Organisational Development Plan

Transcription

1 The best possible outcomes for Southwark people Organisational Development Plan Authorisation Submission September The best possible health outcomes for Southwark people

2 Contents Page Introduction from the chair 3 1. The purpose of our organisational development plan 4 2. Background and context The borough of Southwark Introducing NHS Southwark CCG CCG leadership team and responsibilities 6 3. Our strategic context Goals our aims for the medium to long term Our operating position: priorities and finances 7 4. How NHS Southwark CCG will work Our mission, vision, strategic goals and values Clinical leadership and Locality working at the heart of the CCG Our governance arrangements Defining the organisation s form capacity and capability to deliver Developing the organisation to deliver our strategic goals Our OD priorities Reflecting an emerging organisation Capacity and capability gaps The journey so far Resources Addressing the Gaps an OD plan for the future Plans to meet our core responsibilities The Governing Body Education and Training Safeguarding children and adults at risk Conclusion and next steps 33 Tables 1. CCG OD priorities to ensure development as a membership organisation 4 2. CCG Functions by Point of Delivery List of functions to be procured by the CCG Initial and repeated Roadmap diagnostic Development interventions run in 2011/12 and / Indicative OD interventions Figures 1. Our strategic goals 7 2. Southwark CCG commissioning support budgeted expenditure 2013/ Southwark CCG Organisational Structure Universal improvement by Southwark CCG 22 2

3 Introduction from the Chair I am very pleased to introduce the NHS Southwark Clinical Commissioning Group (CCG) Organisational Development (OD) plan. My clinical colleagues and I are enthusiastic about the future for our local health services. We are confident that our CCG, as a clinically-led membership organisation of all Southwark practices, will be in a prime position to ensure local services of the highest possible quality are organised to deliver better outcomes for our patients. Those of us who know Southwark understand that it is a vibrant and diverse place to live and work. We also know that a range of differing needs exist amongst the population here. Southwark s clinicians have a tradition of being involved in planning and co-designing services and of being committed to working with partners for the common good of our patients and residents. The coming years represent a time of significant change to the way services will be delivered, and to limitations in resources. It is in everyone s interests to ensure that resources are spent effectively, allocated fairly, that services are of the highest possible quality, and produce the outcomes the population both need and deserve. We recognise that the CCG is a new type of commissioning organisation. It will have a different approach to its responsibilities to those that have gone before and consequently will operate differently to its predecessors. Key features will be clinical leadership adding value to commissioning, and a collaborative approach as a membership organisation. Additionally, the CCG recognises the need to work very effectively with a wide range of communities, partners and stakeholders to optimise and transform local services. We must bring clinical insights from practices to the forefront of service design, and better understand the views and priorities of local patients, residents, carers and communities. In every case our ambition is to improve the lives of our patients by working to make local health services the best they can be. To make these improvements a reality we will work hard to deliver our over-arching strategic goals of improving life expectancy, reducing health inequalities and narrowing the variation in primary care quality and outcomes. We have worked hard to develop this OD plan with these goals in mind, and have taken care to clearly set out how we will meet our responsibilities over the coming years. We recognise the context for commissioning and the new system architecture continues to change and we will continue to refine and develop this plan over the coming months leading to April We are confident that by working together with our staff, local people and partners in this new, clinically-led organisation, we can make real improvements to local services and enhance the lives of people in Southwark. Dr Amr Zeineldine Chair of NHS Southwark Clinical Commissioning Group 3

4 1. The purpose of our organisational development plan This is a time of unprecedented organisational change in the NHS. CCGs are completely new organisations, with primary care clinicians leading decisions about commissioning whilst still conducting their role as family doctors for a local population. This duality of role means CCGs are organisations with a complex make-up: staff employed by the CCG, staff employed in small businesses, an organisation of membership practices from a wide geographical area, clinicians, managers and commissioning support staff a melee of different cultures, backgrounds, roles, and experiences. These diverse pieces are now brought together under the umbrella of a CCG by strong leadership and a sense of purpose to improve patient outcomes. A different operating style is needed to ensure that the organisation has a culture, mind-set and behaviours that reflect its ambitions. Organisational development (OD) is a planned and systematic approach to enabling the sustained performance of an organisation through the involvement of its people. Southwark CCG must be an effective and responsive organisation if we are to achieve the best possible healthcare for local residents and serve our staff and members well. This OD plan outlines how our variety will be brought together to create synergy; it identifies how NHS Southwark CCG will use its diversity to ensure clinical value is added to the commissioning process. Extensive work has already been undertaken by the CCG in Shadow form, the OD challenge now is to build on this and pull the diverse pockets together into a cohesive organisation. Table 1: CCG OD priorities to ensure development as a membership organisation OD Aims OD Priorities Identify quality and how to achieve it Is a highly effective commissioner Use partnership, collaboration and matrix working well Is transparent, accountable and accessible Clinically led Customer focussed Collaborative Competent and capable Communicate effectively The purpose of this OD plan is to: shape and support the CCG to deliver its strategic plan ensure that any short term actions support delivery of our longer term objectives ensure all organisational enablers necessary are in place and effective support NHS Southwark CCG to mature its knowledge and expertise on its journey towards authorisation and beyond be a living document, regularly refreshed as different needs are identified and external requirements change 4

