The NHS CB has completed its authorisation process for the 211 CCGs across England after finalising the fourth and final wave of commissioning groups.

The remaining 48 CCGs in wave four have been authorised by the Board’s assessment experts, meaning all commissioning groups are ready to take on their new responsibilities from 1 April 2013.

Dame Barbara Hakin, NHS Commissioning Board National Director: Commissioning Development, called the completion of the assessment process a “tremendous achievement”.

In total, 43 CCGs were fully authorised after they met all of 199 criteria set by the Commissioning Board. A further 168 groups were authorised with conditions, after issues were raised with certain elements of their development. Fifteen CCGs were also issued legal directions after serious concerns were raised. These CCGs will be given additional support by the NHS CB and by neighbouring CCGs to assist their development.

Commissioning groups in the first three waves of the process which were authorised with conditions will be re-assessed by the NHS CB at the end of March to check on their progress since their initial assessment. CCGs in the final wave will be reviewed in June 2013.

“CCGs are a vital foundation of a new, clinically-led NHS that is focused on delivering improved health outcomes, quality, patient safety, innovation and public participation,” said Dame Barbara Hakin.

“CCGs will have wide-ranging responsibilities with regard to patient safety and will manage very large budgets, so it is vital that they are robust and capable of making important decisions. The NHS Commissioning Board has a duty to ensure CCGs have made arrangements to deliver their responsibilities, and we take that duty very seriously.”

The NHS Commissioning Board (NHS CB) has backed all 62 clinical commissioning groups in the third wave of its authorisation process to take on new their responsibilities from 1 April 2013.

Six CCGs were authorised without any conditions but five groups will be given intensive support in their development after concerns were raised. The remaining 56 CCGs were authorised with conditions.

The completion of the third authorisation wave means that 163 of the 211 CCGs across England have now been given the green light to take on their new commissioning responsibilities. From 1 April 2013, CCGs will be responsible for £65bn to commission local health services.

Dame Barbara Hakin, NHS CB National Director: Commissioning Development, said that the “majority of CCGs are now authorised and up-and-running”.

The five CCGs which were singled out for concern are NHS Eastbourne, Hailsham and Seaford CCG, NHS Newham CCG, NHS Herefordshire CCG, NHS Scarborough and Ryedale CCG and NHS Vale of York CCG. The NHS CB said these groups will still be able to take control of their individual commissioning budgets but will be given “intensive support”.

Issues raised by the board include the clear and credible integrated plans of NHS Eastbourne, Hailsham and Seaford CCG, NHS Herefordshire CCG, NHS Scarborough and Ryedale CCG and NHS Vale of York, plus the financial systems and processes used by NHS Newham CCG.

The remaining 48 CCGs are set to authorised next month.

The NHS Commissioning Board has authorised a further 67 clinical commissioning groups to take on local responsibilities for healthcare budgets and services.

All CCGs in the ‘second wave’ of the Board’s authorisation process were approved – although three Groups will be given ‘intensive support’ after serious concerns were raised by the Board.

Dame Barbara Hakin, the NHS Commissioning Board’s National Director: Commissioning Development, said the “vast majority” of CCGs “demonstrated excellence” and were now ready for the “challenge of leading their local health communities”.

The three CCGs which the Board will continue to support as they continue to develop are NHS Nene CCG, NHS Herts Valleys CCG, and NHS Medway CCG.

Concerns raised by the Board include the financial modelling and implementation plan for NHS Herts Valley CCG; that the board at NHS Medway CCG builds a greater understanding and ownership of its financial plan; and that NHS Nene CCG uses nearby NHS Corby CCG as its lead commissioner for Kettering General Hospital NHS Foundation Trust.

Nineteen of the 67 CCGs have been authorised with no conditions after they met all of the 119 criteria set by the NHS CB. A further 45 have been authorised with conditions, with the Board providing some formal support to help continue with their development.

Of the 211 CCGs across the country, the remaining 110 are now set for authorisation over the next two months. “Almost half of the CCGs are now authorised and we are moving at pace towards a clinically-led NHS that is focused on delivering improved health outcomes, quality, innovation and public participation,” said Dame Barbara.

“Authorisation is just the beginning: these new organisations will continue to develop, and I am confident patients will start to see real benefits in their local areas as CCGs begin to realise their potential.”

The NHS Commissioning Board has authorised the first wave of CCGs to take control of the NHS budget to fund healthcare services for their communities.

