SUPPORTING PLANNING 2013/14 FOR CLINICAL COMMISSIONING GROUPs

SUPPORTING PLANNING 2013/14 FOR CLINICAL COMMISSIONING GROUPs December 2012

SUPPORTING PLANNING 2013/14 FOR CLINICAL COMMISSIONING GROUPS First published: 21 December 2012 2

Contents 1. INTRODUCTION... 4 PART A THE FORMAL REQUIREMENT OF ALL CCGS... 5 2. CONTEXT... 5 3. OPERATIONAL ARRANGEMENTS THE 18-MONTH CYCLE... 5 4. PLANNING TIMETABLE... 6 5. CONTENT OF THE SUBMISSION... 7 6. ASSURANCE... 8 7. CONTRACTING... 8 PART B FOR CCGs WHERE THERE IS A NEED FOR GREATER SCRUTINY... 8 8. ADDITIONAL REQUIREMENTS... 8 ANNEX A NHS OUTCOMES FRAMEWORK MEASURES... 10 ANNEX B Expected rights and pledges from the NHS Constitution 2013/14... 12 ANNEX C Plan on a Page Examples... 14 ANNEX D FULL LIST OF ACTIVITY MEASURES... 16 ANNEX E CRITERIA TO SUPPORT ASSURANCE FOR CCGS WHERE MORE DETAILEDASSURANCE IS REQUIRED... 17 The following documents are also part of the Supporting Planning 2013/14 for Clinical commissioning groups suite of documents : Everyone Counts: Planning for Patients 2013/14 - Technical Definitions Clinical commissioning groups planning template for 2013/14 Clinical commissioning group and Provider Objectives for Reduction in CDifficile: 2013/14 3

1. INTRODUCTION This document describes the processes that will be used to support planning for 2013/14 for clinical commissioning groups (CCGs). It provides further information to Everyone Counts Planning for Patients 2013/14, published on 18 December 2012. Supporting Planning 2013/14 for CCGs is the document referred to in Everyone Counts as supporting information. A parallel document, focusing on the assurance of direct commissioning plans, is in preparation and will be available early in 2013. The approach for direct commissioning will mirror that for CCGs and will be based on the priorities and single operating model outlined in the publications entitled Securing Excellence : Primary Care published in July 2012 Specialised Commissioning published with commissioning intentions in November 2012 Military Health and Offender Health issued to area teams in draft in November 2012 due for publication in January 2013 Dental services due for publication in February 2013 This document is set out in two parts and the focus is on the assurance of CCG plans. Part A describes the formal submission that every CCG will make to the NHS Commissioning Board to support this. There are some CCGs where Area Teams (ATs) and regions will need to exercise greater scrutiny, such as where there are conditions of authorisation on planning and/or finances. Part B describes the more detailed submission that CCGs will make where this is the case. The aim is to support CCGs in ensuring that every plan is as strong as it can be by designing an approach that aims to strike a balance between local determination of priorities and the NHS CB responsibility for oversight to ensure that statutory requirements around improving quality and financial duties are being met. Area Teams will work with CCGs to understand the local improvement identified by CCGs against the measures set out in the planning framework so that together, the NHS CB and CCGs, can be jointly satisfied that the statutory duties to deliver the mandate and make sufficient contribution to quality improvement within allocated resources are being delivered. CCGs and ATs will share data and planning assumptions on a transparent basis so that both can be satisfied that their plans secure the best possible outcomes for patients within available resources. The assurance process for local plans, CCG plans, AT plans for direct commissioning and system-wide plans, will build on the authorisation process, which requires CCG to develop clear and credible plans. This will provide a strong base from which to develop 2013/14 plans. In the spirit of assumed liberty, the assurance of plans will be mainly intelligence and discussion based, with a minimal requirement for formal submission to the NHS CB. 4

