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Lambeth Pathfinder Delivery Plan

Consortium Name Lambeth Clinical Commissioning Collaborative

Sector for consortium South East London

Primary PCT for consortium NHS Lambeth

Local Authorities forconsortium

London Borough of Lambeth

Lead contact for application

Name Dr Adrian McLachlan

DesignationChair, Lambeth Clinical Commissioning CollaborativeBoard, Chair Lambeth Collaborative

Email address lambethgpcommissioning@nhs.net

Telephone number 020 3049 4444

Registered patient population

for consortium377,766 (as at 01.4.2011)

Contents Page

1. Introduction 1

2. Our Clinical Board 5

3. Our Mission, Our Vision, Our Plans and how we will Deliver 17

4. Our Management Capacity and Capability 22

5. Our Delegated Responsibilities 25

6. Our Development Needs and Requirements 31

7. Conclusion 33

Appendices

Appendix 1 Job Descriptions of Clinical Board Members

Appendix 2 Board member lead areas

Appendix 3 Terms of Reference LCCCB

Appendix 4 Lambeth Business Plan 2011/2012

Appendix 5 Lambeth BSU Structure Chart

Appendix 6 Organisational Development : Lambeth Pathfinder Statement of Works

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1. INTRODUCTION

1.1 The Lambeth Clinical Commissioning Collaborative has the capacity and capability requiredto undertake commissioning across the range of health services for local people. Whilstrecognising our development needs, we would wish to address these needs over the next twoyears whilst working in active collaboration with local management teams from within Lambeth andacross the SE London Cluster. The purpose of this Pathfinder Delivery Plan is to demonstrate ourcapability and capacity in order to support the approval of delegated authority to the LambethClinical Commissioning Collaborative.

1.2 The Collaborative consists of all 52 practices in Lambeth working across three Localities

and with active engagement across abroad range of clinicians.

North Locality South East Locality South West Locality

Practice List

Size

Practice List

Size

Practice List

SizeHurley Clinic 14699 The Tulse Hill Practice 8674 Streatham High Practice 7019Springfield PrimaryCare Centre

5843 Herne Hill Road MedicalPractice

5871 Dr Ala's Surgery 2200

The South LambethRoad Practice

6249 Brockwell Park Surgery 5158 The Courtyard Surgery 4137

Riverside Medical 5161 Paxton Green GroupPractice

19485 Hetherington Group Practice 10991

Dr Ivor Ferreira 3170 Norwood Surgery 4291 Baldry Gardens FamilyPractice

3706

Waterloo HealthCentre

7856 The Knights Hill Surgery 3392 Dr Curran & Partners 9016

Dr Irani 1548 The Rosendale Surgery 6358 Dr. Gunasuntharam Surgery 3481Mawbey GroupPractice

9226 Herne Hill Group Practice 10748 Sandmere Road Practice 16400

Beckett HousePractice

6122 Iveagh House Surgery 8432 Clapham Family Practice 15570

Lambeth Walk GroupPractice

7598 Foxley Square Surgery 3628 Dr. Masterton's Surgery 6450

Stockwell GroupPractice

14362 Drs Patel & Cresswell 7472 Valley Road Surgery 5330

The Vauxhall Surgery 2827 Brixton Water Lane 7235 Dr. Ramanan’s Surgery 3520Binfield Road Surgery 7409 Crown Dale Medical Centre 10714 The Exchange Surgery 4750Dr Wickremesinghe 5503 Myatts Field Health Centre 4672 Dr Sheila Santamaria 3064

The Corner Surgery 4377 Streatham Common GroupPractice

7697

The Deerbrook Surgery 4256 Clapham Park GroupPractice

13656

Streatham Place Surgery 7835Edith Cavell Practice 8064Streatham Hill GroupPractice

7944

Palace Road Surgery 7217

Brixton Hill Group Practice 11011

HGP at the Pavilion Practice 5372

Total North 97,573 Total South East 114,763 Total South West 164,430

Total Lambeth 377,766

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1.3 Lambeth Clinical Commissioning Collaborative was approved as a Third Wave PathfinderConsortium in March 2011. Since then the Collaborative has developed its leadership, itsgovernance and its operational arrangements within the context of needing to ensure ongoingperformance delivery and to develop further our capability to lead the commissioning of healthservices for Lambeth communities, based on our public health needs assessments. In doing sowe have established effective partnership arrangements within the borough, with local providers,with clinical commissioners and other key stakeholders across south east London. In doing so, wehave been building on the success of Lambeth PCT in developing strong local relationships. Ourkey relationships are set out in the diagram below:

1.4 We have an excellent track record of delivery to date. We will build on our successes in2010/11 when the Clinical Board led for NHS Lambeth on in-year performance issues, includingrecovery plans where required, on clinical pathway redesign, and on the development of ourStrategic Plan refresh and our 2011/12 Integrated Plan. We have a clear understanding of ourdevelopment needs and we are keen to address these as quickly as possible as we take forwardour active learning through practical delivery over 2011/12.

1.5 The Lambeth Clinical Commissioning Collaborative has a clear ambition to achievedelegated responsibility for the full range of commissioning responsibilities during 2011/12 in orderthat we can benefit from the maximum amount of time possible to develop our commissioningcapability in advance of the establishment of formal Consortia arrangements from April 2013. Wefirmly believe that through the opportunities this presents to strengthen clinical leadership andenhanced engagement across primary care the NHS in Lambeth, working with our partners, wewill be better able to deliver on our QIPP and health improvement challenges, delivering pathwayredesign in order to develop a sustainable system that is best able to address the challenges ofincreased demand for healthcare within constrained resources.

1.6 We are proposing a two step approach to delegation wit the commissioning of non-acuteservices being delegated from July 2011, and subject to review, acute commissioning fromSeptember 2011. This approach reflects the relative degree of service and financial risk we haveattributed to these respective commissioning areas. Our risk assessment of our QIPP Plans

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indicates that our areas of higher risk are associated with the management of unplanned andurgent care and the subsequent impact on the use of hospital services in terms of A&Eattendances, admissions and readmissions. We are of course already working in collaboration withBorough and Cluster commissioning teams to address service redesign across our unplanned careprogramme to ensure delivery over 2011/12. A significant element of this will be the work we areundertaking with Southwark Clinical Commissioners, King's Health Partners and social carethrough the Integrated Care Pilot. The LCCCB will formally stocktake our progress, both indelivery of non-acute commissioning and on proposals for the delegation of acute commissioningin September 2011, in advance of progressing to the next stage of delegation for acute services.

1.7 In summary, we will deliver through:

Putting patients at the heart of decision-making at every level of the commissioning process,and commit to improving the patient experience.

Working with the SE London Cluster, NHS London, our local partners and neighbouring ClinicalCommissioning Pathfinders to contribute to strategic development.

Optimising the input of general practice and primary care staff to ensure that commissioning isclinically driven, informed by the insight of clinicians at the front line and guided by public healthprofessional expertise.

Working with our colleagues in secondary care and other providers to break down barriers andunhelpful interfaces between clinicians and services.

Working with the support of local commissioning teams to support our delivery and ourcollective development (and accessing specialist expertise where this is not locally available).

Developing commissioning arrangements in partnership with the Lambeth Council to ensurethat we commission services jointly where this will result in more aligned services, clearerpathways of care and better value for money.

Driving public health intelligence into the commissioning cycle so that we commission servicesthat our patients need, and address inequalities.

Establishing pathways of care that are patient-centred, simplify their journey and deliverimproved clinical outcomes.

Building capacity across primary care for effective commissioning, and support improvementsin quality amongst our constituent practices.

