The NHS outer north east London
commissioning cycle
2012/13 – 2014/15
Jane Gateley
Director of planning and delivery
Contents
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Requirements
London time lines
Design principles
Roles and responsibilities
NHS outer north east London (NHS ONEL) approach
The NHS commissioning cycle
NHS ONEL resource plan and time line
Planning for 2012/13 – 2014/15
What is required?
• Three year plan
• Build on existing plans for 2012/13 –
2014/15
- more detail on how QIPP
initiatives will be delivered
workforce
- strengthened financial, activity,
and work force analysis
• Enable PCTs to meet their strategy
planning requirements and cover all
elements of healthcare to be
commissioned
• Provide pathfinders with CCG level
plans that can be used as part of
their authorisation process (Jul –
Dec 2012)
• Need to align with Operating Plan
cycle 12/13
What should be
provided?
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overview of local health
economy
vision for local
commissioning
areas for improvement
description of initiatives
that will be implemented to
deliver vision
based on JSNA and
priorities identified in Joint
Health and Well Being
Strategy
What format should plan
take?
Key elements:
• Exec summary
• Vision and strategic goals
• Approach
• Case for change
• Key priorities
• Opportunities (current and
new)
• Enablers
• Delivery impact
• Sustainable commissioning
• Implementation
Timeline for planning cycle
Design principles
• Strategic plans will be developed with the relevant partners and maximise the opportunity to increase clinical
engagement in strategic planning
• Cluster chief executives will be held to account for delivering plans on time
• There will be clear leadership and lines of accountability within a cluster for the production of each element of
the plan, especially where pathfinders have received delegated responsibilities
• Pathfinders should engage in developing the whole commissioning strategy plan, and own their local
commissioning strategy plan
• Clusters will support pathfinders in developing their local commissioning strategy plans
• HWBs must be engaged early in the development of plans and must endorse relevant elements of the plans
before they can be formally agreed
• What can be done once across London, should be done once across London including the London-wide
strategic priorities endorsed by the GP Council. Through its assurance role, NHS London will facilitate the
identification of pan-London strategic priorities
• Plans will develop and further substantiate existing four-year PCT cluster plans and as such be clear where
they are building on existing plans
• Learning from previous planning processes will be considered throughout the process by all
• Strategic planning will be aligned with and feed into the operating planning process for 2012/13
• NHS London will continue to provide ongoing assurance over the planning process and of the plans themselves
to report to DH
Roles and responsibilities
Stakeholder
Responsibility
Pathfinder
Leading the development of local commissioning strategy plans and contributing to the
development of the overall cluster plan, including engaging with neighbouring
pathfinders and providers
Emerging Health and
Wellbeing Boards
Engaging in the development of plans for their local populations, promoting and
supporting integrated approaches to commissioning and provision and reviewing and
endorsing plans where they meet the needs and priorities identified in the JSNA and
Joint Health and Wellbeing Strategy as part of finalising plans
Local Authorities
Working with pathfinders / clusters in developing the case for change aligned to the
JSNA and participating in the development of joint commissioning strategies
PCT clusters
Supporting pathfinders in developing their plans, contributing to the NHS CB elements
of plans and ensuring the delivery of cohesive plans to the agreed deadlines
London Specialised
Commissioning Group
Developing elements of the plans related to the specialised services they currently
commission
Providers
Working with commissioners to ensure triangulation of commissioner and provider
plans
NHS London NHS CB
Team
NHS London
Supporting and monitoring the production of the NHS CB elements of plans, making
sure they can be brought together to form a single shadow plan for the NHS CB in
London
Working alongside commissioners to provide assurance that plans are developed in
line with the agreed design principles, that content is developed to the necessary
standards and that plans can be consolidated to derive a pan-London financial and
service position.
NHS ONEL approach
• Meet with each CCG to discuss local approach in early September
• Use NHS commissioning cycle as an enabler for matrix working (see
next slide and detailed resource plan and timeline)
• Begin implementation from mid September
• Communicate/engage partners
• Submit approved plan that meets authorisation requirements by end
of November
• Signed contracts in place by end of February
• Joint implementation plans in place with trusts by end of March
NHS ONEL approach: use the NHS Commissioning Cycle
based on principles …. Plan, Execute, Manage
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7.
