Organisation Structure & Design - Wigan Borough CCG · 2015-05-10 · Organisation Structure and...

Wigan Borough Clinical Commissioning Group

Organisation Structure & Design

Healthy People, Healthy Place.

1. Introduction 4

2. The Building Blocks of the CCG 6

3. A Clinically Led CCG 12

4. Organisational Structure 20

5. Commissioning Support and Utilisation of Running Cost Allowance 33

6. Conclusion 41

APPENDIX 1: Overall use of Running Cost Allowance 42

APPENDIX 2: Ready Reckoner 2 44

Contents

Organisation Structure and Design

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1. Introduction

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• This paper is one of four core documentswhich Wigan Borough CCG (WBCCG) hasproduced to guide and shape it’s earlydevelopment. These are the Integrated Plan,the Organisational Development Plan, theOrganisational Structure and Design paperand the Constitution.

• The paper outlines our Vision and Values andpreferred way of working.

• Through the Strategy on a Page our promisesto the public, members, providers and otherstakeholders are articulated.

• The paper describes the structure, therationale behind the structure, the requiredcapability and capacity, and our relationshipwith our Commissioning Support Unit.

• It demonstrates the total ultilisation of our£25 per head running cost allowance andhow it will be mobilised to meet all ourcommitments and statutory duties.

1.1 CCG’s are a new and different NHSorganisation. They are membershiporganisations, where their members comprise ofthe GP practices in their area, they are clinicallyled and close to their communities and thepatients that they serve, engaging them in theirwork. These principles are central to our design.

Our structure is built to deliver our aims whichare:

• Outcomes and Quality focused

• Clinically Led and Locality Driven

• Strong Partnerships Across the LocalEconomy

• Collaboration with Other Economies

• Public Engagement and Accountability

• Financial Stability

• Integrated and Cohesive Services

1.2 Our Vision:

We will ensure the delivery of excellent healthoutcomes for the population we serve in theBorough of Wigan, maintaining clinicalexcellence and value for money.

1.3 Our Values:

• Good corporate governance. WBCCG iscommitted to ensuring that it is effective atunderstanding the business, can articulateand oversee the delivery of a strong strategicvision, deliver an improved patient experienceand is able to demonstrate robust financialcontrol.

• Respect and dignity. We value each personas an individual, respect their aspirations, andseek to understand their priorities, needs,abilities and limits. We take what others haveto say seriously. We are honest about our pointof view and what we can and cannot do.


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• Commitment to quality of care. We earnthe trust placed in us by insisting on qualityand striving to get the basics right every time:safety, confidentiality, professional andmanagerial integrity, accountability,dependable service and goodcommunication. We welcome feedback, learnfrom our mistakes and build on oursuccesses.

• Compassion. We respond with humanityand kindness to each person and givecomfort and relieve suffering. We find timefor those we serve and work alongside. Wedo not wait to be asked.

• Improving lives. We strive to improvehealth and wellbeing and people’sexperiences of the NHS. We value excellenceand professionalism wherever we find it.

• Working together for patients. We putpatients first in everything we do, by reachingout to all. We put the needs of patients andcommunities before organisationalboundaries.

• Everyone counts. We use our resources forthe benefit of the whole community, andmake sure nobody is excluded or left behind.We accept that some people need more help,that difficult decisions have to be taken. Werecognise that we all have a part to play inmaking ourselves and our communitieshealthier. We recognise that there are healthinequalities and will work towards creatinghealth equality.

• Wide clinical engagement. We believe thatall clinicians have a part to play in the designand delivery of health services. We will ensurethat the experience and knowledge of allclinicians, and best evidence, is used to driveour organisation and decision making.

• Led by front line healthcareprofessionals. We will use the experienceand knowledge of GP’s and other primarycare professionals to ensure that the values ofthe consulting room are embedded withinthe leadership and operation of the CCG.

• Services close to home. Patients wantservices as close to home as possible. We willlisten to patients and strive to commissionmore community / primary care focusedservices.

2.1 Within this section of the paper we describe:

• What we want to do and how we want to do it

• The Foundations of the CCG

• What we are building upon and how are we changing

2.2 This section explains the context and development of the CCG, what we are building upon, andwhat we wish to change and improve. It provides our strategy on a page, and describes thefoundations that underpin the organisational structure and design that has emerged.

2.3 What We Want to do and How We Want to Do It

2.3.1 What determines how we organise ourselves is driven by what we want to do and how wewant to do it.

2.3.2 What we want to do is enshrined in our vision and our values; the aims that we have, ourcommitments to our patients and partners; and our intention to develop a member ledorganisation.

2. The Building Blocks of the CCG

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2.3.3 How we want to work is built upon ourexperience of GP led commissioning across theBorough of Wigan over the past 3 years, whatwe are determined to improve and change, andthe principles that we have established that willunderpin how we work and organise to deliverour ambition.

2.3.4 These foundations, or building blocks ofthe organisation are embedded in the way wewill work together, with the organisationstructure designed to support what we want todo and how we want to do it.

2.4 Foundations of the Organisation

2.4.1 Outcome and Quality Focused

Quality is at the heart of the CCG and we havedeveloped a clear strategy in this area. Quality isabout people and our strategy aims to provideeveryone with the care and compassion theywant and need by enabling their voice to beheard and then designing and commissioningservices with them and for them that are safeand effective. The CCG will seek to ensure thatacross the Borough this is provided reliably toevery person, every time. The CCG has promisedto deliver improved outcomes and as such ourstrategy is focused upon this goal.

2.4.2 Clinically Led and Membership Driven

Our organisation is built around clinicalleadership from our member practices andclinicians. The structure demonstrates a clear

clinical leadership model that will be applied toall that we do. Central to the ability to clinicallylead, is the engagement of member practiceswithin a large CCG. Our 65 practices formedthemselves into 6 localities a number of yearsago, and these localities are now the CCG. Theyare closest to our patients and communities andthus can react to needs and implement changemuch quicker than previous organisations.Practices in localities can support each other,share good practice and hold members toaccount.

2.4.3 Strong Partnerships

We know that relationships are important, withour partners, our communities and ourmembers. Good relationships are built overtime, and ensured through openness, trust,communication and effectiveness of the CCGdelivery. There is a history of strong partnershipbetween the Local Authority and healthcommissioners, and our other health partners.Our structure ensures that attention is paid tonurturing and strengthening our partnerships,and to redefine and explore opportunities fordoing things in a different way.

2.4.4 Collaboration

Collaboration is defined as the action ofworking with someone to produce something.In health terms it is often about organisationsand individuals coming together to commissiondevelop or provide health and social careservices. Currently there are informal and formal


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collaborative arrangements in place betweenPrimary Care Trusts, Foundation Trusts, CCG’sand Local Authorities. The collaboration mostoften occurs when health services are veryspecialist and therefore high cost and lowvolume, or health commissioners and providersmay wish to work on a project across a widerarea than their own population. Collaborationhappens with Local Authorities to help developseamless and often more cost effective servicesin an area. Collaboration has been happeningbetween practices and localities to deliverPractice Based Commissioning (PBC).Collaboration is an essential component ofcommissioning and will be central to the CCG’sway of operating. The CCG is formalisingcollaborative arrangements across GreaterManchester to deliver training and education,research, innovation and health services. We arereviewing a large pooled budget arrangementthat is in place with the Local Authority. TheCCG has brought together 6 PBC groups tocollaborate as one CCG.

2.4.5 Public Engagement andAccountability

The CCG has a significant commitment to publicengagement and accountability outlined withinthe CCG Communication and EngagementStrategy. Three objectives are identified.

• Build continuous and meaningfulengagement with all stakeholders includingthe public, patients, GPs and carers toinfluence the shaping of services and improvethe health of people in Wigan;

• Develop awareness of and confidence inWBCCG as a responsive commissioningorganisation;

• Create a culture that promotes openstakeholder communication and engagementwithin and outside the ClinicalCommissioning Group.

How the CCG is configured and works inpractice is essential to the delivery of ourobjectives. Thus we believe that publicengagement and communication is bestobtained from practices, through to localitiesand to the CCG within a supportingmanagement structure.

2.4.6 Financial Stability

CCG’s must ensure that they remain within theirfinancial limits and therefore it is essential thatthe CCG inherits a balanced and stable financialposition from the PCT. The CCG will facesignificant challenges in commissioning servicesand delivering financial savings, however webelieve that with our proposed model offinancial management working within theclinical and managerial structure, essentialfinancial grip, and thus financial stability can bemaintained by the CCG.

