MANAGING COMMISSIONING AUTHORISATION
finally arrived, where do commissioning groups stand and what should they expect in these final few weeks? When this article went to print, 34 CCGs had been fully established and authorised. Eight of these were authorised with ‘no conditions’, meaning that they met all of the 119 criteria set out by the NHS Commissioning Board. The remaining 26 CCGs had been authorised with ‘minor conditions’, which it is hoped they should be able to shake off come April. But, what exactly are ‘minor conditions’ and what else needs to be done before all engines are go?
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WHAT WILL CCGS WITH CONDITIONS HAVE TO DO DIFFERENTLY TO OTHER CCGS? The minor conditions placed on 26 of the 34 authorised CCGs are based on the 119 criteria they were required to meet – where they failed to do so, the criteria were then listed as conditions. CCGs in this position will have greater supervision in the initial stages of authorisation from the NHS Commissioning Board (NHSCB). Every CCG is required to make a
formal submission to the NHSCB in order to support the assurance of their plans. This is intended to create an emphasis on addressing priorities rather than hitting targets, as the guidance document, ‘Support Planning, 2013/14 For Clinical Commissioning Groups’ states: ‘Rather than imposing targets, the NHSCB expects CCGs to develop their own local priorities through their input into the joint health and wellbeing strategy. However, with assumed liberty comes public responsibility and CCGs are expected to set out real ambition in their plans. “Everyone Counts Planning for Patients 2013/14” asks each CCG to identify three local priorities against which it will make progress during the year. These priorities will be taken into account when determining if the CCG should be rewarded through the quality premium.’ CCGs that have been authorised with conditions around planning or finances will be subject to more scrutiny
his year has been much anticipated, for good or for bad, by CCGs, the NHS Commissioning Board and the Department of Health alike. So, now that it has
than the fully authorised groups. The NHSCB has recommended that in these cases, CCGs and area teams (ATs) work together to consider whether they require other elements of planning processes and documentation in order to better prepare for 2013/14. ‘Area Teams will work with CCGs to understand the local improvement identified by CCGs against the measures set out in the planning framework so that together, the NHSCB and CCGs, can be jointly satisfied,’ says the guidance. CCGs with conditions will be expected to submit more detailed support for their plans with the help of ATs, based on updated criteria from the ‘clear and credible plan’ domain of the CCG authorisation framework. This is the area where CCGs have most commonly failed on so far. The clear and credible domains state that the plan must: • Include a detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance and any other requirements set by the NHSCB, and is integrated with the commissioning plan
• Set out how savings and efficiencies will be delivered while improving quality, with a clear explanation of any changes to existing QIPP plans
• Support delivery of joint health and wellbeing strategies and integrated commissioning, depending on the local timeframe
• Set out how it aligns with national frameworks and strategies, including the NHS Outcomes Framework.
If an area team has concerns about a
CCG’s plan, they will initially raise those concerns with the CCG itself. A more formal meeting with the regional team might be necessary if the CCG and AT cannot agree on how to move forward and overcome the issues. If the NHSCB believes the plan is at risk of ‘failure to discharge, or discharge appropriately, its statutory functions’, then it might request further information and documents from the CCG and possibly a written explanation from the AT detailing the concerns raised. Other CCGs that may face greater
scrutiny from the board are those where there is to be a ‘major service reconfiguration’ that requires
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