NHS Greater Manchester
NHS GREATER MANCHESTER BOARD MEETING
AGENDA ITEM NO 5
Meeting date: 9th June 2011
REPORT OF: Director of Commissioning
DATE OF PAPER: 31st May 2011
SUBJECT: Development of the Commissioning
IN CASE OF QUERY, PLEASE CONTACT Julie Higgins, 0161 212 4821
PURPOSE OF PAPER:
The Greater Manchester PCT Cluster Board is asked to approve the development of
a proposal for consideration by PCT locality boards that are currently uncommitted.
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Development of the Commissioning Support Service
This briefing paper gives an update to the Greater Manchester Cluster Board
on the local programme to develop a Commissioning Support Service (CSS)
offer to GP Commissioning Consortia. It also sets out the options for the next
stage in its development.
1. Background and Progress to date
1.1 The work to develop a Commissioning Support offer for GP
Commissioning Consortia (GPCC) in Greater Manchester commenced in
September 2010 with a request to the ten Greater Manchester PCT Chief
Executives to seek their board approval for the work to progress.
1.2 To date eight PCTs (Salford, Manchester, Bury, Oldham, Heywood
Middleton & Rochdale, Ashton Leigh & Wigan, Bolton and Trafford) have
confirmed their support and participation. Staff from the other two PCTs
are involved in the offer development work although full confirmation of
their involvement has not yet been agreed.
1.3 As work moves from concept design to set up, the GM Cluster Board is
asked to approve the development of a proposal for consideration by
PCT locality boards that are currently uncommitted.
Summary of Work Undertaken
1.4 A small project team was established and the programme was launched
on 14 December 2010 at an event attended by 100 staff from across
Greater Manchester. The approach taken was to facilitate rather than
formulate. Ten work streams were set up each headed by an Associate
and supported by other volunteering staff that formed an advisory ‘expert
1.5 Customer contact work has included presentations to emerging GP
Commissioning Consortia and a GP Reference Group has been
established to share and test out the CSS offer as it develops and to
facilitate listening to the views of GP leaders.
1.6 A brand has been established and marketing materials prepared
including a website http://www.gmcss.nhs.uk/. An initial offer document
has been published and was shared with GP consortia at the Learning
Trade Fair, which was part of the modular development programme for
pathfinder GP consortia.
1.7 In March 2011, external commercial advice was sought. Ron Pierce/DLA
Piper/The Outsource Partnership were appointed to support the early
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business development of the Commissioning Support Service (CSS)
after a procurement process which attracted a strong field.
1.8 The next phase of development will be to develop a business plan and
operational model. A pan Greater Manchester workshop was held for 9
2. CSS Vision
2.1 The development of a Commissioning Support Service is an opportunity
to refocus and reshape the planned work and how it is undertaken to
provide GPCC with an effective market-facing offer. The virtuous red line
that CSS do not intend to cross is that the leadership, accountability and
responsibility for commissioning rests with GPCC and the shape of the
CSS operations will take its lead from GPs and provide support and
expertise to help them thrive and deliver improvements in outcomes.
2.2 The customer focused proposition to GPs is that wider experience,
delivered locally at lower cost is offered. The CSS aims to be high
quality, affordable and competitive. It will have a consistent operating
model that will be outcome focused and responsive to its GPCC
2.3 A strategic approach is required to shape a viable service to support
GPCC beyond 2013 after which PCT Cluster and SHA’s transition roles
will have ended.
2.4 The CSS will seek to migrate expertise (systems, processes, people and
knowledge) from across the PCTs, the GM Commissioning Business
Service and partners to provide support services to help GP
Commissioning Consortia tackle current, immediate and visible
commissioning issues such as:
QIPP cost reduction programme to provide GPCC with the
Reshaping services to deliver improvements in outcomes
Supporting improvement in Primary Care
Maximise quality through better integration of commissioning
Although these must be determined by GPCC and not CSS.
