Agenda Item 9 Appendix 1 Organisational Development Plan Potential for Excellence. 2014/15 2015/16 Author Lisa Webb June 2014 1
Contents Page 1. Introduction 3 2. Context 3 2.1 Framework of Excellence 5 2.2 Equality and Diversity 6 2.3 The Francis Report 7 3. Our Organisation 7 3.1 Our Organisational Development Goals 7 3.2 Our Vision and Mission 8 3.3 Values 8 3.4 Strategic Priorities 9 3.5 Organisational Goals and Corporate Objectives 10 4. Our Organisation framework and plan 11 4.1 Development of the workforce 11 4.2 Leadership skills 11 4.3 Assessment of capacity and capability 11 5. Achievements to date 13 6. Assurance 14 7. Reference Documentation 14 Appendix 1 Organisational Development Plan 16 Appendix 2 Framework for Excellence in Clinical Commissioning review tool 19 2
1. Introduction The organisational Development (OD) Plan describes the journey and actions needed for Luton CCG to commission the best possible health and wellbeing services for the people of Luton. The purpose of the Organisational Development Plan is to set out how Luton CCG will develop its skills, capacity and capability in the range of areas necessary to make it a dynamic, innovative responsive and effective commissioning organisation. The plan outlines how the organisation will support the development of a culture of innovation, increase job satisfaction, develop positive relationships and foster greater participation in creating plans and defining organisational goals. The plan focuses on the following key areas to ensure the establishment of a healthy, successful organisation: values, people, structure and systems. The practice of OD is grounded in a distinctive set of core values and principles that guide behaviours and actions (interventions). These include: Respect and inclusion the perspectives and opinions of everyone are valued equally Collaboration building win-win relationships in the organisation Authenticity people within the organisation should behave congruent with their espoused values Self- awareness committed to developing self-awareness and interpersonal skills within the organisation Empowerment focus on helping everyone in the organisation to increase their individual level of autonomy, and sense of personal power and courage, in order to enhance productivity and elevate employee morale Democracy and social justice recognising that people will support those things for which they have had a hand in shaping; that human spirit is elevated pursuing democratic principles 2. Context The NHS has undergone a period of radical structural change as the Coalition Government implements its intentions for reform set out in the new Health and Social Care Act 2012. On the 1 April 2013 Luton CCG became fully responsible for commissioning health services for the local people of Luton. In parallel with this the NHS in England is required to deliver efficiency savings of 9% in 2014/15 and 2015/16 in order to continue to improve the quality and safety of our health services. The system of delivery will need to radically change and the leadership and skills which were part of the old system will not necessarily be the ones which create an effective new system. The NHS England CCG Development Framework and the NHS England CCG Assurance Framework 2013/14 have begun to look at both the characteristics of a high performing CCG together with the means by 3
which they will be assessed and also what the offers will be to CCGs to support them in moving beyond authorisation to excellence. Emerging characteristics of CCGs in practice which show great potential include: a strong sense of the CCG belonging to its members; driven by insight, learning and a strong wish to improve; holding a powerful vision for change, captured in practical planning; demonstrating inclusive leadership of communities and patients; having a culture of innovation balanced with risk; a clear organisational business model for delivering change; and being strong collaborators with other local commissioners around the needs of local communities. In addition a series of live statements associated with each of the 6 domains of authorisation have been developed to describe excellence in commissioning. Whilst all are relevant 2 domains in particular are relevant to this plan. Domain 4 Domain 6 The Development Framework has identified the following significant service challenges and identified as key priorities these include: Addressing unwarranted variations in quality and safety of present services Reducing health inequalities, including variation in access to services and health outcomes Delivering whole system change, promoting health and wellbeing and independence and avoiding unnecessary use of urgent and emergency services; and Redesigning services to bring them closer to home, wrapped around the complex needs of individuals, including the redesign of primary care The system challenges identified in report are: 4
