When the NHS England North West region needed support to implement proposals to transfer direct commissioning responsibilities to ICSs, Arden & GEM’s Health and Care Transformation team was tasked with developing a framework for integrated commissioning and delivering Organisational Development (OD) support to impacted teams.
Following an initial period of research and engagement, to map the current commissioning landscape, Arden & GEM facilitated a series of interviews, events and workshops to support stakeholders in developing a shared vision and designing future functions for pharmacy, optometry and dental (POD) commissioning.
The North West region, and its three ICSs, established a clear, robust, assured approach for POD integrated commissioning which informed subsequent delegation plans for specialised commissioning.
The challenge
The NHS Operational Planning Guidance for 2021/22 stated an ambition to move NHS England’s direct commissioning functions to ICS NHS organisations as soon as operationally feasible. This would cover five key portfolio areas:
- Pharmacy, optometry and dental
- Section 7a public health
- Specialised commissioning
- Health and justice
- Armed forces.
These changes were intended to empower ICSs to better join up health and care services, improve population health and narrow health inequalities. The North West region needed support in undertaking a programme of work to implement these proposals.
This would include a framework for integrated commissioning, a timetable for implementation, OD support for commissioning staff across the region, completion of key assurance documents and running the Programme Management Office (PMO).
Our approach
With experience of working with national, regional and local partners to design and implement operating models and service frameworks, Arden & GEM’s Health and Care Transformation team began supporting this key programme of work in summer 2021.
Ensuring programme governance
With a wide range of stakeholders involved – from Arden & GEM, NHS England (NHSE) and the region’s three ICSs – robust governance and regular communication was key. In addition to providing weekly highlight reports and monthly progress reports, the following meeting structure was also established:
- Fortnightly working group meetings
- Weekly project team catch ups
- Weekly meetings with the Senior Responsible Officer
- Fortnightly workshops with the specialised commissioning team.
Mapping the current commissioning landscape
Before the team could begin working with stakeholders to co-design a future integrated approach, it was important to capture the current state of commissioning across the five portfolio areas. The CSU brought together information from a wide range of sources covering workforce, performance and governance to establish a detailed, usable, single version of the current commissioning portfolio. This exercise also provided ICS leads with the opportunity to question and better understand the regional direct commissioning landscape they would be receiving.
Engaging with senior stakeholders
In parallel with the mapping activity, the project team also begin a series of one-to-one semi-structured interviews with NHSE and ICS leads to explore the opportunities and challenges presented by the transfer in commissioning responsibilities. As well as informing the design of OD support, a summary report was also made available to the client. While the initial mapping and engagement had taken place across all five portfolio areas, the programme needed to prioritise activities for POD, as this area would be the first to undergo delegation.
Designing future functions
Drawing upon the current state map and the themes from the interviews, a series of staff engagement events was facilitated. These were held in small groups to encourage deep and detailed conversations about where POD commissioning functions currently sit, where they should sit in the future and what needed to be different about them.
Delivering tailored OD support
Working with the ICS leads and NHSE directors, an OD plan was co-produced and tailored for each ICS and their staff groups. As the transfer date for pharmacy would be soonest (July 2022), a range of engagement activities was coordinated with this impacted staff group first to share the potential benefits and understand their concerns. While senior leaders were invited to join the start of these sessions – to deliver scene setting – they would then leave to enable the independent Health and Care Transformation team to facilitate a confidential session where staff could speak freely with anonymised themes shared afterwards.
Finalising delegation agreements
Before commissioning functions could be transferred, pre-delegation assessment frameworks (PDAFs) need to be met by each ICB. Arden & GEM coordinated this process for POD services in the North West, completing the pre-delegation assessment documentation, which was assured by NHSE and shared by the national moderation panel with other areas and regions as an example of best practice.
The outcomes
By working closely and collaboratively with regional and ICS leads, the CSU team has supported the development of a future integrated approach to regional commissioning. As a result, the region developed:
- An agreed articulation of the current commissioning landscape and system readiness
- Consensus on the required future commissioning functions for POD
- A shared vision, values, desired cultures and ways of working
- Joint governance arrangements for the transition period
- Completed and assured pre-delegation agreements for POD
- An established governance structure for the programme of work
- A proven approach to framework development which was subsequently built on and applied by the team to delegation of specialised commissioning.
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