Organisational Development Plan

2014/2016

CCG Strategic Commissioning Plan 1 | P aPage

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CONTENTS

Statement from our Chairman and Chief Accountable Officer 3

Introduction 3

Our Journey So Far 3

Our Vision and Values 6

Our Environment 8

Risk Analysis 9

Our Model for Organisational Development 10

Our Internal Development Plan 19

Our External Development Plan 29

Conclusion 35

Implementation Plan 36

2014/15 Corporate Objectives 39

Appendix 1 – 2 Year Operational Plan on a Page 43

Appendix 2 – 5 Year Strategic Plan on a Page 44

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STATEMENT FROM OUR CHAIRMAN AND CHIEF ACCOUNTABLE OFFICER

‘The collective principle asserts that … no society can legitimately call itself civilised
if a sick person is denied aid because of lack of means’. Nye Bevan’s statement has
perhaps never been more relevant since he first established the NHS, given the
increasing demands on health and social care at a time when our resources are ever
more constrained.

We cannot meet this challenge if we do not develop and adapt – but not just as a
CCG – nor even just as a health and social care system – but instead as a whole
community working better together.

We have to make possible a change in our culture if we are to ensure that every
person receives the aid that they need.

Our CCG is driven first by our values. This is now embedded in our staff contracts
and in how we work together. These values then translate into the wider system and
the way we wish to engage our service providers and the public through our
approach to mutualist healthcare.

Rational approaches which merely deliver structural changes, a drive on

performance targets and imposed efficiencies will ultimately be unsuccessful. These
may be necessary, but we also need to address the motivations and aspirations of
both the public and our staff; and develop an adaptive culture that is more human in
its response and always thinks about patients in their context.

As the leaders of our local healthcare system, one of the most important things that
we do is to ensure that we have an effective Organisational Development plan which
will enable us, our GPs and our local providers to meet these challenges - enabling
us not only to think differently but also to act differently.

This organisational development plan explains how we will make real our values and
continue to develop as a CCG; and how we will embed our mutualist approach to
healthcare to ensure the population we serve has the best possible care and
outcomes that we are able to deliver.

Dr David Hegarty Paul Maubach

Chairman Chief Accountable Officer

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INTRODUCTION

This version of the CCG Organisational Development Plan replaces the original plan
which was produced during authorisation and has been produced as we begin our
second official year. This provides us with the opportunity to reflect on the work that
has been undertaken so far to bring the organisation to where it is now, and sets out
a plan to develop the organisation over the next two years. This plan responds to our
5 year CCG Strategic Plan (approved by the CCG Board in May 2014) and the 2
year Operational Plan (approved by the CCG Board in April 2014) and should be
read in conjunction with both of these documents.

The challenges facing the NHS over the coming years are significant and in Dudley
we are no different; we will all strive to improve patient care and with determination
and a drive to succeed we can do this on the reduced resources we are challenged
with. This plan outlines the development support that will be put in place to enable
these challenges to be overcome and allow mutualist healthcare to be delivered.

OUR JOURNEY SO FAR

Dudley Clinical Commissioning Group became a fully authorised with no conditions

statutory organisation on 1st April 2013, although our life journey began some time
before. GPs in Dudley have worked together since October 2006 when Dudley
Beacon & Castle and Dudley South PCT merged as one organisation. The GPs
within the Dudley borough established themselves as five clusters of GPs and
became fully involved in practice based commissioning. The five localities came
together as Dudley Commissioning Forum and clinicians held lead roles on the
Professional Executive Committee and provided clinical leadership for planned care,
urgent care and long term conditions.

In August 2010 the Dudley GPs unanimously agreed that to have a stronger
influence on commissioning they needed to work more cohesively as one group.
This was agreed by all clusters and was shortly followed by the announcement by
the Secretary of State that clinicians would be put at the heart of leading the NHS
with the establishment of Clinical Commissioning Groups.

This commitment to work together prior to the announcement of the reforms has
given Dudley strong foundations on which to build the development of the CCG.
Dudley has remained consolidated in its configuration and this has enabled the CCG
to develop at a consistently fast pace. Dr David Hegarty has chaired and led the
CCG since 2010 and this consistent stability has had a profound effect on the CCG’s
ability to develop and its sustainability. Dudley was also awarded the HSJ Award for
Commissioning Organisation of the year in 2011, which is further recognition of our
success.

From our conception as a statutory body in April 2013 Dudley CCG has gone from
strength to strength. At the heart of our success is the strength of the clinical
leadership team. Dudley CCG has always remained focussed on what will make us
different to a PCT and that is remaining focussed on being a membership
organisation and the strength of our clinical leadership. Clinical Leaders were both

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appointed and elected back in 2011 and this leadership has seen the organisation
through authorisation and the appointment of our senior management and staff
support team.

At every level within the organisation there is clinical leadership working in

partnership with management and administration expertise to create the team
required to deliver real change and improvement in patient care. As a membership
organisation of currently 47 GP member practices, Dudley CCG has responsibility for
commissioning the healthcare for the Dudley population of approximately 315,000
people. Our member practices are organised in five localities to enhance their
involvement at a local level:

The five localities of GP member practices are at the heart of our decision making
and consultation process. Each locality has two elected GPs on the CCG Board
(Governing Body) and the localities meet every month to discuss issues or
proposals, make recommendations. Every practice is represented at the locality
meetings, which provides real opportunity for the CCG to consult with its member
practices, and provides a two way communication channel to allow information to
flow down from the CCG Board and up from the member practices.

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Our elected members are as follows:

• Stourbridge and Wollescote (Dr David Hegarty & Dr Steve Mann)

• Halesowen and Quarry Bank (Dr Richard Johnson and Dr Jonathan Darby)
• Kingswinford, Amblecote and Brierley Hill (Dr Ruth Edwards and a current
vacancy)
• Dudley and Netherton (Dr PD Gupta and Dr Mona Mahfouz)
• Sedgley, Gornal and Cosesley (Dr Jas Rathore and Dr Kevin Dawes)

The locality meetings are supported by a bi-monthly Membership Event which is a

discussion forum where all of our member practices come together to debate current
topics and developments. Their purpose is to enhance communication, share
information and most importantly to engage practices in debate with regard to the
challenges that the CCG faces and how it functions as an organisation. Feedback is
collected from each event which is taken and acted on by the CCG Executive Team
and Board and presented back to our members as “you said, we did”. We also have
our “star of engagement” which is used periodically to test out how our members feel
as part of the CCG and the results of which are used to determine how we can
improve in our communication and engagement mechanisms.

OUR VISION AND VALUES

Our vision and values were developed by our clinical leaders at the beginning of our
development journey and these will remain with us for the next two years of our
journey.

Our vision:

To promote good health and ensure high quality health services for the people of
Dudley.

Our values:

We will be a caring organisation

We will be a patient centred organisation
We will work together as teams within the organisation and with partners
Quality and safety will be the foundation of everything we do.
We will be an organisation that which leads by example.
We will be a learning organisation.
We will be an inclusive organisation.
We will have a focus on prevention and health promotion.
We will be an innovative organisation.
We will promote excellent financial management.

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Our vision and values are supported by a number of principles that we consistently
adopt in our way of working.

Our underlying principles are as follows:

Patient and public involvement

Clinically led
Primary care at our heart
Working with partners in our communities
Focus on quality and continuous improvement
Live within available resources

Our CCG staff team developed a set of team values that we have committed to in
our way of working and in the way we treat others in our team. As a team, we
expect to live by our values in the way that we treat others and in the way we can
expect to be treated ourselves. We use our team values when we are recruiting to
new members of our team and we have developed our performance development
review process around proven demonstration of our values. They are as follows:

TRUST one another

Be honest.
Focus discussion on real issues and on their resolution, allow differences to be
forgotten.
Embrace constructive challenge in a timely manner and use it as a positive way to
learn.

RESPECT one another

Accept others opinions are valid.
Understand people have individual skills and knowledge.
Show determination, tolerance and sensitivity.
Be courteous and respect freedom to speak, disagree or remain silent.
Ensure no-one becomes isolated in expressing their view and treat all ideas with
respect.

Be OPEN to receiving feedback from others

Embrace constructive feedback.
Listen carefully to all ideas and comments and be tolerant to other points of view.
Be sensitive to colleagues needs for support when challenging or being challenged.
Ensure feedback is timely and objective.
Celebrate success.

Maintain PROFESSIONAL integrity

Show group support and loyalty towards the CCG and each other.
Take personal responsibility for actions.

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 Be accessible, visible and CONSISTENT
Be supportive of decisions made, even though as individuals we may not always
agree.
Demonstrate clear and cohesive leadership.

Take RESPONSIBILITY
Look inwardly for continuous improvement.
Be clear about roles and responsibilities.
Manage own and others time efficiently.
Consider the impact of our behaviour.