All 34 commissioning groups were given the green light to take on the new responsibilities after the NHS CB approved individual policies, conducted site visits, interviewed group leaders and assessed work alongside stakeholders and patients.

Sir David Nicholson, the NHS Commissioning Board’s Chief Executive, said the creation of CCGs is a “great opportunity for the NHS that will have real benefits for patients”.

The NHS CB authorised eight CCGs in the first wave with no conditions after they met all of the 199 authorisation criteria. The remaining 26 CCGs were also authorised, despite needing to develop certain areas.

The authorisation means that more than 10 million people will now have hospital, community health and mental health service commissioned by local leaders.

“This is a step-change to a clinically-led NHS that is focused on delivering improved health outcomes, quality, innovation and public participation,” said Dame Barbara Hakin, the NHS Commissioning Board’s National Director:  Commissioning Development.

“We expect this to bring real benefits to patients as these new organisations begin to realise their potential. Many CCGs have already begun to make a difference by taking early responsibility for planning services.”

CCGs will be responsible for up to £65 billion of the NHS Commissioning Board budget from 1 April 2013.

The remaining 177 CCGs will be authorised in three further waves, set to be announced in January, February and March 2013.

The final ‘wave’ of clinical commissioning groups have submitted their applications for authorisation with the NHS Commissioning Board (NHS CB).

All 46 CCGs in wave 4 of the authorisation process submitted their applications to take on future clinical commissioning responsibilities, the Board confirmed.

Dame Barbara Hakin, National Director: Commissioning Development at the NHS Commissioning Board, said the receipt of applications for all four waves was a “real milestone”.

The NHS CB has now received 211 applications in total as CCGs move towards taking on their new commissioning responsibilities from April 2013 onwards.

The Commissioning Board is responsible for the development of CCGs and introduced the authorisation process to ensure groups are able to commission safely, use budgets responsibly and exercise their functions to improve quality, reduce inequalities and improve outcomes.

“In all four waves, every single CCG submitted its evidence on time and this reflects the hard work and dedication CCG leaders have shown throughout the authorisation process,” said Dame Barbara.

The NHS Commissioning Board has pushed the dates by which CCGs will be fully authorised back by another month – for the second time.

Key meeting dates as part of the authorisation process have been confirmed and show that all CCGs will now be authorised in March instead of February 2013.

Meetings with the moderation panel, the conditions panel and the CCG authorisation sub-committee will be completed by:

• Wednesday 5 December 2012 for CCGs in wave 1
• Friday 18 January 2013 for wave 2
• Friday 15 February 2013 for wave 3
• Wednesday 6 March 2013 for wave 4

The Board’s moderation panel will make recommendations as to whether commissioning groups should be fully authorised or authorised with conditions. A meeting will then take place with the conditions panel who will consider what support a CCG requires if it has not supplied sufficient evidence to meet a threshold for one or more authorisation criteria. Finally, the CCG authorisation sub-committee will make the final authorisation decision.

The conclusions from each meeting will be published immediately after they have taken place – once decision letters have been issued to CCGs.

Despite the NHS CB confirming the dates by which the authorisation process will be completed, the Board has yet to confirm the individual dates for wave 4 CCGs moderation and sub-committee meetings. Additionally, dates for the moderation and conditions panel for waves 2 and 3, and when the conditions panel for wave 4 CCGs will visit are still being agreed by the Commissioning Board.

The schedule as it stands is:

Only one in five of the 211 Clinical Commissioning Groups (CCGs) has a GP in the crucial leadership role of accountable officer.

By contrast, over 70% have appointed a former PCT manager to this role – confirming opinion that the new CCGs will resemble the old PCTs.

GPs have attributed the retreat from ‘clinical leadership’ to the difficulty of combining the workload of an accountable officer with clinical practice.

According to the Health Service Journal, 38% of CCGs said in March they were planning to appoint a GP as accountable officer – but only 22% have done so.

The remaining 78% have appointed former NHS managers, including 72% who have appointed former PCT managers.

The accountable officer for each CCG will be responsible for its functions, finance and governance.

GPs make up 89% of CCG chairs, but this is a less critical role.

Recent guidance for CCGs from the NHS Commissioning Board has indicated that accountable officers need leadership experience.

According to NHS North East Essex CCG’s accountable officer, Shane Gordon, the role is closely similar to that of a PCT leader – and for a GP, taking it on would mean having to give up nearly all clinical practice.