Maintaining the strong financial performance achieved by the PCT.

Ensuring value for money and improving the use of resources through the design and deliveryof QIPP local initiatives, including the shift from unplanned to planned care and fromintervention to prevention, the provision of care in the most appropriate settings and thedecommissioning of poorly-performing or low-value services where necessary.

Securing year on year improvements in the quality and performance of local services againstnational, London and local performance standards and goals and against benchmarkcomparators.

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2. OUR CLINICAL BOARD

2.1 Leadership

Our work is led by the Lambeth Clinical Commissioning Collaborative Board (LCCCB), establishedas a Committee of the Lambeth PCT Board on 1st April 2011. The Board brings togetherleadership from the former Lambeth Practice Based Commissioning Collaborative and theLambeth PCT/SE London Cluster. Our development has been informed by our experience over anumber of years and more recently through the work of the Lambeth Clinical Board fromNovember 2010 to shape the development of clinical commissioning. We have a wealth of skillsand expertise drawn from a number of disciplines and professions from across primary care andexperienced NHS executive and non executive members.

LCCCB membership:

Chair Dr Adrian McLachlan, GPNorth Locality Dr John Balazs, GP (Vice Chair)

Dr Raj Mitra,GPSouth East Locality Dr Gillian Ellsbury,GP

Dr Patricia Kirkman.GP (Vice Chair)South West Locality Ruth Jeffery, Advanced Nurse Practitioner

Dr Ray Walsh, GPManaging Director Andrew EyresNursing Lead VacantDirector of Public Health Dr Ruth Wallis (joint with LB Lambeth)PCT Non-Executive Director Sue GallagherPCT Non-Executive Director Graham Laylee

London Borough of Lambeth Jo Cleary, Executive Director Adult Services

Non Voting Members in attendanceLambeth LINk Nicola Kingston Co Chair, Lambeth LINkLMC Dr Tyrrell EvansKing’s Health Partners Dr John Moxham (tbc)

Executive leads in attendance:Director Integrated Commissioning* Helen Charlesworth-MayDirector of Care Pathway Commissioning Moira McGrathDirector of Corporate Affairs & HR Una DaltonChief Financial Officer Christine CatonClinical Network Lead (interim) Ashok Soni (pharmacist)

*( joint with LB Lambeth)

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The LCCCB Clinical and Non-Executive Members:

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GP- Chair

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GP- North LocalityVice Chair

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embers provide the LCCCB with broad anddelivering healthcare to the population of Lrs have been engaged in commissioning fobination allows us to build on what has woideas. A number of the clinicians on the Bo support them in their role as clinical comalth service evaluation and health economLeadership Programme, BSC Advanced Nevelopment in Leadership in Primary CareLead.

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Dr Ray Walsh

GP- South West Locality

Graham Laylee

PCT Non Executive

Dr John Balazs

GP- North Locality

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Dr Gillian Ellsbury

Ruth Jeffrey

Advanced Nurse

Practitioner - South West

\Locality Locality

Sue Gallagher

Dr Adrian McLachlan

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edge of the opportunities and thepeople.

informed clinical expertise and extensiveambeth, including nursing. Whilst somer a number of years, others are new to therked well, but also to provide freshoard are already engaged in personalmissioning leaders. These include, MScics, King’s Fund Leadership Course,urse Practitioner – Primary Health Care,, Membership of national network of GP

PCT Non Executive

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Our two non-executive Directors are experienced non-executives, who bring their previousknowledge and skills of the Lambeth PCT Board and commercial practice. Working previously asLambeth PCT Vice Chair and Audit Committee Chair,together they bring broad business and NHSexperience, with a real Lambeth focus.

Executive members on the LCCCB will support clinicians in the delivery of the operational anddevelopment issues faced by the Collaborative. Together they have strong and valued experienceand a track record of successful delivery in commissioning and health improvement in Lambethand South East London.

We have established Board roles for both the London Borough of Lambeth and the Lambeth LINkto ensure our work at Board level reaches beyond clinical commissioning into our localpartnerships, social care, our Health and Wellbeing development, and in engaging with ourcommunities. We have invited King’s Health Partners to sit at the Board to support our clinicalengagement with secondary care and to work in collaboration with King’s Health Partners ambitionto support health improvement in inner south east London communities.

The Board has agreed a clear Mission Statement and an overarching Vision to guide its work (seeSection 3.1 below) and in doing so has agreed a set of underpinning values as to how we willundertake to work together as follows:

Our Values

• We always tell the truth.

• We are fair

• We are open

• We recognise our responsibilities to service users and the wider public

• We act responsibly as a public sector organisation

2.2 Codes of Conduct and Register of Interests

All LCCCB members are required to follow the Nolan Principles of Standards in Public Life.LCCCB members are required to follow the Standing Orders of Lambeth PCT which requireLCCCB members to adhere to The NHS Code of Accountability and to declare any interestswhich are relevant and material. All existing members are required to declare such interests andany members appointed subsequently are required do so on appointment. The Standing Ordersdefines what constitutes a potential conflict, actions to be taken with regard to LCCCB decisionmaking by members who feel they have a conflict and where advice can be sought. The LCCCBhas agreed Non Executive LCCCB members will play a key role in supporting the LCCCB indetermining the most appropriate approaches relevant to particular circumstances. We intend todevelop this important work further over the coming months.

The Register of Interests of members of the LCCCB is systematically maintained and is madepublicly available within Board papers. These details will also be published in the PCT AnnualReport. Members are asked to declare any interests at the start of each Board meeting.

The LCCC Board has also agreed that in future the remuneration of members will be published inpublic Board papers.

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2.3 Equalities.

The LCCCB is fully committed to the adoption of the Equality Delivery Scheme, which is beingdeveloped across the whole sector to replace the Single Equality Scheme. We are committed toparticipating actively in the development of the Equality Analysis Tool, and as members of thecluster’s equality group.

Reducing inequalities is core to our Mission Statement. We are committed to ensuring that weinclude equalities considerations in all our commissioning decisions, making reasonableadjustments to services for vulnerable children and adults, and specifically to ensuring that weimprove access to generic health services for people with learning disabilities

2.4 Clinical Appointments to the Board

The LCCCB Chair and Locality Clinical members of the LCCCB were appointed on 1st April 2011following a “selection and election”. Selection being addressed through application and interviewwith PCT Board members and the election process managed through the Electoral ReformSociety. Clinical Board members operate in the knowledge that they have a clear mandate ofsupport from Lambeth practices.

Job descriptions (including tenure, time commitment and remuneration) for the Chair and LocalityBoard Members are attached at Appendix 1. The Locality Clinical members of the LCCCB haveeach taken a lead for our priority health programmes and for key work areas. A full list of theselead areas can be seen at Appendix 2.

Two vice chairs have been appointed, to provide support to the chair and as a developmental rolewith a view to possible succession. Clinical members of the Board also meet informally, as well ashaving one to one meetings with the Chair. Board members also take on a supervisory ormentoring role with others in our Clinical Network.

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2.5 Our Localities, engaging with Lambeth practices

The Lambeth Clinical Commissioning Collaborative has developed from the previous Lambeth-wide PBC Collaborative arrangements and is established around three localities, which have beendeveloped over a number of years. Lambeth’s locality arrangements have been formalised atLCCCB level, with two board members elected from each of the three localities. Terms ofreference for the Localities have been agreed and a process is underway to recruit to furtherClinical Network Lead and Locality Clinical Lead roles, based on clear skills and competencies.

