Planning Framework
NHS North of England
December 2011
Contents
1) Overview and principles
•
•
Introduction
Scope and overview of planning
activities
2) Timetable of activities
•
•
•
Organisational roles and
responsibilities
Minimum CCG Expectations
SHA Operating model
4) Key requirements and criteria for
assessment:
4a) Quality
•
•
•
•
•
•
•
Activity planning
Financial planning
Workforce planning
Contracting
Triangulation
4c)
Reform
•
•
•
•
•
QIPP transformational milestones
Commissioner Development
Public Health transition
Provider development
Choice and empowerment
High level timeline of requirement
3) Roles and responsibilities
•
4b) Resources
Approach to quality
Operational Framework requirements
Annexes
•
Annex A: Detailed CCG requirements
1) Overview and Principles
Introduction
NHS North of England is responsible for ensuring a
successful transition from the existing organisational
arrangements to the new healthcare system as well as
ensuring delivery throughout 2012-13. The
forthcoming planning round is a key part of managing
these processes. The planning round serves two
broad purposes:
• To ensure that robust plans are in place for a safe
and effective transition to the new healthcare system.
• To ensure that plans are in place to ensure
continued delivery of high quality healthcare services
against this backdrop of organisational change and low
growth.
As we enter the 2nd year of QIPP delivery, the
emphasis on whole system transformational change
needs to be greater than ever. Future spending review
settlements are likely to be even lower than the
current settlement, and much of the efficiencies
delivered so far have been through transactional
change, and lower operating costs.
The opportunities for ‘transactional’ efficiencies are
diminishing and transformation is needed now to
deliver high quality and affordable services in the
future.
GPs and other clinicians are expected to play a much
greater role in strategic and operational planning to
improve the quality of services and the health of the
population they are responsible for. This will provide
a firm foundation and a track record of delivery to
support CCGs as they move forward as the
accountable commissioners in 2013.
The planning round is also an opportunity to test the
emerging commissioning support arrangements as
they begin to form their own distinct identity
separate from PCT Clusters. PCT Clusters will need to
plan for the safe transition of commissioning
accountabilities to CCGs and the NCB during 2012-13.
1) Overview and Principles
Introduction (2)
This document provides an overarching framework for
how planning activities will be co-ordinated for the
North of England. The document should be read in
conjunction with the DH operating framework, the
forthcoming planning technical guidance and finance
planning guidance.
NHS North of England will work to a single operating
model for planning activities, and all plans will be
signed off by the SHA Cluster Board. However, much of
the collection, analysis and feedback of plans will be coordinated across the old SHA footprints.
There are no specific NHS North of England planning
requirements over and above those set out in the
operating framework, however we would highlight the
following areas of specific importance:
• The Operating framework requires that CCGs
explicitly support the plan. In line with authorisation
requirements we will require demonstration of CCG
leadership in key aspects of planning (see Annex A for
detail).
• Significant organisational change at a time when major
savings are required places increased risk on service
quality, including patient experience. We will be
assessing plans to ensure there is sufficient focus in
maintaining quality standards and delivery of key
targets.
• The Operating Framework sets out a clear requirement
for transformational milestones linked to key strategic
initiatives to deliver QIPP. This has been a weakness in
some plans in the past and is a key priority for this years
plans.
• Plans should focus on delivery of existing targets and
any regional priorities. Plans will be also assessed on
the extent to which they aim to address long standing
quality, outcomes and health inequalities issues in the
system.
We will issue a more detailed assurance framework and
planning checklist following publication of the DH
technical guidance later in December.
1) Overview and Principles
Scope and overview of planning activities
The Operating Framework sets out the high level
requirements for the planning process.
The principles and assumptions, together with the high
level roles and responsibilities of each organisation and
the information will be collected through the planning
round is detailed in the following sections of this
document.
PCT Clusters are required to produce an integrated plan
consisting of a narrative supported by PCT / Trust data
trajectories. This will have a clear strategic vision for
improving quality and efficiency that is owned by all
key stakeholders and consistent with CCG plans. This
vision should reflect and where appropriate update the
strategic plan submitted last year. There will be no
aggregation of plans above this level.
PCT Cluster narratives should be concise and focused
and describe the measurable differences in the system
that will result from the plan.
Specific planning lines should then flow from this
overarching vision, and provide further detail on that
specific aspect of the plan. This will allow the SHA
Cluster to test the extent to which the vision is
anchored within specific planning lines, and allow
progress to be tracked in year. All elements of
planning should be fixed to provider contracts to
ensure alignment and delivery across the system.
