Commissioning Development

Programme

Building choice of high quality support for commissioners

Commissioning Support Services:

Checkpoint 3 Guidance

June 2012

Objective of, and Outputs from Checkpoint 3

2Checkpoint 3

Checkpoint 3 is the third and final step in the process of assuring CCGs and the NHS Commissioning Board that the emerging CSSs are fit for hosting and sustainable in the long term.

The primary purpose of Checkpoint 3 is to establish, against four key tests (Leadership, Customer, Business and Delivery), whether you have made sufficient progress to date to indicate that (with an on-going Development Plan) you are likely to succeed as viable and independent organisations.

At the heart of Checkpoint 3 are a number of submissions and tests to ensure you are commercially agile enough in this emerging and fluid market for commissioning support.

Activity this summer is focused upon the BDU being able to make individual hosting recommendations for each CSS to the NHS CBA at the end of October 2012. The primary output from Checkpoint 3 is a hosting decision and (if successful) a binding Development Plan.

In order

Timeline Summary, Checkpoint 3

3Checkpoint 3

Checkpoint 3 can be summarised as follows:

May-August: Monthly BDU site visits to agree, monitor and adapt the binding Development Plans from Checkpoint 2

June/July Checkpoint 3 guidance published with Enterprise Financial Model, Workshop and Financial Regime guidance notes

August: CSS submissions:

» full Business Plan

» Enterprise Financial Model

» Balanced Scorecard

Summer: Hosting Guide published describing in more detail the hosting arrangements beyond April 2013 and to externalisation

September: Assessment activities

» CCG Survey

» CSS Staff Survey

» Due Diligence

» NHS CBA visit to CSS Site

October: NHS CBA decides which CSSs will be hosted from April 2013

November onwards: Binding Development plans are agreed, implemented and monitored/supported by the BDU on a monthly basis to April 2013.

Objective and Purpose of Checkpoint 3

“The Full Business Plan (FBP) by the end of August 2012 will describe the business model fully and comprehensively”

4

Checkpoint 3 is a phase rather than a step, which starts from submission of FBPs at the end of August and ends once the NHS CBA has made decisions about those CSSs progressing to hosting.

Only CSS’s who have fulfilled their commitments under their binding Development Plan from Checkpoint 2, as assessed by the BDU (with input from SHAs) will be permitted to proceed to Checkpoint 3.

Checkpoint 3 evaluates the ‘commercial viability’ of CSSs for existing and proposed arrangements from April 2013. It tests all domains in the full Business Plan to draw conclusions about the risks to commercial viability and the scope of services that the CSS will be licensed to provide under the hosting arrangements.

The Purpose of Check point 3

–To assess commercial viability, in order to:

• provide assurance to the NHS CBA that CSSs are ready to trade and can be externalised by March 2016 (and identify those who fail to provide that assurance)

• provide assurance to CCGs and other customers that CSSs are financially viable to deliver high quality and responsive commissioning services

• To provide binding Development Plans to CSSs that need to be fulfilled before hosting

–To provide the draft licence to operate, under a shadow compliance regime (detailed Hosting Guide to be published later this summer)

Checkpoint 3

Principles Impact

Transparency • Communicate purpose and ensure assessments are consistent with this purpose• Ensure clear criteria for assessment and feedback• Design a predictable process, supporting the purpose, with open and ongoing communication

Objectivity • Focus tests on commercial viability and evidence sought in these areas• Include all evidence Full Business Plan and Financial Model and site visit

Balance • Focus on the fundamental tests of commercial viability • For all other tests, look at the leading indicators of future success, potential and likely

development trajectory to inform the bespoke development plan for each CSS• Balance the assessments according to the relative risks of each CSS

Autonomy • Maintain accountability with CSSs for achievement of the and preparations for hosting• Maintain CSSs autonomy on strategic and operational decision making matters once licensed:

CSSs do not need to seek permission from the BDU to operate within the terms of their licence• Exclude the BDU in business decision making, and focus its activity on continuously monitoring

commercial viability and operations within licence terms

Credibility • Maintain a process that retains confidence of CCGs, BDU, SHAs and PCT Clusters• Maintain a process that helps CSS and CCG development

