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 care for individuals, carers and families, empowering and supporting people to maintain independence and to lead full lives as active participants in their community 2
Primary care co-commissioning must enable the right benefits for NW London to help us achieve the vision 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 3
In November CCG members and governing bodies supported the further exploration of co-commissioning opportunities In September and October, constituent In November CCG governing bodies members supported the following: noted the above and supported the following recommendations: • The proposals to date reflect a sound approach to maximising the anticipated benefits and • Agree that continuing to explore options for co- minimising the risks commissioning will enable NWL to shape the process to meet specific local priorities • The CCG will, jointly with the other NWL CCGs, enter into a shadow joint commissioning • Agree that the CCG will, jointly with the other partnership with NHS England in November NWL CCGs, enter into a shadow joint 2014, in a ‘Joint Committee’. commissioning partnership with NHS England in November 2014. In this arrangement, all • Note that in March 2015 members will be asked decisions will continue to be ratified by each to agree that; their CCG will, jointly with other CCG and NHS England CCGs in North West London, progress into a formal joint commissioning partnership with • Note that ‘go - live’ for fully established NHS England in April 2015 arrangements is anticipated to be in April 2015, and agree to support in the resulting requirement to engage further with GP members over 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 4
NHSE Suggested 3 Options for co-commissioning: NWL requirements align more clearly to how Option C: “Delegation” is now being defined A B C Delegated commissioning Joint commissioning arrangements, whereby CCGs Greater CCG involvement in arrangements, whereby CCGs carry out defined functions on influencing commissioning and area teams make decisions behalf of NHS England and area decisions made by NHS together, potentially supported teams hold CCGs to account for England area teams by pooled funding how effectively they carry out arrangements these functions • 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. 5
Functions that NHSE could jointly manage with, or delegate to, CCGs in primary care co-commissioning arrangements 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 6
Statutory national guidance has set out requirements for the mitigation of conflicts of interest 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 7
Benefits and drawbacks of co-commissioning options: Delegated arrangements provide greater and more straightforward control and greater management resources Transferred functions Resources and budgets Governance Other Benefits Drawbacks Benefits Drawbacks Benefits Drawbacks Additional benefits Further challenges • • • • • • • • Will enable the It is unlikely to be Financial reporting CCGs would give CCGs would not be Complex There will be an option CCGs have less commissioning of possible to contract remains un- up influence over accountable governance to continue into influence over how a new offer for for a full new complex as their OOH spend to arrangements with delegated co-commissioning Joint arrangements general practice alternative to the contracting and NHSE as decisions all decision making arrangements in the develops in a wrap around core contract in this transactional would be made reliant on NHSE future • Proformas for joint form arrangement functions remain jointly approval • Terminating arrangements are an NHSE role • • • Greatest CCGs must pool Complex arrangement if due for submission flexibility in scope budgets to be assurances required would on 30 Jan of functions managed by NHSE processes (NHSE potentially be less assumed - will have not yet complex than in • Management not need to defined the delegated resource would be include processes for arrangements limited, part time responsibility for reporting back to • and employed by There is marginally contract and their national team) NHSE with CCGs more time available performance filling any prior to submitting management management proposals functions resource gap • • • • • • • • Will enable May include Greater CCGs would still Will enable more CCG would be Best way of ensuring Proformas for joint CCGs to have responsibility for management need to meet succinct and accountable CCGs shape how co- arrangements are the greatest contract and resource from management condensed commissioning due for submission influence on performance NHSE available to resource gap (but it governance develops in the future on 9 Jan primary care management carry out functions would be smaller arrangements Delegated arrangements • • Best starting point for CCGs may not be commissioning functions (although than in joint • • CCGs would Simpler assurance delivering vision of ready to take on decisions NWL have stated arrangements) manage pooled processes whole systems additional role by that they are not • • Would enable the budgets Financial reporting (therefore best aligns April 2015 (although interested in this • CCGs would have commissioning of becomes with 5 year strategy) NWL could propose function) fully delegated a full new complicated if an extended • functions in Prevents the option • alternative to the Should it not CCGs are transition plan) defining own that HWBB / other core contract in involve managing budgets • strategies, organisation could do Delegated this arrangement performance but not contracts therefore would not co-commissioning of arrangements could management but (although this will lead to CCGs primary care with affect the still involve budget be for NHSE to giving up influence NHSE instead relationship between management, consider) over their OOH CCGs and GP splitting up spend members functions will be complicated to • Terminating define and manage 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 8
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