ckwcb-12-13_operating_plan_v3

2012/13 Operating Plan

Calderdale, Kirklees &

Wakefield District Cluster Board Meeting

17th January 2012Peter Flynn

Contents

• Introduction

• Cluster Plan – Structure & Time Period

• Content of CCG plan

• Key features expected in plans

• Roles/Responsibilities and Products

• Timetable of planning activities

• Key requirements and criteria for assessment:

– Quality

– Resources

– Reform

• Summary

• Annex – CCG (in hand-outs only)

Introduction - Purpose of this planning round

• 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 a

backdrop of organisational change and low growth.

Introduction - Current environment

• Increased emphasis on transformational change

• Less opportunities for transactional efficiencies

• Increased role for GPs and clinicians in planning to

improve quality of services and health of the population

• Opportunity to test emerging commissioning support

arrangements

• PCT clusters still responsible for transition of

accountabilities

Introduction

– focus on transformational change

transformational

transactional

QIPP challenge

Cluster Plan - Structure

Cluster Plan – Period covered

2012/13 2013/14 2014/15 2015/16 2016/17

Commissioning

Reform

Activity,

Finance,

Workforce

CCG Narrative

Content of CCG plan

• Agreed with CCG/PCT planning leads to

enable:

– Easy cross reference between plans

– CCG accreditation. Uses the same 6 domains:1. Clinical Focus and Added Value

2. Engagement with Patients and Communities

3. Clear and Credible Plans:

4. Capacity and Capability

5. Leadership Capacity and Capability

6. Collaborative arrangements

Section To Include

Introduction A strategic assurance

1. Clinical Focus and Added Value

1.1 Vision 1.2 Strategic direction 1.3 Understanding population health needs 1.4 Engagement from all constituent practices 1.5 Engagement with Providers

2. Engagement with Patients and Communities

2.1 Engagement plan 2.2 Engagement with patients, public and the population 2.3 Engaging with communities and stakeholders 2.4 Enabling Access & Offering Choice

3. Clear and Credible Plans:

QIPP, Activity, Finance, Workforce,

Contracts & CQUINS

3.1 Delivery of Outcomes 3.2 QIPP (Transformational & Transactional) 3.3 Activity 3.4 Finance 3.5 Workforce including Providers 3.6 Contracts & CQUINS

Delegation and CCG Development Plans

3.7 Budget setting and scope 3.8 Statutory accountabilities 3.9 CCG development plan 3.10 Risk management arrangements 3.11 Quality and patient care 3.12 OD support 3.13 Equality and diversity 3.14 Communications

4. Capacity and Capability 4.1 Build, share, buy model of service provision 4.2 CCG capacity and capability timetable 4.3 Training and development plan 4.4 Plans for good governance and managing conflict of interest

5. Leadership Capacity and Capability

5.1 Terms of reference 5.2 Board structure and governance 5.3 CCG committee governance: evidence of assurance

6. Collaborative arrangements 6.1 Memorandum of understanding 6.2 Constitution and interim arrangements 6.3 Partnership arrangements 6.4 Health and Well-being Board

Appendices

Include: Activity Plans

Finance Plans and Narrative Workforce details

Key features expected in plans

• Explicit CCG support & leadership

• Transformational milestones to deliver QIPP

• Continue to deliver existing targets, e.g.

– Access: 18 Weeks, A&E, Cancer, YAS

– Quality & Safety: EMSA, HCAI

• Address Quality, Outcomes and Health

Inequalities

Key roles/responsibilities & productsRole/Responsibility Products

CCGs Engaged in all aspects of

planning (see Annex A in

hand-out)

5 year clear and credible plan

PCT

Cluster

Coordination of all

planning and alignment of

all plans

3 year plan including:

• Vision for the healthcare system

• Key transformational initiatives and

milestones

• Approach to Reform

PCTs Collection unit for

planning information

Activity, Finance, Workforce

trajectories & Signed Contracts

Providers Engaged in planning

process

Provider plans informed by the above

TimetableDate Requirement Scrutiny by:

