The NHS Commissioning Board Authority (NHSCBA) has appointed its 15th Commissioning Support Unit (CSU) managing director.

Tim Andrews has been appointed to lead the Cheshire, Warrington and Wirral CSU after serving as its interim MD. He also previously led the Commissioning Lab.

His appointment follows five other MDs being selected by the NHSCBA in the second round of recruitment. The Authority initially planned to appoint 14 MDs during the second phase of recruitment but failed to fill its target of 14 positions.

The Commissioning Board has been criticised by certain CCGs for the amount of time it has taken to fill all 23 MD positions for CSUs. Dr Joe McGilligan, Chair of ESyDoc CCG, claimed the delay in appointing a MD for his regional CSU was slowing down the group’s authorisation process.

The Board recently renamed commissioning support organisations as CSUs in an attempt to differentiate those which are to be hosted until 2016 and suppliers from the private sector.

Four strategic clinical networks have been introduced by the NHS Commissioning Board Authority (NHSCBA) to improve health services to specific groups of patients.

The first four networks will focus on cancer, cardiovascular disease, maternity and children’s services and mental health, dementia and neurological conditions.

The NHSCBA said the networks will assist local commissioners to reduce “unwarranted variation in services and encourage innovation”.

They will exist for a period of five years and will be managed by 12 locally-based support teams.

The teams will build and oversee effective network arrangements locally and help networks develop an annual programme of quality improvement in services.

Sir Bruce Keogh, NHS Medical Director, said it was important to retain the strategic clinical networks after the commissioning transition period had been completed. “We are keen to preserve things which we know have worked and worked well. There is a feeling networks have been instrumental in helping to improve care,” he said.

However, Neil Churchill, Chief Executive of Asthma UK, said the charity was dismayed that respiratory disease had been overlooked by the Commissioning Board Authority. “We are surprised and disappointed,” he said. “It is a national priority under the NHS Outcomes Framework and appears to be the only major area to have been overlooked.”

He added that the decision was a “lost opportunity to transform care in line with the Government’s own respiratory strategy”.

The Commissioning Board now plans to outline what it expects from each strategic clinical network and what targets they should aim for, by way of improvement programmes, when they are operational next year.

The NHS Commissioning Board Authority has completed its recruitment for the national and regional leadership team of its Operations Directorate with two new appointments.

Ann Sutton, Chief Executive of Kent and Medway PCT cluster, has been appointed as Director of NHS Commissioning (Corporate) and Lyn Simpson, NHS Director of Operations, Department of Health, joins as Director of NHS Operations and Delivery (Corporate).

Ian Dalton, Chief Operating Officer and Deputy Chief Executive of the NHS Commissioning Board Authority, said the posts “provide strategic leadership and oversight” to help the NHS reach its potential.

The new director for corporate commissioning, Ann Sutton, will be responsible for devising the national framework for the Commissioning Board’s direct commissioning responsibilities.

The DH’s Lyn Simpson will take on the responsibility for NHS planning and performance and assurance of delivery by CCGs, and will be the national lead for NHS emergency preparedness, resilience and response.

The Commissioning Board will take on its statutory responsibilities from next April.

What does the ‘single operating model’ for primary care commissioning mean for GPs?

The NHS Commissioning Board Authority’s ‘single operating model’ for primary care commissioning represents a major step in defining the relationship between GPs and the new NHS. As such, it is essential reading for anyone with a stake in prescribing behaviours and, more widely, in patient pathways.

A major question posed by the Lansley reforms is: who should commission the commissioners? If GP-led groups are responsible for commissioning secondary care, who can commission primary care? The answer, the NHS Commissioning Board, was greeted with mistrust by many GPs who asked why they needed some Big Brother watching over the job they had always done.

In addition, the passage of the Health and Social Care Act left a lot of broken glass scattered through primary care. The relationship between clinical outcomes and money, the involvement of the private sector in the NHS and the apparent fragmentation of the health service are issues that divided
the GP profession.

So the single operating model has the task not only of outlining new clinical and business relationships, but of building professional bridges. The Board tackles this challenge by saying up front that it seeks to
achieve “the right balance between national consistency and local decision making”.

Unlike earlier documents describing the infrastructure of the new NHS, Securing excellence in commissioning primary care does not list concrete developments to be in place by April 2013. Rather, it outlines a pattern of relationships that will develop from that date, when the new single operating model
for primary care commissioning becomes operative. It represents the parts of the new
NHS working together with a clear goal of outcome improvement.

The commissioning challenge
According to Dame Barbara Hakin, National Director for Commissioning Development, the new system aims to “tackle unwarranted variation and take positive steps towards raising the overall standard of primary care”. The document notes that primary care, while accounting for only 15% of the NHS budget, has a
profound role in making “preventative interventions” and influencing all the care patients receive.

The challenge of replacing “many different systems” for primary care commissioning with “a single national
operating model” without losing “vital local responsiveness”, the Board says, depends on “establishing relationships and arrangements across the new organisations” – including CCGs, whose health strategies
will set the context for primary care.

The NHSCB will be responsible for planning, securing and monitoring primary care services. Its local area teams will manage the performance of GPs and other primary care providers (dentists, community pharmacists and opticians), and will help to support providers in difficulty and deal with major emergencies.

The local area teams will support patient “choice and control in designing services that respond to their needs”, focusing on “the basic service offer” (such as early diagnosis) to reduce variations and health inequalities. Likewise, they will support the development of “local area clinical leadership teams” that draw on the expertise of all types of primary care clinicians. Finally, their focus on patient outcomes means they will look for “improvement strategies” at all times.

