What does the NHS Oversight Framework mean for CCGs?

NHS England and Improvement released the new oversight framework for 2019/20 on 23 August.

With the move to system working, their framework has been revised to reflect that NHS England and NHS Improvement will be assessing CCGs and providers more consistently.

There is also a more prominent role for regional directors and system leaders. System review meetings will be typically held on a quarterly basis between system leaders and the regional team. Regional teams will use data from the metrics already used in the CCG IAF as well as local information and insight to identify where commissioners may need support. Providers will also be subject to this process.

NHS England and Improvement have committed to making their “reporting and dashboards, integrated performance data on activity and quality standards, available to organisations, systems, regional and national teams to enable performance discussions to use a ‘single version of the truth’.”

Some key changes:

  • Most of the oversight metrics will be fairly similar to last year, but with some elements a little closer to the LTP priorities. There are 6 new metrics:
    • Evidence-based interventions – delivery of the EBI programme
    • Learning disabilities mortality review: the percentage of reviews completed within 6 months of notification
    • Overall size of the planned care waiting list
    • Patients waiting over 52 weeks for planned care
    • Children and Young People and Eating Disorders investment as a percentage of total mental health spend
    • Reducing the rate of low priority prescribing (we will be hosting an event in November to support this – email office@nhscc.org if you’re interested in attending)
  • ‘Segmentation’ – there are now 4 segments, describing the sort of support needed. This ranges from ‘maximum autonomy’ through to ‘legal directions’. It is likely this will reflect the ‘outstanding’ to ‘inadequate’ ratings but the segment is determined by the level of support teams have decided is appropriate (universal, targeted or mandated). It does not necessarily mirror the annual assessment for CCGs.
  • NHS England and Improvement have said that framework is not radically changing the goalposts, just meant to highlight similarities between provider and CCG assessment so this should help with system working.
  • An annual assessment for CCGs still exists as it is a legal requirement. This judgement will continue, “reached by considering a CCG’s performance in each of the indicator areas over the full year and balanced against the financial management and qualitative assessment of the leadership of the CCG.” As metrics used from assessment are measuring overall outcomes, often not solely within the CCG’s control, NHS England and Improvement have emphasised that “metrics have already been incorporated from NHS Improvement’s provider oversight approach” and that “CCGs are expected to focus on the strength and effectiveness of their system relationships, using all the levers and incentives available to them, to make progress.”

NHSCC will be liaising with the NHS England and Improvement team to understand how the annual assessment will fit with the more regular quarterly discussions.

The oversight framework for 2020/21 is likely to be more significantly changed, and we will be engaging with NHS England and Improvement over the next few months to ensure this meets the needs of CCGs.


27 August 2019