OUR ENVIRONMENT

The external factors within which we work have a significant bearing on both what
we are here to do, and whether we will be able to achieve it. If our business is to
improve the health and wellbeing of our population then we must improve life
expectancy whilst also reducing the variation in life expectancy across the borough.
Significant variations occur by geography, registered vs unregistered patients, male
vs female, long-term poor mental health and homelessness. We will need to work
hard to support primary care to reduce unwarranted variations and have a clear
understanding how we will target specific interventions. It can be considered the
norm to live with a long term condition, and our strategy recognises the important of
enabling patient autonomy. A largely disproportionate level of cost and healthcare
interventions are incurred during the last year of life which represents both poor
value for money and poor outcomes for patients and is reflected in the high number
of frail elderly that are admitted to hospital. We will be engaging in conversations
with our public about the last year of life and our integration programme will work to
improve the patient journey during this time.

The economic context in which we operate means that we are experiencing negative
growth in investment, meaning we need to do more with less whilst improving health
outcomes. Through our mutualist strategy we will promote individuals to become
more autonomous and manage better their own health care. We will need to invest
in preventative, lower cost interventions and disinvest in high cost care and
maximise the efficiency of front line care to maximise patient contact time.

Our supplier market has two extremes; we have two large scale complex secondary
care organisations (Dudley Group Foundation NHS Trust and Dudley Walsall Mental
Health Partnership Trust) and alongside much smaller scale organisations such as
our GPs, Nursing Homes and the voluntary sector. We will need to consider this
market and how we should be shaping it to provide more resilience and capability
and encouraging research and innovation.

NHS England impacts on our organisation in two ways; they operate as our regulator
and they have responsibility for commissioning the services from our member
practices. We work very hard to manage our performance and assurance
relationship with NHS England and we will be working with them to pilot a project on
the co-commissioning of primary care.

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We are co-terminous with our Local Authority (Dudley Metropolitan Borough Council)
and our relationship operates on many levels. They are the local democratically
elected body that provides strategic oversight for local healthcare delivery through
the Health and Wellbeing Board, they publically scrutinise our significant service
changes and are partners in commissioning services for our local population. Our
relationship with them therefore is complex as they are expected to both hold us to
account and work in partnership with us. Will be working closely to develop our
working relationship, and through the Better Care Fund to integrate health and social
care services around our membership practices.

RISK ANALYSIS

The aim of this plan is to prioritise our investment in development to mitigate the
risks that have been outlined below:

Internal

Our main risk internally within our organisation is having the capacity and capability
to deliver the challenging agenda that we have been set. Our CCG operates on an
employed team of 50 employees (with others embedded in the organisation from the
CSU etc). We need to make sure that we are prioritising the work of our team
effectively to ensure we have the ability to deliver the organisational objectives that
are described at the end of this plan. Our other key risks are:

That our team do not uphold and work to our values.

Not embracing the difference and opportunity that being a membership and
clinically led organisation brings.
A lack of engagement on the part of our membership.
The size of the problems we are trying to achieve become overwhelming.
That we are unable to maintain our current good financial position.

External

Inability to provide sustainable improved health outcomes for our patients.

Integration of health and social care does not achieve the system and culture
changes we require.
Relationships within the system become fragmented, defensive and
unproductive.
There is a breadown in the system we lead.
The necessary culture changes are unachievable.
The financial viability of our main providers.
Depletion of GP workforce (27% over 55 and 10% over 65)

This plan is not intended to be all encompassing as the plan will be embryonic and
flexible to change over the next two years. A Succession Plan and Talent
Management Strategy will be produced to accompany the plan to ensure we are
prioritising our workforce. It is clear that our success will be measured by whether
we have the ability to deliver the ambitions we have set.

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OUR MODEL FOR ORGANISATIONAL DEVELOPMENT

The model we have adopted to apply our approach to organisational development is

the Weisbord Six-Box Model (organisations and systems). Weisbord’s model is a
framework developed by Marvin Weisbord to assess the functioning of organisations.
It is a generic framework, based on the techniques and assumptions of the field of
organisational development. The six-box model is comprised of the following
components (boxes):

1. Purposes: What 'businesses' are we in?

2. Structure: How do we divide up the work?
3. Relationships: How do we manage conflict (coordinate) among people? With our
technologies?
4. Rewards: Is there an incentive for doing all that needs doing?
5. Leadership: Is someone keeping the boxes in balance?
6. Helpful mechanisms: Have we adequate coordinating technologies?

To use the model properly, we have applied it to our CCG

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Our purpose is the reason we are here (To promote good health and ensure high
quality health services for the people of Dudley).

Our long term Strategic Plan (2014-2019) outlines what we commit to deliver over
the next five years:

Promote good health and wellbeing; reduce inequalities in health; and

commission services and interventions that help us achieve those goals.
Privilege services which operate on a population basis and which are designed to
support health and wellbeing – particularly primary care prevention services.
Recognise the key role of the individual person, in contributing to their personal
health and wellbeing – and the collective engagement of the local population in
contributing to their collective health and well-being; so promoting recognition of
autonomy for the individual alongside mutual roles and responsibilities.

To do this we will develop our mutualism concept to include the registered population
of our member practices encouraging people to take responsibility for their own
healthcare; we will develop patient involvement through consent and true
participation through our GP Practice Patient Participation Groups; we will implement
integrated working including all primary care, community, mental health and social
care services at a practice, locality and borough wide level making the changes
necessary to provide the efficiency savings to support the Better Care Fund; we will
manage our own financial challenges and that of our providers; develop high quality
primary care via the implementation of our Primary Care Development Strategy and
development of proposals surrounding joint commissioning with the Area Team;
redesign urgent care and develop a new Urgent Care Centre for the borough.

Our key aims are to improve: healthy life expectancy; health outcomes; quality and
safety; and system effectiveness. We will allow variations in the delivery of services
to reflect different needs and inequalities in health in our local communities; however
we will remove variations in performance and clinical practice which adversely affect
the delivery of health outcomes.

Our key outcome objectives are:

Effective and efficient care

Healthy life expectancy
Mutual approach to achieving best possible outcomes
High quality care for all

Our organisational development plan responds to our strategy by explaining how our
structures, business models, service provision and organisational cultures will be
radically reassessed in light of the social, economic, technological, environmental
and economic challenges we face. Our strategy describes how we will place the
patient at the centre of our networked community. Our organisational development
plan delivers our strategy around clinical leadership and putting primary care at the
heart of everything that we do.

Our structure is the way our organisational is built; currently 47 member practices
arranged in five localities with a team of people employed to support our organisation

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 to fulfil its duties. Our structure is driven by improving the health and wellbeing of
our population and improving the quality of treatment services we purchase on
behalf of our registered population.

Our governance structure places clinicians and patients at the centre of everything
we do. Our Clinical Executives chair our Committees, with vice chairmanship
provided by our members. We have ensured that we have clinician and lay
members as majority members of our committees. The structure is as follows:

Governing Body
(setting strategy and governance)

Finance & Clinical Primary Care

Quality and Safety
Performance Development Development
Committee
Committee Committee Committee
(holding system to
(holding the system (implementing (enabling
account)
to account) change) membership)

Communications &
Engagement Remuneration
Audit Committee
Committee Committee
(governance)
(engaging public and (governance)
patients)

Each committee is chaired by a Clinical Executive (with a Lay Member Vice Chair)
and meets on a monthly basis reporting to the bi-monthly CCG Board. The table
above shows the responsibilities of each committee. We will be undertaking a
review of the effectiveness of both our governing body and our committees during
2014.

As local leaders of the NHS, our relationships with our patients, partners and
providers are critical to our collective success for the registered population of Dudley.
Our strategy recognises the importance of mutual engagement which is balanced
alongside responsibilities, enabling our registered population to use resources
responsibly and to recognise they are part of a community (CCG) and the community
is part of them.

We ask our population to take responsibility for managing their own health and
wellbeing as much as possible. In return we will develop an active membership
programme that incorporate a patient portal providing health and wellbeing, access
to their own healthcare records and clear mechanisms for access to their local
healthcare services through their GP.

Our GP membership, arranged around our localities, are the closest we can get to
our registered population. Our membership are trusted by our population and they
know the needs of our patients the best. Our priorities and decision making is led by
our GP membership and we have ensured that we have opportunities for clinical
involvement at every level within the organisation. Primary care is at the heart of our

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organisation and we are embracing the opportunity to work alongside NHS England
to pilot co-commissioning primary care services.

One of our key priorities for the next two years is integrating health and social care
community services around our GP membership practices. We are working closely
with Dudley Metropolitan Borough Council, Dudley Group Foundation NHS Trust,
Dudley and Walsall Mental Health Partnership Trust and Dudley Council for the
Voluntary Sector to create the mechanisms for teams without walls focussed
around the patient.

Our CCG Board has recognised its duty to understand the requirements of equality
legislation and how this must influence the CCG’s approach to commissioning.

To enable this, Dudley CCG was funded by the NHS Institute for Innovation and
Improvement, supported by Shapiro Consulting Ltd (specialists in effective diversity
management) to work through the Connect Programme. The Connect Programme
enabled inclusive leadership in practice and covered the following three objectives:

1. Develop the commitment, confidence and capabilities of the Dudley CCG

Board and senior management team to successfully lead and embed equality,
diversity and inclusion into its commissioning system, governance process
and organisational culture.
2. Increase the effectiveness of Dudley CCG and the Health and Wellbeing
Board to work in partnership to advance equality, diversity and inclusion
across the local healthcare system.
3. Build the capacity of Dudley CCG to help ensure that it meets statutory
equality requirements and build on the potential opportunities offered by
diversity and inclusion to achieve critical outcomes including improvements in
QIPP and patient safety.

