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Inside authorisation

Inside authorisation

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With the first wave of authorisations now completed, how ready are clinical commissioning groups (CCGs) to begin commissioning in April? For the last few weeks, members of The King’s Fund’s leadership development team have been working with CCGs, taking part in mock panels and development centres to help them prepare for authorisation. In the last year, we have worked with more than a third of CCGs, so what have we learned about how they are faring?

I have been struck by the enthusiasm and commitment of CCG members as they prepare for authorisation and look forward to life beyond April. There is a strong collective desire to “get it right”, to learn from feedback and an overwhelming sense of wanting to do their best for colleagues and patients. Member engagement is being taken very seriously and, most importantly, patients appear to be at the centre of business discussions in a way we have not often experienced in the past, in either provider or commissioning organisations.

The composition and “personality” of each CCG team we have worked with has been different. The breadth of clinical and non-clinical expertise among some of them is really encouraging, with informed and positive contributions being made by lay members, practice managers, nurses and allied health professionals working alongside their GP colleagues. The new arrangements require CCGs, clinicians and former PCT managers to develop new working relationships.

Although this sometimes raises sensitivities and challenges, everyone we have come across is working hard to make the personal and professional adjustments needed.

The challenges for CCGs should not be underestimated - they are undertaking a major shift in their role, moving from clinical practitioner to commissioner, and from assessing individual patient need to understanding population health. This requires a different skill set, which they have been developing over the past year and will need to continue to work on through their organisational development plans.

And they are having to do all this in an environment in which the roles of organisations within the newly reformed NHS are still unclear, posts are not yet filled, previous structures have not quite disappeared and skilled and experienced staff are leaving the service.

Not surprisingly, CCGs have found some aspects of their new role difficult.  Developing a convincing narrative around quality, innovation, productivity and prevention (QIPP) plans is one aspect some have struggled with - these need to be articulated in terms of how they will improve quality, meet patient need and improve value for money, not just the financial savings they will deliver.

Another is how they make the best use of the array of information at their disposal, including patient experience data, to inform the design of services and improve care.   

In summary, the CCGs we have worked with are approaching authorisation with energy and enthusiasm and a desire to get beyond the process and into doing the job for real.

For those CCGs still preparing for the authorisation process, I would offer the following advice:

- Have the courage to be distinctive - be clear about what makes you different from previous commissioning organisations.
- Be strategic and focus on the big picture.
- Know your figures -  have a convincing narrative around your QIPP plans and don’t leave it to your finance lead to field these questions.
- Understand your key relationships - be clear about how you will use your relationship with your commissioning support unit, the NHS Commissioning Board and health and wellbeing boards, as well as other CCGs you will be collaborating with.
- Demonstrate how you listen and respond to the patients you serve - explain what you do with the data you collect.
- Get your governance right - this will define how you work so it is important to show that you understand the structures and processes you have put in place. Have a ‘Plan B’ - explain how you will handle external conflict and internal dissent and demonstrate you have the skills to do this.
- Be comfortable with not knowing the answer - you are a new organisation doing something that has not been done before so it is alright not to have the answer as long as you know when and where to go for advice and support.
- Have a development plan - outstanding performance requires on-going development of individuals, the team and the organisation.
- Talk about talent – have a convincing plan for how you will select and develop the next generation of leaders for your CCG.

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