All together now
Most primary care commissioning will take place through the Board’s local area teams working with CCGs, local authorities and health and wellbeing boards. The Board as a central authority will “ensure consistency” and provide the framework for performance management and quality assurance. Crucially, this system involves “fewer managerial resources” and “larger geographical footprints” than the previous system. It does not remove local initiative: it just removes the SHA and PCT management layer.

At the heart of the model are the common operating procedures for local area teams, of which the most important is “to standardise the performance management frameworks and processes at practice, provider and individual levels”. Managing variability and the healthcare market are also key priorities.

Commissioning support services may also assist local area teams: emphasis is placed on the value of
business intelligence in providing “a single flow of standardised information”, and the potential for CCGs to share support for primary care development and redesign with local area teams.

Micro commissioning
CCGs themselves will work closely with the NHSCB to review the “micro commissioning decisions” made by
GPs in “each referral and prescription”. The Board says that its work with CCGs has shown they can progress effectively together towards “quality improvement” through benchmarking, data sharing and peer review. It notes further that CCGs will be able to commission integrated “wrap-around” community-based services in which GP practices can participate, with care taken to manage conflicts of interest.

The local area teams will establish relationships with a range of partners, including CCGs, Local Healthwatch, health and wellbeing boards, local authorities, Public Health England local units and the CQC. Clinical networks will feed into the primary care system “with a particular focus on early diagnosis and timely treatment”. Public health commissioners will advise local area teams on priorities for the local
population, and work with them to develop health improvement initiatives that may include primary care.

The Board concludes: “During the next three to six months, we will fully explore all the interdependent relationships critical for the operating model and take any action necessary to ensure that they will work effectively.” It encourages discussion of the model within PCT clusters and feedback on
potential improvements.

A business network
The single operating model for primary care commissioning is not so much a ‘one size fits all’ as an ‘all things to all people’. It shows the old hierarchical NHS giving way to something much closer to a business network, with shared rules and goals but different cultures. The imprecision of the arrangements described displays the will to promote clinical innovation and business
development.

The emerging structure is designed to give GPs more confidence that they will be neither isolated nor controlled. Those who need guidance and support will receive it, while others will have the freedom to change treatment pathways and business models. This will help to defuse opposition to reform in the
profession, while setting the stage for further changes.

For pharma, the new model points to the development of a complex and flexible customer network with many points of contact. Key account managers are much concerned with how primary care operates and the factors influencing it. This model shows primary care in a dynamic field of NHS and other stakeholders, responding to ideas from all sides: an exciting prospect for suppliers.

The NHS Commissioning Board Authority (NHSCBA) has appointed the first 16 local area team (LAT) directors.

Six positions in the North, a further six in Midlands and East, three in the South and one in London have been filled during the first round of recruitment.

Ian Dalton, Chief Operating Officer and Deputy Chief Executive of the NHS Commissioning Board Authority, was “delighted” that “key appointments to such important leadership posts” were filled.

In total, there will be 27 local area teams – but London will have an integrated structure with one director controlling three LATs to reflect the “distinct nature” of the capital. The NHSBA hopes to complete the recruitment process “shortly”.

Appointments include Chris Long, current Chief Executive of NHS North Yorkshire and York PCT Cluster and NHS Humberside PCT Cluster, for North Yorkshire and Humber LAT in the north.

Wendy Saviour, Director of Partnerships at the NHSCBA, will lead Birmingham and Black Country in Midlands and East; Simon Weldon has been appointed to head the London LAT; and Debbie Fleming, SHIP PCT Cluster Chief Executive, will oversee Wessex.

LATs will have the same core functions around CCG development and assurance, emergency planning, resilience and response, quality and safety, configuration, system oversight and partnership and stakeholder engagement.

Senior leaders of LATs will also join health and wellbeing boards as partners.

Teams will also be responsible for commissioning GP services, dental services, pharmacy and certain optical services. Ten LATs will lead specialised commissioning, with a handful also commissioning other services such as military and prison health.

“This puts us in a position to quickly develop the local presence of the NHS Commissioning Board, building strong relationships with our partners and communities to firmly focus on driving improvement for our patients,” said Ian Dalton.

Senior clinical leaders from CCGs across the country have been invited by the NHS Commissioning Board (NHSCB) Authority to join a new NHS Commissioning Assembly.

The Assembly will see leaders from CCGs and the Commissioning Board work together to build an effective relationship between at a local and national level.

A letter from Sir David Nicholson (pictured), Chief Executive, Commissioning Board Authority, and 15 other CCG clinical bosses, said senior leaders were invited to be “involved in the next steps” in developing relationships.

The purpose and the roles of the Assembly will be to bring together CCG and NHSCB leaders to create shared leadership across the country to ensure clinically-led commissioning develops and flourishes.

It aims to be an infrastructure through which commissioners and the Board can together create national strategy and direction and be the mechanism that allows CCGs to have a shared voice on key issues.

Also, the Assembly will prove a learning network where the two can excel in the future.

The whole Assembly would meet once a year, Sir David proposes in the letter, as part of a learning event for commissioners.

“We propose the first Commissioning Assembly meeting could take place in late autumn 2012,” the letter said.

A series of priority areas have already been identified where CCG leads and the Commissioning Board could work together to support the development of clinical commissioning, including quality, improving primary care and strategy and innovation.

Sir David added that he hoped senior leaders accept the invitation to “join us in shaping this important set of relationships”.