Primary care in England is transitioning to become accountable for commissioning local health services through Clinical Commissioning Groups (CCGs). [1] CCGs must go through an authorization process to gain statutory status by April 2013. [2] This process involves demonstrating financial balance, patient safety, leadership ability, and a credible plan for continued service delivery and redesign. [3] Julian Given discusses the authorization timeline and requirements, emphasizing the need for CCGs to show a track record of managing budgets, current projects, and relationships to ensure a smooth transition.

1. English Healthcare Commissioning
What is Primary Care expected to do?
Julian Given
17th November 2011

2. Introduction
Julian Given
- Head of Informatics
- Director
- Senior Performance Manager
- Cancer Services Commissioner
- Strategic Management
- Business Modelling

3. The English Transition
•Why should Primary Care Commission Services?
•How to balance the books
• How to demonstrate responsibility for billions £s
•Authorisation

4. Commissioning simplified
1. Identify our population’s health needs
2. Note national priorities from the DH
3. Commission service provision to meet 1 and 2
4. Manage provision via contracts
5. Performance manage to ensure “bangs per buck”
6. Keep within budget
7. Maintain public confidence in the NHS

5. CCG
Authorisation
point
PCT
Dec 2010 April 2011 April 2012 April 2013

7. £1,693
What is the
mean per How much is
capita ours?
income of a How much are
PCT in the various
2011/12? specialty
admission costs?

8. Total allocations per head
PCT
£
Islington PCT 2,350
Newham PCT 2,320
City and Hackney Teaching PCT 2,275
Knowsley PCT 2,246
Liverpool PCT 2,200
Buckinghamshire PCT 1,407
Leicestershire County and Rutland PCT 1,403
Mid Essex PCT 1,399
South Gloucestershire PCT 1,370
Berkshire West PCT 1,367
England 1,693
North East SHA 1,901
North West SHA 1,868
South Central SHA 1,467
South West SHA 1,599

9. Bridges Non Elective admissions 2008/09 to May 2011
1650
1600
1550
1500
Admissions
1450
1400
1350
1300
1250
1200
Oct
Nov
Mar
Oct
Nov
Mar
Oct
Nov
Mar
Aug
Aug
Aug
Apr
Jun
Jun
Jun
May
Jul
Apr
Dec
Jan
May
Jul
Apr
Dec
Jan
May
Jul
Apr
Dec
Jan
May
Sep
Feb
Sep
Feb
Sep
Feb
2008/09 2009/10 2010/11 2011/12
Year/Month

10. PCT with 500,000 population

11. Where were they 2 years later?
Hospital over spend
increasing
Despite £88m (10%) budget
increase
Prescribing no longer under
spent (budget cut by £2m)
PCT management cost £55m
(£11m increase)

12. 1856 1784 33
£750,000

13. Transition Authorisation

14. Transition: Authorisation:
the process through the process through
which the NHS needs which the ability to
to move to new have statutory
structures status is confirmed

15. DH
Commissioning Board
Commissioning Board
Sector Offices x4
Primary (SHA clusters) Specialised
Care Commissioning
contractors
Clinical
Commissioning
Commissioning Groups x200
Support
Organisations x50
(PCO clusters)
Clinical NHS
Health and Other
Senates FTs providers
Wellbeing
Boards x 150 Clinical
Scrutinise CCGs Networks

16. Transition
• All CCGs to be authorised by 1st April 2013: Monday
– levels of status 1st April
– consequences of not making it 2013
– statutory body
– statutory responsibilities
– NHS Employer
– PCT assets nb estates
• CSOs and timescales
• Management budget per head - £25?

17. Authorisation
• Financial balance:
— urgent and emergency care
— medicines management
• Lead on 2012/13 contracts
• Patient safety – nb Mid Staffs
• Sustain Bridges way of working:
— education and training
— service redesign
— deliver current projects
— outreach and relationships
• Track Record

18. Authorisation

19. Authorisation
Clinical and Patient, carer and
Clear and
professional focus Community
credible plan
that adds value engagement
Constitution,
Collaboration
governance and Leadership
for commissioning
capacity to deliver

22. What we are doing……
.. and what we need to do
• Self assessment and peer assessment
• Authorisation visits and meetings
• Track record:
— current projects
— financial stability
— 2012/13 contracts
• True transition plan - future structures, CSO, deeper and broader activity

23. Thank you for listening
julian.given@nhs.net
julian.given@clarityhealthcareconsulting.com