5 2. Background and context 2.1 The borough of Southwark Southwark is a densely populated, geographically small and narrow inner London borough that stretches from the banks of the river Thames to the beginning of suburban London south of Dulwich. The population is relatively young, ethnically diverse, with significant contrasts of poverty and wealth. There is wide distribution in educational achievement, access to employment and housing quality. Major regeneration programmes have been underway for some time leading to significant changes in landscape and population structure and this continues to be the case. Major health indicators such as mortality and life expectancy have improved, but there are significant inequalities in these indicators for people living in different parts of the borough. Southwark s population is estimated at 294,400 (source ONS 2010). Southwark s population has increased by 37,700 over the last 10 years (ONS Mid-1991 Population Estimates) and is estimated to increase by 37,500 (13%) between 2010 and % of the population is under the age of fifty with a large proportion of the population aged between 20 and 45. There is a high level of ethnic diversity with 63% of people being white, 26% black (of which 16% are of African origin). Amongst younger people, 68% of school pupils are from ethnic minority backgrounds. Southwark s level of deprivation has improved in recent years but still remains the 12th most deprived London Borough (41st nationally). Deprivation is not evenly distributed across the borough but concentrated in the area between the more affluent strip close to the river and Dulwich in the south. Men in Southwark can expect to live for 77.8 years, women 82.9 years. Male life expectancy is lower in Southwark than London or England. However, life expectancy for males has increased over the last decade and the gap between Southwark and England is steadily reducing. Over the last decade female life expectancy has been steadily increasing and is now higher than the national average. Within Southwark there is much variation in life expectancy, the difference between the worst off and best off is 9.5 years for males and 6.9 years for females. Continuing inequalities in health within the borough remain of concern. The numbers of deaths per year are reducing in Southwark. The death rate has fallen, from per 100,000 in 2000 to per 100,000 in 2009, bringing it broadly in line with the rate for London (523.1) and England (547.3) and below near neighbours Lambeth (644.4) and Lewisham (604.2). Approximately one third of these deaths are early deaths (under the age of 75) with the main causes of premature mortality cancers (35%), circulatory disease (23%) and respiratory disorders (5%), with major contributions to long term morbidity from diabetes and renal disease, hypertension, mental illness and HIV, linked to the specific population demographic. This is the context in which the CCG will develop as an organisation. 5

6 2.2 Introducing NHS Southwark CCG Southwark Clinical Commissioning Group (CCG) is a membership organisation of all general practices serving the local community. The CCG is coterminous with the London Borough of Southwark local authority. The combined registered population of Southwark s 47 general practices is circa 318,000. In November 2010 Southwark Health Commissioning was one of eight clinical commissioning groups in London to be awarded First Wave pathfinder status. Building on a strong track record of local clinical commissioning, the members of the emergent CCG were able to demonstrate compliance with the three tests set by the Secretary of State (relating to local GP leadership and support, local authority engagement and an ability to contribute to the delivery of the local QIPP agenda) at the earliest stage in 2011/12. Since this time the emergent CCG in Southwark has worked with NHS South East London PCT Cluster to develop the capacity and capability to assume 100% delegated responsibility for all areas of commissioning that it is scheduled to assume statutory responsibility for from April As a first wave pathfinder and a CCG with significant and long held delegated responsibility for commissioning we have had an opportunity to shape the development path of these new organisations and to learn by experience over the last 18 months. 2.3 CCG Leadership Team and Responsibilities As a membership organisation, the CCG will be run by its member practices. To do this effectively the CCG has established a Governing Body, which will act to perform those functions and responsibilities delegated by the CCG member practices and those accountabilities required in the Health & Social Care Act (). The CCG Governing Body is responsible for assuring the delivery of commissioning and corporate objectives set out in the Integrated Plan. The CCG is clinically-led and will operate with a borough-based management team to direct activities across the scope of the commissioning portfolio. Although the Governing Body will act to take decisions on the vast majority of CCG business, members have agreed to create a forum for more direct practice involvement in decision making and have proposed a Council of Members on which each practice is represented. The Council will meet bi-annually and act to both approve the annual commissioning plan and seek direct assurance from the Governing Body that it is delivering the plans. The Council will also be the forum for considering any changes to the CCG Constitution ahead of proposing these to the NHS Commissioning Board. We have prioritised distributive leadership and partnership working as an organisation and our OD plans will seek to respond to this. 6