2.4.7 Integrated Services

Amongst the many duties that CCG’s have, one isto promote integration, that integration must:improve the quality of those services (includingthe outcomes that are achieved from their


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provision), reduce inequalities between personswith respect to their ability to access thoseservices, or reduce inequalities between personswith respect to the outcomes achieved for themby the provision of those services. The CCG hasmany providers of care and the commissioning ofservices has traditionally taken place in a non-integrated manner. The CCG structure is designedto bring the contracting process for all providerstogether in one work stream and (essentially) toalign that to some dedicated clinical leadership.This process will be supported by much moreclinical cooperation and engagement across allproviders and commissioners.

2.5 What We Are Building Upon

2.5.1 There are six localities in Wigan Borough,each with its own communities andrelationships.

• Atherleigh

• Patient Focus

• TABA

• Wigan

• Wigan North

• United League

2.5.2 GP practices have developed stronglocality identities that they will maintain withinthe CCG. These localities have been central toeffective Practice Based Commissioning over thelast few years. Localities have experience of

managing delegated budgets, leadingcommissioning work streams, demandmanagement, QIPP delivery and clinicalleadership. GP’s have had a leading role incontract and redesign negotiations anddiscussions.

2.5.3 Each locality has its own executivecommittee made up of member practicesrepresented by GP’s and practice managers.Nursing forums and Practice manager forumsare present in most localities and all localitieshave Patient Participation Groups (PPG).

2.5.4 Each locality has had a managementallowance from which it purchased managerialand administrative support and reimbursedclinicians for clinical engagement activities.Localities have experience of working togetheron Borough wide schemes and local schemes.

2.6. How it will change

2.6.1 The CCG will be a statutory organisationthat must be clinically led, therefore thestructure of the CCG has to be developed toembed that leadership. In Wigan Borough eachlocality has elected a GP lead representative whowill act as the Clinical Executive and as amember of the Governing Body. One of thoseleads applied through an open process,amongst the clinical leads, to become Chair. Thisleft a vacancy for one of the localities whoelected a replacement. This means that 7 GP’ssit on the Governing Body and therefore theywill be the majority decision makers within thenew organisation. GP members will chair key


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committee’s such as Clinical and CorporateGovernance Committee’s, Finance andPerformance. Plans are also in place to recruit 5Clinical Directors who will lead the majortransformational work streams and a clinicalleadership model has been developed tosupport this. An effective managementinfrastructure has been designed to support andfacilitate the organisation to work as a clinicallyled membership organisation. An accountabilityagreement and scheme of delegation has beenagreed with practices and localities that outlineroles, responsibilities and expectations.

2.7 Commissioning Support

2.7.1 A significant strength of any organisationwill be the staff that work within the CCG.Wigan Borough CCG is fortunate in thatsignificant numbers of Primary Care Trust staffhave continued to work locally and to have beeninterim assigned to the CCG. These staff retainorganisational memory, have well developedrelationships and insight within the local healtheconomy and have a track record of delivery andgrip within the local health economy. Togetherwith the small number of dedicated localitystaff, it is intended that the CCG will make thesignificant majority of its commissioningfunctions, that is, employ staff within the CCG,and utilise external commissioning supportwhere it provides additionality, specialistexpertise or better value for money. Externalcommissioning support will be obtained inbusiness critical areas such as IM and T, BusinessIntelligence and Procurement. Our full

intentions are described later within the paper;however, relationships with commissioningsupport providers will be managed by namedmanagers within the structure.

2.8 Strategy on a Page

2.8.1 The new organisation that we are buildingwill be judged on its ability to deliver itsstrategic intentions.

2.8.2 The Strategy on a Page describes in anaccessible form the context within which theCCG will be operating, the vision agreed by themembership, and the strategic themes,objectives and outcomes drawn from nationaland local plans and priorities.


Strategy On A Page Wigan Borough ClinicalCommissioning Group 2012 to 2017

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• Wigan Borough Clinical Commissioning Group (WBCCG) consists of six groupings of GP practices. Each grouping has anidentified geographical locality within the borough.

• The CCG has the responsibility to plan and purchase health services for approximately 320,000 patients with a total budget of£450 million against a backdrop of a poor economic climate.

• Across the CCG area there are early deaths resulting from heart disease, stroke, cancer, alcohol related disease and obesity.

• The area has one of the highest rates of people claiming unemployment benefit as a result of mental health problems and thelevels of dementia will rise over the next decade.

• System reform of the treatment and management of Long Term Conditions is essential.

• We believe that through Clinical Commissioning and joint planning with our partners, our patients and the public, we will beable to tackle this challenge over the next five years.

VISION

WBCCG will ensure the delivery of excellent health outcomes for the population is serves in the borough of Wigan, maintainingclinical excellence and value for money. This will be achieved through effective commissioning; achieving the maximumimprovements possible in the health of patients served by its member GP Practices and of all Wigan Borough residents; maintainingan excellent clinical performance; delivering value for money, and providing clinical leadership and member engagement.

STRATEGIC THEMES

Delivery of key nationalinitiatives and priorities.

Development of an effectiveand efficient ClinicalCommissioning Group (CCG).

Development of acommissioning system thatembeds the NHS Constitutionand the principle of “NoDecision About Me WithoutMe”.

Delivery of Quality,Improvement, Performance,Prevention requirements acrossall levels.

Delivering improved outcomesfor our population and reducedhealth inequalities.

Commissioning the highestquality services.

OBJECTIVES

• Implementation of NHS Operating Frameworks.• Delivery of national Key Performance Indicators.• Transition to the new NHS system.

• Successful Authorisation as a CCG.• Redesign of Primary Care Services.• Clinically led commissioning.• Compliance with duties and responsibilities.

• Effective communication systems.• Improved choice and Shared Decision Making.• Patient engagement in CCG decisions.• Transparency and accountability.

• Achievement of CCG economy QIPP targets.• CCG collaboration in regional QIPP program.• Participation of all NHS providers.• Participation with LA.

• Joint planning, needs assessment with H and WB.• Implementation of NHS Outcomes Framework.• Robust health intelligence.

• Quality embedded within the CCG and contracts.• Development of strong performance culture.• Knowledgeable and skilled workforce.• Continuous improvement.

OUTCOMES

• Deliver key national priorities.• CCG performs to a high level.• CCG leads a local health system that has delivered the

NHS reforms.

• Be a fully authorised CCG.• Improvements in the quality and performance of

Primary Care.• Success and annual assessment.

• Good stakeholder communication.• New providers to health system.• Reduction in referrals attributable to Shared Decision

Making.• Year on year reduction in appeals against CCG processes

and policies.

• Engagement in collaborative CCG schemes.• Leadership of some economy QIPP programmes by

providers.• Joint QIPP priorities agreed with LA.• Financial balance in a system under pressure.

• Agreed set of joint priorities.• Systems in place to monitor and measure Outcomes

Framework.• Strategic planning tools in place.

• Robust CQUIN and penalty scheme.• Early warning systems in place.• Effective quality management.• Workforce development strategy.• Achievement of CCG Quality Payment.

3.1 This section of the paper describes the CCG’sapproach to designing and embedding clinicalleadership within the new organisation. ClinicalLeadership and membership engagement are theessential ingredients, “what is different ?” aboutthe organisation. The section describes:

• A Clinically Led Organisation

• Clinical Commissioning Leadership

• Membership Participation in Decision Making

• Strategic Commissioning Groups

• Clinical Leadership

• Clinicians Leading Decision Making

3.2 A Clinically Led Organisation

3.2.1 Clinical Leadership is embedded withinthe organisational design of the CCG, from the

practice to the board room. The diagram belowillustrates the overview of the CCG design. Itshows the interaction between the localities, thecorporate functions the clinical leadership, andthe management support.

3.2.2 The principles of the design are that it is:

• Based on critical difference factors andenablers;

• Designed to manage corporate / statutoryresponsibilities, Wigan-wide commissioningand programmes of innovation;

• Designed not to recreate layers of PCTbureaucracy and not to create multiple layersfor practices as well;

• To support a strong culture and identity ofclinical commissioning.

3. A Clinically Led CCG

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Patients / Practices

Provider role only

Interested - one off

Interested in specifictasks & finish groups

Clinical Champions

Clinical Director

1

2

3

4

Mem

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Commissioning Strategy &Corporate Support

CorporateFunctionsCorporateFunctions

Governing Body

• Service Design and Implementation• Clinical Governance• Corporate Gov• Finance & Performance• Remuneration• Audit

ALLocality

PFLocality

TABALocality

NWLocality

WiganLocality

ULLocality

CommissioningStrategy &

Innovation Groups

Locality Support

3.3 Clinical Commissioning Leadership

3.3.1 One of the critical difference factors forWigan is to create processes and structures thatsupport real clinical involvement and decisionmaking in commissioning as a membershiporganisation. To support this, Wigan CCG hasdeveloped a constitution and an accountabilityagreement for localities that makes clear thatthe localities are the ‘board in action’. It iscurrently developing membership processes, tosupport localities to shape CCG strategydevelopment and review.