Leading local communities in embracing new service offers Achieving collaborative agreement across several commissioners to shared priorities; and Releasing resources trapped in familiar but out-dated services for re-investment The NHS England Assurance Framework 2013/14 looks at the core elements of assurance to ensure that the CCG delivers the best possible services and outcomes for patients within their financial allocation. The core elements of the process are: 1. Delivery ensuring that the CCG is delivering for its population the full range of outcomes and standards (both national and local) agreed in its plan 2. Capability - ensuring the CCG is set up to serve patients and communities effectively, both now and for future generations with required skills and knowledge, and is exhibiting the appropriate behaviours 3. Support determining the nature and level of support a CCG needs to be a great commissioner Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Domain 6 A clinical and Multi-professional focus, with quality central to the organisation Good engagement with patients and the public, listening to what they say and truly reflecting their wishes A clear and credible plan over the medium term to deliver great outcomes within budget, which has been determined in partnership locally, and reflects the priorities of the health and wellbeing strategy Proper constitutional and governance arrangements, and the capacity and capability to deliver all their duties and responsibilities Collaborative arrangements with other CCGs, local authorities and NHS England, appropriate commissioning support and good partnership relationships with their providers Great Leaders who individually and collectively make a real difference 2.1 Framework of Excellence The framework sets out what excellent practice in CCG clinical commissioning looks like across six key areas: Clinical and member engagement, public engagement, planning, governance, collaboration and clinical leadership. It has been developed in partnership with commissioners and other key stakeholders. The six domains of excellence are: 1. A strong clinical and multi-professional focus with significant member engagement 2. Meaningful involvement of patients, carers and the public 3. Clear and credible plans 4. Robust governance arrangements 5. Collaborative commissioning 6. Clinical Leadership 5
The objectives/actions in Appendix 1 have been mapped to the 6 domains for assurance of assurance organisational health and capability. The diagram illustrates the steps along the journey to excellence. As a fully authorised CCG, we have successfully passed through the authorisation phase and we are currently positioned in the assurance phase. This means that we have to provide regular formal assurance to NHS England that we are continuing to meet our on-going responsibilities to patients and the public. For more information on the national CCG assurance process, please refer to CCG Assurance Framework 2013/2014. The journey towards excellence Draft Framework of Excellence in Clinical Commissioning: For CCGs, November 2013 The external and internal landscape has changed significantly since 2011 and so by using a diagnostic tool (see Appendix 2), we have reviewed where we are against the six domains since undertaking a number of developmental activities. We plan to address the above using the objectives attached in Appendix 3 this will enable regular reporting on progress to the OD Steering Group and, where appropriate, to the Executive Team and Board 2.2 Equality and Diversity This document supports the delivery of LCCG s Diversity Strategy and Action Plan which sets out our vision and intentions for embedding the equality and diversity agenda into its core business functions over the next three years. Our equality objectives, which were identified through the implementation of the Equality Delivery System (EDS), have been embedded within the strategy ensuring we take a proactive approach towards excellence from the outset. 6
(For further information please refer to LCCG s Diversity Strategy and Action Plan). 2.3 The Francis Report Good leadership must be visible, receptive, insightful and outward looking. Leadership and managerial skills are not the same but both are required. Leadership skills are required to be shared at all levels in an organisation, from board to ward, and all staff must be empowered to use their own judgement in providing the best possible care for patients. Robert Francis The CCG has described elsewhere (A Culture of Care; Our plans to implement the recommendations of the Francis report) our approach to implementing Francis. Clearly a significant theme of the report is culture and leadership and the CCGs approach to implementing the report highlights this plan as one of the key vehicles for implementing Francis. The priorities set out in 7, and the specific objectives in Appendix 1 are targeted at creating the right culture, developing our leaders and ensuring staff have the right skills and motivation. 3. Our Organisation 3.1 Our Organisational Development Goals LCCG has developed three outcome goals for a healthier Luton based on the local health needs expressed in the Joint Strategic Needs Assessment 2011 (JSNA). These are: Every Child and Young Person has a healthy start in life Reduced health inequalities in Luton Healthier and More Independent Adults and Older people 3.2 Our Vision and Mission Our Vision A Healthier Luton Our Mission We will work in partnership with patients, their carers, providers and other partners to deliver a high quality and cost effective NHS to the people of Luton, empowering them to lead healthy and independent lives" 3.3 Values As a new organisation we are committed to continuously improving our services, building our offering around the needs of informed people who are active partners in decisions made about their healthcare. Our vision is underpinned by a charter of values and beliefs developed following consultation with GP practices. 7
