The NHS outer north east London commissioning cycle

2012/13 – 2014/15

Jane Gateley Director of planning and delivery

Contents

• 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

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?• 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

Planning for 2012/13 – 2014/15

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

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

NHS 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

1. Assess needs: through a systematic process, understanding of the health and health care needs of the PCTs resident population.

2. Describe services and gap analysis: reviewing the services currently provided and based on needs, defining the gaps (or over provision).

3. 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.

4. Risk management: understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it.

5. 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).

6. Contract implementation: put those strategic plans into action through contracting.

7. Provider development: (including care pathway re-design 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.

8. Managing provider performance: monitor and manage the performance of providers against their contracts, especially against KPIs

Lead: Jane MooreOutput: Prioritised JSNA for each borough

Lead: Conor BurkeOutput: Service and gap analysis

Lead: Conor BurkeOutput: Commissioning intentions

Lead: Jane GateleyOutput: Risk assessment of plans

Lead: Jane GateleyOutput: Commissioning Strategy Plan

Lead: Conor BurkeOutput: Signed contracts and SLAs

Lead: Conor Burke Output: Joint implementation plan

Lead: Conor BurkeOutput: 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 principlesNo confusion of what to do, who to call or where to go999 immediate life threatening callsNHS 111Electronic Directory of Service

A joined up and co-ordinated system24/7 rapid response teamICMLTC managementEoLCReablement

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: •All GP practices•Patients and public•Clinicians including secondary care •Providers•Health and well-being boards•Local authorities

High level timelineKey milestones Leads MonthCCG workshops completed CCG/ONEL CSP lead Early October

CCG template issued to cluster leads and CCGs ONEL CSP leads Early October

First cut information provided by cluster leads and BDs

BDs/cluster leads 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 CCGs/ONEL Exec Early Nov

Final draft ONEL CSP incorporating CCG plans CSP lead 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 Board 17 November

Submission to NHSL CSP cluster lead 30 November

NHSL assurance process CCG involvement required TBC

NHSL assurance process ends/final plan sign off December