3.3.2 In order to support clinicians to lead andimplement programmes of end-to-endcommissioning and locality innovation projects,

Wigan CCG has developed a membershipengagement model, with four tiers ofengagement. This model supports: thedevelopment and implementation of strategiccommissioning programmes, through theClinical Strategy Groups (CSG’s) and projects;the development, testing and implementationof novel and short-term commissioning projects,to inform the development of thecommissioning strategy; a wider process formembership consultation and involvement viathe localities.

3.3.3 This supports a network model andenables clinicians to engage with thecommissioning agenda in a way that suits theirinterest and time commitments.


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Provider role - as part of a member practice, all GPs and other primary care professionals are involved with theCCG as providers of primary care, by making treatment decisions and referrals for their patients. This involvementis managed through the policies and targets of the Board and through the Locality structures and engagements.

Tier 1: Interested one-off task - Locality clinicians who are happy to contribute on a one-off, or very shortterm basis, e.g. Read a document, comment on a new model, attend a commissioning project event.

Tier 2: Task and Finish Groups - Locality clinicians who want to work on a short-term project forcommissioning improvement. They would work with clinical champions and take part in pathway redesigns,improvement events, develop clinical solutions.

Tier 3: Clinical Champions - responsible for directing and overseeing a strategic commissioning project ofwork, or a short-term innovation project, agreed by the Board. Clinical champions may also contribute to widerprogrammes of work. This role would be accountable to a Clinical Director and would develop and exploreclinical solutions or methods to the challenge. The clinical champion would also liaise with the wider clinicalcommunity on the project and seek input and support.

Tier 4: Clinical Director - responsible for directing and overseeing a strategic commissioning programme ofwork (or agreed innovation programme), delivered through a number of related projects. The Clinical directorwould set the strategic direction for the programme and identify the key clinical issues and engagement. TheClinical director would take a lead in external and internal communication and engagement for the programme.

Provider role only



Clinical Champions

Clinical Director

1

2

3

4

All tiers of the membership engagement model will be supported by appropriate levels of business, management and technical support through corporatenetworks described next.


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3.4 Membership Participation in Decision Making

3.4.1 The CCG is designed to ensure that patients and members can influence the development ofstrategy and thus commissioning. Key to this happening is that the localities and practices becomethe main vehicle for member and patient and practice engagement. The necessity for 6 localitieswithin a 320.000 people, 65 practice CCG speaks for itself when it comes to meaningfulengagement.

The diagram below illustrates how the CCG will aim to develop its strategy in the future in aninclusive and meaningful way.

Shaping Strategy: how Localities shape the CCG corporate strategy

Patients

Provider role only



Clinical Champions

Clinical Director

1

2

3

4

Practices

Governing Body

Localities have their own prior processes to feed into each event.

CCG - Wide strategic membership events - to listen to the Localities on strategy, ideas 1 x quarter

ALLocality

PFLocality

TABALocality

NWLocality

WiganLocality

ULLocality

National / Regional / LocalDrivers & Partnerships

Governing Body takes outputs from each event and puts inplace any arrangements to effect what has been agreed.

This could be anything from:• Setting up a new or changed Strategic Commissioning

Group;• Directing a Strategic Commissioning Group;• Setting up a task/finish project;• Allocating a project to a Locality;• Writing a letter or a policy etc.

All actrion is performance managed by the GoverningBody.

These events are designed andprogrammed to support the GoverningBody deliver its Commissioning Plan intime for contract negotiations for thefollowing year.For example, the first event is aboutcontext and priorities, the second andthird on particular areas for developmentand the final to confirm the Plan.


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3.4.2 Essentially the CCG strategy needs to beclinically driven and clear processes and supportneed to be built within the OrganisationalDesign. The CCG has opted to utilise StrategicCommissioning Groups as the vehicle forstrategy design and development. It is thereforeimportant to describe the workings of thesegroups to understand their relationship to theCCG design.

3.5 Strategic Commissioning Groups

3.5.1 Wigan Borough CCG will managestrategic programmes of commissioning andmajor service redesign through a StrategicCommissioning Group (SCG) model shown here(note the actual project examples are forillustrative purposes only). This draws upon themembership engagement model describedpreviously. Wigan Borough CCG will have anumber of major programmes ofcommissioning. These will cover the majorareas of health need and service transformationacross Wigan. A Commissioning Programme,such as Long Term Conditions, would be led bya Clinical Champion. This role would direct anumber of commissioning and/or innovationprojects, through a project planning cycle and anumber of task and finish groups (whererequired). All of these elements would drawupon clinical input, which would attractappropriate reimbursement.

3.5.2 In order that clinical time can be directedto added value activities, this model needs to berobustly supported by a corporate supportnetwork, drawn across different and

multidisciplinary teams. The Clinical Director ofeach SCG would be supported by a seniorservice transformation manager. This managerwould likely have subject knowledge of thecommissioning programme area and wouldmanage and deliver the necessary outputs fromthe programme. The Service TransformationManager would also ensure that the variousprojects within the programme and the ClinicalChampions are supported with strong projectmanagement support and servicetransformation expertise and any necessarytechnical information and financial resource.

Populated by Locality clinicians and practioners

Innovation Groups, testing new service ideas ordelivery mechanism to feed into the CSGs

Strategic Commissioning Programme 1: LTCLed by Clinical Director

Supported by Service Transformation Manager

Supported by CSG Support Network drawn from thecentral support, including financial modelling, dataanalysis, service redesign change management,

programme and project management.

Diabetes

Led by ClinicalChampion

Heart Disease


Dementia


COPD


Task &Finish

Task &Finish

Task &Finish

Task &Finish


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3.6 Clinical Leadership

3.6.1 The CCG has an extensive base of clinicalleadership already established and will seek tobuild and further support this in the neworganisation.

3.6.2 Over a third of GP’s are actively engagedin leadership or redesign roles across theBorough and within Localities. The CCGstructure will build and develop its leadershipcapability, and strengthen the clinical leadershipthrough organisational development.

3.7 Key Roles:

3.7.1 CCG Chair: Clinical Chair, recruited fromthe 6 Clinical Executives. Chairs the GoverningBody and Commissioning Executive.

3.7.2 GP Clinical Executives: GP GoverningBody executives for each of the 6 localities.Elected Clinical Executive role and CCG wideleadership roles including the following areas:

• Corporate governance

• Finance and Performance

• Clinical Governance

• Mental health

• Contract Management

• Health and Wellbeing board

• Medicines Management

3.7.3 GP Deputy Clinical Executive: Electeddeputies for each of the 6 localities

3.7.4 Locality GP members. A number ofGP’s currently take the lead at locality level andat Borough level for a number of areasincluding;

• Long Term Conditions

• Demand Management

• Pathway redesign

• Performance Intervention

• Safeguarding

• Mental Health

• Cancer

• Stroke

3.7.5 In addition the CCG has agreed toformalise these arrangements in a number ofkey roles to support it’s four Tier ClinicalLeadership model. These roles are 5 clinicaldirector and 5 clinical champion posts.

• Clinical Director of Strategy andRedesign - To provide Senior Clinicalleadership in the development and delivery ofthe CCG’s clinical strategy and serviceredesign programmes including any QIPPinitiatives in this area.

• Clinical Director of Contracting andPerformance – To provide senior clinicalleadership and input into the Contracting andPerformance processes of the CCG.

• Clinical Director of Quality andEffectiveness - To provide Senior Clinicalleadership in the development and delivery ofthe CCG’s Quality and Effectiveness strategyincluding any QIPP initiatives in this area.


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• Clinical Director of Primary CareDevelopment - To provide Senior Clinicalleadership in the development and delivery ofthe CCG’s primary care development strategyincluding any QIPP initiatives in this area. Thisrole will also include responsibility for IM andT and Nursing.

• Clinical Director of MedicinesManagement - To provide Senior Clinicalleadership in the development and delivery ofthe CCG’s Medicines Management strategyand programmes of work including any QIPPinitiatives in this area.

• Clinical Champion of Children andFamilies - To provide Senior Clinicalleadership and advice for the programme ofwork relating to Children and Families. Toinfluence and develop the strategic directionof these services and ensure that all statutoryobligations are met and to promote thewelfare of children.

• Clinical Champion of Mental Health - Toprovide Senior Clinical leadership to improveoutcomes of the portfolio services. enhancecommunity mental health promotion and toprevent mental illness through earlyintervention for high risk groups.

• Clinical Champion for Long TermConditions - To provide Senior Clinicalleadership and advice for the long termconditions programme of work and to ensuredelivery of the relevant QIPP initiative. Take alead role in Joint Commissioning for a range ofservices to meet service users and carer needs.

• Clinical Champion for Cancer - To provideSenior Clinical leadership and advice for thecancer programme of work and to ensuredelivery of the relevant QIPP initiative.

