Delegation of Commissioning
Responsibilities (DR) to
pathfinders and emerging
Clinical Commissioning Groups
(CCGs)
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What is it? Why should pathfinders
and emerging CCGs take on DR?
The process for achieving delegated
commissioning responsibilities
What is the delegation of
commissioning responsibilities?
• Prior to authorisation as statutory bodies, pathfinders
can take on responsibility for commissioning and
associated budgets.
• This can only be achieved through the establishment of
a Board committee of the Primary Care Trust (PCT)
cluster with membership drawn from the pathfinder,
and responsibility delegated to that committee.
• Taking delegated responsibility for some or all of the
available commissioning budget allows pathfinders to
learn about commissioning in a supportive
environment, and develop a ‘track record’ prior to
authorisation.
Applying for delegated commissioning
responsibilities
• Pathfinders should work with their local PCT cluster
and/or Strategic Health Authority (SHA) cluster to
develop plans to take on delegated responsibility for
some or all of the available commissioning
responsibilities and budget.
• This should include the preparation of the core
governance, development and delivery documents set
out in the SHA cluster delegation guidance.
• The PCT cluster Chief Executive retains overall
accountability for delivery, and the budget.
The Delegation Process
Pathfinder / emerging CCG, and
PCT cluster agree clinical and
financial outcomes the pathfinder
wishes to be responsible for
achieving and indicative timetable
for further delegation
Pathfinder and PCT cluster agree:
•A Draft Pathfinder Constitution
•Pathfinder Development Plan
•Establishment Agreement for Board
committee
•Delivery agreement between
pathfinder and PCT cluster
PCT cluster assurance of
readiness of pathfinder to
assume responsibilities
SHA assurance of cluster
delegation process
PCT cluster Board
approval of delegation
4
SHA cluster guidance for delegation
To ensure consistency and transparency of approach
across England, SHA (SHA cluster from October 3)
guidance has been devised to support local and
regional work
The process set out in the guidance is intended to
enable pathfinders/CCGs to:
• improve clinical and financial outcomes before
authorisation,
• take responsibility for commissioning decisions,
• develop their organisations to deliver practical
outcomes, and
• build a track record in preparation for authorisation.
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Assessing pathfinder/ emerging CCG readiness to
assume delegated responsibilities
Criteria have been developed under 5 main areas for use by PCT
clusters and/or SHA clusters to assess and assure the readiness
of pathfinders/CCGs to assume delegated responsibilities.
1. Clearly defined outcomes for the activities the pathfinder
wishes to take delegated responsibility for
2. A plan for how the pathfinder will achieve the specified
outcomes including how they will manage the risks (specifically
financial risk) associated with them?
3. A plan for the performance management of activities the
pathfinder wishes to take delegated responsibility for
4. A plan for how the pathfinder will access the commissioning
support it needs to deliver any delegated responsibilities
5. Appropriate transfer of decision making responsibility, and
established governance structures for managing delegated
responsibilities
National Indicator
An indicator has been created to monitor the progress made on
delegating commissioning responsibilities to pathfinders through
the establishment of Board committees. This includes the
following areas:
• Total available commissioning funds
• Percentage commissioning budget applied for by pathfinders
• Percentage commissioning funds delegated
% commissioning budget delegated =
Total value of delegated budget
___________________________________
Total available commissioning funds (excluding for example
primary care commissioning, specialist commissioning, and public
health commissioning)
Resources to support delegation
• SHA Cluster Delegation Guidance
• Indicator – Gateway Letter from Barbara Hakin
• PCT Cluster and/or SHA Cluster
Commissioning Development Teams