Primary care co-commissioning webinar Dr Julia Simon, Primary Care Co-commissioning Programme Director, NHS England julia.simon@nhs.net                                               18 March 2015

Introduction Welcome and thank you for joining the latest co-commissioning webinar. The webinar is supported by the following: Julia Simon, Primary Care Co-commissioning Programme Director Stefanie Rutherford, Senior Co-commissioning Manager Rachel Patterson, Deputy Director of Organisational Change Victoria Raby, Head of Planning Delivery Gerard Hanratty, Partner at Capsticks Maria Murray, NHS England Central Finance Rebecca Jowett, Operations Officer David Peat, Co-commissioning Project Officer

Overview of the webinar Update on the approvals process for joint and delegated commissioning; Overview of the delegation agreement; Update on joint commissioning arrangements; Lay member training programme; Timeline and next steps; Workforce update; and Q&A session.

Update on the approvals process 63 CCGs have been approved to take on delegated commissioning responsibility for primary medical services. 87 CCGs have been approved to assume joint commissioning arrangements with NHS England subject to constitutional amendments being made and the Terms of Reference being signed. CCGs will have the opportunity to implement joint commissioning arrangements on a quarterly basis hereafter and delegated arrangements on an annual basis. For CCGs not approved at this stage, we will continue to provide the support we can to help them to achieve their ambitions.

Delegation agreement The delegation agreement has now been shared with CCGs granted delegated arrangements. It has been developed in collaboration with the joint CCG and NHS England primary care co-commissioning programme oversight group. CCGs are asked to return a signed copy of the delegation agreement by 5pm on Tuesday 24 March. This is to enable financial allocations to be made on 1 April 2015. All outstanding governance matters (such as constitution amendments and ratification of revised conflicts of interest policies) must be resolved by the time the agreement is signed.

Summary of the delegation agreement The delegation agreement sets out the key functions to be delegated to CCGs. This includes: decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts; the approval of practice mergers; planning primary medical care services, including carrying out needs assessments; undertaking reviews of primary medical care services; decisions in relation to the management of poorly performing GP practices; and Premises Costs Directions Functions.

Premises functions Premises Costs Directions Functions will be delegated to CCGs to give CCGs maximum flexibility and responsibility for the use of health spending in their geographic area.   The premises functions include: making payments in relation to recurring premises costs (such as rent); and premises developments or improvements. Capital expenditure will not be delegated to CCGs due to the capital approvals process. CCGs must comply with any guidance issued by NHS England or the Secretary of State when taking decisions on the Premises Costs Directions and must liaise where appropriate with NHS Property Services and Community Health Partnership.

Reserved functions The following primary medical care functions will continue to be carried out by NHS England: management of the national performers list; management of the revalidation and appraisal process; administration of payments in circumstances where a performer is suspended and related performers list management activities; Capital Expenditure Functions; Section 7a Functions; Functions in relation to complaints management; and Decisions in relation to the Prime Minister’s Challenge Fund.

Complaints management We are undertaking detailed design work to look at options for managing complaints in the future, with input from CCGs. NHS England will maintain responsibility for complaints management from 1 April 2015 whilst the design work is underway. Our priorities are to make sure we meet our legal obligations, get the design work right, that any transition is well managed and that the current high standards are maintained. We will keep our colleagues fully informed as more information becomes available.

Section 7a Functions Section 7a functions (for example national screening and immunisation programmes) will not be delegated to CCGs. This includes any enhanced services arranged or provided through primary care but which are part of the Section 7a Functions agreement. This means that the public health teams in NHS England will remain the responsible commissioner for all Section 7a programmes. The policy intent of section 7a is to ensure that commissioning for public health programmes is undertaken on a sufficient geography to commission population based programmes and that the integrity of the national screening and immunisation programmes is safeguarded, through national commissioning arrangements. Section 7a functions will not be delegated at present because we need to undertake detailed scoping work with public health teams, the Department of Health and Public Health England to further understand how public health benefits could be strengthened under delegated arrangements and how public health expertise could best be provided. While Section 7a functions will not be delegated, the co-commissioning model is an opportunity to strengthen local partnership arrangements and levers to focus on improving public health outcomes. A small public health implementation project group has been established to look at the key issues around co-commissioning and to develop recommendations about how public health teams in NHS England (including the embedded PHE staff) can work with CCGs to strengthen their relationship for public health commissioning. The group will also provide recommendations on the management and reporting implications for the section 7a agreement. The recommendations from the group will be made to the Public Health Oversight Group with the aim to publish guidance early in April.