• Clinical Champion for MedicinesManagement – Each locality currently has achampion and their work will be coordinatedthrough the Clinical Director.

3.7.6 All these roles have job descriptions andperson specifications and will be recruited toprior to 1st April 2013.

3.7.7 It is anticipated that other clinicalchampion roles may emerge as the strategystreams develop, and some roles maybe timelimited and undertaken on a task and finishbasis, however the Clinical Champion roles arelikely to remain permanent.

3.7.8 All these roles will attract remuneration.

3.7.9 The diagram overleaf illustrates themanagement relationships between the ClinicalChampions and Clinical Directors.

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Clinical Directors and their Clinical Champions

CDStrategy

and ServiceRedesign

CCMentalHealth

CCLong TermConditions

CCCancer

CCChildren &Families

CDPrimaryCare

Development

CDQuality

CDContracting

andPerformance

Locality CCMedicines

Management


Management


Management


Management


Management


Management

CDMedicines

Management

3.8 Clinicians Leading Decision Making

3.8.1 In developing the design the CCG hasensured that clinicians lead decision makingacross the CCG with the support of the ChiefOfficer, Chief Finance Officer, other GoverningBoard members and senior managers. Clinicianschair all the key decision making groups, andthe members of those bodies have been elected

to represent their localities as well as to takecorporate positions. We believe that in this waythe organisation has the real potential toengage and represent the views of all itsmember practices.

3.8.2 The diagram below illustrates the CCGgovernance structure; boxes with a red outlineindicate areas led by clinicians.


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Governance Framework

The WBCCG Governing Body will ensure they have receipt of the required assurancesfrom the committees as detailed below to provide evidence of organisational

compliance

CLINICALGOVERNANCECOMMITTEE

Assurance• Quality and

Safety• Clinical • Effectiveness• Patient• Experience

CORPORATEGOVERNANCECOMMITTEE

Assurance• Corporate

Business• Statutory

Compliance

FINANCE ANDPERFORMANCECOMMITTEE

Assurance• QIPP• Finance• Contracting• Capital• Performance

SERVICE DESIGNAND

IMPLEMENTATIONCOMMITTEE

Assurance• Strategy• Policy• Service design • Work-plan

REMUNERATIONCOMMITTEE

Assurance• Implementation

National Arrangements

• Contractual Arrangements

• EmployeeT&C’s

• Employee Remuneration

WIGAN BOROUGH CLINICAL COMMISSIONING GROUP GOVERNING BODY WBCCG AUDIT

COMMITTEE

Assurance• Probity• Regulation• Governing Body

AssuranceFramework (BAF)

• Internal Audit• Annual Accounts

and Reports• Annual Governance

Statement• Counter Fraud • Links to External

Audit

SMT AND

OPERATINGMODEL

LOCALITYEXECUTIVE

CHAIR MEMBER

of CCG

GOVERNINGBODY


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4. Organisational Structure

4.1 Wigan Borough CCG has many duties andfunctions to deliver. It needs to have amanagement structure that supports cliniciansin leading and developing the CCG’s businessand strategy. It needs to have a structure thathas the leadership, people, skills and knowledgeto provide management and finance support,business intelligence, data analysis, projectmanagement and other essential organisationalskills.

4.2 This section describes:

• Organisational Responsibilities

• The organisational, clinical and managerialstructure of the CCG

• A narrative for the structure

• Key roles within the CCG

4.3 Organisational Responsibilities

4.3.1 Whilst it is vitally important that the CCGis clinically led with the full ownership andengagement of its membership practices, it willalso need to demonstrate probity andgovernance commensurate with its considerableresponsibilities for patient’s healthcare and taxpayers money.

4.3.2 The CCG will be vital to delivering thequality and productivity agenda which isessential as we move into an era of increasinghealthcare need and lower growth in NHSresources.

4.3.3 The CCG will have to be an effective andsafe statutory body which embodies Nolanprinciples. This has been built into the design ofthe organisational structure.

4.3.4 The CCG in line with all CCG’s isconstrained by a cap of £25 per populationhead on its management costs which will meana reduced workforce, broader portfolios ofresponsibilities and more team working acrossfunctions to ensure efficiency and make best useof the skills in the organisation.


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4.4 The CCG Structure

Clinical ExecutiveLead Finance and

Performance

Finance andPerformance

Audit Committee

RemunerationCommittee

ClinicalDirector

ClinicalDirector

ClinicalDirector

WiganMembership

Locality

Clinical Leadershipand Engagement

Strategy/PartnershipWorking

Innovation

Implementation

TABAMembership

ULCMembership

PFMembership

Wigan NorthMembership

ALMembership

ClinicalDirector

ClinicalDirector

ClinicalChampion

ClinicalChampion

ClinicalChampion

ClinicalChampion

ClinicalChampion

GOVERNING BODY

C.S.U. Support Services

Service Delivery and

Implementation

CorporateGovernanceCommittee

ClinicalGovernanceCommittee

ChiefFinance Officer

Director Quality

and Safety

Chief Officer(Accountable)

Clinical ExecutiveLead ServiceDelivery and

Implementation

Clinical Executive

Lead CorporateGovernance

Clinical Executive

Lead ClinicalGovernance

Chair

Governance CommissionedServices

Finance

Performance

Quality and Safety

Medicines Management/ Continuing Health Care


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4.5 Structure Narrative

4.5.1 CCG’s will be different from anypredecessor NHS organisations. Whilst we aremoving from a Primary Care Trust to a newClinical Commissioning Organisation, manysimilar functions and responsibilities of theformer PCT will still be retained.

4.5.2 The CCG will retain responsibility forcommissioning services to meet the populationneeds and will have a budget of approximately£450 million.

4.5.3 The cost of local PCT Managementstructures over the last two years has reducedfrom £57.40 per population head in 2010/11 to£39 per population head in 2022/12 and from2013/14 will be £25 per population head whilstthe work has not reduced by a similarproportion.

4.6 Key Principles for developing TheStructure

4.6.1 Clinical Leadership will be embeddedwithin the organisational design from thepractice to the board room through a 4 tierclinical leadership model led by clinical directors.The 4 tiers will allow GP members to engage inthe CCGs objectives at a level that suits theirinterests, capacity and availability.

4.6.2 We recognise that some of our memberpractices may choose to fulfil a provider roleonly but will be involved through the localitystructure and will be offered opportunities tooffer comment on all the CCG’s development.

4.6.3 Locality responsibilities will be increasedincrementally in accordance with the scheme ofdelegation as they gain experience andconfidence.

4.6.4 Under the leadership of the Chief Officerand Directors, management teams will beresponsible for working alongside ClinicalLeaders to develop CCG’s key strategies andcommissioning priorities.

4.6.5 Groups of management functions havebeen organised to reflect the CCG’s keyresponsibilities as a Statutory Body.

4.6.6 As the focus will be on delivery we willestablish a programme and project office tooversee implementation of the work streamsand to monitor their progress.

4.6.7 We will streamline staff reportingarrangements and broaden spans of control forindividual managers.

4.6.8 We will enable all staff in theorganisation to develop. Career progression andsuccession planning of both clinical andmanagerial leaders will be a priority.

4.6.9 The structure will create parity of gradesacross functions and levels of responsibility, e.g.Associate Directors, NHS band 8d, AssistantDirectors, NHS band 8b.

4.6.10 The structure is predicated on teamworking across the organisation so as to reduce‘silo’ working and to make best use of all theskills available.


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4.7 Key Changes following Consultationwith Member Practices and Staff

4.7.1 The Accountable Officer (Chief Officer) willtake the Executive Lead for the development ofthe Localities and for partnership working forthe CCG.

4.7.2 Management roles within the Localitieswill be strengthened and extended. Three wholetime equivalent Assistant Directors for Localitieswill be established and have been uprated fromGrade 8a to 8b in line with all Assistant Directorposts. It is anticipated that Assistant Directorswill look after two Localities if full-time or oneLocality if part time.

4.7.3 In recognition of the need for apermanent managment presence in theLocalities and high quality administrativesupport to Locality Executive Heads and LocalityAssistant Directors we will establish six band 5Locality Executive Support Officers.

4.7.4 We are ensuring following feedback fromthe Localities, that commissioning/provider rolesare separated managerially for Primary Care

4.7.5 The CHC/Medicines Management postsits outside the £25 per head management costcap.

4.7.6 The Local Authority will retain thehosting arrangement for the joint Safeguardingand Partnership Associate Director post,therefore the status quo will be maintained, butwill be reviewed and may well change inforthcoming months to reflect the Public Healthtransition and links to the Local Authority.

4.7.7 We have made some shifts between andacross existing support team roles to ensurecapacity across the system and to be able todeal with emerging responsibilities, some ofwhich are not yet clarified but will develop asthe Local Area Team is established.

4.7.8 We recognise that it is an emergingstructure and all these areas will need to remainunder review especially during the first year ofauthorisation.

