NHS Eastern Cheshire
Clinical Commissioning Group
One Team, Working Together
An Organisational Development Plan to deliver an effective clinically led
commissioning organisation
The next 3 - 5 years
August 2012
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 1
CCG Information Reader Box
Document Purpose
For information
CCG Website Link
www.ec3health.co.uk
Title
NHS Eastern Cheshire Clinical Commissioning Group Organisational
Development Plan
Author
Publication date
NHS Eastern Cheshire Clinical Commissioning Group
August 2012
Target Audience
NHS Commissioning Board Local Area Teams, Commissioning Support Unit
Managing Directors, NHS Trust CExs, Directors of Nursing, Local Authority
CExs, Councilors, Director of Public Health, Director of Children, Family and
Adult Services, NHS Trust Board Chairs, Clinical Commissioning Group
Chairs, GPs, LAP Chairs, Directors of Commissioning, PPG Chairs, Voluntary,
Charity and Faith Sector representatives, members of the public
Circulation list
NHS Commissioning Board Local Area Teams, Commissioning Support Unit
Managing Directors, NHS Trust CExs, Directors of Nursing, Local Authority
CExs, Councilors, Director of Public Health, Director of Children, Family and
Adult Services, NHS Trust Board Chairs, Clinical Commissioning Group
Chairs, GPs, LAP Chairs, Directors of Commissioning, PPG Chairs, Voluntary,
Charity and Faith Sector representatives, members of the public
Description
The Organisational Development Plan of NHS Eastern Cheshire Clinical
Commissioning Group outlines the Clinical Commissioning Groups
commitment and approach to the development of its employed staff,
member practice staff and others so as to support the delivery of the
groups ambitious aims and objectives and statutory duties inherent in
becoming a successful clinically led commissioning organisation
Action required
N/A
Timing
N/A
Contact details
NHS Eastern Cheshire Clinical Commissioning Group
1st Floor West Wing, New Alderley Building
Macclesfield General Hospital, Victoria Road,
Macclesfield, Cheshire, SK10 3BL
T: 01625 663477
F: 01625 663285
Email: [email protected]
For recipients use
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 2
Contents
Page
Contents
Foreword
4
1
Introduction
5
2
Strategic Context
7
3
Who we are – a profile of NHS Eastern Cheshire Clinical Commissioning
Group
8
4
Vision, values and principles of the clinical commissioning group
9
5
Structure of the clinical commissioning group – how we work
11
6
Organisational development model
18
7
Implementation, monitoring and review of organisational development
21
8
Resources to deliver the organisational development plan
22
9
Conclusion
22
Appendix One
One Team, Working Together – organisational structure of the
clinical commissioning group
23
Appendix Two
What we do – the leadership teams
24
Appendix Three
Safeguarding leads
25
Appendix Four
Review of initial assessment
26
Appendix Five
Samples of what was said at semi-structured interviews with staff
Appendix Six
SWOT Analysis
28
29
Appendix Seven
PEST Analysis
30
Appendix Eight
What staff said success would look like in three to five years
31
Appendix Nine
Outline of the organisational development implementation action
plan objectives and actions
33
39
Glossary
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 3
Foreword
We are pleased to introduce the Organisational Development Plan for NHS Eastern Cheshire
Clinical Commissioning Group. The plan builds on a long and successful history of working
together across the 23 General Practices of Eastern Cheshire, with other stakeholders and
most importantly our staff, local people and their communities.
For the development of the clinical commissioning group we are clear that it needs a different
way of working and so we have taken everything back to basics so as to put in place new and
stronger foundations.
We have made engagement with our patients, carers, public, clinicians, partners and staff a
high priority. Through this we have been able to produce our vision and values which have
helped us in designing our structure based on the principle of “one team, working together” to
support a clinically led commissioning organisation.
We are proud of our achievements so far and look forward to taking the clinical commissioning
group to its ultimate place of being a high performing and highly regarded organisation.
Paul Bowen
Jerry Hawker
Executive Chair
Chief Officer
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 4
1.
Introduction
1.1
Organisational development can be defined as “a planned and systematic approach to
enabling sustained organisational performance through the involvement of its people.”
It focuses on making sure an organisation has the right ‘fit for the future’ workforce to
achieve its strategic ambitions. It includes:
changing behavioural norms and cultural attitudes
building workforce support for the new structures
creating new ways of working to achieve the organisation’s objectives
1.2
This Organisational Development Plan for NHS Eastern Cheshire Clinical Commissioning
Group builds on the initial plan that was presented to the Governing Body in January
2012. It covers a period of critical development - from being a nascent organisation to a
live and fully functioning statutory organisation. This updated plan is one of our
enabling documents that support the delivery of our ambitious aims and objectives and
statutory duties inherent in becoming a successful clinically led commissioning
organisation.
1.3
Organisational development is an iterative process and the content of this plan and the
implementation action plan reflects this. The plan helps the clinical commissioning
group to understand where it is today, what it needs to deliver in the future and the
changes required in order to achieve the desired outcomes. The plan concentrates on
the internal attributes and features of the organisation such as structure, systems,
skills, culture and leadership that are required to support its vision and its objectives.
1.4
A development framework and action plan populated by diagnostic work and
supported by a governance structure will enable the clinical commissioning group to
achieve its organisational development aims. The key developmental areas are
identified, prioritised and progress is tracked. This ensures sustainability and longevity.
1.5
This plan assumes a three to five year development period to become fully developed
and embedded. It works back from the vision of the clinical commissioning group,
identifying and developing the key organisational building blocks that are required to
deliver the vision.
1.6
It is good practice to use a model to ‘hang’ organisational development activities on.
The clinical commissioning group has decided to use the 7-S McKinsey model (Figure
One) to help focus the three to five year strategic development objectives and each has
actions against them. The use of the 7-S model was decided because:
it is the best fit with our organisational development style e.g. trying to balance hard
and soft elements to achieve effectiveness
it enables connections e.g. workforce development and learning and development
to be made explicitly
it is inter-dependant and each element is mutually reinforcing
it requires a corporate approach
it is easily understood
it is visually helpful in communication
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 5
Figure One
1.7
The McKinsey 7-S Model
This plan recognises that other parts of the NHS family and wider health and social care
system are also going through significant organisational change and details are still
emerging from them. The dynamics of change on this scale will impact on the
development of the clinical commissioning group and reflects the need for a flexible
and adaptive approach.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 6
2.
Strategic context
2.1
NHS reforms resulting from the Health and Social Care Act 20121 challenges clinical
commissioning group’s to transform themselves into very different organisations to
predecessor organisations. The clinical commissioning group will be required to
embrace the concept of a membership organisation, providing organisational
development for both the members working on behalf of the clinical commissioning
group and staff employed within the clinical commissioning group.
2.2
We will work in collaboration with all key stakeholders to support an integrated and
joined-up system of health and social care, while simultaneously stimulating
competition and innovation. We will need to demonstrate improvements in long term
health outcomes, while maintaining progress on our day to day delivery. Finally we will
need to demonstrate value for money while meeting demands for wider access and
choice and wider patient and public involvement.
2.3
This plan has to reflect the environment in which it operates. In terms of gearing up the
clinical commissioning group for the challenges ahead, some further environmental
analysis will be required as a continuous process and feed all aspects of planning for
the clinical commissioning group’s organisational development.
2.4
The plan has been developed to reflect the three main environments in which we work:
the internal environment - our Governing Body, Sub-committees,. staff,
management and clinicians;
and the technology required to support clinical
commissioning activities, operational resources and finance
the micro-environment - our external customers, our local population, clinical
commissioning group membership and local referring GP practices, Commissioning
Support Units, healthcare suppliers, our strategic partners particularly Cheshire East
Council as our joint commissioning and health and wellbeing corporate partner
the macro-environment -. Political and legal, Economic, Socio-cultural, and
Technological Factors. These are known as PEST Factors. In order to gear up our
collective understanding of the new commissioning environment we would need to
consider these factors when developing the clinical change programmes
1
Health and Social Care Act (2012) http://services.parliament.uk/bills/2010-11/healthandsocialcare.html
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 7
3.
