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 [email protected] North West [email protected] Yorks and Humber [email protected] 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 [email protected] North West [email protected] Yorks and Humber [email protected] 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 [email protected] North West [email protected] Yorks and Humber [email protected] 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 [email protected] Sector wide efficiency requirements 4.0% 4.0% 4.0% 4.0% NHS North West [email protected] 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 [email protected] 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 [email protected] North West [email protected] Yorks and Humber [email protected] 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 [email protected] North West [email protected] Yorks and Humber [email protected] 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 [email protected] 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 [email protected] Yorks and Humber [email protected] 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 [email protected] Yorks and Humber [email protected] 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 [email protected] 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 [email protected] 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 [email protected] North West [email protected] Yorks and Humber [email protected] 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.