PCT Cluster Integrated plan
Strategic vision
-Service Vision
-Key initiatives
- Transformational
milestones
Transition
Alignment / Assurance
PCT/ Trust
trajectories
Quality/
performance
QIPP
milestones
Activity
Finance
Workforce
Contracts
Informatics
CCG clear
and credible
plan
CCG development
CSO development
NCB Transition
PH transition
HWB development
Provider
development
2) High level timetable of requirements
Date
Requirement
20/01
PCT Cluster submit draft of strategic vision and data trajectories for Operating Framework requirements
27/01
SHA Cluster submits plans to DH
January
Mid year review process used to test quality and ambition of service vision
w/c 30/01
Feedback meetings to PCT clusters
17/02
DH Feedback to SHA Clusters
24/02
Near final data trajectories submitted
Early March
Plans analysed against assurance criteria – feedback and further info requests if necessary
15/03
Contracts signed
w/c 26/03
Final plans received from PCT Clusters
31/03
Confirmation to DH of contracts signed
05/04
SHA Cluster submits plans and assurance documents to DH
April
14 X Cluster plan sign off meetings
Key:
DH milestones in black
NHS NofE milestones in blue
3) Roles and responsibilities across the system
The key roles and responsibilities for organisations in
the system are as follows:
Clinical Commissioning Groups
CCGs should be engaged in all aspects of the planning
process according to their stage of development, and in
line with requirements for authorisation. The table on
the following slide sets out the minimum expectations
for CCG involvement in each element of the process.
CCGs are also required to produce their own 5 year
‘clear and credible plan’ for health services that informs
and is visible within the PCT Cluster plan.
PCT Clusters
The PCT cluster will be responsible for production of an
integrated plan that is clearly developed from the CCG
Clear and Credible Plans. This plan should cover the
period 2012-13 to 2014-15 and should refresh the 4
year plan submitted last year. This integrated plan
should include:
• A three year strategic narrative, setting out the vision
for the healthcare system in 2014-15, and the key
initiatives that are in place to deliver it.
• The key transformational initiatives, underpinned by
planning milestones
• The approach and key priorities for improving service
quality and managing risk
• The approach to and progress on key areas of reform,
including commissioner development, public health
transition and provider development, and patient
empowerment.
The PCT cluster will also be responsible for collecting
and presenting PCT level planning information, and
ensuring that there alignment between the PCT plans
and the strategic narrative.
Each PCT cluster will have a single planning lead who
will have responsibility for co-ordinating planning
activity across the cluster area.
PCTs
PCTs will remain the unit of collection and analysis for
much of the planning information in line with their
statutory responsibilities for 2012-13. This will include
activity, finance, workforce, informatics
transformational milestones and contracts.
3) Roles and responsibilities – minimum CCG expectations
CCGs will be expected to lead as much of the process as they wish, support by emerging commissioning support
organisations and PCT Clusters. The minimum expectations are indicated by the thin end of the triangle for each
of the planning areas. Annex A provides further detail on the specific requirements for CCG engagement.
OPERATING
FRAMEWORK
CATEGORY
QUALITY
PLANNING AREA
Key priorities
Operating Framework requirements
Strategic narrative
Transformational milestones
Commissioner development
REFORM
Provider development
HWB development
PH Transition
Choice and Empowerment
Activity and beds
Finance
RESOURCES
Workforce
Contracting
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
3) Roles and responsibilities across the system
SHA Cluster
Providers
The SHA Cluster is responsible for the assurance and
sign off of system plans.
It is expected that all main providers are engaged in
and share ownership of the strategic narratives and
underpinning plans submitted by each system. Existing
governance arrangements such as whole system
transformation boards or QIPP programme
management offices should be used to facilitate this
engagement.
The SHA will assure system plans and submit to DH:
• Data trajectories for all PCTs
• Cluster milestones for transformational change.
• Milestones for transfer of SHA functions to new bodies
• A narrative setting out the assurance process and key
risks and mitigating actions.
The SHA cluster will operate under a single operating
model in carrying out this function (see following slide).
Within this single operating model, plans will be
collected, analysed and feedback provided on the old
SHA footprint. There will be a single planning ‘coordinator’ for each old SHA area who will form the main
point of contact. These contacts are as follows:
North East Roselle.Oberholzer@northeast.nhs.uk
North West Karen.Campion@northwest.nhs.uk
Yorks and Humber Ian.Holmes@yorksandhumber.nhs.uk
Provider business plans should be informed by and be
consistent with CCG, PCT and PCT Cluster planning
submissions.
3) Roles and responsibilities – SHA Cluster operating model
Applying the one, three, many
model…
One
Three
Many
(within a
consistent
framework)
Planning requirements
from each system
Templates for
information
Planning assumptions
Assessment criteria
Time line
Approach to sign off
Approach to triangulation
Governance model
Planning PMO
Collection of data
Planning ‘leads’ on old
SHA footprints forming
part of the PMO
Analysis of plans
including triangulation
‘Domain’ level
communications
PCT Cluster planning
leads
Development of plans
Sign off meetings
North of England SMT
SRO: Richard Barker /
Mark Ogden
Workforce
Activity
/performance
Single ‘lead’
with coordinating
role
Finance
QIPP
Quality
Contracting
Single lead
with coordinating
role
Overarching narrative
Strategic alignment
Reform milestones
Commissioner
Development
North
East
North
West
PCT
cluster
Activity
Finance
Workforce
QIPP
Contracts
Performance
Informatics
System
plans
System
plans
CCG
Leadership
Provider
Development
Planning ‘PMO’
Public Health
Communications
Informatics
Y&H
PCT
cluster
PCT
cluster
System
plans
System
plans
CCG
Leadership
System
plans
System
plans
CCG
Leadership
4a) Key requirements and criteria for assessment: quality
Quality
Requirement
How tested?
Quality and patient outcomes should be a common
thread throughout all plans. In addition to plans that
ensure delivery of operating framework targets, plans
will be tested on the ambition to improve quality
(including quality in primary care) and outcomes and
address longstanding quality issues. The key areas are as
follows.