Who we are – a profile of NHS Eastern Cheshire Clinical Commissioning Group
3.1
The clinical commissioning group is comprised of the 23 member GP practices located
in Alderley Edge, Bollington, Chelford, Congleton, Disley, Handforth, Holmes Chapel,
Knutsford, Macclesfield, Poynton and Wilmslow, with a combined patient population of
over 201,000.
3.2
The clinical commissioning group has formed a local East Cheshire Partnership Board
that enables the clinical commissioning group to work closely with all its provider
partners including East Cheshire NHS Trust, Cheshire East Council, Cheshire & Wirral
Partnership NHS Foundation Trust and our practices to ensure shared commitment to
delivering our plans and priorities.
3.3
Overall, the population served by the clinical commissioning group is older and less
deprived than the England average. There is a lower proportion of people aged 15
years or under and a higher than average percentage of people aged over 65 years
than England as a whole (20% compared to 16%).
3.4
Life expectancy at birth is a major indicator of the overall health experience of a
population. This has continued to increase for both male and female residents within
the Eastern Cheshire geographical area. Latest figures show life expectancy figures for
both male and females residing within the clinical commissioning group are higher than
Cheshire East Council and England averages, at 83.3 years for females and 79.8 years
for males (82.3 years and 78.3 years respectively for England, 2007-09 data).
3.5
The clinical commissioning group receives an indicative revenue resource of £235
million for 2012/13. The clinical commissioning group has worked closely with its
commissioning partners and the NHS Cheshire, Warrington and Wirral Cluster to
understand how this revenue resource should be most effectively split across the
respective commissioning organisations.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 8
4.
Vision, values and principles of the clinical commissioning group
4.1
“Inspiring better health” is the vision of the clinical commissioning group and reflects
our desire to bring a new approach to commissioning healthcare in Eastern Cheshire,
working with our communities, stakeholders and patients.
4.2
The vision is supported by a set of values
that embody the culture and style of
working that enables the clinical
commissioning group to become an
organisation that local communities,
practices and staff can be proud of.
4.3
Developing an inspiring and successful
place to work is at the centre of our
commitment to the practices and staff
that work for the clinical commissioning
group.
We have established five
principles that we consider as essential
“foundation blocks” in determining what
is core work for us, and what we believe is
important to seek external support for.
These are:
Clinical leadership - the clinical
commissioning group will be clinically
led through its 23 practices, held in
high esteem by all clinicians, valued
and respected by communities and
supported by a lean and supportive
management team
Figure Two: Our values
Valuing People
Listening to and respecting the
public, patients’ communities and
staff
Working Together
To deliver the right care, in the
right place at the right time
Innovation
Creating
the
culture
environment that inspires
supports good ideas
and
and
Quality
Striving for the best possible care to
achieve the best outcomes
Investing Responsibly
Making the right decisions for the
best value, affordable healthcare
Local experts in health needs and improving health outcomes - our practices are
the greatest source of knowledge and expertise in understanding local health
needs and leading improvement in health outcomes, working closely with the
Local Authority and Public Health. Through our locality peer groups and lead GPs
we will always ensure that the clinical commissioning group is practice – led
Local leadership and community engagement - the clinical commissioning group
will be the local leader of the NHS, working in partnership with its stakeholders,
communities and patients to shape our future. The clinical commissioning group
will therefore lead local investment into community engagement through our
forums and staff. We will also invest in education and development with practices,
staff and communities
Expertise in local provider relations and quality improvement - building effective
and strong relationships with our key providers is central to a successful
commissioning organisation. It supports high quality integrated care and improves
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 9
access and choice. Most importantly we believe successful local provider
relationships encourage a shared commitment to continuously improving the
quality of care for our communities
Local assurance in finance, performance and governance - our structure reflects
the importance of taking ownership of our governance arrangements, keeping
them simple but effective. We recognise our responsibility for ensuring that we
make the right decisions for best value affordable care and that these
responsibilities are conducted in an open, honest and transparent way that installs
confidence in our peers, stakeholders and communities
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 10
5.
Structure of the clinical commissioning group – how we work
5.1
Figure Three sets out the high level governance structure of the clinical commissioning
group and the relationship between the Governing Body, member practices, subcommittees and employed staff. This structure is consistent with national guidance and
is reflected in our Constitution.
Figure Three: Governance structure of the clinical commissioning group
5.2
2
The NHS (Clinical Commissioning Groups) Regulations 20122 outlines that there must
be a minimum of six members (including its Chair and deputy chair) on the Governing
Body of the clinical commissioning group. The following roles have been mandated by
the NHS Commissioning Board:
Chair of the Governing Body (Board)
Chief Officer / Accountable Officer
Individuals acting on behalf of the member practices
Lay member with a lead role for governance
Lay member with a lead role for patient & public involvement (PPI)
Doctor who is a secondary care specialist
Registered Nurse
Accountable Officer*
Chief Financial Officer*
(*Nationally mandated appointment process)
NHS (Clinical Commissioning Groups) Regulations 2012 http://www.legislation.gov.uk/uksi/2012/1631/contents/made
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 11
5.3
The clinical commissioning group has considered and agreed that a qualified Public
Health representative would bring additional skills and experience in outcomes based
commissioning to the Governing Body and that membership on the Governing Body
would be beneficial.
5.4
Further details on the membership and appointment process for our Governing Body
can be found in the document entitled ‘NHS Eastern Cheshire Clinical Commissioning
Group Organisational Structure’.
5.5
The work on the operational structure and way of working for the clinical
commissioning group has followed much earlier work to identify and agree the vision
and values and can now demonstrate a process based on form follows function.
5.6
A challenge for the clinical commissioning group in meeting its aim to have a strong
local team, while achieving appropriate scale for business continuity and career
progress, is to remain within its running costs, set by the Department of Health at £25
per head of population. This figure is well below traditional Primary Care Trust running
costs.
5.7
Analysing our projected running costs has helped us to understand what functions and
roles will be undertaken by the clinical commissioning group and how we will work
collaboratively with Cheshire East Council, other local clinical commissioning groups,
Commissioning Support Services and other organisation(s) to gain economies of scale.
5.8
“one team, working together” - meeting this challenge has resulted in the recruitment
towards and the development of a single, flexible and multi-tasking team led by
clinicians and underpinned by skills in strategic planning, project management, quality,
facilitation, and relationship management.
5.9
Appendix One shows the operational structure of the clinical commissioning group,
based on the organisations values and principles articulated above and the roles,
responsibilities and duties that are required to be undertaken by the clinical
commissioning group, either through its own organisation, through collaborative
approaches or through use of a Commissioning Support Organisation.
5.10
Appendix Two outlines the responsibilities of the leadership functions (Business,
Clinical, Corporate) within the one team.
5.11
Figure Four encapsulates how - based around the commissioning cycle - the clinical
commissioning group intends to operate, its process of identifying its priorities,
developing its commissioning intentions and reviews what it does.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 12
Figure Four
The way we work
5.12
Clinical leadership of the clinical commissioning group is paramount. The clinical
commissioning group will ensure that there is a clinical perspective and clinical
leadership in everything the clinical commissioning group does. In addition to roles on
the Governing Body, all General Practitioners (Partner or salaried), Practice Nurses and
Practice Managers working in the member practices of the clinical commissioning
group will have the opportunity to undertake a leadership role within the clinical
commissioning group.
5.13
Leadership roles will be offered in a wide variety of ways that will give flexibility to
practice representatives to undertake work for the clinical commissioning group while
balancing their commitments to General Practice. Leadership roles will fall largely into
three categories, depending on the scope of the role and associated time
commitments. These are:
Full Time member of the Leadership Team (minimum 8 sessions per month),
providing expert professional advise to the CCG in one of the following themed
areas
General Clinical leadership
Quality and performance
Provider Development & Clinical Relations
Corporate Responsibilities
Clinical or Professional Leadership of a Programme or project
Subject Expertise (e.g. Clinical lead for Cancer, Medicines Management)
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 13
5.14
The clinical commissioning group already has established clinicians and practice staff
working in the leadership team, covering Quality and Performance, Public & Patient
Engagement, Corporate Services and Clinical Development.