7 3. Our strategic context 3.1 Goals our aims for the medium to long term NHS Southwark s CCG strategic plan identifies a number of goals which will be achieved when we successfully implement improvements in our priority areas. Figure 1: Our strategic goals: 3.2 Our operating position: priorities and finances Our service priorities were identified by clinicians and practices, recognising the need to drive improvement in quality of care and patient outcomes. In considering priorities we worked closely with public health colleagues and listened to the views of Southwark patients and public and see our seven priorities as crucial to delivering our goals: Better outcomes for people with Long Term Conditions Outpatient services that enhance patient experience Improve rates of early diagnosis and to better quality of life for people with cancer Improve outcomes for people with mental health needs Develop a well-integrated and high quality system of urgent care Support more people to stay healthy and prevent ill-health Embed clinical and cost-effective prescribing across care settings 7

8 Our Integrated Plan has identified indicators which we will used to evaluate the impact of clinically-led commissioning on improving quality and outcomes over the life of the strategy. The CCG will operate with a commissioning budget of circa 400m. The overall CCG riskprofile has improved as a consequence of strong financial performance in 2011/12 and because of steps taken to manage financial risk. This includes reducing the risk held on provider overperformance and strengthening our reserve position. Southwark CCG will inherit a sound financial platform, although must deliver the major change programmes set out in this plan to maintain financial balance in the years ahead. A detailed view of the CCG financial position is included in the Integrated Plan 8

9 4. How NHS Southwark CCG will work 4.1 Our mission, vision, strategic goals and values We will need to work differently and with partners if we want to make this vision a reality. Organisational success will be measured in terms of improved health outcomes and improved patient satisfaction with the care provided. Our behaviours will demonstrate our values. The ambition, values and behaviours our employees and member practices have signed up to will iteratively shape our organisational culture and operational priorities. Mission The CCG s mission or overarching purpose is to commission high quality services that improve the physical and mental health and wellbeing of Southwark residents and result in a reduction in health inequalities. The CCG will ensure commissioning for our population will be: Evidence based Focused on clinical outcomes and high quality standards of care Led by local frontline healthcare professionals Determined by local need Informed by genuine patient and public engagement, and Result in more information and choice for patients Vision The CCG will work to achieve the best possible health outcomes for Southwark people. The vision for services commissioned on behalf of Southwark s population is that they function to ensure: People live longer, healthier, happier lives no matter what their situation in life The gap in life expectancy between the richest and the poorest in our population continues to narrow The care local people receive is high quality, safe and accessible The services we commission are responsive and comprehensive, integrated and innovative, and delivered in a thriving and financially viable local health economy We make effective use of the resources available to us and always act to secure the best deal for Southwark Values We have defined the values and behaviours that we will adhere to and that our members, staff and patients can expect from us as being: Continue to be guided by the founding principle of the NHS - that good healthcare should be available to all, free at the point of delivery Place patients, health improvement and quality at the heart of everything we do Be honest and open about the actions and decisions we take 9

10 Remain accountable to the public and recognise our responsibility to act in the best interests of the population we serve Ensure our decisions are evidence based, fair and make best use of the resources we have available to us Act responsibly as a public sector organisation and are committed to working in partnership with local government, voluntary organisations and the wider community to ensure a united approach to tackling the wider determinants of poor health in Southwark. Appendix One sets out the alignment between our values, our OD priorities and our strategic goals 4.2 Clinical Leadership and Locality working at the heart of the CCG The leadership arrangements and locality working of the CCG are outlined in detail in the CCG Organisational Structure Document. In summary: NHS Southwark CCG is a membership organisation of all 47 practices in the borough. It is organised around three localities of practices. The localities reflect a recent consultation, Transforming Southwark s NHS which involved more than 3,000 local residents and stakeholders in discussions about future service provision. The localities were agreed as being representative of areas where clinical teams had already established collective working, so were retained both as a practical means to organise the CCG and also to plan service change. Each locality meets at least eight times per year, led by their clinical leads and supported by members of the CCG Management Team. These forums provide an opportunity for two way communication between the shadow Governing Body members and their localities, and for agendas to be set which reflect commissioning issues at that time. The CCG has established a number of communication routes including an intranet to facilitate interaction. The agendas, papers and minutes of all shadow Governing Body (SCCC) meetings are made available to practices ahead of the meetings in order that constituents can be aware of the discussions, see concerns and issues are played in and be able to comment upon those papers. Engaging member practices is critical to the success of the CCG. The CCG runs Protected Learning Time (PLT) events that provide further opportunities for practices to come together, discuss commissioning issues and convey core messages. Southwark PLTs regularly have an audience of over 100 people and so have enabled the CCG to keep contact with practices and representatives across the area. Our constitution introduces a new forum, a Council of Members, which further involves members in the running of the organisation. The clinicians making up the leadership team of the Governing Body each hold a portfolio for commissioning and for corporate functions to lead and manage the local health system. These portfolio areas are outlined in the job description and person specification against which GP leads were recruited via a formal Selection/ Election process (May-June ). The person specifications also contained the competencies required as a clinical leader, and all applicants were interviewed against these before being offered for election by all Southwark GPs. When taken together the portfolios cover the entirety of commissioning responsibilities across the borough. 10

