Telford and Wrekin Clinical Commissioning Group Organisational Development Plan 2012/13

Transcription

1 Telford and Wrekin Clinical Commissioning Group Organisational Development Plan 2012/13 Draft OD plan V1 Jan 2012 Nicky Wilde 1

2 Organisational Development Plan for Telford and Wrekin Clinical Commissioning Group 2012/13 1. Executive Summary All new organisations need a plan for their own. With the Health and Social Care Bill promising to deliver such a radical change, this is especially important for emerging Clinical Commissioning Groups (CCGs). CCGs will need to be authorised to operate. Authorisation, understandably, will require demonstration of competence, both with evidence of competent commissioning activity, and with demonstration of competence on paper in the form of structures and. This document sets out the plans for the CCG both before authorisation and beyond. The Plan set out below articulates the principles that drive the CCG, drawn from National, Regional and local priorities. It sets out the perceived priorities for the CCG and demonstrates how the CCG has reflected on what skills exist within its members. From this reflection, the CCG has defined areas of competence that need further in order for the organisation to be fully mature. These are set out in detail below, but briefly they consist of a Human Resources Plan, a detailed communication and engagement plan, a finance plan, an operational plan and a framework. With the CCG still in and with some of the executive staff not being in place, this will inevitably be a view that changes. It is expected that some will come from appointment of staff suitable to address these needs and some will come from training for the current and future members. 2. Background This is the first Organisational Development plan produced by Telford and Wrekin Clinical Commissioning Group (CCG) and has been developed using the Telford and Wrekin Clinical Commissioning Strategy October 2011, the national and regional commissioning framework and the Clinical Commissioning diagnostic Tool provided by the Department of Health to assist Clinical Commissioners in assessing readiness for authorisation. Organisational Development is planned organisation-wide intervention to ensure and develop the people skills required to bring about significant improvements in the organisations effectiveness and viability in achieving its strategic ambitions. This document, together with the Strategic Development Plan, sets out how we will work with our partners and key stakeholders to effectively manage performance and deliver excellence. There are 3 specific areas of Organisational Development which need to be addressed in order to successfully deliver excellence, these are ensuring that the:- Draft OD plan V1 Jan 2012 Nicky Wilde 2

3 Organisational structure provides the right people, with the right skills in the right roles Governance assurance is robust in order to ensure the management processes are in place to deliver the organisational objectives and statutory requirements Systems for capturing the progress of projects and programmes which enable the delivery of improved health outcomes are assured. There are many uncertainties currently facing the Commissioning Group, in a period of unprecedented and dramatic change, having a strong plan underpinned with clear strategies for internal engagement and communications will be essential. This document states the intentions of the Group as at January 2012 and will evolve as further clarity is provided from Cluster, Strategic Health Authority and Department of Health. Organisational values The structure of the new commissioning organisation will follow the principles of Form follows Function and the Clinical Commissioning Group believes that adopting this approach will allow the new organisation to develop around need and not around historical happenings, which should generate an effective but efficient management structure. A key element of this is to ensure that the new organisation develops a culture which will improve clinical outcomes but which has low bureaucracy, whilst ensuring Governance arrangements are secured. The plans produced and subsequently implemented will be designed and developed to underpin all commissioning functions with the following principles and values: 7 Nolan principles: Selflessness, Integrity, Objectivity, Accountability, Openness, Honesty and Leadership. Respect, Dignity and Compassion To put patients and the public at the heart of commissioning in Telford and Wrekin allowing services to be personal and responsive to local need. To deliver effective planning for health services based on a true understanding of the population and their needs based on the Telford and Wrekin Joint Strategic Needs Assessment. To maintain and improve the quality of health outcomes and the safety of services for patients. To ensure clinical engagement and the achievement of the Quality, Innovation, Productivity and Prevention agenda (QIPP) To ensure a partnership approach to health and social care e.g. through the Health and Wellbeing Board To work within the resources available Clinical Commissioning Priorities The CCG Board has set out a clear vision of putting patients at the forefront of commissioning no decision about me, without me. The strategy to deliver this will comprise of the following main components: Draft OD plan V1 Jan 2012 Nicky Wilde 3

