primary care joint committee (pcjc) meetings · e-mail: [email protected] author contact:...

Primary Care Joint Committee (PCJC) Meetings

The following Joint Committee meetings, listed below, will be held in common at:

6.00pm to 8.30pm on 11 June 2015 at

South Bank Suite, Coin Street Conference Centre

108 Stamford Street South Bank London, SE1 9NH (Nr Waterloo and Southwark Tube stations and Waterloo East BR)

NHS Bexley CCG and NHS England PCJC

NHS Bromley CCG and NHS England PCJC

NHS Greenwich CCG and NHS England PCJC

NHS Lambeth CCG and NHS England PCJC

NHS Lewisham CCG and NHS England PCJC

NHS Southwark CCG and NHS England PCJC

Primary Care Joint Committees meeting in common

AGENDA 6.00pm to 6.50pm

Seminar – All Six Joint Committees

Item Time Papers Lead

1 Meet and Greet 6.00 -

Andrew Bland

2 Introductory Seminar Sarah Blow Chief Officer, NHS Bexley CCG David Sturgeon Director of Primary Care, NHS England (London) Andrew Bland Chief Officer, NHS Southwark CCG

6.10 A All

7.00pm to 8.30pm

Meeting in Common of the Primary Care Joint Committees in South East London

Item Time Papers Lead

3 Welcome and Introductions

7.00 - Andrew Bland

Co-commissioning of Primary Care South East London’s CCGs and NHS England Primary Care Joint Committees

4 Election of Chair for the meeting Meeting Chair to be elected from amongst the six Primary Care Joint Committee chairs

7.05 Verbal Andrew Bland

Appointed Meeting Chair leads

5 Terms of Reference for the Primary Care Joint Committees of:

NHS Bexley CCG and NHS England

NHS Bromley CCG and NHS England

NHS Greenwich CCG and NHS England

NHS Lambeth CCG and NHS England

NHS Lewisham CCG and NHS England

NHS Southwark CCG and NHS England Committee members are asked to note the Terms of Reference for each committee

7.10 B - H Borough committee members

6 Register of Interests

7.15 Chair

7 Operating Model of Joint commissioning in south east London’s boroughs

Primary Care Co-commissioning Memorandum of Understanding: Core principles (NHS England)

Overview of NHS England (London Region) Draft Operating Model: Co-commissioning of Primary Care Version 5

Operating Models and arrangements in support of Primary Care Joint Committees in South East London’

Members to consider and endorse the proposed and emerging arrangements

7.25 I

J

K

David Sturgeon David Sturgeon Andrew Bland

8 Recommendations for amendment to the terms of reference for the Joint Committees Any proposed changes would form a recommendation to Governing Bodies

7.50 Verbal Gilbert George

9 Questions from Members of the Public

8.20 Chair

10 Meeting Close

8.30

Enc A



DATE OF MEETING: 11 June 2015

ENCLOSURE A

INTRODUCTORY SEMINAR

AUTHOR: Andrew Bland, Chief Officer, NHS Southwark CCG

SUMMARY: This seminar will present:

- Primary Care Co-commissioning Plan on a Page to demonstrate how NHS England and six CCGs will work together for primary care co-commissioning

- Our Healthier South East London programme update including whole system model and local care network implementation proposal.

KEY ISSUES: Nil

RECOMMENDATIONS: The Committee members are asked to:

1. Note the Plan on a Page and proposals within the Our Healthier South East London

programme.

CCG CONTACT: Name: Gilbert George, SEL Governance Project Lead E-Mail: [email protected]

AUTHOR CONTACT: Name: Andrew Bland, Chief Officer, NHS Southwark CCG E-Mail: [email protected]

mailto:[email protected]


Co-commissioning of Primary Care in South east London South East London’s CCGs and NHS England Primary Care Joint Committees

Co-commissioning of Primary Care Plan on a page NHS England and our six boroughs working in collaboration

Our Healthier South East London Improving Health and Care Together

Enc Ai

Co-commissioning Primary Care Plan on a Page South East London’s CCGs and NHS England Primary Care Joint Committees

Level Two - joint commissioning arrangements will benefit patients and the public in our boroughs, general practice providers and support delivery of our collective and individual Five-year strategic plans

Our governance model and arrangements will support robust future joint commissioning of primary care with NHS England, maintaining current statutory duties for CCGs and NHS England

Our planning process and operational model will allow CCGs in South East London in collaboration with NHS England to achieve a sustainable approach to commissioning primary care in future

1 2 3

5 6 7 8

9 10

Joint commissioning arrangements

• SEL CCGs have formed joint commissioning arrangements by CCG with NHS England

• Across England, 87 CCGs have opted to joint commission primary care with NHS England

• Joint commissioning arrangements allows sufficient local flexibility to contracting and design locally-focussed incentive schemes

• Greater number of CCGs in collective arrangements improves our approach to risks associated with resource and staffing, conflict of interest and supports our wider collaboration

• GMS contract entitlements will stand as per nationally agreements

Primary Care Joint Committee (PCJC) Joint Committee Structure Conflict of interest Accountability

Finance and budgets

• Our six Joint Committees, meeting together will allow local focus whilst supporting a collaborative approach between all 6 CCGs and NHS England and be an effective vehicle for borough and collective strategic decision-making

• The Joint Committees will allow CCGs to take on differential local commissioning focus under the joint commissioning model, and to share local approaches e.g. prioritisation of implementation of GP specifications, contracting approaches for federations for example, design of new Local Enhanced Services’

• The Joint Committee shall consist of: Four representatives from each CCG, this

will include a Lay Member (Chair), the CCG Chair, Chief Officer and another GB clinical lead

Three representatives from NHS England’s Area Team as follows: The Medical Director, Area Director and Head of Primary Care (or a named deputy of appropriate seniority for any of these representatives)

The membership will meet the requirements of each of the named CCGs’ Committee Terms of Reference

• The Joint Committee (JC) shall resolve all matters relating to conflicts of interest in line with the Conflicts of Interest Policy of their CCG

• As a committee of the CCG Governing Body The PCJC shall establish and maintain a Register of Interests for all Members and regular attendees of the JC and its sub-committees and groups. The Register will be made available for public scrutiny at each JC meeting (and will form part of the wider CCG register following local arrangements)

• Each CCG will be responsible for ensuring that the entries for its representatives are accurate and up to date.

• Through arrangements for co-commissioning, CCGs will have accountability for both meeting their own individual plans and ambitions, as well as being accountable as part of a joint commissioning relationship with NHS England

• By meeting together Joint Committees will also support the delivery of Our Healthier South East London and specifically our stated plans for Community Based Care and Local Care Networks

• Financial accountability of co-commissioning primary care will rest with NHS England. NHS England shall remain the statutory body who will hold the budget for Primary Care Medical Services.

• In 2015/16 finance will be led by NHS England, however there will be involvement through CCG leads for primary care financing. The key responsibility at the borough level will be to ensure matters such as the fair allocations of non-contractual funding is proportionately distributed and that financial risks are made transparent to each CCG.

• The Joint Committee will have a number of operational subgroups to support the work of the Joint Committee

• The subgroups will function to support the majority of the primary care co-commissioning work. Each subgroup will report into the Joint Committee where decision making over the relevant functions will take place.

• The first meeting of the Joint Committee will discuss and approve the subgroups and their function

Scope of co-commissioning

• Co-commissioning currently involves only those arrangements which relate to general practice

• NHS England still reserves the right to establish new national approaches and rules on expanding primary care provision – consistent with the NHSE’s Five Year Forward View (FYFV)

• Individual GP performance (appraisals, the medical performers list, revalidation) will be reserved for NHS England alone

• NHS England will remain responsible for administration of payments / list management

• Co-commissioning will support CCG’s approach to community based care (CBC) transformation

Five Year Forward View – New Models OHSEL CBC Transformation 4

Accessible Primary Care supported by: 1.Development of @ scale working: Local Care

Networks (LCNs) with federations or ‘At scale’ general practice with collective responsibility for the population

2. Estates premises that are safe and high quality 3.Technology Enabled Care: to deliver increased

capacity, continuity and coordination of care 4.Workforce: developing the workforce 5.Coordination of Care: patient centred

coordinated care and GP continuity 6.Proactive Care: health and well being, self care

and health literacy for the population

Proposed Workstreams to support PCJC Benefits of co-commissioning 11

• Joining up the commissioning system through co-commissioning is critical to helping unlock new models of integrated care described in the FYFV such as Multispecialty Community Providers (MCPs).

• As new models develop they could become a focal point for a wider range of care to benefit their registered patients. For example larger group practices could potentially have senior nurses and geriatricians working alongside community nurses, therapists, pharmacists, psychologists, social workers, and other staff in providing and coordinating patient centric care

• Improved engagement with patients, public and stakeholders to give them a greater voice to influence general practice and how it evolves

• CCGs can enhance locally and clinically-led commissioning of core and enhanced general practice services with ability to influence transfer of budgets from acute to primary care/OOH

• CCGs can use local knowledge/experience for planning and dialogue to support transformation

• The delivery of components of transformed primary care across SEL per our 5 year strategic plan and alongside that the delivery of Primary Care specifications across London

Our Healthier South East London - CBC 12

We have used the Christmas Tree Model to understand the south east London population

• Public Health have developed a model of the SE London population based on the use of the Kernow Model of population demographics developed in Cornwall and a well-evidenced Scottish model of Long Term Conditions (LTCs) prevalence.