Engagement work has been undertaken with the three localities in Lambeth in order to ensure therole of the localities is developed further and that there is excellent two way communicationbetween the LCCCB, the localities and the broader pool of primary care practitioners. We arecurrently reviewing the effectiveness and efficiency of our communication processes acrossprimary care. Each Locality has a linked public health consultant to advise on the health needs ofthe locality population and to work with practices.

The role of our localities is highlighted as a significant contributor to the success of clinicalcommissioning and sustainable service delivery. Locality specific leads on the LCCCB will ensuresuccessful two-way communication between the practice level and locality responsibility forimproving patient care, and broader Lambeth-wide strategic decision making. This will besupported by primary care-led locality meetings to facilitate group discussion and agreement on awide range of clinical issues. There is a programme of clinician to clinician peer support meetingsin place which are used as an opportunity to discuss clinical practice on an individual basis.Clinical Board members carry a responsibility relating to engagement with practices in their locality,as well as a portfolio of areas of commissioning responsibility. This ensures that all practices havethe opportunity to be involved in commissioning activities and that any local performance issuesare identified and addressed.

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We have run practice based incentive schemes, supported by practice based action plans, toreview referrals, A&E attendances and prescribing practice. The development and review of theseplans has been supported by the peer to peer visits by locality board members. We will build onthis work to ensure continued practice level planning and engagement results in the piloting ofinnovative approaches to the commissioning and delivery of services.

Practice based incentive plans are in place to deliver QIPP plans for primary care prescribing andreduced outpatient attendance targets have been agreed through localities. These are beingsupported by the peer to peer visits. Practices are provided monthly reports of activity and spendagainst their indicative budgets and this will be expanded to include all areas of delegated activityover 2011/12.

For 2011/12 we are investing £100k to support Locality delivery in addition to practice basedincentive schemes. In developing this fund we have ensured there is clarity on the success criteriaand that arrangements are in place to measure the effectiveness of the approach. Effectivenesswill broadly be measured in terms of:

Local practice engagement and ownership of priorities and delivery Wider engagement with providers and patients Impact on finance and activity

2.6 Engaging Clinicians and our Clinical Network

In order to ensure effective leadership Locality Clinical Board Members have each taken a lead forpriority programmes of work or key work areas and we have identified leads for acute, communityand mental health service contracts to review and oversee contract performance and servicequality. We recognise, however, that we will need the skills and engagement of clinicians beyondthose in formal Board roles. In order to continue the breadth of clinical engagement established bythe Professional Executive Committee of NHS Lambeth and the Lambeth PBC Collaborative, weare promoting multi-professional engagement drawn from across a range of clinical disciplinesand local providers to develop the best ways of delivering appropriate care to patients. This willinclude pathway redesign, leadership in implementing new pathways of care, a fora education andknowledge sharing, and also act as a means to nurture the next generation of clinical leaders.

A Lambeth Clinical Network has been established to maximise the clinical input and leadership forcommissioning across Lambeth. While it incorporates some of those individuals from the existingclinical networks it also looks to provide clinical leadership in areas where there has been little orno input to date. A role has been established to allow the Network to be coordinated, supportedand developed by a senior clinician. We are keen to see the Lambeth Clinical Network as ameans of engaging clinicians across the full range of professions and as a way of securing anddeveloping sustainable clinical leadership for the future

Within our programme of work we are also engaging the statutory practitioners committeesrepresenting all areas of primary care. The LMC is represented at our Board meetings and LCCCBmembers attend Local Medical Committee (LMC) meetings. We have good links andcommunications to the other practitioner committees, in particular the Local PharmaceuticalCommittee. We intend to hold a primary care summit for LMC, Local Pharmaceutical Committee(LPC), Local Dental Committee (LDC), and Local Ophthalmic Committee (LOC) in summer 2011.

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2.7 Engaging with patients and Lambeth communities

The LCCC Board seeks to build on our good local track record of involving patients and the publicin health decision-making, and has highlighted engagement as a priority area for developmentduring 2011/12. The LCCCB has grasped early opportunities to take this work forward, presentinga stocktake and proposed approach to engagement for 2011/12 at its first public board meeting inJune. These proposals had been shared with stakeholders in advance and have been positivelyreceived by the both the Lambeth LINk and the Health Scrutiny Committee.Work is well underway to take forward the key strands of LCCCB’s approach to engaging patientsand our diverse communities, which include:

Ensuring that our health improvement and QIPP programmes have detailed engagement plansand that effective assurance mechanisms are in place that fit well with wider SE London NHSCluster mechanisms

Knowledge and capacity-building events for clinical commissioners on legislation, policyguidance, best practice in engagement and an introduction to Lambeth’s key community groups,fora and existing engagement mechanisms

Being visible and accountable: Board meetings held in public, a website that informs andengages Lambeth’s residents, attendance at community events and meetings

Appointing a clinical Board members an Engagement Champion and making best use of Non-Executives on the Clinical Board to maintain key relationships with Lambeth’s communities.

Forging purposeful and constructive relationships with MPs and local authority ScrutinyCommittee members as both representatives of Lambeth residents and as routes into localcommunities

Building a strong and unified community engagement approach with partners in thedevelopment of Lambeth’s Health and Wellbeing Board

Developing a close and positive working relationship with the LINk, establishing reliablecommunication channels, both formal and informal, scheduling senior leadership attendance atLINk meetings and supporting the development of a local HealthWatch through provision oftraining workshops on areas requested by the LINk including NHS finance, the commissioningcycle, quality and public health needs and health needs assessment

Working with Lambeth’s voluntary and community sector through umbrella organisations, suchas LVAC regular fora and individual organisations

Support to develop patient reference groups at GP practice level again in partnership withLambeth LINk

We are using the benefits of closer integration with London Borough of Lambeth to plan a moreintegrated approach to stakeholder and community engagement focused around our Localities.We will work with the London Borough of Lambeth to support their Cooperative Council strategy.

Our approach is determined by a strong population approach based on local needs assessmentand analysis of the evidence base so that commissioned services serve the population and areclinically and cost effective and culturally sensitive.

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Ongoing patient and public engagement informs our commissioning and care pathway redesignimprovement. Examples include:

mental health long term conditions (respiratory, diabetes, cardio vascular disease ) children’s and young people’s services sexual health services teenage pregnancy development of community primary care services

In addition, engagement has taken place with gynaecology, MSK, dermatology, headache andgastroenterology involving service users through the care pathway redesign team. Through focusgroups, service user surveys and 1:1 interviews, we have sought input on our proposed QIPPchanges around long term conditions, planned care and decommissioning plans.

As part of our Mental Health Improvement Programme, service users have been involved inservice improvement work on a co-production basis, which includes substantial feedback onexperience of services. The innovative Lambeth Living Well Collaborative, consists of clinicalcommissioners, primary care, the voluntary sector, users and carers, SLaM, Lambeth CommunityHealth, London Borough of Lambeth, and PCT representatives. The Collaborative has presentedproposals to wider partners and stakeholders. The LMC and LINk have also been consulted onproposed changes and the Overview and Scrutiny Committee have been engaged for futureconsultation.

Through the GSTT Charity sponsored Diabetes Modernisation Initiative, and in partnership withKing’s Health Partners, Southwark clinical commissioners, and working with LINk, and DiabetesUK we are looking at new and innovative ways of engaging with people with diabetes.

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2.8 Engaging with our Partners

We have identified our key partners and have developed strong and supportive relationships,building on those effective and strengthening partnerships that already exist in Lambeth.