Joint commissioning 87 CCGs have been approved to take on joint commissioning arrangements from 1 April 2015. NHS England Regions are now working with these CCGs to ensure that terms of reference for the joint committees and CCG constitutions are completed and signed off by 31 March 2015. The approvals process for 2015/16 in-year submissions is currently under discussion and will be communicated shortly.

Lay member training dates We are currently providing training for CCG lay members to support them in their enhanced role in the commissioning of primary medical services. The forthcoming training dates are: March 17th Leeds 18th Birmingham 24th London 31st London April 1st Manchester 2nd Leicester 8th London 14th Taunton 15th Bristol 16th Newcastle 21st Leeds 22nd London 23rd Cambridge 28th Birmingham May 5th Taunton 6th Manchester 7th Newcastle 12th London 14th Cambridge 14th Nottingham 19th London www.england.nhs.uk/commissioning/pc-co-comms/lay-member-training/

Timeline and next steps Date (2015) Action March Delegation agreement shared with CCGs granted delegated arrangements. On-going discussions with NHS England staff in sub-regional teams and trade unions on resourcing models. Lay member training provided. 1 April Financial transfers to be made for delegated commissioning. Joint and delegated arrangements to be fully implemented locally. 2015/16 On-going support for the implementation of co-commissioning arrangements. Lay member training provided (up to end of May) Co-commissioning evaluation programme launched with first update in September. Mini audit of conflicts of interest management (September). Publication of conflicts of interest management case studies (October).

Primary care co-commissioning: workforce update Rachel Patterson Deputy Director of Organisational Change, NHS England                                              

Primary Care Co-Commissioning HR Working Group The second HR Working Group took place on 9 March 2015. Key items covered were the legal advice provided on employment models; what this is likely to mean for teams; and how we quickly undertake a workforce data collection exercise. The employment advice received confirms that TUPE does not apply, however provides for three employment models that could be used to protect NHS England staff, retain expertise and ensure continuity of service for the overall benefit of patients. The three models are: - to be assigned to a CCG or group of CCGs - to be formally seconded to a CCG - direct employment by a CCG The intention is for the employment models presented to form part of the delegation agreement thus requiring CCGs to follow one of them.

Next Steps The detail of the employment models and how they may be used in different regional teams is still to be developed. To support this activity the following work is taking place: a detailed workforce data collection and mapping exercise is taking place through the Heads of Primary Care; once collated this data will be used to establish the most appropriate model of employment applicable in different areas; in order to inform this work, a workshop is being organised to take place w/c 13 April, with legal input. The default position in the first instance is for the assignment model to apply while this work continues.

Communications re: Workforce Reports and updates have been provided at the February and March Organisational Change Partnership Forum meetings to ensure Trade Union colleagues are involved in discussions and fully appraised of progress to date. As there is more information becoming available and some clearer employment positions are emerging it is expected that an updated staff and manager briefing and updated FAQs will be provided in the near future.

Questions/Follow Up Key Organisational Change and Programme Delivery Team contacts: Rachel Patterson, Deputy Director of Organisational Change Rachel.patterson3@nhs.net Helen Lambert, Organisational Change Manager Helen.lambert2@nhs.net

Questions received Functions: Interpretation and translation / Equality and Diversity / Violent patients / Serious Incidents /Sustainability – will responsibilities for managing these services for Primary Care be transferred to CCGs? What is the interface likely to be between the Medical Director in the NHS England sub-region and CCGs under delegated commissioning arrangements? Data sharing: Is there any national guidance on cross-organisational sharing of files and folders between NHS England and CCGs for co-commissioning? Will CCGs that are fully delegated have to abide by the policies of NHS England for example the policy for list closures i.e. when a practice wants to close its list to new patients. Some CCGs believe they will be able to operate their own policies is this permissible given that overall accountability will remain with NHS England and we could end up with a 100 different policies? Can the Audit Chair be the Chair or Vice Chair of the Joint Committee?

Thank you and close Further information on primary care co-commissioning can be found at: https://www.england.nhs.uk/commissioning/pc-co-comms/ If you have any further questions, please email: england.co-commissioning@nhs.net We would appreciate your views on the webinars and how they can be improved in the future to best meet your needs.