• The SE London population has been segmented here to show those people living healthy lives, those with risks of developing LTCs and those who are living with LTCs. These segments of the population are demonstrated, based on their size, as the Christmas Tree Model.

• Community Based Care (CBC) aims to support people to live healthier lives and reduce those people exposed to risk factors either by birth or behaviour. For people with a LTC, CBC will take a rehabilitative/ reablement approach enabling people to manage their own health positively and to prevent deterioration wherever possible. For those people with complex LTCs or who are in the last year of life, support will be available to enable them to continue to lead as full and active life as possible.

• Community Based Care will be delivered through Local Care Networks (LCNs). The services available will be proactive, accessible, coordinated and provide continuity; with a flexible, holistic approach to ensure every contact counts. This will be primary care delivered to geographically coherent populations, at scale, whilst still encouraging self-reliance.

Costs

Health and

wellbeing group

(16%)

Early

stages

of LTC

(25%)

People experiencing

inequalities or putting

their health at risk

(50%)

Early stages

of LTC

(25%)

3+ LTC

(9%)

EoL

(1%)

People with multiple complex needs where standard services are

not effective who need personalised care

3

24 LCNs supporting whole populations across SE London will form the core of Community Based Care. This will be a universal service covering the whole population ‘cradle to grave’. An LCN will involve primary, community and social care colleagues working together and drawing on others from across the health, social care and the voluntary sector to provide proactive patient centered care. Services will be delivered in ways that respond to the varied needs and characteristics of our communities.

Primary care working within LCN’s

GP Units & Community services GP Networks

Enablers supporting the transformation

The Local Care Networks are the super enabler for integration of services

IM&T, Commissioning Framework, Workforce, Estates

4

Self care

• Health coaching

• Self management tool kits

• Social prescribing

• Optimising neighbourhood assets

Managed care

• Anticipatory care planning

• Active case management

• Disease management

• Public health programmes

Population

needs

and

budget

Specialist input shared between LCNs:

Pulled into care delivery from outside the network:

Virtual clinics | Specialist nurses | Consultants |

Geriatricians | End of Life expertise | Specialist

rehab

Wider community

infrastructure:

Police | fire service | schools |

Housing

Affordable high

quality outcomes

Strong confident communities

Mental

health

Social

care /

worker

3rd sector District

nurses

OT /

Physio

GPs

Pharmacy GPs

HCA

Practice

nurses

Carers

Diagnostics Care Co-ordination Person

Urgent and emergency

Local Care Networks will operate

beyond usual GP hours in order to

reduce referrals to emergency care

Health

visiting Family

health

Community

matrons Benefits

advice

Proactive, Accessible , Coordinated, Continuous Care

Strong confident

communities are a

critical part of the

foundation of the

model. Initiatives will

seek to build

community

resilience so that

they support local

people to be

physically and

mentally healthy and

take care of peoples

social needs.

A rapid response team will

make sure patients who need

urgent and emergency care

will receive the treatment they

need in the right place at the

right time and will support

patients to return home and

move back to local health and

care services

H

Self care

Managed care

Personalised care

Care coordination Person

Maternity Cancer

Early detection Geographic

midwife teams for low risk mothers

Children & young people

Children’s Integrated Community

Team

Acute Short Stay Paediatric

s Assess’mt

Unit

Elective Care

Centres Planned care

Diagnostics support

Specialist Response

Clinic Urgent & emergency

care

Mums-to-be will receive a

personalised service,

continuity of care and a

range of birthing options

Children and young

people will be able to

access more specialised

services through children's

integrated community

teams

Patients who need

planned care across SEL

will receive consistent

quality and outcomes

regardless of the setting.

Improve patient

outcomes through

prevention and early

detection and

diagnosis of cancer;

stronger support for

people living with

and beyond cancer

Rapid response

“home ward”

Condition focused midwife cohorts for high

risk mothers

Serving geographically coherent populations

between 50,000 – 150,000

• Leadership team • All general practices working

at scale (federated with single IT system and leadership)

• All community pharmacy • Voluntary and community

sector • Community nursing for adults

and children • Social care • Community Mental Health

Teams • Community therapy • Community based diagnostics • Patient and carer engagement

groups

‘The Core’ (as a minimum all Local Care Networks should encompass)

• Strong and confident communities

• Accessible HOT clinics and acute

oncology (urgent and emergency

and cancer care)

• Specialist opinion (not face to

face) and clear specialist service

pathways

• Pathways to MDTs

• Integrated 111, LAS and OOH

system (interface with UCCs co-

located with ED model)

• Housing, education and other

council services

• Community based midwifery

teams

• Private and voluntary sector e.g.

care homes and domiciliary care

• Cancer services

• Children’s integrated community

team and short stay units

• Rapid response services

• Carers

• And there will be others..

Working with…

• Asset mapping supporting

enhanced self management/care

e.g. social prescribing

• Prevention – Obesity, Alcohol and

Smoking

• Improved Core general practice

access plus 8-8, 365

• Enhanced call and recall –

improves screening and early

identification and management

of LTCs

• Reduction in gap between

recorded and expected

prevalence in LTC

• Supporting vulnerable people in

the community including those in

care homes and domiciliary care

• Reduction in variation (level up)

primary care management of LTCs

• Reablement – Admissions

avoidance and effective discharge

• MDT configuration – main LTC

groups (incl. MH) and Frail elderly

• End of Life Care

Big hitters

Bexley

Bromley

Greenwich

Lewisham

Lambeth

Southwark

Integrated Pathways of care

Integrated Single System Leadership and Management

11

Population and

outcomes

Value realisation =

health outcomes achieved

true cost of achieving those outcomes

GP federation

Determination of core services and shared leadership

Determination of services that link into the Local Care Network

Strategic impact assessment Demonstrate the activity & finance implications for the Target Model assessing the value equation; patient outcomes over cost

Design Agree the Target Model (‘the core’, ‘working with’ and ‘big hitters’)

Provider models Looking at the localised Target Model, outline options and select provider model (for example the provider models described in the Five Year Forward View)

Local interpretation Using the target model to articulate shared design principles, interpret these to meet the needs of local communities

Contracting and business models With a preferable provider model selected, commissioners consider the contracting models, and providers the business model, that enables them to deliver

The case for change and outcomes Identify why we need to change and what we want to achieve.

The proposed high-level approach to implementation of Local Care Networks across south east London has been described as:

8

Enc B




ENCLOSURES B-H

Terms of Reference for Primary Care Joint Committees

AUTHOR: Gilbert George, Governance Project Lead and Sheetal Mukkamala, Corporate Governance Manager

SUMMARY: Terms of Reference for Primary Care Joint Committee were approved by NHS England as part of the south east London joint commissioning submission as well as by respective CCG governing bodies and membership, where applicable.

KEY ISSUES: Nil


1. Note the terms of reference for each committee.

CCG CONTACT: Name: Andrew Bland E-Mail: [email protected]

AUTHOR CONTACT: SEL Clinical Commissioning Group Name: Sheetal Mukkamala E-Mail: [email protected]



Enc C

1 | P a g e

NHS Bexley Clinical Commissioning Group

“The CCG”

Primary Care Joint Commissioning Committee

Terms of Reference

Introduction

In May 2014 NHS England invited Clinical Commissioning Groups (CCGs) to expand

their role in primary care commissioning and to submit expressions of interest setting

out their preference for how they would like to exercise expanded primary medical

care commissioning functions. One option available was that NHS England and

CCGs would co-commission primary medical services.

One of the aims of co-commissioning is to help align the commissioning system and

to develop better integrated out of hospital services based around the diverse needs

of local populations.

The governing body of the CCG (“the Governing Body”) have resolved to establish a

committee to be known as the Primary Care Joint Commissioning Committee (“Joint

Committee”). The Joint Committee is a co commissioning committee of the

Governing Body with full representation from NHS England.

Statutory Framework

The National Health Service Act 2006 (as amended) (“NHS Act”) provides, at section

13Z, that NHS England’s functions may be exercised jointly with a CCG, and that

2

functions exercised jointly in accordance with that section may be exercised by a joint

committee of NHS England and the CCG. Section 13Z of the NHS Act further

provides that arrangements made under that section may be on such terms and

conditions as may be agreed between NHS England and the CCG.

Purpose

The role of the Joint Committee shall be to work jointly with NHS England and in

association with Clinical Commissioning Groups in South East London, namely:

NHS Bexley Clinical Commissioning Group;

NHS Bromley Clinical Commissioning Group;

NHS Greenwich Clinical Commissioning Group;

NHS Lambeth Clinical Commissioning Group;

NHS Lewisham Clinical Commissioning Group; and

NHS Southwark Clinical Commissioning Group.

to carry out the functions relating to the commissioning of primary medical services

under section 83 of the NHS Act except those relating to individual GP performance

management, which have been reserved to NHS England and those functions

relating to primary Care, (including the duty to support NHS England improve the

quality of primary care) within the Act within the London Borough of Bexley.

In order to facilitate joint learning and for the system to be as effective and efficient

as possible the joint committees of the six CCGs in south east London will usually

meet together

The Joint Committee remit includes areas such as:

planning (including carrying out needs assessments) primary medical care

services for the geographical area in question;

undertaking reviews as appropriate;

co-ordinating a common approach to primary care commissioning as

appropriate;

managing relevant budgets.