Improvement across all five
domains in the NHS
Outcomes Framework
Evidence of grip/maintenance of
quality
Evidence of improvement
Measurement of outcomes
Alignment with Public Health
and Social Care outcomes
frameworks
Collaboration of other agencies
e.g. local authorities, Health and
Wellbeing Boards
Board assurance that quality
is continually improving
Board reports
Robust governance procedures
Identification of risk and
detailed mitigation plans
Risk register and action plans
Alignment with other plans –
e.g. finance, activity,
workforce
Cross referencing of issues that
will impact upon other areas
Ensure providers
demonstrate improvements
in quality and safety
Contracting (including CQUIN)
Quality Accounts
Regular reviews of progress
Performance reports
Clinical engagement
Patient engagement
• Overall, how well do PCT / PCT clusters improve quality
in patient care?
• What processes does the PCT cluster have in place for
quality governance and identification and mitigation of
risk?
•How will they know requirements are being delivered?
• How will PCTs / PCT clusters get performance back on
track where standards have dropped?
• The plan should be signed off by the Medical Director
and Director of Nursing.
Contacts:
North East Sharon.lamont@northeast.nhs.uk
North West Anglea.Brown@northwest.nhs.uk
Yorks and Humber
David.Thompson@yorksandhumber.nhs.uk
4b) Key requirements and criteria for assessment: resources
Activity
Activity plans need to be based on latest contract
discussions and reflect contracting intentions. PCT
clusters should provide reconciliation between
contract and these activity plans.
Changes in activity need to link back to specific
programmes of change – e.g. QIPP programmes,
transformational milestones and other service
reconfiguration. Activity profiles to be supported by
a narrative describing the trajectory and rationale. If
trajectory differs from historic trend narrative must
explain the actions being taken to change the
profile.
Activity should be profiled for seasonality and other
in-year factors i.e. monthly plans not expressed as
1/12th of annual
Data collected on Unify by on old SHA footprint
Uploads in January, February and March.
Requirement
How tested?
Internal consistency
Consistency with baseline
Profiled to reflect seasonality
External consistency
Triangulation with workforce
Triangulation with finance
Triangulation with contracts
Activity changes are linked
to firm strategic plans
evidenced in narrative
Linked to QIPP programmes and
transformational milestones
Linked to service
reconfiguration
Activity plans deliver
targets
E.g. does elective activity
deliver backlog clearance /
sustain RTT delivery
Contacts
North East James.Martin@northeast.nhs.uk
North West Donna.McGill@northwest.nhs.uk
Yorks and Humber
Forrest.Frankovitch@Yorksandhumber.nhs.uk
4b) Key requirements and criteria for assessment: resources
Finance: Key Messages from Operating Framework
• It is a requirement that no PCT or SHA will plan for a
deficit in 2012/13;
• PCTs should continue to set aside 2% recurrent
surplus headroom which should only be used for nonrecurrent purposes;
• Although the Operating Framework refers to a 2.5%
growth in PCT allocations, it also refers to this being
reviewed in light of the GDP deflator forecast
(subsequently announced as being 2.7%). PCT 2012/13
revenue allocations will be announced in December;
• 2013/14 running cost allowance for Clinical
Commissioning Groups (CCGs) expected to be £25 per
head of population (prior to any entitlement of quality
premium);
• 2014/15 – overall running costs of NHS
superstructure will be on average 1/3 lower than
running costs of NHS in 2010-11;
• 2012/13 capital expenditure for NHS trusts and PCTs
will be agreed by SHA clusters. No unspent capital by
PCTs to be carried forward;
• PBR to expand to develop and incentivise best clinical
practice and better patient outcomes;
• NHS Trusts should plan for surpluses consistent with FT
pipeline plan and TFA. Breakeven or operating deficit plans
(in NHS trusts) will only be countenanced where an NHS
trust is in formal recovery, it has been agreed with its SHA
cluster, and is consistent with the TFA;
• Consistent applications across NHS North of DH Policy
for only paying 30% marginal rate for emergency
admissions and 70% being top sliced, transferred to the
SHA, to be used for strategic investments;
• Consistent application across NHS North of DH Policy for
emergency readmissions and marginal rates, for
emergency readmissions subject to some exemptions;
• National efficiency requirement for 2012/13 is 4%,
reduced by pay and price inflation;
• 1.8% net deflator comprises:
4% efficiency less 2.2% pay and prices giving
1.8% net deflator (1.5% cash back, 0.3% embedded);
• Tariff price adjuster will be a reduction of at least 1.5%,
and this will be alongside the embedded efficiency (0.3%)
be applied to non-tariff services (and be confirmed in
2012/13 PBR Guidance);
4b) Key requirements and criteria for assessment: resources
• 2012/13 – CQUIN will be developed so that for all
standard contracts the amount providers can earn will
be increased to 2.5% on top of actual outturn;
• Where CQUIN funding has been used previously to
achieve a higher standard of care, that funding may be
made recurrent through CQUIN where the
commissioner is satisfied it is necessary to maintain
improvement;
• CCGs not responsible for resolving PCT legacy debt
incurred prior to 11/12, and should have no planned
deficits in 2012/13;
• The proposed value of the bundle of central initiative
budgets devolved to SHAs for local management is
£6,394 million. This is the same cash amount as in
2011/12;
• Shadow allocations for CCG, NHS Commissioning
Board and Public Health shadows grants are due in
January.