11 GP leads on the Governing Body hold three key responsibilities to allow them to operate with increasing delegated responsibility: A leadership, management and engagement role for member practices in their locality A commissioning portfolio across the borough with responsibility for securing agreed QIPP plans in each area A corporate portfolio across the borough with responsibility for ensuring effective performance management for each area of local commissioning A secondary care Nurse and Doctor are being recruited to the Governing Body in line with national recommendations and we anticipate them being in post by Autumn. A Practice Nurse is also part of our shadow Governing Body to represent their peer group, and multi-disciplinary views are included through a number of forums. A Future Leaders programme has been run to facilitate clinical succession planning (see section 5). A similar succession planning programme will be introduced for Lay Members in recognition of the importance of the role, its isolation from main-stream work and potential difficulty to fill, and the number high calibre of applicants from a recent recruitment drive. 4.3 Our governance arrangements The governance arrangements and locality working of the CCG are outlined in detail in the CCG Organisational Structure document. In summary: As a membership organisation it is the members of the CCG who are accountable for exercising its statutory functions and delivering against its responsibilities and objectives. The CCG remains accountable for all its functions, including those that it has delegated. The Scheme of Reservation and Delegation in the Southwark CCG constitution sets out the key functions and who has delegated responsibility for fulfilling these. In essence, the member practices have: delegated key strategic functions to a Council of Members; delegated other strategic functions and all operational functions to the Governing Body; permitted the Governing Body to delegate appropriate operational functions to its various committees; The Governing Body has ultimate responsibility for CCG delivery of plans, purpose and mission. The Governing Body will consider reports to track the overall position against all aspects of performance, quality, finance and QIPP delivery whilst delegating responsibility for implementation to strategic programme boards and committees. 4.4 Defining the organisation s form capacity and capability to deliver Identifying the CCG s Commissioning Support Intentions As part of the work completed to develop the governance and organisational structures of the CCG, the leadership team in Southwark has completed a process of review of all commissioning support functions to identify those which needed to be local and those that should be provided at scale. Clinical leads have worked closely with officers to model a number of scenarios looking at how they should use their running cost allocation to ensure the CCG has 11

12 the capacity and capability to support the CCG deliver its full range of responsibilities and in this achieve value for money. The process allowed clinical leads to understand the scale of change required from existing staffing structures in order to deliver an efficient and effective commissioning support function within the 25 per head management cost allowance. In determining the structure of their commissioning support, the CCG leadership team considered the following factors: Opportunity to secure expert support (by sharing resource if needed) To maintain a strong borough-based presence to oversee redesign & delivery Affordability within 25 per head allocation Retain and build upon local relationships where these are working effectively Alternative support services available Southwark CCG s Organisational Structure was published on 9 August, with post being filled during August in accordance with the agreed HR processes. Recruitment to vacancies will take place during September. The new CCG structure will operate in shadow form to promote team working with clinical commissioners, and to see that staff gain a better understanding of roles and responsibilities required from April. Developing the South London Commissioning Support Unit (SLCSU) Having identified those services that the CCG elected to buy, CCG clinicians and senior managers participated in workshops across south London CCGs to test the feasibility of a Commissioning Support Service being provided across the 12 emerging CCGs, recognising the opportunity for significant efficiencies of services provided at such scale. This work identified key differences in the approach and requirements of CCGs and underpinned the creation of the emerging SLCSU. CCG clinical leads and senior management team have continued to work with the SLCSU on the development of their Outline Business Cases to support the CSU through the phases of the NHS Commissioning Board s BSU s business review process for authorisation. Extensive work with SLCSU on clarifying and refining their offer and the interfaces with the CCG s own staff and functions has been completed over the previous months, which has included participation in codesign workshops, function focused groups and reviews (e.g. acute contracting, performance and information), and supporting the CSU team in writing specifications. The CCG and CSU structures will work in shadow form from October, enabling the CCG to be fully-functional before it assumes statutory responsibility for commissioning in April Working with the Local Authority As part of this process the CCG held discussions with Southwark Council about possible options for procuring support services and joint commissioning arrangements. The CCG and local authority signed memorandum of understanding committing both organisation to explore these opportunities in the future. This agreement acknowledged that the Local Authority was due to undertake a significant restructure of its own management arrangements, now due to conclude in October. 12