Specifically this includes the following activities:

3

GMS, PMS and APMS contracts (including the design of PMS and APMS

contracts, monitoring of contracts, taking contractual action such as issuing

breach/remedial notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and

“Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality Outcomes

Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers, and making decisions in relation to retirements,

dispersals and terminations;

Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes);

and

Awarding contracts in relation to primary care following a procurement

In particular the Joint Committee will support the Governing Body in fulfilling the

following functions and duties, to:

Act, when exercising its functions to commission health services, consistently

with the discharge by the Secretary of State and NHS England of their duty to

promote a comprehensive health service and with the objectives and

requirements placed on NHS England through the mandate published by the

Secretary of State before the start of each financial year and in line with the

JSNA and direction of the local Health and Wellbeing Board strategy;

Meet the public sector equality duty ;

Act effectively, efficiently and economically;

Act with a view to securing continuous improvement to the quality of services;

Have regard to the need to reduce inequalities;

Promote the involvement of patients, their carers and representatives in

decisions about their healthcare;

Act with a view to enabling patients to make choices;

Promote innovation; and

Act with a view to promoting integration of both health services with other

health services and health services with health-related and social care

services where the CCG considers that this would improve the quality of

services or reduce inequalities.

In performing its role the Joint Committee will exercise its management of the

functions in accordance with the agreement entered into between NHS England and

4

the CCG (“the Agreement”), which will sit alongside the delegation and these terms

of reference. The Agreement will support information sharing, resource sharing,

contractual mechanisms for service delivery (and ownership) and interplay between

contractual and performers list management.

Authority / Delegation

The Joint Committee is authorised by the Governing Body to:

Carry out its functions within the financial limits set by the Governing Body in

relation to CCG funds as agreed from time to time

Investigate any activity within its Terms of Reference.

To obtain outside legal or other independent professional advice and to

secure the attendance of outsiders with relevant experience and expertise if it

considers this necessary.

Meet in common with the primary care commissioning committees of the

other Clinical Commissioning Groups in South East London listed above

Membership

The membership of Joint Committee shall consist of:

The Lay Member for PPI of the CCG

The lay member who has qualifications, expertise or experience such as to

enable the person to express informed views about Governance;

The secondary care specialist OR the Registered Nurse who is also a

member of the Governing Body of the CCG.

The Accountable Officer of the CCG

The Chair of the CCG

Another GP who sits on the governing body from a member practice of the

CCG (this should be a different practice to the CCG Chair)

Three members from NHS England (two of whom will be non voting

members) comprising

o The Medical Director for South London or a named deputy of

appropriate seniority;

o The Director of Commissioning Operations or a named deputy of


o The Director of Primary Care or a named deputy of appropriate

seniority.

5

The Chair of the Joint Committee shall be the Lay Member for PPI of the CCG.

The Vice Chair of the Joint Committee shall be the lay member who has

qualifications, expertise or experience such as to enable the person to express

informed views about Governance of the CCG. When meeting in common with other

Joint Committees a single meeting chair will be agreed between the individual

Committee chairs by agreement or simple majority vote, in the event of a tie the NHS

England member will cast a vote for one of the tied candidates.

A member who cannot attend a meeting will be expected to arrange and brief a

nominated deputy to attend and exercise the full powers of the member they

represent at the meeting. It is essential that members brief their deputies on the

business to be transacted.

Persons in attendance but without voting rights may include other Governing Body

members and employees of the CCG as required.

A standing invitation will be issued to the local Healthwatch, Local Medical

Committee and Health and Wellbeing Board, who may attend but not vote.

Quorum & Conflicts of Interest

The quorum required for any business to be transacted at a meeting is at least 50%

of the members of the committee rounded up to the next whole number present at

the meeting. This must include the voting member from NHS England.

The committee chair is responsible for managing conflicts of interest that arise in a

meeting, with advice from the executive member of the committee.

Where members are required to withdraw from a meeting due to a conflict of interest

or any other reason that does not affect the meeting quoracy then a decision or vote

can proceed as normal.

Where more than 50% of the members of a meeting are required to withdraw from a

meeting or part of it, or are absent for any other reason the chair may:

Defer the matter to another meeting of the committee, which may be quorate

Refer the matter to the to the a conflicts of interest panel in line with the

conflicts of interest policy

6

Use the decision making procedure outlined below provided that quoracy can

be obtained for any urgent decisions

Where a conflict is identified the conflict and the action will be recorded in the

minutes of the meeting and the register of interests updated accordingly.

Decision Making

The Joint Committee will make decisions within the bounds of its remit.

Each voting member of the Joint Committee shall have one vote, except where a

decision relates to a statutory function of either NHS England or the CCG as

provided for below. The Joint Committee l will always strive for consensus in

decision making and will reach decisions by a simple majority of members present,

but with the committee Chair having a second and deciding vote if necessary.

NHS England will have one vote.

Decisions will be published by both NHS England and the CCG.

Decisions relating to Statutory Functions

A nominated CCG member of the Joint Committee will have a casting vote on any

decision pertaining to one of the CCG’s statutory functions that has been included

within the scope of the Joint Committee.

The NHS England vote will be weighted to equal the total number of votes held by

the CCG at any meeting where decisions pertaining to NHS England Statutory

Functions are taken.

NHS England members will have the casting vote for any decision pertaining to one

of the NHS England’s statutory functions that has been included within the scope of

the Joint Committee

Procedure

The Joint Committee shall adopt the Standing Orders set out in Schedule 1 to these

Terms of Reference. The Standing Orders will include provision for the following:

Notice of meetings;

Handling of meetings;

Agendas;

7

Circulation of papers; and

Conflicts of interest.

Meetings of the Joint Committee shall normally be held in public. However, the Joint

Committee may resolve to exclude the public from a meeting that is open to the

public (whether during the whole or part of the proceedings) whenever publicity

would be prejudicial to the public interest by reason of the confidential nature of the

business to be transacted or for other special reasons stated in the resolution and

arising from the nature of that business or of the proceedings or for any other reason

permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or

succeeded from time to time.

Members of the Joint Committee have a collective responsibility for the operation of

the Joint Committee. They will participate in discussion, review evidence and provide

objective expert input to the best of their knowledge and ability, and endeavour to

reach a collective view.

The Joint Committee may call additional experts to attend meetings on an ad hoc

basis to inform discussions.

Members of the Joint Committee shall respect confidentiality requirements as set out

in the Standing Orders in Schedule 1.

Frequency of Meetings

Meetings will be held as necessary, but not less than twice in a year.

Reporting

The CCG will ensure a person shall act as Secretary to the Joint Committee and will:

Circulate the minutes and action notes of the Joint Committee to all members

within five working days of any meeting of the Joint Committee;

Report the proceedings of each meeting of the Joint Committee (which will

include a presentation of the minutes and action notes of the Joint

Committee) to the next meeting of the Governing Body and to NHS England

Produce an executive summary report which sets out the decisions made by

the Joint Committee which will be presented to NHS England and the

Governing Body every two months for information.

8

The Chair shall draw to the attention of the Governing Body any issues that require

disclosure to the full Governing Body or require executive action.

Review of Arrangements

These Terms of Reference shall be reviewed by the Governing Body on at least an

annual basis, reflecting the experience of the Joint Committee in fulfilling its functions

and the wider experience of NHS England and the CCG in primary medical services

co-commissioning. These Terms of Reference may be amended by mutual

agreement between NHS England and the Governing Body at any time to reflect

changes in circumstances which may arise.

Withdrawal from the Joint Committee

The CCG may withdraw from the Joint Committee in accordance with a decision

made under its constitution.

9

Schedule 1 – Standing Orders

1. Calling meetings

Ordinary meetings of the Joint Committee shall be held at regular intervals at

such times and places as the Joint Committee may determine.

2. Agenda, supporting papers and business to be transacted

All Agenda items and relevant papers will be circulated to members and

published on the website of the CCG at least 5 working days in advance of the

meeting.

The Agenda will be prepared by the Secretary and approved by the Chair of the

Joint Committee (or, if they are not available, the Vice Chair) at least seven

working days before the meeting.

3. Chair of Meeting

At any meeting of the Joint Committee the Chair of the Joint Committee shall

preside. If the Chair is absent from the meeting, the Vice Chair, if any and if

present, shall preside.

If the Chair is absent temporarily on the grounds of a declared conflict of interest

the Vice Chair, if present, shall preside.

If both the Chair and Vice Chair are absent, or are disqualified from participating,

or there is neither a Chair nor Vice Chair of the Joint Committee a Chair shall be

chosen by the members present, or by a majority of them, and shall preside.

When the joint committee meets together with any or all of the other joint

committees of CCGs in south east London one of the chairs shall be appointed to

administratively chair the meeting

4. Suspension of Standing Orders

Except where it would contravene any statutory provision or any direction made

by the Secretary of State for Health or NHS England, any part of these Standing

Orders may be suspended at any meeting, provided at least two-thirds of the

members are in agreement.

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A decision to suspend Standing Orders together with the reasons for doing so

shall be recorded in the minutes of the meeting.

A separate record of matters discussed during the suspension shall be kept.

These records shall be made available to the Governing Body’s audit committee

for review of the reasonableness of the decision to suspend the Standing Orders.

5. Record of Attendance

The names of all members of the meeting present at the meeting shall be

recorded in the minutes of the Joint Committee’s meetings. The names of all

members of the Joint Committee and all non-voting attendees present shall be

recorded in the minutes of the Joint Committee meetings.