4 Development of clinical dialogue within the local health economy both primary care and with providers Substantially strengthen collaboration with the Local Authority including shared working an co-location as appropriate Foster the involvement of patient organisations and the public in all the activities required for commissioning close co-operation with Health watch etc The 4 areas outlined in the national operational framework Getting the basics right every time, maintaining a grip on performance, meeting quality and productivity challenge and building the new delivery system. National performance measures The 5 Cluster ambitions Eliminating avoidable pressure ulcers, making every contract count, significantly improving quality and safety in Primary Care, Ensuring radically strengthened partnership between NHS and local governance and creating a revolution in patient and customer experience CCG will adhere to the directives in the national and regional operational framework and will ensure that local emphasis based on health needs evidence established through the Joint Strategic Needs Assessment drives the delivery plans. The above will be reflected in the production of the operational plan for 2012/ Current Organisational position and progress to date To deliver the vision and priorities of the Clinical Commissioning Group the organisational priorities have been identified as being:- Sharing the values, priorities and visions with communities, patients and stakeholders Developing leaders and a formal learning programme Understanding and sharing the needs of our population Securing a competence workforce Promoting the culture of engagement Developing a robust infrastructure for delivery Assurance of Governance arrangements Areas of Competency The Organisational Development Action Plan has been developed around the six areas of competency dictated in the diagnostic Tool. These areas must be delivered or as a minimum formally agreed action plans in place in order for the Commissioning Group to be authorised for legal status. These areas are:- Clinical Focus Organisational Capacity and Capability Clear and Credible Planning Engagement with patients / Communities Leadership capability and capacity Collaborative arrangements Draft OD plan V1 Jan 2012 Nicky Wilde 4

5 Baseline Assessment A baseline self assessment has been undertaken using the national diagnostic tool to establish the current position of the Clinical Commissioning Group. The baseline assessment was undertaken by members of the Clinical Commissioning Board. Appendix 1 provides a summary of each of the 6 competency areas highlighted and is further broken down into sub-sections. In addition to the selfassessment score for each area, the current position, a brief gap analysis and identified need is also included. The baseline assessment has highlighted that although the Clinical Commissioning Group has made significant progress in the of a Commissioning Organisation since the pathfinder was approved in January 2011 there is still a significant amount of planning and formalisation of processes before it achieves its ambition to be a first class clinical commissioning function. Out of the six areas of competency above, the scoring by members of the Board have shown that in five of the areas CCG has scored an average of three out of the five and in the sixth area of Engagement with patients and communities slightly behind scoring 2. In order to enhance performance we need to build and complete our plans in respect of:- Human Resources Communications and Engagement Finance Operational Plan Governance To do this we will need to finalise and recruit our senior executive function. Executive management support There are well defined GP roles and clinical activities progressing within the Consortium. This needs to be supported by a slick executive team, designed not in the mode of a predecessor organisations, but one that is responsive to the requirements of the CCG, and is affordable within a reduced cost envelope. Currently the dedicated management support is available from 4 staff members:- Clinical Commissioning Lead Manager (until end of March 2013) Practice Liaison Officer(until end of March 2013) Programme Manager (until end of March 2012) Secretary to Board (until end of March 2013) A chief financial officer has been appointed to Telford and Wrekin from the Cluster and recruitment is currently ongoing for a Chief Executive Officer. Draft OD plan V1 Jan 2012 Nicky Wilde 5

6 Key skills required The key skills which the commissioning Group need to ensure that they have within their team are Clinical Focus Commissioning, leadership, clinical, clinical governance, communication Organisational Capacity and Capability Organisational, Human Resources, Succession planning, learning, Clear and Credible Planning, Programme and project management, organisational, Governance, Finance, Engagement with patients / Communities Communication and Leadership Leadership capability and capacity leadership, communication, Collaborative arrangements - communications Planned Organisational Structure The CCG approach will be to directly employ a small team responsible for turning the aspirations of the CCG into reality. This will comprise the Executive Team as described earlier, together with a very limited number of specialist advisors e.g. head of medicines management. The vast majority of services will be procured from the proposed West Mercia Commissioning Support Service (WMCSS). The organisational required will be to ensure we have skills at both clinical level and within the executive team clearly understand what we want and to translate this into a clear, concise service specification which the CCG will hold WMCSS to account to ensure effective delivery. This may require training for respective members of the team. 4. Frameworks / Action Plans To enable a consistency of approach and deliver incremental change over the next 18 months (whilst recognising the external factors which are outside the control of the Clinical Commissioning Group), there are several Frameworks and action plans which need to be developed and implemented. Human Resources plan A HR plan will be developed to meet the Vision of CCG by ensuring the of leaders and a formal learning programme and securing a competence workforce is delivered. It will also ensure that the organisational priority of designing an Organisational structure which provides the right people, with the right skills in the right roles is achieved. Recommendations for succession planning for organisational and Leadership Capacity and Capability of the Commissioning Group and must clearly link with an affordability model within the finance plan. Draft OD plan V1 Jan 2012 Nicky Wilde 6