Comprehensive Offer and Franchise Options
2.5 The initial focus of the CSS will be to provide a market responsive offer to
GPCC to support them to thrive. In addition to that core market the
intention is to seek to explore the potential for economies of scale and
lowering the unit cost base through potentially providing commissioning
and business support services to:
NHS Commissioning Board
Federated GPCC Commissioning Arrangements
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2.6 In the latter part of the transition period the CSS can also support the
3. Cluster, SHA, DH and CSS Interdependence
3.1 The relationship between the CSS and the Cluster is important to
understand as the CSS will evolve from PCTs within the Cluster of
Greater Manchester PCTs.
3.2 DH published on 31 January 2011 guidance on the creation and
implementation of PCT Clusters (Gateway reference 15520). This made
it clear that one of the primary Cluster’s objectives was supporting the
development of commissioning support to consortia:
3.3 Extract from DH PCT Cluster Guidance (gateway 15520):
Supporting development of commissioning support for consortia
Clusters By June 2011 ensure continual Ensure continual availability
availability of commissioning of commissioning capacity
capacity Work with NHS CB to put in
Work with SHA commissioning place new organisational
support development team, options for commissioning
consortia and other clusters to support
develop and begin implementation
of organisational models for
Work with clinical networks to
identify and put in place role in
PCTs Support cluster in making people Support cluster in making
and systems available in support of people and systems
commissioning available in support of
Consortia Engage with initial commissioning Make choices/place
(including support offer contracts for commissioning
commissioning Engage in process for designing support
support future commissioning support
3.4 In respect of commissioner support it is the role of the Cluster to:
Provide a basis for the development of commissioning support
arrangements, allowing current commissioners and new entrants to
develop a range of commissioning support solutions from which
consortia and the NHS Commissioning Board can secure expert
Provide a mechanism to enable high quality NHS staff to move to
new roles in consortia, commissioning support arrangements and
the NHS Commissioning Board, including minimising unnecessary
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Respective Transitional Roles
3.5 The principle focus of the CSS is the development of a sustainable offer
going forward from 2013. The transitional arrangements need to be put
in place and managed through the cluster to avoid fragmentation and
loss of local understanding and organisational memory. That is for the
Cluster Board to shape. The CSS’s role is to develop a market-facing
offer to GPCC and needs the Cluster’s support and leadership to do so.
Review of Guidance: Assignment for Transition
3.6 From a review of the guidance on the assignment of staff (DH guidance:
Assignment for Transition, Gateway Reference: 15864 Date: 31 March
2011), the following four issues have been identified that will need careful
consideration by the Cluster Board:
i). Assignment of Staff: How will staff and other resources be
‘assigned’ from the PCT cluster to the emerging GPCC and
ii). Resources set within expected running cost allowances: What
process will be used to ensure that initial assignment structures will
be consistent with expected running costs?
iii). Development resources for commissioning support: What
resources will be available to establish commissioning support
options for GPCC?
iv). Consistency with GPCC needs and wishes: How is GP informed
3.7 There will need to be a separate, open and transparent HR process for
staffing the CSS and that will need to be a function of the GPCC
requirements and not the crystallisation of staffing structures following
the assignment process.
3.8 There is expected to be a DH ‘Kite Marking’ assessment of potential
providers of Commissioning Support, equivalent to the GPCC
authorisation process. This may either be a direct process or by proxy
through the GP consortia pre-authorisation/authorisation process. The
CSS needs to anticipate this requirement to ensure that it is ready to
3.9 A business review stocktake questionnaire on commissioning support
has been issued by DH and was completed on the 23 May 2011. This
review is intended to help to inform and support SHAs and PCT clusters
in developing a range of high-quality commissioning support functions
that are responsive to the needs of emerging GP consortia. The GM PCT
Cluster has provided a response which is appended to this report.
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The business review includes two phases:
Stocktake: the stocktake will provide an early assessment of overall commissioning
support capacity and capability as at 31 March 2011. The assessment will support the
further development of commissioning support development and risk management plans.