5.15
These roles are increasingly being complemented by Clinicians appointed to undertake
project or pathway specific work. The clinical commissioning group has recently
appointed a Cancer and End of Life Lead, Prescribing Lead, Dementia Lead and is
seeking to expand its appointments of clinicians supporting the clinical commissioning
group three year clinical strategy.
5.16
The clinical commissioning group has worked actively with external organisations
including the Success Factory3, NHS Leadership Academy4, and Capita5 to introduce a
range of leadership development tools and programmes for our lead clinicians.
5.17
Working Collaboratively - The Department of Health publication “Towards
Establishment: Creating responsive and Accountable Clinical Commissioning Groups” 6
sets out a clear view on collaborative working. It states that in order to commission
improvements in health and healthcare for local populations and to drive the
integration agenda around the needs of individuals, it will be important for clinical
commissioning groups to have robust collaborative arrangements with other
organisations. There are a number of areas where the clinical commissioning group has
agreed to work collaboratively with both NHS South Cheshire Clinical Commissioning
Group and NHS Vale Royal Clinical Commissioning Group as well as with Cheshire East
Council.
5.18
It has been agreed that the Medicines Management Team will be hosted by one of the
three clinical commissioning groups and will continue to work in a shared way across
the three clinical commissioning group areas. Formal governance arrangements and
terms of engagement have been produced through an agreed Memorandum of
Understanding to ensure that all parties are clear at the outset of how these
arrangements will work.
5.19
The clinical commissioning group will continue to build joint commissioning
arrangements with the local authority, based on the successful pilots run under the
Primary Care Trust. Areas that will be jointly commissioned include the following:
learning disabilities
multiagency safeguarding hub
dementia care
autism services
care homes contracting
carers services
3
http://www.thesuccessfactory.co.uk/
http://www.leadershipacademy.nhs.uk/
5
http://www.capita.co.uk/Pages/default.aspx
6
Towards Establishment: Creating responsive and Accountable Clinical Commissioning Groups
4
http://www.commissioningboard.nhs.uk/files/2012/01/NHSCBA-02-2012-6-Guidance-Towards-establishment-Final.pdf
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 14
5.20
Other areas continue to be explored. The clinical commissioning group is working with
its partners to establish these joint commissioning arrangements under a
Memorandum of Understanding, to complete existing Section 28 agreements.
5.21
The commissioning of cancer services will be undertaken with resources from within
the clinical commissioning group, but working collaboratively in a clinical
commissioning team across the Eastern Cheshire, South Cheshire and Vale Royal
Clinical Commissioning Groups. This will ensure a consistent commissioning approach
and enable the clinical commissioning group to work most effectively with the Cancer
networks.
5.22
The clinical commissioning group is working closely with Cheshire East Council, NHS
South Cheshire Clinical Commissioning Group, and NHS Cheshire, Warrington & Wirral
Cluster (in advance of the commencement of the new Local Area office of the NHS
Commissioning Board) to ensure robust safeguarding arrangements are established.
This approach includes the development of a new Safeguarding Hub. Governance and
operation arrangements will be completed by quarter three 2012. Appendix Three sets
out the name and designated leads working for or on behalf of the clinical
commissioning group.
5.23
The clinical commissioning group is committed to working with emerging
Commissioning Support Services and exploring opportunities with other local partners.
Commissioning Support Services will become an important partner(s) to the clinical
commissioning group, enabling the clinical commissioning group to access affordable
high quality services that it is not realistic to manage in-house, either due to the
advantages from economies of scale, specialist knowledge which only needs to be used
occasionally or services that benefit a national or regional approach.
5.24
Our approach to commissioning support services is an evolving process, balancing the
development of our core structures with the intelligent commissioning of support
services drawing on guidance and expert knowledge that continues to be updated. In
addition, the clinical commissioning group continues to explore opportunities with a
wide range of potential providers of commissioning support services including Local
Authorities, neighbouring clinical commissioning groups, NHS provider organisations
and the third/private sector. Recent publications that support our understanding and
development of a Commissioning Support Service include:
NHS Operating Framework 2012/137
Developing Clinical Groups – Towards Authorisation8
Developing Commissioning Support – Towards Service Excellence9
Secretary of State for Health letter to CCGs dated 16th February 2012
NHS Eastern Cheshire Organisational Development – Papers 1 & 2
Commissioning Support Business review & assurance process – Checkpoint 2
7
NHS Operating Framework 2012/13
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131428.pdf
8
Developing Clinical Groups – Towards Authorisation
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_130318.pdf
9
Developing Commissioning Support – Towards Service Excellence
https://www.wp.dh.gov.uk/commissioningboard/files/2012/01/NHSCBA-02-2012-8-Guidance-Developing-commissioning-support-Towardsservice-excellence.pdf
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 15
5.25
The clinical commissioning group expects to work with the Cheshire Warrington and
Wirral Commissioning Support Unit in a shadow arrangement allowing the relationship
to develop on a new customer-focused and business like arrangement demonstrating
fitness for purpose and value for money. During the period April to October 2012 the
clinical commissioning group will develop its requirements for Commissioning Support
services which will be articulated through a range of service specifications and key
performance indicators.
5.26
Once established as a statutory public body, the clinical commissioning group will be
subject to the procurement rules that govern the public sector. Subject to the
publication of further guidance, the clinical commissioning group will seek to procure a
full range of commissioning support services from April 2013, based on a robust,
transparent approach that matches our vision and values, and ensures that the clinical
commissioning group can access the highest quality, proven services from a range of
providers commensurate with size and scale of the available market.
5.27
Our approach to developing and accessing Commissioning Support - as part of Equity
and Excellence: Liberating the NHS10 the government has set a challenge for clinical
commissioning group to be part of a commissioning system that is better and more
efficient than anything that has gone before. In considering what services, resources
and expertise to access from Commissioning Support Units the clinical commissioning
group has considered each of the following elements:
what functions does the clinical commissioning group consider core, within its
structure
what functions will the clinical commissioning group develop collaboratively with
other clinical commissioning groups
wow it will develop integrated (joint) commissioning arrangements with the Local
Authority
what functions/services it will seek to “contract” from a Commissioning Support
Organisation
what functions/services it will seek to procure on a “buy as you go” basis
5.28
10
The clinical commissioning group will take a proactive organisational development
approach with Commissioning Support Services, which ensures that the “one team,
working together” approach is extended through to Commissioning Support Services.
To achieve this the clinical commissioning group will ensure that Commissioning
Support Services will be designed to complement our three core functions and their
area specific responsibilities (Figure Five) providing a natural extension to our in-house
“core leadership”. Each team will be the budget holder for commissioning from the
Commissioning Support Services, enabling each team to flex between in-house
resources and skills and those procured on a contracted or “pay as you go” basis.
Equity and Excellence: Liberating the NHS
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 16
Figure Five:
Leadership teams and their responsibilities
Clinical Leadership Team
Business Leadership Team
Business Support Services
Corporate Leadership Team
Clinical Support Services
Business Intelligence
Health Needs
Assessment
Contract
Support/analysis
Performance Monitoring
Quality Monitoring
Benchmarking
Practice level information
Procurement expertise
Regional level contracting
Continuing Health Care
Complex Children’s
Packages
Complex Care packages
(non-Continuing
Healthcare e.g. Acquired
Brain Injury)
NHS Funded Care
Individual Funding
Requests (Bespoke care)
Clinical Policy Assurance
Clinical Project Support
Line of Accountability
5.29
Corporate Support
Services
Financial services
HR/Organisational
Development
Communications
Corporate Governance
support (FOI ,Complaints)
Information Governance
Strategic Planning
Support
Equality & Diversity
Invoicing/payroll
Legal / Audit /IT
Service Relationship
The clinical commissioning group has agreed a single point of contact (Service
Manager) with the local Cheshire, Warrington and Wirral Commissioning Support Unit
and clear lines of communication between each service area covering all functions
within that support service are established. The Service Manager will be expected to
regularly meet with the clinical commissioning group leadership teams and
demonstrate a strong understanding and commitment to the clinical commissioning
group vision, values and overall strategy.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 17
6.