7 Board lead: Chief Operating Officer Communication and engagement plan including PPI. A first draft of the communication strategy has been informally discussed and will be presented to the Clinical Commissioning Board for formal debate. A formally adopted communication and engagement plan will ensure that the vision of the CCG in terms of sharing the values, priorities and visions with communities, patients and stakeholders and promoting the culture of engagement is met. The Strategic priorities of the Development of clinical dialogue within the local health economy both primary care and with providers and substantially strengthening collaboration with the Local Authority and fostering the involvement of patient organisations and the public in all the activities required for commissioning will be delivered by the Communications and Engagement plan. Board Lead: Dr Karen Stringer with the support of PPI Manager Lead for CCG when appointed Governance Assurance Framework To ensure that the legal and statutory requirements, quality and performance, including Primary care, QIPP etc are assured, a Governance Framework must be developed. This will be approved by the CCG Board to ensure that the clinical focus is kept at the forefront of the assurance process. A Governance Assurance Framework will ensure that the vision of assurance of Governance arrangements and understanding and sharing the needs of our population will be delivered. It will also ensure the Organisational Development priority of providing a Governance assurance framework which is robust in order to ensure the management processes are in place to deliver the organisational objectives and statutory requirements. Board Lead: Dr Andy Inglis with the support of Governance Manager Lead for CCG when appointed Finance plan A robust financial plan had been developed which includes a formal deliverable QIPP plan. The submission of a Finance Plan to Board will ensure the ongoing financial elements of CCG are formally managed. A series of training events will be developed to ensure senior clinicians and other Board Members are aware of their financial responsibilities and can effectively undertake them. Board lead: Chief Finance Officer Draft OD plan V1 Jan 2012 Nicky Wilde 7

8 Operational Plan Telford and Wrekin Clinical Commissioning Priorities outlined in this document need to have an overall operational plan to ensure that progress against the agreed priorities is appropriately managed. It is recognised that at present much of the delivery of this work will be fulfilled in partnership with the Commissioning Support Service and Local Authority however the responsibility to ensure that targets are met will remain with the CCG. The Operational Plan will ensure that CCG is ready and prepared to meet its health outcomes commitments, provide assurance for the authorisation process and delivery the vision of a robust infrastructure for delivery. It will ensure that the Organisational Development priority of having systems for capturing the progress of projects and programmes which enable the delivery of improved health outcomes. The strategy of the Clinical Commissioning Group meeting the 4 areas outlined in the national operational framework Getting the basics right every time, maintaining a grip on performance, meeting quality and productivity challenge and building the new delivery system and meeting the National performance measures and the 5 Cluster ambitions Eliminating avoidable pressure ulcers, making every contract count, significantly improving quality and safety in Primary Care, Ensuring radically strengthened partnership between NHS and local governance and creating a revolution in patient and customer experience will be contained within the Operational Plan. Board lead: Executive Lead for Project Management and Delivery. Draft OD plan V1 Jan 2012 Nicky Wilde 8

9 Draft - Organisational Development Actions Area for Action Clinical Focus and Added Value 1. Clinical Leadership The emerging CCG has clinical leaders that are able to influence and lead others to deliver on the emerging CCGs objectives of improving the health of the population and using the budget most wisely. : 3 In The CCG has 5 elected GPs on the Board. Members have undertaken a leadership course. GP Chair leads the GP Executive Team. Nominated Executive GP members lead on QIPP, Quality, Governance & Authorisation, Acute Commissioning and Finance, Engagement and Non acute commissioning, GP practice interface. Active engagement with GP Forum (attended by all GP Board members) e.g pathway work/traqs currently ongoing, regular newsletters, GP Leads from Telford and Wrekin practices for all projects. All clinical projects involve wider clinical stakeholders e.g. acute trust Actively engaged with Practice managers through monthly meetings Strategic Development Plan in place which has been approved by CCG & PCT Boards Active membership of Telford and Wrekin Health and Wellbeing Board Practice visits Experience of PCT PEC Chair and former PEC Chair Evidence required around needs No succession plan in place/ plan for future leaders Limited knowledge in some areas e.g. corporate functions Individual members and Board Team to review their needs assessment and agree action plans. Succession plan/ plan to be developed (HR Plan) Training and Development Programme Secure corporate governance knowledge Draft OD plan V1 Jan 2012 Nicky Wilde 9