• Health and Wellbeing (and Lambeth First)Lambeth has been designated as an Early Implementer Health and Wellbeing site and withlocal partners we have the H&WBB has held a series of workshops, facilitated by the KingsFund, to discuss the priority areas for joint working. LCCCB members are taking a leadingand very active role in the development of our health and wellbeing arrangements inLambeth. The H&WBB will develop the Joint Strategic Needs Assessment (JSNA), aborough-wide Health and Well-being Strategy and for overseeing health improvement in ourlocal community. All partners are committed to ensuring that the work of the Board haspractical benefits for the people who live in Lambeth. Two further areas of importance havebeen identified as enhancing the involvement of our communities and the role of PublicHealth.

• Commissioning Partners (including Social Care)- Lambeth Council , through a shared Integrated Commissioning Team for specific

commissioned services including mental health and substance misuse, learningdisability, adults with physical disabilities, older adults, carers and children services

- Other Clinical Commissioners; including Southwark, through our joint Planned andUnplanned Care programmes and more widely across the SE London Cluster andClinical Networks through shared acute contract management and certaincommissioning support functions.

• King’s Health PartnersLambeth CCC is actively engaged with King’s Health Partners at a range of different levels;for example;- LCCC Board members as members of the three FTs Members Councils- working together on system redesign, in particular through the Integrated Care Pilot Co

chaired by the LCCCB Chair and South London and Maudsley (SLAM) Chief Executive- working through programmes of pathway redesign in mental health, planned and

planned care and in public health- engagement with Clinical Academic Groups and across the KHP leadership- driving up quality in secondary care trough programme of quality review and our Quality

account- we are recruiting a KHP representative to sit on the LCCCB Board.

• Statutory bodies representing primary care (see section 2.6)

• Lambeth LINk (see section 2.7)

• Patients and Lambeth Communities (see section 2.7)

• Other Local PartnersWe have established good relationships with other key local partners. In particular with localvoluntary sector providers and with the Guy’s and St Thomas’ Charity both at level of theCharity Board and through a range of individual programmes.

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2.9 Engaging with staff

We have a strong history in Lambeth of clinical leadership in partnership with contract,commissioning and redesign manager leads. Previously clinical commissioners have engaged withcommissioning managers across aspects of re-design and contract management and we are nowseeking to build on this. All staff supporting commissioning are being encouraged to re-focus theirapproach in support of clinical leadership across the full range of primary care clinicians.

An event is planned for 1st July 2011 for all primary care clinicians, practice staff andcommissioning support staff, including public health, to meet and further develop a jointunderstanding of each others roles and how we can best support each other to develop clinicalcommissioning in Lambeth.

The Clinical Board was involved in the design and development of organisational structures androles in South East London and specifically for the Lambeth team. LCCC Board members areworking with Senior Management and commissioning support teams to develop the most effectiveways of working. LCCCB members will attend an away day planned on 30th June 2011 forLambeth commissioning teams to support this ongoing work.

We ran an all practice event for clinicians and other practice staff in February 2011 with focusedworkshops on different contracts to understand key issues for practices and to seek views ofpractices on key aspects of the contracts which have been fed into contract negotiations.

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2.10 Governance Arrangements

The Lambeth Clinical Commissioning Collaborative Board is a Committee of the Lambeth PCTBoard which itself operates on a collective basis with the five other PCTs in the South East LondonCluster. A diagram showing our key governance relationships is set out below;

The LCCCB Chair, Managing Director and the two non executive members sit on the joint SouthEast London PCT Board.

Our Non-Executive Members also sit on the Joint Audit Committee, the Joint Performance,Finance and QIPP Committee (as Chair), the Joint Quality & Safety Committee and the JointRemuneration and Employment Committee.

The Managing Director is a member of the SEL Cluster Management Board and DevelopmentGroup

The LCCCB Chair is a member of the two important executive south east London groups:

The Clinical Strategy Group which brings together the Clinical Board Chairs and otherclinical leaders form across the cluster to review strategic clinical issues.

The Stakeholder Reference Groups will be the fora where engagement on strategic changein health services across boroughs can be reviewed collectively with patientrepresentatives and stakeholders.

A quarterly Lambeth ‘borough’ stock take meeting, bringing together primary, community andsecondary care commissioning and performance functions across the Cluster teams is held on aregular basis.

The Chair is a member of the London-wide GP Commissioning Council, and other Clinical Boardmembers have also attended.

The Terms of Reference of the LCCCB as approved by the PCT Board are attached at Appendix3. Minutes of the LCCCB will be formally submitted to the PCT Board.

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The LCCC Board has been meeting formally on a monthly basis since 1st April and will meet inpublic quarterly. In addition, over this initial period, the Board has been meeting informally everymonth and holds a teleconference every two weeks to ensure momentum is maintained. We areactively reviewing the effectiveness of our Board arrangements to maximise our effectiveness andto ensure strong engagement with our stakeholders. Regular weekly meetings are held with theLCCCB Chair, Managing Director and Clinical Network Development Lead.

Our locality structure will play a pivotal role in shaping the success of the consortia. The outcomesof LCCC Board meetings are communicated direct to practices and through localities. Aprogramme of locality based meetings and visits have been established for the year ahead tosupport this work.

Within this governance framework we will work with all 52 Lambeth practices across our threelocalities, with a wide range of clinical colleagues, with our partners and with our local communitiesand their representatives. All of our partners are critical to our ability to secure our mission andvision.

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3 OUR MISSION, OUR VISION, OUR PLANS AND HOW WE WILL DELIVER

3.1 Our Mission and Our Vision

The LCCC Board has agreed a Mission Statement and strategic Vision as follows:

Our Mission:Our Mission is to improve the health and reduce health inequalities of Lambeth people and tocommission the highest quality health services on their behalf.

Our Vision:1. Health improvement is at the heart of all we do. We will increase life expectancy for all andreduce the difference in life expectancy between the most and least deprived in our diversecommunities.

2. We will maintain a thriving, financially viable, health economy delivering safe and effective highquality care.

3. We will commission comprehensive integrated care that meets the needs of local people. Wewill value diversity amongst providers, but will expect excellent outcomes.

4. In delivering this Vision we recognise the need:

- for a rigorous, population needs based approach to commissioning, supported by publichealth expertise.- to work with Lambeth people and their representatives to commission services that bestmeet their needs.- to work in partnership with colleagues, across geographic, organisational andprofessional boundaries. This will include primary care practitioners, the London Boroughof Lambeth, King's Health Partners and neighbouring health commissioners.- to support innovation in workforce development and in the local application of teaching,training and research.- to look first to local colleagues for management support

Our Strategic and Annual Plans set out how we will achieve our Vision and our operationalprogramme and performance management frameworks will support us to ensure we remain ontrack to deliver.

3.2 Our Strategic Plan 2011/12 – 2014/15

Our Strategic Plan Refresh was led by the Clinical Board and was co-produced with cliniciansalongside representatives from Lambeth Council, local voluntary groups and the Lambeth LINkduring winter 2010/11. It has been informed through prioritisation criteria developed with all keylocal stakeholders using the Joint Strategic Needs Assessment (JSNA) to ensure a populationbased approach. We have a clear vision and strategic approach to the delivery of healthimprovement, QIPP and enhancing service quality through our strategic health programmes.

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3.3 Our Integrated Plan and QIPP Plan 2011/12

The Clinical Board led the development of the 2011/12 Integrated Plan for Lambeth. Thisaddresses our financial framework, QIPP proposals, performance standards, workforceassumptions, and informatics assumptions..

QIPP plans were developed through multi disciplinary programme boards including GPcommissioning programme leads in out of hospital care, community services, mental health, end oflife care and sexual health, long term conditions and staying healthy. The Clinical Board hasprioritised our work on Mental Health and on Long Term Conditions, in particular diabetes. Havingbeen involved in the planning stages, clinical leads are actively engaged in the delivery of ourpriority QIPP programmes. Assumptions and focused areas for acute outpatient savings wereagreed through the Lambeth Practice Based Commissioning Collaborative. These were based onpriority areas identified through practice based commissioning locality groups and subsequent carepathway redesign project groups, including GP locality representatives and other primary andsecondary care clinicians.