• PCTs should agree plans and associated transfers of
reablement monies with local authorities for 2012-13.
Requirement
How tested?
2% recurrent funding for
non-recurrent investments.
Through PCT financial plans
submitted. Submission of robust
business cases to support nonrecurrent investments.
National efficiency
requirement of 4%.
Review that included in financial
plans.
Tariff price adjuster of at
least 1.5%.
Submission of Trust / PCTs income
and activity plans; review of
contract activity and financial
values.
Continued delivery of QIPP.
Review of plans and alignment
between commissioners and
providers.
Review CQUIN plans
between commissioners
and providers to ensure
congruence.
Review assumptions in contracts /
financial plans between
commissioners and providers to
check assumptions similar.
No liabilities or legacy debt
to be carried forward into
CCGs.
Assurance that PCTs include detail
in plans to show how they will
manage final positions.
Financial Planning Guidance
• DH to provide PBR guidance in December 2011 and
detailed financial guidance in January 2012. Detailed
Financial Planning Guidance will be provided by SHA
cluster in the near future.
4b) Key requirements and criteria for assessment: resources
Key Financial Assumptions – subject to confirmation
Key Financial Assumptions – Notes
Sector Wide Efficiency
1.
2.
Note
201213
201314
201415
PCT allocation uplift
1
2.7%
2.0%
2.0%
Commissioners pay
and non-pay inflation
(split below)
2
2.2%
Pay inflation
2
1.0%
1.0%
Commissioner nonpay inflation
2
Incremental drift
3
Non pay inflation
(providers)
4
Social care allocations
5
£622
m
GMS
6
0.5%
Dentistry
7
Prescribing
8
Equitable access
allocation
9
2.7% as per GDP deflator 2012/13;
2.2% as per Operating Framework. Pay inflation 1% per
annum in 2013/14 and 2014/15. Requires allocating
between pay and non-pay inflation. Future projections
required;
3. To be determined locally
4. TBC;
5. As per 2012/13 Operating Framework. This is in addition
to the PCT allocation uplift;
6. Link to GMS 2012/13 changes
http://www.pcc.nhs.uk/medical
7. TBC;
8. Prescribing inflation should be estimated by individual
PCTs based upon local intelligence;
9. TBC.
4b) Key requirements and criteria for assessment: resources
Monitor Acute Assessor and Downside cases
Contacts
201213
201314
201415
201516
NHS North East
Ian.Cameron@northeast.nhs.uk
Sector wide efficiency
requirements
4.0%
4.0%
4.0%
4.0%
NHS North West
Mike.Burns@northwest.nhs.uk
Additional recurrent
efficiency
0%
0%
0%
0%
Assessor case
Total recurrent efficiency
4.0%
4.0%
4.0%
4.0%
Additional non-recurrent
efficiency
0.7%
0.6%
0.6%
0.6%
Implied in year efficiency
requirement
4.7%
4.6%
4.6%
4.6%
Sector wide efficiency
requirements
4.4%
4.5%
4.6%
4.7%
Additional recurrent
efficiency
0.3%
0.3%
0.3%
0.3%
Total recurrent efficiency
4.7%
4.8%
4.9%
5.0%
Additional non-recurrent
efficiency
1.3%
1.6%
1.8%
2.1%
Implied in year efficiency
requirement
6.0%
6.4%
6.7%
7.1%
Downside case
NHS Yorkshire & Humber
Jackie.Brittain@yorksandhumber.nhs.uk
4b) Key requirements and criteria for assessment: resources
Workforce
The SHA expects to assure workforce plans for both
Safety and Quality and will require analysis of the
triangulation of workforce, finance and activity.
National assumptions will be provided to inform
workforce planning.
Requirement
How tested?
Key Lines of enquiry and
Operating Framework
challenges
Assurance against Operating
framework tests
Data templates
Analysis against activity and
finance and National
Assumptions
Overarching narrative
describing workforce plan
Key lines of enquiry , Safety
and Quality and key
challenges
Compliance with Key lines of
enquiry and DH Workforce
Assurance Framework
A clear and evidenced description of the assurance of
Safety and Quality of workforce plans is paramount.
Detailed guidance describing key requirements and
criteria that detail the collection and analysis of
information will be available from the following
individuals and will reflect the DH Operating
framework and technical guidance.
Contacts
North East Derek.marshall@northeast.nhs.uk
North West Mike.Burgess@nhsnorthwest.nhs.uk
Yorks and Humber
Jonathan.Brown@yorksandhumber.nhs.uk
4b) Key requirements and criteria for assessment: resources
Contracting
Requirement: Agreed 2012/13
contracts in place
How tested?
• All contracts must be agreed and signed by 15 March
2012.