The following principles (as used in C1&2) have been used to shape the design of Checkpoint 3 (C3):

5

Checkpoint 3 Design Principles

Design of Checkpoint 3

Outputs from Checkpoint 3

There will be three core outputs from Checkpoint 3:

1. The first output will be the result of a formal assessment of the CSS position at Checkpoint 3 against a set of fundamental tests of commercial viability. It will set out the rationale as to why the CSS either has or has not been assured to proceed to hosting. The result of the formal assessment will be made by the NHS CBA at the 30&31 October 2012 meeting. The result will be public and the detailed feedback communicated to the CSS leader by the BDU.

2. Where the CSS has been assured to proceed to Hosting, there will also be a detailed and binding Development Plan, which will be prepared by the BDU and agreed with the CSS. This plan will set out in in detail:

– The development required to reach hosting

– The evidence that will be required to demonstrate achievement

– The owner of each development objective

– The milestone for achievement

– Reporting requirements

The Development Plan will be signed by the CSS leader and the BDU. Failure to meet Development Plan milestones will prompt further assessment of viability to progress to Hosting.

3. The BDU will also provide CSSs with the ‘license to operate’ arrangements which will describe in more detail the policies, processes and operational arrangements that will underpin hosting.

6Design of Checkpoint 3

Checkpoint 3 overview

7

Breach of binding agreement

August 2012 – March 2013Binding agreement of licence

terms breachedDecision to Stop

Breach of binding agreement?

Decision to Stop

Compliance Monitoring

April 2013 – March 2016Breach of licence terms

Decision to terminate

operations

SHA final assessment of completion of Checkpoint 2 Development Plan

Checkpoint 3 Commercial ViabilityFundamental Assessment Tests

Binding development

plan

Draft licence to operate

Binding CSS Development and Improvement plan May 2012 – August 2012 Development support from SHA

Monitoring by BDU

Post Checkpoint 2

Checkpoint 3

Hosting ExternalisationCheckpoint 3

Decision to Stop

Hosting

Outputs of Checkpoint 2 – 3 Scenarios

8

Checkpoint 2Outline Business PlanMarch 2012

Viability testAugust 2012

Scenario 1 – CSS application process stops because a failure against commercial viability tests

Scenario 2 – Proceed to Hosting with a requirement for development and improvement (Development Plan for Hosting)

Checkpoint 3 Outputs: Two Scenarios

CS

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Time

Checkpoint 3

HostingApril 2013

Binding development plan

Licence to operate

Compliance MonitoringSept 12 to Mar 13

Checkpoint 3

Summary of Evidence base for Checkpoint 3 Assessment:

9Checkpoint 3

Checkpoint 3 is a phase that has two discrete elements: a one off assessment of commercial viability (Sept 2012) and on-going compliance monitoring of the binding Development Plan and draft licence to operate up to April 2013.

The totality of inputs into the viability tests are:

1. C2 compliance: The completed C2 Development Plan summary, approved, validated and monitored monthly by the BDU: not a C3 test as such, rather a precondition to C3 tests.

2. FBP: The Full Business Plan submitted by the CSS: “The Full Business Plan (FBP) by the end of August 2012 will describe the business model fully and comprehensively”. (See appendix 1).

3. EFM: The Enterprise Financial Model submitted by the CSS with input from Cluster Director(s) of Finance

4. DD: An independent financial Due Diligence report on the CSS commissioned by the BDU

5. Site Visits: Interview of CSS Team by NHS CBA Panel. Part day on site will also include a session between CCG leads for that CSS and NHS CBA. A staff session will also be held with NHS CBA Panel.

6. Surveys: CCG and CSS staff surveys to inform the Customer and Delivery tests.

The inputs into the compliance monitoring process are:

1. Reports defined in the binding Development Plan and related evidence submitted

2. Review by the BDU of progress since Checkpoint 2

3. Additional information as required by the BDU to confirm specific areas of uncertainty within the FBP and EFM

Inputs from CSS/SHA: 1. C2 Development Plan summary

The binding Development Plan agreed at Checkpoint 2 must be assessed by the BDU who will look at:

Has sufficient progress been made?