10 Ongoing collaboration with Shropshire County CCG 2. The populations health and clinical needs The emerging CCG has a comprehensive, up-to-date understanding of the needs of it s population, now and over the next 5 years such that, if asked, the emerging CCG leadership and constituent practices could describe the main health issues facing their (respective) population. : 3 In CCG currently works closely with Public Health colleagues on feedback from the JSNA. This is embedded into the CCGs Vision, Values and Ethos and has supported the of strategic objectives of the new organisation within a finite resource. This is reflected in the Strategic Development Plan Ongoing membership of Telford and Wrekin Health and Wellbeing Board CCG ensuring individual practices receive their specific Public Health Data GP Board Members actively involved in the prioritisation round Closer working with individual patient groups required Costed plan Robust Clarity required on formal future arrangements around Public Health Identify formal arrangements to develop a delivery plan to meet the identified gaps Development of robust 3. Understanding providers The emerging CCG understands how healthcare services, and healthcare providers, can meet the needs of the population, and the constraints on this. : 3 In Current knowledge is varied there is a better understanding of SaTH than of other provider areas e.g. Community Trust, mental Health. A GP Member continues to work with SaTH to improve quality GP Board members leading on contract planning round, CQUINS GP practices have a working group to review the community contacts Individual practice level data for secondary care Formal CCG data reviewed bi-monthly at QPR committee Further knowledge/understanding of other contracts e.g mental health Costed plan to be formally agreed Analysis of providers available but not being utilised CCG Executive Lead required (currently using PCT resource) Development of robust in conjunction with Cluster PMO and exec CCG lead CCG Executive Lead required (currently using PCT resource) Draft OD plan V1 Jan 2012 Nicky Wilde 10

11 CCG active in the reconfiguration of local hospital services including quality issues. 4. Values and behaviours Values and behaviours are agreed by all the constituent practices of the emerging CCG. Through the way the emerging CCG works, behaviours that support it s values are promoted and strengthened, whilst those behaviours that do not promote its values face sanctions. : 3 In GP Lead identified in every Telford and Wrekin practice for clinical commissioning Monthly practice clinical commissioning Forum meetings attended by all practices (mangers and GP leads) A number of practice managers were asked to review the diagnostic tool this highlighted that communication on all levels needs to be improved with practice staff to raise awareness. The Inter-practice agreement has been reviewed and agreed by the GP Forum. Final versions have been sent to Practices for signing with a return date of CCG GP Leads have established a programme to attend individual practice meeting at least annually. Vision, values and behaviours clearly stated in the Strategic Development Plan. CCG GP Board member chairs GP forum Values and behaviours to be embedded in all aspects of the organisations activity. Communication and Engagement Strategy plan is not yet approved/in place Continue to strengthen links between GP Board and all GPs in Telford and Wrekin No CCG constitution formally developed Wider sharing of Vision, Values etc though PPI Communication and Engagement Plan to be developed and approved Development of robust Review purpose/function of GP Forum and how the CCG engage with practices CCG constitution to be developed, consulted upon and published. 5. Continuous improvement There is a conscious, and promoted, culture in the emerging CCG of systematically and : 3 In The CCG incentive scheme Additional practice led clinical project e.g QP indicators deliver continual clinical improvement. Active engagement and involvement of GP practices relating QIPP initiatives QIPP plans fully monitored however further monitoring and evaluation of smaller projects required. Wider clinical engagement Development of robust Draft OD plan V1 Jan 2012 Nicky Wilde 11

12 continuously improving the quality of clinical care to improve health outcomes within the given budget. The Strategic Development Plan articulates a vision to deliver outstanding, equitable, safe and locally driven care. The Plan requires supporting documentation around how this will be achieved. The Operational Plan to support this will be completed by Practice liaison and support PLT sessions Development of TRAQS GP Lead for improving provider quality services. (non-medical & nursing etc) Review of QP programme Engagement with Patients/Communities 1. Engagement with patients, public and the population Patient and Public Engagement is embedded into the organisation and the full commissioning process. : 2 Getting started There is recognition on the value of engagement and needs to be further developed as part of a communication and engagement plan. Development work currently ongoing locally by PCT Communications Officer reporting to CCG informal meetings. There is recognition of the need for a CCG specific website accessible by patients and public and is currently in All practices have a patient engagement plan/forum A briefing paper to be presented to CCG Formal Board in February with a Active engagement/ppi needs to be embedded in commissioning decisions No specific website Lack of consistent engagement No formal PPI manager/exec Lead to CCG (currently PCT staff) No formal strategy in place Robust processes for engagement with communities Communications and engagement strategy for CCG to be fully approved Development of robust Development of website PPI exec manager lead to CCG to be appointed Format required for PPI Draft OD plan V1 Jan 2012 Nicky Wilde 12