Organisational development model
6.1
In producing this plan and in order to identify our development priorities a number of
perspectives have been sought from within the clinical commissioning group, Central
and Eastern Cheshire Primary Care Trust and samples from other interested parties. A
variety of assessment methods were used including:
a review against the McKinsey 7-S model
a review of the initial self-assessment using the national diagnostic tool (Appendix
Four)
a review of key national and local guidance documents
a series of semi-structured interviews with clinical commissioning group staff and
external stakeholders (Appendix Five)
observations at meetings of the Governing Body and functional teams
a SWOT analysis (Appendix Six)
a PEST analysis (Appendix Seven)
feedback from staff on ‘what success will look like for the CCG in 3 – 5 years’
(Appendix Eight)
feedback from clinical commissioning group staff away day development sessions
6.2
This work has captured a range of important insights, which has strengthened the
development process and informed this plan. From the insights gained we have
created a model (Figure Six) that represents the insights, the challenges and the areas
to address as development takes place. The inner circles are the areas of strength
leading out to the outer circles which represent areas that require more emphasis on
development in the first year.
Figure Six
Insight and development model
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 18
6.3
It has been evident from the insights that we have captured so far that there is synergy
in thinking between staff in describing the current state and the desired state for the
clinical commissioning group. The overall impression is one of a growing positive
reputation for the clinical commissioning group being gained through the development
and articulation of a vision, a set of values, relationships and shaping the emerging
commissioning organisation. The following features were identified as critical to
success:
clinically led
patient focussed for quality
implementing and following a robust commissioning cycle
commissioning is owned and contributed to by all - not individual roles
informed by engagement alongside health needs and evidence
outcome focussed
partnerships
6.4
The insights that we have captured have also informed the development of seven
overarching strategic objectives for our organisational development plan, based
around the McKinsey 7-S model:
Strategic Objective One: To have a clinically led process to set the strategic direction
and produce/implement clear and understandable strategic objectives for
commissioning services to improve health and reduce inequalities across the
population served (McKinsey 7-S - Strategy)
Strategic Objective Two: To have in place a structure that is aligned to the delivery
of the vision of the clinical commissioning group and able to work differently and
effectively - internally and within the wider Health and Social Care system and based
on the key design principle of “one team, working together” (McKinsey 7-S Structure)
Strategic Objective Three: To have in place robust systems that enables decision
making, priority setting, planning, execution and management of the business in the
most effective way for this type and style of organisation (McKinsey 7-S – Systems)
Strategic Objective Four: To take forward the organisation based on our strong
values and principles and gain a positive reputation and make a difference to
patients as a result (McKinsey 7-S – Shared values)
Strategic Objective Five: To develop the right culture and leadership to drive and
deliver the business which results in gaining a positive reputation for the way we
work together and with others (McKinsey 7-S – Style)
Strategic Objective Six: To ensure that NHS Eastern Cheshire Clinical Commissioning
Group is best placed to recruit, develop and retain appropriate staff to realise the
vision and that they are the right people for the culture of the organisation
(McKinsey 7-S – Staff)
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 19
Strategic Objective Seven: To have a workforce (internally and to draw on from
external support services) that collectively has a comprehensive breadth and depth
of skills, knowledge, experiences and the right mindset to fulfil the responsibilities of
the clinical commissioning group and to innovate. (McKinsey 7-S – Skills)
6.5
These strategic objectives are underpinned by key objectives and actions– as outlined
in Appendix Nine within the implementation action plan. These objectives and actions
have been set as through their achievement we will be able to demonstrate and realise
measurable improvements in the development of our organisation – through our
patient, our staff, our partners, our structure and our successes.
6.6
As part of the stated iterative process the clinical commissioning group will continue to
gather insights and widen the range of views sought to help further inform and steer
the groups organisational development.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 20
7.
Implementing, monitoring and the review of organisational development
7.1
The organisational development plan, and its implementation action plan, has the aim
of creating a high performing and highly regarded statutory NHS clinically led
commissioning organisation. It reflects where we are now as a nascent organisation in
a changing and challenging environment, what needs to be done to develop our ‘one
team, working together’ culture and which supports our development against the six
self-assessment domains for authorisation. Achieving authorisation is one point of our
journey towards excellence.
7.2
The implementation action plan to deliver the aims and objectives of the organisational
development plan is structured around the McKinsey 7-S model, aligned to the six selfassessment domains and recognises the three main environments in which we work
which are identified in our strategic context, namely:
the internal environment e.g. though developing our staff and Governing Body via
training (mandatory and optional), personal development reviews, HR policies.
Development of structures, systems to enable the ‘one team, working together’
culture
the micro-environment e.g. developing relationships with our member practices,
partners and local public, through development of such things like Eastern Cheshire
Community HealthVoice, East Cheshire partnership board, joint commissioning
arrangements, and development of relationships with commissioning support
services
the macro-environment e.g. through our membership of and development of the
Health and Wellbeing Board, relationships with our locally elected representatives,
local authority colleagues, NHS Commissioning Board
7.3
The members of the Leadership Team of the clinical commissioning group owns,
shapes and evaluates the organisational development plan. The Corporate Team is
responsible for the monitoring of the delivery of the actions identified within the
implementation action plan, maintaining an evidence log and taking soundings from
staff and stakeholders in the ongoing process. Leads from within the clinical
commissioning group will be responsible for individual sections of the implementation
action plan. A standing agenda item on the monthly Corporate Team meeting will cover
progress on the implementation of the plan.
7.4
To achieve this high level response and good governance arrangements, an update on
the implementation of the plan via completed actions of the implementation action
plan will be a main agenda item on the clinical commissioning group Governing Body
every 3-4 months. The Governing Body will review the actions and outcomes and be
assured that the action plan is maintained with supporting evidence. This will form the
track record required as part of the authorisation process for the clinical
commissioning group and for future annual assessments.
7.5
The Governing Body lead for the organisational development of the clinical
commissioning group is the Chief Officer, supported by the Corporate Services
Manager.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 21
8.
Resources to deliver the organisational development plan
8.1
The organisational development plan will draw on the funding available to support the
clinical commissioning group in its development process. Funding will be reviewed
annually and we will seek to ensure best value for money whilst also securing the most
effective people/process to achieve the outcome (adhering to procurement
requirements).
8.2
To ensure best use of the funding some actions will require facilitation either internally
– using people with the relevant skills - or using external organisational development
expertise. This will be determined by the leads for each section of the implementation
action plan. Those identified as leads are the ones responsible for “making it happen”
but not necessarily delivering the action – they will commission the work and be
responsible for overseeing it and ensuring it is delivered in the right context for the
clinical commissioning group. They will also update (or provide the information e.g. to
a co-ordinator) the action plan for their areas of responsibility.
8.3
We will also look to access resources and expertise from organisations such as:
commissioning support services
local education boards of Health Education England
academic networks
the NHS Leadership Academy
National Institute for Innovation and Improvement11
Royal College General Practitioners Centre for Commissioning12
relevant independent Organisational Development Consultants for the design and
delivery of some actions
9.
Conclusion
9.1
This organisational development plan has been produced in light of the wide scale
changes to the NHS and the emerging clinical commissioning group in Eastern Cheshire.
The clinical commissioning group has gathered and considered perspectives from a
number of people and organisations and although not exhaustive the process has
gleaned valuable insights.
9.2
These insights along with documents and other processes such as the self assessment
have been used to turn thoughts into actions.
9.3
It is acknowledged and research shows that it takes three to five years to develop and
begin to truly embed an organisation. Therefore, this plan is future focussed whilst
also being mindful of the need for a year on year action orientated approach. It starts
from a position of building on developments that have taken place in the recent past
11
12
http://www.institute.nhs.uk/
http://www.rcgp.org.uk/centre_for_commissioning.aspx
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 22
and confidence that the initiatives and objectives identified in the action plan are the
right ones.