The outcome of this work will be a refreshed CCG Equality and Diversity Strategy
that recognises best practice and reflects our strategic and operational plans.

The Equality Delivery System described within the new legislation sets out two clear
objectives for staffing and leadership, which are used as a guide to the organisations
development. These are:

For staff – increase the diversity and quality of the working lives of the paid and non-
paid workforce, supporting all staff to respond better to patients’ and communities’
needs. The desired outcomes are:

• Recruitment and selection processes are fair, inclusive and transparent so that
the workforce becomes as diverse as it can be within all occupations and grades.
• Levels of pay and related terms and conditions are fairly determined for all posts,
with staff doing the same work in the same job being remunerated equally.
• Through support, training, personal development and performance appraisal,
staff are confident and competent to do their work, so that services are
commissioned or provided appropriately.

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• Staff are free from abuse, harassment, bullying, violence from both patients and
patients’ relatives, and from their colleagues, with redress being open and fair to
all.
• Flexible working options are made available to all staff, consistent with the needs
of patients, and the way that people lead their lives.
• The workforce is supported to remain healthy, with a focus on addressing major
health and lifestyle issues that affect individual staff and the wider population.

For the Board – ensure that equality is everyone’s business, and everyone is
expected to take an active part, supported by the work of specialist equality leaders
and champions. The desired outcomes are:

• The CCG Board and senior leaders conduct and plan business so that equality is
advanced, and good relations fostered, within the organisation and beyond.
• Middle managers and other line managers support and motivate staff to work in
culturally competent ways within a work environment free from discrimination.
• Use the NHS Equality and Diversity Competency Framework to recruit, develop
and support strategic leaders to advance equality outcomes.

To achieve these outcomes, the CCG will need to have good quality information
about the workforce, disaggregated by race, disability, gender, age, sexual
orientation and religion or belief. This information is provided to our Remuneration
Committee on a regular basis.

We will seek to use our influence as leaders and commissioners of local healthcare
services to ensure that provider organisations and commissioning support services
adopt a similar approach to equality and diversity through our contractual
arrangements.

To be an inclusive organisation as set out in our values, our workforce will be

supported and feel confident in their ability to challenge discrimination, advance
equal opportunities, foster good relations and safeguard human rights, as directed by
the NHS Constitution.

How we co-ordinate technology to enable our mechanisms will be a key enabler to

the development of our organisation. Our IT Strategy sets out our intentions over
the next two years and by the end of June 2014 we will have every one of our
member practices on the same IT system (Emis web). This will enable records to be
shared, increase the opportunities for patients to be treated at other surgeries for
special services, and will mean that the GP systems will be connected to our out of
hours and urgent care primary care services (our Urgent Care Strategy outlined in
our Operational Plan).

With primary care at the heart of what we do, we must ensure that we are creating
opportunity for improving our primary care estate through our Primary Care Estate
Strategy. We have already undertaken a tabletop analysis of our estate, and will
commit to a further indepth review to identify estate that is in need of improvement or
replacement over the next five years. This will be translated into a priority plan for
investment that is developed and agreed by our membership.

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We clearly articulated to our providers at our Commissioning Conference in
September 2013 that we will be moving away from activity driven performance
monitoring and will only commission services from providers who are able to
demonstrate the value they have made to a patient’s life. By participating in the
Building Healthy Partnership project we have worked closely with one of our
voluntary sector providers (Summit House) to develop a tool to measure social value
(PSIAMS). We will be expanding the use of this tool across our providers. We are
committed to “thinking differently” and have a culture that embraces innovation and
ideas on how we can work to achieve different outcomes. We commit resource
every year to enable innovation and this resource is split equally across our five
localities. Ideas will be generated from our membership each year, and in future we
plan to introduce a “Dragons Den” style approach to encouraging new ideas to come
forward from our GP members and CCG teams.

Our rewards describe the way we recognise staff for the contribution to our
organisation and their achievements. The culture of our organisation is set by our
values and behaviours; the values that are set by our own team:

The values are embedded in the staff contract and we use the values to recruit to
new members of the team and over the coming months every member of our
organisation will be trained in how to recruit staff on the same value set as our own.
We have also revised our process for appraising our staff and have designed a
process for performance development and appraisal that is based on our values.
This is supported by a 360 degree appraisal (again based on our values and
obligatory for any member of our team who has management responsibility).
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Successful completion of our performance review will see staff rewarded by pay
progression through the incremental ranges of their band. This will be rolled out for
all staff within the CCG during 2014/15.

Our teams are also rewarded by the training and development that is offered to
them. For our CCG staff team, training and development needs and opportunities
will be developed through their performance development review. We recognise our
staff are our strongest asset, and wholeheartedly commit to providing staff with
opportunities to develop both within and outside our organisation. We are an active
participant with the national CCG development team and have strong connections
with the Leadership Academy. These relationships enable us to both shape and
participate in development for staff in CCGs across the country. We support
coaching for staff, commit to fund organisation wide development (such as the
HFMA finance modules for all staff) and are keen to enable every member of our
team to reach their full potential.

The development of staff within our membership practices is of equal importance.

We have a budget dedicated specifically to practice staff training and will create
plans for development for Practice staff, Practice Managers and Practice Nurses.
This is alongside the educational programme we also run for our GP members.

We recognise the contribution of our staff each week with our CCG “Star” of the
week. This is awarded to an individual who has gone above and beyond the call of
duty and shone to their peers. It is peer nominated and is awarded by the Chief
Officer at the weekly staff briefing. We are also celebrating our first year with an
award ceremony that recognises and rewards its members and staff. The award
categories are as follows:

Innovation of the Year

Thinking and Doing Differently
Working in Partnership
Improving Patient Care
GP of the Year
Practice Manager of the Year
Practice Nurse of the Year
CCG Star of the Year
Dr Liz Pope Award for Outstanding Contribution (in memory of one of our
inspirational leaders)

These awards will be given at the same time as our Long Service Awards, and will
follow our Annual General Meeting.

The rewards for our patients will be through our commitment to commission services
that add value to their lives, our promise to only commission services of high quality
and our dedication to empowering the patient voice to have more influence over
decisions that are made about their healthcare and increase the opportunity for
engagement. Our Operational Plan describes how we will ensure the best possible
outcomes for our registered population by improving the patient experience and
value added outcomes of healthcare, increase early detection of dementia,
improving individual autonomy and improving access and choice of services. A

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number of specific initiatives have been agreed that will enable commissioning for
value added outcomes:

Citizen empowerment and engagement (active citizenship leading to social

prescriptions)
Elective pathway modernisation (streamlined pathways leading to a reduction in
outpatient attendances)
Integrated care (aligned health and social care teams providing proactive care
leading to a reduction in emergency admissions)
Community rapid response (alternative to ambulance conveyance leading to a
reduction in appropriate hospital admissions)
Integrated urgent care (providing a single point of access to reduction A&E
attendances)
Systematic management of long term conditions (service delivered that respond
to health inequalities leading to modelled prevalence for heart failure and chronic
kidney disease)
Quality programme (implementation of CQUINs and quality initiatives that lead to
7 day working across acute and community services)
Primary Care Strategy (delivering primary care at scale leading to higher quality
services and federated localities)
Market shaping and development (creating responsive integrated community
services by subjecting some services to AQP)

All of the above initiatives will be delivered within the next two years.

Our strategy demonstrates how we will commit to removing unwarranted variation in

care and evaluating individual clinical performance to inform patient choice. We will
commission a specific piece of work that analyses the performance and outcomes of
our clinical providers of care best value in both financial and outcomes.

Patient and public engagement has been and will remain of vital importance in the
development of our organisation. We are creating a mutualist based relationship
with member practices and their registered membership by development of our
Patient Participation Groups. The majority of our practices have a Patient
Participation Group, and our aim is for every practice within the borough to have an
active Patient Participation Group by end of March 2015. We will continue the work
that we have started to develop these groups, enabling them to develop at their own
pace with a bespoke toolkit that will help them develop the skills they require to be
effective. We are currently working with the groups to look at a structure that would
enable them to have a locality influence and a stronger voice at Board with the
possibility of a member of the public having a place at the Board. We have engaged
our PPG representatives in a development workshop with our Board and will be
repeated this over the next two years to test whether patient engagement is as
influential as it can be.

Our mutualist approach will endeavour to create a more engaged relationship with
our registered population, enabling them to have a clear share in how services are
shaped and developed; as well as a more personalised service which encourages
more autonomous self management. Most importantly our members will know, value
and understand the benefits of being a member of our CCG. We work closely with

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our local Healthwatch, who have a place on our CCG Board. We also have an
established Healthcare Forum which meets on a bi monthly basis and discusses
items of strategic importance to the CCG. Each Healthcare Forum is chaired by
either our Chair or one of our Clinical Executives and is well attended by our
membership population. They are an important forum for consultation and their
views are taken very seriously when planning services or changes.