Two major capital schemes proposed and funded through the Strategic Plan have strongengagement from local GPs and the next phase of planning for Norwood Hall a significant schemefor the south of the borough is led by a Project Board including the Chair and Vice Chair of theSouth East Lambeth PBC Group.

3.4 Our Business Plan 2011/12

Our agreed Lambeth Business Plan attached at Appendix 4 sets out our key 2011/12 objectivesand organisational leads. The Business Plan centres around our three key areas of business:

Operational delivery: To deliver our agreed priority programmes with robust operational riskand financial management and effective high quality care

Organisational development: To manage the transition of commissioning responsibility toGP Consortia and the establishment of new Health and Wellbeing arrangements, within thecontext of engaging public and patients and managing equalities

Governance and Assurance: To ensure systems and processes are in place to supportindividual, team and corporate accountability for delivering patient centred, safe, high qualitycare, within our resource limits.

All of our key standards, QIPP targets and CQUINs are linked to specific objectives and leadsidentified. The Business Plan forms the basis for individual objective setting and performancereview for every member of staff in the Lambeth Business Support Unit. Each key objective withinthe Business Plan has a notified Director lead and key objectives are assigned at AssistantDirector level.

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3.5 Overseeing and Assuring Delivery

The LCCCB will oversee delivery of our Business Plan, within an overall planned agenda, acrossour three main business areas as above. The LCCCB will receive a comprehensive IntegratedPerformance and Governance report addressing;

i) our Board Assurance Framework,

ii) our risks to delivery, and

iii) our performance against the objectives as set out in the Business Plan.

In order to ensure delivery of our objectives two multi disciplinary groups have been established:

Operations Group – Chaired by the Managing Director, with membership comprisingall NHS Lambeth Directors and Assistant Directors. This group meets twice a monthwith the role of overseeing and quality assuring our operational performance, includingthe priority programmes and routine contract management. Where necessary, this willinclude the development of Action Plans in-year to ensure performance remains ontrack. The preparation and quality assurance of Integrated Performance andGovernance reports to the LCCCB are co-ordinated through this meeting.

Development Group – Chaired by the Managing Director, with membership comprisingall NHS Lambeth Directors. This group meets twice a month with the role of reviewingprogress in organisational development and issues of assurance and governance. Thismeeting will quality assure reporting to the LCCCB on policy, patient safety andorganisational development objectives.

We meet regularly with the South East London Cluster leads to discuss and review performance ofthe cluster-led contracting and support teams (eg acute and primary care). These meetings areused to ensure delivery of elements of the Business Plan which are dependent on cluster-wideperformance.

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3.6 Programme Management ApproachIn order to deliver our strategic priorities we have put in place enhanced programme managementarrangements for 2011/12. We have agreed four overarching health programmes as set out in thediagram below, each with a Director-led Senior Responsible Officer and a Clinical CommissioningLead. Two of the four Programmes are managed jointly with Southwark Clinical Commissioners.

Programme Initiation Document

- Project overview (includin- Key stakeholders- Success factors- Assumptions- Risks- Key milestones/deliverab- Benefits summary- Communications and Eng- Budget

All PIDs are developed by the prthe programme, and approved b

Lambeth Clin

Unplanned Care

Joint with Southwark

Urgent Care Frail Older

People

Pla

Joint w

managemconditions

early dete secondar managem

in the mosettings

shifting sepromoting

reducingvariability

s have been agreed for these four programmes wh

g objectives and approach)

les

agement Plan

ogramme leads, overseen by the Senior Responsy the Lambeth Operations Group.

Operations Group

South East London Joint PCT Boards

ical Commissioning Collaborative Board (LCCCB)

Mental Health

Lambeth LivingWell Collaborative

Forensic services Payment by

Results Talking Therapies/

Counselling Dementia

nned care

ith Southwark

ent of long term(including HIV)

ctiony preventionent of elective carest appropriate

rvice provisionappropriate referral

inappropriatein care

Joint Lambeth and

Page 20 of 33

ich cover:

ible Officer for

Staying Healthy

Access to preventionTobacco and alcoholAdult and ChildhoodobesityPhysical activityPovertyHealth determinants

Southwark GP Leads

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3.7 Information Management and monitoring

We recognise that the key aspect of the performance management cycle for which there will begreater direct involvement of clinical commissioners over te transition period will be ensuring thedelivery of performance improvement. This will be through redesign of patient pathways, includingacross the primary and secondary care interface and through driving up quality and reducingvariation particularly in primary care.

Delegation to LCCCB will not alter current data flows. There is well-established national guidanceon production of data returns and existing data reporting processes will remain in place supportedby the Lambeth BSU and Cluster teams.

Availability of Performance InformationThe LCCCB Integrated Performance and Governance Integrated will include a suite ofperformance dashboards at regular times during the year, which will contain the latest availabledata and so that performance can be tracked against plans and over time. These dashboards willcover as a minimum Operating Framework headline and supporting measures, existing publichealth Indicators (i.e. the 2010/11 Vital Signs metrics) and Patient Safety. Further more in-depthdashboards on urgent care and on RTT performance are in development and should be availableduring Q2. These dashboards currently show data by provider and by commissioner respectively,but not a provider split of individual commissioner data. Such a split will be part of thedevelopment of the Dashboards during the year.

Performance on Operating Framework standards will be reported to each formal meeting of theLCCCB (as well as to Cluster Management Board, Operational Group, Finance, Performance &QIPP Committee and the PCT Boards). These reports will give an overview of performance andwill address issues relating to specific geographical areas or individual organisations by exception.

The LCCCB Board Assurance Framework and Risk Register is updated monthly for reporting andreview by the LCCCB. It will inform the monthly Cluster Board Assurance Framework and RiskRegister process.

3.8 Planning for 2012/13 and Beyond

The LCCCB will lead the development of Lambeth commissioning plans for 2012/13 and beyond indoing so we will draw on our experience in this role to develop and lead planning for 2011/12 onbehalf of Lambeth PCT. We will work with our Health and Wellbeing partners and other localstakeholders to take forward our strategic plan priorities, informed by our JSNA and to addressnational requirements and priorities. As such, we will work within the NHS London and SouthEast London Cluster planning framework. The LCCC Board meeting at the start of July willconsider the timetable and action required to deliver the 2012/13 planning round. Final plans willbe recommended to the PCT Board for final sign in the light of the NHS Operating Framework inspring 2012.

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4 OUR MANAGEMENT CAPABILITY AND CAPACITY

4.1 Borough delivery support requirements

In order to deliver our Business Plan the Lambeth Clinical Commissioning Consortia will accessthe managerial and commissioning support of the Lambeth BSU and South East London Clusterteams. The Collaborative were actively involved in the design and the recruitment to the supportservices structures for the Cluster and specifically of Lambeth BSU. The role of the directoratesand teams is to deliver the Business Plan under the leadership of the LCCCB. The full LambethBSU structure chart, summarised below, can be seen in Appendix 5.

The BSU has been structured in a way to maximise support to the Consortium across the followingteams:

Care Pathway Commissioning Team - Responsible for coordination and development ofstrategic planning and commissioning within the PCT, including Lambeth's contribution to theCluster Strategic Plan and Integrated Plan. In so doing, it provides the key interface with GPcommissioners on commissioning strategy, including QIPP delivery. The Directorate leads on keypathway redesign priorities including urgent care, elective and long term conditions, medicinesmanagement and community contracting. It works closely with other borough based teams tosupport and advise South East London primary care and acute contracting.