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 23
Appendix One
‘One Team, Working Together’ – organisational structure of the clinical commissioning group
NHS Eastern Cheshire Clinical Commissioning Group
‘one team, working together’
Page 24
Appendix Two
What we do – the leadership teams
Clinical Leadership Team
Corporate Leadership Team
Business Leadership Team
Improving Health Outcomes
Clinical Services Leadership
Implementation of NICE Guidance
Clinical Commissioning
Pathway Development
Integrated Patient Care Programme
Health Improvement (with Public Health)
Health Needs Assessment
Reducing Health Inequalities
Strategic Planning
Commissioning Plans & Annual Report
Health & Wellbeing Board
Organisational Development
Commissioning Support
Operating Framework
Annual Financial Budgets
Relationship Management
Local Market Management
Business Management
Service & Provider development
Local key contract management
Local key contract negotiations
Demand / Activity Management
Procurement Strategy
Clinical Leadership
Local Clinical Forum
Clinical Strategy
Clinical leadership for QIPP
Clinical Education & Training
Clinical Research & Innovation
Clinical Senates & Networks
Demand Management Policies
Clinical Governance
Clinical Pathway audits
Clinical Best Practice Audits
Peer Reviews
Patient Outcomes / PROMS
‘One Team, Working Together’
Communications & Engagement
Patient & Public Engagement
Local external affairs management
Stakeholder Engagement
Local communications
Health Watch
Finance & Governance
CCG Board / Sub Committees
CCG Constitution
Standing Financial Instructions /
Schemes of Delegation
Financial Management & Accounting
Financial & Governance Audit
Corporate Performance & Risks
Safeguarding
January 2012
Page 25
Quality & Performance Assurance
Quality & Performance Monitoring
Monthly statutory reporting
CQUINS / Advancing Quality
Access & Choice
Patient Experience
Formulary Management
Benchmarking
CCG Practice Support
Quality Support
Medicines Management Support
Practice activity management & support
Budget management support
Appendix Three
Safeguarding leads
NHS Cheshire, Warrington and Wirral
Board Lead - Cathy Maddaford
Director of Nursing Performance and Quality
Tel: 0151 514 6406
NHS Eastern Cheshire Clinical
Commissioning Group
Board Lead – Dr. Paul Bowen
Chair
Tel: 01625 663477
NHS South Cheshire and
NHS Vale Royal Clinical
Commissioning Group
Board Lead - Fiona Field
Director of Partnerships and Governance
Tel: 01270 275 434
Safeguarding Leads and Professionals
Moira McGrath
Designated Nurse Safeguarding Children
Tel: 01270 275 246
Dr Katina Marinaki
Designated Doctor Safeguarding Children
Tel: 01625 661 759
Dr Baljinder Singh
Designated Doctor Safeguarding Children and Looked After Children
Tel: 01270 275 369
Sheila Williams
Designated Nurse for Looked After Children
Tel: 01625 663146
Lindsay Rattapana
Designated Nurse Safeguarding Adults
‘One Team, Working Together’
January 2012
Page 26
Appendix Four
Review of initial self-assessment
The charts below show an aggregate assessment of each area. A maximum ""fully
developed"" assessment will show as 100%, or 5 out of 5 whereas the lowest possible
assessment will show as 0% or 0 out of 5. Note: that opt-outs will count as 0. Note: scores
are indicative only and reflect self-assessment. They are comprised from collating the
""scroll bar"" inputs for each statement
The charts show the data in three different ways.
‘One Team, Working Together’
January 2012
Page 27
Area
Clinical Focus and Added Value
Average Score
72%
Engagement with Patients / Communities
60%
Clear and Credible Plan
65%
Capacity and Capability
58%
Collaborative Arrangements
80%
Leadership Capacity and Capability
63%
‘One Team, Working Together’
January 2012
Page 28
Appendix Five
Samples of what was said at semi-structured interviews
with staff
“we went back to basics and built new foundations which are stronger and are helping us
to work differently”
“well on the pathway of development”
“good start and obvious commitment to patient and public engagement”
“good level of understanding across practices with open and honest leadership”
“staff matter”
“willingness to explore even if it means going down a few dead ends”
“fast pace of development need to be clear about expectations”
“what does the vision actually mean”
“locality and peer group meeting are an important part of how it works”
“GPs and others need to understand the whole world in they exist”
“relationship and trust building is evident and feels healthy”
“leadership is driving the culture being focussed on patient experience and outcomes”
“clinically led commissioning is at the centre of the organisations way of working – it is not
in titles but all contributing to the cycle – this makes it different from the PCT”
“need to agile, flexible and decisive”
“next 12 months feels even more challenging”
“trying hard to work collaboratively”
“focussed on direction of travel”
“a lot of other skills amongst Board members”
‘One Team, Working Together’
January 2012
Page 29
Appendix Six
SWOT Analysis
STRENGTHS
WEAKNESSES
Built on strong foundations
Good start with Patient and Public
Engagement
Given a mandate by practices
Election process for Board GPs
Clear vision, values, principles and
supporting structure
Commissioning cycle
Commitment to development at
all levels and a lot of energy
Leadership styles
GP buy in
Pathfinder status
Willingness to think differently
Communication,
media
and
reputation plan
Capacity
and
capability
and
balancing multiple jobs
Decision making and priority setting
processes and bravery e.g. to
decommission
Leadership styles
Development of member practices
Degree of clinical engagement
OPPORTUNITIES
THREATS
Transformation
Integration
Market development and outcome
focussed
Shadowing to understand the
whole health and social care
systems challenges and
opportunities
East Cheshire NHS Trust
Foundation Trust application
process/outcome
Becoming a Primary Care Trust
Funding
Not attracting and keeping the right
people
Poor transition management
Not clinically led
East Cheshire NHS Trust Foundation
Trust application process/outcome
Dominant medical culture
Not having continued sign up from
General practice
Political policy changes
‘One Team, Working Together’
January 2012
Page 30
Appendix Seven
PEST Analysis
Political Factor
Economic Factors
The political arena has a huge influence upon
the regulation of our local health care system,
the money available and the priorities for
disease management. We will need to
consider issues such as:
political pressure as a consequence of
changing health care threshold issues
current and future legislative
requirements
healthcare market
international (EU) legislation
regulatory bodies and processes
(changes to Care Quality Commission)
government policies & operational
expectations
government term and the risk of
change within strategic planning
timescales
The clinical commissioning group will
need to consider a number of economic
drivers when developing the design of
their local healthcare system.
Socio-Cultural Factors
Technological Factors
Understanding the diversity of needs within a
given population and planning health
improvement products (i.e. services that
provide advice, support, intervention and
support wellbeing) is a fundamental aspect of
health system commissioning.
The clinical commissioning group has
been working with the PCT to consider
many technological innovative tools and
techniques each designed to provide the
answers to questions around future
demand, economic and health impact
assessment.
Aligning clinical commissioning programmes
with the defined understanding and therefore
needs of our local population, based on socio
cultural factors will be an important aspect of
Clinical Commissioning Group activities. The
new clinical commissioning model will require
programmes that enable, over time, to build
organisational capability and drive the clinical
commissioning group to become a true
market driven commissioner. By this we mean,
driven by the needs of our people and
delivered by the capabilities specifically
engineered into our economy through a
network of highly regulated suppliers.
‘One Team, Working Together’
The continuous development of the
clinical QIPP (Quality, Innovation,
Productivity and Prevention) programme
will be a critical feature within the
transition period and beyond 2013 when
clinical commissioning groups will hold
corporate accountability for the
economic stability of the local healthcare
system.
In terms of technological influences the
clinical commissioning group will
consider further requirements to best
meet the needs of both the clinical
commissioning group as an emerging
organisation and the commissioning
competencies it would need to develop.