13 Securing Capacity & Capability To ensure we have capacity and capability to undertake our full range of responsibilities within the management cost allowance of 25 per head, the CCG has mapped out what can best be delivered locally by a dedicated in-borough team and what support would be better procured and provided at scale. The process we undertook to get there is detailed in the above section (and in detail with the CCG Organisational Structure document) and the mapping of CCG commissioning functions is included in figure 2. Table 2 then sets out how the CCG will utilise its 25 per head of population allowance to secure the capability and capacity required to enable it to meet its responsibilities and deliver its Integrated Plan. Figure 2: Southwark CCG Commissioning Support Budgeted Expenditure 2013/14. -per-head-of-population Accommodation % Administration & Corporate Affairs % Commissioning Support Unit % CCG Based Commissioning % Clinical Lead and Network % Governing Body % Other Non Pay % 13

14 Table 2: CCG Functions by Point of Delivery Function CCG Structure DH Category (Towards Service Excellence) SLCSU Directly Employed by CCG Shared with other CCGs Patient Involvement Communications & PPE Strategic Communications and Public Engagement Communications & PPE Patient Experience Communications & PPE Infrastructure Services Business Intelligence & IT Data Safety Services Business Intelligence & IT Clinical Redesign Business Intelligence & IT Data Management Services Business Intelligence & IT Contract & Financial Activity Information Business Intelligence & IT Provider Management Information Business Intelligence & IT Local Health Strategic Planning Info Business Intelligence & IT Clinical Policy Development Support for Service Redesign Implementation of Clinical Policies Support for Service Redesign Quality and Value Assessments Support for Service Redesign Market Assessment Procurement & Market Management Contract Requirements Procurement & Market Management Procurement Services Procurement & Market Management Management of Complex / Exceptional Cases Procurement & Market Management Co-ordination of Joint Commissioning Procurement & Market Management Continuing Health Care Procurement & Market Management Prescribing Services Procurement & Market Management Contract Renewals Management Provider Management Provider & Contract Management Provider Management Safeguarding Provider Management Quality and Governance Provider Management Performance Management System Back Office Financial Strategy Back Office Financial Management Back Office Financial Accounting Back Office HR & Payroll Back Office Legal Services Back Office Corporate Governance Back Office The NHS Southwark CCG clinical leadership team values the dedicated support it has received from NHS Southwark Business Support Unit over the period in which it has operated with delegated authority from the PCT Board. Clinical leads in Southwark agreed that retaining a strong-borough based team was absolutely necessary to ensure that the CCG is able to operate as an effective organisation. Having completed the scenario planning using the DH Ready Reckoner Tool V2, and having determined those support functions it wanted to retain in-house, CCG clinical leadership have led the design of the CCG s organisational structure. The CCG organisational structure is included on figure 3 on the following page. The CCG will be supported by a borough-based team that includes the following functions: Chief Officer & Chief Financial Officer Senior Management Team CCG Quality & Performance Management Strategic and Business Planning CCG Governance, Risk Management and Assurance Organisational Development Membership and public engagement 14

15 Service Redesign Team Support to CCG Localities and Member Practices Community Contract Management Mental Health Contract Management Mental Health Service Redesign Continuing Healthcare Commissioning Safeguarding and designated nurse for child protection Administrative Team and Corporate Secretariat CCG Medicines Management Functions shared with other CCGs Sexual Health Commissioning (with Lambeth) SEL CCG Programme Management Office (Across south east London CCGs) Southwark aims to have full staffed its organisational structure by October, following the London-wide staff engagement process. The Chief Financial Officer will be responsible for the management of the SLCSU Service Level Agreement with specific KPIs managed and monitored by the CCG Senior Management Team. 15

