Primary care co-commissioning in North West London Hounslow CCG - - PowerPoint PPT Presentation

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Primary care co-commissioning in North West London Hounslow CCG - - PowerPoint PPT Presentation

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Primary care co-commissioning in North West London Hounslow CCG Governing Body update January 2015 1 In North West London there is a vision for joined-up whole systems care with general practice at its core We want to improve the quality of

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Primary care co-commissioning in North West London Hounslow CCG Governing Body update

January 2015

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In North West London there is a vision for joined-up whole systems care with general practice at its core

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We want to improve the quality of care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community

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Ultimately we want to achieve the right benefits for patients:

  • Improved access to primary care and wider out-of-hospitals services, with more services available closer to home
  • High quality out-of-hospitals care
  • Improved health outcomes, equity of access, reduced inequalities
  • Services that are joined up, coordinated and easy for users to navigate around
  • A better patient experience through more joined up services
  • A greater focus on prevention, staying healthy and patient empowerment

Primary care co-commissioning could enable us to achieve these benefits through:

  • The ability for local GPs and people to influence decision making in primary care to align with local priorities and

initiatives to support achievement of the vision of NW London

  • The ability to make sustainable investment into primary care, and to commission for a new and enhanced offer for

general practice

  • The ability to influence the necessary investment in estates
  • Streamlined and efficient governance arrangements that allow for effective and consistent decision-making with

localisation

Primary care co-commissioning must enable the right benefits for NW London to help us achieve the vision

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In September and October, constituent members supported the following:

  • The proposals to date reflect a sound approach

to maximising the anticipated benefits and minimising the risks

  • The CCG will, jointly with the other NWL CCGs,

enter into a shadow joint commissioning partnership with NHS England in November 2014, in a ‘Joint Committee’.

  • Note that in March 2015 members will be asked

to agree that; their CCG will, jointly with other CCGs in North West London, progress into a formal joint commissioning partnership with NHS England in April 2015

In November CCG governing bodies noted the above and supported the following recommendations:

  • Agree that continuing to explore options for co-

commissioning will enable NWL to shape the process to meet specific local priorities

  • Agree that the CCG will, jointly with the other

NWL CCGs, enter into a shadow joint commissioning partnership with NHS England in November 2014. In this arrangement, all decisions will continue to be ratified by each CCG and NHS England

  • Note that ‘go-live’ for fully established

arrangements is anticipated to be in April 2015, and agree to support in the resulting requirement to engage further with GP members

  • ver the coming months
  • Recognise that no formal changes to decision

making are possible without a constitutional change that will require a mandate from CCG members

In November CCG members and governing bodies supported the further exploration of co-commissioning opportunities

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NHSE Suggested 3 Options for co-commissioning: NWL requirements align more clearly to how Option C: “Delegation” is now being defined

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  • NW London CCGs initially expressed an interest in option B, ‘joint commissioning’,

arrangements

  • In light of new guidance from NHS England, is has become apparent that delegated

arrangements may align best with what we have been describing for NW London. For this reason the option that would deliver the required benefits may be, ‘delegated arrangements’

  • In any future arrangements, contract and performance management would need to continue

to be a responsibility and function of NHSE. We understand that this could be the case under delegated arrangements as there will be no novation of core contracts.

Greater CCG involvement in influencing commissioning decisions made by NHS England area teams Joint commissioning arrangements, whereby CCGs and area teams make decisions together, potentially supported by pooled funding arrangements Delegated commissioning arrangements, whereby CCGs carry out defined functions on behalf of NHS England and area teams hold CCGs to account for how effectively they carry out these functions

A C B

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Functions that NHSE could jointly manage with, or delegate to, CCGs in primary care co-commissioning arrangements

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NW London have agreed that primary care co-commissioning should not be about:

  • CCGs contract or performance

managing GPs or practices

  • Taking away the core contract

Further information can be found in the following guidance: Next steps towards primary care co-commissioning. NHS England and NHS Clinical

  • Commissioners. 10

November 2014. Publications Gateway Reference 02501

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Statuary guidance states that:

  • Any co-commissioning committee must have a lay and executive

majority, Chair and deputy Chair

  • Any parties that could be conflicted in decision-making will declare

their conflict and will abstain from voting

  • The local Health and Wellbeing Boards and HealthWatch will have a

right to nominate a representative to attend committee meetings as an observer Further information can be found in the following guidance: Managing conflicts of interest: statutory guidance for CCGs. NHS England. 18 December 2014. Publications Gateway Reference 02726

Statutory national guidance has set out requirements for the mitigation of conflicts of interest

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Benefits and drawbacks of co-commissioning options: Delegated arrangements provide greater and more straightforward control and greater management resources 8

Transferred functions Resources and budgets Governance Other

Benefits Drawbacks Benefits Drawbacks Benefits Drawbacks Additional benefits Further challenges

Joint arrangements

  • Will enable the

commissioning of a new offer for general practice in a wrap around form

  • Greatest

flexibility in scope

  • f functions

assumed - will not need to include responsibility for contract and performance management functions

  • It is unlikely to be

possible to contract for a full new alternative to the core contract in this arrangement

  • Financial reporting

remains un- complex as contracting and transactional functions remain an NHSE role