Assurance of progress with
contract negotiations from each
PCT cluster
Weekly status report from
clusters to SHA w/c 13th february
2012
• Commissioners are expected to arrange appropriate
Mediation/Adjudication if there is a risk that contracts
will not be signed by 15th March 2012. If
Mediation/Arbitration is invoked the SHA must be
informed through the weekly status report
Contracts agreed and signed by
15 March 2012
9.00am Friday 16th March:
Written confirmation from PCT
Cluster CEs to SHA Cluster Chief
Operating Officer that all
contracts are signed
Copies of all new 2012/13
contracts and deeds of variation
submitted to SHA
Contracts received at SHA by
close on Monday 16th April 2012
Successful completion of
contracts transition
Submission of evidence
Stocktake phase complete by
PCT clusters by 31 March 2012
Receipt of PCT Cluster Chief
Executive formal sign off of
steps one and two of the
contract transition stocktake in
line with DH guidance
Stabilise phase - as per national
guidance
To be confirmed through coproduction with SHA/clusters
Shift phase - as per national
guidance
To be confirmed through coproduction with SHA/clusters
• The mandated contractual terms, conditions and
schedules cannot be altered in line with Department
of Health guidance.
• The contracts contain provision to incorporate local
requirements, Commissioners are expected to use
these as appropriate for their Provider.
• Additional information, including reporting templates,
will be issued by the appropriate contract lead:
North East Joyce.Lovell@northeast.nhs.uk
North West Janet.Collinson@northwest.nhs.uk
Yorks and Humber
Kay.Wilson-Poe@yorksandhumber.nhs.uk
4b) Triangulation of plans
Triangulation of plans
As part of the SHA assessment, system plans are
‘triangulated’ to test the robustness of planning lines
when compared against each other. Individual
planning lines should represent one dimension of a
underpinning strategy, ‘triangulating’ plans against
each other allow to test the coherence of plans.
Triangulation is not an exact science as the data
collected through the planning process does not
allow us to make a direct and granular comparison. It
does however give an indication of the degree of
alignment and risk.
The triangulation analysis is carried out as follows:
COMMISSIONER ACTIVITY PLANS
AGAINST PROVIDER
FINANCE/INCOME PLANS
• Are plans aligned between providers and commissioners?
• Do commissioners have the specific programmes and plans in place to
deliver the lower activity trajectories they are planning?
• Do the activity plans look realistic and achievable compared to historic
trends?
COMMISSIONER FINANCE PLANS
AGAINST PROVIDER WORKFORCE
PLANS
• Do the provider workforce plans look consistent with the provider
savings requirements?
• Are their clear quarterly headcount and pay bill trajectories for the
providers?
WORKFORCE PLANS AGAINST
ACTIVITY PLANS
• Is the productivity gap (the difference between activity plans and
workforce plans) realistic and safe?
• Do the workforce plans look realistic compared to activity to be
delivered?
4c) Key requirements and criteria for assessment: reform
Reform: Overview
2012-13 is a critical year for reforming the healthcare
system. The PCT Cluster integrated plans will need to
clearly demonstrate progress on the two aspects of
reform:
• Progress on key milestones towards transition to the
new healthcare commissioning structures.
• Progress on transformational QIPP initiatives to
reform the way healthcare services are provided in line
with lower growth in funding.
The PCT Cluster narrative should show how the plan
will deliver both the transition to new commissioning
organisations and key service reconfigurations.
The service vision will set out a high level vision for how
the health system will be reformed to deliver high
quality services with lower financial growth. This
should be underpinned by a number of key initiatives.
These initiatives should be delivered through a number
of milestones should focus on the key system wide
transformational programmes. The anticipated
financial and activity implications of achieving the
milestones should also be provided.
Service
vision
Measureable
changes
Key
initiatives
Transform
ational
milestones
There should be clear read across between the savings
identified and those submitted in previous planning
rounds.
Transformational (QIPP) milestones
The Operating Framework sets out the clear message
that plans should include key transformational QIPP
milestones, that demonstrate that the actions to be
taken in year to deliver sustainable services in the
future. We do not require detailed plans on all
‘transactional’ QIPP projects.
FIMs templates will be used to capture the total savings
planned to deliver QIPP in the system. Not all financial
savings identified in the FIMs returns will have
associated transformational milestones, however we
would expect that at least 50% of savings to be linked
to these transformational milestones.
4c) Key requirements and criteria for assessment: reform
The key assessment criteria are as follows:
Contacts
Requirement
How tested?
North East
Roselle.Oberholzer@northeast.nhs.uk
Are planned savings
sufficient to address the
challenge?
Savings identified in FIMs
versus last year and ‘share’
of top down challenge.
Are QIPP programmes
sufficiently transformational?
Assessment of
transformational milestone
template. % of total savings
covered by transformational
programmes
Is there are clear read across
to the service vision?
Assessment of service vision
against QIPP milestones.
Do plans translate to lower
activity and finance
trajectories?
Assessment of QIPP
programme template.
Triangulation with finance
and activity data.
Are robust governance and
PMO arrangements in place?
PCT Cluster strategic
narrative.
Is there sufficient CCG and
provider ownership of plans?
PCT Cluster strategic
narrative.
North West
Melanie.Ogden@northwest.nhs.uk
Yorks and Humber
Sarah.Bronsdon@Yorksandhumber.nhs.uk
4c) Key requirements and criteria for assessment: reform
Commissioning Development
The Cluster integrated plan should be used to
demonstrate progress on the key milestones for the
transfer of commissioning functions to successor
organisations. It should also demonstrate delivery of
the 4 Outcome Framework performance measures for
Commissioning Development.