We have developed a service transformation team that works with leadership from clinical leads toreview and re-commission services. Re-commissioned services include musculo-skeletal services,diabetes, ultrasound, headache services, ophthalomology, oral surgery. Current redesign projectsinclude gynaecology, respiratory, heart failure and dermatology. We are developing partnershipworking with Southwark in order to plan effectively with King’s Health Partners and optimise use ofredesign and commissioning skills. The service redesign team work jointly with London Boroughof Lambeth to provide greater focus on unplanned care redesign. The partnership with LondonBorough of Lambeth includes the borough based procurement advice and support to GPcommissioners.

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Integrated Commissioning Team - The Director of Integrated Commissioning is a joint healthand social care appointment and leads a joint commissioning team covering the commissioning ofmental health, children’s services, older peoples services, health & wellbeing and social exclusionwhich will continue to be developed as commissioning support to LCCC. This team will work withthe Care Pathway Commissioning Team to generate the service and financial benefits that can beachieved by commissioning services across the whole healthcare economy for all residents.

Core Support Teams - a number of core local management and governance support functions,including; governance, organisational development, finance, HR, public involvement andengagement, quality assurance, performance management and with a pooled administrativesupport team

Public Health - providing an understanding of population health needs informing commissioning,service redesign and care pathway redesign and providing an evidenced based perspective topriority setting, including service evaluation and effectiveness.

4.2 Joint working with Southwark

Lambeth and Southwark acute services are in main delivered by Guy’s and St Thomas’s andKing’s who are working together through King’s Health Partners. To maximise our influence andincrease efficiency of commissioning resources we have developed close working arrangementswith Southwark. This includes:

Joint meetings of clinical commissioning leads to agree strategic approach and priorities. Joint leadership of work with KHP including clinical engagement with contract monitoring

supplied by the cluster based acute commissioning team. Two joint QIPP Programme Boards for Planned and Unplanned care supported by joint

redesign work in pathways e.g. frail elderly, muscular-skeletal, CVD, gynaecology andothers).

Collaborative work and a developing shared work programme on medicines managementand service redesign planned joint development session between formal redesign teams inJuly.

Lambeth is coordinating commissioner for the Community Health Service contract on behalfof Lambeth, Southwark, Lewisham and Wandsworth.

Lambeth hosts the Sexual Health Commissioning team on behalf of Lambeth, Southwarkand Lewisham.

4.3 South East London Cluster delivery support requirements

Working arrangements with cluster-wide teams are in place, coordinated through the ClusterManagement Team and through functional teams. In particular through following functional teams:

Acute Contracting Primary Care Contracting Communications and Engagement Strategy and QIPP Finance, ICT, Estates Perforamnce/Information

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We have a longstanding collaboration for acute commissioning with Southwark and Lewisham nowmanaged through the Cluster Acute Contracting Team across South East London with jointcontract, quality and planning meetings and with clinical leadership from clinical commissioninggroups as well as through clinically led pathway development and commissioning groups.

We work in partnership with the cluster primary care team to identify local needs and variation ,particularly for ensuring contracts reflect local priorities for staying healthy, long term conditionsmanagement, medicines management, referrals and urgent care. We have a challenging jointQIPP programme for primary care.

For contracting budgets managed at a cluster level, we will continue to access the managerial andcommissioning support agreed in South East London. Two early priorities are to ensure ourinformation governance and our business continuity and emergency planning arrangements arerobust.

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5 OUR DELEGATED RESPONSIBILITIES

5.1 Our proposed Delegated Budgets 2011/12

The Pathfinder, through the Lambeth Clinical Commissioning Collaborative Board propose to takefull delegated responsibility for focused areas of commissioning from July 2011, building towardsour ambition of full delegated responsibility by September 2011. We believe that delegation willsignificantly enhance the ability to deliver on the service and health improvement ambitions andthe local QIPP challenge that we share with NHS South East London and NHS Lambeth through astep change in clinical leadership and in the further engagement of primary care and cliniciansmore broadly.

We are proposing a two step approach to delegation with the commissioning of non-acute servicesbeing delegated from July 2011, and subject to review, acute commissioning from September2011. This approach reflects the relative degree of service and financial risk we have attributed tothese respective commissioning areas.

Proposed areas for delegation from July 2011:

1. Adult Mental Health, including opportunities arising from the Lambeth Living WellCollaborative and the management of forensic services where there we have a significantQIPP agenda over the period of the Strategic Plan

2. Community and continuing care services, including our prioritisation of district nursing,services for the frail elderly and further opportunities for integration with secondary care.

3. Prescribing, including further work to unify the formulary between acute and primary careand common approaches to the entry of new drugs.

4. Lambeth enhanced services with primary care

5. Our Staying Healthy initiatives

6. Associated reserves and earmarked funds

Proposed areas for delegation from September 2011:

1. Acute Activity, incorporating referral management and continuing the existing work onpathways of care, including for musculo-skeletal services, gynaecology, neurology,ophthalmology, diabetes, CVD, and respiratory care,

We will keep under review the range of our delegated services as arrangements for thecommissioning of services to support improved public health and the development of the NHSCommissioning Board are clarified over 2011/12. Where formal accountability may sit with otherbodies we recognise the critical importance of working in active partnership with othercommissioners to ensure the effective integration of commissioning of services across the carepathway.

Our planned outcomes for delegated commissioning activities are incorporated within our BusinessPlan will be further refreshed over the coming months to inform our 2012/13 commissioningintentions. In summary our outcome measures cover:

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Delivery of Financial balance and our QIPP plans Quality assurance of ongoing safety of services Patient reported outcomes and improved patient experience of services Enhanced effectiveness of services and care pathways Shift of care to out of hospital setting and from treatment to prevention Delivery of performance standards.

Our Business Plan explains clearly how our responsibilities will be managed through the LCCCBand supporting programme and performance management frameworks. We will stocktake deliveryagainst our outcome measures during September 2012 in advance of progressing to the nextphase of delegation.

Whilst we are aware Lambeth PCT has a relatively strong underpinning financial position thereremains a significant financial challenge, in particular related to delivering on QIPP plans acrossour unplanned and planned care and for mental health if the Consortia and the PCT are to remainon target for delivery of the planned surplus. LCCC is committed to the delivery of our financialcontrol total as a critical factor in allowing us to plan ahead with confidence, to retain our earnedautonomy over the period of transition and to ensure a sound legacy starting position for the newClinical Commissioning Consortia from April 2013. Table 1 below sets out the proposeddelegated budgets to the LCCCB during 2011/12;

Table 1 – Proposed delegated budgets2011/12

Budget

To Be

Delegated

Not

Delegated Management Support£000s £000s £000s

Acute Commissioning (proposed delegation from 01.09.11) 318,120 318,120 Cluster/Specialised Commissioning GroupNon Acute Commissioning - Mental Health 103,940 103,940 Lambeth BSUNon Acute Commissioning - Community and Continuing Care 81,496 81,496 Lambeth BSUSub Total - Commissioning 503,556 503,556 0

Primary CarePrescribing 37,875 37,875 Lambeth BSUPrimary Care - Enhanced Services 4,382 4,382 Lambeth BSUPrimary Care - Other 52,298 575 51,723 Cluster (Cluster/BSU for premises)Dental and Community Pharmacy Services 21,799 21,799Sub Total - Primary Care 116,353 42,831 73,522

AdminstrationBusiness Support Unit (including Public Health) 9,518 9,518 Lambeth BSUCluster and Other Administration 4,768 0 4,768 Cluster/Lambeth BSUSub Total - Corporate Budgets 14,285 9,518 4,768

OtherHosted Programme Budgets 4,271 0 4,271 Lambeth BSUContingency - 0.5% 3,147 3,147 0 Cluster/Lambeth BSU2% Non Recurrent Investment Fund 12,274 12,274 0 Cluster/Lambeth BSU (awaiting decision)Other 2,684 2,684 0 Cluster/Lambeth BSUSub Total - Reserves & Contingency 22,376 18,105 4,271Grand Total Expenditure 656,571 574,010 82,560Revenue Resource Limit 663,176Planned 1% Surplus 6,605

We are working closely with the SE London Cluster through regular stocktake meetings with leadsfrom across all areas of commissioning responsibility to identify key performance and QIPP risks,and, as necessary, to develop plans to coordinate recovery action to ensure delivery. Thisincludes making best use of the 2% non recurrent investment to enhance our existing schemesand enable those planned for 2012/13.

