Timetable of ReformsPlanned date CommitmentOctober 2011 NHS Commissioning Board established in shadow form as a special health authorityDuring 2012 Health Education England and the NHS Trust Development Authority are established as special health authorities, but in shadow form, without full functionsApril 2012 The next step in extending the choice of Any Qualified Provider, which will be phased in graduallyBy October 2012 NHS Commissioning Board is established as an independent statutory body, but initially only carries out limited functions – in particular, establishing and authorising clinical commissioning groupsOctober 2012 Monitor starts to take on its new regulatory functions HealthWatch England and local HealthWatch are established1 April 2013 SHAs and PCTs are abolished and the NHS Commissioning Board takes on its full functions Health Education England takes over SHAs’ responsibilities for education and training The NHS Trust Development Authority takes over SHA’s responsibilities for the foundation trust pipeline and for the overall governance of NHS trusts Public Health England is established A full system of clinical commissioning groups is established. But the NHS Commissioning Board will only authorise groups to take on their responsibilities when they are readyApril 2014 Expectation is that the remaining NHS trusts will be authorised as foundation trusts by April 2014. But if any trust is not ready, it will continue to work towards FT status under new management arrangements.April 2016 Monitor’s transitional power of oversight over foundation trusts will be reviewed (except for newly authorised FTs, where Monitor’s oversight will continue until two years after the authorisation date if that is later)
The NHS Commissioning Board Approval, assurance and performance monitoring of clinical commissioning groups Commissions specialist services, military, dentistry, pharmaceutical, ophthalmic, prisons and secure mental health Contracts with GP providers of primary medical services Duty to promote integrated services and research and innovation Promotes NHS Constitution
Clinical Commissioning Groups Tasked with securing improvement in physical and mental health of their patients and with the prevention, diagnosis and treatment of illness Commission secondary, specialist and community care services from NHS, independent sector and social enterprises Duty to promote integrated services Design and review care pathways Duty to promote research and innovation Promote NHS Constitution Must have a governing body with decision making powers that meets in public
Monitor Protect and promote patients interests by promoting VFM and quality Licenses new providers Sets consistent tariffs Supports vital service continuity and integrated services
Choice and Competition Bill will outlaw any policy to increase or maintain market share of any sector of provider Competition as a means to an end Competition on quality not price Guidance to be published on how choice and competition to be applied to particular services Fixed tariffs for AQP services Best Value for non-tariff services
Care Quality Commission Regulates quality and safety of care providers Approval of care providers Fitness to practice Safety of premises and equipment Infection control, safeguarding + risk management
Health Watch Health Watch England is a sub-committee of Care Quality Commission Local Health Watch are networks of local corporate bodies Remit is to: be a voice for NHS patients investigate and report on effectiveness of delivery of services provide mechanism through which informed public opinion influences regulation
Local Authorities/Health and Wellbeing Boards Local authorities will lead on public health with funding and support from Public Health England Health and Wellbeing Boards will encourage commissioners to work together in integrated manner and will lead on local public involvement – CCGs must involve them before publishing annual plan Will develop a joint health and wellbeing strategy Board to include local authority members, plus heads of social care, childrens services, public health, CCGs, Health Watch and NHS Commissioning Board
How will CCGs be Established? Application to the NHS Commissioning Board by two or more persons who are providers of primary medical services Proposed area of operation Name of accountable officer and other prescribed info Draft constitution with proposed name and policies to avoid conflict of interest. Regs will set out criteria Board must consider before approving
Funding Arrangements for CCGs Annual funding from NHS Commissioning Board CCGs must balance the books over the year (controlling the behaviour of member practices?) Additional incentive payments? No details as yet.
Key Commercial and Governance Issues Workforce issues Existing property and contracts Public law duties Managing conflicts of interest
Workforce Issues Will TUPE apply to transfer existing PCT staff? Is there a transfer or a ‘service provision change’? How will NHS pension membership be addressed?
Existing Property and Contracts Are we taking on onerous liabilities? Proper due diligence required Could we source premises, equipment and back-office services more cost-effectively? Can we negotiate protections for pre-transfer liabilities?
Public Law Duties Freedom of Information Act applies? CCGs susceptible to judicial review? Human Rights Act challenges? Equality & Diversity obligations
Managing Conflicts of Interest CCGs constitution should detail duty to act with integrity and transparency Declaration of Interests Appointment of independent non-executives Rigorous procurement procedures
Concluding Remarks The system is complex There is a risk that bureaucracy could stifle autonomy and innovation There is much detail to fill in through Regulations
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