PART A THE FORMAL REQUIREMENT OF ALL CCGS 2. CONTEXT Rather than imposing targets, the NHS CB expects CCGs to develop their own local priorities through their input into the Joint Health and Wellbeing Strategy. However, with assumed liberty comes public responsibility and CCGs are expected to set out real ambition in their plans. Everyone Counts Planning for Patients 2013/14 asks each CCG to identify three local priorities against which it will make progress during the year. These priorities will be taken into account when determining if the CCG should be rewarded through the Quality Premium. Plans should be built on the assumption that no indicator contained within the national NHS Outcomes Framework or the CCG Outcome Indicator Set deteriorates. The focus of planning should lie on maximising health gain for the population. For each of the five domains, we have identified the measures from the NHS Outcomes Framework best placed to provide assurance in planning and delivery, where CCG data exists and a baseline can be determined for 2013/14. These are set out in Annex A and will be used to inform CCGs and the NHS CB on whether progress is being made through the CCG assurance framework. Annex A also shows which measures will be used in-year as well as annually and which measures will be used in the Quality Premium. The national requirements, in terms of operational standards expected from the NHS Constitution, are shown in Annex B, including the additional measures as specified by the NHS CB for 2013/14 in Everyone Counts Planning for Patients 2013/14. The technical definitions for each of the measures are described in Everyone Counts: Planning for Patients 2013/14 - Technical Definitions. 3. OPERATIONAL ARRANGEMENTS THE 18-MONTH CYCLE Preparing plans for the year ahead is the first phase of an 18-month cycle. CCG assurance will match this 18-month cycle. The cycle starts with planning for the year ahead, and assurance of those plans. Alongside this runs the second phase on contracting. The third phase is in-year delivery and the final phase is year-end assurance and accountability. This takes place after the end of the year, once performance and delivery for the relevant year is known. This document relates to the first and second phases planning and contracting. There will be further guidance, to be agreed before the start of 2013/14, which is currently work in progress, involving Area Directors and CCGs, to describe CCG assurance and covering in-year monitoring and assurance, recovery and support and intervention and escalation. 5

4. PLANNING TIMETABLE Date Activity CCG Plans 18 Dec 12 Allocations published Planning guidance published 21 Dec 12 Supporting information published Draft NHS Standard Contract published w/c 7 January UNIFY2 1 Data collection available 2013 25 Jan 13 CCGs to share first draft of plans with Area Team Directors to include: Plan on a Page including key elements of transformational change; Template covering Self certification of delivery of the NHS Constitution, Mandate and Clostridium difficile objective; Self certification of assurance of provider CIPs; Trajectory for Dementia and IAPT; Trajectories for locally selected priorities; Activity trajectories for 4 key measures elective FFCEs, non-elective FFCEs, first outpatient attendances, A&E attendances; Financial information By 8 Feb 13 Area Directors to provide feedback to CCGs End Feb Re-submission of Finance Templates and update on contractual negotiations 11 Feb to Discussions to support Area Team Director assurance of plans 29 Mar 13 31 Mar 13 CCG and NHS Commissioning Board contracts signed off 5 Apr 13 Final CCG plans shared with Area Team Director 8 Apr to Board analyses CCG plans and plans for direct commissioning with a 19 Apr 13 view to identifying risks to delivery 22 Apr to Board confirms that plans add up to a position that delivers the 10 May 13 By 31 May 2013 mandate and improves patient outcomes within allocated resources Each CCG publishes its prospectus for its local population 1 Unify2 is an online data collection portal used by the NHS to collect and share performance information, aggregate data and statutory returns. 6