6. Minutes

The minutes of the proceedings of a meeting shall be drawn up by the Secretary

and submitted for agreement within 5 business days of the meeting and they will

be confirmed as a true record of the meeting by the Chair and others present at

the next meeting of the Joint Committee

The minutes of the Joint Committee will be made available to the public on the

CCG’s website. Minutes of meetings or parts of meetings from which members of

the public are excluded shall not be made public.

7. Conflicts of Interest

Conflicts of interest shall be dealt with in accordance with the CCG’s conflict of

interest policy, which shall be applied mutatis mutandis to the Joint Committee.

8. Confidentiality

Meetings of the Joint Committee shall be held in public save where the Joint

Committee resolves to exclude the public from a meeting in accordance with the

Terms of Reference.

Enc D

NHS Bromley Clinical Commissioning Group

“The CCG”

“Primary Care Joint Commissioning Committee”

Terms of Reference

Introduction













2

Statutory Framework







Purpose












relating to primary care, (including the duty to support NHS England improve the

quality of primary care) within the Act within the London Borough of Bromley.


as possible, the Joint Committees of the six CCGs in South East London will usually

meet together.






appropriate;

Managing relevant budgets.

3








Framework (QOF);





and






















4

















Membership

The membership of the Joint Committee shall consist of:

The Lay Member for patient & public involvement (PPI) of the CCG

The Lay Member (Governance) of the CCG

The secondary care specialist OR the registered nurse member of the

Governing Body




CCG (this should be a different practice from the CCG Chair)

Three members from NHS England (two of whom will be non-voting

members) comprising





5


seniority.

The Chair of the Joint Committee shall be the Lay Member (PPI) of the CCG.

The Vice Chair of the Joint Committee shall be Lay Member (Governance) of the

CCG. When meeting in common with other Joint Committees, a single meeting chair

will be agreed between the individual Committee chairs by agreement or simple

majority vote. In the event of a tie, the NHS England member will cast a vote for one

of the tied candidates.









Quorum

The quorum required for any business to be transacted at a meeting is the

attendance of at least 50% of the voting members of the Joint Committee rounded up

to the next whole number present at the meeting. This must include the voting

member from NHS England.

Where a quorum cannot be convened from the membership, owing to arrangements

for managing conflicts of interests or potential conflicts of interest, the Chair of the

meeting will comply with the conflicts of interest policy.

Decision Making


Each voting member of the Joint Committee shall have one vote except where a


provided for below. The Joint Committee will always strive for consensus in decision

6

making and will reach decisions by a simple majority of members present, but with

the committee Chair having a second and deciding vote if necessary.








the CCGs at any meeting where decisions pertaining to NHS England Statutory




the Joint Committee.

Procedure



Notice of meetings;


Agendas;











7











Reporting



















8




9


1. Calling meetings






meeting.


Joint Committee (or, if they are not available, the Vice Chair) at least seven working

days before the meeting.

3. Chair of Meeting






If both the Chair and Vice Chair are absent, or are disqualified from participating, or

there is neither a Chair nor Vice Chair of the Joint Committee a Chair shall be


When the Joint Committee meets together with any or all of the other joint

committees of CCGs in South East London, one of the chairs shall be appointed to

administratively chair the meeting.






10





for review of the reasonableness of the decision to suspend the Standing

Orders.






6. Minutes




the next meeting of the Joint Committee.


CCG’s website. Minutes of meetings or parts of meetings from which members

of the public are excluded shall not be made public.




8. Confidentiality



Terms of Reference.

Enc E

1 | P a g e

NHS Greenwich Clinical Commissioning Group

“The CCG”


Terms of Reference

Introduction













Statutory Framework



2





Purpose













quality of primary care) within the Act within the London Borough of Greenwich.



meet together






appropriate;



3







Framework (QOF);





and
























4















Membership












members) comprising






seniority.

5
















Quorum








Decision Making







6












the Joint Committee

Procedure



Notice of meetings;


Agendas;













7









Reporting




















8



9


1. Calling meetings






meeting.




3. Chair of Meeting

















10











6. Minutes











8. Confidentiality



Terms of Reference.

Enc F

1 | P a g e

NHS Lambeth Clinical Commissioning Group

“The CCG”


Terms of Reference

Introduction













Statutory Framework




2




Purpose













quality of primary care) within the Act within the London Borough of Lambeth.



meet together






appropriate;



3







Framework (QOF);





and
























4















Membership












members) comprising






seniority.

5
















Quorum








Decision Making







6












the Joint Committee

Procedure



Notice of meetings;


Agendas;













7









Reporting




















8



9


1. Calling meetings






meeting.




3. Chair of Meeting

















10











6. Minutes











8. Confidentiality



Terms of Reference.

Enc G

NHS Lewisham Clinical Commissioning Group

“The CCG”

“Primary Care Co-Commissioning Committee”

Terms of Reference

Introduction










committee to be known as the Primary Care Co-Commissioning Committee

(“PCCC”). The PCCC is a co commissioning committee of the Governing Body with

full representation from NHS England.

Statutory Framework





2



Purpose

The role of the PCCC shall be to work jointly with NHS England and collaboratively

with Clinical Commissioning Groups in South East London, namely:











quality of primary care) within the Act within the London Borough of Lewisham.

The PCCC remit includes areas such as:





appropriate;









Framework (QOF);

3





and


In particular the PCCC will support the Governing Body in fulfilling the following

functions and duties, to:



















In performing its role the PCCC will exercise its management of the functions in

accordance with the agreement entered into between NHS England and the CCG

(“the Agreement”), which will sit alongside the delegation and this terms of reference.

The Agreement will support information sharing, resource sharing, contractual

mechanisms for service delivery (and ownership) and interplay between contractual

and performers list management.


The PCCC is authorised by the Governing Body to:

4









Membership

The PCCC shall consist of:

Three “independent” members, one from each of NHS Lewisham Clinical

Commissioning Group; NHS Greenwich Clinical Commissioning Group; NHS

Bexley Clinical Commissioning Group; comprising:

o A lay member who has qualifications, expertise or experience such as

to enable the person to express informed views about Governance;

o A secondary care specialist;

o A Registered Nurse who is also a member of the Governing Body of

one of the above-named CCGs.







members) comprising






seniority.

The Chair of the PCCC shall be the independent member from the CCG.

The Vice Chair of the PCCC shall be the Accountable Officer of the CCG. When

meeting in common with other PCCCs a single meeting chair will be agreed between

5

the individual Committee chairs by agreement or simple majority vote, in the event of

a tie the NHS England member will cast a vote for one of the tied candidates.









Quorum


attendance of at least 50% of the voting members of the PCCC rounded up to the

next whole number present at the meeting. This must include the voting member

from NHS England.




Decision Making

The PCCC will make decisions within the bounds of its remit.

Each voting member of the PCCC shall have one vote. The PCCC shall reach

decisions by a simple majority of members present, but with the Chair having a

second and deciding vote if necessary.

NHS England will have one vote plus a veto where it would otherwise breach its

statutory duties or agreed national NHS England policy.


6

Procedure

The PCCC shall adopt the Standing Orders set out in Schedule 1 to these Terms of

Reference. The Standing Orders will include provision for the following:

Notice of meetings;


Agendas;



Meetings of the PCCC shall normally be held in public. However, the PCCC may

resolve to exclude the public from a meeting that is open to the public (whether

during the whole or part of the proceedings) whenever publicity would be prejudicial

to the public interest by reason of the confidential nature of the business to be

transacted or for other special reasons stated in the resolution and arising from the

nature of that business or of the proceedings or for any other reason permitted by the

Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from

time to time.

Members of the PCCC have a collective responsibility for the operation of the PCCC.

They will participate in discussion, review evidence and provide objective expert input

to the best of their knowledge and ability, and endeavour to reach a collective view.

The PCCC may call additional experts to attend meetings on an ad hoc basis to

inform discussions.

Members of the PCCC shall respect confidentiality requirements as set out in the

Standing Orders in Schedule 1.



Reporting

The CCG will ensure a person shall act as Secretary to the PCCC and will:

Circulate the minutes and action notes of the PCCC to all members within five

working days of any meeting of the PCCC;

7

Report the proceedings of each meeting of the PCCC (which will include a

presentation of the minutes and action notes of the PCCC) to the next

meeting of the Governing Body and to NHS England


the PCCC which will be presented to NHS England and the Governing Body

every two months for information.





annual basis, reflecting the experience of the PCCC in fulfilling its functions and the

wider experience of NHS England and the CCG in primary medical services co-

commissioning. These Terms of Reference may be amended by mutual agreement

between NHS England and the Governing Body at any time to reflect changes in

circumstances which may arise.

Withdrawal from the PCCC

The CCG may withdraw from the PCCC in accordance with a decision made under

its constitution.

8


1. Calling meetings

Ordinary meetings of the PCCC shall be held at regular intervals at such times

and places as the PCCC may determine.




meeting.


PCCC (or, if they are not available, the Vice Chair) at least seven working days

before the meeting.

3. Chair of Meeting

At any meeting of the PCCC the Chair of the PCCC shall preside. If the Chair is

absent from the meeting, the Vice Chair, if any and if present, shall preside.



If both the Chair and Vice Chair are absent, or are disqualified from participating, or

there is neither a Chair nor Vice Chair of the PCCC a Chair shall be chosen by the

members present, or by a majority of them, and shall preside.