13 recommendation to develop a local CCG communications strategy Communications and patient liaison team existing in the PCT. Active patient engagement in of clinical projects. Secondary care experience of patients TRAQS analysis of patient opinion No formal equality delivery system for CCG in place to become an integral part of all commissioning design processes/decision reporting. Develop relationships with LINks and the emerging Healthwatch organisation. Implementation of equality delivery system 2. Engaging with communities To define and deliver on its purposes, the emerging CCG has engaged with the different communities in the geographical area it covers. :2 Getting started There is recognition of the value of engaging with communities and this will be further developed through the emerging communications and engagement strategy. Membership of Health and Wellbeing Board Communications and patient liaison team existing in the PCT. The communication plan also needs to cover community engagement e.g vulnerable adults, ethnic minorities. Voluntary groups, hard to reach groups Active engagement/ppi needs to be embedded in commissioning decisions No specific website Lack of consistent engagement No formal PPI manager/exec Lead to CCG (currently PCT staff) No formal strategy in place Communications and engagement strategy to be fully approved Development of robust Development of CCG website No formal PPI exec manager lead to CCG (PCT staff) Format required for PPI to become an integral part of all commissioning Draft OD plan V1 Jan 2012 Nicky Wilde 13

14 processes/decision reporting. Clear and Credible Plan 1. Strategy and implementation There is a practical and implementable strategy, developed collaboratively, that clearly sets out the priorities for the emerging CCG and why those priorities are likely to lead to greatest health gain taking into account the future changes. : 3 In A strategy has been created by the CCG and approved by the PCT Board. This was shared with the Local Authority Health and Wellbeing Board and GP practices prior to approval Further input is required from stakeholders to develop this document further in the future and to ensure support and commitment. Executive team recruitment not secured. Reliant on existing PCT staff on an informal basis. QIPP plan approved Prioritisation plan in Ongoing SaTH engagement Green rating received across all areas of the configuration risk assessment Operational and OD plans to be approved No CCG executive team in place Engagement with Community Health Trust Provider engagement to be included in Communications and Engagement Plan Approval of OD and Op plan Approval to recruit exec team Engagement with Providers to be included in Communication and Engagement Plan Development of robust governance assurance reporting mechanism 2. Getting best value out of system In order to achieve best outcomes for the population within the available resources the emerging CCG is equipped to ensure that the needs of the population are met by the : 2 Getting started The prioritisation process is being led by a GP Board Member who has also been involved in the commissioning round. Further skills/capacity required to manage the process. QIPP and QP indicators work ongoing Development of primary care services currently led by PCT Medical Director Data available at practice level Costed Plan CCG commissioning Executive team required Lack of clarity over future of primary care Executive leads Costed plan to be developed Development of robust Draft OD plan V1 Jan 2012 Nicky Wilde 14

15 providers of healthcare services. The emerging CCG has prioritised what it needs to do to achieve these outcomes within resources. analysis support available from PCT Benchmarking ongoing Member of Health and Wellbeing Board 3. Vision There is a clear vision (narrative) of what the emerging CCG s purpose is and how it will achieve it s purpose, that is to achieve better patient outcomes within available resources and discharge its statutory duties. : 4 Being rolled out. The vision is clearly detailed in the Strategic Development Plan Achieving better patient outcomes by application of the vision and values will be detailed in the Operational Plan currently being developed There is a lack of clarity on final statutory duties Operational plan to be developed Communications and Engagement strategy required No constitution published Vision to be shared more openly Awaiting formal notification of formal statutory duties Approval; of Operational Plan and Communications strategy Development of robust Constitution to be developed to include formal statutory duties. 4. The case for change There is a clear, consistent and communicated reason for the things that the emerging CCG is going to do, and how success will be tracked. These reasons are understood and accepted by Practices and providers. : 2 In Details in the Strategic Development Plan Limited use of providers in planning process This is being addressed through the of the Operational Plan Completion of the approval process of the Operational Plan Development of Communications plan to include robust stakeholder engagement on the case for change Documented reasons for change Costed plan Information from JSNA to be incorporated into of Operational Plan Communications and Engagement Plan to be developed Development of robust Draft OD plan V1 Jan 2012 Nicky Wilde 15

16 Capacity and Capability 1. Structure and Culture of Change Key elements of structural and cultural change (transition) plans are in place, with the skills required to support this, including project management and monitoring success. : 3 Getting started Staff alignment exercise has been completed OD, Operational and Communications plans currently in First phase structure and costings have been completed Clinical Commissioning Manager and Programme Lead currently in place to support Programme management support now in place and project plan produced. Transition Group active with representatives from CCG, PCT, Local Authority, Public Health and HR Transition project plan developed and monitored by members of the transition group. QIPP and QP Inter-practice agreement Incentive scheme CCG management team to address financial gap to be a 34 to 25 per head No CCG management team Further guidance required from Cluster and SHA Need to secure ongoing executive and programme management support through of formal structure. No formal plans approved Governance assurance required Confirmation of CSS structure require Confirm phase two structure and complete costings Approval of plans Development of robust CCG Governance exec manager lead to develop policies, procedures, scheme of delegation Formal policies and procedures Scheme of delegation to be developed 2. Contracting/ Procurement The emerging CCG has the clinical, commercial, legal : 3 In CCG secures expertise from existing PCT officers. GP Board member appointed to lead contract negotiations Contract management support exist via Review of contract and procurement support required Confirmation of proposed structure Confirm phase two structure Approval of plans Development of robust Draft OD plan V1 Jan 2012 Nicky Wilde 16