January 2012
Page 31
Appendix Eight
What staff said success will look like in three to five years
We have created a well performing health economy with good patient and population
outcomes including evidence that more people are taking more responsibility for
their own health
We are patient focussed not organisationally driven
We have one team, working together and delivering better outcomes through a
robust clinically led commissioning cycle and a common understanding of what we
mean by commissioning
We are recognised and have a strong reputation for our integrity, realism and passion
for our vision and values and clear strategic objectives
Partners want to work with us
We have influenced and supported the development of primary care through positive
working relationships with the NCB and practices state that it has been a positive and
productive experience
Our communities and partners really understand what we are here for and who to
contact about what
We have mature relationships with our providers but with real contestability
Peoples needs are addressed sooner and are more cost effective
Care pathways make sense and are integrated where it is appropriate and reduced
duplication
We have consistently improved quality and managed resources well
We work as a dynamic and interactive organisation without hierarchy and this reflects
our culture
Staff are happy in their roles, understand their responsibilities and feel valued and we
have a workforce development/succession plan
All General Practices are on board and involved in commissioning
Patients and public feel that their views are sought, taken into account and influence
decisions
We receive positive feedback from local people that we have embraced “no decision
about me without me”
The level of care delivered in the community has increased and regarded by people as
effective and therefore other people want to move into the area
There has been a significant reduction in services delivered in hospital – the hospital
does what only a hospital can do
We have achieved national recognition for our approach to clinically led
commissioning and we feel proud about the way it works and what it achieves
We have productive relationships with partners including the 3rd sector
We have robust systems in place that achieve transparent accountability whilst
encouraging innovation and brave decision making supported by good access to
intelligence and business processes
We have managed conflicts of interest and GPs/others say that it is open and
transparent and helps GPs to find the balance in the dual role of providing and
commissioning
We communicate well internally and externally – we have a simple but powerful story
that we share and use it to illustrate why, what, how, who and when
Equality and diversity is evident in what we do and how we do it
‘One Team, Working Together’
January 2012
Page 32
We built on the best from previous models and we ask what others think of the way
we work
We have delivered our share of the Quality, Innovation Productivity and Prevention
Target
Clinical leadership and engagement is evident and the driver for change and
accountability
The vision and values are part of everyone’s thinking and behaviour
We have robust inclusive processes and systems for Business Planning and
commissioning based on clear priorities
We performance manage based on qualitative outcomes not just quantitative
We have been innovative with our management resources internally and able to
maximise resources and expertise externally
We only make decisions at Board level when we are sure that local people, patients,
staff and stakeholders have been engaged
‘One Team, Working Together’
January 2012
Page 33
Appendix Nine
Outline of the organisational development
implementation action plan objectives and actions
The implementation action plan to deliver the aims and objectives of the
Organisational Development Plan is structured around the McKinsey 7-S model,
aligned to the six self-assessment domains and recognises the three main
environments in which we work which are identified in our strategic context. The six
self-assessment domains covered are:
Domain One: a strong clinical and professional focus which brings real added
value
Domain Two: meaningful engagement with patients, carers and their
communities
Domain Three: clear and credible plans which continue to deliver the Quality
Innovation Preventative Programme (QIPP) challenge within financial resources,
in line with national outcome standards and local joint health and wellbeing
strategies
Domain Four: proper constitutional and governance arrangements, with the
capacity and capability to deliver all their duties and responsibilities including
financial control as well as effectively commission all the services for which they
are responsible
Domain Five: collaborative arrangements for commissioning with other clinical
commissioning groups, Local Authorities and the NHS Commissioning Board as
well as the appropriate commissioning support organisation
Domain Six: great leaders who individually and collectively can make a real
difference
‘One Team, Working Together’
January 2012
Page 34
Strategic Objective One: To have a clinically led process to set the strategic direction
and produce/implement clear and understandable strategic objectives for
commissioning services to improve health and reduce inequalities across the
population served (McKinsey 7-S - Strategy)
Key Objectives
1.1 To embed the
1.2 To ensure the
1.3 To ensure that
commissioning cycle as
commissioning
investment,
a whole organisational
intentions/business
disinvestment and
way of working, which objectives year on year reinvestment to achieve
includes member
demonstrate a line of
appropriate services –
practices and a high
sight from the vision
e.g. quality and
level of clinical
through to personal
accessibility - are
engagement and
objectives and appraisals supported by a robust
ownership.
QIPP financial plan
1.4 To ensure
understanding of the
strategic direction by
telling the “story”
Actions
1.1.1 Develop a “how
we work” paper,
including a description
of the how the
commissioning cycle is
embedded within the
organisation
1.1.2 Develop systems to 1.1.3 Develop processes
ensure member practices that ensures clinical
are included
engagement and input
into the commissioning
decisions of the clinical
commissioning group
1.3.1 Ensure current
1.3.2 Develop the
contract plans 2011/12 financial plan for 2012/13
are delivering
(which integrates the
QIPP plans)
1.3.3 Evaluate the
process and make
changes as necessary for
continuous
improvement
1.4.2 Have a process in
place so that the CCG
teams are routinely
‘briefed’ on the
Commissioning
Business Plan and
Strategic Direction
(both internally and
externally)
1.4.4 Develop a calendar
of stakeholder events /
patient engagement
events
1.4.3 Have a process in
place for regular
communication with
Practices
‘One Team, Working Together’
1.2.1 Embed the
commissioning
objectives in clinical
commissioning group
staff appraisals and
objectives process
1.4.1 Develop a
consistent corporate
story about the clinical
commissioning group
its origins, its role and
ambitions and ‘so
what’.
January 2012
Page 35
Strategic Objective Two: To have in place a structure that is aligned to the delivery
of the vision of the clinical commissioning group and able to work differently and
effectively - internally and within the wider Health and Social Care system and based
on the key design principle of “one team, working together” (McKinsey 7-S Structure)
Key Objectives
2.1 To design a
structure for the
whole organisation
2.2 To work with
staff and the
Governing Body to
determine new
ways of working to
deliver the
objectives,
reflecting
management costs
and risk sharing
within other
organisations
2.3 Have in place
a Governing
Body
Governing Body
that reflects the
Future Forum
findings
2.4 Develop the
effectiveness of
the federal way
of working
2.5 Develop
shared
leadership for
Health and
Wellbeing
Actions
2.1.1 Implement a
structure that
ensures a dynamic
and interactive
way of engaging
with patients,
clinicians, and
stakeholders and
achieves
accountability
without
unnecessary
bureaucracy
2.2.3 Assess
leadership
potential and
competency for
clinical
commissioning
group clinical leads
in shaping the
clinical
commissioning
group and service
developments
2.1.2 Put in place
a development
programme for all
the workforce to
enable them to
adapt and
develop into the
one team,
working together
mode
2.1.3 Corporate
Services Team to
oversee the
development,
implementation
and review of the
OD Plan
2.2.1 Develop an
agreed decision
making process
with devolved
responsibilities
2.2.2 To have
plans in place to
define and
procure
commissioning
support services
2.2.4 Develop and
agree a MOU
between NHS
South Cheshire
Clinical
Commissioning
Group and NHS
Vale Royal Clinical
Commissioning
Group for the
Medicines
Management
Team
2.3.1 Recruit /
appoint to the
Governing Body
2.3.2 Assess the
skills possessed
by Governing
Body members
and build
competencies
/skill where
required
2.3.4 Develop
portfolios and
clinical leadership
roles for key
aspects of the
Governing Body’s
work (Governing
2.4.1 Support the
development of
the membership
of the locality
peer groups
2.5.1 Be an
active member
of the Cheshire
East Health and
Wellbeing Board
2.5.2 Develop an
approach with
the Local
Authority for
shared
leadership with
the Health and
2.3.3
Commission a
Governing Body
Development
programme that
enable the
Governing Body
to focus on
Culture, Strategy
and
Accountability
with clear and
speedy decision
making and
minimal
bureaucracy
2.5.3 Develop
joint strategies
for local
commissioning
‘One Team, Working Together’
January 2012
Page 36
Body & Leadership
2.5.4 Participate in
development
events led by the
Health and
Wellbeing Board
Wellbeing Board
2.5.5 To develop
integrated teams
across the
Cheshire East
footprint
Strategic Objective Three: To have in place robust systems that enables decision
making, priority setting, planning, execution and management of the business in the
most effective way for this type and style of organisation. (McKinsey 7-S – Systems)
Key Objectives
3.1 To strengthen the
3.2 Have a robust
links with Public Health Communications and
and the process for
Engagement plan
having and updated
Joint Strategic Needs
Assessment
3.3 Ensure patient
experiences are captured
by providers to inform the
development/refinement
of services
3.4 Ensure
appropriate
information and
intelligence is used
to inform service
development and
changes
3.5 Ensure that the
3.6 Ensure equality
clinical
and diversity is
commissioning group embedded through
follows good
the culture, systems
governance to
and processes of the
underpin transparent clinical commissioning
accountability
group
3.7 Establish modern and
enabling IT systems that
support business
development, delivery and
performance management
3.8 To increase and
demonstrate
influence in clinical
commissioning
group decision
making
Actions
3.1.1 Support the
production of an
updated Joint
Strategic Needs
Assessment by
providing essential
information
3.2.2 Produce a plan
to increase
communications and
engagement
(patients, public,
carers, practices, staff,
providers, voluntary
sector and other
stakeholders) in the
commissioning
process
3.5.1 To explore,
design and establish
systems and
processes for good
governance
3.1.2 Contribute to
the development of
the Joint Health and
Wellbeing Strategy
3.1.3 Support the
development and agree an
MOU with Cheshire East
Public Health on the ‘public
health offer to clinical
commissioning groups’
3.2.1 Agree and
identify the resources
available for
Communications and
Engagement
3.3.1 To monitor this
through the contract
management process,
so that patient
experience and
feedback is part of
‘core’ business.
