System Transformation Questions

Below are some questions and answers about the system transformation workstream and plans to establish a strategic commissioner for Kent and Medway.

What is a strategic commissioner? Why create one?

Clinical Commissioning Groups are currently responsible for the majority of NHS commissioning (the planning and funding of healthcare). There are eight CCGs across Kent and Medway. We already work together on a range of projects such as the stroke service review; and in locality groupings for work like the East Kent hospitals review.

A strategic commissioner would take on elements of the CCGs’ work where it makes sense to commission things once across Kent and Medway.

Making strategic commissioning decisions across the 8 CCGs is good because it provides consistency and reduces duplication; both for ourselves and the hospital, community and mental health services we work with. It will help improve services for patients by reducing variation in quality and access to care; driving up standards across all providers.

Is the strategic commissioner a new organisation with more managers?

The strategic commissioner is not an organisation. CCGs will remain the accountable organisations for NHS commissioning. They would form a joint committee for strategic commissioning and delegate certain responsibilities. Each CCG would be represented within the governance of the strategic commissioning function. The strategic commissioning function would use existing resources from across the CCGs.

How will the local clinical voice be heard within the strategic commissioner?

Making sure the local voice of both clinicians and patients is heard at the strategic commissioner level is essential. This will be part of the next phase of work to design which functions sit with local CCGs and which with the strategic commissioner.

What has happened already?

The proposals to establish the strategic commissioner and a shared management team across CCGs have been agreed by all eight CCGs and an initial series of design workshops were held in March-May 2018. A steering group including the clinical chairs of all eight CCGs has been set up and is supported by a governance group with lay-members for governance from each of the CCGs.

What are the next steps?

Over the summer of 2018 we will be designing where the different functions of commissioning need to sit and how to ensure that the local voice of clinicians and patients is heard at the strategic level. We will be working with staff, member practices and lay-members of each CCG to consider how current functions will be delivered in future. The aim is to run the strategic commissioner in shadow form from April 2019 before finalising the on-going approach from April 2020.

Have all eight CCGs approved the plans?

Yes. Six of the eight CCGs approved the plans by March 2018. NHS South Kent Coast and NHS Thanet Clinical Commissioning Groups confirmed their involvement shortly after.

How will it affect individual CCGs?

CCGs remain independent NHS organisations and will continue to be until any potential option to merge CCGs was considered. CCG Governing Bodies will continue to be the local decision makers and the 2018/19 contracting round will be signed off by individual CCGs, but we will work together where we can for consistency.

A merger of CCGs is one potential option for the longer-term which we will be discussing in the coming months, but it is not the only option and no decisions have been made at this stage. A proposal to merge would require all the CCGs involved to engage and seek the views of their membership practices and other stakeholders, and NHS England would also have to approve.

How does it fit with the Sustainability and Transformation Partnership (STP)?

Strategic commissioning has a close fit with the objectives of the Sustainability and Transformation Partnership. The STP includes all NHS organisations and Kent and Medway councils. It covers providers as well as commissioners and is overseeing the transformation of both. It also links with NHS England and NHS Improvement on quality assurance of all providers and commissioners. The intention would be that STP responsibilities will transition to the strategic commissioner over time.

Will there be a public consultation on these changes?

We are working with existing CCG lay-members on the design of the strategic commissioner; but this does not require formal consultation. If a proposal to merge CCGs was developed a formal public consultation may be required. We are looking into this but reiterate that no decision to merge has been taken.