20 Jan PCT Cluster submit draft of strategic vision and data trajectories for

Operating Framework requirements

26 Jan CKWD Mid year review process with SHA used to test quality and

ambition of service vision

w/c 30 Jan SHA Feedback meetings to PCT clusters

07 Feb Board Review of Draft Plan

17 Feb Final CCG Plans available

24 Feb Near final data trajectories submitted

27 Feb CLT signoff of final plan

06 Mar Cluster Plan to Public

Board Meeting

15 Mar Contracts signed

w/c 26 Mar Final Cluster plans submitted Cluster Plan to Public

Board Meeting (if needed)

31 Mar Confirmation to SHA and DH of contracts signed

April Cluster plan sign off meetings with SHA

Key Requirements &

Success Criteria– Quality

• 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.

Key Requirements &

Success Criteria – Resources

• Activity

• Finance (cost of Activity)

• Workforce

• Contracts

• Triangulation

Triangulation of PlansAs 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• 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 ACTIVITY

PLANS AGAINST PROVIDER

FINANCE/INCOME PLANS

COMMISSIONER FINANCE

PLANS AGAINST PROVIDER

WORKFORCE PLANS

WORKFORCE PLANS AGAINST

ACTIVITY 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?

• 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?

Key Requirements &

Success Criteria – Reform

Against the 3 year vision for services, plan must

include:

• Transformation (QIPP) milestones

• Commissioning Development

– Clinical Commission Groups (CCGs)

– Health & Wellbeing Board (HWB)

– Commissioning Support Unit (CSU)

– NHS Commissioning Board (NCB)

People transition phases

Phase 1(complete)

• an initial assignment of employees to support emerging CCGs (Finance, OD, Governance, Commissioning)

• employees given first indication of possible assignment destination in 1:1 or team meetings

Phase 2(01/12– 04/12)

• firmer determination of people & function mapping in advance of the establishment process

• employees receive letters confirming likely destination of function

• transitional (interim) assignments made to key roles for CCGs/CSUs

Phase 3(04/12 – 04/13)

• preparation for transfer by sender and receiver organisations, including the requirement to consult on TUPE / COSOP transfers

• consultation as required on associated measures, e.g. structural changes

• substantive appointment processes related to structural changes if required*

*substantive appointments unlikely to take effect until the transfer date

Key Requirements &

Success Criteria – Reform

• Commissioning Development (continued)

– Public Health Transition

– Provider Development

– Choice & Empowerment

– Use of Technology

Public Health Transition

• Being managed through the Programme Office

• Sign off of Public Health transition plans needs

to be considered and agreed as to where this

will be done and when.

• i.e. Role of PCTs, Cluster, Local Authorities

• To be discussed at Feb 2012 Cluster Board

Overall Summary of the Cluster Plan

• What is the vision for healthcare provision in

3 years time?

• What are the key transformational initiatives

that will enable the vision to become real?

• What are the milestones in those

transformations?

• What are the resources needed and the

resulting whole system savings?

Summary

• We have a detailed aggressive timetable to work to

• This will challenge CCGs, PCT and Cluster

• There is abundance of guidance and support

• Opportunities for NEDs to engage with plans via

CCEs

• Will help the CCGs start to prove they can take

ownership of the health services agenda

• Questions?

Annex A: CCG responsibilities

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.

OPERATINGFRAMEWORK

CATEGORYPLANNING AREA

CCG leading the process

with support

CCG co-leadership of the process

CCG active involvement

in the process

CCG engaged

in process

No CCG

Input

QUALITY Key priorities



• 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

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

QUALITY OF requirements



• 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

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM Strategic narrative



• 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.

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM Transformational milestones



• 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.

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM Commissioner development


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM Provider development


• 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


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM HWB Development


• 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.



• 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.

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM PH Transition


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

REFORM Choice and Empowerment


• 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.



• 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.

OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

RESOURCES Activity


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

RESOURCES Finance


• 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.


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

RESOURCES Workforce


• 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.


OPERATINGFRAMEWORK



with support



in the process

CCG engaged

in process

No CCG

Input

RESOURCES Contracting


• 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.

ckwcb-12-13_operating_plan_v3

Documents

ccg development plans

engagement plan

activity plans finance

ccg capacity

plans ccg accreditation

credible plans

plans rolesresponsibilities

robust plans