We require strong, inspirational and motivational leadership to enable our

organisation to reach its full potential and ambition. As the local leaders of the NHS
we have established the Dudley Leadership Group which includes Chief Officer level
membership of our local organisations (CCG, acute trust, mental health trust, local
authority and voluntary sector). This group will continue to hold a strategic focus on
the development of services in the borough. We also have strong connections
through our local Health and Wellbeing Board, who also undertake regular
development to ensure they are operating at their optimum effectiveness. We will
endeavour to continue to provide influence and drive to our local Health and
Wellbeing Board.

We established a Collaborative Leadership Team with our main acute provider

(Dudley Group Foundation NHS Trust) during the summer of 2013 and this has
enabled a deeper understanding of both organisations and enabled the relationship
of commissioner and provider to develop in a much more constructive way. We
have now established a similar group with our local mental health provider (Dudley
and Walsall Mental Health Partnership NHS Trust). We have also established
quarterly Board to Board meetings with these organisations to discuss and progress
strategic alignment, and we will also be establishing Board to Board meetings with
West Midlands Ambulance Trust and Black Country Partnership Trust.

We have embedded a network leadership model that enables leadership at every

level within the organisation. One of our values is responsibility and we encourage
our staff to take responsibility and demonstrate leadership at every level.

We are committed to being a learning organisation and embrace opportunities to

participate in research through our member practices. We will be appointing to a GP
Clinical Lead for Research after which we will review our Research Plan. To support
our commitment to education and research we have developed links with the Health
Services Management Centre in Birmingham and will be progressing our work in this
area over the next two years. We will be also forming alliances with other local
academic institutions as we develop our educational programme for our member
practices.

We have an active interest in publishing the work that we are leading on, and have
recently submitted an article to the European Health Management conference on our
work with the voluntary sector through Building Healthy Partnerships. We have
plans in place to publish our work on our mutualism strategy and will be presenting
at a conference in Copenhagen in 2014.

Alongside all of the above is the development of our CCG as it matures to a high
performing organisation capable of transformation, innovation and commissioning at
the most effective level. Our commitment to organisational development is

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demonstrated by our decision to provide our organisational development expertise
in-house following appointment to our Organisational Development Practitioner in
June 2013. This role sits alongside the Chair and Chief Accountable Officer and
whilst holds senior management responsibility (for human resources and CCG
administration), sits separately to the remainder of the senior management team to
enable an external view. Our Organisational Development Practitioner is supported
by external expertise, through strategic partners and organisational/leadership
development providers. Our focus on organisational development has been
fundamental to the success of our CCG to date and we are committed to
participating in research and theoretical studies to underpin the areas suggested
within the Strategic and Operational Plans and will publish our work accordingly.

OUR INTERNAL DEVELOPMENT PLAN

The culture of our CCG has always been clear; our organisation is clinically led and
is a membership organisation configured by our local GP practices. We take clinical
engagement very seriously and have been recognised nationally for our commitment
to the importance of clinical engagement. We invested early in our journey in a GP
lead for engagement of our membership. This role is undertaken by a retired Dudley
GP who is well respected by all his colleagues within our GP community. He works
in partnership with our Head of Membership and their team connect with every
practice to help them develop as both commissioners and providers of high quality
primary care. The impact of this team on the development of primary care and
commissioning has been phenomenal and is a function that the CCG seeks to build
on in the future with the recruitment of specific GPs with special interest to develop
the clinically led commissioning function. This team is the eyes and ears of primary
care and influences at every level in the organisation.

Our CCG Constitution was developed in collaboration with our constituent practices,
our LMC and the expertise of BMA lawyers. All practices were engaged in its
development and have ownership of the constitution, which is reviewed every six
months.

Our member practices elect two GP representatives (based on a three year term) to
represent their locality on the CCG Board (governing body). Each elected locality
GP has a specific area that they provide clinical leadership expertise on. Specific
development is given to the elected locality GPs to ensure they have the skills and
expertise to lead their localities and clinical lead areas. Each elected GP will have
their development plan reviewed within 2014/15.

We have developed a Clinical Leadership Structure (see overleaf) which is led by

four appointed Clinical Executives. This structure includes the clinical lead areas of
the GP elected Board members and also other clinical leads. This structure was
reviewed in November 2013. Clinical Executive posts are in the first instance
ringfenced to GP elected Board members only (as per the CCG Constitution) and if
not appointed to from the GPs on the Board they are then open to any GP across
Dudley to apply. Clinical Lead roles however are automatically made available to all
GPs across the borough. Our Clinical Executives are:

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• Clinical Executive for Finance and Performance (Dr Jas Rathore)
• Clinical Executive for Quality and Safety (Dr Ruth Edwards)
• Clinical Executive for Acute & Community Commissioning (Dr Steve Mann)
• Clinical Executive for Integration and Partnerships (Dr Steve Cartwright)

Three of our Clinical Executives are GP elected Board members. The fourth
(Clinical Executive for Integration and Partnerships) is by appointment a co-opted
member of the Board (non-voting). Each Clinical Executive is appointed for a term of
three years.

Every Clinical Lead post has been aligned to one of the Clinical Executive portfolios
in the structure to strengthen leadership and to provide clear reporting mechanisms
and accountability.

All of the GPs that have a place on the Board (voting or non voting) participate in our
Clinical Forum. Clinical Forum is informal; clinician led and meets monthly to provide
an avenue for ideas, innovation, debate, discussion and challenge away from the
formal board table. The introduction of Clinical Forum has had a tremendous impact
on the engagement of our clinical leaders and the development of localities. It
enables ideas to be generated and move forward much quicker than they did before.
Clinical Forum is deliberately informal and is a model that the CCG intends to follow
when developing all of its locality forums.

Page | 20

Clinical Executive
Commissioning
(Dr Steve Mann)
Various clinical areas (vacancy)
Meds Management (Dr PD Gupta)
Various clinical areas - vascular
(Dr J Darby)
End of Life/Cancer (Dr Lucy
Martin)
Diabetes (Vacancy)
Respiratory (Dr Mark Hopkin)
Pain (Dr Richard Johnson)
Clinical Leadership Structure
Chair (Dr D Hegarty)
Clinical Executive Clinical Executive Clinical Executive
Finance & Quality and Safety Integration & Partnerships
Performance/Primary Care (Dr Ruth Edwards) (Dr Steve Cartwright)
(Dr Jas Rathore)
Corporate Systems & Redesign Safeguarding/Q&S Support Mental Health (Dr M Mahfouz)
(Dr J Darby) (vacancy)
Primary Care Development/GP GP Education & Research Children’s (Dr T Horsburgh)
Mentorship (Dr K Dawes) (vacancy)
Primary Care Engagement Prevention, Older People &
(Dr R Gee) Dementia (vacancy)
IT & Caldicott Guardian
(Dr R Johnson)
Page | 21
Innovation (Dr Richard Johnson)
Development of our CCG Board

Our Board began meeting in public in July 2012 and held its first meeting as a
statutory organisation in April 2013.

The voting members of the Board are as follows:

Dr David Hegarty (Chair)

Dr PD Gupta & Dr Mona Mahfouz (Dudley and Netherton locality)
Dr Richard Johnson & Dr Jonathan Darby (Halesowen and Quarry Bank locality)
Dr Jas Rathore & Dr Kevin Dawes (Sedgley, Coseley and Gornal locality)
Dr David Hegarty & Dr Steve Mann (Stourbridge, Wollascote and Lye locality)
Dr Ruth Edwards and a current vacancy (Kingswinford, Amblecote and Brierley Hill
locality)
Chief Accountable Officer (Paul Maubach)
Chief Finance Officer (Matthew Hartland)
Chief Quality and Nursing Officer (Rebecca Bartholomew)
Secondary Care Clinician (Mary Heber)
Lay member – governance (Steve Wellings)
Lay member – patient engagement (Julie Jasper)
Lay Member – quality and safety (Chris Handy)
Chief Executive of Dudley Metropolitan Borough Council (John Polychranakis)

The non-voting members of the Board are:

Director of Public Health (Valerie Little)

Clinical Executive for Integration and Partnerships (Dr Steve Cartwright)
LMC Representative (Dr Tim Horsburgh)

Also in attendance are:

GP Engagement Lead (Dr Richard Gee)

Head of Commissioning (Neill Bucktin)
Head of Membership (Daniel King)
Head of Communications and Engagement (Laura Broster)
Organisational Development Practitioner (Stephanie Cartwright)
Healthwatch (Jayne Emery)

The Board of the CCG have been involved in a Board Development programme
since its appointment in 2011 and this programme will continue over the next two
years. This programme has covered the development of the CCG vision and values,
understanding what it means to sit on the Board of a public statutory organisation, up
skilling Board members in key business areas (eg finance, commissioning,
engagement, communications, governance, media, safeguarding and quality) and its
function to hold the organisation and local health system to account.