The intention is to build on strength and to ensure that staff are supported through
development so that future commissioning support is resilient and viable.
Strategic review: a process is being put in place to support the development of a
business model for commissioning support, which will meet customer requirements and
deliver services at the appropriate scale. A strategic approach will be in place by October
2011, leading to a process through transition that will produce differentiated, business
viable commissioning support. Key tests will include a consistent standards-based
process, demonstration of commercial resilience, customer commitment, national fit and
the ability to meet established criteria.
3.10 The CSS will support the Cluster to keep abreast of these developments
and it needs to have the space to develop independently to meet the
needs of GPCC.
Impact of the legislative pause (new engagement exercise)
3.11 From a review of the new engagement exercise documents, it is not
considered likely that there will be a major change in direction of
Government policy that would significantly affect the direction of travel in
the development of commissioning support. The overall timing and core
pillars of the transition remain broadly in place. The four themes set out
in the NHS listening exercise have been reviewed and a summary
appended to this paper.
3.12 The current ‘pause’ in the progress of the health bill must not mean that
the CSS development work stalls or stutters. Changes have gone too far
to alter the key tenets of the reforms: namely GP leadership,
accountability and responsibility. However, any CSS proposal must
remain flexible to potential changes in policy.
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4.1 There is a pressing need to make rapid progress during the early part of
2011/12 if the CSS is to be able to demonstrate delivery and to gear up
to be ready in time.
GPCC Development Critical Path
June 11 July 11 Aug 11 Sept 11 Oct 11 Nov 11 Dec 11 Jan – Mar April – July – Oct – Dec Jan –
12 June 12 Sept 12 12 March 13
NHS CB Formally Established
7 CSS Development
NCB Authorisation of GPCC
Commissioning Support Tender TUPE Consultation Process,
6 Process Contract Novation and
Assignments , Property/Facilities
partition, Financial set-up
GPCC Operational Solution
Model Office Development
Authorisation Submissions to NHS CB 4 3 Transition commencement gateway
Transition to new structures
1 Shadow Running
4.2 To manage operational risk, it may be appropriate to have a shadow
running year (2012/13) before the abolition of PCTs on 31 March 2013.
4.3 To demonstrate commissioning success before the watershed of 31
March 2013, a complete annual commissioning and contracting cycle
needs to be influenced so GPs can recognise the benefits of the CSS. In
order to do this, common processes need to be established. The
commissioning cycle (or QIPP decommissioning) does not fit discretely
into the financial year. For example the development of local
commissioning intentions and the potential giving of notice to providers
contractually need to be undertaken 6 months ahead of the year which
they affect. To impact on the 2012/13 financial year this would need to
be completed by 30 September 2011.
4.4 It may make sense to focus on one or two key GP facing services and to
commence this shadow period earlier. Perhaps coinciding with the
Cluster creation timescales set out in this guidance (June 2011) and well
before the abolition of SHA on 1 April 2012, who are responsible for the
4.5 A fait accompli or ready made solution must not be presented to GPCC
and they must be provided with market facing service options. That said,
future customers will not be interested in the CSS’s internal processes,
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beyond that they will expect them to be effective, to work to support the
strategic direction that they set and to deliver outcomes.
4.6 All of this work will take time and the earlier this begins the less the
operational transition risk will be.
5.1 The challenge is to create a business model that lives within projected
income. Designing these structures will require significant work and
effort at a time when overall management resources are reduced (as a
result of the 40% required management costs reductions); attentions are
potentially diverted (by the development and implementation of Clusters
and other transitional arrangements); policy direction of travel is unclear
(generated by the legislative pause and new engagement exercise); and
that staff are naturally focused on the day job rather than creating the
future (driven in part by the uncertainty of future employment).