He noted that the programme for GP revalidation would deter many GPs from trying to become accountable officers.

Consequently, he argued, it was unclear “whether the NHS is serious about clinical leadership”.

Dr Chaand Nagpaul of the BMA’s GPs committee said the pressure of authorisation deadlines had forced most CCGs to rely on experienced managers who needed little training.

However, a Commissioning Board spokeswoman commented: “What is important is that there is a good mix of expertise in the broader leadership team, of clinicians and managers.”

NHS engagement is about combining thorough market intelligence with a robust targeting plan.

The imminent authorisation of the first wave of Clinical Commissioning Groups (CCGs) promises to provide Key Account Managers with yet more information on which they can base their call strategies. By November, 35 CCGs will hope to have successfully navigated the comprehensive authorisation process and be approved to take on their new commissioning duties from April 2013. A further 177 prospective CCGs will be reviewed across the final three authorisation waves, with decisions on all the new local organisations expected by the end of January 2013. The dawn of a new era for commissioning is almost upon us. And as the reform rhetoric turns into reality, a new customer landscape for UK pharma will have emerged.

The four-wave authorisation process will place into the public domain a wide range of important documentation that was required not only to support individual CCG applications but, more importantly, to provide strategic blueprints for the long-term development of these embryonic local health organisations. Key documents include Joint Strategic Needs Assessments, Commissioning Intentions, Integrated Plans, Joint Health & Wellbeing Strategies, Organisational Structure Plans and draft Joint Commissioning Agreements. In some of the more proactive local organisations, such information is already available.

Elsewhere, it remains in late-stage development. Either way, the data and plans set out in these documents will undoubtedly provide crucial insights for KAMs targeting existing, new and emerging decision-makers and influencers at the local level.

And therein lies the problem. Identifying the most important and influential stakeholders in a changing NHS remains one of UK pharma’s biggest challenges. Earlier this year, the NHS Alliance’s Chief Officer, Mike Sobanja, said that the industry was about to embark on a game of ‘Spot the Commissioner’. He was not wrong. But to win, medical sales professionals tasked with the responsibility for identifying and developing key customer accounts must take the gaming metaphor a stage further and set about playing a conventional game of ‘Guess Who?’ Unfortunately, winning won’t be child’s play – it will require an insightful and educated approach.

But guess who, indeed. The current reorganisation of the NHS is bringing an increasing number of players to the table. Alongside CCGs, the Department of Health has recently published further details on the establishment of 27 Local Area Teams (LATs). Ten of these will be specialist commissioning hubs; the remainder will be afforded a variety of commissioning responsibilities. In addition, commissioning will be supported by 12 Clinical Senates, whose full remit is, as yet, unclear. Beyond this, the NHS Commissioning Board (NHS CB) – which itself will exert major influence over local commissioning plans – has more recently rebranded commissioning support services as Commissioning Support Units (CSUs). The NHS CB is currently conducting an authorisation process that will determine which organisations will provide ‘scale services’ to support CCGs – and has approved 23 to date. Critics claim the new CSUs look suspiciously like PCTs.

Regardless, it’s clear that in the very near future, pharma will find some of its key customers are housed in a CSU. They will also reside in fledgling Health & Wellbeing Boards. Undoubtedly, the new commissioning landscape will present a complex customer matrix for the industry.

Such is the speed and scale of the reforms that targeting customers in an environment that appears to be changing on a daily basis could easily be reduced to a guessing game. But pharma’s approach needs to be much more sophisticated than that. KAMs know that the old-school ‘noise-based’ approach to customer engagement will no longer work. Call plans must be targeted and efficient. But how?

Guess who?
The challenge really is like playing a giant NHS-themed game of Guess Who? Figuratively, every KAM has their own game board. The characters on it will differ, in terms of remit and influence, from one local health economy to another. And they will also be dependent upon disease area. A fully comprehensive board will comprise a mixture of clinicians and payers, as well as, potentially, influencers from social care and local authorities. Crucially, the game is as much about ruling out irrelevant customers as it is about identifying key targets. The former will determine the latter. The most adept sales professionals will be those who command sufficient market knowledge to be able to discern between an important stakeholder and a non-starter. They will then be able to use this information to form an efficient call strategy. Market data will clearly inform these targeting decisions. And there is a lot of it out there.

The imminent arrival of strategic documentation emanating from the CCG authorisation process will be just the latest in a deep mine of useful NHS data available to the industry. From QOF data to QIPP plans, HES data to CQUIN frameworks, the modern NHS is generating performance data, indicators and metrics at a rapid rate of knots. Used properly, it can be gold dust.