In addition to the Board Development Programme, individual Board members also

receive additional input to ensure they are upskilled to the level of existing Board
members who have more experience. This additional input is delivered by the Chief
Finance Officer and Organisational Development Lead and specifically focusses on

Page | 22
the history and commissioning journey in Dudley, with detailed explanation of the
governance and financial reporting and assurance mechanisms and explanation of
commissioning processes. It also covers work on behaviours and any specific skills
enhancement that may be required. Our Lay Members play a vital role in holding the
CCG to account and provide valuable assistance and guidance to those newer
members who do not have the same level of experience. Each of our Lay Members
has a particular area of focus and are designated committee level representation
appropriate to their focus area. The same applies to our clinical board members who
have specific lead areas as part of their Board member role.

When our Board was first formed, we produced our CCG Code of Conduct which
was collectively agreed to adhere to. The Code of Conduct was developed to
ensure the CCG Board was upholding high standards of behaviour and etic ate that
would set an example to the rest of the organisation. Our Code of Conduct is
embedded within the organisation; abided by our Board Members and others and
referred to should the need arise.

Our CCG Code of Conduct is as follows:

The Dudley Clinical Commissioning Group agree to abide by the Nolan Principles of
Public Life:

Selflessness
Holders of public office should act solely in terms of the public interest. They should
not do so in order to gain financial or other benefits for themselves, their family or
their friends.

Integrity
Holders of public office should not place themselves under any financial or other
obligation to outside individuals or organisations that might seek to influence them in
the performance of their official duties.

Objectivity
In carrying out public business, including making public appointments, awarding
contracts, or recommending individuals for rewards and benefits, holders of public
office should make choices on merit.

Accountability
Holders of public office are accountable for their decisions and actions to the public
and must submit themselves to whatever scrutiny is appropriate to their office.

Openness
Holders of public office should be as open as possible about all the decisions and
actions they take. They should give reasons for their decisions and restrict
information only when the wider public interest clearly demands.

Honesty

Page | 23
Holders of public office have a duty to declare any private interests relating to their
public duties and to take steps to resolve any conflicts arising in a way that protects
the public interest.

Leadership
Holders of public office should promote and support these principles by leadership
and example.

The Dudley Clinical Commissioning Group Board members will aim to:

• Respect one another as possessing individual and corporate skills, knowledge

and responsibilities.
• Show determination, tolerance and sensitivity, posing rigorous and challenging
questions, tempered by respect.
• Show group support and loyalty towards the CCG and each other.
• Listen carefully to all ideas and comments and be tolerant to other points of view,
being sensitive to colleagues’ needs for support when challenging or being
challenged.
• Be honest, open and constructive.
• Be courteous and respect freedom to speak, disagree or remain silent.
• Embrace challenge and regard challenge as a test of the robustness of decision
making processes. Ensure no one becomes isolated in expressing their view and
treat all ideas with respect.
• Read all papers before the meeting and clarify points of detail with the relevant
author before the meeting. Arrive punctually, participate wholeheartedly and try
where possible to stay for the duration of the meeting.
• Ensure papers are distributed 7 days in advance of the meeting, and avoid where
possible tabling papers at meetings.
• Dispose of papers appropriately as confidential waste.
• Focus discussion on material issues and on their resolution, allow differences to
be forgotten.
• Make the most of time available by supporting the chair, colleagues and guests in
maximising scope and variety of views heard. Individual points should be
relevant and concise.
• Ensure mobile phones are on silent if they need to be left on, and leave the room
to take a call if the call is urgent.
• Remember that we are representative of the whole of Dudley, not representing
localities or individual practices.
• Be supportive of the decisions of the Board, even though as individuals we may
not agree.
• Embrace the use of technology that has been made available.
• Treat each other as adults, and behave in an adult manner.

The Dudley Clinical Commissioning Group will aim to not:

• Keep referring to past history or previous disagreements.

• Regard any arrangements as unchangeable or unchallengeable.
• Adopt territorial attitudes, any member of the team has the right to challenge and
question another.

Page | 24
 • Be offensive or act in an attacking, crushing or dismissive manner, and will be
ready to apologise.
• Take offence or take comments personally, and always remain open to
discussion.
• Regard papers as being ‘rubber stamped’ without discussion or agreement.
• Breach confidentiality.

Our Executive Team

The CCG Executive Team is a combination of the Chair and Clinical Executives
alongside the CCG senior management team. It has been established since April
2011 and meets on a weekly basis. The structure is shown below:

Chair Chief Accountable

Officer

Clinical Executive Clinical Executive Chief Finance Head of Commissioning

Finance & Performance Commissioning Officer
Head of Membership

Clinical Executive Clinical Executive Chief Quality and

Head of Communications &
Integration & Partnerships Quality & Safety Nursing Officer Engagement

Organisational Development Practitioner

The Executive Team is well established and ensures that clinician and management
partnership is embedded at the helm of the organisation. It has responsibility for
ensuring the smooth day to day running of the CCG, referring items appropriately to
relevant CCG Committees or to the Board.

This team undertakes specific facilitated team development; as both clinical and
management teams and collectively as the Executive Team. We include personality
profiling, 360° appraisal and work continuously to develop and enhance the
performance of this team and the individuals. We will continue to undertake their
team and individual development throughout the life of this organisation to ensure we
are developing a leadership team capable of taking our ambitious organisation to
where it aspires to be. It is imperative for this team to operate effective and to
demonstrate inspirational leadership to all of the staff team and our member
practices.

Our Executive Team have participated in two strategic retreats, and these will
continue every six months for the next two years. These retreats provide an
opportunity for reflection on the effectiveness of both the organisation and the team,

Page | 25
the opportunity for blue sky thinking, strategic thought processing and planning for
the sustainability of both the organisation and the local health economy.

The most challenging area of development for the organisation has been the change
of culture from a management led organisation to a clinically led organisation and
this has not been underestimated. A membership organisation constituted by its GP
Practices; with a clear commitment to clinical leadership partnered with management
expertise has been the continual focus of our organisational development plan to
date. It has been imperative to ensure that both Clinical Executives and Senior
Managers have demonstrated strong, trustworthy and reliable leadership styles and
they have been continually supported to do this. This leadership team are
responsible for leading and empowering others to work in innovative ways and to
think differently to how they have thought before.

Chair and Clinical Executives

Our Chair (Dr David Hegarty) was appointed in 2010 and elected to the Board in
November 2011 for a three year term. Shortly afterwards, our Clinical Executives
were appointed following a recruitment process in January 2012 and they are
subsequently recruited to as vacancies arise. These appointments are also for a
three year term. Development Plans are produced for the Chair and each Clinical
Executives which focus on the development needs specific to the particular
individual. These include leadership development, skills development, mentoring or
coaching and are reviewed on a regular basis. Each Clinical Executive is also
expected to undertake a health service recognised senior leadership programme if
they haven’t already (eg. Aspiring Directors). The Chair and each Clinical Executive
receive regular input from the Organisational Development Practitioner as part of
their ongoing development.

Lay Members

Our CCG has three lay members and a Secondary Care Clinician, who is also
considered part of the lay member team. They are as follows:

Lay Member for Governance Steve Wellings

Lay Member of Patient Engagement Julie Jasper
Lay Member for Quality and Safety Chris Handy
Secondary Care Clinician Mary Heber

Two of our lay members (Lay Members for Governance and Patient Engagement)
and our Secondary Care Clinician were appointed prior to authorisation following the
national guidelines for roles required on CCG Governing Bodies. Both of Lay
Members had previously held Non-Executive Director roles on the Dudley PCT
Board and therefore brought with them a wealth of experience. Our Secondary Care
Clinician also bought with them significant expertise in secondary care which has
had a profound effect our Board and in our committees. Our third Lay Member was
appointed last year following recognition that quality and safety was such a
significant area of focus for the CCG, and acknowledgement that the demands on
our lay members was increasing significantly.

Page | 26
Our Lay Members provide very valuable input to our organisation. They provide
challenge where they should and hold a mirror up to the team enabling us to reflect
on our development. Because of their experience, they provide a sense check that
enables us to move forward appropriately and their collective experience at Board
level provides a necessary balance with more inexperienced members of the
Governing Body. They meet regularly with the Chair and Chief Accountable Officer,
provide vice chairmanship to our committees and maintain links on national
programmes to ensure their own development and that of the organisation are
maintained.

Senior Management Team

Our Chief Accountable Officer (Paul Maubach) was appointed in July 2012, closely
followed by our Chief Finance Officer (Matthew Hartland) and Chief Quality and
Nursing Officer (Rebecca Bartholomew). These three posts are voting members of
the CCG Board and therefore have titles that distinguish their difference within the
senior management team. Our Head of Commissioning (Neill Bucktin), Head of
Communications and Engagement (Laura Broster) and Head of Membership (Daniel
King) are the remaining members of the Senior Management Team. Our
Organisational Development Practitioner (Stephanie Cartwright) also has senior
management responsibility but as described earlier, this role sits outside of the team
to offer reflective input and development support.

Regular dedicated team development is crucial to the effectiveness of the senior

management team. Each member of the team is encouraged to identify a mentor to
enhance their own personal development and performance. Individuals are also
encouraged to undertake leadership development (eg Top Leaders, Aspiring
Directors, Leadership Academy programmes) to enhance their performance and
develop their skills. The Chief Accountable Officer and senior management team
receive regular input from the Organisational Development Practitioner as part of
their ongoing development.

