1. Delegation of Commissioning Responsibilities (DR) to pathfinders and emerging Clinical Commissioning Groups (CCGs) - What is it? Why should pathfinders and emerging CCGs take on DR? The process for achieving delegated commissioning responsibilities

2. What is the delegation of commissioning responsibilities? Prior to authorisation as statutory bodies, pathfinders can take on responsibility for commissioning and associated budgets. This can only be achieved through the establishment of a Board committee of the Primary Care Trust (PCT) cluster with membership drawn from the pathfinder, and responsibility delegated to that committee. Taking delegated responsibility for some or all of the available commissioning budget allows pathfinders to learn about commissioning in a supportive environment, and develop a ‘track record’ prior to authorisation.

3. Applying for delegated commissioning responsibilities Pathfinders should work with their local PCT cluster and/or Strategic Health Authority (SHA) cluster to develop plans to take on delegated responsibility for some or all of the available commissioning responsibilities and budget. This should include the preparation of the core governance, development and delivery documents set out in the SHA cluster delegation guidance. The PCT cluster Chief Executive retains overall accountability for delivery, and the budget.

4. The Delegation Process Pathfinder / emerging CCG, and PCT cluster agree clinical and financial outcomes the pathfinder wishes to be responsible for achieving and indicative timetable for further delegation Pathfinder and PCT cluster agree: A Draft Pathfinder Constitution Pathfinder Development Plan Establishment Agreement for Board committee Delivery agreement between pathfinder and PCT cluster Pathfinder and PCT cluster agree: A Draft Pathfinder Constitution Pathfinder Development Plan Establishment Agreement for Board committee Delivery agreement between pathfinder and PCT cluster PCT cluster assurance of readiness of pathfinder to assume responsibilities SHA assurance of cluster delegation process PCT cluster Board approval of delegation 4

5. SHA cluster guidance for delegation To ensure consistency and transparency of approach across England, SHA (SHA cluster from October 3) guidance has been devised to support local and regional work The process set out in the guidance is intended to enable pathfinders/CCGs to: improve clinical and financial outcomes before authorisation, take responsibility for commissioning decisions, develop their organisations to deliver practical outcomes, and build a track record in preparation for authorisation. 5

6. Assessing pathfinder/ emerging CCG readiness to assume delegated responsibilities Criteria have been developed under 5 main areas for use by PCT clusters and/or SHA clusters to assess and assure the readiness of pathfinders/CCGs to assume delegated responsibilities. 1.Clearly defined outcomes for the activities the pathfinder wishes to take delegated responsibility for 2.A plan for how the pathfinder will achieve the specified outcomes including how they will manage the risks (specifically financial risk) associated with them? 3.A plan for the performance management of activities the pathfinder wishes to take delegated responsibility for 4.A plan for how the pathfinder will access the commissioning support it needs to deliver any delegated responsibilities 5.Appropriate transfer of decision making responsibility, and established governance structures for managing delegated responsibilities

7. National Indicator An indicator has been created to monitor the progress made on delegating commissioning responsibilities to pathfinders through the establishment of Board committees. This includes the following areas: Total available commissioning funds Percentage commissioning budget applied for by pathfinders Percentage commissioning funds delegated % commissioning budget delegated = Total value of delegated budget ___________________________________ Total available commissioning funds (excluding for example primary care commissioning, specialist commissioning, and public health commissioning)

8. Resources to support delegation SHA Cluster Delegation Guidance Indicator – Gateway Letter from Barbara Hakin PCT Cluster and/or SHA Cluster Commissioning Development Teams