5.2 There are six challenges that need to be addressed during the
development phase of the CSS if it is to gain GPCC business:
i). Agreeing the scope of activities within offer
ii). Creating an appropriate business model and infrastructure
iii). Deciding on organisational form
iv). Ensuring financial viability
v). Securing GPCC support
vi). Staffing the CSS
Scope of the Offer
5.3 A menu of services has been included in the GPCC offer document and
further work has now started to refine this offer. Discussion is needed to
refine the offer in consultation with GPCC requirements.
5.4 The approach is to develop the service model and refine that within the
cost model to gain GPCC commitment
5.5 Work is progressing to clarify the CSS core business offering. The
necessary consolidation of processes needs to be undertaken. This is
necessary to drive efficiencies and the design systems will be the basis
for delivering a service to GPCC and for training staff. If the CSS is to
successfully secure GPCC support and commitment, it must be able to
demonstrate and show its skills and ability in a coherent manner, as
GPCC will need to direct that ability.
5.6 A key time critical task will be the pulling together of the various PCT
systems process and approaches in order to have a coherent standard
offer for GPCC. There is no opportunity to have a long debate or dispute
over which approach is technically the best. If there is still a debate on
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approaches at the time GPCC start to make their ‘make or buy’ decisions
then other external offers may look more attractive.
5.7 Work is progressing to identify the most appropriate organisational
5.8 The CSS cost model must operate within the income it can generate. The
establishment of a financial operating model must therefore consider the
likely market share that can be generated together with a pricing model
5.9 Explicit agreement from GP consortia will be required. It is suggested
that they are given the choice to participate in a transitional shared
service arrangement through the CSS by signing up to a non-binding
Memorandum of Understanding or letter of intent to allow this process to
progress. Those GP consortia not wishing to participate will be able to
establish alternative arrangements.
5.10 The current natural wastage and opportunistic reductions in staffing
levels through MARS may result in skills gaps that will need to be
recruited to and potential duplicate staffing that may result in additional
redundancies. This will need careful management.
5.11 With any change, there will be those who find it difficult to adapt for
whatever reason and they may resist the fundamental redesign of our
commissioning approaches. Staff need to be supported through the
changes that need to be made.
5.12 The Cluster needs objective oversight to ensure that the right skills end
up within GPCC and support services. Each needs to feel that they have
the first call on the rare skills needed and the Cluster will need to guard
against these potentially competing pressures.
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5.13 The CSS approach is to develop practical support solutions and a ‘model
office’ to meet GPCC needs. Standardisation and consolidation of the
approaches undertaken across GPCC supported will be key if the offer is
to be low cost. To make the offer a reality, the CSS needs to innovate
through undertaking activity on behalf of GPCC.
…influences the shape…
…reflects back learning (success or failure)…
5.14 Any approach needs to link with the shared services being developed
across Greater Manchester e.g. HR, Primary Care Contracting, GMBIN
Information Systems, Procurement, GMCPB Networks consolidation and
other local arrangements such as in the NE sector. These principally
focus on the transition period and discussions are being held to
understand how that work may shape services beyond 2013. Different
views of the appropriateness of these arrangements are held locally in
different parts of Greater Manchester.
5.15 In order to establish the CSS as a real service rather than virtual offer,
individual responsibilities could be set (initially by the Cluster or GPCC)
to test the business model being developed. Staff would have to be
seconded and double running avoided. However the risk must be
managed of the perception of the CSS ‘pinching the best staff’ and to sell
the benefits of wider collaboration through the CSS model.
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6. Next Steps
Upping the scale of CSS development operations
6.1 In order to move on to the next stage of the CSS’s development,
resources need to be identified. The scale of resource for the
development of the CSS needs to be significantly increased if the service
is to develop to effectively support the GP consortia within limited
timeframes and to help manage the operational transition risks.