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Our risk assessment of our 2011/12 QIPP Plans (see Table 2 below) indicates our areas of higherrisk are associated with the management of unplanned and urgent care and the impact on the useof hospital services in terms of A&E attendances, admissions and readmissions. We are working incollaboration with Borough and Cluster management teams to address service redesign across ourunplanned care programme to ensure delivery over 2011/12. An significant element of this will bethe work we are undertaking with Southwark Clinical Commissioners, King's Health Partners andsocial care through the Integrated care Pilot.

Table 2 – Lambeth QIPP Plans Risk Assessment 2011/12

2011/12Risk Assessment

Description Proposed Date ofDelegation

£ Sector

Reduction in Outpatient Follow Ups 1st Sept 2011 £1,377,000 G

New OP referrals (GP/GDP) 1st Sept 2011 £1,224,000 R

Clinical Haemotology 1st Sept 2011 £179,000 G

Consultant to Consultant referrals 1st Sept 2011 £200,000 G

Reduce A&E Attendance 1st Sept 2011 £117,000 R

Emergency Admissions 1st Sept 2011 £518,000 G

Emergency Admissions - prevention COPD, CHF and Diabetes 1st Sept 2011 £224,000 R

Excess Bed Days per spell 1st Sept 2011 £297,000 G

Procedures of Limited Clinical Effectiveness 1st Sept 2011 £339,000 A

Acute Prescribing and medicines management 1st Sept 2011 £443,000 G

Other productivity & efficiency measures 1st Sept 2011 £252,000 G

Redesign of maternity pathway 1st Sept 2011 £59,000 G

Sexual Health - HIV Voluntary Sector 1st Sept 2011 £186,000 G

Sexual Health - ToPS and Vasectomies 1st Sept 2011 £26,000 G

Urgent Care - Redesign of A&E front end 1st Sept 2011 £67,000 G

Other guaranteed acute QIPP savings 1st Sept 2011 £836,000 G

Sub Total: Acute £6,344,000

New OP referrals (GP/GDP) - Shift - Replacement Costs 1st July 2011 (£462,000) G

Pathway Improvement Community Services 1st July 2011 £500,000 G

Telehealth - Community Services 1st July 2011 £250,000 G

Integration Savings - Community Services 1st July 2011 £200,000 G

Mental Health Improvement Programme 1st July 2011 £1,157,000 G

Prescribing 1st July 2011 £700,000 A

Other guaranteed non-acute QIPP savings 1st July 2011 £600,000 G

Review of Growth Funding Not Delegated £500,000 A

List size revew Not Delegated £500,000 G

Performance Management of Enhanced Services 1st July 2011 £250,000 A

QOF Exception Review Not Delegated £10,000 G

Review efficiency of access to GP Services Not Delegated £125,000 A

Reduce/redirect Enhanced Services 1st July 2011 £2,032,000 A

Review GP Contracts and propose GSE Fair Price Not Delegated £550,000 R

Dental - Review of UDA Prices Not Delegated £370,000 A

Sub Total: Non Acute £6,682,000

Total Savings £13,026,000

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5.2 Managing Financial Risk

The current overall NHS Lambeth Resource Limit is £663 million as set out in Table 1. It isproposed that budgets to the annual value of 574,010 are delegated to LCCC on behalf ofLambeth PCT during 2011/12.

The Clinical Board was actively involved in the delivery of financial balance during 2010/11 and thedevelopment, agreement and implementation of contingency proposals to mitigate risk and ensurefinancial balance. This process involved working with PCT commissioning and finance staff toreview existing budgets and identify, and risk assess proposals to deliver in year savings withoutcompromising patient safety or delivery of key financial targets. Experienced finance andcommissioning staff remain in place during 2011/12 providing dedicated support Lambeth clinicalcommissioners in ensuring financial delivery. We recognise that it also remains critical to work inclose collaboration with colleagues at the Cluster to manage risk and deliver service and financialobjectives.

During 2011/12 the LCCCB will be provided with monthly finance reports on performance againstQIPP targets and aligning monitoring and forecasting at both Borough and Cluster level. TheLCCCB will receive a detailed assessment of the overall forecast financial position during thesecond quarter of 2011/12 in order to determine the extent to which the any contingencyapproaches will be required. This review will remain under monthly review from Quarter Two basedon reported and forecast activity and on contractual provisions. Contingency approachesconsidered will include:

Seeking to effectively manage expenditure in overspending areas to budgetwhere possible, working with partners

Enhanced claims management and activity validation for acute services

Maximise effective use of the 2% Non Recurrent investment funds to ensure delivery of QIPPPlans, where appropriate working with other Clinical Commissioners and the SE LondonCluster teams.

Ensure delivery of the impact of changes arising from the revised Operating Framework, e.g.use of best use of social care and re-enablement funding to deliver service change andmanage risk across organisational boundaries.

Identification of new QIPP and savings opportunities.

Further consideration of the acceleration of QIPP plans, including 2012/13 proposals

Withholding any fortuitous savings identified, so as not to enter into any new unplannedcommitments.

Review of the potential to delay or reallocate planned 2011/12 investment which has notcommenced and to freeze any new commitments

Agreement, with partners, of mitigating actions, contingencies and demand managementplans to reduced projected over performance.

A review of all available resources and flexibilities across all PCT budgets, including LambethPCTs planned surplus for 2011/12.

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Financial and performance assessment and the contingency plans will be developed by theOperational Group and recommendations for action over the rest of the financial year, in responseto will be discussed and approved by the LCCCB, in SE London Cluster team and PCT Boards.

During 2010/11 through the PBC Collaborative practices were directly involved in the developmentof PBC budget setting for 2011/12 in accordance with national guidelines. Lambeth practices,working with Lambeth PCT, participated in the road test of a fair shares pilot budget model for useduring the 2011/12 budget setting round and the PCT worked with GPs to deliver an agreed set ofbudgets for 2011/12.

As part of in year financial management all practices currently receive monthly financial andactivity reporting information on commissioned services Lambeth Clinical Commissioners haveaccess to practice level analysis currently using Xiom (a web-based data warehousing system)and are involved in the development of other information management systems. Practice visitsthrough Locality leads will review financial and activity performance at practice level and atconsolidated locality level.

