Highlights of the Week - 11th July 2014

This week we have started the planning process for 2015/16 in earnest.  It will be a complex year as the process around our commissioning intentions will need to seamlessly fit together with the joint programme of work that will follow from the Financially Challenged Local Health Economy work;  this is moving in to the second phase where we need to turn our global intentions in to substantive plans.  In order to get that right, we need to start earlier and really clearly map out for all our stakeholders how the different elements support each other.

The irony of starting looking at next year is that we are both still finalising the fine points of some of the contracts for this year and are in the middle of significant operational pressures that require complete focus on the quality and financial aspects of the current year's performance.

It all feels increasingly like, whether in the hospital where emergency activity growth is making the environment feel like winter pressures in the summer or in the commissioning organisation, there is not going to be the usual slightly quieter period that exists after completing one contracting round and before the winter pressures kick in.

And what happens when there is no space in a system to recover and regroup? I think it is a real concern for the NHS in all aspects of the current work burden.  Whilst we can see the impact of financial overspends or treatment pressures, I'm not so sure we are sighted on what the long-term impact will be of the level of pressure that staff are now being expected to work under.

Time then for some....

Highlights of the Week - 11th July 2014 (@jeclo)

Highlights of the Week 1: Drawing up the outline of our Primary Care Programme points to the huge opportunities for improving care
We've been finalising the key strategic programmes of work for the next couple of years, one of which is the co-commissioning of primary care, so this week I spent some time discussing the different elements and projects that constitute this programme; essentially mapping the process by which we move from an outline strategy to having a detailed workplan for the development of primary care.

One of the five pillars that make up our 5-year strategy is about general practice, working at scale being the organising unit of care.  This is a really exciting proposition - federated groups or merged general practices being large enough for community health and social care services to map on to the practice population and create a 1:1 relationship.  The opportunities that would create across a whole range of urgent and planned care are huge and something that I really believe we should be paying more attention to nationally.

The programme looks at benefits beyond that too for both general practices as commissioners and as providers.  The wider primary care market creates even more options, though we are not looking to commission these in the first instance, taking an incremental approach.  We will make sure that we join things up though and so the possibilities around pharmacy, for example, will be a key part of the programme of work.

Highlights of the Week 2: The Big Listen-Feedback from our staff is really encouraging about how the Locality and CCG is starting to mature
We had the third of our "Big" events this week, where we get together with a group of staff who either work in the Western Locality or support our work to explore how well things are working.  We have now run these on a six monthly basis over the last 18 months and this time had around 50 members of staff.  Interestingly, showing how our direction of travel is moving, this time there were 6 members of local authority staff who had taken up the opportunity to attend .

We talked about integration and our key workplan for the year to make sure everyone understands the key focus for the locality and CCG.  Most importantly, though, we gave people time to reflect on things and provide feedback on those key areas.

The core of the event is the "Big Listen" a space where the Leadership Team in the Locality are invited to listen to feedback (without interruption, comment or justification) from the members of staff present.  It has taken some practice to get to a point where the listening environment is created and staff feel able to openly share, but we are definitely moving in the right direction and the benefits are clear.

We got feedback this week that staff feel things are generally improving and some of the systems and processes in the CCG are starting to mature and feel more secure. Clearly some of that is about the issues themselves; some, I am sure, is because our determination to listen and to feedback ("You said, we did") demonstrates it is worthwhile.

Highlights of the Week 3: The presence of Local Authorities at our away day looks right and the presentation is really joined up
The second of three highlights from the development day is the joint presentation that was given about integration with Devon County and Plymouth City Councils by a joint team from the CCG and Local Authority.  We are working hard with both Councils on the integration agenda - both of service delivery and of commissioning - so there is a lot to say, especially at this moment with Plymouth City Council as we have reached the point of agreeing a joint business case setting objectives for March 2015 and 2016.

The feedback from staff noted how impressed they were about the seamless join between the organisations presenting and the obvious work that has gone on over the last weeks and months to get to a point where the messages are the same from either party.

There are huge challenges ahead with lots of discussions about governance, accountability and money to resolve before we get to move towards the level and scale of integration that we envisage, but this week was another sign that we have got many things right.

Highlights of the Week 4: We've asked a lot of staff through changes over the last 2 years, but they are still up for integrating commissioning
And the final away-day highlight was the reaction of our staff to the presentation on integration.  The vast majority of the Locality and CCG are made up of staff who went through the transition from PCTs, Clusters, networks and Strategic Health Authorities to end up working in NEW Devon.  This means that it is only about 18 months since they were last applying for jobs, being interviewed and coping with all the anxieties that this involved.

That change process was long and protracted, so there was an extended period of worrying about futures, salaries and being employed that they had to cope with.  This week, we discussed moving towards integrated commissioning and the kind of options we are considering.  Everyone understands what this means - eventually some and potentially all health and social care staff within the scope of the programme of integrated commissioning may move to a new organisation through some, as yet undetermined change process.  We can't yet say 'who' and we don't yet know 'to where', but we did discuss the sense of change.

Clearly staff were concerned, but given a couple of hours to think, discuss and reflect, the overriding response was that integrating makes clear sense and that we should be pursuing that line if we are to deliver on our vision to make the biggest impact for patients most efficiently.  Lots of feedback and pleas to ensure we manage our HR processes with a greater sense of understanding of the impact on individuals, but an acknowledgement of the need to progress; hugely encouraging.

Highlights of the Week 5: The Governing Body is carefully considered the responses to our community services consultation; the purpose is clear
We have finished an 8 week consultation on our community services strategy and our preferred option for procurement.  We have attracted significant attention as we are looking at a non-competitive award of contract for some significant elements of service in order to maximise the benefits of service integration.

The feedback this week was, as expected, mixed with a range of different opinions on the proposed way forward.  Faced with this broad range, the Governing Body has an important decision to take about the next steps leading up to key meeting in October when final options need to be determined to achieve the required timeline.

The discussion this week and listening carefully to the detailed views that have been expressed was very positive for the Governing Body balancing the different perspectives with a reminder of the purpose of the reprocurement.  There are no easy solutions and no risk free options; it is all about balance and judgement.  It does, however, feel like we are listening hard, considering carefully and do understand the importance of the next steps. This is another intense process with few gaps with staff who have been working flat out for many months; we also are thinking about how we support them.

And in terms of the long-haul, on the upside, after a very long, sometimes exciting, but too often painful, period of heightened watchfulness has been brought to an end.  Whilst I'll miss the fantastic talent, overall my total fatigue with the situation means that I'm relieved that we can now move forward.  On this issue at least, I can now rest.  Goodbye Luis Suarez, good luck in Barcelona, thanks for the memories.  Now relax.....


You can read other blogs related to the work of the Western Locality of NEW Devon CCG
About our workplan: Western Locality Workplan
About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.