6.2 Expenditure and external costs will be minimised to support the
sustainability of operations going forward. However, some development
resource is required to create a customer focused CSS within Greater
Developing a Core Leadership CSS Team
6.3 The progress made in developing the CSS so far has been under the
sponsorship and leadership of Mike Burrows. Following his appointment
as Chief Executive of the GM Cluster, this involvement will naturally
6.4 There is currently a full time project officer and a part time programme
director. Beyond that, all other efforts, energy and contributions are
provided by volunteers from the wider pool of commissioning staff within
6.5 The core team needs to be expanded and the following transitional roles
are suggested (job descriptions are being developed). The programme
structure and governance will need to reflect the engagement work that is
ongoing to develop the offer. This proposed leadership team needs to be
designed to take the CSS through its evolution process through to the
consideration, development and set up of ‘live’ operational and
managerial arrangements before 31 March 2012:
CSS Service Line Offer Development
Commissioning Services Leads
o Local Engagement
o Commissioning Support Services
o Business Support Services
CSS Business Development (plus Supporting the Offer Development)
Corporate Services Leads
o Cost, Commercial and Finance Lead
o Communications & Marketing Lead
o Human Resources and Organisational Transition Lead
o IM&T Lead
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6.6 These transitional roles can be offered as secondments through to 31
March 2013, from the pool of expertise that exists within the Cluster.
Agreement is sought from the Cluster to make available relevant staff to
apply for these roles. In addition HR guidance is needed to develop a
process to fill the secondments in an open and transparent way.
6.7 If successful the outcome of the development phase will be to create a
live business unit with the appointment of a Managing Director and an
Executive Team who will provide the necessary dedicated management
and leadership to take the CSS business forward.
6.8 The CSS currently has no budget or resources and will not be in a
position to secure GPCC income before 2013/14 although, as set out in
paragraph 5.8, it must develop an outline expectation of its potential
income stream based on its anticipated market share.
Interim Staffing Costs
6.9 The working assumption is that funding of core roles and secondments
detailed in this paper will continue to be funded through existing
employers through to March 2013, as the CSS does not yet have the
means to recruit or employ staff.
6.10 A staffing budget will need to be created to ensure that staffing resources
remain consistent with projected CSS income and the ability to deliver
against the support offer committed to from GPCC.
6.11 It should be noted that staffing, administrative and development costs to
date have largely been met by two PCTs, although staff from each PCT
have been involved in the development work. There may need to be an
agreement to share costs over the participating organisations to ensure
Development and Start Up Costs
6.12 In establishing the CSS, non-recurrent funding, in addition to the core
team, will be required to cover the following expenses:
Marketing, communications materials and event costs;
Training of staff (e.g. customer care etc) and a development;
programme to achieve the required cultural change;
External commercial support, legal, accountancy and other
professional fees; and
Project team accommodation
6.13 Costs need to be kept to a minimum. This is necessary to ensure that
the CSS is financially viable and does not create the burden of
expectation that expenditure on avoidable costs may generate. However
creating a new organisation that can compete and operate effectively
needs sufficient management time and resource.
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6.14 The aim is to create a viable business during 2011/12 and creative
options and compromises will be fully explored to minimise costs without
jeopardising the overall goal.
6.15 From discussions with GPs, they recognise the risk to the CSS’s
development of it being conflated with the Cluster. To guard against this,
the CSS needs to be free to develop in response to GPCC needs and
requirements. It is therefore proposed to create a governance structure
that reflects that intent.
6.16 A draft Programme Board Terms of Reference is appended to this
document (see appendix 3).
Separate Legal Entity
6.17 A piece of external work has been commissioned to help identify an
appropriate separate legal identity, owned by the NHS. This is needed to
allow the CSS to exist beyond 2013. Proposals on its use will be brought
to a future Cluster Board.
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7.1 The Board is asked to:
a) approve the development of a proposal for consideration by PCT
locality boards that are currently uncommitted;
b) support the next stages of the CSS’s development incorporating the
development of a fully costed proposal for undertaking the next phase
of the work;
c) support the establishment of formal CSS governance arrangements;
d) support the work to establish options for the establishment of a
separate legal entity;
e) support early devolution of commissioning activity to the shadow CSS
where supported by GPCC.