4.7.9 In addition to the Chief Officer thestructure outlines two Director roles for theCCG. This is the minimum we can safely operatewith.

4.7.10 The Chief Financial officer (CFO) is astatutory post, will have a professionalqualification in accountancy and the experienceto lead the financial management of the CCG.The CFO role how now been deliberatelybroadened to include responsibility forperformance management and commissionedservices.

4.7.11 The second Director level post will be theDirector of Quality & safety. This is to reflect theincreasing national and local focus on theimportance of quality being at the heart ofeverything the CCG does.

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4.7.12 The Director of Quality & Safety will beresponsible for providing a lead role for Qualityincluding links with external regulatory bodies,will be the strategic lead for communicationsand reputation management for theorganisation, will lead the delivery of medicinesmanagement support and continuing healthcarefunction, and will be the identified link with thelocal office of the NHS Commissioning Board.

4.7.13 To ensure sufficient senior managementcapacity, leadership, and ownership of keyprogrammes of work, the structure has sixAssociate Directors [one of which is excludedfrom the management cost allowance due tothe clinical nature of their role] withresponsibility for defined functions.


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4.8 Board Membership

Wigan Borough CCGGoverning Body

Tim DaltonChair

Trish AndersonChief Officer(Accountable)

Mike TateChief Finance

Officer

Dr Gary CookSecondary Care

ConsultantMember

Ms HelenMeredith

Nurse BoardMember

Mr Frank Costello

Interim LayMember

Mr MauriceSmith

Interim LayMember

Dr SanjayWahie

Clinical Lead

Dr Tony EllisClinical Lead

Dr Ashok Atrey

Clinical Lead

Dr PeteMarwick

Clinical Lead

Dr Deepak Trivedi

Clinical Lead

Dr Mohan Kumar

Clinical Lead


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4.9 Board Roles

(extracted from “Clinical Commissioning groupgoverning body members: Roles, Outlines,Attributes and Skills”)

4.9.1 Chair:

• leading the governing body, ensuring itremains continuously able to discharge itsduties and responsibilities as set out in theCCG’s constitution;

• building and developing the CCG’s governingbody and its individual members;

• ensuring that the CCG has properconstitutional and governance arrangementsin place;

• ensuring that, through the appropriatesupport, information and evidence, thegoverning body is able to discharge its duties;

• supporting the Accountable Officer indischarging the responsibilities of theorganisation;

• contributing to the building of a sharedvision of the aims, values and culture of theorganisation;

• leading and influencing clinical andorganisational change to enable the CCG todeliver commissioning responsibilities;

• lead the CCG ensuring it is constantlycommitted to and be able to discharge itsfunctions;

• be the senior clinical voice of the CCG ininteractions with all stakeholders including

the NHS Commissioning Board; and

• have the respect and authority of themember practices

4.9.2 Chief Officer (Accountable Officer):

The Accountable Officer is responsible forensuring that the CCG complies with its:

• duty to exercise its functions effectively,efficiently and economically;

• duty to exercise its functions with a view tosecuring continuous improvement in thequality of services provided to individuals for,or in connection with, the prevention,diagnosis or treatment of illness;

• financial obligations, including informationrequests;

• obligations relating to accounting andauditing;

• duty to provide information to the NHSCommissioning Board, following requestsfrom Secretary of State;

• performs its functions in a way whichprovides good value for money;

• ensures that the CCG fulfils its duties toexercise its functions effectively, efficientlyand economically;

• thus ensuring improvement in the quality ofservices and the health of the localpopulation;

• ensure that the regularity and propriety ofexpenditure is discharged, and thatarrangements are put in place to ensure that


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good practice (as identified through suchagencies as the Audit Commission and theNational Audit Office) is embodied and thatsafeguarding of funds is ensured througheffective financial and management systems;

• the Accountable Officer, working closely withthe Chair of the Governing Body, will ensurethat proper constitutional, governance anddevelopment arrangements are put in placeto assure the members (through thegoverning body) of the organisation’s ongoing capability and capacity to meet itsduties and responsibilities.

4.9.3 Chief Finance Officer (Director ofFinance):

• to provide financial advice to the Board andshould be a qualified accountant withsignificant experience and expertise;

• responsible for supervising financial controland accounting systems and compliance withstatutory responsibilities;

• oversee robust audit and governancearrangements leading to propriety in the useof CCG resources;

• be able to advise the governing body on theeffective, efficient and economic use of itsallocation to remain within that allocationand deliver required financial targets andduties; and

• produce the financial statements for auditand publication in accordance with strategy

requirements to demonstrate effectivestewardship of public money andaccountability to tax payers.

4.9.4 Clinical Executive (Locality Executive):

• shape the priorities and plans for the CCG toimprove the health outcomes and servicesacross the borough;

• direct and are responsible for the localitydelivery of the CCG’s aims and objectives (asset out in the Scheme of Delegation toLocalities);

• manage challenges and / or conflicts ofinterests within the localities;

• ensure that the clinical engagement model isoperational and the CCG is clinically led(through the various working groups);

• ensure that the CCG fulfils its duties toexercise its functions effectively, efficientlyand economically thus ensuring improvementin the quality of services and the health of thelocal population; and

• ensure and account for robust governancearrangements for the CCG.

4.9.5 Lay Member (Governance):

The role of this lay member will be to bringspecific expertise and experience to the work ofthe governing body. Their focus will be strategicand impartial, providing an external view of the


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work of the CCG that is removed from the day-to-day running of the organisation. Their rolewill be to oversee key elements of governanceincluding audit, remuneration and managingconflicts of interest. They will need to be able tochair the audit committee.

• This person will have a lead role in ensuringthat the governing body and the wider CCGbehaves with the utmost probity at all times.

4.9.6 Lay Member (Public Engagement):

As well as sharing responsibility with the othermembers for all aspects of the CCG governingbody business, this lay member will have specificresponsibility to ensure that:

• public and patients’ views are heard and theirexpectations understood and met asappropriate;

• the CCG builds and maintains an effectiverelationship with Local Healthwatch anddraws on existing patient and publicengagement and involvement expertise; and

• the CCG has appropriate arrangements in placeto secure public and patient involvement.

4.9.7 Secondary Care Specialist:

As well as sharing responsibility with the othermembers for all aspects of the CCG governingbody business, as a doctor who is a secondarycare specialist on the governing body, thisclinical member will bring a broader view, fromtheir perspective as a specialist doctor, on health

and care issues to underpin the work of theCCG. In particular, they will bring to thegoverning body an understanding of patientcare in the secondary care setting.

4.9.8 Registered Nurse:

As well as sharing responsibility with the othermembers for all aspects of the CCG governingbody business, as a registered nurse on thegoverning body, this person will bring a broaderview, from their perspective as a registerednurse, on health and care issues to underpin thework of the CCG especially the contribution ofnursing to patient care.

4.10 Competency of Governing Body

4.10.1 The Chair, Chief Officer and ChiefFinancial Officer have successfully completed thenational assessment process and are deemed“ready”.

4.10.2 The Secondary Clinician and Nurse havebeen appointed following a regionalcompetency process and competitive interview.

4.10.3 The interim Lay Members areexperienced non – executives from the formerPCT. Permanent positions will be advertised andfollow the prescribed process.

4.10.4 The Locality Executive Clinical leads wereappointed following election by their membersand are being supported through a boarddevelopment programme. Some of the leads arereceiving coaching. They have also been leadersof their PBC Consortia.


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4.11 Management Structure

Director of Quality and Safety

Associate Director of Quality andGovernance

Assistant Directorfor Quality

Primary CareQuality Lead

Provider QualityLead

Quality SupportOfficer

Assistant Directorof Governance

Primary CareDevelopmentLead

DevelopmentSupport Officer

Head ofCommunications

BusinessInformationManager

GovernanceSupport Officer

CorporateExecutive Supportx 2 wte

CorporateExecutive Supportx 2 wte

CorporateSupportApprentices

FacilitiesManagement x0.53 wte

Associate DirectorMedicinesManagement andContinuingHealthcare

Assistant Directorsfor MedicinesManagement x 2wte

MedicinesManagementSupport Officers x1.48 wte

MedicinesManagementTechnicians x 6.57wte

Assistant Directorfor ContinuingHealthcare

Head ofContinuingHealthcare

ContinuingHealthcareMatrons x 8 wte

ContinuingHealthcareProgrammeManager x 0.52wte

ContinuingHealthcareSupport Officers x2 wte

ContinuingHealthcareSupport Officer x0.8 wte

Associate DirectorLocalitiesCollaboration andEngagement

Assistant Directors– Localities x 3wte

Locality ExecSupport Officers x6 wte

Assistant Directorof ProgrammeDevelopment

ProgrammeSupport Officer

Associate Director Partnerships (JointPost)