17 and other skills and capacity to negotiate, write and manage contracts for the provision of health services. PCT officer Knowledge on procurement of services within CCG is limited as service is currently provided by HCS CCG GPs commissioning training Confirmation of CSS arrangements 3. Administrative functions The necessary administrative functions are in place to run the organisation. : 3 In Monthly formal CCG Board meetings Information from PCT legacy document available Ongoing discussions regarding CSS Work has been carried out with regards to aligning current posts with those of CCG/CSS. Further work necessary to confirm support available Process for recruitment of COO in progress Lack of clarity around CSS responsibilities and CCG exec lead posts confirmation of alignment of staff required Governance assurance not in place Policies and procedures not in place for CCG Confirm phase two structure Approval of plans Development of robust Executive GP Lead for commissioning in place CCG Executive management support required currently supported by PCT manager 4. Clinical elements of governance Systems are in place to effectively monitor and track quality and safety so the emerging CCG has early warning of problems and there are clear processes for acting when problems are detected. : 2 Getting started The CCG already has members involved in quality monitoring within primary and secondary care Currently assessing the quality of primary care through the incentive scheme There is currently little assurance mechanisms in place around decision making although there is a process document din the Strategic Development plan Although there is a lead GP there is an urgent requirement for executive lead support Assurance process required Assessment of incentive scheme required Informatics capacity Risk assessment required around the lack of executive support Development of robust in conjunction with Cluster PMO and CCG executive lead. Draft OD plan V1 Jan 2012 Nicky Wilde 17

18 Managing decision making has been incorporated into the Strategic Development plan Assessment of incentive scheme to be carried out 5. Emerging CCG structure and capability; Learning and Development The emerging CCG has, or is able to assemble, the right commissioning skills and build the best operating model to most effectively commission services (in house, shared or bought in). : 2 Getting started CCG has considered the activities which will be required to achieve objectives however further work will need to be undertaken to identify the right people with the right skills. Some work has been carried out aligning staff/posts to CCG/CSS and identify issues relating to any gaps. CCG have engaged with HR to outline potential processes. No formal HR plan Further HR guidance required HR plan to be developed including learning and 6. Integration of governance Effective integrated corporate governance systems of finance, probity, statutory duties and clinical quality, are in place. They go beyond being compliant with legal requirements, and identify and adopt good practice and innovation in the running of the organisation and fulfilling statutory duties. : 2 Getting started Outlined in the strategic plan CCG understands the need for integrated governance which will be incorporated into the Operational Plan. Governance currently supported by the PCT CCG has asked PCT Governance lead to consider the Towards Establishment Creating responsive and accountable CCG s document which was published in draft in November 2011, to establish a way forward CCG Board meetings and transacting business within delegated responsiblites No CCG executive management lead for governance No CCG constitution in place No CCG reporting/governance assurance process beyond CCG Board Appoint executive lead for governance Development of CCG constitution Engagement with Locality Cluster NEDs and LSMs in support of of governance structures Development of CCg reporting structure/assurance Draft OD plan V1 Jan 2012 Nicky Wilde 18

19 7. Financial management capacity/capability There is capacity and capability in the organisation for robust financial management of budgets. : 3 Getting started Current PCT financial management is of a high quality. There is ongoing discussion around how this will reflect in the CCG. Chief Finance Officer appointed within the Cluster for Telford and Wrekin on a secondment basis Further work to be undertaken to develop an appropriate finance training programme Currently awaiting further information around CSS structure- temporary informal joint finance structure in place with Shropshire CCG/PCT Lack of information around CSS structure No formal structure yet agreed for finance department in CCG/CSS Confirmation of CSS structure Confirmation of CCG structure Appointment of CFO on a substantive basis 8. Financial planning controls The emerging CCG has a financial planning process that allows prioritisation of resource for commissioning services for its population and ensure that the funds are spent only as intended. :4 In Current PCT financial management is of a high quality and good resource in currently in place for financial controls. There is ongoing discussion around how this will reflect in the CCG. Chief Finance Officer appointed within the Cluster for Telford and Wrekin on a secondment basis Further work to be undertaken to develop an appropriate finance training programme Currently awaiting further information around CSS structure CCG board members leading financial planning and prioritisation process for 2012/13 Lack of information around CSS structure No formal structure yet agreed for finance department in CCG/CSS Confirmation of CSS structure Confirmation of CCG structure Appointment of CFO on a substantive basis Draft OD plan V1 Jan 2012 Nicky Wilde 19