Director of Commissioning
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Impact of the legislative pause (new engagement exercise)
The NHS listening exercise sets out four themes, these have been considered in
relation to the impact on the approach to developing the CSS:
Theme Key question Impact Assessment
Choice and competition, further How is it best ensured Choice and competition
engagement needed with patients that competition and will remain and the
and the public to understand their patient choice drives question is how they will
priorities for introducing choice, NHS improvement? be used for improving
and to understand how competition care. The continued focus
can best be used as a tool for on outcomes and
improving care; improvement remain valid.
Patient involvement and public How is the NHS made The offer includes support
accountability, where the priority properly accountable to for GPCC for patient
is to test plans for the new the public, to make sure engagement. Any
organisations and structures to that patient involvement changes are likely to
ensure that public accountability is is at the heart of its increase the importance of
sufficiently strong and that patient decision making? this aspect of the offer
involvement runs through the new
system. This has been a particular
concern with respect to GP‐led
consortia so pathfinders need to
drive engagement on this issue;
Education and training, where How is it ensured that This largely focuses on
there is an opportunity for further NHS staff in the future clinical training. The
engagement to test the ideas have the right skills to fundamental redesign of
coming out of the recently meet changing patient the commissioning support
completed consultation on needs? Are the offer will seek to ensure
‘Developing the Healthcare arrangements proposed that staff provide the
Workforce’ and to stimulate further for education and support that is needed and
debate on how to move forward training the best ones to have the right skills to do
and manage transition; ensure this? so.
Clinical advice and leadership, How is it ensured that GPs have made it clear
clinicians must be in the driving advice and leadership that there should be no
seat in the new organisations and from NHS staff watering down of the
integrated working between themselves on improving clinical leadership and that
primary and secondary care and services and tackling the relationships between
between commissioners and patient needs are at the primary and secondary
providers is strengthened not heart of the health care are strengthened.
undermined in the new system. service? Clinicians will be
supported to deliver their
vision and facilitated to
support joint working
between primary and
It is not considered that there will be a significant change in direction of
Government policy that would affect the direction of travel in the development
of commissioning support.
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Appendix 2: Review of Guidance: Assignment for Transition
GUIDANCE: Assignment for Transition, Gateway Reference: 15864 Date: 31 March 2011
Guidance Comment in respect of the
development of Commissioning
1.2 Assignment for transition is the responsibility With the establishment of Clusters of
of the employer: the PCTs. PCTs this responsibility will potentially
transfer to the Cluster.
Assignment process Consideration needs to be given as to
2.1 The HR Annex to Sir David how staff and other resources will be
Nicholson’s letter (15 December 2010 – Gateway ‘assigned’ from the PCT cluster to the
reference 15272) introduced the concept of emerging CSS.
assignment of PCT employees to support
emerging GP consortia and associated
commissioning support functions.
2.2 The concept specifically relates to the A process is required to establish initial
transition period, which is intended to last until 1 assignment structures that will be
April 2013……Their running costs will be between consistent with expected running costs.
£25 and £35 per head of population, which will
cover both employment within the GP consortium
and commissioning support costs.
2.4 Assignment for transition will not in itself bring The assignment process needs to be
about a change to the current employment status used to establish a reasonable structure
or terms and conditions of PCT employees. It is a and use that process to gain experience
practical method of supporting relevant PCT ahead of the HR process that will move
employees, but it cannot guarantee employment staff to new employers.
in future statutory GP consortia and associated
commissioning support functions.
2.5 Assignment for transition may be used: a). To Commissioning support units need
support fixed-term pieces of work to enable new resources to establish the new
organisations to become established as statutory organisations. Fixed term secondments
organisations. These pieces of work will cease during the transition would appear to be
either shortly before or at the point that the new consistent with this guidance.
organisations are established (see also 6.8)
2.6 Assignment for transition should encourage a Explicit agreement from GP consortia
legacy of partnership working that is carried will be required. It is suggested that
forward into the new commissioning system. they are given the choice to participate
Emerging GP consortia will need to determine in a transitional shared service
what their needs are, as part of the wider arrangement through the CSS by
transition discussions with PCTs. It will then be signing up to a non-binding
the responsibility of PCTs as employers to Memorandum of Understanding or letter
arrange that assignment process. of intent to allow this process to
progress. Those GP consortia not
wishing to participate will need to set out
their alternative arrangements.