3.4.1 Work with the health
and social care economy to
agree the appropriate
information and intelligence
3.4.2 Use agreed data
to monitor services
(performance review
and improve)
3.5.2 Have in place a
3.6.1 Develop an Equality
process for reviewing and Diversity Plan
relevant documents
such as a
Constitution, Terms of
Reference, SORD and
risks register
‘One Team, Working Together’
3.6.2 Identify Equality
and Diversity
Objectives for the
clinical
commissioning group
January 2012
Page 37
3.6.3 Develop the
required Equality
Delivery System
action plan and
implement
3.7.1 Agree a
document
management system
3.8.1 Establish a cross
practice working group to
review the level and depth
of engagement from GPs,
Practice Nurses and Practice
Managers
Strategic Objective Four: To take forward the organisation based on our strong
values and principles and gain a positive reputation and make a difference to
patients as a result (McKinsey 7-S – Shared values)
Key Objectives
4.1 Ensure understanding of the values/principles of the clinical commissioning group
Actions
4.1.1 Create
marketing tools e.g.
banners, posters,
bulletins, newsletters,
website etc.
4.1.2 Deliver
engagement events
with the public
4.1.5 Produce
standards of expected
behaviours that
reinforce the agreed
values and culture
4.1.6 Test out the
values / behaviours
using
360 degree
process with
stakeholders
self assessment by
the Governing
Body and staff and
review
4.1.3 Reinforce the
importance of values
through appraisals,
Governing Body
meetings, staff
meetings, engagement
with patients, the
public and stakeholders
4.1.4 Describe how
the values are
demonstrated in
everyday practice
Strategic Objective Five: To develop the right culture and leadership to drive and
deliver the business which results in gaining a positive reputation for the way we
work together and with others (McKinsey 7-S – Style)
Key Objectives
5.1 Develop the “one team, working together” model
5.2 Develop a coaching culture
Actions
5.1.1 Follow up on the
initial MBTI work done and
roll out to the whole
organisation to identify
development needs
5.1.2 Build on the
emerging culture and
different leadership
styles – using
appreciative inquiry
work with staff and
stakeholders
5.1.3 Identify best
features that exist and
are relevant to the
clinical commissioning
group – what needs to
be kept, dropped or
added
5.1.5 From the feedback,
take these features and
translate them into tangible
ways of working that
5.1.6 Hold focus
groups (mixed
internal and external
participants) across
5.2.1 Create a
coaching programme
for the Governing
Body, leadership team
‘One Team, Working Together’
5.1.4 Develop a
common set of
agreed Leadership
Standards across
the Management
Team.
January 2012
Page 38
everyone will recognise and
reinforces that
individual/team/Governing
Body need to work in this
way
the towns to test out
the culture and
reputation of the
clinical
commissioning group
and line managers
Strategic Objective Six: To ensure that NHS Eastern Cheshire Clinical Commissioning
Group is best placed to recruit, develop and retain appropriate staff to realise the
vision and they are the right people for the culture of the organisation. (McKinsey 7-S
– Staff)
Key Objectives
6.1 To have an
effective Governing
Body to lead the
organisation
6.2 To develop
posts to be
directly employed
by ECCCG with
clear roles and
accountabilities
6.3 To ensure
staff with the
right skills and
experience are
appointed
6.4 Have a fully
informed,
engaged and
motivated
workforce
6.5 To support
the creation of a
commissioning
support offer for
HR and OD
6.1.1 To put in place
a selection/election
process in order to
secure the
appropriate skills,
experience and
knowledge for an
effective Governing
Body
6.1.2 Develop
Governing Body
member skills
using coaching
and mentoring
schemes, 360
degree feedback
and mutual peer
support
processes
6.3.2 Induct into
new roles
6.1.3 To put in
place a process
for succession
planning for
Governing Body
members and
other key roles
6.2.1 Develop
Job Description
and Person
Specifications
that clarify roles
and
responsibilities
6.2.2 Create a
fair appointment
process in line
with Cluster and
National
transition
policies and
guidance
6.4.1 Review
formal and
informal
methods for
communicating
and engagement
with the
workforce
6.4.6 Embed an
annual appraisal
cycle and the
production of
personal
development
plans
6.4.2 Produce a
regular
workforce
engagement
newsletter
6.4.3 Produce
regular
Workforce
Information and
support for line
managers
6.4.7 Maintain a
programme of
Wellbeing and
Engagement in
line with the
Boorman Review
6.5.1
Identify and
create service
description of
HR and OD
services that will
be required by
the clinical
commissioning
group
Actions
6.3.1 Have the
processes in place
for recruitment and
selection
6.4.4 Develop a staff
influence
programme
6.4.5 Hold
regular whole
team OD away
day
‘One Team, Working Together’
January 2012
Page 39
Strategic Objective Seven: To have a workforce (internally and to draw on from
external support services) that collectively has a comprehensive breadth and depth
of skills, knowledge, experiences and the right mindset to fulfil the responsibilities of
the clinical commissioning group and to innovate. (McKinsey 7-S – Skills)
Key Objectives
7.1 Ensure key skills are maintained across all
functions of the clinical commissioning group to
enable the clinical commissioning group to deliver its
full range of responsibilities
7.2 Develop awareness, skills and
competencies of the wider clinical
commissioning group membership
Actions
7.1.1 Audit current skills
to inform an annual
Learning and
Development planning
cycle
7.1.2 Develop a
workforce development
plan and programme
drawing on internal and
external resources in
order to address skill
needs/ gap
7.1.5 Ensure all staff are
aware of and are able to
access mandatory and
statutory training (e.g.
safeguarding, equality
and diversity,
information governance,
fire safety)
7.1.6 Access clinical
leadership
development
programmes for clinical
Governing Body
members and aspiring
clinical Governing Body
members
7.2.1 Design and run a
clinical leadership and
engagement
programme for wider
clinicians
7.2.2 Design and
implement an action
learning set for GPs to:
explore working in 2
roles i.e. GP as a
front line provider
who commissions for
the
individual
patient through a
referral and as a
Governing
Body/Management
Group
GP
who
commissions
strategically and for
the
whole
population
working in a federal
model
taking advantage of
ambiguity
‘One Team, Working Together’
7.1.3 Identify and
determine what is
needed in house or what
needs to be
commissioned externally
from commissioning
support offers in order
that any contracted CSS
will provide capacity and
capability.
7.1.7 Implement a
Governing Body
development
programme
7.1.4 Embed an
annual appraisal
cycle and the
production of
personal
development
plans.
7.1.8 Implement
a development
programme for
staff that enables
them to
understand and
adapt/develop to
a different way of
working as a
shared
management
team and working
with and through
others e.g. CSS
7.2.3 Hold a series of
workshops across the
area for non clinical staff
in the clinical
commissioning group
and Practices to
understand the what and
how of the clinical
commissioning group
and where they fit in the
overall way of working
January 2012
Page 40
Glossary
Term
Central and
Eastern Cheshire
Primary Care
Trust
Abbreviation
CECPCT
Clinicians
Meaning
is the Primary Care Trust (PCT) that has
been responsible for the commissioning
of health services for the central and
eastern areas of Cheshire. Also see
Commissioning. The 2011/12 NHS
Operating Framework announced that
individual PCTs were to cluster with
neighbouring PCT so as to retain effective
management capacity in all PCTs until
their abolition in 2013. On 1st June 2011,
CECPCT was formally clustered with NHS
Warrington, NHS Western Cheshire and
NHS Wirral. Also see NHS Cheshire,
Warrington and Wirral cluster
-
are qualified healthcare professionals doctors, nurses and members of the
allied health professions, e.g. dieticians,
occupational therapists, physiotherapists,
podiatrists and speech and language
therapists
Clinical
Commissioning
Group
CCG
are groups of GPs that will, from April
2013, be responsible for designing local
health services in England. The Health
and Social Care Act 2012 devolves
responsibility for the majority of
commissioning of health services from
Primary Care Trusts to local clinical
commissioning groups. They will work
with
patients
and
healthcare
professionals and in partnership with
local communities and local authorities.