Our Staff Team

As part of our authorisation process, we undertook a thorough options appraisal of

the make/buy/share arrangements for CCGs and developed an organisational
structure for the CCG with designated support functions to be bought from our local
Commissioning Support Unit (CSU). This structure was reviewed in April 2014 as
part of our assessment of our efficiency and effectiveness and as a result various
changes will be made to these arrangements. Our CSU embedded teams will
continue to be recognised as important parts of our organisational structure and are
included in our team development.

The majority of our employed staff were appointed by July 2012 which enabled the
organisation to function completely in shadow form for at least six months before
formal authorisation and inauguration as a statutory body. Amendments have been
made to structures to meet the needs of our changing environment. Significant time
and resource has been and will continue to be invested in team development to
ensure the team grows and develops as the organisation matures. Particular focus
and energy is given to the organisational culture as a membership organisation, a

Page | 27
clinically led organisation and most importantly a learning organisation that we all
feel proud to be part of.

The working relationships between clinicians and management support and how
these relationships are maximised to their full potential has been and will continue to
be a key focus, recognising the strengths that this partnership brings. Following the
appointment of the Chief Accountable Officer in July 2012, the organisational
structure was reviewed, commencing with the senior management team.

Communication is key to the success of our CCG. Weekly staff briefings are led by
our Chief Accountable Officer or deputy (Chief Finance Officer) and include all
members of our staff team. We also hold monthly Staff Development sessions
where the staff team come together to discuss development areas of the
organisation and ensure staff are involved in decision making and organisation
priorities.

We have a staff side recognition agreement and two staff side representatives who
provide useful advice to all of our staff. We have an established staff forum which is
led by our staff side representatives and is attended by a member of staff from each
of our teams, on behalf of each team.

During 2014 we will be developing a Talent Management Strategy for our workforce.
We are lucky enough to have many rising stars within our staff team, and our Talent
Management Strategy will outline how these stars can be identified and supported
substantially in their development.

Our Member Practices

Specific development is focussed in enabling our member practices to grow in their

role as clinical leaders and commissioners. This is achieved through regular twice
yearly visits from our Membership Engagement Team (led by our GP engagement
lead) and also an annual visit from our Chief Accountable Officer. Support will
continue to be given to the evolving role of our locality meetings and also to our full
membership engagement events. We use a star of engagement to plot how
engaged member practices feel and whether they feel they have an arena where
they can share their views. This is regularly reviewed and acted upon to ensure that
we are engaging effectively with our membership.

Page | 28
OUR EXTERNAL DEVELOPMENT PLAN

Development of our Patient Population

The development of our registered population is crucial to the implementation of our

mutualism strategy. We want to create a patient population that takes responsibility
for its own health and wellbeing. To do this we intend to privilege our registered
population via our member practices and develop our interaction and engagement
through our Patient Participation Groups (PPGs). We currently have 41 practices
out of 47 who have a Patient Participation Group and our intention is that by the end
of 2014 all practices will have a group established. We want our patients to take
more ownership for their own healthcare, and to be actively involved in how we
improve the health outcomes of our population. We will do this by developing our
PPGs to have a more influential voice within the CCG, through practice, locality and
Board level. We have commissioned a project via the Voluntary Sector that will work
with these volunteer groups to help them to grow and develop to be more effective
and efficient in their operation, particularly around power and influence. We are
working on this agenda in partnership with our member practices, therefore the
outcome of this work will be shared responsibility for healthcare and wellbeing.

Development of our Membership

Dudley CCG recognises the importance of sustainable primary care that is fit for
purpose. Our Primary Care Development Strategy has been regionally acclaimed by
NHS England. It describes the areas of focus in primary care development and will
be refreshed following the recent publication of our Strategic and Operational Plans.
Senior management from the CCG meet regularly with senior representation from
the NHS England Team (responsible for commissioning primary care) through a
Primary Care Interface Group. Dudley CCG is ambitious in its plans for co-
commissioning of primary care with NHS England, acknowledging the benefits of
improving the quality of primary care. We have invested in work with the Primary
Care Foundation, who have worked with every one of our GP practices in producing
a Practice Development Plan designed to help them improve their efficiency, access
and appointment times for our patients. The CCG will use the information within the
development plans to produce workforce development and succession plans for our
GP workforce. In Dudley 10% of our GPs are over 65 years old and 27% of our GPs
are over 55 years old. This is also mirrored in our Practice Nurse workforce
therefore plans will need to be developed that set out how will we will continue to
attract and recruit to our clinical primary care workforce along with a Succession
Plan to outline how we intend to fill vacancies that arise. This will be particularly
challenging as GP recruitment is a national problem, not just a local problem. We
will work with our local medical schools to ensure newly qualified GPs are aware of
the opportunities in Dudley and will work on how we market the Dudley borough as a
place to live and work for GPs.

Communication with the membership practices is continuously reviewed for

improvement and a membership bulletin is distributed on a fortnightly basis. The
CCG Communications and Engagement Strategy was approved by the Board in
2013 and will be refreshed during 2014 following the publication of the five year

Page | 29
Strategic Plan and two year Operational Plan, with particular emphasis on the next
stages of the development journey for Patient Participation Groups.

GP Education

A programme of GP education events has been established that which takes place
on alternate months to our Membership Events. The education events have a
different emphasis and provide an opportunity for networking and team building
alongside enhancing skills and knowledge in particular clinical areas. They are often
organised with expertise from the secondary care sector working with GPs to discuss
best practice in clinical care and patient pathways.

Practice Nurse Development

During our authorisation stage, an election process was undertaken for an elected
Practice Nurse to represent the views of the workforce at Committee and Board
level. A similar process was undertaken to GP election with Practice Nurses
nominating themselves for election followed by a ballot to select the individual to take
on the role.

Due to personal circumstances, our elected Practice Nurse representative resigned

from her role during the summer of 2013 and as yet the Practice Nurse workforce
have chosen not to replace this role at the current time. This is part due to the
appointment of our Chief Quality and Nursing Officer whose responsibility includes
leadership and professional support to the Practice Nurse workforce. Regular
engagement events have been established with our Practice Nurses to look at how
as a workforce they can be more engaged with the CCG, network with each other
and share best practice. Attendance can be variable based on personal choice and
practice/workload demand. We will continue to work on the development of this part
of the workforce and we will be producing a specific Education and Training Plan for
Practice Nurses which incorporates the regular clinical updates that the staff need
alongside specific development opportunities such as the Practice Nurse Diploma,
Advanced Nurse Practitioner or Nurse Prescribing courses. Our intention is to
partner with one of our local Universities to provide this development. The Practice
Nurse engagement events will continue to ensure that as a group they feel valued
and included to increase opportunity for networking with other colleagues. It is
anticipated that as our integration work develops, this engagement agenda will
spread wider into our community nursing workforce, with the intention of bringing
together these groups of staff to work more closely together.

Practice staff engagement is very important to Dudley CCG. The teams will strive for
continuous improvement in communication and their expertise as they build a
workforce sustainable for the future. It is imperative that they have ways to engage
with the organisation and to ensure that they have a mechanism of enabling their
views to be heard.

Practice Management Development (Dudley Practice Managers Alliance)

Dudley Practice Managers Alliance (DPMA) is an independent body which has been
established for a number of years now. The Alliance brings Practice Managers

Page | 30
across the borough together as a workforce on a monthly basis to share
developments in General Practice, receive updates and to network/group problem
solve etc. In addition to the Alliance, we also have an elected Practice Manager who
was elected during authorisation to represent the Practice Manager workforce at
CCG committee level. Our elected Practice Manager works in partnership with the
DPMA to ensure their voice is heard. Their expertise influences debate and decision
making particularly through our Primary Care Development and Finance and
Performance Committees leading on key areas of work relating to these two areas.

A specific budget is allocated to education and training for the Practice Manager
workforce and the spend against this budget is agreed by the DPMA and CCG Head
of Membership. Plans for 2014-2016 will include regular development updates for all
staff and specific support for staff who want to undertake further education or
development in specific areas of their role.

Practice Managers possess a range of skills that support the efficient and effective
running of our member practices. Similarly to many areas across the country, our
localities are entering discussions around opportunities gained from federating or
partnering with other practices (including the potential for a locally led GP provider
company) to potentially share back office functions, develop shared expertise and
increase their market potential. This agenda will need particular expertise and
development as this develops over the next two years.

Practice Staff Development

The staff employed within our member practices are a valuable part of our workforce.
They are often the first interaction with our patients before they receive any medical
advice. They are a powerful source of knowledge and expertise and have the ability
to direct our patients to the most appropriate source of medical attention that they
need. In some areas however, they have been a part of the workforce that have
received minimal development opportunities and we will be improving opportunities
for staff over the next few years. A Training Plan will be produced for these staff
which will include Amspar training for all staff for example, to bring the workforce to a
consistent level across the borough.

Development of the System

Whilst we have responsibility for leading the local health economy, we cannot
achieve fundamental change and improvement to the health and wellbeing of our
population on our own. We will be working to develop our relationships with all of
our members, providers, partners and patients through a variety of mechanisms to
increase awareness, focus our efforts and align our strategies to achieve more
through true collaboration.