2.7 Assignment for transition should have locally To manage operational risk it may be
agreed phases leading up to the end of the appropriate to have a shadow running
transition, which is intended to occur at 1 April year (2012/13) before the abolition of
2013. These phases are based upon emerging PCTs on 31 March 2013. The
GP consortia taking increasing responsibility contracting round effectively starts with
during the transition for delivery of QIPP in discussions in September with the
preparation for the establishment process led by establishment of commissioning
the NHS Commissioning Board. They will be intentions and the potential serving of
flexible to reflect the local development of any service change notices. Therefore it
arrangements. may make sense to commence this
shadow period earlier, perhaps
coinciding with the timescales set out in
this guidance (June 2011) and before
the abolition of SHA on 1 April 2012,
who are responsible for the transition
process (see 2.11).
3.7 The Operating Framework for the NHS in This is a key determinant for the
England 2011/12 identifies initial key roles (which development of Commissioning Support
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are not exclusive) to support emerging GP Units. It is not clear how well developed
consortia: this role is and when and how this will be
brought to a working conclusion that
A commissioning expert to support the emerging avoids the loss of expertise and
GP consortium in their assessment of those organisational memory. There is a risk
commissioning activities they will carry out of under estimating what is needed and
themselves, those where they may choose to act by the time it is understood, that
collectively, and / or where they may choose to capacity has disappeared.
buy in commissioning support from other
organisations both during the transition and
4.3 PCTs will support employees working in The scale of support for the
commissioning support functions to develop development of commissioning support
commissioning support. They will work with functions needs to be significantly
employees to identify the employment implications increased if they are to develop to
for them, including compliance with Transfer of effectively support the GP consortia
Undertakings (Protection of Employment) within limited resources and to help
regulations (TUPE) and the Equality Act 2010 manage the operational transition risks.
4.4 In addition to providing commissioning See above comment in relation to 3.7
support, PCTs will help emerging GP consortia to This is a key determinant for the
assess which commissioning activities they carry development of Commissioning Support
out for themselves, those where they choose to Units. It is not clear how well developed
act collectively, and / or where they may choose to this role is and when and how this will be
buy in commissioning support from other brought to a working conclusion that
organisations both during the transition and avoids the loss of expertise and
beyond. This assessment will be done within the organisational memory. There is a risk
context of the total running costs of between £25 of under estimating what is needed and
to £35 per head of population, which will cover by the time it is understood, that
both employment in the GP consortium and capacity has disappeared.
commissioning support costs.
5 Phasing the process Assignment phases 1&2 are part of the
Phase 1: as a minimum, an initial assignment transition and phase 3 is the populating
of employees by the end of June 2011 to of the new commissioning structures.
support emerging GP consortia
Phase 2: further assignment of employees in Greater clarity is required to support GP
advance of the establishment process consortia and staff through the process.
Phase 3: prior to the point of the new
organisations taking on their statutory
functions, PCTs and GP Consortia will be in There will need to be a separate open
position to prepare for TUPE/Cabinet Office and transparent HR process for staffing
Statement of Practice on Staff Transfers in the the CSS and that will need to be a
Public Sector (COSOP). This preparation will function of the GPCC requirements and
include the legal requirement to consult on not the crystallisation of staffing
TUPE transfers, which should be reasonably structures following the assignment
timed and allow for meaningful consultation. process. It is important that this
happens in a manner that is fair and
6 Process of assignment for transition To minimise costs there is a need for a
6.1 A collaborative approach will be encouraged planned workforce process at an
between emerging GP consortia, PCTs, Trade appropriate level (senior?) to reduce the
Unions and professional bodies on all staffing potential for avoidable costs.
aspects of managing the transition. All parties The current opportunistic reductions in
should take account of the need to minimise costs staffing levels through MARS and
and avoid unnecessary redundancies, i.e. those natural wastage may result in skills gaps
beyond the redundancies necessary to reduce that will need to be recruited to and
administrative costs by a third. potential duplicate staffing that may
result in additional redundancies.