Work is on-going as part of the Board Development process to agree the practical ways to ensure that the evolving culture of the new CCG reflects these values. Using McKinsey s 7S Model, the Shared Values set out above should be reflected in the following aspects of the CCG s operations: Strategy developed through partnership with our partners, focused on health outcomes for our local population, expressed in language people can understand and making the best possible use of the resources available to us. Structure simple and understandable, enabling the right people to talk to the right people, clear accountabilities and processes for getting things done and transparent decision making Staff - recruiting people who identify with the needs of our local area and want to see real improvement, good communicators, clinicians with relevant and high quality expertise and experience who are open to learning new ways of working and thinking in new ways Skills Clinical Knowledge, well organised and effective use of time, excellent communication skills, effective team approach both within the organisation and outside with its patients, public, partners and providers, strong sense of integrity. Systems which enable decisions to make well and implemented quickly through effective joint working, planning systems which enable a balanced bottom-up, partnership and top-down approach, an infrastructure which enable effective deployment of people, property, information and money? Style working in an efficient, open, thoughtful and highly responsible manner which takes other people and agencies perspectives into account. Open to continuous learning and willing to try new ways of working to achieve better outcomes. 8
3.4 Strategic Priorities In order to deliver our outcomes we have developed ten strategic priorities which we believe will have the biggest impact. Our focus on these strategic priorities will be maintained in 2014/15 Ensuring a healthy start in life for children and young people Primary and secondary prevention of disease Empowering people to live independently Active management of Long Term Conditions Improving medicines optimisation Managing planned care resources effectively and ensuring the quality of referrals Improving urgent care Improving the lives of people with mental health needs The integration of health and social care Delivering high quality, safe and value for money services 3.5 Organisational Goals and Corporate Objectives Organisational Goal 1 Implement year 1 of the Five Year System Strategy and proactively influence and support its implementation across the Luton health system. 9 1. Achieve the delivery of the Financial Recovery Plan and all elements of the QIPP programme to the value of 5.7m in 2014/15 2. Work with partner organisations and the Health and Wellbeing Board to ensure the delivery of objectives set out in the CCG Operational Plan including: Better Together care Team project Capacity and Capability of Primary Care Procurement of mental health and community services and transition to new providers Organisational Goal 2 Further develop the CCGs capacity and capability to achieve its objectives Corporate Objectives 3. Further development of practice engagement ensuring effective distributed clinical leadership is in place across our member practices, to include the implementation of 4 Clusters 4. Implementation in house, or externally provided, current Commissioning Support functions. To include Contract Management, Performance Management, Business Intelligence, Comms and Engagement 5. Ensure that a Robust Governance and Risk Management Framework is in place to ensure that the CCG is well governed and that statutory and legal duties are met. 6. Continue the Organisational Development of the CCG to Organisational Goal 3 Systematically improve the quality of provision and reduce variation, including ensuring services are shaped to meet the needs of Luton communities. 7. Continue development of patient / user / carer / public engagement so that the views of all our communities are heard and actively reflected in our commissioning 8. Ensure effective clinical governance to achieve high quality, safe services, with good patient experience, good clinical outcomes and reduced health inequalities 9. Ensure delivery of all standards required by the NHS Constitution including RTT, Cancer waits, Ambulance Response, emsa.
Organisational Goal 1 Implement year 1 of the Five Year System Strategy and proactively influence and support its implementation across the Luton health system. Organisational Goal 2 Further develop the CCGs capacity and capability to achieve its objectives Corporate Objectives include leadership and workforce development Organisational Goal 3 Systematically improve the quality of provision and reduce variation, including ensuring services are shaped to meet the needs of Luton communities. How will we deliver these objectives? Appendix 1 outlines how we will deliver the 11 objectives linking to the Framework of excellence and Assurance framework. 4. Our Organisation framework and Plan 4.1 Development of the Workforce The CCG aims to support a culture of life-long learning for all directly employed staff. Individual personal development plans resulting from appraisals will identify any gaps in current knowledge as well as the skills and competencies required to fulfil emerging roles in the new organisation. A training needs analysis through the appraisal has been undertaken to inform the training plan. A training plan, refreshed annually, will combine individual personal development with those that will support the CCG to deliver organisational responsibilities. A talent map through the appraisal process has informed a succession plan for the organisation. The succession plan will be refreshed annually. The Talent Management and Succession Plan will show the capacity of the organisation and the capability relating to the demographics and talent mapping. The Department