  • CCGs would give

up influence over their OOH spend to NHSE as decisions would be made jointly

  • CCGs must pool

budgets to be managed by NHSE

  • Management

resource would be limited, part time and employed by NHSE with CCGs filling any management resource gap

  • CCGs would not be

accountable

  • Complex

governance arrangements with all decision making reliant on NHSE approval

  • Complex

assurances processes (NHSE have not yet defined the processes for reporting back to their national team)

  • There will be an option

to continue into delegated arrangements in the future

  • Terminating

arrangement if required would potentially be less complex than in delegated arrangements

  • There is marginally

more time available prior to submitting proposals

  • CCGs have less

influence over how co-commissioning develops

  • Proformas for joint

arrangements are due for submission

  • n 30 Jan

Delegated arrangements

  • Will enable

CCGs to have the greatest influence on primary care commissioning decisions

  • Would enable the

commissioning of a full new alternative to the core contract in this arrangement

  • May include

responsibility for contract and performance management functions (although NWL have stated that they are not interested in this function)

  • Should it not

involve performance management but still involve budget management, splitting up functions will be complicated to define and manage

  • Greater

management resource from NHSE available to carry out functions

  • CCGs would

manage pooled budgets

  • CCGs would still

need to meet management resource gap (but it would be smaller than in joint arrangements)

  • Financial reporting

becomes complicated if CCGs are managing budgets but not contracts (although this will be for NHSE to consider)

  • Will enable more

succinct and condensed governance arrangements

  • Simpler assurance

processes

  • CCGs would have

fully delegated functions in defining own strategies, therefore would not lead to CCGs giving up influence

  • ver their OOH

spend

  • CCG would be

accountable

  • Best way of ensuring

CCGs shape how co- commissioning develops in the future

  • Best starting point for

delivering vision of whole systems (therefore best aligns with 5 year strategy)

  • Prevents the option

that HWBB / other

  • rganisation could do

co-commissioning of primary care with NHSE instead

  • Proformas for joint

arrangements are due for submission

  • n 9 Jan
  • CCGs may not be

ready to take on additional role by April 2015 (although NWL could propose an extended transition plan)

  • Delegated

arrangements could affect the relationship between CCGs and GP members

  • Terminating

arrangement may be more complex than in joint arrangements

NHS England have agreed that any submission of proposals in January may be in draft form. This will allow us to engage with members fully prior to any binding decisions being made

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Prior to making a binding decision on the way forward next year, NW London will need to carry out a rigorous due diligence process to determine the right way forward.

Components to explore for the two options are:

  • 1. Functions to be transferred and lines of accountability
  • 2. Management resource required to carry out transferred functions, both in terms of capacity and of

capability

  • 3. Budgets to be pooled, including capital budgets that will enable vital investment into primary care estates
  • 4. Governance, including effective decision-making that reflects individual CCG priorities and mitigates

against conflicts of interest, and will align with statutory guidance Also to consider when exploring the above:

  • Affordability and financial impact on each CCG
  • Infrastructure required and CCG preparedness for change
  • Alignment with shared NWL 5 year strategy
  • Stakeholder engagement requirements, and potential impact on the relationship between CCGs and

GP membership

NO BINDING DECISIONS CAN BE MADE WITHOUT THE FORMAL APPROVAL OF CONSTITUENT PRACTICES

Before making any binding decisions..

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  • Submit a draft proforma on 9th January (in line with NHS England

timescales) to ensure we do not miss the opportunity to co-commission in 2015/16. At this stage, this could specify that NW London are interested in either joint or delegated options and we would reserve the right to withdraw the application if it is not supported by constituent members

  • Initiate a process of rigorous due diligence as the final guidance and

information emerges from NHS England

  • Carry out a series of engagement with the CCG governing body, GP

members, Londonwide LMC and other stakeholders in co- commissioning and how it could be used to support the delivery of a new offer for general practice

  • Carry out a formal vote of the CCG constituent practices in March on

whether to proceed with co-commissioning in 2015/16

Next steps

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The following documentation provides in greater detail the scope for each of the co-commissioning options set

  • ut by NHS England and further supporting guidance:
  • Next steps towards primary care co-commissioning. NHS England and NHS Clinical Commissioners. 10 November
  • 2014. Publications Gateway Reference 02501
  • Managing conflicts of interest: statutory guidance for CCGs. NHS England. 18 December 2014. Publications Gateway

Reference 02726

  • Primary care co-commissioning: regional roadshows questions and answers. NHS England. 18 December 2014.

Publications Gateway Reference 02761

  • GPC update on co-commissioning of primary care: Important Guidance for CCG member practices and LMCs. GMC.

December 2014. For further information or to submit a comment, please contact your CCG Chair, Londonwide LMCs representative, or the NW London Primary Care Transformation team:

  • Londonwide LMCs, North West London MD – Tony Grewal, Tony.Grewal@lmc.org.uk
  • Londonwide LMCs, North West London MD – Eleanor Scott, Eleanor.Scott@lmc.org.uk
  • Collaboration of NW London CCGs, Primary Care Transformation Programme, Deputy Director - Matthew Walker,

Matthew.Walker@nw.london.nhs.uk

Further information and guidance

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