16 Figure 3: Southwark CCG Organisational Structure 16

17 SLCSU Structure The CCG recognise that standardisation of processing functions at greater scale can bring significant benefits to the organisation by taking advantage of scaled-up services that provide high-quality expertise and offer economies of scale. Southwark CCG has worked with partner CCGs in south east and south west London to shape commissioning support services ensuring we can procure the services we need to enable us to deliver our Integrated Plan. Having carefully considered, and assessed, our preferred options for the provision of commissioning support, the Southwark Clinical Commissioning Committee (Governing Body, post-authorisation) have agreed to procure services from the South London Commissioning Support Unit. The South London CSU has identified one of its Directors to be the liaison lead for Southwark, and has outlined plans to introduce a Stakeholder Board comprised of senior representatives from all its customers. At the end of March Southwark CCG signed a short MoU with the CSU agreeing to work jointly to develop CSU services for the CCG. A detailed Memorandum of Understanding has been subsequently agreed and incorporates the main elements to be included in an SLA progresses this by agreeing the main elements which will form part of an SLA. The MoU details how the parties have agreed to work together during /13; acts as a precursor to the SLA which will be required from 1 April 2013, setting out the key elements which will be included in the SLA; supports the CSS in preparing its Full Business Plan by evidencing customer commitment; and explains how the CSS and CCGs will work together during the period of shadow CSS operation (from 0ctober ). The draft SLA is under development and will be agreed by October. It will set the target standards for operations during the period October to March 2013 and will allow for shadow running of the SLA before formal commitment to detailed KPIs in early We would expect commissioning support service providers to develop and work with other suppliers to secure best practice products and services, recognising that innovation and development opportunities may not only be present within the South London CSU at a single scale. We will continue to test our internal and external commissioning support going forward and between we will put in place arrangements to go through a compliant procurement for support services as appropriate. In planning for this process we have worked with CCG partners to look value for money and market testing (some of these considerations are included in the draft South London CCG and South London Commissioning Support Unit Organisational Development narrative to support authorisation is included as Appendix 2). These arrangements may include CCGs setting priorities for the CSU to undertake Value for Money reviews on specific services with the aim of testing all services by This would include a structured and independently assured process for benchmarking price and quality against other commissioning support providers or the business support marketplace. The Chartered Institute of Public Finance (CIPFA) value for money toolkit will be explored to offer cost and performance comparisons with other public sector providers. South London CSU Core Functions Through its extensive engagement with the SLCSU, the CCG leadership team considered the following functions in table 3 to be of benefit to the organisation when delivered at scale. The lists of functions have been agreed through co-production between Southwark CCG, local CCG partners and the emerging CSU. Clinical leaders have been centrally involved in the series of development workshops run to establish CCG requirements for their CSU. 17

18 Securing Communications Capacity & Capability The CCG has worked with management colleagues, partners in neighbouring CCGs and other at the SLCSU to agree the shape and structure of dedicated external and internal communications capacity. The CCG leads recognise this function has a particularly important role in enabling the CCG to engagement member practices, patients and the public in order to deliver its Integrated Plan. CCG senior managers and clinicians have participated in SLCSU workshops specifically focussed on developing a communications service at scale and this has been secured in the MoU and subsequent SLA with the SLCSU. Table 3: List of Functions to be procured by Southwark CCG from South London Commissioning Support Unit Function Acute Contract Management Individual Funding Requests (IFRs) Advice & Support on Clinical Procurement Performance Reporting & Data Management CCG ICT Financial Management & Planning Financial Governance & Control, Counter-Fraud, Internal Audit HR Estates and Health & Safety Purchasing (non-clinical) Communications and PPE Clinical commissioning network Description Comprehensive contract management service, providing performance, negotiation and transactional support for CCGs across their acute services contract portfolio Management of the end-to-end IFR process The clinical procurement service will provide CCGs with responsive, flexible and up-to-date advice and guidance in relation to clinical procurement Provision of standard reports and data sets across a range of areas covering: commissioning, financial and clinical, as well as statutory reporting A support service which covers the strategic and operational Information Communication and Technology needs of CCGs Providing financial and business advice, internal and external financial reporting Support on statutory duties, relationship management of outsourced services, and technical expertise (e.g. financial controls, governance advice, cash management) Support on employee services (transactional), employee development, and provision of expert advice and support Advisory service providing expert knowledge on health property and estates related issues Best practice advice on the purchasing and procurement of nonclinical resources so that CCGs can achieve cost savings and value in non-clinical spending Communicating and engaging with all stakeholders, managing the reputation For the commissioning of cancer, CVD and stroke services The Memorandum of Understanding between Southwark CCG and South London Commissioning Support Unit is attached as Appendix 3. 18