9



for review of the reasonableness of the decision to suspend the Standing

Orders.



recorded in the minutes of the PCCC’s meetings. The names of all members of

the PCCC and all non-voting attendees present shall be recorded in the minutes

of the PCCC meetings.

6. Minutes




the next meeting of the PCCC.

The minutes of the PCCC will be made available to the public on the CCG’s

website. Minutes of meetings or parts of meetings from which members of the

public are excluded shall not be made public.



interest policy, which shall be applied mutatis mutandis to the PCCC.

8. Confidentiality

Meetings of the PCCC shall be held in public save where the PCCC resolves to

exclude the public from a meeting in accordance with the Terms of Reference.

Enc H

1 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland

The best possible health outcomes for Southwark people

NHS Southwark Clinical Commissioning Group

“The CCG”


Terms of Reference

Introduction

In May 2014 NHS England invited Clinical Commissioning Groups (CCGs) to expand their

role in primary care commissioning and to submit expressions of interest setting out their

preference for how they would like to exercise expanded primary medical care

commissioning functions. One option available was that NHS England and CCGs would co-

commission primary medical services.

One of the aims of co-commissioning is to help align the commissioning system and to

develop better integrated out of hospital services based around the diverse needs of local

populations.



Committee”). The Joint Committee is a co commissioning committee of the Governing Body

with full representation from NHS England.

Statutory Framework

The National Health Service Act 2006 (as amended) (“NHS Act”) provides, at section 13Z,

that NHS England’s functions may be exercised jointly with a CCG, and that functions

exercised jointly in accordance with that section may be exercised by a joint committee of

NHS England and the CCG. Section 13Z of the NHS Act further provides that arrangements

made under that section may be on such terms and conditions as may be agreed between

NHS England and the CCG.

Enc H



Purpose

The role of the Joint Committee shall be to work jointly with NHS England and in association

with Clinical Commissioning Groups in South East London, namely:







to carry out the functions relating to the commissioning of primary medical services under

section 83 of the NHS Act except those relating to individual GP performance management,

which have been reserved to NHS England and those functions relating to primary Care,

(including the duty to support NHS England improve the quality of primary care) within the

Act within the London Borough of Southwark.

In order to facilitate joint learning and for the system to be as effective and efficient as

possible the joint committees of the six CCGs in south east London will usually meet

together.


planning (including carrying out needs assessments) primary medical care services

for the geographical area in question;


co-ordinating a common approach to primary care commissioning as appropriate;



GMS, PMS and APMS contracts (including the design of PMS and APMS contracts,

monitoring of contracts, taking contractual action such as issuing breach/remedial

notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and “Directed

Enhanced Services”);

Enc H




Framework (QOF);




Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes); and


In particular the Joint Committee will support the Governing Body in fulfilling the following

functions and duties, to:

Act, when exercising its functions to commission health services, consistently with

the discharge by the Secretary of State and NHS England of their duty to promote a

comprehensive health service and with the objectives and requirements placed on

NHS England through the mandate published by the Secretary of State before the

start of each financial year and in line with the JSNA and direction of the local Health

and Wellbeing Board strategy;





Promote the involvement of patients, their carers and representatives in decisions

about their healthcare;



Act with a view to promoting integration of both health services with other health

services and health services with health-related and social care services where the

CCG considers that this would improve the quality of services or reduce inequalities.

In performing its role the Joint Committee will exercise its management of the functions in

accordance with the agreement entered into between NHS England and the CCG (“the

Agreement”), which will sit alongside the delegation and these terms of reference. The

Agreement will support information sharing, resource sharing, contractual mechanisms for

service delivery (and ownership) and interplay between contractual and performers list

management.

Enc H





Carry out its functions within the financial limits set by the Governing Body in relation

to CCG funds as agreed from time to time


To obtain outside legal or other independent professional advice and to secure the

attendance of outsiders with relevant experience and expertise if it considers this

necessary.

Meet in common with the primary care commissioning committees of the other

Clinical Commissioning Groups in South East London listed above

Membership


The Lay Member for PPI of the CCG/ Lay Member for Quality of Commissioned

Services

The lay member who has qualifications, expertise or experience such as to enable

the person to express informed views about Governance;

The secondary care specialist OR the Registered Nurse who is also a member of the

Governing Body of the CCG.

The Accountable Officer of the CCG/ Nominated Deputy


Another GP who sits on the governing body from a member practice of the CCG (this

should be a different practice to the CCG Chair)

Three members from NHS England (two of whom will be non-voting members)

comprising

o The Medical Director for South London or a named deputy of appropriate seniority;

o The Director of Commissioning Operations or a named deputy of appropriate seniority;

o The Director of Primary Care or a named deputy of appropriate seniority.

The Chair of the Joint Committee shall be the Lay Member for PPI of the CCG/ Lay Member

for Quality of Commissioned Services.

Enc H



The Vice Chair of the Joint Committee shall be the lay member who has qualifications,

expertise or experience such as to enable the person to express informed views about

Governance of the CCG. When meeting in common with other Joint Committees a single

meeting chair will be agreed between the individual Committee chairs by agreement or

simple majority vote, in the event of a tie the NHS England member will cast a vote for one

of the tied candidates.

A member who cannot attend a meeting will be expected to arrange and brief a nominated

deputy to attend and exercise the full powers of the member they represent at the meeting.

It is essential that members brief their deputies on the business to be transacted.

Persons in attendance but without voting rights may include other Governing Body members

and employees of the CCG as required.

A standing invitation will be issued to the local Healthwatch, Local Medical Committee and

Health and Wellbeing Board, who may attend but not vote.

Quorum

The quorum required for any business to be transacted at a meeting is the attendance of at

least 50% of the voting members of the Joint Committee rounded up to the next whole

number present at the meeting. This must include the voting member from NHS England.

Where a quorum cannot be convened from the membership, owing to arrangements for

managing conflicts of interests or potential conflicts of interest, the Chair of the meeting will

comply with the conflicts of interest policy.

Decision Making


Each voting member of the Joint Committee shall have one vote, except where a decision

relates to a statutory function of either NHS England or the CCG as provided for below. The

Joint Committee will always strive for consensus in decision making and will reach decisions

by a simple majority of members present, but with the committee Chair having a second and

deciding vote if necessary.


Enc H





A nominated CCG member of the Joint Committee will have a casting vote on any decision

pertaining to one of the CCG’s statutory functions that has been included within the scope of

the Joint Committee.

The NHS England vote will be weighted to equal the total number of votes held by the CCG

at any meeting where decisions pertaining to NHS England Statutory Functions are taken.

NHS England members will have the casting vote for any decision pertaining to one of the

NHS England’s statutory functions that has been included within the scope of the Joint

Committee

Procedure

The Joint Committee shall adopt the Standing Orders set out in Schedule 1 to these Terms

of Reference. The Standing Orders will include provision for the following:

Notice of meetings;


Agendas;




Committee may resolve to exclude the public from a meeting that is open to the public

(whether during the whole or part of the proceedings) whenever publicity would be

prejudicial to the public interest by reason of the confidential nature of the business to be

transacted or for other special reasons stated in the resolution and arising from the nature of

that business or of the proceedings or for any other reason permitted by the Public Bodies

(Admission to Meetings) Act 1960 as amended or succeeded from time to time.

Members of the Joint Committee have a collective responsibility for the operation of the Joint

Committee. They will participate in discussion, review evidence and provide objective expert

input to the best of their knowledge and ability, and endeavour to reach a collective view.

Enc H



The Joint Committee may call additional experts to attend meetings on an ad hoc basis to

inform discussions.

Members of the Joint Committee shall respect confidentiality requirements as set out in the

Standing Orders in Schedule 1.



Reporting


Circulate the minutes and action notes of the Joint Committee to all members within

five working days of any meeting of the Joint Committee;

Report the proceedings of each meeting of the Joint Committee (which will include a

presentation of the minutes and action notes of the Joint Committee) to the next

meeting of the Governing Body and to NHS England

Produce an executive summary report which sets out the decisions made by the

Joint Committee which will be presented to NHS England and the Governing Body

every two months for information.




These Terms of Reference shall be reviewed by the Governing Body on at least an annual

basis, reflecting the experience of the Joint Committee in fulfilling its functions and the wider

experience of NHS England and the CCG in primary medical services co-commissioning.

These Terms of Reference may be amended by mutual agreement between NHS England

and the Governing Body at any time to reflect changes in circumstances which may arise.


The CCG may withdraw from the Joint Committee in accordance with a decision made under

its constitution.

Enc H




1. Calling meetings

Ordinary meetings of the Joint Committee shall be held at regular intervals at such times

and places as the Joint Committee may determine.


All Agenda items and relevant papers will be circulated to members and published on the

website of the CCG at least 5 working days in advance of the meeting.

The Agenda will be prepared by the Secretary and approved by the Chair of the Joint

Committee (or, if they are not available, the Vice Chair) at least seven working days

before the meeting.

3. Chair of Meeting

At any meeting of the Joint Committee the Chair of the Joint Committee shall preside. If

the Chair is absent from the meeting, the Vice Chair, if any and if present, shall preside.

If the Chair is absent temporarily on the grounds of a declared conflict of interest the Vice

Chair, if present, shall preside.

If both the Chair and Vice Chair are absent, or are disqualified from participating, or there

is neither a Chair nor Vice Chair of the Joint Committee a Chair shall be chosen by the

members present, or by a majority of them, and shall preside.