CCG development
• Evidence of CCGs leading prioritisation, financial
planning, QIPP planning and contracting and
participating in workforce planning.
• Evidence of CCGs engaging with patients and the
public, Health and Wellbeing Boards and providers.
• Evidence of CCGs working with H&WB on emergent
JSNA based strategy and priorities.
• Evidence of collaboration with neighbouring CCGs in
areas such as lead commissioning, risk sharing and
common support arrangements.
• Evidence of CCGs taking full devolved responsibility
for commissioning budgets so that a track record of
delivery can be used for authorisation.
• Evidence of CCGs operating as arms length
organisations to build a track record.
• PCT Clusters will need to ensure CCGs are ready for the
authorisation process beginning in October.
• Evidence of thorough planning by CCGs to improve the
quality and productivity of services, improve health
outcomes for patients and reduce unwarranted
variation within their financial allocation.
• Workforce plans for staff moving to CCGs.
• Evidence of CCGs developing service specifications for
commissioning support services and leading
negotiations with emerging providers.
• SLAs between CCGs and Commissioning Support
Organisations signed off by the end of February 2012.
Health and Wellbeing Board transition
• Evidence of PCT Cluster and CCG support for Health
and Wellbeing Boards development.
• Evidence of full engagement of developing Health and
Wellbeing Boards in relevant commissioning and
reform plans by CCGs and PCT Clusters.
• Evidence of patient and population engagement in
developing commissioning plans through Health and
Wellbeing Boards.
4c) Key requirements and criteria for assessment: reform
Commissioning Support development
National Commissioning Board development
• Resilience of PCT functions destined for
commissioning support.
• Evidence of emerging commissioning support
organisation supporting CCGs directly and
independently of PCT Clusters.
• Evidence of establishing budgets and HR frameworks
for the creation of commissioning support
organisations in line with the time scales for
submitting outline and final business cases to the
Business Development Unit to demonstrate viable
businesses.
• Evidence to support the National requirements to
develop exit strategies from the NHS Commissioning
Board
• Evidence of commissioning support requirements
being articulated by CCGs and used by
commissioning support organisations to provide
individual support to each CCG.
• Workforce plans for staff moving to commissioning
support.
• SLAs between CSOs and CCGs signed off by end of
February 2012
• Resilience of PCT functions destined for the NCB.
• Plans for complete separation of NCB functions from
CCG, commissioning support and Public Health
functions.
• Plans for close down or handover of PCT Cluster
functions to the NCB.
• Workforce plans for staff moving to the NCB.
• Ongoing transition of contracts to the NCB.
• Arrangements for transfer of specialist
commissioning to the NCB.
Contacts
North East and North West
Cameron.ward@northeast.nhs.uk
Yorks and Humber
Chris.Willis@northeast.nhs.uk
4c) Key requirements and criteria for assessment: reform
Public Health transition
Expectations of Cluster plans
The key paragraphs relating to public health transition
in the NHS Operating Framework are 3.17, 3.18 and
5.8.
The SHA will also be looking for evidence and assurance
that the PCT Cluster is:
• Maintaining a clear focus on the delivery of better
health outcomes for local people – including reducing
health inequalities.
• Jointly managing the public health transition with
local government.
• Using the national Public Health Transition Planning
Guidance(due to be published shortly) to assure the
production of local plans and deliver progress in key
areas.
• Identifying the future destination for all relevant
statutory public health functions and mandated
services – and clear migration plans.
• Taking account of financial allocations for public health
services and planning for transfer to all the relevant
‘receiving’ organisations. Public health resources should
be both transparent in Cluster financial plans and have
appropriate ‘read through’ into PH local transition plans.
• Working in partnership with local government
colleagues and others to produce local HR transition
agreements and mechanisms for the formal transfer of
public health staff to ‘receiving’ organisations in line with
the Public Health Transition Concordat. Plans for staffing
at local level should be transparent in Cluster HR plans
and processes and have clear ‘read through’ into local
Public Health Transition Plans.
• ‘Setting aside’ resources to meet any potential
liabilities relating to public health staff.
• Identifying contracts for local public health services and
working with local government and other colleagues to
reach agreements on transition.
•Ensure the PH function has effective working
arrangements in place with CCGs and CSUs.
4c) Key requirements and criteria for assessment: reform
Clusters will also be expected to work proactively with
local government to facilitate preparations for early
transition in 2012/13. Where there is local agreement
- and assurance processes are in place - Clusters will
support and encourage local transfer by end October
2012. All other processes to support transfer will need
to be completed with local partners by end December
2012.
Local public health plans: expectations
Public health transition plans should be developed in
detail at local level and clearly co-produced with local
government. Drafts should be available in line with the
timetable for the draft Cluster Plan (Jan 12). PCT
Clusters may wish to append the local Public Health
Transition Plan to their overall submission.
Draft local public health plans should include details on
how formal sign off by the local authority will be
agreed and a timeline for this.
Final versions of local public health transition plans
should be available in March in line with the PCT
Cluster planning timetable.
A Public Health Preparation Toolkit is due for publication
in early 2012. Local teams – supported by their PCT
Clusters - will be expected to make best use of this and
other resources to support transition.
Local public health teams, working with PCT Clusters and
local government are encouraged to carry out peer
reviews to support and test their local plans between
draft and final versions.