Page | 31
Implementation of Integrated Working

High on the agenda for the next two years is the implementation of integrated
working across the borough. Dudley CCG will be investing in an Organisational
Development Programme to support the integration of community services for our
registered population. The Integration Plan developed in collaboration with partner
organisations (Dudley Group Foundation NHS Trust, Dudley Metropolitan Borough
Council, Dudley & Walsall Mental Health NHS Trust and Dudley Council for the
Voluntary Sector) outlines the vision of integrating primary and community health
services with social care and the voluntary sector around our GP Practices who are
organised in five localities across the Dudley borough:

• Halesowen & Quarry Bank

• Stourbridge, Wollescote & Lye
• Kingswinford and Brierley Hill
• Dudley & Netherton
• Sedgley, Coseley & Gornal

Essentially, teams will be organised at three levels:

• A “Practice/Community Integrated Team” directly aligned to the GP practice

• A “Locality Integrated Team” combining teams that are only operationally efficient
if organised at locality level and who work closely with the Practice teams.
• A “Borough Wide Team” which would consist of services that are of a small and
specialist nature and again only operationally efficient if organised at borough
level who work closely with the practice and locality teams.

Services will be delivered through the most accessible and localised point. There
will be a clear connection (a named individual) who relates between the three team
levels. On a day to day basis the fundamental team that a GP Practice will relate to
for the majority of support for their patients will be their Practice/Community
Integrated Team. For some smaller practices, they may share a
Practice/Community team with another practice, but the principle of named
individuals will still apply. All teams will function on a 7 day basis eventually.
Page | 32
Each locality will need to identify a GP lead who will support both the integrated
teams at all levels, and also work with other GP locality leads to develop services to
work continually on improving the patient journeys. These leads will be identified
through the existing locality meetings and will be supported by the Clinical Executive
for Integration and Partnerships.

It is proposed that as soon as possible after 1st April 2014 the District Nursing and
Virtual Ward teams will be working within the new integrated arrangements. These
teams will “lead by example” throughout this integration programme and will enable
other teams to learn from their experience and allow momentum to be gained.

What is described above and within the Integration Plan requires a different way of
working for all of the teams within the community providing health and social care.
The biggest challenge to these new working arrangements will be the change of
culture required. Simply rearranging staff teams will not work; real change will be
delivered through hearts and minds. The organisational development process will be
delivered by learning through doing. Staff will be engaged using real patient stories
that each and every one of them will be able to relate to. The workforce themselves
are the best people to advise on how working in different ways to achieve different
outcomes can really be achieved. Leaders will inspire others by using these patient
stories to reinforce messages to staff. The process will be led by the Organisational
Development Lead at Dudley Clinical Commissioning Group but will involve staff
from Dudley Group NHS Foundation Trust, Dudley & Walsall Mental Health
Partnership NHS Trust, Dudley Metropolitan Borough Council and Dudley Council for
Voluntary Services. Whilst each organisation will need to identify their leaders for
integration; every member of staff who is involved in the new way of working will
participate.

The organisational development process will contain elements of the following:

System Leadership Support

External expertise with experience in integrating health and social care services was
sourced during Autumn 2013 and this support has been working closely with the
Integration Working Group. This group brings the organisations responsible for
delivering this plan together and the external support provides robust challenge and
facilitation to ensure this group is working to its optimum effectiveness. This support
will continue throughout 2014.

Change Management Programme

To integrate services properly means radically changing the way that health and
social care is delivered to Dudley CCG registered population and this involves a
change to the way of working for all of the staff involved. These changes will need to
be led by leaders across all of the teams and organisations who have been
empowered to facilitate change, removing some of the organisational boundaries
that currently exist that can and will hinder true integration, to create real teams
without walls. Five change programmes, one in each locality, will be commissioned
to develop leaders as change facilitators, empowering them with the skills necessary

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to lead their teams through the changes, to empower individuals in new working
practices and to embed a culture that will be led by hearts and minds. Each
programme will use the real patient stories that have been described above and will
use the expertise of those working within the system to shape the culture. These
leaders will need to work within their own and other organisations to enable true
partnership working and therefore each programme will contain individuals from
across the four organisations. The programme will involve taking the leaders
through change methodology, looking at individual strengths and needs and up
skilling individuals to facilitate change throughout the health and social care system
creating a team of leaders across the health and social care system who can
demonstrate real leadership by example.

Organisation Wide Team Development

Humans can be resistant to change for many reasons; change fatigue, fear of the
unknown and not believing the change is necessary to name just three. Any
successful leader needs followers who believe in the vision that they are working
towards which is real improvement to patient care. This is where the real patient
stories come to life and staff involved can shape the new arrangements based on
their own experiences and learning.

There is significant evidence to prove that the demonstration of the reasons for
change is highly effective through theatrical production as it shows issues affecting
real people and their lives through a thought provoking performance. Using this
type of approach would be a powerful and engaging way of initiating this process
with staff.

A facilitative process will be implemented that will include every single member of
staff that will be working as part of the integrated teams. This is anticipated to be in
excess of 1,000 members of staff across all of the organisations. There will be a
maximum of 49 practice teams and various other locality and borough wide teams
that will all be included. This process will begin with specific inaugural events that
will outline the reasons behind the changes and will involve the System Leaders
themselves (Paul Maubach, Paula Clarke, Gary Graham, Andrea Pope-Smith and
Andy Gray) sharing their thoughts and joint commitment to improving the lives of the
patients of our registered population. The development process will continue over
the next two years with specific work on culture and team development at GP
practice, locality and borough wide levels (and including the staff working in General
Practice). Staff will be encouraged to put the patient at the heart of the change and
to share their expertise in how teams can work closer together to improve the patient
journey ensuring that these changes are evolutionary whilst succinct across the
borough.

The CCG will work with the teams to agree improvement objectives based upon
delivering better outcomes for patients and the better care fund targets. This will then
be supported by an integrated performance framework so all staff can see how their
work contributes to the whole improvement of the system One of the outcomes of
the facilitated work with individual teams will be the identification of skills gaps and
additional training needs, for example influencing and negotiating skills,

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assertiveness, team building etc. Therefore a designated allocation of funding will
be available to support such training and development that is identified.
System Development

By June 2014 all of our member practices will be on Emis web which will allow our
registered populations records to be accessed via any surgery where they may be
receiving treatment and in our new Urgent Care Centre which will be opening early
next year.
Dudley CCG will be investing in the development of mobile IT for all teams to
improve the amount of face to face patient time. This will include the establishment
of a systems design team to work with the groups to ensure that the IT and software
is developed with and involving the front-line staff and will include the connection of
mobile systems with GP Practice systems to centralise the patient record. This will
be supported by the development of patient consent; which allows patients to
consent to sharing their records via their GP practice. Dudley CCG IT Strategy
describes the system development in more detail.
Locality links with our Voluntary Sector
We are extended the remit of our integration plans to include the voluntary sector by
investing in a project that will see a Link Worker in each locality tasked with being the
interface between primary care and the sector. These roles will connect our GPs
and community workers with organisations that can help their patients by looking
beyond just the medical problem and looking at the patient and their way of life as a
whole. There are many services that can help patients by providing interventions
that will improve their quality of life and health outcomes without prescriptive medical
intervention. We will be working closely with the sector to maximise this opportunity
and encourage our population to see help from elsewhere than their GP.

CONCLUSION
We are an ambitious organisation, built on our values, that is determined to make a
real difference to our registered population by being clinically led, thinking differently
and working in a way that has not been done before. Our Strategic and Operational
Plans are ambitions and set real challenge to our CCG; there is a lot to deliver. To
realise our ambition and true potential requires dedicated and time and resource in
organisational development and the intention of this plan is to demonstrate the
priority it holds, and to prioritise where the time and resource will be spent. We will
do this by privileging our member practices, our commitment to integration and our
patients by making a real difference to their lives.