20 9. External financial control requirements The emerging CCG can stand up to public scrutiny regarding its spending of public funds. : 3 In Chief Finance Officer appointed on a secondment basis Good systems and audit processes which would stand up to scrutiny currently in PCT There is a process for transparency of spend via PCT process No formal CCG audit arrangements in place currently as part of PCT arrangement Clear audit arrangements required Collaborative Arrangements 1. Managing relationships The emerging CCG has the skills to understand the relationships they, as an organisation, need as good commissioners, and how to get the most of these relationships. : 3 In Good relationships in place further required around critical partnerships e.g. Cluster, LA, SaTH, Other providers, Practices, other CCGs Key relationships have been recognised and dialogue with LA taking place through a Transition Group. Good working relationship with Practices through GP Forum and inter-practice agreement, practice visits In the process of developing the communications strategy. GP Member leading on patient and public engagement with support from PCT officer No formally approved plan in place for management of key relationships No formal collaborative agreement sin place to support existing relationships Development of robust Development of formal collaborative agreement. Section 75/pooled budgets, risk sharing etc 2. Engagement with other commissioners The emerging CCG has arrangements to work collaboratively with other commissioners including : 3 In CCG have regular discussions with both the Local Authority and neighbouring CCG which resulted in a formal documented joint approach in some specific areas e.g CCG/CSS discussion paper. However further guidance is now No decision on future commissioning arrangements No formal collaborative agreement sin place to support existing relationships Further discussion and agreement required in order to formally progress commissioning team structure Draft OD plan V1 Jan 2012 Nicky Wilde 20

21 the NHS Commissioning Board, other emerging CCGs, and Commissioning Support Service. awaited from the Cluster. Further work required by CCG to formalise other areas e.g joint contracting Ongoing discussion with regards to future structures CCG/CSS In the process of working up a costed plan for potential future models Development of formal collaborative agreement. Section 75/pooled budgets, risk sharing etc 3. Engagement with providers There is access to the specialist skills and capacity to actively manage supplier relationships and clinical engagement. : 3 In CCG has had meetings with various providers however there is a need for a more formal structure of engagement as the organisation develops. Communication and engagement plan in progress Quality and contracts currently being discussed in the planning round Currently considering options to widen choice of providers Service redesign work ongoing with input from LHE wide clinicians e.g. MSK service Communications and engagement plan Further detail required around current smaller providers Need to raise awareness of all services available to GPs Approval of Comms and Engagement Plan Stocktake of all services currently commissioned 4. Existing relationships and processes Recognising that at a time of change relationships can be lost, there is an excellent understanding of existing relationships and a robust handover mechanism. : 2 Getting started Work has been undertaken to identify responsibilities to be transferred PCT to CCG and work is ongoing with the Cluster. The PCT s legacy document has supported some of this work however the CCG is keen to ensure there is ongoing dialogue as well as the of more formal No formal agreement in place going forward for commissioning arrangements Agree a structure for CCG/CSS/LA working within the allotted cost envelope Draft OD plan V1 Jan 2012 Nicky Wilde 21

22 documentation. Currently reviewing existing and future commissioning arrangements and relationships Work ongoing around costed plans for affordability of potential models. CCG engaging with former NEDs (now LSMs) 5. Engagement with Local Authorities and others There are effective relationships with all Local Authorities, district/borough councils and partnerships in the community. : 3 In Leadership capacity and capability Well established working relationship with LA. Well organised joint commissioning arrangements historically. CCG continues to build on the good relationship with the LA which includes joint working through the Transition Group. Further work needs to continue e.g Joint Commissioning, Health and Wellbeing Board, Overview and Scrutiny Current work ongoing around CSS structures with potential links to LA Active membership of health and wellbeing Board LA had input into the of the Strategic Plan Clarity around future joint commissioning arrangements Clarity required around future CSS arrangements No formal collaborative agreements in place to support existing relationships Future CSS arrangements to be confirmed Joint commissioning arrangements to be confirmed Development of formal collaborative agreement. Section 75/pooled budgets, risk sharing etc 1. Leading change Leadership motivates individuals within the organisation to make : 3 In CCG members have undertaken a leadership programme which involved change management and leadership. Currently recruiting to COO post which COO and executive team required HR plan including learning and required Clarity of individual and team roles Appointment of COO HR plan to be developed Structure to be confirmed Draft OD plan V1 Jan 2012 Nicky Wilde 22