5.3 Operational Performance Delivery

The performance management of delegated responsibilities will be through the ClinicalCommissioning Collaborative Board. Lambeth’s Service Transformation/ QIPP ProgrammeManagement arrangements have been reviewed as part of the new framework to supportdelegated responsibilities to LCCCB during 2011/12. The LCCCB will be supported in this by theOperational Group, chaired by the Managing Director and consisting of all Lambeth BSU AssociateDirectors and key cluster leads for acute and primary care contracting teams. Key targets andlead managers/clinicians have been aligned to our programmes and to each key objective andthere are a clear action plan with timescales to ensure progress is tightly managed.Implementation of the Business Plan will ensure that we delivery on our service objectives therange of statutory responsibilities as will as managing the transition to clinically-led commissioningand the new Health and Well-being arrangements. In addition the LCCC will hold quarterlystocktake meetings with the senior director leads from across the Cluster functional teams andfrom Lambeth Business Support Unit to ensure delivery remains on track.

The PCT, GP Commissioners and SEL sector have worked together to put in place a process toensure active involvement of Lambeth clinical commissioners in the setting of 2011/12commissioning intentions and contract negotiation process. This has ensured that contractsreflect the views and concerns of GP commissioners in advance of them taking on formaldelegated authority. The Clinical Board developed and agreed CQUIN priorities to take intonegotiation with providers following discussion with lead clinicians. Lead Clinicians attend contractmonitoring and quality review meetings with providers and this will be further developed during2011/12, including appropriate feedback mechanisms to all practices.

Our three Localities will play a key role in undertaking peer review, highlighting any localperformance issues, agreeing solutions and in the implementation of action plans. We currentlyreport activity and finance data at practice, locality and borough level on a monthly basis. During2011/12 we will improve the quality and timeliness of data, its analysis and presentation.

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One of the key issues for Lambeth Clinical commissioners will be to work in collaboration with theSE London Cluster primary care contracting team to commission services to reduce variation inservice quality provided by primary care, particularly in the care of people with long termconditions. LCCC is taking a lead in London on the implementation of the Population HealthManagement and Clinical Checking (PHMCC) Tool originally commissioned by CommissioningSupport for London, supplied by United Health. This versatile Tool will support improved pathwayredesign and the active management of patients in particular those most frequently in contact withservices and those with Long Term Conditions. This will include monitoring of acute activity atpractice level, risk stratification from practice records, medicines management and the verificationand clinical checking of acute activity and billing. We are in the process of implementing thesystem to go live from July 2011. This will build on Clinical Commissioners experience over thepast two years in using the Bupa Health Dialog system, previously commissioned by NHSLambeth, around risk stratification of patients to support prevention of admission.

5.4 Resolving Conflicts and Escalation Process

We recognise that in the unlikely scenario that agreement is not reached with PCT/Clustercolleagues in relation to either operational delivery matters or in terms of strategic direction anescalation process will be required to swiftly resolve nay areas of disagreement and to allow foreffective action to be agreed.

The following approach has been proposed to escalate and swiftly resolve any areas ofdisagreement:

Stage 1 The Lambeth Clinical Commissioning Collaborative will actively seek to reachagreement with relevant SE London Cluster lead (eg Director of Operations, Director ofDevelopment, Managing Director etc) on any concerns raised (eg on specific arrangementsfor delegation, delivery requirements, support to be provided etc).

Stage 2 If timely agreement cannot be reached, then the Lambeth Clinical CommissioningCollaborative Chair will meet with the Cluster Chief Executive to set out concerns with a viewto actively reaching swift resolution.

Stage 3 If, in very exceptional circumstances, agreement still cannot be reached then NHSLondon will be asked to review and recommend a way forward over the transition period

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6 OUR DEVELOPMENT NEEDS & REQUIREMENTS

6.1 Pathfinder Development Framework

The LCCCB has assessed our commissioning development needs based on the domains in theNHS London Pathfinder Development Toolkit and have prioritised the following needs:

Priority 1; Empowering Patients Leadership People, Process & IT (enablers)

Priority 2; Finance Governance Procuring Monitoring

Priority 3; Vision and Strategy Planning

We are keen to utilise the support offered through the NHS London commissioned provideralliance and have completed our Organisational Development Statement of Works (see Appendix6). The support will cover development for the LCCCB and the primary care practitioners in thethree localities.

While awaiting the NHS London procured support we have started defining and addressing ourpriority areas.

i) Empowering patients and the publicWe have discussed our approach at the LCCCB held on public on 1st June 2011 and have setout our focus for the coming year which is outlined in Section 2 above.

ii) LeadershipWe have agreed terms of reference for the LCCCB, the LCCCB members received acomprehensive induction pack on relevant issues and an away day in April 2011 provideddedicated time for members to agree the mission, vision and values. A programme ofdevelopment sessions, including topics such as Finance (25th May), Public Health (8th June)and Acute Commissioning (September) have been agreed to provide context for LCCCBmembers. We have approached the National Leadership Council to provide Individual and/orTeam Coaching sessions for LCCCB members through the funded national programmeavailable to all Pathfinders.

iii) People, Process and Information Management (enablers)The Pathfinder Organisational Development Lead is responsible for supporting the LCCCB andNHS Lambeth staff in the development of the emerging GP Consortia and ensuring that wemake maximum use of all development resources available. The Business Plan will be used asthe basis for setting team and individual objectives and PDPs will be in place for all staff by theend of June. This will ensure that the ‘enablers’ are efficiently developed over the year in linewith the organisational requirements. The LCCCB identified a specific development need forSpeed Reading skills to help clinical and non-clinical members manage their portfolios of workwithin time constraints. This training will be run on 22nd June in the afternoon.

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In addition to the LCCCB specific development work, we will continue to work with our colleaguesin the Local Authority and across the cluster in order to ensure that commissioning developmentsupport is focused in the most appropriate places and with maximum benefit. This includessupporting NHS staff to develop commissioning support organisations and we will fully engage inthe NHS London led piece of work which is assessing the commissioning support requirementsand developing future options

6.2 Use of £2/head Development Funding

The £2/per head development funding equates to £756K per annum for Lambeth. An element ofthese funds have already been committed, with the support of the LCCCB and the SEL Clusterteam, within start budgets supporting both key dedicated roles in the Lambeth BSU and theLambeth Clinical Commissioning Collaborative Board. There are plans in place for the use of thebalance of funds to support local commissioning development and in particular clinicalengagement in commissioning and in our health and QIPP programmes.

The application of funds is as follows:£’000

1. Business Critical Support PostsIncluding Chief Financial Officer and OD Lead 130

2. Clinical Engagement and Clinical Leadership SupportIncluding Clinical Network lead, Business support to Clinical Network,systems to support LCCCB and Localities, training & development supportand clinical backfill 420

3. Commissioning Information SupportIncluding Information Analysis and management tools 206

Total 756

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7 CONCLUSION

This Pathfinder Delivery Plan seeks to demonstrate the capability and capacity of the LambethClinical Commissioning Collaborative, working within the SE London Cluster PCT governanceframework, to receive delegated authority to take on responsibility for the commissioning of nonacute health services for the population of Lambeth from July 2011 and with a view to the furtherdelegation of acute commissioning from September 2011.

We have a clear Vision and we believe that moving rapidly towards taking on responsibility acrossthe system is the right aim. We are, however, also aware that our Vision is ambitious and we arerealistic in understanding that its achievement will require further improvement in our capabilities.

Our overarching aim over this first period will be to ensure ongoing delivery of service qualitystandards and of our Integrated Plan and QIPP Plan commitments. At the same time we will workwith our partners to redesign service systems and care pathways to more provide for moreintegrated, responsive and high quality services for Lambeth people and to ensure a sustainableposition for local health services.

We are also clear on our development needs and would wish to ensure we can address these asquickly as possible. We look forward to receiving further details of the London wide developmentsupport package to assist us in this regard.

In developing this Delivery Plan we recognise the important commissioning support role played bythe Lambeth Business Support Unit and Cluster teams in providing responsive and high qualitycommissioning support.