Scrutiny

2012 has been quite a year. A year of personal scrutiny. What does that mean? The word apparently originates in Latin: scrutinium; from scrutari, meaning "those who search through piles of rubbish in the hope of finding something of value." A common definition is: 'to look closely (as for mistakes)'. Seems apt.

The start of the year (and the 2 years before that) saw our practice achieve the RCGP Quality Practice Award, a real team achievement and recognition of the focus on patient service, access and meaningful systems by the practice and its attached staff. The visit, following an enormous submission of 'evidence' included patient and staff interviews, observation and a nurse going through every drawer in my room to make sure all was in order and in date. That was a nervous ten minutes. We passed, and it has been a great experience for staff morale and a catalyst for patient engagement in the practice.

As a CCG Chair I then had an assessment to ensure I was able to fulfil the role, at least on paper. Maths and English tests and 360degree leadership surveys were followed by a visit to London where I was interviewed in great detail by the Hay Group and underwent a series of role play and written assessments. A full day later I had a stamp of approval and my first ever migraine. I also discovered that after a certain age writing for 30 mins in examination conditions is almost impossible. If the writer's block doesn't get you, the cramp will.

Next came authorisation. Armed with personal approval to be Chair, was the CCG up to it? We promised ourselves we'd take it as part of the day job, that we were doing the role, that we wouldn't get submerged in 'evidence.' We were wrong. To anyone who thought the process would simply be a formality, the fact that only 8 CCGs have been authorised without conditions (including Bassetlaw) will hopefully provide some assurance. We are a better CCG for having been through the process, but it's good to be focusing on quality and patients rather than process.

Finally, revalidation. My appraisal today was very similar to previous appraisals - a valuable opportunity to reflect on my clinical practice rather than policies and process. So what was different about a 'revalidation appraisal.' Mainly the surveys. Another 360 degree survey, but this time my colleagues in the practice, both clinical and managerial, including my secretary and other reception staff. This was followed by a patient survey. Both were done through an independent company (Edgecumbe) and the process was very smooth with clear reports afterwards. It felt much more personal than previous QOF surveys, and unlike previous 'leadership' surveys this was about my interactions with patients, my consultation skills, how I support staff.

So all my evidence has been submitted now for revalidation. The CCG has been authorised. The practice has the QPA for the next 3 years. A good year, with a focus on quality and assurance. 2013 should be easier. Wait, what's this on everyone's twitter feed? 35 outcomes for CCGs? A new planning framework? More scrutiny by the Local authority?

Better start collecting evidence.

The Site Visit

Despite the fact we had arranged to meet at 8am many of us were there at 7.30.  Having been through the journey towards authorisation together, this was a big day.  As any X-Factor contestant will testify, it 'meant everything,' we'd 'put so much work into it' and we certainly felt like we were about to be judged.  Would we get past the NHS version of Boot Camp?

The site visit, according to the rhetoric, is meant to be supportive, constructive, developmental and a lot of other similar words. All positive.  The training session I'd attended had left me doubtful. Would it just be World Class Commissioning in another form?  Could a team of strangers really learn anything about (judge) our CCG in one day? 

Our anxieties were unfounded.   The tone was set by the panel chair immediately, and was excellent.  At the end of the day I was extremely proud of the CCG team, of their passion in describing patient service improvements and the pragmatism where challenges exist.

My top tips for site visits:

1.     Use the agenda to determine who should attend. Our agenda was very clear, identified which 'Key Lines of Enquiry’ (KLOEs) would be discussed when, and helped us field a strong team in each breakout session.

2.    Involve other stakeholders where possible. A local authority director of social care attended to describe our joint working and was extremely useful, particularly for the panel local authority representative.

3.    Examine each outstanding KLOE and make sure each is addressed. We prepared an evidence pack for the panel to reference and they found this very helpful.

4.    Use the presentation carefully. It's a short time to focus on the CCG story and subtly deal with as many KLOEs as possible. There's a full day ahead, but many areas that were difficult to get across in a paper submission can be clarified at this point.

5.    Make sure someone in each CCG group is responsible for checking KLOEs are addressed. Our panel were very organised, going through each in turn.  After the training I was worried this wouldn't be the case.  They also stuck to outstanding KLOEs only.

6.    Think what is likely to concern the panel most.  Safeguarding, clinical engagement, financial plans.  We had to emphasise the fact that we'd worked as one organisation with the PCT for over a year, and this was reflected in our policies/plans.

7.    Focus on patients.  All the areas above mean nothing if we don't relate them to patient care, better outcomes.  Identify areas where the CCG has dealt with quality issues, with financial issues, and where patient and clinician input has been effective in producing change.

The site visit was the positive experience it was meant to be.  We are a better CCG for having been through the authorisation journey.  Now to get back to focusing on the actual job, not the process.

Authorisation

Submission. The word meant a lot in Bassetlaw last week. We've had it on calendars, discussed deadlines for completing it and finally achieved it. Our authorisation documents were finally uploaded along with the other 34 CCGs in wave 1.

So how was it? Was submission, as the word suggests, 'an act of yielding oneself to a superior force or to the will of another' ?

We have always aimed to do submission as part of the day job. We had most of the policies and documents already as part of our CCG development. We did have some key tasks: updating the constitution to reflect national guidance and advice, repeating our self-diagnostic and subsequent OD plan, and describing work already done in case studies. And changed our name. Bassetlaw Commissioning Organisation is dead, long live NHS Bassetlaw Clinical Commissioning Group.

The name change posed a challenge. We had built a lot of awareness locally in the name of BCO and reassured patients that there was a future once the PCT vanished. A lot of effort has since gone into reassuring people this recent development is a change in name only.

I have to confess to doing very little once it came to submission. This was partly due to the fact that we had a lot of the documents, but mainly due to an excellent (small) team who put in a huge amount of discretionary effort to signpost evidence and upload 200 documents. The technology worked, thankfully, and we can now get back to actual commissioning. Despite our best efforts authorisation dominated at least a week.

The feeling at Bassetlaw is that this has been a beneficial process. We have reviewed all our documents, challenged ourselves in front of our members and had an excellent 360 degree survey which has made our work on engagement seem worthwhile. We need to build on this.

We have responsibility for a lot of public money and patient services. Authorisation to date has felt proportionate to this. Difficult to get right, but necessary.

We now await feedback regarding gaps in evidence and 'key lines of enquiry' before our site visit on the 12th September. I hope I'm as positive after that.