Local health organisations are being measured on their ability to eliminate variation in care, reduce hospital admissions and improve health outcomes. And they are increasingly required to report on how they are faring against these objectives. Proactive KAMs can use this data to develop messages that target commissioners of care and demonstrate how their drugs can impact service delivery in line with known priorities.

But data is only part of the answer. On its own, information is not enough. Success will only come from having an understanding of what it means, and establishing how it can be targeted in the right direction. A KAM can have all the data in the world, but if they are not able to translate it into an offering that demonstrates a meaningful gain for a customer, it is worthless.

The key account management game of Guess Who? will ultimately be led by the messaging you have developed, which, in turn, will have been driven by local circumstances and those customer needs identified within relevant market data. If you have a health economic message, certain clinical customers can be ruled out. If your value proposition can make a difference to a QOF target, once again, it will dictate a more precise customer group and eliminate others.

The rapidly expanding availability of NHS information promises great national and local insights for KAMs – and the Department of Health’s recently published Information Strategy indicates that a growing emphasis is being placed on the need to capitalise on the promise of data to drive improvements in patient care. But medical sales professionals must not lose sight of the fact that once they have reviewed all the available data and determined their product messaging, they still need to identify the key customers with whom those messages will most resonate. And they must then tackle the industry’s other long-standing challenge: gaining access to them. Having something to offer that can help customers meet their own objectives provides the best possible chance to achieve this.

So it’s clear that, faced with an evolving NHS bedeviled by rising demand, reduced resources and major reorganisation, productive industry engagement will only come through the development of a market access strategy that marries environmental intelligence with accurate customer targeting. This all links back to the need to establish a robust CRM strategy that integrates all aspects of customer data into a single platform, and communicates them effectively and efficiently across the commercial organisation. This approach will prevent KAMs going off in different directions and developing flawed strategies based on poorly-interpreted information.

In a dynamic, fast-changing market, only meaningful engagement that communicates the right message to the right customers will make any discernible difference. Anything else will be pure guesswork.

David Round is General Manager, UK at Cegedim Relationship Management.

The authorisation dates for clinical commissioning groups have been pushed back a month by the NHS Commissioning Board.

The Board has extended its original deadlines to allow for an extra period of dialogue between itself and the commissioning groups in the four separate waves of authorisation.

Dame Barbara Hakin, Managing Director of Commissioning Development, said the delay was not “material” in the day to day running of CCGs across England.

The switch means CCGs in wave one of the authorisation process will now be confirmed in November, rather than next month. Waves two, three and four have also been similarly affected. All CCGs should now be fully authorised by February 2013.

Board papers from the Commissioning Board’s recent monthly meeting also revealed how authorisation process will work. CCGs will be initially assessed by the Board’s local area teams. Those findings will then be reviewed by a ‘moderation panel’ to ensure applications are consistent across the country.

Applications will then be assessed by a ‘conditions panel’ which will apply further checks before the Board completes the authorisation process. CCGs will be able to discover the outcomes of the ‘conditions panel’ in order to supply any comments or new evidence to prevent the need to have any conditions imposed upon them.

Five clinical commissioning groups (CCGs) have requested to be switched from their original authorisation wave due to time constraints.

NHS Bolton CCG, NHS Hillingdon CCG and NHS Stafford and Surrounds were unable to meet the deadline for the second authorisation wave and have been pushed back into the third wave. NHS Essex CCG and NHS West Norfolk have also moved from the third wave to the fourth.

Dr Chaand Nagpaul, General Practitioner Committee negotiator, said the “political timetable” CCGs were given for each authorisation wave was “unrealistic for many”.

“It’s eminently sensible that CCGs should not rush to be authorised within a timescale quicker than their own choosing,” Dr Nagpaul said.

A spokesperson for the NHS CB said the requested switch was due to CCGs’ “own operational plans” and that changes were “expected and the NHS CB was pleased to support them”.

“We are working closely with all CCGs to guide and support their establishment: CCGs and the NHS CB share a common goal of creating a patient-focused, clinically-led and sustainable commissioning system, with flexibility to respond to local needs.”

The switch follows several other CCGs across the country which were moved back an authorisation wave at their own request or due to clerical errors by the NHS Commissioning Board. The changes now mean there will be 65 CCGs in wave three and 45 in the fourth authorisation wave.