When the joint committee meets together with any or all of the other joint committees of

CCGs in south east London one of the chairs shall be appointed to administratively chair

the meeting


Except where it would contravene any statutory provision or any direction made by the

Secretary of State for Health or NHS England, any part of these Standing Orders may be

suspended at any meeting, provided at least two-thirds of the members are in

agreement.

Enc H



A decision to suspend Standing Orders together with the reasons for doing so shall be

recorded in the minutes of the meeting.

A separate record of matters discussed during the suspension shall be kept. These

records shall be made available to the Governing Body’s audit committee for review of

the reasonableness of the decision to suspend the Standing Orders.


The names of all members of the meeting present at the meeting shall be recorded in the

minutes of the Joint Committee’s meetings. The names of all members of the Joint

Committee and all non-voting attendees present shall be recorded in the minutes of the

Joint Committee meetings.

6. Minutes

The minutes of the proceedings of a meeting shall be drawn up by the Secretary and

submitted for agreement within 5 business days of the meeting and they will be

confirmed as a true record of the meeting by the Chair and others present at the next

meeting of the Joint Committee

The minutes of the Joint Committee will be made available to the public on the CCG’s

website. Minutes of meetings or parts of meetings from which members of the public are

excluded shall not be made public.


Conflicts of interest shall be dealt with in accordance with the CCG’s conflict of interest

policy, which shall be applied mutatis mutandis to the Joint Committee.

8. Confidentiality

Meetings of the Joint Committee shall be held in public save where the Joint Committee

resolves to exclude the public from a meeting in accordance with the Terms of

Reference.

Enc I-K




ENCLOSURES I-K

Operating Model for Joint Commissioning in south east London CCGs

AUTHOR: Andrew Bland, Chief Officer, NHS Southwark CCG

SUMMARY: The operating model for joint commissioning of primary care south east London boroughs is presented for the committee’s consideration. This section comprises of three papers:

Enclosure I - MOU – core principles

Enclosure J - Overview of NHS England (London Region) – draft operating model;

Enclosure K – this document describes the responsibilities and partnership between each of the CCGs in South East London (CCGs) and NHS England for the operation of their Primary Care Joint Committees (PCJC) for each borough

KEY ISSUES: Nil


1. Consider the operating model of joint commissioning in south east London boroughs.

AUTHOR CONTACT: Name: Andrew Bland E-Mail: [email protected]


www.england.nhs.uk

Core Principles

V1.4

Primary Care Co-

Commissioning

Memorandum of

Understanding

Enc I

www.england.nhs.uk

• Two documents have been created in order to support clarity of understanding between parties entering co-commissioning arrangements and forms an agreement between the parties on how they will deliver primary care commissioning functions.

• MoU Core Principles (this document) aims to outline key pieces of information and act as a summary/ introduction to;

• MoU Roles and Responsibilities (accompanying excel doc) which outlines the key functions of Primary Care Commissioning and responsibilities of the various parties to enact them under the new arrangements

Introduction to the MOU

www.england.nhs.uk

The MOU is an agreement

• To set out the common purpose of the parties in delivering primary medical care functions at both joint commissioning and delegated commissioning levels;

• To set out the period of the relationship

• To describe the relationship between the parties;

• To set out how each party shall contribute to the delivery of primary care functions;

• To define the expected performance of each party;

• To agree how disputes or failures to perform shall be addressed.

Purpose of the MOU

www.england.nhs.uk

This document should be read in association with:

• Roles and Responsibilities MOU

• Scheme of Delegation for Level 3 Co-commissioning

• Local agreements for joint and integrated

arrangements that have been agreed by the Director

of Primary Care and relevant Accountable Officer

• Terms of Reference of Committees

• Next Steps towards Primary Care Co-commissioning

Associated Documents

www.england.nhs.uk

This document is intended for NHS England (London) and CCGs at both joint and delegated levels of commissioning

Separate documents may be created following local discussions to show variance between levels and local areas

Key terminology when reading these documents:

• “The Committee” refers to the decision making body. In joint commissioning this will include both CCG and NHS England representatives, in delegated this will be CCG only

• Level 2 /Joint Commissioning terms both refer to the co-commissioning option where NHS England and CCGs make joint decisions

• Level 3 / Delegated Commissioning terms both refer to full delegation of Primary Care Commissioning functions to the relevant CCGs

Terminology

www.england.nhs.uk

Enabling CCGs to have greater influence on decisions relating to primary medical care functions is intended to support the expansion and strengthening of primary care medical services. The purpose of primary care co-commissioning is to enable clinically led, optimal local solutions in response to local Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies by;

Harnessing CCG’s clinical insight and energy to drive changes in their local health systems;

Developing an integrated approach to improving healthcare by giving CCG’s greater say over the commissioning of both primary care;

Developing a more collaborative approach to designing local solutions for workforce, premises and information management and technology challenges.

In doing so the parties shall ensure

that CCG’s and Committees have access to a fair share of the area team’s primary medical care commissioning staff resources to deliver their responsibilities and manage outcomes;

The NHS Regional team retains a fair share of existing resources to deliver all their ongoing primary medical care commissioning responsibilities and manage outcomes;

All parties recognise and address potential conflicts of interest that may arise from the arrangements;

All parties endeavour to secure consensus for all decisions and changes to the memorandum of understanding and other operational agreements.

They share expertise and knowledge to enhance strategy, policy development and decision making; and

Develop integrated primary care commissioning teams

Common Purpose

www.england.nhs.uk

• The Operational agreement is intended to cover the

period between 1 April 2015 and 31 March 2016

• Parties shall agree any extension to the agreement by

1 September 2015

• Where any or all parties decide not to extend or to

withdraw from the agreement they shall give 6 months

notice of their intention.

Period of the Agreement

www.england.nhs.uk

The MOU is a bilateral agreement between;

• The NHS England London Regional Team

• London SPG’s and CCG’s Committees

It is not proposed that the MoU is used as a contractual document. It is proposed that it is agreed by both parties and confirmed in writing. CCGs will also be asked to sign an SLA (under development by National Teams)

It is anticipated that the parties shall endeavour to deliver their responsibilities through mutual consensus and common agreement that:

• recognises limits in resources;

• the need for each party to continue to meet their existing organisational commitments;

• that there will be competing priorities that shall be managed within existing resources

Relationship between the parties

www.england.nhs.uk

The NHS England regional team will continue to provide an operational contracting function on a fair share basis* to each SPG/CCG and Committee within the limits of their resources. This includes;

• Assessment and authorisation of national contract payments (includes QOF, DES and Premises);

• Ensuring systems and contracts are in place to make payments promptly and accurately;

• Undertaking Contract reviews and negotiation;

• Identifying risk in the provision of services;

• Making available policies, procedures and operating approaches

• Making available GP services to support decision making and strategy development;

• Providing expert advice and guidance;

• Securing services (APMS, Advanced Services and DES)

• To undertake engagement and consultation with relevant stakeholders

• Providing data and information required to support delivery of primary care functions

• Provision of some tasks that have been delegated to CCG’s and SPGs

The Regional Team’s Responsibilities

* In the NHS England commissioing team structure allows for 8D and 8B support at each of the 5 SPG areas. The contracts team

will support across all areas and will not have geographical assignation, as agreed by SPG leads and NHS England

www.england.nhs.uk

A Committee* will be established to:

• Deliver primary medical care commissioning functions;

• Determine defined applications for changes to contractual arrangements;

• Make decisions to secure new services;

• Assess and make recommendations about the quality of GP services;

• Support and agree strategic development and implementation

• Ensure that resources are managed and utilised effectively.

Responsibilities of the Committee

* Either NHS England and CCGs if joint or CCGs only in delegated commissioning

www.england.nhs.uk

1. To make prompt and accurate payments to contractors

2. To make available, in a timely fashion to

Committees/CCG’s, any necessary information and data

to support decision making, planning and strategic

development

3. To respond to Provider queries and requests in a timely

manner;

4. To ensure that reports are clear and concise and contain

sufficient information to support decision making.

5. To act in accordance with Statutory Regulations, national

direction and guidance and local policy

Regional Team Performance Standards

Please note: further detail regarding KPIs to be agreed

www.england.nhs.uk

Standard Exclusion

1. Payments The RT shall submit monthly and quarterly payment

schedules for all practices to the PCSS in accordance

with the national timetable.

Where delays are due to services or

information provided by other parties

Where contractors submit invoices for

payments (APMS contracts)

2. Data and

Information

The RT shall acknowledge all requests for information

and data within 5 working days confirming when the

information will be reasonably be made available to the

CCG

Where the information or data is not

routinely collected as part of contract

management

Where it has not been validated by

providers

3. Queries The RT shall acknowledge all queries within 5 working

days and shall endeavour to provide a full response or

an update with 20 working days.

Where further investigations are

required

Where the query relates to activities

or functions outside the responsibility

of the area team

4. Reports Reports to be provided in accordance with the TOR of

the Committee

Where a decision is required urgently

in order to maintain patient safety or

service continuity

RT Quantified Standards

www.england.nhs.uk

• To make decisions in a timely manner, ensuring continuity of safe and adequate services;

• To issue clear and concise notification of their decisions

• To act in accordance with Statutory Regulations, national direction and guidance and local policy;

• To act in fair and proportionate manner;

• To be transparent in all business conduct and decision making and

• To manage conflicts of interest

Committee Performance Standards

Please note: further detail regarding KPIs to be agreed

www.england.nhs.uk

• The RT shall appoint a Lead [Head of Primary Care] to liaise with and manage the relationship with each Joint Committee or Delegated CCG/SPG

• The RT Lead will support and contribute to joint and integrated working arrangements

• The RT Lead shall provide feedback to the RT, Joint Committees and Delegated CCG/SPG about the performance under the MOU, highlighting areas of concern or potential improvement

• All parties shall meet quarterly to review and revise the arrangements by mutual consent, (ref MOU user Group).