of Health document delivering high Quality, effective, compassionate care: Delivering the right people with the right skills and the right values- A mandate from the Government to Health Education England: April 2014 to March 2015. This document describes the strategic objectives and deliverables of the Government in the areas of workforce planning, health education and training and development. The Objectives in this mandate are pertinent to the LCCGs A healthier Luton. Objective six in the document The right workforce with the right skills, values and competencies talks about the values and behaviours, excellent education, competent and capable staff, developing a workforce skilled for research and innovation, widening participation, and working in partnership the patient and public voice and local accountability. All of which are demonstrated in this plan. 4.2 Leadership skills The CCG is committed to developing its leaders linked to the National Leadership Councils leadership framework. A staff development programme is in place linked to the competencies of the Leadership 10
framework, Royal College of Nurses competency framework and Agenda for Change competency framework. NHS Leadership Academy is currently providing leadership interventions to support emergent leaders in the organisation via a nomination process. 4.3 Assessment of capacity, capability CCG plans for development take account of the development needs of the leadership and the wider organisation based on an appropriate assessment The Board completed the CCG diagnostic tool. This tool is a developmental interactive self-assessment tool to allow Clinical Commissioning Groups to understand and reflect upon their: 1. Values 2. Culture 3. Behaviours 4. Wider Organisational Health It encourages the leadership team to have conversations about their roles and responsibilities as statutory bodies. The CCGs self-assessment also allows it to pose a series of questions that help shape the short, medium and long term organisational priorities and therefore the capacity and capability needed. In summary these are; Strategy What is the mid-term and long term vision for the CCG? What interventions are needed to realise the CCG s vision? What decisions do we need to make now, or soon, to ensure you ll be best serving local needs in the future? Finance - How robust are the existing QIPP plans? When risk assessed, do they address the full extent of the QIPP gap? Do QIPP plans have the ingredients of a robust, deliverable plan? Contracting underlying risks associated with third party arrangements are identified, assessed, mitigated and monitored Quality - Do we have the capacity to monitor the performance of every commissioning contract on a continual basis? Do we clearly understand our provider s current performance and any concerns? Are we in possession of accurate, relevant, and useable information to assess the safety and quality of a service? Do we have the capacity to undertake our own (or independent) audits, inspections and investigations? People - What provisions have we made to get people to work more closely together across organisational boundaries? How are our biggest health challenges reflected in workforce plans? How are we going to enable the management teams to understand and better manage our workforce now and in the future to deliver the outcomes for the CCG? Patients - Are we confident that our patient engagement activities cover all communities including the vulnerable and minorities? Are we satisfied that we have the right patient engagement systems to support your ambitions for the CCG? How do we know what our patients think about the care they receive? 11
Governance - Are we clear about the information the Governing Body needs to do its job Is the information we are receiving complete and accurate? What isn t it telling us/ how does the Governing Body assure itself that the CCG is fully discharging its legal duties, long term and short term? It would be recommended to revisit this assessment annually to establish any changes and implement support where required. Healthcare Leadership Model (360 degrees appraisal) Staff will exhibit a range of leadership behaviours across the seven domains of the leadership framework dependent on the context in which they operate. It is essential that all staff are competent in each of the five core leadership domains: 1. demonstrating personal qualities, 2. working with others, 3. managing services, 4. improving services and 5. Setting direction. The other two domains, creating the vision and delivering the strategy, focus more on the role and contribution of individual leaders. To help users understand and apply the Leadership Framework each domain is divided into four elements and each of these elements is further divided into four descriptive statements which describe the behaviours all staff should be able to demonstrate. This will help the organisation with post Francis recommendations and the Assurance framework. Myers Briggs To assist the CCG staff and the Clinical leaders with understanding behaviours a Myers Briggs questionnaire and feedback session have been delivered to the Board and will be disseminated to all staff via a team approach followed up with an OD event. This will commence in June 2014. CCG 360 Degrees Stakeholder Survey 360 degrees stakeholder survey conducted via NHS England in March 2014 looked at the relationships with a range of health care partners across the system. The response rate was 57%. The overall comparison nationally appeared good however areas that need working on are: Overall Engagement Listening to views Patient and Public Engagement Understanding Commissioning decisions Improved Outcomes for Patients Knowledge of plans and priorities Strong and Robust Leadership Skills and experience of Leadership 12