Has the CSS Team demonstrated a grip of the developmental issues and shown the drive to make the changes necessary?

Has the CSS Team responded well to change during the monthly BDU visits?

Has the offer to CCG customers been honed and worked up with them?

It is not envisaged the BDU will perform any additional checks as a matter of routine. However, if for any reason it has cause for concern it reserves the right to require any information needed to satisfy itself and validate that the development actions have been completed appropriately.

10Checkpoint 3

Inputs from CSS: 2. The FBP Document

11Checkpoint 3

The FBP will be submitted by the leader of the CSS to the BDU by 31st August the FBP. The FBP will be an evolution of the OBP, which was defined in the December 2011 guidance.

The key differences between the OBP and the FBP are included in Appendix 1. In summary, these are:

The level of detail. The FBP will need to set out in much more detail in such areas as the offer to customers, the way delivery is organised, the management structures that are in place and will be in place and the signed service level agreements (as draft contracts with customers). They will include the results of any survey carried out.

The focus on the description of a viable business. While the FBP will demonstrate financial viability, the triangulation of the EFM with the CSS business, its USPs, the customer focus and delivery capability will be examined at Checkpoint 3

The inclusion of the details of the preferred exit plan from the BDU by March 2016. The detailed Hosting Guide will be published later this year and the options open to CSSs to exit the NHS CBA communicated.

The FBP will be reviewed and assessed by the BDU against both the fundamental viability tests and leading indicators across relevant domains.

The FBP will be presented by CSS as a ‘living’ document with evidence that it is being used to plan and organise a commissioning support business that will be commercially viable, customer focussed and a confident provider of high quality commissioning support services. It should outline the ‘as now’ position of the CSS development story, the separation of PCT Cluster(s), the ‘as is’ position and the expected development ‘journey’ through hosting and exit.

Inputs from CSS: 3. The Enterprise Financial Model

12

The BDU will evaluate long-term financial projections to gauge the financial viability and sustainability of the CSS’s business plan.

The review of the key assumptions underlying the projections will include sensitivity and scenario analyses to evaluate the impact of the key risks faced by the CSS. To facilitate this review, CSSs will be provided with a financial model template (Enterprise Financial Model), completed to support the business plan.

See accompanying guidance and slides from the finance workshop.

Checkpoint 3

Inputs from experts: 4. A financial Due Diligence report on the business

Towards Service Excellence makes it clear that Checkpoint 3 will include a due diligence (DD) on the Business Plans at that point. The due diligence will focus on financial and commercial matters and will be carried out by independent specialists in this area.

An independent report will set out any areas of risks and concern.

The DD will be carried out on the FBP, EFM and CSS Team.

Most due diligences are carried out on businesses with a trading history, therefore an approach suited for business start up will be used. The due diligence work will be funded by the BDU.

In addition to the due diligence, the advisers will also provide an independent valuation on the CSS. A further valuation will be conducted as part of the exit plan to validate the growth and development of the CSS over the hosting period.

13Checkpoint 3

Inputs from CSS: 5. Site Visit by NHS CBA

14Checkpoint 3

September will see a visit by the NHS CBA to all CSSs as part of Checkpoint 3 assessment.

The purpose of this visit is to:– Perform a Panel assessment of the CSS on site for the four evidence areas of Leadership, Customer, Business

and Delivery. This part of the visit will follow closely the process for the Panel meeting at Checkpoint 2.– Meet with CCG leads for that CSS and to hold discussions around the commercial relationship, development

and service agility and innovation– Meet with a selection of staff to gauge the degree to which new commercial skills, behaviours and mind-sets

are being developed.

Inputs from CSS: 6. Surveys

15Checkpoint 3

September will see two key surveys conducted: CCG and Staff

The purpose of CCG survey is to:

Assess the strength of the commercial relationships with the CSS. Determine the expectation of service flex from the CCG perspective. Determined the degree to which the CCG expects service flex to be implemented by the CSS. Determine the CCG view of pricing, risk and responsiveness in the CSS relationship. Determine the confidence the CCG has in the ability of the CSS to innovate and develop services.