19 Public Health The CCG has worked with colleagues in Southwark Local Authority and with partners at Lambeth CCG and local authority to scope an opportunity to secure a public health resource once this function transfers to local authorities from April Southwark CCG Board has endorsed a proposal for an innovative and progressive specialist public health service covering both Lambeth and Southwark. The new shared resource will enable the two boroughs to lead the way in improving health outcomes, reducing health inequalities, delivering our Integrated Plan and implementing the Health & wellbeing Strategy. A shared Director of Public Health to be appointed by September will provide the leadership and expertise over the period of transition. The CCG will begin to work under these arrangements from October in shadow form ahead of the transfer of public health to the local authority in April We are currently in the process of developing a core offer and SLA to secure our future public health resource from the new shared service. A draft Memorandum of Understanding (MoU), which has been developed in partnership with Southwark Local Authority has been signed September and commits both parties to working collaboratively to define the core offer and work to establish the new organisation in shadow form from January 2013, operating under these terms and secured with an SLA. The Southwark Memorandum of Understanding on Public Health is attached as Appendix 4. 19

20 5. Developing the organisation to deliver our strategic goals 5.1 Our OD priorities The CCG has identified the strategic goals it will target on in order to improve the quality of care and patient outcomes. To deliver these the CCG has also identified the OD actions it needs to take. This section sets out how we will deliver change and the phases of implementation. The tables overleaf include OD plans for /13 and headline OD intentions in for 2013/14. Our OD priorities to support our strategic ambition are summarised below and expanded on in the tables on subsequent pages. Our OD priorities are: 5.2 Reflecting an emerging organisation Given the strategic context, NHS Southwark CCG needs to ensure it is offering maximum support to itself as a new organisation. This OD plan is very much an emerging document reflecting a continually evolving context. The focus for the next stage is re-defining itself as a 20

21 membership organisation. The organisational development plan will enable us to progress through authorisation and beyond in an efficient, effective manner, ensuring we have the capability, capacity and culture necessary to deliver our responsibilities. This OD plan is for the two-year period until one year post-authorisation. Before April 2013 the plan will be refreshed and revised in response to the rapidly changing environment and so clarify the OD priorities for 2013/ Capacity and capability gaps We recognise that as a First wave Pathfinder and in our early work we prioritised leadership, governance and structure. This was the right focus in order to define a robust, clinically led new organisation. Our OD plan now needs to extend across the whole organisation in order to pull it into a cohesive unit in which everyone understands the mission, goals, priorities, and their role in achievement of them. As we recruit to the CCG management team and develop an enhanced understanding of every members needs we are seeking to continually review our OD plans. At the current time we have: drawn on diagnostics from a variety of sources used the diagnostics to define a plan which acknowledges the uncertainties of a new organisation in a rapidly evolving environment, recognised that we must be fleet of foot, open to change, and able to react to emerging issues planned to deliver in-house wherever possible and boost capacity by accessing whatever external resources we can identify (NMET 1 CPD, MADEL, National Leadership Academy, Top Leaders, National Innovation Institute, etc.) Sources used to understand our emerging development needs include: review of the Pathfinder Development Plan and Statement of Works roadmap diagnostic process and refresh undertaken with GP Leads online 360 assessment for GP Leads development plans for Chief Officer and Chief Financial Officer feedback gathered at SCC Away Day sessions, PLTs, locality meetings and practice visits outcomes from staff workshops on developing the CCG and CSU staff survey results and action plans staff appraisals and PDPs In a short space of time the CCG has already taken great strides forward on its journey to become authorised as a statutory organisation, supported by a range of development and training initiatives. A national diagnostic tool for CCGs was used to self-assess our readiness for statutory authorisation. The original and repeat scores are shown below. 1 NMET non medical education and training levy, MADEL medical and dental education levy 21

22 Table 4: Initial and repeated Roadmap diagnostic scores indicating the priority areas for shadow Governing Body development: Range of mean score Domains with lowest mean scores First Roadmap Diagnostic Repeat Roadmap Diagnostic 2.2 to to 3.7 Planning ( 2.4 ) Empowering Patients & Public ( 2.8) Monitoring ( 2.2) Monitoring ( 3) Clinical Governance ( 2.4) Clinical Governance ( 2.5) Board members were supported in identifying their training needs and based on this an ongoing development programme has been provided since Autumn Figure 4: Universal improvement by Southwark CCG across all domains Comparative Analysis:Scores by Competency Initial Roadmap Repeat Roadmap 5.4 The journey so far The CCG has a credible track record and has already made significant progress on its development journey. The shadow Governing Body (SCCC) has been working successfully since achieving first wave Pathfinder status, though recognises there is still work to ensure the CCG maintains full capability and capacity for services. As a new organisation it expects to develop in its role, reviewing and adjusting the OD plan to reflect learning and emerging issues. Areas it has already moved forward on include OD advice: The CCG has worked closely with OD teams from five neighbouring CCGs, the Commissioning Development teams at cluster and NHS London to seek advice on organisation design and process improvement, benchmarking and best practice for key staff roles. This informed the design of our employed staff structure, shared areas, and those to be provided by CSU. Board Development: Facilitated events have taken place to support the CCG board develop our strategy, values, and mission beyond the monthly formal Governing Board meetings. Succession planning: A pilot scheme was run for primary care doctors interested in developing their leadership and commissioning skills. Following a competitive 22