All GP practices will have to belong to a
Clinical Commissioning Group. The clinical
commissioning groups will be supported
and held to account by an independent
NHS Commissioning Board
Commissioning
-
in health terms commissioning is the
process of deciding which health services
are needed for a given population,
acquiring them and ensuring that the
services meet the defined needs. The
‘One Team, Working Together’
January 2012
Page 41
Term
Abbreviation
Department of
Health
Meaning
process ranges from assessing population
needs, agreeing priorities, setting targets
and outcomes, to procuring services and
monitoring the service providers. Also see
Central and Eastern Cheshire PCT
-
is a department of the United Kingdom
government with responsibility for
government policy for health and social
care matters and for the National Health
Service in England along with a few
elements of the same matters which are
not otherwise devolved to the Scottish,
Welsh or Northern Irish governments. It
is led by the Secretary of State for Health
with two Ministers of State and two
Parliamentary Under-Secretaries of State
East Cheshire NHS
Trust
ECT
East Cheshire NHS Trust was established
in 2002. It consists of three hospitals at
Macclesfield, Knutsford and Congleton.
Since 1 April 2011 East Cheshire NHS
Trust has been an integrated community
and acute trust providing healthcare
across central and eastern Cheshire and
surrounding areas, in hospital, at home
and in community settings
Equality Delivery
System
EDS
is a performance monitoring tool
developed by the Department of Health
and is designed in line with the Equality
Act 2010. It is designed to ensure existing
Primary
Care
Trusts,
clinical
commissioning groups and providers of
commissioned NHS services are meeting
their Equality Duty to ensure that Equality
is embedded into all the work of NHS
organisations
‘One Team, Working Together’
January 2012
Page 42
Term
Equality Duty
Abbreviation
-
Meaning
requires public bodies to consider all
individuals when carrying out their day to
day work – in shaping policy, in delivering
services and in relation to their own
employees. It requires public bodies to
have due regard to the need to eliminate
discrimination, advance equality of
opportunity, and foster good relations
between different people when carrying
out their activities
General
Practitioner
GP
a doctor providing primary care services,
usually providing the first point of contact
for NHS patients
Governance
-
refers to the system by which
organisations (whether established as
companies,
statutory
bodies
or
otherwise) are directed and controlled
Health
Inequalities
-
term that describes the gap between the
health experience of different population
groups such as the well-off compared to
poorer communities or people from
different ethnic backgrounds.
The
Department of Health is committed to
reducing health inequalities by 10% by
2010 as measured by infant mortality and
life expectancy at birth
HSCB
is an Act of the Parliament of the United
Kingdom. It is the most extensive
reorganisation of the structure of the
National Health Service in England to
date
HealthWatch
-
will be a new independent consumer
champion and a statutory part of the
Care Quality Commission with a remit to
champion services users and carers
across health and social care. One of the
provisions in the Health and Social Care
Act 2012 is the creation of HealthWatch
England and local HealthWatch
Joint Strategic
JSNA
analyse the health needs of populations
Health and Social
Care Act 2012
‘One Team, Working Together’
January 2012
Page 43
Term
Needs
Assessment
Abbreviation
Life Expectancy
Local Involvement
Network
NHS Cheshire,
Warrington and
Wirral
‘One Team, Working Together’
Meaning
to inform and guide commissioning of
health, well-being and social care services
within local authority areas. The Health
and Social Care Act 2012 outlines that
clinical commissioning groups and local
authorities, through the Health and
Wellbeing Board, will have a statutory
responsibility to produce a JSNA and a
joint health and Wellbeing strategy. The
main goal of a JSNA is to accurately assess
the health needs of a local population in
order to improve the physical and mental
health and well-being of individuals and
communities
LE
the number of years a person could
expect to live if they experienced the agespecific mortality rates of the given area
and time period for the rest of their life.
Life expectancy is calculated separately
for males and females
LINks
local organisation of individual and
organisational members which collects
and represents the views of health and
social care service users and the public.
Under the Health and Social Care Bill,
LINks will be superseded by local
HealthWatch
-
was formally constituted from 1 June
2011 and comprises of Central and
Eastern Cheshire Primary Care Trust, NHS
Warrington, NHS Western Cheshire and
NHS Wirral. It has a single Chief Executive
and a single Executive Board which has
two Non-Executive Directors from each
PCT and has responsibility for the affairs
of all four PCTs, which will remain as
individual statutory bodies. Clustering of
PCTs ensures that each PCT can maintain
focus on the delivery of critical business
functions in their area, such as improving
the performance and quality of health
services, whilst having the capacity to
provide strong support to emerging
January 2012
Page 44
Term
Abbreviation
Meaning
clinical commissioning groups and local
authorities who are taking on the
responsibility for Public Health. Whilst
not statutory bodies they are necessary
to sustain PCT capability and enable the
creation of the new NHS system
NHS
Commissioning
Board
NHSCB
is a Special Health Authority, established
on 31 October 2011, and is intended to
play a key role in the Government’s vision
to modernise the health service and
secure the best possible outcomes for
patients. Its role is to make all the
necessary preparations for the successful
establishment of the NHS Commissioning
Board on 1st April 2013. The NHSCB will
be nationally accountable for the
outcomes achieved by the NHS, and
provide leadership for the new
commissioning system. It will support the
development of and - upon establishment
and authorisation - will hold CCGs to
account. It will also directly commission a
range of services including primary care
and specialised services and have a key
role in improving broader public health
outcomes. Accountable to the Secretary
of State via an annual mandate, the
NHSCB will be an independent, statutory
body, free to determine its own
organisational shape, structure and ways
of working
Organisational
Development
OD
“a planned and systematic approach to
enabling
sustained
organisational
performance through the involvement of
its people.” It focuses on making sure an
organisation has the right ‘fit for the
future’ workforce to achieve its strategic
ambitions
PEST Analysis
-
stands for "Political, Economic, Social,
and Technological analysis" and describes
a framework of macro-environmental
factors used in the environmental
scanning component of
strategic
‘One Team, Working Together’
January 2012
Page 45
Term
Abbreviation
Meaning
management
Primary Care
Trust
PCT
a type of NHS trust, part of the National
Health Service in England. PCTs
commission primary, community and
secondary care from providers. Until 31
May 2011 they also provided community
services directly. Collectively PCTs are
responsible for spending around 80% of
the total NHS budget. Primary Care Trusts
are scheduled for abolition on 31st March
2013 with GP-led Commissioning
Consortia assuming most of the
commissioning
responsibilities
they
formerly held. See Clinical Commissioning
Groups. The public health aspects of PCT
business will be taken on by local
councils. See Public Health
Public Health
-
is generally thought of as being
concerned with the health of the entire
population, rather than the health of
individuals - and therefore requiring a
collective effort - and as being about
prevention rather than cure. The three
domains of public health are: health
improvement; health protection; and
health services. Under the Health and
Social Care Act 2012 Public Health
commissioning functions currently the
responsibility of Primary Care Trusts will
be taken on by local authorities, Public
Health
England
and
the
NHS
Commissioning
Board.
See
NHS
Commissioning Board
SWOT Analysis
-
is a strategic planning method used to
evaluate
the
Strengths,
Weaknesses/Limitations, Opportunities,
and Threats involved in a project or in a
business venture. It involves specifying
the objective of the business venture or
project and identifying the internal and
external factors that are favorable and
unfavorable to achieve that objective
‘One Team, Working Together’
January 2012
Page 46