The purpose of the Staff survey is to:

Determine the extent of the staff journey travelled to the new commissioning support skills and behaviours. Determine the extent to which the CSS Leadership Team have supported them in that journey. Determine the strength of staff engagement that has taken place through 2012. Determine the staffs’ views of the CSS Leadership Team.

Monitoring Inputs: Binding Development Plan and associated reports

As with Checkpoint 2, the BDU will produce a Development Plan for the CSS to agree, with binding obligations that need to be met before hosting on 1 April 2013.

The Development Plan will also include reporting requirements to the BDU as it prepares for hosting. This will include a monthly submission of a Balanced Scorecard and a monthly visit by the BDU. More guidance on the balanced scorecard, including will circulated shortly

The breadth, depth and frequency of reports will be tailored for each CSS and proportionate to the risks identified by the BDU during the commercial viability assessment.

Reporting will be direct from the CSS to the BDU. Should the CSS not fulfil the binding obligations in the agreed Development Plan, the CSS will be removed from the process, and an alternative solution identified with CCGs.

16Checkpoint 3

Monitoring Inputs: Draft licence to operate and associated reports

Alongside the development plan, the ‘license to operate’ arrangements (provisional from October and more formal from April 2013) will describe the rules, processes and policies that will underpin the operational arrangements of CSSs during the hosted period. More information on this will be shared in the Autumn.

As part of these arrangements there are likely to be some additional checks up to and during hosting that provides the Commissioning Board with the necessary reassurance that CSSs continue to provide efficient, responsive and viable services.

17Checkpoint 3

18

Checkpoint 3 Assessment Tests – Introduction

Design of Checkpoint 3

There will be two assessments at Checkpoint 3. The first is formal assessment of the CSS position at Checkpoint 3 against a set of fundamental tests of commercial viability. The tests will cover:

Commercial viability - The criteria will cover:

The triangulation of leadership, customer, delivery and business development domains into a coherent, confident and credible CSS. This will also include an adapted variant of the OGC Gateway 4 tests

The strength of the business pipeline which will include both the track record of existing services and payments, strength of committed future income including signed SLAs for 2013/14 and will include other documentary evidence of customer agreement, commitment or intent

The robustness of commercial plans including the clarity, coherence and credibility of service line plans

A fully developed operating model which demonstrate the fitness of model to customer reach and service offering and the appropriate use of supply chain partners and evidence of agreement

A fully developed Enterprise Financial Model with detailed sensitivity analysis including commercial risks

Due diligence and valuation. This will be an independent opinion as to the CSSs 4 year commercial viability and the identification of key risks and concerns This will also include a provisional valuation .

The degree of commercial capability within the CSS. This includes both the CSS leader and the leadership team

A preferred commercial exit plan from hosting by the BDU by March 2016.

Governance - The criteria will cover:

Compliance with NHS CBA financial regime and the necessary financial controls

Compliance with NHS CBA governance regime. This will include an assessment of corporate governance and management; High level controls; Risk assessment framework and Management reporting framework and operational KPIs in the Balanced Scorecard.

Role of the BDU • The BDU retains sole responsibility for Checkpoint 3, from submission of FBP to Hosting. • The BDU will assess FBP documents following their submission on 31st of August against commercial viability

assessment criteria.• Following its review of the FBP and independent due diligence report, the BDU reserves the right to request

additional information it deems necessary to make a decision on whether to proceed to hosting arrangements.

Role of the SHA • SHAs will continue to support CSS development following Checkpoint 2 and assist the resolution of issues that

threaten successful assessment at Checkpoint 3.• Where CSSs fail to demonstrate that they have passed the viability, SHA clusters will be responsible for

completing the impact assessment and support CCGs and PCT Clusters to resolve the implications on CCG authorisation and CSS staff.

• Development Plans agreed by the BDU with CSS will be shared with SHAs and they will continue to provide development support to CSS up to Hosting.

Role of the PCT Cluster

• The PCT Cluster should confirm arrangements for separation.

