• Senior leadership at Somerset CCG criticised in review
  • Leaders must “minimise” time spent on attending meetings
  • Review warns implementation of financial turnaround plan is too slow

Senior chiefs at a clinical commissioning group rated inadequate should spend less time in meetings and improve their leadership behaviour, a highly critical internal review has said.

Executives at Somerset CCG, which was rated inadequate by NHS England and placed in special measures last month, were also told its financial turnaround plan was being implemented too slowly and there was a “rapidly escalating risk” that projects will not deliver enough savings.

The details were revealed in a capacity and capability review of the senior leadership by consultancy Attain, which was commissioned by the CCG.

The £722m budget CCG, whose accountable officer and chair are David Slack and Ed Ford respectively, covers a population of 550,000.

The review’s other findings, based on “a wide range of interviews”, included:

  • stakeholders view decision making as “weak” with difficult decisions often deferred;
  • provider management is not proactive enough; and
  • “insufficient” clinical engagement on addressing the CCG’s delivery priorities.

David Slack, who will leave his position as the CCG’s managing director at the end of the month, told HSJ the CCG is addressing the issues.

The CCG commissioned the £39,000 review after its financial position worsened rapidly and NHS constitution targets were missed.

The review, carried out between March and May, said clinical and executive leaders “need to minimise total time spent on meeting attendance and maximise doing time and supervision of work within directorates”.

It said there needed to be “greater clarity of meeting purpose” and assurances that “decisions taken are acted upon”.

The review also suggested the CCG was not explicit enough in its decision making process and it needed to “strengthen its assertiveness” in communicating with stakeholders.

On clinical engagement, the review said: “Time needs to be spent strengthening the link between executive directors and clinicians to support delivery.”

This financial year the CCG has been set a control total deficit of £1.7m, which would bring its cumulative deficit to £4.7m while its underlying deficit would be £7.1m.

But for 2017-18 the organisation is forecasting a £17.2m deficit and – as it has agreed a risk sharing agreement with its providers – the area is part of the capped expenditure process.

To tackle the financial pressures, a turnaround plan has been developed. However, while the review highlighted the plan as a “strength”, it warned implementation was too slow and progress on reducing demand was “inadequate”.

The reviewers found the CCG’s management of providers needed to be more proactive and priority driven. “There needs to be a shift from more traditional types of provider management (improvement notices, penalty application, etc) to proactive management within the system risk share agreement,” the report said.

The review noted that in other financial circumstances a “sound case could be made to invest in more senior, experienced capacity”, but it concluded that this was not currently viable.

It urged the CCG to address its ways of working, to free up time to focus on achieving its financial targets and manage the system’s performance against constitution standards.

The review also highlighted some positive findings such as:

  • a strong vision of outcomes based commissioning;
  • collaborative working with partners across the health system; and
  • increased transparency of the financial position.

It made eight recommendations, including: implementing a “bespoke leadership development programme” for senior leaders; reviewing and refocusing leadership meetings to minimise duplication; and ensuring leaders have an appropriate focus on quality and performance.

Mr Slack said the CCG is implementing recommendations. 

“Our priority now is to use the opportunity offered through the Sustainability and Transformation Partnership to work more efffectively with our partners as a whole healthcare system,” he said.

“We have jointly addressed the need to reduce our financial deficit through the recent Capped Expenditure Process.” 

The review was obtained by HSJ through the Freedom of Information Act, though only the executive summary was provided. The rest was withheld due to the Data Protection Act.

The CCG recently announced plans to create a single commissioning body with Somerset county council, as part of the area’s drive to develop an accountable care system.


CCG leaders spend too much time in meetings, damning review finds