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Appendix 3: Draft Programme Board Terms of Reference
Commissioning Support Service Programme Board
Terms of Reference
1. Purpose and Accountability
1.1 To oversee the development and implementation of the Commissioning Support Service
1.2 To make decisions regarding the development and implementation of the CSS
1.3 The CSS Programme Board will be accountable to the GM PCT Cluster Board
2. Membership and Quorum
2.1 The core membership shall comprise:
- Greater Manchester PCT Cluster Non-Executive Director
- Greater Manchester PCT Cluster Director of Commissioning Development (chair)
- Greater Manchester PCT Cluster Director of Finance
- CSS Programme Director (vice chair)
- GPCC representative (invitation extended to all GM GP Commissioning Consortia)
- GPCC representative (invitation extended to all GM GP Commissioning Consortia)
- GPCC representative (invitation extended to all GM GP Commissioning Consortia)
Support provided by - CSS Programme Support Officer
2.2 Core members may send a deputy in their absence
2.3 Other members and attendees will be co-opted as necessary
2.4 The CSS Programme Board will be chaired by the GM PCT Cluster Director of
Commissioning Development. The position of Vice Chair will be held by the CSS
2.5 A quorum will be three.
The CSS Programme Board has delegated responsibility for:
3.1 Designing and developing the services that will be offered by the CSS (including
internal corporate functions)
3.2 Involving future customers in the design of the CSS
3.3 Identifying and establishing the most appropriate organisational form for the CSS
3.4 Keeping all stakeholders informed of programme progress
3.5 Forging partnerships with organisations that will enhance the CSS offer
3.6 Securing the necessary resources for programme delivery
3.7 Performance managing programme progress
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4. Conflicts of Interest
4.1 To ensure that members are aware of what may constitute a Conflict of Interest, that
Conflicts of Interest are formally disclosed, and subsequently managed in adherence
with GM PCT Cluster Conflict of Interest Policy, the Nolan Principles for Standards in
Life, and in favour of the commissioning and delivery of high quality, safe and cost
4.2 To formally record within the relevant minutes the mechanisms for making members
aware of what may constitute a conflict of interest, any disclosure of conflicts of
interest and the actions taken in the management thereof. Any failures to disclose, or
other breaches of policy, must be reported to the GM PCT Cluster Board by the
Chair, in the first instance.
4.3 Depending on the topic under discussion and the nature of the conflict of interest, the
member may be:-
Allowed to remain in the meeting and contribute to the discussion;
Allowed to remain in the meeting but asked to refrain from participating in the
discussion, voting or attempting to influence any vote;
Asked to leave the meeting for the duration of the item under consideration.
4.4 Members are expected to protect and maintain as confidential any privileged or
sensitive information divulged during the work of the CSS programme. Where items
are deemed to be privileged or particularly sensitive in nature, these should be
identified and agreed by the Chair. Such items should not be disclosed until such time
as it has been agreed that this information can be released.
5. Term of Delegated Powers
5.1 Until the abolishment of PCTs on 31 March 2013
6. Frequency of Meetings
6.1 Meetings will be held on a monthly basis.
6.2 Extraordinary meetings may be called at the discretion of the Chair
7.1 The CSS Programme Board will report to the GM PCT Cluster Board through the
Director of Commissioning Development.
7.2 The minutes of the CSS Programme Board will be made available to the Boards of
the partner organisations
8. Review Date
8.1 These Terms of Reference will be reviewed as appropriate.
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