Safeguarding –DesignatedNamed Doctor

Safeguarding –DesignatedNamed Nurse

SafeguardingSupport Officer

CommissioningManager -Childrens

AssociateDirectorCommissionedServices

AssistantDirectorCommissioning

AssistantDirectorCommissioning

CommissioningManager –Acute /Community

CommissioningManager – Non-NHS / MH

CommissioningClinical SupportOfficers x 2 wte

CommissioningSupport Officersx 1.7 wte

CommissioningSupport Officer

AssociateDirector ofPerformance /QIPP

AssistantDirector ofPerformance /QIPP

Head ofPerformance

PerformanceSupport Officer

AssociateDirector, Financeand Contracting

AssistantDirector –FinancialManagement

AssistantDirector –Financial Control

Head ofFinancial Control

Financial ControlSupport Officer





FinancialManagementLeads x 4 wte

FinancialManagementSupport Officer

FinancialManagementSupport Officersx 3 wte

FinancialManagementSupport Officersx 3.56 wte

FinancialManagementSupport Officersx 3 wte

Chief Officer(Accountable)

Chief FinanceOfficer

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4.11.1 The Chief Officer and each of theDirectors will have Associate Directors workingon specific programmes of work for them. Theseare the key posts for the support teams to theCO and two Directors. These individuals willdirectly supervise and manage groups of staff toensure delivery of agreed plans and targets andwill enable the CO and Directors to focus theirenergies on the strategic direction of theorganisation in partnership with Clinical Leads.

4.11.2 Associate Director of MedicinesManagement and Continuing Care:

Will lead on:

• Managing and supporting the medicinesmanagement team to provide specialistadvice to practices and ensuring delivery ofMedicines Management priorities.

• Managing the continuing Healthcare Team toensure effective assessment, allocation ofresources and review of patients requiringcontinuing healthcare.

4.11.3 Associate Director for Quality:

Will lead on:

• Developing and implementing quality safetysystems.

• Championing and promoting quality withinthe CCG and across the healthcare systemfrom whom we commission care.

• Implementing quality assurance techniques.

• Developing governance systems and theboard assurance framework.

4.11.4 Associate Director Localities,Engagement and Collaboration

Will lead on:

• Supporting and developing Locality ExecutiveCommittees.

• Developing Locality plans and pan CCGpriorities and plans.

• Directly managing the programme office andensuring implementation of initiatives.

• Developing engagement with members,patients, the broader population group andrelevant stakeholders.

• Developing collaborative arrangements forwork across GM CCG’s.

4.11.5 Associate Director For Partnerships /Head of Service (Joint with LA)

Will lead on:

• Directly managing the Joint SafeguardingUnit for both adults and children and thedesignated posts.

• Developing links and relationships with theHealth and Wellbeing Board andHealthwatch.

• Developing Joint Commissioning Plans for therelevant service areas.


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4.11.6 Associate Director CommissionedServices:

Will lead on:

• Developing all CCG contracts with providers,across Acute, Mental Health, and Communitysettings.

• The annual planning cycle for contractnegotiation.

• The monthly contract management of CCGproviders.

• Agreeing year end and financial positions bycontract.

• Development of the CCG Winter Plan.

• Managing provider performance targets.

4.11.7 Associate Director Finance,Performance and Sustainability

Will lead on:

• Identifying the CCG QIPP gap and associatedplans.

• Working with partners to identify potentialschemes.

• Reporting progress on a monthly basis to theGoverning Body.

• Monitoring overall performance of the CCGagainst its targets and reporting to theGoverning Body.

• Creating a corporate report for the CCG.

4.11.8 Deputy Director Finance andContracting:

Will lead on:

• Financial Planning.

• Financial management and budget reporting.

• Financial Accounting.

• Producing the final accounts.

• Providing financial input into providercontracts.

• Linking contract requirements into thefinancial planning round.

• Developing financial staff.

4.11.9 The Associate Directors will haveworking to them a range of posts to be able todeliver the functions outlined in their keyresponsibilities. These posts will be developedand amended from existing posts from withinthe organisation to reflect the way of workingfor the new CCG and the new responsibilities itwill have.

4.11.10 The Associate Directors will beexpected to liaise and manage any servicesrelating to their areas of responsibility which arebought from the Commissioning Support Unit(CSU).


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4.12 Other Key Statutory Roles

• Safeguarding – Designated Nurse Lead,Designated Adult Lead Posts including MentalCapacity Act responsibility identified withinthe structure. Additionally the designatedpaediatrician is identified within theSafeguarding policy

• SIRO - Responsibility to be held by theDirector of Quality

• Complaints Manager to be held by Head ofGovernance

• Caldecott Guardian to be held Director ofQuality

• Executive Safeguarding lead held by ChiefOfficer

4.13 Collaboration

There is a detailed description of ourarrangements for collaboration within theIntegrated Plan, however within themanagement structure there is an AssociateDirector with specific responsibility to leadCollaborative arrangements across GreaterManchester and other CCG’s. The AssociateDirector for Partnerships will lead collaborationwith the Local authority, additionally the ChiefFinance Officers team will provide the capacityto undertake contracting functions with and onbehalf of other CCG’s.

It has been agreed within our Service LevelAgreement (SLA) with Greater ManchesterCommissioning Support Unit (CSU) that WBCCGwill lead the contracting arrangements for allother CCG’s with our major providerWrightington and Wigan and Leigh FT.


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5.1 Commissioning support needs to be able tohelp, not hinder the process of clinicalcommissioning. Essentially the CCG has tobalance the levels of commissioning support,what it buys, with the level of commissioningsupport that it employs, what it makes, withinthe CCG, however, any management supportthat the CCG utilises has to fall within a £25 perhead running cost allowance.

5.2 This section describes:

• The Rationale for the CCG’s Make, Buy, Sharedecisions

• The utilisation of the £25 running costallowance

• On-going Relationship with CSU

5.3 The Rationale for the CCG’s DecisionsAs To Whether To Employ Staff Directly orbuy External Commissioning Support

5.3.1 An essential element of the CCG’sauthorisation is that at the point ofauthorisation it can declare that the CCG will becompliant with all its statutory responsibilitiesand has the capacity and capabilities to deliverthose responsibilities.

5.3.2 The CCG spent a significant amount oftime working through it’s Make, Share or BuyDecisions, internally, with the GM cluster andwith Greater Manchester CommissioningSupport Unit (GMCSU), but at the outset wereinclined to employ the bulk of commissioningsupport rather than to outsource it, This wasdriven by the following considerations:

• The former PCT had a very stable andexperienced workforce with a positive workethos and culture.

• The CCG will be running the organisation forhalf the running costs that the PCT did.

• The CCG has now been working closely withformer PCT staff and has developed a lot ofconfidence in their capabilities andcompetencies.

• The staff have local knowledge, contacts andorganisational memory.

• The majority of staff live and work in thearea, which has been a strong motivatingfactor for working in Wigan and are also ourpatients.

• The residual PCT staff have contributeddirectly to a high performing PCT which hasretained financial balance and grip. Thatperformance has been maintained as clinicalleadership has moved to the CCG.

• Many staff will work more than theircontracted hours to complete tasks whennecessary.

• Staff are flexible and can be directed towardspriorities as they arise.

• Staff have a sense of pride being in asuccessful organisation and care about“Wigan”. This is apparent through low staffturnover and low levels of sickness.

• All the above has ensured that we have aresilient organisation, and sets positivefoundations for the CCG to succeed.

5. Commissioning Support and Utilisation of Running Cost Allowance


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5.3.3 CCG Intentions

• After undertaking the Make, Buy, Shareexercise the CCG has shown that it is willingto buy and share functions where doing sowill provide best value and make sense.

• The CCG understands that it will havesignificant responsibilities andaccountabilities and believes that it isessential that the existing staffing work ethosand culture is transferred into and directlyemployed by the CCG.

• The CCG believes that it cannot deliver itsaccountabilities and responsibilities by havingmost of its staff employed in an externalorganisation.

• The national commissioning support modelbeing offered has been developed withoutany evidence of successful application.

• Any offers of commissioning support will notbe bespoke.

• The CCG believes that it should determine itsown organisational arrangements andstructure as long as it is delivered within therunning cost allowance.

• The CCG is of a sufficient size and scale,(320.000 population) against the McKinseyaffordability scale to directly employ staff toundertake the majority of its responsibilities.

5.3.4 CCG’s can choose to either providesupport in-house, share support with otherCCG’s or buy support from whoever they wish,provided that they are assured of the qualityand value for money of that service, it reflects

their requirements and objectives and isaffordable within the running cost envelope.

5.3.5 The NHS Commissioning Board is seekingassurance through the authorisation processthat the CCG has been through a robust processto arrive at these decisions and that CCG’s areinformed customers of the support they arereceiving or providing.