5. CONTENT OF THE SUBMISSION To support assurance of CCG plans, every CCG will make a formal submission to the NHS CB, by sharing with their Area Team, covering : o Plan on a Page including key elements of transformational change; o Template covering : Self certification of commitment to delivery of the rights and pledges of the NHS Constitution, Mandate and Clostridium difficile objective; Self certification of assurance that provider cost improvement plans are deliverable without impacting on the quality and safety of patient care; Trajectory for dementia diagnosis rates and Improving Access to Psychological Therapies (IAPT) - proportion of people entering treatment; Trajectories for locally selected priorities; Activity trajectories for 4 key measures elective finished first consultant episodes(ffces), non-elective FFCEs, first outpatient attendances, A&E attendances; o Financial information, including a brief overview of financial position, underlying assumptions and associated risks. Examples of Plan on a Page are included at Annex C. The template covering the remaining content (excluding finance) is available in Clinical commissioning groups planning template for 2013/14. This template will be submitted via UNIFY2. CCGs will need a Unify2 account to submit this data and colleagues in regional and area teams will also need accounts to facilitate CCG account creation and view uploaded data. To request an account please go to: http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx and click 'Request a Unify account'. The Clostridium difficile objectives for each organisation in 2013/14 are available in Clinical commissioning group and Provider Objectives for Reduction in CDifficile: 2013/14. The template requires CCGs to self certify that they will continue to reduce the incidence of Clostridium difficile so that the number of infections in 2013/14 will be equal to or less than their objective. In addition, CCGs are required to populate a financial planning template, including income and expenditure assumptions, QIPP plans and associated risks. These will be consolidated with the NHS CB financial plans to ensure that our combined financial duties are met. The NHS CB will not be collecting QIPP milestones or monitoring milestones centrally. The NHS CB will use a set of system sustainability measures, of which the activity trajectories listed above are a subset, to track progress in-year. 7

6. ASSURANCE Based on the assumed liberty principle, assurance for the majority of CCGs should be a minimal process, focused on a face-to-face discussion, supported by intelligence on current delivery and trends, and with additional interactions mainly being in relation to queries of clarification. It is recognised that across the country different approaches are being developed that bring together CCGs and ATs to consider commissioning and it is for local determination about the best way to operate this, however, it is recommended that there is at least one face to face meeting. This meeting would have the objective of sharing plans, how as co-commissioners, ATs and CCGs can work together to deliver integrated care and the health and well-being strategy, and also to discuss system risks and mitigation. 7. CONTRACTING As part of robust business processes it will be essential that plans and assumptions are underpinned by signed contracts for clinical services. The expectation remains that all contracts are signed by 31 March 2013. Area Teams will be responsible for tracking progress on the negotiation of contracts for CCG-commissioned services and regional offices will have oversight of contracts for the NHS CB s directly commissioned services. CCGs will be asked to confirm the status of their contract negotiations at the end of February, with area teams providing support where appropriate during the course of March. Parallel processes will apply to contracts held by the NHS CB. It is expected that disputes will be exceptional. Where they do occur the process for resolution is set out clearly in the standard contract. The NHS CB will work closely with Monitor and the NHS Trust Development Authority to ensure that consistent messages on contracting are received by commissioners and providers. PART B FOR CCGs WHERE THERE IS A NEED FOR GREATER SCRUTINY 8. ADDITIONAL REQUIREMENTS There are some CCGs where ATs and regions will need to exercise greater scrutiny : i) where there are conditions of authorisation on planning and or finances ii) there are significant financial or quality problems iii) there is to be a major service reconfiguration that requires multi-commissioner commitment iv) CCGs volunteer - say because they are not confident of producing a plan that resolves all the issues they face. It is recommended that, where this is the case, CCGs and ATs consider whether here are other elements of planning process and documentation that would be helpful to prepare for the 2013/14 planning round: 8

Narrative based on clear and credible plans Larger suite of activity measures and trajectories (as shown in Annex D) QIPP transformational milestones Quality indicators based on national dashboard On-going quality assurance of provider CIPs Other indicators including workforce Patient, public insight and experience 9. ADDITIONAL ASSURANCE For these CCGs there will be a more detailed assurance process. ATs will work with CCGs to assure the CCG plan and assurance will be based on updated criteria from the clear and credible plan domain of the CCG Authorisation framework. These are described in Annex E. Where an Area Team has concerns about a CCG s plan the Area Team will initially discuss those concerns with the CCG. A more formal meeting may be convened if the CCG and AT cannot agree next steps to resolve the issue. This may be brokered where appropriate by the relevant regional team. In the majority of cases these discussions will resolve issues and provide assurance that the plans are appropriate or will be revised. If concerns persist to the extent that the NHSCB believes that a CCG in agreeing the plan is at risk of failure to discharge, or discharge appropriately, its statutory functions, the NHS CB may formally request additional information from the CCG under the terms of sections 14Z17 and 14Z18 of the NHS Act 2006 (as amended). This section also allows the NHS CB to request such information from a CCG if it considers that the CCG in discharging its plan would be at risk of failing to deliver in the interests of the health service. At the point this request is made the NHS CB will define what information or documents will be required. The NHS CB may also use section 14Z19 of the same Act to require a written or oral explanation. 9

