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bjbj Now, with the Board s consent I would like to change and bring forward item five,
the emerging clinical commissioning group configuration, ahead of the Operations Directorate,
because my sense is that that discussion would then flow more appropriately into the Operations
Directorate. Is the Board content for me to do that? Thank you very much. Barbara, over
to you in terms of clinical commissioning group configuration. Emerging Clinical Commissioning
Group Configuration: Names, Geography and Constituent Members Dame Barbara Hakin National
Director Commissioning Development Opening comments Thank you, Chairman. This paper brings
together for the Board the proposed configurations of emerging clinical commissioning groups
across England: those nascent clinical commissioning groups that want to come forward to be authorised
and established during the latter half of 2012-13, ready to go live in their role in
April 2013. They will be established as NHS bodies, and as you will see from the paper,
the proposed numbers are 212 at the moment, which is a very significant change from some
of the original numbers which were first considered. What we have seen is groups of practices across
England coming together and determining their geographical coverage, the patients that they
will represent, and I think that we should see this the position we find ourselves in
at the moment I think we should really celebrate the success of the last 12 months of those
practices in the proposed CCGs and those people who have supported them in SHA and PCT clusters,
because the work to get us to this point has been tremendous. Progress Defining boundaries
for CCGs I think it is a remarkable achievement in that as the practices have come together,
they have come up with a set of arrangements which not only allow them to be responsible
for their registered population, which is one clear responsibility that they have, and
that these NHS bodies will also be responsible for all the unregistered patients within their
area and for anyone requiring emergency or urgent care, who happens to be within their
area at the time. Through the work of the practices and the PCTs supporting them, we
have attached to the paper a map showing that the whole of England is covered, the CCGs
have been able to define their boundaries and the boundaries are material really to
the unregistered population and the delivery of urgent care. Still, the basis of the CCG
is still the practices and their registered populations. So, I think we should congratulate
them that they have been able to come together with a common interest of making sure that
they look after all the communities and all the populations in England. The CCGs at the
moment are working on their constitutions and determining how they will be governed,
the creation of their governing bodies, and appointing their senior personnel ready to
come forward to authorisation. The tables identify not only the numbers of the CCGs
and their geography but also the names of each of them. You will notice that they all
have a name which includes NHS and the geographical identification as well as a CCG. A new type
of organisation I think it is important to remember as well that these similarly are
very different organisations than any that we have seen before in the NHS, based on the
membership of the constituent practices, but with those constituent practices and the clinicians
in them having a remarkable responsibility to ensure that working with their patients
and their populations, and all the other key stakeholders and particularly all the health
and social care professionals in the area, and working with their health and wellbeing
boards can begin to identify the best services for that locality that they can commission.
Statistics I think there are some interesting numbers that we can just go through. There
are 212 emerging commissioning groups, which incorporate 8,355 GP practices. The smallest
proposed CCG is in Corby, which has only six practices and a population of 67,800. The
largest CCG proposed is North East and West Devon, which is 130 practices and a population
of 901,000. So, you will see, members of the Board, that there is a very significant variation.
The vast majority of the CCGs are between 150 and 400,000. There are 16 with a population
of between 500,000 and one million. 86 of the CCGs proposed exactly match current local
authority boundaries. Some actually cover span two local authorities. Many CCGs are
wholly within a local authority. Crossing local authority boundaries A small number
do cross local authority boundaries, but those CCGs are working with their local authorities
on what will be best for that population, because the reasons for crossing local authority
boundaries are usually to do with their patient flows, where patients from different local
authorities all have one particular hospital as their main provider, and they desire for
the CCG to be able to represent that population in the delivery of NHS services, whilst recognising
absolutely the need for them to be able to represent the population with their local
authority on those areas where health and social care overlap, and other health and
wellbeing issues. Authorisation waves The paper also identifies the authorisation waves.
We have 35 CCGs that have come forward to be in wave one. Those nascent organisations
are working very *** their preparation for authorisation and their stakeholder surveys
are underway. That wave should be completed by October 2012. Waves two, three and four
then follow each month, so that between October and January the Board will wish to note that
hopefully we will be bringing forward 212 CCGs to be authorised and established with
or without conditions. I think that we shouldn t underestimate the magnitude of the authorisation
process. The Board might also wish to note that we have recently awarded a contract to
PricewaterhouseCoopers to support this process. The bulk of that contract is for support,
additional resource and additional capacity at this very busy time in terms of analysis
and assessment, but also to support us in the assurance of the process, making sure
that it is robust and consistent and give the Board additional assurance on that. Commissioning
support organisations I think it s also worth at the same time me relaying to the Board
that, alongside the process for CCGs, we have also been going through the assessment and
authorisation process for commissioning support organisations. And the Board will want to
note that there s been really good progress with the CSOs, and they will be so material,
because without comprehensive commissioning support, the Board won t be able to be assured
as CCGs go throughout authorisation that they can deliver all their roles. 23 of 26 potential
organisations went successfully through checkpoint two of the process and will now move to checkpoint
three. The recruitment of the managing directors of those commissioning support organisations
will be undertaken during June. Proposals for the Board The Board has confirmed its
commitment to hosting these organisations for a transitional period, but with the clear
expectation that these hosting arrangements will be formed in way for them to be at arm
s length and clearly separated from the NHS CB s core and routine business, so that we
can both ensure that the organisations have the best possibility to move to independence,
which is their wish, and we will have a major role in supporting them to do that, but also
to ensure that the Board s core business is not deflected from by this very significant
hosting arrangements, which could be in the order of 7,000 staff. I would propose, if
I might, that I bring something to the next Board meeting, which gives greater clarity
on the programme arrangements for the hosting of commissioning support, so that we can see
how it works alongside the CCG authorisation process. So, if I could ask finally, then,
that the Board would do four things, really. Firstly, note the work that s been done and
the names and geographical distribution of these 212 CCGs. I think it s important also
if the Board could note the indicative running costs for the individual CCGs. You will remember
that the running costs were based on 25 per head of population. There is a difficult and
complex calculation to be made to determine exactly what that population is, given that
I ve already explained that it is a mixture of the registered practice population and
responsibility for unregistered patients, and also that there had to be a moderating
process to make sure that the final number matched the ONS statistics for the whole of
England. I would like the Board to agree that these are the configurations and these are
the 212 organisations that it will expect to support through the authorisation process,
and also approve the timing, where you will see that we have a slight skew in the timing.
We felt it was important to keep a relatively small number in wave one, given that it would
be the first round. Two and three are the largest waves and wave four will then be the
smallest. All these places in the waves have been agreed by the individual CCGs themselves.
Ed Smith: Thank you, Barbara. I think just on that point it looks like the wave two CCGs
are double the number of wave one, reflecting that increase. hTCs hq-l [Content_Types].xml
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