5.3.6 Decisions on the type of support requiredwill ultimately rest with CCG’s, and will dependon a number of factors, including:

• Clarity on organisational remit (internalgovernance arrangements)

• Size of operation (recognition of in-housecapacity) and scalability

• Gaps in in-house skills or resources (people,systems, technology, processes, financialbudget)

• CCG operating style / preferences

• Affordability and value for money

• The nature of the specific services

• Environmental factors, such as localrelationships

• Market segmentation and availability ofappropriate services

• Outcome of the business review process forlocal NHS commissioning support services


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5.3.7 Authorisation needs to assess that theCCG can:

• Operate within their running cost envelopeand access capacity and capability to delivertheir full range of responsibilities

• Assure themselves that they are paying a fairprice for a reasonable quality service

• Benchmark in-house costs with that ofbuying a service

• Adequately describe the services they want tomake, share or buy (through a servicespecification if buying in)

• Identify and manage an appropriateprocurement process in line with their viewon their future commissioning supportrequirements, in order to be able to secure asupplier of support services and formalise theterms of their appointment via a contract forthese services in due course

5.3.8 For CCG’s that have decided to provide allor some commissioning support functions ‘in-house ‘the draft applicants’ guide stated thatthe process of assessment of these functionswould be analogous with that of the BusinessDevelopment Unit (BDU) process forcommissioning support. As such, as part of theirauthorisation application specific tests will berequired to be completed by CCG’s that intendto provide healthcare procurement, IM&T,business intelligence and data warehousing in-house. While these won’t necessarily be the onlyservices provided by a CCG in-house, or may beprovided in-house whilst other services aresourced via procurement or a CSS, they are

business critical and therefore will be thedeterminant of how a CCG is assessed overallfor its support services. The CCG is buying all theabove business critical services from the GMCSU which is going through the BDUCheckpoint process and has achieved all keystages at this time.

5.2.9 The CCG went through a number ofiterations of its Make, Buy Share decisionmaking process, and an example of that processis demonstrated in the table on the next page.

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Operating Model: balance between make/share and buy

Activity

Member relations and PCSupport

Strategy and Corporate

Service Transformation(Local)

Service Transformation(System Wide)

Service Performance andContracts

Local Knowledge (in house CSO)

Engagement and communication Lead and teamLocality Business ManagersLocality Engagement LeadsPrimary Care FacilitatorsPrimary Care Dashboard (organisedthrough Director of Corporate Affairs)

JSNA with Local AuthorityGap analysisDevelopment of Improvement Plans – via SCGsFinancial analysis and programmebudgetingLocal communications and engagement– through Locality EngagementCorporate Governance reporting forBoard Handling and learning from localcomplaints (some FOI understanding)

Managed through the StrategicCommissioning and Innovation Groups

Local performance team to prepareperformance dashboardsPatient experience analystsBusiness intelligenceContract teams – dev and monitoringProductivity reviewsContinuing care (in house team)

Community Knowledge (Share)

Performance analysts for localities– to confirm

JSNA with Local Authority (someelements of health and social careintelligence – particularly publichealth)

Shared elements of plans at GMlevel (e.g. Clinical senate andnetwork plans)

Handling wider and / or systemwide complaintsEquality and diversity awarenessand training

Shared joint working with the LAin terms of analytic support

Shared with GM community

May share patient and publicexperience monitoring with LAMay need to share some GMelements of contract monitoring.Share with LA intelligence andaspects of GM policy.

Economy of Scale or Impact –Greater expertise (buy – frombest provider)

CCG Training

May buy some benchmarkingwith peer groups over time

National communicationalignment and managing seriousincident campaigns Social marketing advice SUIsEmergency planningLegal AdviceInformation GovernanceAccountability and FOIs

Some elements of intelligencewhich cannot be supported byCSLS

May need to buy training and / orsome elements of performanceintelligence


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Activity

Service Performance:Medicines Management

Safeguarding

Finance Support

HR Services

Information managementand technology

Procurement and marketmanagement

Effective use of resources

Estate and facilitiesmanagement

Local Knowledge (in house CSO)

Prescribing advisors:Practice level intelligenceOperational medicines management(practices and providers)

Board representation (currently AOresponsibility)Senior Business Manager

Locality financial management andinformation (profiles – working with BMsand analytic teams)Financial planning and reporting

The CCG will have a local analyticalcapacity to support SCGs and localitydata sets

Managing local contracting relationshipsand information via the SCGs

Community Knowledge(share)

Share aspects of GM policy,thresholds

Share local knowledge andpolicies with LA

Some elements of GM systemwide procurement

Economy of Scale or Impact –Greater expertise (buy – frombest provider)

Safeguarding training and seriouscase reviews

Internal auditExternal auditLedgerPayments handling

Workforce planningStaff ManagementODL&D

Infrastructure and supportBusiness intelligenceStrategic adviceAppraisal of new technologies

Procurement services and trainingDecommissioning services

EUR PolicyIndividual funding requests

Facilities and estate

5.3.10 From these processes and considerationsthe CCG agreed a final decision on what itwished to make and what it wished to buy andreflected that within its organisational design.

5.3.11 What follows is the detail of our finaldecisions, the application of Value for Money(VFM) testing, and some discussion as to howwe will manage our relationship with theCommissioning Support Unit.

5.4 The use of the £25 per head runningcost allowance

5.5 All CCG’s have to provide managementsupport within a cap of £25 per head, howeverour CCG only received £24.35 per head which isunder the £25 per head expected and thus wehave had to be even more careful about theaffordability of our organisation and reflect thatwithin the design.


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5.6 We have significantly reduced themanagement costs from a peak of £57.40 in2010/11 to £25 today and developed astructure that supports much more clinicalleadership and engagement.

5.7 Below are details of the services we havepurchased from the Greater ManchesterCommissioning Support Unit (GMCSU).

Schedule 3 - Pricing

Client: NHS Ashton, Leigh and Wigan CCG Pricing Schedule Year Total Working Year Total WorkingFY13 Plan FY13 Plan

Workstream Workstream

Inside running costs: Sales SpendPerRegPopEUR: Effective Use of Resources 105,206 0.33MED: Medicines Management 65,274 0.20CME: Comms and Engagement 39,321 0.12EDH: Equality Diversity and Human Rights 0 -HRO: HR and OLD 83,862 0.26New: SCI: Standalone Commissioning Intelligence 236,524 0.74GOV: Governance 45,722 0.14FIN: Financial Management 0 -SSR: Strategic & Service Redesign 90,606 0.55TPM: Total Provider Management 0 -MKT: Market Management 83,153 0.26CHC: Continuing Healthcare 0 -RES: Resilience - This may come back into the schedule 0 -

Total Running Costs Product 749,668 2.34Outside running costs:

IMT: Info Mgt and Technology 623,905 1.95

Please note some of IM&T is likely to go into running costs, at this it is anticipated to be immaterial

Total Outside Running Cost Product 639,905 1.95Total SLA 1,373,573 4.29

Pre-committed, agreed IMT transitional costs 291,667 0.91Total including IM&T Transitional Costs 1,665,240 5.20


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5.8 Below is a cost comparison between the CSU costs for providing commissioning support andthe CCG’s costs of providing the support in house.

5.9 The comparative analysis carried out in July2012 shows that the CCG compared the costsof the CSS services to ensure V.F.M. wasachieved. The recently released Ready Reckoner2 (Appendix 2) has also been used to comparecosts.

5.10 The costs are compared using the cost perhead of population. The areas where there areno internal costs are areas where this is just partof a person’s role.

WBCCGCSS Current Diff Value£ p p £ p p £ p p £

CHC Core £2.17 £1.98 (£0.20) (£63,000) MakeCHC Spec £0.14 £0.18 (£0.06) (£19,917) Make

Comms All £0.12 £0.00 (£0.12) (£39,699) Buy no int cost

E&D All £0.11 £0.00 (£0.11) (£35,412) Buy no int cost

EUR All £0.29 £0.20 (£0.09) (£29,061) Buy

Governance £0.12 £0.00 (£0.12) (£38,644) Buy no int cost

HR £0.18 £0.44 £0.26 £83,947 Buy

IM&T £1.80 £2.56 £0.75 £241,742 BuyIM&T – BI £0.60 £1.05 £0.45 £143,701 BuyMarket Mgt £0.25 £0.60 £0.35 £112,470 Buy

Medicines Mgt Strat £0.33 £0.44 £0.11 £35,422 BuyMedicines Mgt £1.24 £1.27 £0.03 £9,000 Make

Resilience £0.07 £0.00 (£0.07) (£21,434) Buy no int cost

Service redesign £0.28 £0.00 (£0.28) (£90,606) Buy no int cost

TPM Strat £2.18 £2.05 (£0.13) (£41,086) Make

TOTAL £9.89 £10.66 £0.77 £247,424

Healthy Place, Healthy People.

