacity and capability they need in order to
take responsibility from 1 April 2013:
• Desktop review
Wave 1 (July 12)
• 360 feedback
Wave 2 (Sept 12)
• Site visits
Wave 3 (Oct 12)
Wave 4 (Nov 12)
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Clinical Commissioning Groups
(CCGs) proceeding to authorisation
50 CCGs across NHS South of England
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Clinical Commissioning Groups (CCGs)
Current priorities:
• Recruitment to senior leadership roles and
governing body
• Governance structures + constitution
• Commissioning support development
• Collaboration and federated agreements
• Delivery/building a track record and;
• Getting ready for authorisation!
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Commissioning Support Units (CSUs)
Most Clinical Commissioning Groups will buy in
services from Commissioning Support Units
Commissioning Support Units are being set up by PCT
Clusters
These services may include (as examples) contract
monitoring, performance management, contract
negotiation, medicines management and prescribing
services.
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Commissioning Support Units (CSUs)
Clinical Commissioning Groups have been working
with Commissioning Support Units to decide what
services they will build themselves, what they will
buy from CSUs or others and what they will share
with other CCUs (their build/buy/share
arrangements).
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Commissioning Support Units (CSUs)
• Across NHS South of England, there are five
emerging Commissioning Support Units
• They are currently being tested through a national
assessment process
• Commissioning Support Units that pass through the
national assessment process will be hosted by the
NHS Commissioning Board from 1 April 2013
• In the future, they are expected to become
commercial organisations.
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Commissioning Support Services (CSUs)
1. Best West (Bristol, North
Somerset, South Gloucestershire
and Somerset)
2. Central Southern
(Gloucestershire and Swindon,
Berkshire, Buckinghamshire and
Oxfordshire)
3. Commissioning Support South (Southampton,
Hampshire, Isle of Wight and Portsmouth)
4. Surrey and Sussex
5. Kent and Medway
N.B. There are no CSUs yet covering Devon,
Cornwall and Dorset
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NHS Commissioning Board
• The NHS Commissioning Board will be
nationally accountable for the outcomes
achieved by the NHS, and will provide
leadership for the new commissioning system
• The NHS Commissioning Board will have
overall responsibility for a budget of £80bn, of
which it will allocate £60bn directly to Clinical
Commissioning Groups.
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NHS Commissioning Board
There will be:
• 1 Board
• 4 regions (South, London, Midlands and East,
North)
• 27 Local Area Teams (7 across the South)
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Local Area Teams of the NHS
Commissioning Board (LATs) across NHS
South of England
1. Devon and Cornwall
2. Bristol, North Somerset and South
Gloucestershire
3. Bath and North East Somerset,
Wiltshire, Gloucestershire,
and Swindon
4. Bournemouth, Poole, Dorset, Southampton,
Hampshire, Isle of Wight and Portsmouth
5. Berkshire, Buckinghamshire and
Oxfordshire
6. Surrey and Sussex
7. Kent and Medway
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NHS Commissioning Board
The 27 Local Area Teams will have the same core
functions around CCG development and
assurance, Emergency Planning Resilience and
Response, quality and safety, partnerships,
configuration and system oversight, but will have
variations in their direct commissioning
responsibilities.
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NHS Commissioning Board
• All Local Area Teams will take on direct
commissioning responsibilities for GP services,
dental services, pharmacy and optical services
• Around 10 will lead on specialised
commissioning across England
• A small number will carry out the direct
commissioning of military health NHS services.
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Provider System
– NHS Trust Development Authority
– Clinical Networks
– Clinical Senates
– Academic Health Science Networks
– Foundation Trusts
– Monitor
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NHS Trust Development Authority
• Following the abolition of Strategic Health
Authorities (SHAs), the NHS Trust Development
Authority (NHS TDA) will be responsible for
overseeing the performance management and
governance of NHS Trusts, including clinical
quality, and managing their progress towards
foundation trust status
• The NHS Trust Development Authority is a shortterm body which will cease to exist when all Trusts
are Foundation Trusts.
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Academic Health Science Networks
• AHSNs were recommended in “Innovation Health
and Wealth” which was launched by Prime Minister
alongside the Life Sciences Strategy December
2011
• They will provide a systematic delivery mechanism
for local NHS, universities working with industry and
other partners such as local government to
transform the identification, adoption and spread of
innovations and best practice
• Application will be by prospectus which the AHSNs
need to prepare themselves.
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Clinical Senates
• Clinical senates will have a close relationship with
strategic clinical networks. Each geographical area
will have one clinical senate, taking a broader,
strategic view on the totality of healthcare within that
patch
• Clinical senates will provide evidence-based advice
to help commissioners put the needs of patients
above those of organisations or professions. They
are likely to play a key role in providing a strategic
overview of major service change – for example, on
service redesign and reconfiguration.
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Clinical Networks
• Many different type of clinical networks are in
existence and this is valued by the DH
• However, only Strategic Clinical Networks (SCNs)
will be established and hosted by the National
Commissioning Board from April 2013 – the
remainder will be have to secure their own
resources from providers or commissioners
• The SCNs will be: Cancer, Cardiovascular disease,
Maternity and Children, Mental Health, Dementia
and Neurological Conditions.
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Foundation Trusts
• NHS foundation trusts are firmly part of the NHS
and subject to NHS standards, performance
ratings and systems of inspection
• However, NHS foundation trusts are different from
existing NHS trusts in the following ways:
– They are independent legal entities - Public benefit
corporations
– They have unique governance arrangements and are
accountable to local people, who can become members
and governors.
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Foundation Trusts
• Foundation Trusts are different from NHS Trusts:
– They are set free from central government control and
are no longer performance managed by health
authorities. As self-standing, self-governing
organisations, NHS foundation trusts are free to
determine their own future
– They have new financial freedoms and can raise capital
from both the public and private sectors within borrowing
limits determined by projected cash flows and therefore
based on affordability. They can retain financial
surpluses to invest in the delivery of new NHS services
– They are overseen by Monitor.
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Monitor
• Monitor is an independent regulator of NHS
Foundation Trusts
• The Health and Social Care Act 2012 makes
changes to the way health care is regulated in order
to strengthen the way patients interests are
promoted and protected
• Monitor will become the sector regulator for all health
care and will need to work closely in this role with the
Care Quality Commission (CQC) which is the current
regulator for both health and social care services.
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Other Health Bodies (not explained
in this presentation)
• Health and Wellbeing Boards
• Public Health England
• Health Education England
• Health watch England
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