Clear and visible Clinical leadership The plan in appendix 1 will show how LCCG will address these areas. Framework of Excellence tool The OD steering group developed a tool to review what areas within the framework needed attention. The outcome of this questionnaire is demonstrated in the in appendix 2. 5. Achievements to date This is not LCCG s first OD Plan. It developed and implemented a plan in 2012, prior to authorisation. The CCG therefore has a good foundation on which to build and this plan aims to take the CCG towards a standard of excellence as set out in the beyond authorisation national domains. Achievements over the last year include; A comprehensive Staff support programme in place with a range of development offers including to practice staff A CCG wide OD Group established, chaired by our Accountable Officer and with CCG and practice staff membership A tailored Board development programme An appraisal and talent mapping process implemented to understand the skills and learning needs of the organisation and to motivate staff Regular staff meetings to encourage inclusion and sharing of information Monthly mandatory training reports in place on compliance and non-compliance show Improvement Process of training applications has been implemented to allow accessibility and Understanding of the funding process Links with the HEE on Leadership interventions and CCG development are underway The Talent Management and Succession Planning document following appraisals A training plan has been implemented 6. Assurance The delivery of the OD Plan will be assured through a combination of; Internal Monitoring of Delivery OD Steering Group and Executive team reports on progress. Board observation feedback Staff Survey and follow up actions Appraisal and talent map Routine reporting of training uptake an outcomes Leadership Academy self-assessment tool External Assessment. 13
The Organisational Health assessment as part of the national CCG Assurance Framework. This will comprise a combination of; Self-certification e.g. that our plans are based on an organisational wide assessment of capacity and capability, key roles meet national requirements 360 Survey Feedback from partner organisations and member practices on their assessment of the leadership in embedding culture and distributed leadership NHS England Area Team quarterly Check Point Reviews 7. Reference Documents NHS Outcomes Framework 2012-13 http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh _131700 Education Outcomes Framework are identified in the guidance document From Design to Delivery http://www.hee.nhs.uk/work-programmes/education-outcomes/ NHS England Draft CCG Development Framework commissioning development(july 2013) NHS England CCG Assurance Framework 2013/14 outline proposal and interim arrangements (May 2013) NHS England Draft Framework of Excellence in Clinical Commissioning: For CCGs (November 2013) Department of Health Delivering high quality effective, compassionate care: Developing the right people with the right skills and the right values. A mandate from the Government to Health Education England: April 2014 to March 2015 (April 2014) https: www.gov.uk/government/uploads/attachmentdata/file/306967/hee mandate 2014-15.pdf 14
Appendix 1 Organisation Development Plan Summary Framework of Excellence Domain 1. A strong clinical and multiprofessional focus with significant member engagement Corporate Objective Specific Actions Lead Delivery/Timescale 3. Further development of practice engagement ensuring effective distributed clinical leadership is in place across our member practices, to include the implementation of 4 Clusters Implementation of Primary Care Clusters Delivery of CCG Elements of Health Inequalities work plan Nicky Poulain Nicky Poulain Delivery of Member s Forum and PLT Programme Rod While Active engagement in Clinical Networks Carol Hill Develop local Clinicians Forum Rod While Implement GP Clinical Leaders Programme Nina Pearson 2. Meaningful involvement of patients, carers and the public. 7. Continue development of patient / user / carer / public engagement so that the views of all our communities are heard and actively reflected in our commissioning Implementation of Neighbourhood Governance Framework Establish practice level PPGs Comms Comms Phase 2 Urgent Care Awareness Programme Comms Commissioning Intentions Engagement Programme Comms Delivery of Personal Health Budgets Nicky Poulain 3. Clear and credible plans 1. Achieve the delivery of the Financial Recovery Plan and all elements of the QIPP programme to the value of 5.7m Implementation of robust Programme Management Office Implementation of QIPP Assure application and internal assurance process Nicky Poulain Nigel Armitt Process around commissioning intentions and strategic planning implemented Rod While Implementation of Turnaround Environment Nigel Armitt 15