• Innovation and good practice shall be discussed and disseminated via quarterly meetings

Implementation and Review

www.england.nhs.uk

• Each party shall act in a reasonable and consensual manner to address failures, risks or concerns under the agreement;

• Where there are failures to perform each party will ensure that steps are taken to remedy any system failure, providing support and expertise where needed;

• Where concerns or failures cannot be resolved by mutual consent they shall be referred to a panel established by both parties who shall determine how the matter can be resolved in order to ensure safe and effective delivery of primary care functions

• It is likely this will include

• Out of area lay members (e.g. 2)

• A CCG accountable officer not related to the area in question

• A Senior NHS England resource not related to the area

• All parties shall be bound by the resolution process

Escalation Processes

www.england.nhs.uk

A Panel will be established to review and resolve any

concerns or failures under the MOU that have not be resolved

through mutual consent. Any decision will be binding to all

parties. The Panel will consist of the following membership:

• Two Committee lay members

• A Senior NHS England Director

• A CCG Accountable Officer/ Clinical Chair

Where possible the members shall not be from a AT, SPG or

CCG associated with the concern or failure

Resolution Panel

South East London’s CCGs and NHS England Primary Care Joint Committees South East London’s CCGs and NHS England Primary Care Joint Committees

Overview of NHS England (London Region) Draft Operating Model: Co-commissioning of

Primary Care Version 5 11 June 2015

1

Draft work in progress

Enc J

South East London’s CCGs and NHS England Primary Care Joint Committees

Defining Primary Care Co-Commissioning for SEL CCGs

2

Co-commissioning for primary care refers to the increased role of CCGs in the commissioning, procurement, management and monitoring of primary medical services contracts, alongside a continued role for NHS England.

In South East London each CCG has opted for Level 2 Joint Commissioning with the NHS England (London).

NHS England and the CCG form a “joint committee” (in South East London

the six ‘joint committee’ will meet in common) to support commissioning of

primary care. Together they vary/ renew existing contracts for primary care,

and commission services. They can also take action to, for example, design

local incentive scheme as an alternative to the Quality and Outcomes

Framework (QOF) or Directed Enhanced Services (DES).

Incr

easi

ng

CC

G c

on

tro

l Draft work in progress


Responsibility remains with NHS England

At all levels of co-commissioning, NHS England will retain a role in supporting delivery of commissioning and contracting functions. Moreover, the following responsibilities will remain with NHS England and will not be included in joint or delegated committees:

• Continuing to set nationally standing rules to ensure consistency and delivery goals outlined in the Mandate set by government.

• The terms of GMS contracts and any nationally determined elements of PMS and APMS contracts will continue to be set out in the respective regulations/ directions.

• Functions relating to individual GP performance management (medical performers’ lists for GPs, appraisal and revalidation).

• Administration of payments to GPs.

• Patient list management will remain with NHS England.

• Capital expenditure functions.

3


Section 1.5 - “Responsibilities remaining with NHS England”, Operating Model: Co-commissioning of Primary Care v5, P.7


Decision making scope of the Joint Committee

4

# Type of decision Description Committee requirement

1 Decisions to be

made at the

committee

The committee is

required to make a

decision

Evaluate the information provided

Make a decision

Review and support implementation of decision

2 Decisions clear

under approved

policy

Some activities do not

require a ‘decision’

because the action

required is dictated by

approved policy

[In one of the first committees] Note the appropriate

national policies

[In one of the first committees] Agree any local policies that

will determine when decisions are brought to the

committee

Review reports into the committee regarding actions taken

under these policies

3 Urgent decisions

which cannot

wait till the next

committee

There will be some

instances where a

decision needs to be

made in a time frame

which means it cannot

be decided in the

committee meeting.

[In one of the first committees] Agree the types of decisions

which are permitted to be made out of the committee

[In one of the first committees] Agree the method of

decision making in urgent situations

Review reports into the committee regarding decisions

made through the urgent process

Comment and adjust future processes if necessary

Wherever possible, policies should be built up to document

agreed processes.


Note: In all decision making CCGs / NHS England will seek to maximise the involvement and engagement of the other party as far as circumstances / governance allows


Functions which will now be decided in the joint committee (Formerly NHS England) :

5

Name Function Estimated

volume of

activity

across

London

(12 mths)

Committee

decisions

needed

Decision

possible with

approved

policy

Need for

urgent

decisions

Pro

cess

1

Determination

of key decisions

or requests

List Closure 20

Practice mergers/ moves 100

Boundary Changes 20

Securing services through APMS contracts 40

PMS (reviews etc) Ongoing

Discretionary Payments 600

Remedial and breach notices (Actual)

Contract termination-e.g Death/ Bankruptcy/

CQC

(Actual)

Contractual changes (contentious/ important) 100

Contractual changes (transactional) 650

Pro

ce

ss 2

Financial

Processes

Ensuring budget sustainability Ongoing

Management Accounting Ongoing

Pro

cess

3

Strategy &

Policy

Securing quality improvement Ongoing

Developing and agreeing outcome framework

e.g. LIS

70

Securing consistent population based provision

of advanced and enhanced services

50

Premises plans, including discretionary funding

requests

200



Decision making in the Joint Committee

Exactly how each Committee structures its decision making processes must be agreed by the Committees themselves. However, there are several key principles, such as the requirement for there to be considerable engagement between NHS England and the CCGs outside of the committee.

The following high level process flows have been created to demonstrate how we expect decisions might be made under co-commissioning.

Decisions made by the Committee (Process 1)

Some joint discussion and pre-work will be required in all decision making processes, but for decisions that are made by the Committee, it is likely that additional input will be required from both the CCG and NHS England in order to conduct the necessary preparation and where appropriate a recommendation into the committee, this is illustrated at the blue arrow, “Engagement process”, in the process outlined on the next slide .

Decisions that can be made by agreed policy (Process 2)

As set out in slide 4, there is a likelihood that Committees will wish to prioritise the Primary Care matters they choose to focus on. The Primary Care Committee’s scope listed above contains elements where it is unlikely that a decision is required from the Committee, either because there is clear National or other policy which clarifies what action should be taken in different circumstances, or because the events are sufficiently high volume/ low risk, as to not be of sufficient concern to scrutinise in Committee meetings (for instance, minor transactional change to contracts).

6



Process 1: Process map showing basic process for making decisions under co-commissioning

7


Engagement between

committee, NHSE, and sub-groups as

necessary


Process 2: Process map for making decisions by agreed policy

8


“Figure 4: Process map for making decisions by agreed policy”, Operating Model: Co-commissioning of Primary Care v5, P.12


Process 3: Process map for urgent decision-making

It is important that the committee agree which decisions can be made in this way, the criteria required and the processes/ guidance for making these decisions. It may be appropriate that there are two levels of urgent decision making processes:

• A decision making sub-committee

• The Director of Primary Care is used for immediate and necessary decisions.

Whichever of these two is enacted, as the process map below illustrates, any decision that is taken in this way will have to be fed back into the next Committee who will then be able to understand the reasons that the conclusion was reached.

9



Other decision-making processes – finance and strategy

For Joint Committees, NHS England will continue to do all financial and management accounting. However, it will produce monthly financial reports (for instance, covering spending against forecast and narrative on variance) for these Committees, which will allow them to take decisions on budget management – ensuring financial balance.

Finance reports will be received and considered alongside CCG ‘Business As Usual’ committees to provide a system position to co-commissioners.

10

Process 4: Process map showing financial processes



Process 5: Process map for strategy and policy processes

11



Other potential Committee responsibilities

In addition to the above standard processes, there are other Primary Care elements which the Joint Committee is expected to be involved in. Some of these areas are listed below.

Figure 6: Other potential Committee responsibilities

12

Item Committee Requirement

Appeals and disputes Responsible for agreeing a policy and procedure for managing appeals and disputes submitted by GPs in relation to their

GP contract.

Counter Fraud Ensuring that proper processes are in place to prevent fraud within the NHS

Interpreting services Ensure that patients can interpret services when using GP practices

Freedom of Information

requests

Signing off FOI requests

Occupational Health The committee shall ensure that GPs have access to occupational health services in accordance with national guidance

Controlled drugs

reporting

The Committee is responsible for ensuring that practices are complying with legal requirements for use of controlled

drugs and that CCGs and NHSE have proper controls in place to maintain patient safety. The RT will carry out reporting,

analysis and compliance that aids this.

Safeguarding To ensure that GP Practices have effective safeguarding systems in place in accordance with statutory requirements,

national guidance and Pan London Policy/ Procedures. The CCG will proactively support Primary Care to improve well-

being of children and adults, providing assurance to NHSE, whose role it is to ensure compliance with safeguarding

standards.

Incident management For both serious and non-serious incident management, the Committee is responsible for ensuring that there are proper

processes in place for the reporting and review of incidents, so that they can be identified and managed. The CCG and

NHS E will support and contribute to investigations, as required.