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5.11 One can see the Buys in Human Resources(HR), Information Management Technology(IM&T), Market Management and StrategicMedicines Management all produce a savingfrom current CCG costs.

5.12 The makes in Total Provider Management(TPM) and Continuing Health Care (CHC) alsoproduce a saving when compared to theproposed GMCSU costs.

5.13 Appendix 1 shows the total running costsof WBCCG which will be £7,354,303 comparedto a budget of £7,800,000. This works out at£22.96p per head of population when using the‘crude’ population figure of 320,300.

5.14 Another factor taken into considerationwhen determining the level of our in-house andour Commissioning Support and whichmitigated against the use of a GreaterManchester Commissioning Support providerfor service redesign and contracting products,was the nature of our geography and ourrelationship with our main providers.

5.15 WBCCG is the largest CCG in GreaterManchester (GM) and is at the west end of theGM conurbation, its main provider of acuteservices is Wrightington, Wigan and Leigh(WWL)FT. WBCCG provides 72% of this trust’sincome. WWL provides 64% of WBCCG’scommissioned Acute Care.

5.16 WBCCG’s main provider of CommunityServices is Bridgewater Community HealthcareNHS Trust and Five Boroughs PartnershipFoundation Trust provides most of its MentalHealth Services. Both these trusts lie outside the

GM conurbation therefore the needs of WBCCGare quite different from the other CCG’s in GMwhich rely on providers within Manchester formost of their health care.

5.17 We believe that the GMCSU model ofsupport would not enhance or improve ourcommissioning arrangements or grip with theseproviders and that we wish to retain the skillsand knowledge that we currently have in houseto manage these providers and their contracts.

5.18 A Service Level Agreement has beenagreed with Greater Manchester CSU and thecurrent managers of the procured services willmeet with the CSU managers to agree theservice specification, lines of responsibility andKey Performance Indicators that will ensure thata quality service is received by WBCCG to enablethe CCG to deliver its statutory responsibilities. Itis intended that the Associate Director ofPerformance will be responsible for overallmonitoring of the contract, and with ClinicalSupport from relevant Clinical Directors, otherAssociate Directors will manage the relationshipwith CSU in areas relevant to their portfolio’s.

5.19 The CCG will undertake a formalprocurement process for Commissioningsupport between 2013 and 2016, howeveroptions are limited at this time because of theimmaturity of the new CSU’s and their currentlack of capacity to offer services outside theircurrent footprints. Additionally, CCG’s havebeen directed to purchase CommissioningSupport from Greater Manchester CSU.

The CCG will review its contract with GM CSUduring 2013.


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The CCG believes that it has developed a robustand logical Organisation Design that is alignedto its vision and values, demonstrates that weare a clinically led organisation, with significantand experienced capacity and capability todeliver our statutory functions and candemonstrate a compelling rationale for our‘Make, Buy and Share decisions’.

The structure provides value for money and isaffordable within the £25 per headmanagement allowance. It also providesflexibility, opportunity for staff development andcareer progression and lays the foundations forwhat we believe will be a strong and sustainableorganisation.

Trish Anderson

Accountable Officer

6. Conclusion

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Appendix 1: Overall use of Running Cost AllowanceRole Band WTE Cost £Chair Chair 1 £47,500Accountable Officer VSM 1 £158,424Chief Financial Officer VSM 1 £131,929Locality Executive Leads 6 £240,768Clinical Board Members Other – sessional £110,929Public Meetings and Board Non Pay - £50,000Lay Members Other – sessional £32,000Associate Director Localities, Communication Band 8d 1 £91,249AD Localities Band 8b 3 £190,839Clinical Directors £114p.h. - £240,768Clinical Champions £114p.h. - £200,640Clinical Engagement £114p.h. - £327,243Locality Exec Support Officers Band 5 6 £181,209A D of Programme Development Band 8b 1 £63,613Programme Support Officer Band 5 1 £30,201Associate Director Strategy and Partnership Band 8d 1 £91,249Safeguarding – Designated Named Doctor GP 0.30 £46,152Safeguarding – Designated Named Nurse Band 8b 1 £63,613Safeguarding Support Officer Band 3 0.8 £15,200Commissioning Manager – Children’s Band 8a 1 £48,992Income from WMBC -£45,625Director of Quality & Safety VSM 1 £114,739Associate Director for Quality Band 8d 1 £91,249A D for Quality Band 8b 1 £63,613Primary Care Quality Lead Band 7/8a 1 £47,787Provider Quality Lead Band 7/8a 1 £47,787Quality Support Officer Band 4/5 1 £26,716A D of Governance Band 8b 1 £63,613Governance Support Officer Band 6 1 £35,000Primary Care Development Lead Band 7/8a 1 £47,787Development Support Officer Band 5 1 £29,000Head of Communications Band 8a 1 £56,269Business Information Officer Band 7 1 £45,500Corporate Executive Support Band 5 2 £60,403Corporate Executive Support Band 4 2 £50,265Corporate Support Apprentice £30,000Facilities Management Band 3 0.53 £12,011Associate Director, Medicines Management Band 8d 1 £96,317A D for Medicines Management Band 8b 2 £127,226Medicines Management Administration Band 3 1.47 £32,641Medicines Management Technicians Band 5 6.57 £222,950Medicines Management No Pay £8,500A D for CHC Band 8b 1 £63,613Head of CHC Band 8a 1 £60,467CHC Matron Band 7 8.00 £376,634CHC Programme Manager Band 6 0.52 £20,914CHC Support Officers Band 4 2 £63,408CHC Support Officers Band 3 0.8 £20,754CHC Non Pay £46,500Associate Director Commissioned Services Band 8d 1 £91,249A D Commissioning Band 8b 1 £63,613A D Commissioning Band 8b 1 £63,613


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Appendix 1: contd.Commissioning Manager – Acute / Community Band 8a 1 £53,866Commissioning Manager – Non-NHS / MH Band 8a 1 £53,367Commissioning Clinical Support Officers Band 7 2 £90,000Commissioning Support Officers Band 6 1.7 £76,000Commissioning Support Officer Band 5 1 £35,000Associate Director of Performance/QIPP Band 8d 1 £91,249Assistant Director of Performance/QIPP Band 8b 1 £63,613Head of Performance Band 8a 1 £51,781Performance Support Officer Band 5 1 £33,044Associate Director, Finance and Contracting Band 8d 1 £91,249Assistant Director, Financial Management Band 8b 1 £63,613Assistant Director, Financial Control Band 8b 1 £63,613Support Officers, FM&C 14.56 £639,488Support Officers, FC 6.00 £195,411Payroll SLA Non Pay - £54,000Audit - £305,000Provisions inc Legal Provisions/Capital Charges/Interest/Depreciation -£497,000Premises/accomodation/Corporate Non Pay i.e. Stationary £614,040SOLLIS and Finance IT Non Pay -Non Pay - £92,575Subtotal CCG Make 103.26 £7,687,940Commissioning Support Unit (CSU)Communications CSS Offer £39,321EUR Policy Support £105,206Risk Management and Assurance £45,722HR ALL £83,862IM&T CSS £623,524IM&T CSS BI £236,524Market Management £83,153Medicines Management Strategic £65,274Service Redesign CSS £90,606Subtotal CSU BUY £1,373,573Resiliance CSS Offer £21,434GM Healthier Together £160,150Total Management Support in Government Body and Clinical Work 103.26 £9,243,097Non Running Cost ItemsSafeguarding Posts 2.10 £124,965IM&T CSS £623,905Clinical Posts within Structure (CHC and Meds Man) 24.37 £1,139,924

Total Non Running Cost Items £1,888,794

Total Running Cost Items 76.79 £7,354,303

Population 320300 £22.96

Running Cost Budget £7,800,000


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Appendix 2: Ready Reckoner 2Overall Summary

Summary of all running costs

Table 1

Running Cost Allowance £7,800,000 £25Corporate Base Costs £2,944,442 £9.19Clinical Leadership Costs £1,230,713 £3.84Other Staff Costs £2,193,911 £6.85Total £6,369,065 £19.88

Total cost as a percentage of Running Cost Allowance 81.7%

Balance of running cost allowance £1,430,935 £5.12

CCG Population Number of Practices

320,300 65

Own Costs

Total Cost Cost per head

Table 1

Running Cost Allowance £7,800,000 £25CCG Services bought-in Service Lines Costs £931,252 £3NHS CSS bought-in Service Lines Costs £- £-Other bought-in Service Lines Costs £54,000 £0Total £985,252 £3


Balance of running cost allowance £6,814,748 £22

Own Costs


Total of Table 1 and Table 2

Running Cost Allowance £7,800,000 £25Total cost £7,354,317 £22.96


Balance of running cost allowance £445,683 £2.04

Own Costs



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