ANNEX A NHS Outcomes Framework measures which the NHS Commissioning Board and Clinical Commissioning Groups will use to track progress (ie data can be generated at clinical commissioning group level and a baseline can be determined against which progress can be considered). Domain Measures that are suitable for both in year and annual assessment Measures that are suitable for annual assessment only In Quality Premium Preventing people from dying prematurely None Potential years of life lost (PYLL) from causes considered amenable to healthcare Potential years of life lost (PYLL) from causes considered amenable to healthcare Under 75 mortality rate from cardiovascular disease Under 75 mortality rate from respiratory disease Under 75 mortality rate from liver disease Under 75 mortality rate from cancer Enhancing quality of life for people with long term conditions Combined measure of Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s and 2 measures from domain 3. Proportion of people feeling supported to manage their condition Health-related quality of life for people with long-term conditions Dementia Diagnosis Rates Helping people to Combined measure as above Patient Reported Outcomes 10 Combined measure of Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Emergency admissions for acute conditions that should not

Domain Measures that are suitable for both in year and annual assessment Measures that are suitable for annual assessment only In Quality Premium recover from episodes of ill health or following injury with Emergency admissions for acute conditions that should not usually require hospital admission Measures (PROMs) for elective procedures: i)hip replacement, ii)knee replacement, iii)groin hernia, iv)varicose Veins usually require hospital admission Emergency admissions for children with lower respiratory tract infections (LRTI) Emergency admissions for children with LRTI Emergency readmissions within 30 days of discharge from hospital Ensuring that people have a positive experience of care Patient experience of i GP Services ii GP Out of Hours services Patient experience of hospital care (needs attribution to CCG ) Patient experience measure Friends and family test Treating and caring for people in a safe environment and protecting them from avoidable harm Incidence of healthcare associated infection: MRSA Incidence of healthcare associated infection: Clostridium difficile None Incidence of healthcare associated infection: MRSA and Clostridium difficile 11

ANNEX B Expected rights and pledges from the NHS Constitution 2013/14 (subject to current consultation) including the thresholds the NHS Commissioning Board will take when assessing organisational delivery Referral To Treatment waiting times for non-urgent consultant-led treatment Admitted patients to start treatment within a maximum of 18 weeks from referral 90% Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral 92% Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting no more than 6 weeks from referral 99% A&E waits Patients should be admitted, transferred or discharged within 4hours of their arrival at an A&E department 95% Cancer waits 2week wait Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% Cancer waits 31 days Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers 96% Maximum 31-day wait for subsequent treatment where that treatment is surgery 94% Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen 98% Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy 94% Cancer waits 62 days Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer 85% Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% Maximum 62-day wait for first definitive treatment following a consultant s decision to upgrade the priority of the patient (all cancers) no operational standard set Category A ambulance calls Category A calls resulting in an emergency response arriving within 8minutes 75% (standard to be met for both Red 1 and Red 2 calls separately) Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% Mixed Sex Accommodation Breaches Minimise breaches 12

Cancelled Operations All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the patient s treatment to be funded at the time and hospital of the patient s choice. Mental health Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period 95%. Additional measures NHS Commissioning Board has specified for 2013/14. Referral To Treatment waiting times for non-urgent consultant-led treatment Zero tolerance of over 52 week waiters A&E waits No waits from decision to admit to admission (trolley waits) over 12 hours Cancelled Operations No urgent operation to be cancelled for a 2 nd time Ambulance Handovers All handovers between ambulance and A & E must take place within 15 minutes and crews should be ready to accept new calls within a further 15 minutes. Financial penalties, in both cases, for delays over 30 minutes and over an hour. 13

