How our CCG is preparing to go live

Dr Hamish Stedman, Fiona Moore and Scott McKenzie update on Hundreds Health-Salford's progress

Fiona Moore and Dr Stedman: a consensus to demonstrate the value of list-based general practice (Photograph: UNP)
Fiona Moore and Dr Stedman: a consensus to demonstrate the value of list-based general practice (Photograph: UNP)

Hundreds Health-Salford (HHS) has now made measurable progress in its development as a clinical commissioning group (CCG) and hopes to be able to submit an application for authorisation in July.

We have now appointed our clinical board and lay members. We appointed a lay member with commercial responsibilities in addition to the two stipulated lay members covering governance and eng­agement.

We also intend the board nurse appointment to be a lay role with a lead responsib­ility for oversight of safeguarding and quality. However, this will be confirmed on receipt of the final CCG authorisation guidance.

Recruitment process
The recruitment process for a chief operating officer is underway. This post holder will be our accountable officer, as our lead clinician is already our chair. We have now developed and agreed our governance arrangements for 2012/13 in order to enable HHS to deliver all of its duties on becoming a stat­utory organisation.

These have been developed with the intention of being as close as possible to the ones that will be used post April 2013.

A first draft of our proposed internal staffing structure is open for consultation with staff. It is hoped that the HR process will have been confirmed by the end of the consultation, allowing staff to be assigned into the roles quickly and enabling us to test the future planned arrangements prior to April 2013.

HHS has also decided the service functions it would like delivered by commissioning support services (CSS). How­ever, the specifications and pricing mechanisms of these are yet to be agreed.

HHS progress
  • Use of Commissioning Support Services (CSS).
  • Joint working with the local authority.
  • Progress to authorisation.
  • Concerns over allocation formula for future CCG budgets.

Shared services
HHS has identified a number of areas (for example, engagement and communications) where partnership with the local authority would deliver both efficiencies and outcome benefits for both organisations and the populations they serve.

Being a membership organisation, HHS continues to work closely with its constituent practices to ensure that all local processes are built from the ground upwards. Across the city there is a consensus to demonstrate the value of list-based general practice, with the focus being on improving health outcomes and reducing health inequalities.

Credit must be paid to our practices, which continually strive to red­uce unnecessary spending and generate innovative ideas to drive up quality and efficiency in care pathways. Prevention and self-care are the key comp­onents in our pathway planning.

HHS has worked hard to ens­ure there is genuine clinical ownership and a real understanding of the accountability for the resources deployed every day within its members.

This work is underpinned by strong management support and a ‘golden thread’ of strong and empowered patient/public eng­agement.

Engagement within HHS works in tandem with our local authority via our pathfinder health and well­being board and includes feedb­ack and input from of our population.

HHS has also strived to ensure that real clinical and practice-based engagement is recognised within all processes. This engagement always targets reforming care, not simply structures.

This work is made possible by our CCG ‘neighbourhoods’ and is supported by our neighbourhood support team.

This includes working with our current and prospective providers around the workforce required to deliver the service specifications.

Our goal is to be fully authorised as early as possible within the process. Strong governance and safe risk management throughout the CCG underpin this and we will look to our lay members to act as cri­tical friends.

HHS has a close working relationship with our LMC. However, it continues to share the BMA concerns about the lack of funding detail within the Bill. The privatisation of the CSS and loss of local knowledge at so many levels also remains a joint concern.

Authorisation process
HHS was rated ‘green’ for all four components of its initial risk assessment.

It is anticipated that there will be a further two risk assessments based on governance and leadership.

As part of the staged development and handing over of res­ponsibilities to HHS, the PCT locality board will cease to function from April 2012. This will be replaced by our shadow board.  

To enable this to happen, the cluster (NHS Greater Manchester), has met our shadow board and both have signed an acc­ountability agreement.

It is anticipated that final authorisation requirements will published soon. If so, we will be in a position to submit our application at the earliest possible opportunity (expected to be July 2012).

Forthcoming challenges
Although internal structures and CSS requirements are well developed, there is further work still to be undertaken on CSS pricing structures. Detail on exactly what running costs will cover is still awaited.

We have significant concerns that the £25 per head of population will not be sufficient to deliver effectively what is required for population need.

This is further compounded by the changes to running cost allocations, which is now to be based on raw population list size.

We have further concerns about the allocation formula for future CCG budgets. Early clarification regarding how the NHS Commissioning Board plans to allocate CCG budgets is essential for strategic planning.

If the weighting factor for deprivation is decreased, there will be an appreciable adverse impact on the funding available to deliver a health and wellbeing service to a population with major health needs.

  • Dr Stedman is the lead GP and Fiona Moore is head of clinical commissioning at pathfinder consortium HHS. Scott McKenzie is a business consultant specialising in commissioning support

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