North of England Contact
Carol.Massey@yorksandhumber.nhs.uk
4c) Key requirements and criteria for assessment: reform
Provider Development
The planning process is not intended to not
supersede or duplicate the FT trajectories and
assurance processes already in place. Instead the
plans should cover:
• A high level assessment of the impact of
commissioning strategies on existing providers,
including where appropriate approach to ensuring
provider sustainability / viability.
• A description of progress to date and assessment of
the impact of any proposed organisational changes
on the provider side (including FT authorisation or
organisational transactions).
• An assessment of any quality and safety risks in the
system as a result of lower financial growth and QIPP
/ efficiency initiatives and approach to management
of this risk.
• A summary of the approach to choice and
competition adopted within the system, including
services subject to Any Qualified Providers.
• Evidence that there is ownership of the strategic
narrative and QIPP plans across the system, including
providers and that there is alignment between PCT
and provider planning assumptions.
North of England Contact
Alison.Hughes@yorksandhumber.nhs.uk
4c) Key requirements and criteria for assessment: reform
Choice and Empowerment
• Allowing for better use of aggregated information
PCT Clusters need to ensure that plans demonstrate
how they will work with CCGs and providers to drive
forward improvements in patient choice and
empowerment. This should include:
• Developing and implementing plans to achieve full
roll out of the National Summary Care Record.
• Demonstrating that providers are taking appropriate
steps to ensure that their services are listed on
Choose and Book in a way that allows patients to
book appointments with named consultant-led
teams.
• Improving the proportion of GP referrals to first out
patient appointments booked using Choose and
Book.
• Giving patients better access to their records
• Providing information on outcomes to support
choice
• Supporting integrated care through enabling the
appropriate sharing of information between
organisations
• Providing assurance that appropriate information
governance policies and guidelines are implemented
and followed in practice and that national data sets
are implemented.
• The approach to driving choice and personalisation,
including the implementation of any qualified
provider policy.
The PCT Cluster narrative should describe how
enabling work streams such as technology will
underpin the delivery of the service vision.
4c) Key requirements and criteria for assessment: reform
The key assessment criteria are as follows:
Requirement
How tested?
Bookings to services where
named consultant- led team
was available from April 2012
Through assessment of PCT
cluster plans
Proportion of GP referrals to
first outpatient appointments
booked using Choose and Book
Through assessment of PCT
cluster plans
% of patients with electronic
access to medical records
Through assessment of PCT
cluster plans
Patients who have been
written to about the summary
Care record should have a
record created by March 2013
Through assessment of PCT
cluster plans
Better use of aggregated
information and
implementation of IG polices &
guidelines
Assurance of PCT Cluster
Plans , IG toolkit submissions
& SUI monitoring
The approach to choice and
personalisation, including AQP
Through assessment of cluster
plans
Contacts
North East
Susan.Thompson@northeast.nhs.uk
North West
Debbie.Bywater@northwest.nhs.uk
Yorks and Humber
Rose.Hand@Yorksandhumber.nhs.uk
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
QUALITY
Key priorities
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Agreeing with the PCT Cluster the roles, responsibilities and timescales for the completion of all commissioning
activities for the delivery of the quality requirements in the Operating Framework.
• Co-leadership of prioritisation and activity planning with support from commissioning support services and the
PCT Cluster to meet the quality requirements of the Operating Framework.
• Assessing the needs of the local population working with the H&WB, determining commissioning priorities and
commissioning intentions for all delegated budgets that will impact of the quality of services.
• Producing a clear and credible commissioning plan* that addresses the quality needs of the local population and
demonstrates how the CCG will improve the health outcomes for patients and the wider public through the
efficient use of delegated resources.
• Include any pre-existing National, Regional and local requirements in CCG plans.
• CCGs should link their plans to the updated JSNA and highlight where and how they intend to change the
existing Integrated Strategic Operational Plan or similar PCT strategic plan document.
• Producing an annual Operating Plan that clearly identifies how resources will be moved around the local health
system to bring about the changes in service configuration, capacity and quality that are needed to deliver
prioritised outcomes and QIPP efficiency savings. A plan on a page may be used as a high level summary.
* NHS North of England expects that CCG detailed plans directly inform the 3 year PCT Cluster narrative plan for
12/13 to 14/15 and also contain a CCG narrative plan for 15/16 and 16/17.
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
QUALITY
OF requirements
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Identification of milestones that will impact on the quality of services.
• Agreement of all quality milestones with the PCT Cluster.
• Ownership of trajectories associated with operating framework requirements.
• Preparing plans to demonstrate how all CCG duties will be met eg how the quality of primary care will be
improved
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
Strategic narrative
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Agreeing with the PCT Cluster the roles, responsibilities and timescales for the completion of all commissioning
activities associated with reform that require CCG input.
• Ownership of the strategic vision and key initiatives.
• Encourage CCG members and other clinicians to feed into the planning process by identifying risks and
opportunities in reformed organisations and provider services.
• Collaborate with neighbouring CCGs to ensure all CCG QIPP plans that impact on provider reform are coherent
across the PCT Cluster.
• Review all existing PCT and Regional QIPP initiatives and either include remaining actions or additional remedial
actions where there is under-delivery.
