Shared learning database

Wolverhampton Clinical Commissioning Group
Published date:
March 2014

Wolverhampton Clinical Commissioning Group (WCCG) is committed to ensuring that there is a systematic process in place for planning, implementing, auditing and evaluating NICE guidance in the services it commissions.

It accepts that NICE guidance is evidence based and represents good practice and effective use of resources, hence the requirement of a WCCG Policy.

WCCG will ensure through the contracts and service level agreements with providers that, where relevant, providers will demonstrate compliance with current NICE recommendations, as outlined in our policy and monitored via our assurance group.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

WCCG has a responsibility for commissioning and delivering services that are compliant with NICE guidance and NICE Quality Standards in order to: - ensure patients and service users receive the best and most appropriate treatment - ensure the NHS resources are used to provide the most clinically and cost effective treatment - ensure equity through consistent application of NICE guidance

WCCG has an obligation to demonstrate that NICE guidance is being implemented in the organisations for which it is commissioner and is also obliged to assure itself that arrangements led by others on our behalf are also implementing NICE guidance. Regular reports are received from our commissioned services following their internal clinical effectiveness meetings which outline their decisions to implement NICE guidance.

Reasons for implementing your project

Wolverhampton Clinical Commissioning Group (WCCG) inherited a basic working group previously established by the Primary Care Trust (PCT).

Wolverhampton has a population of 249 000 and is the 12th largest City outside of London. The number of patients registered with a Wolverhampton CCG GP is 262,000, and there are 52 GP practices. Wolverhampton is a relatively compact geographical area so wards are in general quite densely populated. Wolverhampton has an 8% unemployment rate and is part of the West Midlands urban area in an ethnically diverse community.

Prior to April 2010 provider services were required to meet the Standards for Better Health with implementation of NICE guidance included in these standards, specifically core standards and developmental standards. Healthcare providers are now required to be registered with Care Quality Commission and as part of this registration healthcare providers and have to comply with regulations.

Due to the transition from PCT to CCG, it was necessary to review the current NICE policy and as a baseline assessment a scorecard self-assessment was completed to identify any gaps within previous processes and areas for improvement in line with changes to NICE nationally.

Within the self-assessment we synthesised areas NICE had identified within a previous publication 'How to put NICE guidance into practice'. Using the sectioned principles we filtered CCG areas within each principle area and developed three main themes for the self-assessment - Leadership and Board support, Implementation and Commissioning NICE.

How did you implement the project

Following the NICE Self-assessment that the CCG produced, a number of actions became apparent following the scoring process. The CCG found that a number of the requirements had substantial compliance; however the minority of the requirements needed intervention.

One of the requirements showed a clear need for a successful working group and robust policy. The previous policy produced appeared to be provider led rather than Commissioner led and on this basis it was identified within the self-assessment that review was needed.

Since 2011 the NICE Assurance Group had started to progress however there were a number of weaknesses in the process i.e lack of commissioner representation which led to delays and ambiguity mainly associated with Business Cases status/progression.

The Policy review, development of the group and self-assessment incurred minimal costs. (Staff time during working hours).

Key findings

Through discussions at the NICE group with stakeholders, providers and the CCG's overarching Quality and Safety Committee the Policy was successfully approved and ratified in 2013. The Policy provides an exemplary process which is clear, concise and robust.

One of the areas within the self-assessment showed that some of our providers were more pro-active with NICE and regularly produced detailed documentation; others however needed more guidance and support. Therefore it was felt that it would be beneficial to use a rotation of themed meetings to ensure progression of guidelines within an acceptable period of time. This was underpinned by the approval and implementation of the new NICE Guidance Policy & Procedure for Commissioners.

Since this has been introduced, our providers have been able to present their compliance levels at Meetings. Through the self-assessment, engagement with our Contracting and Finance team has facilitated cross referencing to ensure that we are commissioning effectively and enabling the provider and commissioners to understand each other's requirements.

The Trust(s) undertake their own audits and present their findings in accordance with plan of audits. Where necessary the Chair of NICE Commissioning Assurance Group requests specific audits to be undertaken to demonstrate assurance to the CCG of the extent and effectiveness of implementation of individual guidance. This is fully documented within minutes of meetings.

The CCG concluded to critique on a six monthly basis and where necessary a process was agreed to escalate any issues or specific areas of concern to an overviewing Clinical Quality Review group. The group also provide an executive summary on a monthly basis to appraise Board Members and other senior CCG personnel.

Key learning points

- Initially we would recommend engagement with providers to gain a full understanding of their performance.
- An initial self-assessment should be carried out to identify gaps, targets and actions.
- Establish a working group with committed input from providers, create a terms of reference document for that group, identify the correct staff members to attend and nominate a Chair who would hold responsibility and escalate concerns on behalf of the group.
- Create or revise a Policy to ensure that the process is underpinned.
- Establish a programme of audit to monitor compliance levels.
- Critique on a 6 monthly basis the effectiveness of the group and performance of providers.
- Where necessary invite and involve NICE colleagues to attend meetings and provide assurance that processes are being followed correctly.
- Continue to build on current knowledge levels and strive to obtain high levels of performance.
- Apply for a shared learning award!

Contact details

Annette Lawrence / Matt Boyce
Quality and Patient Safety Manager / Quality Assurance Co-Ordinator
Wolverhampton Clinical Commissioning Group

Is the example industry-sponsored in any way?