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OD IMPLEMENTATION PLAN

Model Workstream Lead Deliverables External support

Component 2014/15 2015/16 required
Structure Housekeeping and All Senior Complete all outstanding
hygiene factors Managers transitional work by the end
(ensuring we have of quarter one.
the basics right)
Professional Rebecca Ensure professional Review
development for all Bartholomew development and clinical
clinical staff supervision is in place.
OD process to Steph OD process begins May 14 Continue with
support integration Cartwright Tenders for facilitation and implementation
change management
support
Review of Matt Hartland Review by end of quarter 2
Committee
effectiveness
Estate Matt Hartland In depth review of CCG tbc
Development Plan estate
Relationships Development of Neill Bucktin Agree proposal
relationship with Recruit Research Assistant
HSMC Evaluation and review
PPG development Helen Aspire to establishment of a Continue PPG development Dudley CVS
Ashford/Steph PPG in each practice. programme.
Cartwright Develop toolkit
Continue PPG development
programme.
Relationship with Paul Maubach Board to Board meetings
providers established will all main
providers.
Continuation of
Collaborative Leadership

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 Team meetings with DGFT
and DWMHPT
Mechanisms All member Matt Harland Achievement by July 2014.
practices on one
system (Emis Web)
Research and Steph Revise plans Update plans if necessary
Innovation Cartwright
Sharing best Paul Maubach Publication of articles key
practice pieces of work
Leadership Recruitment training Steph Training sessions for all Refresher training via CSU HR Team
for all staff Cartwright & staff monthly staff development
CSU (HR) session
Equality and Steph Revised Strategy ratified by Review
Diversity Strategy Cartwright/ CCG Board by July 2014
including refresh of Neill Bucktin
EDS objectives
Equal Opportunities HR CSU/Steph Policy refresh and ratified Review CSU HR Team
Policy Cartwright by Remuneration ommittee
Succession Plan Steph Separate plans for staff Review and update
Cartwright & team, clinical leadership
David Hegarty and membership
Workforce Steph Production by the end of Review and update
Development Plan Cartwright Quarter 2
Communications Laura Broster Refresh
and Engagement
Strategy
Primary Care Dan King Refresh
Development
Strategy
CCG Board Steph Continuation of programme Continuation of programme Sourced when
Development Cartwright and review of Governing required
Programme Body effectiveness.
Executive Team Steph 360 degree appraisals 360 degree appraisals Simon Western
Development Cartwright Six monthly retreats Six monthly retreats (Privileged
Conversations)

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 Senior Steph 360 degree appraisals 360 degree appraisals
Management Team Cartwright Dedicated time for team Dedicated time for team
Development building and organisational building and organisational
objectives review objectives review
Clinical Leadership David Hegarty Appoint to all vacancies.
Rewards Staff satisfaction Steph
survey Cartwright Undertaken each year.
Values Based PDR Steph Policy ratified PDRs in place for all staff
process in place Cartwright Training for managers
PDR arranged for all staff
Education and Steph Produced following Reviewed following PDPs
Training Plan Cartwright completion of PDPs and and consultation with
consultation with membership
membership
Review of education in
primary care.
Innovation Steph Development of “Dragons
Cartwright/ Den” style process for
Daniel King innovation funding.
Purpose Develop concept of Daniel King
co-commissioning
primary care with
NHS England
Environment CCG development Steph Sit on national group to
and leadership Cartwright shape development support
to CCGs and design of
leadership development
opportunities

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 Appendix 1
2014/15 CORPORATE OBJECTIVES

Model Workstream Board lead Management Objectives External

Component Lead Q1 Q2 Q3&4 support
requred
Purpose Strategic Plan David Hegarty Paul Maubach Approval of plan Embedding Board
objectives assurance
Operational Plan Clinical Execs Neill Bucktin Establishing Board Prioritisation for
PMO & PIDs assurance 16/17
OD Plan – Clinical Execs Steph Approval of plan Building Board For
external Cartwright capacity in the assurance integration
system facilitation
OD Plan - David Hegarty Steph Approval of plan PDRs, PDPs Board
internal Paul Maubach Cartwright and Board assurance
programme
Financial Plan Jas Rathore Matt Hartland Ensure clear Board Compliance
budget & QIPP assurance on with financial
plans for all progress and QIPP
areas targets
Commissioning Ruth Edwards Rebecca Proposals to Finish Board Trisha Curran
for Quality Bartholomew Board for July restructuring assurance

Structure Integrated Care Steve Neill Bucktin Building the Provider Projects as per HSMC (on
Cartwright leadership compliance to Operating plan evaluation)
the model
Integrated Care Steve Neill Bucktin Rapid response Evaluating performance
Cartwright service
Reablement Steve Neill Bucktin Personal Projects as per Operating plan
Care Cartwright budgets
Urgent Care Steve Mann Neill Bucktin, Specification for Public Tender, Competing CSU
Matt Hartland UCC new financial tender process procurement
model

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 Elective Care Steve Mann Neill Bucktin Project plans Projects as per Operating plan
based on SDIP
7-day working Steve Mann & Neill Bucktin Schedule of 7- Plan for Oversee roll-out
and parity of Steve day services implementation
esteem Cartwright

Relationships VCSE Steve Laura Broster Consult with Setting up

Engagement Cartwright Richard Haynes VCSE on input VCSE link
Neill Bucktin to integration workers
Membership Jas Rathore Daniel King Ongoing programme of membership engagement
Engagement events linked to CCG in-year plans
Patient / Public David Hegarty Laura Broster Developing Ongoing programme of public Dudley CVS
Engagement Julie Jasper Richard Haynes PPG training engagement events linked to
CCG in-year plans
NHSE Co- Jas Rathore Daniel King Joint workshop Implement
commissioning with NHSE shadow
arrangements
DMBC BCF joint Steve Neill Bucktin Establishing Embedding Prioritisation for
governance Cartwright Performance Shadow 16/17
Framework arrangements
Patient Consent Jas Rathore Dan King, Develop patient Test spec. and Go-live for use
Richard Haynes consent roll out of patient
specification implementation consent
Equality Diversity David Hegarty Steph Refresh Establish Talent
Inclusion Cartwright Strategy Mgmt plan

Mechanisms Single IT system Richard Matt Hartland Complete EMIS Agree data Map out and EMIS
Johnson roll-out sharing begin realising
protocols benefits
Commissioning- Richard Matt Hartland Developing specification for Begin tender
led IT Johnson whole community system process
Mobile IT Richard Matt Hartland Testing options Begin roll-out Complete IT contract
Johnson implementation
PSIAMS Steve Neill Bucktin Tender for App Pilot testing Begin phased Cloudberry &
Cartwright development roll-out Dudley CVS

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 Estates strategy Jas Rathore Matt Hartland Complete map Agree vision Develop plans Estates
of estates and rules with for priority areas specialists
NHSE
Primary Care Kevin Dawes Dan King Establish 14/15 innovation Ensure
Innovation programme & training resources implementation
Performance Jas Rathore Matt Hartland Single CCG Ensure framework used and
Framework framework escalation process works
Clinical pathway Jonathan Matt Hartland Develop Pilot testing Use for 16/17 Deloitte
monitoring Darby concept prioritisation
Risk Steve Neill Bucktin Ensure full Test outputs Embed way of CSU
Stratification Cartwright implementation with V.Wards working
Tendering Steve Mann Neill Bucktin, Tender for smaller scale community services in CSU
services Matt Hartland order to begin testing / shaping market provision
Medicines PD Gupta Neill Bucktin Review current Ensure effectiveness in efficiency Public Health
Management objectives & quality improvement
EPRR Rebecca Rebecca Ensure the CCG holds Providers to account for their
Bartholomew Bartholomew EPRR role via Contracts

Leadership Governing Body David Hegarty Paul Maubach, Review Board Ensuring public accountability Paul Capener
Matt Hartland effectiveness and compliance with these plans
Good Steve Matt Hartland Audit plan for Audit Committee oversight on
Governance Wellings, Non- year governance of CCG activities
Executives
H&WB Board David Hegarty Paul Maubach Sign-up to CCG Partnership working on key
strategy strategic themes
Primary Care Kevin Dawes Dan King Review benefits of productive practice; develop
Development capacity for a Quality Improvement Support Team
Primary Care Richard Gee Dan King Application of the quadrant model
Improvement in peer / performance meetings
Network Steve Steph Network Leadership training and development Simon
Leadership Cartwright Cartwright programme Western
CCG Locality Jas Rathore Dan King Move focus of all CCG
Leadership engagement to localities

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 System David Hegarty Paul Maubach Ensuring effectiveness of the Dudley Leadership
Leadership Group to coordinate partnership agenda
Communications David Hegarty Laura Broster Main consultation on care in last
Richard Haynes years of life
Health Scrutiny David Hegarty Paul Maubach Ensuring effective relationship with HOSC

Rewards Values David Hegarty Paul Maubach, Build values Promote values within CCG on-
Steph and 360s into going working and development
Caretwright PDR process
Better Outcomes Steve Neill Bucktin, Develop shared outcome objectives across primary CSU (new
Cartwright, Jas Dan King, Matt and community services – linked to BCF, QOF, community
Rathore Hartland Quality Premium & our strategic objectives metrics)
Value Jas Rathore Matt Hartland, Develop Plan on NHSE input
commissioning Dan King Primary Care timetable for
quadrant model P.Care / PMS
reviews
System Jonathan Matt Hartland Developing systematic approaches to improving
efficiency Darby efficiency (eg: comms, referrals, invoicing)
Training & Rebecca Rebecca Oversee application of ‘Care, Compassion,
Development Bartholomew Bartholomew Competence, Communication, Courage,
Commitment’ with primary & community nursing
Training & Ruth Edwards Dan King Ensure we have a comprehensive Primary Care
Development (previous role) education and development programme
Celebrating David Hegarty Steph AGM and
success Cartwright annual awards
Contract Jas Rathore Matt Hartland Ensuring effective contract management and
Performance penalty application with providers
Quality Ruth Edwards Rebecca Ensuring assurance on safety, safeguarding &
Improvement Bartholomew quality improvement of all providers
Urgent Care Steve Mann Neill Bucktin Ensuring efficient system working and performance NHSE input
performance through the UCWG
Integration Steve Neill Bucktin Ensuring efficient system working and performance
performance Cartwright through the ICWG

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Appendix 1
Operational Plan on a page

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Appendix 2
Strategic Plan on a page

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