• Ensure engagement with H&WB
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
Transformational milestones
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Agreeing with the PCT Cluster the roles and responsibilities of all parties engaged in reform.
• Input into all aspects of reform as required by PCT Cluster, SHA Cluster, Local Authorities and local providers.
• Identification of the key transformational developments that will be required to deliver QIPP.
• Clinical leadership of discussions with local provider clinicians to agree local service reconfigurations.
• Identification of milestones to deliver the reform of commissioning structures and providers.
• Agreement of all reform milestones with the PCT Cluster.
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
Commissioner development
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Production of the CCG’s own organisational development plan.
• Clarification of support required from PCT Cluster.
• Development of agreements with commissioning support organisations and signing of SLAs.
• Partnership working with Health and Wellbeing Board(s) to establish productive local arrangements.
• Input into transitional work programmes to develop NCB functions by the PCT Cluster.
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
Provider development
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Understand the reconfiguration issues and pressures of local trusts.
• Lead or co-lead all contract and reconfiguration discussions with local providers.
• Encourage CCG members and other clinicians to feed into the planning process by identifying risks and
opportunities in reformed organisations and provider services.
• Collaborate with neighbouring CCGs to ensure all CCG QIPP plans that impact on provider reform are coherent
across the PCT Cluster.
• Support local Any Qualified Provider procurements and show where CCG plans promote patient choice.
• Support aspirant Foundation Trusts in-line with the planning and partnership responsibilities of CCGs outlined in
the forthcoming DH tool kit.
• Need to ensure quality of services is maintained or improved during any service changes
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
HWB Development
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Direct engagement with LA and HWBs to develop effective local partnerships and strategy functions for adults
and children, including involvement in JSNA. Support the refresh of the JSNA through the Health and Wellbeing
Board(s).
• Consultation of local stakeholders when developing CCG commissioning plans through the Health and Wellbeing
Board(s).
• Involvement in Health and Wellbeing Board(s) prioritisation and engagement activity that aligns with healthcare
as locally required.
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
PH Transition
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG responsibilities
• Input into transitional work programmes to develop Public Health functions by the PCT Cluster.
• Clarification of the commissioning support services the CCG will require from Public Health.
• Input into public health commissioning plans as required by local Public Health teams.
CCG
engaged
in process
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
REFORM
Choice and Empowerment
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Identification of opportunities to engage patients and the wider population in healthcare planning and the
delivery of services.
• Sign up to the approach to expand choice and AQP in the cluster.
• Liaison with commissioning support services to secure support for public and patient engagement.
• Agreement of all engagement activities with the PCT Cluster.
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
RESOURCES
Activity
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Co-leadership of activity planning with support from commissioning support services and the PCT Cluster.
• Engagement of local partners in activity planning, including the public and patients, Health and Wellbeing
Board(s) and providers.
• Include any National, Regional and pre-existing local requirements in CCG plans.
• Production of costed and balanced activity plans to inform contract discussions with local providers.
• Production of an annual Operating Plan that clearly identifies how resources will be moved around the local
health system to bring about the changes in service configuration, capacity and quality that are needed to
deliver priorities outcomes and QIPP efficiency savings.
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
RESOURCES
Finance
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Co-development of CCG financial plans with support from commissioning support services and the PCT Cluster.
• Full involvement in all decisions on prioritising investments for delegated budgets.
• Approval of all financial plans for delegated budget areas.
• Incorporation and updating of existing PCT and SHA QIPP targets into CCG financial plans.
• Linking of all financial investments to revenue source i.e. all movements in activity should be connected so that
disinvestments in one area can be monitored to support investment in other areas.
• Detailed plans that demonstrate how the CCG will maintain financial control for delegated budgets and contribute
to the PCT Cluster’s management of non-delegated budgets.
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
RESOURCES
Workforce
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
CCG responsibilities
• Identification of where CCG commissioning intentions will impact on workforce planning assumptions.
• Direct engagement with providers where planned service configuration and capacity changes will impact on
providers.
• Professional input to the workforce planning process undertaken by the PCT Cluster to provide assurance of
provider workforce plans.
No
CCG
Input
Annex A: CCG responsibilities
OPERATING
FRAMEWORK
CATEGORY
PLANNING AREA
RESOURCES
Contracting
CCG leading
the process
with support
CCG coleadership of
the process
CCG active
involvement
in the process
CCG
engaged
in process
No
CCG
Input
CCG responsibilities
• Co-leadership of the 2012/13 contracting discussions with providers utilising support from commissioning
support services and the PCT Cluster.
• CCGs may wish to co-sign PCT Clusters contracts with providers.
• Review of 2011/12 contract outturn position and identification of actions and further commissioning intentions
as required to return activity to plan.
• Collaboration with neighbouring CCGs to produce a single CQUIN and quality schedule for each provider by
incorporating and developing existing CQUIN and quality measures and addressing National and Regional
priorities.
• Co-production of a monthly activity plan for each provider that aligns with financial and QIPP plans.
• Agreement of contract negotiation position with member practices, PCT Cluster and neighbouring CCGs prior to
initiating discussions with providers.
• Early identification of any service changes requiring procurement support and the subsequent sourcing of
procurement expertise from commissioning support services.
• Description of how the contracts will be monitored during the course of the year and member practices engaged
in this process.