A draft document released by the DoH last month revealed the process clinical commissioning groups (CCGs) will follow in the run-up to their authorisation.
By April 2013, all CCGs should be established, either as fully authorised CCGs with commissioning responsibility or in 'shadow' form. The NHS Commissioning Board (NCB) will fulfil the commissioning responsibilities of 'shadow' groups until they are ready to take them on themselves.
CCGs can become established as early as July 2012, once the NCB is established (between July and October 2012).
Once a CCG is established it can operate as a statutory body, sign contracts, and take on formal employment of staff.
CCGs would not however be able to take on commissioning responsibilities independently of their PCT cluster until 1 April 2013. By next month all CCGs must have completed a self-diagnosis, using the national DoH tool or a recognised alternative.
The self-diagnosis is not part of the authorisation process but is mandatory for all CCGs. It is designed to assess CCGs on some of the key areas that are likely to be required for authorisation.
The first official phase of authorisation will be a risk assessment of their proposed 'configuration'.
Assessment will begin in October 2011 and all CCGs will need to have completed the process by December 2011.
The risk assessment will help CCGs understand whether their proposed configuration arrangements will meet the authorisation criteria defined in the Health and Social Care Bill.
The risk assessments will be led by four SHA clusters (London, north, Midlands and south) working to a 'single operating model' and supported by the commissioning development team in the DoH.
Following the risk assessment, CCGs will then be ready to complete the authorisation process. In order to become established and authorised, CCGs will need to apply to the NCB.
The NCB will then evaluate CCGs across six domains. These are:
- A strong clinical and professional focus.
- Meaningful engagement with patients, carers and their communities.
- Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge within financial resources, in line with national outcome standards and local strategies.
- Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities as well as effectively commission all the services.
- Collaborative arrangements for commissioning with other CCGs, local authorities and the NCB.
- Great leaders who can make a real difference.
In order to demonstrate capability across these six domains, emerging CCGs will need to compile evidence, including their commissioning plan, constitution, prospectus and organisational development plan. CCGs may also wish to include examples of how they have delivered the QIPP challenge locally.
The NCB will then check the validity of the evidence. As well as providing evidence of their commissioning capability, CCGs will be subject to a '360 degree review'.
The review will look at how well CCGs are working with local partners, such as the shadow health and wellbeing boards, clinical senates and constituent practices.
In order to make the final decision on whether or not a CCG is fit to be authorised, the NCB will consolidate all of the information gained from submitted evidence and the '360 degree review'.
It will then assess and discuss its findings with the CCG and relevant stakeholders.
Once established and authorised, CCGs will be subject to an annual assessment, looking into their performance and organisational capabilities.
Dr Michael Dixon, chairman of NHS Alliance, is concerned that annual assessment of CCGs could become 'an examination hurdle that you have to jump'.
Rather than examining CCGs, PCT clusters should form a relationship with them, making assessment a mutual process, 'not some great surprise, where you get a letter through the post saying you've passed or you haven't passed'.
Dr Dixon also has concerns about the structure of the NCB.
'It puts the four SHA clusters under the NCB and then the PCTs and then the CCGs at the end of the line.'
Dr Dixon believes it is important for CCGs to ensure that they have an equal relationship with the NCB. 'CCGs will need to be forthright to ensure they do get a proper 50/50 power sharing role, otherwise things will go back to the way they were,' Dr Dixon says.
England's national clinical commissioning network lead at the DoH Dr James Kingsland says there is still detail that needs to be added. 'It shouldn't be taken as gospel yet.'
Although the document is still in draft form, Dr Kingsland does not expect the six authorisation domains to change dramatically.
Dr Kingsland stresses the importance of an authorisation process that is a help. 'We've got to have a process which is developmental, not punitive,' he explains.
Dr Steve Kell, GP and chairman of Bassetlaw Commissioning Organisation in Nottinghamshire, welcomes the guidance. 'We are working as a team to ensure we are ready for authorisation as soon as possible,' he says.
'The criteria are challenging but achievable and we recognise that responsibility brings accountability.'
|Key dates for CCGs|
October 2011: CCGs to complete self-diagnosis.
December 2011: CCG authorisation risk assessment process to be completed.
2012: Authorisation can begin based on six domains.
July 2012: Earliest CCGs can be established.
1 April 2013: CCGs can take on commissioning responsibilities independent of PCTs.