ANNEX C Plan on a Page Examples 14

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ANNEX D FULL LIST OF ACTIVITY MEASURES Measure Definition Frequency of Plan/Forecast Non elective FFCEs Non-elective FFCEs Monthly GP written referrals to hospital No of GP written referrals Monthly Other referrals for a first outpatient appointment First outpatient attendances following GP referral No of other referrals No 1st outpatient attendances after GP referral Monthly Monthly All first outpatient attendances No of first outpatient attendances Monthly Elective FFCEs No of elective FFCEs (ordinary adms & separately daycases) Monthly A&E attendances Number of attendances at A&E departments in a month (total and type 1) Monthly Ambulance Urgent & Emergency Journeys Number of urgent and emergency journeys via ambulance, monthly Monthly Diagnostic Activity 4 x Endoscopy-based tests Monthly Diagnostic Activity 11 x Non-endoscopy based tests Monthly Numbers waiting on an incomplete Referral to Treatment pathway Total numbers waiting at the end of the month on an incomplete RTT pathway Monthly 16

ANNEX E CRITERIA TO SUPPORT ASSURANCE FOR CCGS WHERE MORE DETAILEDASSURANCE IS REQUIRED Overarching 1. Is the plan clear on how the system will achieve sustainable service and financial performance alongside quality and productivity improvements? 2. Does the plan provide sufficient linkages between finance and activity, is there a clear link between commissioner and provider activity changes and financial planning and do these align with the planned transformational changes in 2013/14 and 2014/15? 3. Does the plan provide sufficient linkages between organisations within the health economy, e.g. TFA actions are consistent with other areas of the plan? 4. Are high level risks identified that represent the most significant threats to the system that would prevent successful delivery of the plan? 5. Does the plan give due regard to the public sector Equality Duty (PSED), and are equality objectives integrated into the plan? Clear and credible plans 1 that set out how CCCGs will take responsibility for service transformation 6. The plan includes a detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and is integrated with the commissioning plan. 7. The plan sets out how savings and efficiencies will be delivered whilst improving quality and this is integral to the plan. There is a clear explanation of any changes to existing QIPP plans. 8. The plan supports delivery of JHWS and integrated commissioning, depending on local timeframe. 9. The plan sets out how it aligns with national frameworks and strategies, including the NHS Outcomes Framework. 1. Clear & credible plans :1. Does the plan clearly identify how the health system will be transformed and improved in 2014-15 from that in 2012-13? And is the plan clear on how the system will achieve this? 2. Does the plan articulate how the CCG will quantify, measure and monitor delivery of their share of the national savings challenge? 3. Are plans for savings appropriately phased and articulated for each year until 2014-15 (i.e. not too heavily front- or back- loaded) and do plans provide headroom (e.g. the savings for reinvestment are greater than the investment and challenge identified)? 17

Plan is understood by CCGs, members etc 10. The CCG can demonstrate that the process for developing its plans and priorities was inclusive and transparent. 11. The plan clearly demonstrates where and how the CCG is working with other CCGs to meet QIPP and other challenges. 12. The CCG can demonstrate that stakeholders are aware of and understand CCG priorities. 13. The CCG can demonstrate that member practices understand at least at a high level their local plan and priorities. 14. Member practices receive timely information to inform their involvement in CCG planning and monitoring delivery of those plans. Plan is evidence based and rooted in needs of population 15. The plan reflects JSNA and stakeholder engagement. 16. The plan makes good use of evidence and analysis to determine needs and priorities. The CCG can articulate the likely inherited issues and operating environment and set out a plan for resolution 17. Declaration that the inheritance from PCT is quantified, identified, understood and robust transition arrangements in place. 18. Where the area covered by the CCG is not on track to meet the plan for 2013-14, there is a clear and time-limited resolution path to recover. Contracts in place to secure future delivery 19. 2013-14 contracts with main providers agreed and signed off. 20. CCG has arrangements in place to manage all contracts. 21. CCG has systems in place to track performance of main providers. 22. CCG has arrangements in place to collaborate with neighbouring CCGs in areas such as lead commissioning where there is more than one CCG contracting with a provider. 18

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Crown copyright Year 2012 First published 21 December 2012 Published to Name, in electronic format only. 20