8.
Assess needs: through a systematic process,
understanding of the health and health care needs
of the PCTs resident population.
Describe services and gap analysis: reviewing
the services currently provided and based on needs,
defining the gaps (or over provision).
Deciding priorities: given a list of desirable
actions, using available evidence of cost
effectiveness and based on robust and defensible
ethical framework, prioritise areas for purchase.
Risk management: understanding the key health
and health care risks facing the PCT and deciding
on a strategy to manage it.
Strategic options: bring together all the available
information into a single strategic commissioning
plan that outlines how the PCTs will deliver its core
objectives (including those of the SHA and DH).
Contract implementation: put those strategic plans
into action through contracting.
Provider development: (including care pathway redesign and demand management): support provider
improvements or introduce new providers to deliver
the services required (including setting up demand
management systems and designing new care
pathways). This includes supporting providers in
decommissioning of services where appropriate.
Managing provider performance: monitor and
manage the performance of providers against their
contracts, especially against KPIs
Lead: Jane Moore
Output: Prioritised JSNA for each borough
Lead: Conor Burke
Output: Service and gap analysis
Lead: Conor Burke
Output: Commissioning intentions
Lead: Jane Gateley
Output: Risk assessment of plans
Lead: Jane Gateley
Output: Commissioning Strategy Plan
Lead: Conor Burke
Output: Signed contracts and SLAs
Lead: Conor Burke
Output: Joint implementation plan
Lead: Conor Burke
Output: Performance reporting
Current opportunities
• Opportunity 10
• Primary care discharge facilitation adults
• A&E discharge team
• Rapid Response – PELC/NELF
• Surgical hot clinics
• Model for urgent/UCC utilisation
• SPA/111 DoS
• Ambulatory care
Opportunities – future priorities?
•O10 What would a good urgent and emergency care service look like?
“A good urgent and emergency care service is the range of healthcare services available to people
who need medical advice, diagnosis and or treatment quickly and unexpectedly. People using
services and carers should expect 24/7 consistent and rigorous assessment of the urgency of their
care need and an appropriate and prompt response to that need.” Dr Agnello Fernandes –
August 2011
Key principles
No confusion of what to do, who to call or where to go
999 immediate life threatening calls
NHS 111
Electronic Directory of Service
A joined up and co-ordinated system
24/7 rapid response team
ICM
LTC management
EoLC
Reablement
Opportunities future priorities cont’d
Safe responsive and a high quality service
Improved patient access to urgent same day GP appointments
High quality responsive out of hours service
Multi professional urgent and emergency care workforce
MH services located in EDs
Out of hours services co-located and integrated with urgent care services
24/7 social care response service
Safeguarding the young and vulnerable
Child protection and adult safeguarding will be statutory responsibilities
Patient and public involvement
Improved public education and marketing or urgent and emergency care services
Patient representation on the Boards of Commissioners
Next steps
A “good” CSP will be developed and tested with:
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All GP practices
Patients and public
Clinicians including secondary care
Providers
Health and well-being boards
Local authorities
High level timeline
Key milestones
CCG workshops completed
Leads
CCG/ONEL CSP lead
Month
Early October
CCG template issued to cluster leads and CCGs
ONEL CSP leads
Early October
First cut information provided by cluster leads BDs/cluster leads
and BDs
Mid October
Initial engagement with Las
CCG/BDs
During October
Joint engagement event patients
CCG/ONEL Comms lead
Mid October
1st cut CCG plans issued
CSP cluster lead
End October
Joint CCGs alignment/assurance event
Final draft ONEL CSP incorporating CCG plans
CCGs/ONEL Exec
CSP lead
Early Nov
Mid Nov
HWB presented with final draft plan
CCG/Borough Directors
Mid November
CCG sign off via Joint CCC/local CCCs?
CCGs
Mid-Nov
Board sign off
Submission to NHSL
NHSL assurance process
NHSL assurance process ends/final plan sign off
Board
CSP cluster lead
CCG involvement required
17 November
30 November
TBC
December