23 application/interview process applicants were offered mentoring, participation in development events, and access to leadership meetings. The scheme was very successful and will be rerun in /13. Partnerships: External funding has been secured to provide a bespoke development programme to support partnership working. This will be run in conjunction with Lambeth and Lewisham CCGs, the neighbours with whom we will work increasingly in partnership. Support and development for our member practices: The management team has shaped an organisation that is practice-facing, meets the needs of the members, and the 3 locality groupings within the CCG. For over a year we have been funding, organising and providing Protected Learning Time sessions for clinical and non-clinical staff working in member practices. Funding provided via a LIS (Local Incentive Scheme) allows practices to close for a session a month to undertake education development. This has provided the opportunity to tailor training events to focus on clinical updates, and offered the opportunity to ensure that member practices are kept up to date with progress in the CCG. Each event is evaluated and steps are taken to incorporate practice views in future plans. We are about to re-launch a practice nurse forum through our Practice Nurse representative on the Governing Body. We will support clinicians to undertake the new role of Practice Representative on the Council of Members. These may take place at each of the protected learning time events to enable greater coverage. The constitution was drafted in consultation with member practices. We have written and circulated a handbook for the member practices as a useful reference guide for them regarding CCG development. Staff development and engagement: We recognise the need for greater visibility of CCG central staff to GP practice teams and more integral working between practice staff, GP leads and central support managers. Once CCG staff are confirmed in post a programme to build up team working across boundaries will be launched. All staff have appraisals and PDPs. Managers will be asked to develop individual and team objectives for beyond authorisation for 2013/14. Regular staff briefings are held to advise staff of key transition issues as PCT functions increasingly transfer to CCGs. The Chief Officer (designate) facilitates regular team meetings to take a temperature check of issues and concerns. 23

24 Table 5: Some of the development interventions run in 2011/12 and /13. Authorisation Domain A strong clinical and multi-professional focus which brings real added value Meaningful engagement with patients, carers and their communities Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge within financial resources, in line with national requirements (including excellent outcomes), and local joint health and wellbeing strategies Development needs identified Improved ownership of Southwark Vision More engagement with secondary care clinicians Need to move from patient and public engagement to greater involvement in decision-making Basic Finance training for GP leads More robust data and information to understand primary and secondary care activity and quality Some development actions taken so far Leadership away-day run to revisit vision & increase ownership by GP Leads Vision shared with all GPs at PLTs Joint development session held with secondary care and LA to focus on local needs and service redesign Communications review done Patient engagement workshop run 1:1 support provided for GP Leads on patient and public engagement Acute Trust Finance session run for clinicians Investment and prioritisation Master class run Data and informatics support provided Master class run Becoming an intelligent client 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 Develop outcome-based clinical commissioning focused on pathways Leadership away day run on designing a new-look membership organisation Contracts and Procurement workshop run Practical CoI training run Pathway & outcomes-based commissioning Master class run Risk Appetite workshop run for Board Commissioning Strategy Plans workshop run on focusing on outcomes 24

25 Collaborative arrangements for commissioning with other CCGs, local authorities and the NHS Commissioning Board as well as the appropriate external commissioning support Great leaders who individually and collectively can make a real difference Need to work collaboratively with the LAs and neighbouring CCGs Variation in representation on the Board from North and South practices Joint development day run with LA, Lambeth and Lewisham CCGs Joint Clinical Strategy Committee launched for Lambeth, Southwark and Lewisham Joint development programme scoped with Lambeth and Southwark to be delivered in Autumn 1:1 sessions run with GP Leads to review roles and portfolios 1:1 leadership coaching for GP Clinical Leads based on their 360 feedback Future Leaders programme run for aspiring clinical leaders Re-election of Governing Body using transparent Selection/election process 5.5 Resources Southwark CCG has allocated approximately 300k in /13 to enact its organisational development plan, including elements which may move to other bodies such as Practice Learning Time events. In addition the CCG management structure includes a Head of OD and Governance and a dedicated Membership development team to support the delivery of this plan 5.6 Addressing the Gaps an OD plan for the future Having identified our gaps, this plan shows an outline of how we will address our organisation development needs up to A full, prioritised OD plan will be developed once structures and individuals are known. Table 6: Indicative OD interventions The following tables expand on our OD goals and the interventions to be achieved in /13 and 2013/14 which were informed by our diagnosis. 25