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Checkpoint 3: Implementation – Roles of the BDU and SHA clusters

Checkpoint 3

ImplementCheckpoint 3 20

Key processes March April May June July August September October

C3 Design

Monthly Monitoring

FBP Template

Governance regime

Financial regime

EFM

EFM training

Due diligence

C3 Development Plan

Draft Licence

Draft Compliance regime

Develop Publish

Checkpoint 3 Timeline

Submit

21

Checkpoint 3: Timeline between C2 Binding Development Plan and 31st August

Checkpoint 3

The BDU retains responsibility for Checkpoint 2 Development Plan Monitoring.

Monthly site visits will continue by BDU staff to ensure the development needs addressed at Checkpoint 2 are being met. Each month RAG ratings will be applied to all CSSs across the key evidence tests (Leadership, Customer, Business and Delivery).

This monthly activity takes place up until the end of August when the full Business Plan, Enterprise Financial Model and Balanced Scorecards are submitted for Checkpoint 3.

C3 Compliance Monitoring 22

CCGs evolve mission, ethos, vision, operating model and begin to discuss do/buy/share options and define commissioning support requirements

As part of preparations for authorisation, CCGs establish firmer agreements with CSS and demonstrate management costs are within envelope

CCGs work with CSS to establish Service Level Agreements. While ‘shadow’ CSS and Cluster Teams are supporting CCGs to this point, CCGs from Oct 2012 are receiving CSS consistent with management cost

CCG acting as customer of CSS. Period of time provides track record of delivery required for authorisation

Early plan and development

Sept – Dec 2011

Stage 1Initial implementation

Jan – Jun 2012

Stage 2Mobilisation

Jun - Oct 2012

Final approval and NHSCB hostingOct – Apr 2013

• Forming ethos, values, mission, and early customer engagement

• Key functions identified for potential inclusion in CSS offer

• At scale activities defined• High level review of the

potential market players• Governance arrangements

confirmed to enable design process

• Commissioning Support value proposition confirmed

• Decision on arrangements for April 2013 – host or outsource

• CSS leadership and business development team in place

• Organisational architecture confirmed

• Planning completed and design principles agreed

• Value proposition completed

• HR and OD plan in place• Staff consultation

commences • Assets, estates &

supporting infrastructure confirmed

• Finance, costing and pricing structure emergent and visible; consistent with (RCA)

• Model CS contract established

• CSS commence in shadow forms

• Risk assessment and mitigation plans in place

• PCT clusters implementing TUPE consultation and staff transfers as appropriate

• Customer relationships and marketing and approach agreed

• Evidence of CSS contract pipeline with MOA/SLA for contract 2013/14

• Due diligence undertaken on plans

• Notation or assignment of existing contracts confirmed

• Partnership arrangements identified

• Commercial plans produced• NHSCB decision of support

to be hosted

• Compliance with assurance criteria

• Contracts and SLAs agreed• 360 assessment of

business models undertaken

• Risk assessment and mitigation plans in place

• Performance monitoring systems established

• Formal transfer to hosting arrangement

• CSS trading under NHSCBA hosting arrangements

Checkpoint 1Service Prospectus

December 2011

Checkpoint 2Outline Business Plan

March 2012

Checkpoint 3Full Business Plan

August 2012

Reminder of the CSS assurance process and timescales Summary of the Assurance process

Annex 1: The FBP Document

23Checkpoint 3

CONTENT

A. Executive Summary – updated from OBP

B. Vision and Purpose - updated from OBP

C. Context and Planning Assumptions – updated from OBP (focus on local context, agility and responsiveness to market/customer changes in demand)

D. Market Analysis – updated from OBP (show here or in E, impact of analysis on value proposition, USP and offer)

E. Customer Strategy – updated from OBP.

F. Operating Model Design – updated from OBP (including a detailed section on Innovation and service improvement)

G. Organisation Design and Leadership – updated from OBP.

H. Supply Chain and Partnering Strategy – updated from OBP.

I. Governance – updated from OBP.

J. Finances – updated from OBP. See Finance Guidance and Enterprise Financial Model (separate)

K. One year and three year Programme Plan – updated from OBP

Appendix – updated from OBP

Commissioning Development

Programme

Building choice of high quality support for commissioners

Commissioning Support Services:

Checkpoint 3

June 2012