Framework of Excellence Domain Corporate Objective Specific Actions Lead Delivery/Timescale 2. Work with partner organisations and the Health and Wellbeing Board to ensure the delivery of objectives set out in the CCG Operational Plan Ensure all members of the planning unit are called to account by the Better Together Programme Board Carol Hill Ensure all providers are called to account by the System Resilience Group Nina Pearson Regular Board to Board meetings with major providers Carol Hill Long BCF Risk Share agreement in place Nigel Armitt Delivery of JSNA 2014 Public Health / Rod While Revised MOU with LBC Public Health Public Health / Rod While 4. Robust governance arrangements 5. Ensure that a Robust Governance and Risk Management Framework is in place to ensure that the CCG is well governed and that statutory and legal duties are met. Re-launch Risk Management Framework and raise awareness of risk register Revise CCG Constitution Rod While Rod While Conduct mapping exercise of legal duties Rod While 8. Ensure effective clinical governance to achieve high quality, safe services, with good patient experience, good clinical outcomes and reduced health inequalities Implementation of IIA Implementation of Equality and Diversity training E&D Team E&D Team MBTI Staff Programme Lisa Webb 5. Collaborative commissioning 4. Implementation in house, or externally provided, current Commissioning Support functions. To include Contract Management, Performance Management, Business Intelligence, Comms and Engagement Finalise structure Complete Consultation Collaborative and s75 agreements in Place Carol Hill HR Carol Hill Complete 16
Framework of Excellence Domain Corporate Objective Specific Actions Lead Delivery/Timescale Deliver Induction and refresher programmes Lisa Webb Shared Services work programme Nicky Poulain Long 6. Clinical leadership 3.Further development of practice engagement ensuring effective distributed clinical leadership is in place across our member practices, to include the implementation of 4 Clusters Implementation of Primary Care Clusters Delivery of CCG Elements of Health Inequalities work plan Nicky Poulain Nicky Poulain Delivery of Member s Forum and PLT Programme Rod While Active engagement in Clinical Networks Carol Hill Develop local Clinicians Forum Rod While Implement GP Clinical Leaders Programme Nina Pearson Definitions: Delivery Timescale: term within 3months Term within 6 months Long Term within 1 year. 17
Appendix 2 Framework of Excellence Outcomes of Board Prioritisation Exercise An assessment tool was implemented by the Organisation Development Steering Group utilising key questions from the Draft Framework for Excellence. The Board made an assessment of our current position and what do we need to do? The CCG Board reviewed the outputs of this tool in the form of a discussion in May 2014. The objective of the Board Development Session was for the Board to agree our priorities for focus over the next 12 months. At the end of a discussion members were each given 5 stickers and asked to vote for their top five priorities for the current year. The votes should take into consideration current performance and therefore areas where it was considered we were doing well on should not be prioritised. What does excellence look like? Area 1. A strong clinical and multi-professional focus with significant member engagement. 18 Board Votes % Votes Available A constant clinical focus on improving quality and health outcomes and reducing health inequalities. 7 58% 1 Significant engagement of constituent member practices to increase the focus and the delivery of service redesign 5 42% 1 Strong involvement of the wider multi-professional clinical community in commissioning to deliver transformational change. Area 2. Meaningful involvement of patients, carers and the public. Priority (1, 2, 3) 1 8% 3 The public and patient voice is at the heart of every decision taken. 3 25% 2 An understanding of the assets and needs of the population at locality level 0 0% 3 Patients and carers participate in planning, managing and making decisions about their care and treatment 4 33% 2 Effective mechanisms to capture patient and public insight so that it underpins and informs CCG decision-making processes 4 33% 2 A reputation for being a transparent and open organisation which is trusted by the local population 3 25% 2 Area 3. Clear and credible plans Strategic plans which are aligned with joint health and wellbeing strategies 0 0% 3
Clear and credible operational plans which are evidence based, measurable and affordable 5 42% 1 Outcomes based contracts with all providers 0 0% 2 A strong track record of delivering changes that improve quality and productivity, whilst delivering financial savings to ensure the sustainability of future services Area 4. Robust governance arrangements Robust governance arrangements, rigorous enough to withstand challenge but flexible enough to enable local ownership from the clinical community A system of strong internal controls which enables clinicians to focus their time and effort on driving improvements in services and outcomes 5 42% 1 1 8% 3 2 17% 3 An innovative commissioning support provider which anticipates its needs 1 8% 3 Area 5. Collaborative commissioning Strong collaborative ties to health and wellbeing boards, with the CCG being a recognised system leader 2 17% 3 Strong and productive partnerships with its area team which lead to measurable improvements in the quality of primary care 5 42% 1 Effective partnerships with other CCGs to co-commission services where will improve quality and drive efficiencies 1 8% 3 Area 6. Clinical leadership Transformational leaders who deliver measurable improvements in patient experience and health outcomes and deliver quantifiable reductions in health inequalities 2 17% 3 System leaders who influence the whole health economy 0 0% 3 Distributed multi-professional clinical leadership throughout the CCG and member practices 7 58% 1 Strong succession planning and leadership development 2 17% 3 Key: The key below shows the top three priorities determined by the voting board. Priority Definition Count 1 >5 Votes 6 2 3-4 Votes 5 3 <3 Votes 11 19