23 changes in what they do. will be crucial in taking this forward. Limited executive team members appointed to CCG limited finance and management support available. Looking to recruit full executive team. Clarity required around the of HR plan Clinical leadership outlined at section one in this plan Communications plan in progress GP monthly newsletter and forum Staff involved in discussion and feedback around CCG/CSS proposals Vision and values developed and shared with LA 2. Business Intelligence and Reporting The right reporting mechanisms exist so the emerging CCG leadership is aware of progress in delivering their strategy. : 3 In Good skills exist within the PCT and are accessible on an informal basis by CCG A review of committee structure has taken place led by the PCT Governance Lead however further work is required as guidance is received. No formal mechanism within CCG for business intelligence and reporting CCG/CSS structure required Development of robust 3. The role of leadership in governance, including appropriate delegation The emerging CCG is clear about how it makes decisions. : 3 Getting started The inter-practice agreement has been developed in partnership with practices through the GP Forum detailing delegation and responsibilities. Final documents have been issued to Practices with a return date of No formal governance mechanism within CCG Lack of clarity regarding interim decision making responsibilities and communications channels Appointment of executive team Development of robust Draft OD plan V1 Jan 2012 Nicky Wilde 23

24 The delegation of functions, duties and actions, and of decision making is clear. There is an appropriate distribution of power, responsibility and accountability amongst practices. Detailed in the Strategic Development Plan Good skills exist within the PCT and are accessible on an informal basis by CCG CCG is currently accountable to PCT Cluster between CCG and Cluster. Constitution to clarify decision making and delegation. 4. Leading a commissioning organisation There is a leadership team in place with sufficient knowledge of commissioning processes to be able to endure effective delivery. : 3 In An executive team structure has been identified and approved by the CCG Board. Recruitment of staff with correct level of skills and knowledge is now a priority Lack of Commissioning Director support from PCT Currently no CSS structure in place although CCG GPs are developing commissioning skills Lack of clarity around structure, exec team and CSS Support Appointment of exec team Confirmation of CSS structure 5. Leadership roles The roles and responsibilities of the individual leaders, emerging CCG, and the constituent practices are clear and aligned to the Vision, Values and Strategy. : 3 In Executive roles are identified GPs and Execs are working across agreed portfolios which are fully aligned to overall CCG objectives Inter-practice agreement clearly states the role of constituent practices, CCG etc. Review of committees and reporting in progress The is recognition of accountability Governance and accountability of various roles required Formal governance and assurance arrangements not clarified No mechanism in place for PDP review /self-assessment Development of robust Learning and Development plan required Draft OD plan V1 Jan 2012 Nicky Wilde 24

25 however further of formal mechanisms still to be confirmed 6. Financial elements of governance The Leadership of the emerging CCG is able to make transparent, defensible, informed, robust and sustainable decisions about the allocation of public funds on the basis of systems that are compliant with legal, statutory and regulatory requirements and national governance policies. : 2 Getting started CCG understands the principles involved but is yet to develop a governance policy Discussion has taken place on how appropriate financial decisions are made. Further required. CFO has been appointed to Telford and Wrekin on a secondment basis and sits on the CCG Board SO and SFI s have been developed across the cluster for use on a consistent basis Finance department has been set up on an informal basis and shared with Shropshire County CCG Discussions with internal audit have taken place regarding governance procedures and available training for Board members. CCG Board members are an integral part of financial planning, budget setting and prioritisation for and are leading the prioritisation and planning group. No formal governance policy in place Board members not fully trained in finance and governance No formal structure for finance department going forward Governance policy to be written and to include financial governance SFO/SFIs to be formally approved by CCG Training to be arranged with internal audit regarding governance procedures Formalisation of structure including appointment of substantive CFO 7. Internal Engagement Leadership understands how to involve those who : 3 In The CCG is in discussion with PCT/Cluster relating to No formal future structure Formalisation of structure Draft OD plan V1 Jan 2012 Nicky Wilde 25

26 will actually make things different, such that the success of the changes that are brought about is made most likely. involvement/allocation of staff. Further work is required in the of the Communications and Engagement plan. Strategic Development plan available for all staff via PCT Board approval process and published on PCT website Communications plan in progress with emphasis on visibility of CCG as new commissioning organisation All staff have received 1:1 meetings with managers and will receive correspondence from the PCT by end of January. GP monthly newsletter and forum Staff involved in discussion and feedback around CCG/CSS proposals HR plan currently not in place Regular CCG updates via e-newsletter which has included information around elected CCG Board members All CCG Board members based at PCT headquarters and accessible. Draft OD plan V1 Jan 2012 Nicky Wilde 26