Domestic Homicide

Reviews

The Committee will ensure that GPs contribute to domestic homicide reviews, where necessary. The CCG and NHS

England will support this where their resources are appropriate.



Governance and Membership

Committee constitution

While much of the decision-making processes will be determined by Committees/ Joint Committees, the constitution of the Committees themes have been set by NHS England, as a condition of co-commissioning.

Other Committee attendees

In the interests of transparency and the mitigation of conflicts of interest, a local Health Watch representative and a local authority representative from the local Health and Wellbeing Board will have the right to join the joint committee as non-voting attendees. This will help to support alignment in decision making across the local health and social care system.

Please refer to the MOU NHSE London “Primary Care Co-Commissioning Memorandum of Understanding Core Principles V1.4”

13



Meeting in private:

As standard, the Committee meetings will be held in public. However, the Committee may require to close part of the meeting on account of the matters to be discussed. It may be appropriate for the committee to seek the views of the audit chairs once a definition of this policy has been created for each committee. Below are some criteria which Committees may wish to consider:

• Whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings; or

• If the discussion is commercially sensitive; or

• Where the matter being discussed is part of an ongoing investigation; or

• For any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

Otherwise, Members of the Committee shall respect confidentiality requirements as set out in the CCG Constitution and Standing Orders.

14



Voting in the Joint Committee

The Committee should aim wherever possible to make decisions by consensus. However, where this is not achieved, a voting method will need to be used.

The voting process will determined by a simple majority of members present. Absent members will not be allowed to vote – unless agreed with the Chair beforehand.

Each “voting” member of the Committee will have one vote, and the voting power of each group (CCG members and NHSE staff) should amount to 50% of all voting power. This can be achieved by either:

• Selecting voters, so that the number of NHSE voters is equal to the number of CCG voters; or by

• Weighting the votes of either side, so that each group represents 50% of total voting power.

In cases where the vote has not determined an outright decision, the Chair will have a second, deciding vote. The Committee can only take decisions if Quorate is reached.

Assurance

Both NHS England and CCGs will also have a casting vote, in cases where their statutory objectives might be undermined. In Joint Co-Commissioning Committees, this casting vote can be used during the voting process.

15


Section 4.3 - “Voting process”, Operating Model: Co-commissioning of Primary Care v5, P.17

Enc K

Co-commissioning of Primary Care


DOCUMENT CONTROL

Version Date Amendments Approved by:

Version 1.0

01 June 2015

Established

Andrew Bland

Version 1.1

11 June 2015 PCJC

Operating Models and arrangements in support of Primary Care Joint Committees in South East

London

This document describes the responsibilities and partnership between each of the CCGs in South East London (CCGs) and NHS England for the operation of their

Primary Care Joint Committees (PCJC) for each borough

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1. Background South east London CCGs are well placed to improve the commissioning of general practice and primary care. Each CCG has agreed to work together in joint commissioning arrangements with NHS England London Regional Team from 1 April 2015. In this way CCGs will develop capacity, capability and expertise to commission general practice. This will ensure improvement at scale and pace in line with the local strategic plans of each CCG and the development and delivery of Our Healthier South East London – the five year strategic plan. By meeting together and working in collaboration the CCGs have enhanced their ability to manage potential risks such as conflicts of interest and resource pressures, actively learn from one another and collaborate at a scale greater than one borough when it is in the best interests of patients and residents to do so. CCGs will also have the opportunity to align primary care development initiatives, contracting and investment for out-of-hospital care with general practice and primary care. The Five Year Forward View, published by the leadership of the NHS in England, sets out the ambition for general practice and out-of-hospital services to be joined up in new models of care and organisational forms. Those ambitions are reflected in our local plans and will benefit from a new system focused platform for commissioning. CCGs are set up with the remit to understand the needs of their populations, and recognise the specific demand pressures on general practice and primary care. As the ‘new deal for primary care’ evolves, CCGs will be able to ensure that new investment is channelled effectively to improve patient care.

2. Purpose and scope

This document, ‘Operating Models and arrangements in support of Primary Care Joint Committees in South East London’ details how the six PCJCs for primary care co-commissioning across the six boroughs will function individually and when meeting together. This document describes the understanding and expectations each member and representative party agrees to at the outset of the PCJC, which meets for the first time on 11 June 2015. The document also describes the supporting arrangements and decision making or working groups that will support the committees in their effective undertaking of their responsibilities. It sets out the expected relationships, roles and responsibilities between each of the six clinical commissioning groups (CCGs) in South east London and NHS England London Regional Team:

NHS Bexley CCG

NHS Bromley CCG

NHS Greenwich CCG

NHS Lambeth CCG

NHS Lewisham CCG

NHS Southwark CCG

NHS England London Regional Team (RT) The document also describes the roles and responsibilities of other non-voting attendees of the PCJC.

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This document is specifically for the purpose of the six south east London PCJCs for primary care co-commissioning, for those primary medical services as outlined in the six CCG Primary Care Joint Committee Terms of Reference. The PCJCs have been set up to act as a decision making body, where NHS England London Regional Team and CCGs will discuss wider issues about primary care commissioning and make joint decisions. This document will be reviewed and amended accordingly at appropriate intervals as the PCJCs instruct. It should be read and considered alongside the:

Terms of Reference of each PCJC (Papers B-H)

The Primary Care Co-commissioning Memorandum of Understanding Core Principles (Paper I)

The Draft Operating Model: Co-commissioning of Primary Care (Version 5) (Paper J)

3. JC remit and structure As described in the Terms of Reference for each borough’s committee, the PCJCs are responsible for the selected functions for commissioning primary medical services for their populations. These are set out below.

Figure 1: Table showing former NHS England functions that will now be decided in the committee

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Additional functions can be included within the scope of the PCJC, where this is agreed by the CCG Governing Bodies and NHS England. For additional information on the agreed process for decision making in reference to the above figure 1, please see Future Operating Model: Co-commissioning of Primary Care v5, NHS England. This document relates only to the exercising of PCJC functions outlined at figure 1. Exceptions will be dealt with in the context of the PCJC, as already provided for in the voting provisions of the committee Terms of Reference. Exceptions to approvals at PCJC level occur, where NHS England exercises their statutory duties (which in theory could be contrary to the collective view of the PCJC). Where an area of discussion fulfills the criteria of a Reporting Exception, the agreed process and a standard report template will be completed. Where this criteria is reached, this will be discussed more thoroughly at the PCJC. Each borough based committee will take decisions or make recommendations in accordance with their particular remit. Where committees are considering the same issue in more than one borough those relevant committees may consider the decision together but will make their own decisions.

The PCJC will consist of: Voting Members:


The lay member who has qualifications, expertise or experience such as to enable the person to express informed views about Governance;

The secondary care specialist OR the Registered Nurse who is also a member of the Governing Body of the CCG.



Another GP who sits on the governing body from a member practice of the CCG (this should be a different practice to the CCG Chair)

Three representatives (two of whom will be non-voting) from NHS England London Regional Team, as follows: the South London Medical Director, the Director of Commissioning Operations and Head of Primary Care (or a named deputy of appropriate seniority for any of these representatives)

Non-voting attendees:

A representative from Healthwatch

A representative from the local Health and Wellbeing Board

A representative from the local medical committee

4. Membership of the PCJC The principles of membership include:

Each member has a responsibility to represent the views and interests of their organisation under their statutory responsibilities, balancing the interests for patients and public in their borough as a whole, with the principal aim to improve primary care services across that borough and reduce health inequalities which result from variations in quality and access to primary care.

Each member is responsible for considering and identifying any individual interests as per their CCG’s conflict of interest policy, and must declare these to the PCJC

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membership at the beginning of the meeting. Conflicts of interest should be reviewed at each meeting. Conflicts of interest may arise from any member of the JC including non-voting attendees. Each member and non-voting attendee has a responsibility to safeguard against the risk to the business of the PCJC, both through actual and perceived conflicts of interest.

A Register of Interests will be maintained for members and non-voting attendees of the PCJC and its working groups as part of the CCG’s overall register.

The PCJC membership consists of voting and non-voting attendees.

Chair and Vice-Chair

The Chair and Vice Chair of the committee must be CCG Lay Members Role of NHS England London Regional Team Members

Three representatives of NHS England London RT, as follows: the Medical Director, Area Director and Head of Primary Care (or a named deputy of appropriate seniority for any of these representatives)

The NHS England London RT will appoint a Lead (Head of Primary Care) to liaise with and manage the relationship with the PCJC as per the NHS England

The responsibilities of the NHS England London Regional Team and PCJC are outlined in the NHS England Primary Care Co-Commissioning Memorandum of Understanding Core Principles V1.4.

Role of CCG Members

Six representatives from each CCG; this must include at least one Lay Member and can include the CCG Chair, Chief Officer and Lay Member

The membership will meet the requirements of each of the named CCGs’ constitutions

The Chief Officer of each CCG is responsible for reporting out from the PCJC to their Governing Body according to their usual processes for Governing Body committees

Role of Lay Members

All lay members on the PCJC are recommended to attend the national lay member training and should be able to demonstrate a good understanding of the business of the PCJC, and governance and implications of the conflict of interest policy

A lay member cannot be Chair of the JC if they are also the Chair of their CCG Audit Committee

Role of Health and Wellbeing Board

The PCJC will include a representative from the amongst the Local authority members of the Health and Wellbeing Board as mandated in the NHS England guidance on primary care co-commissioning. The local authority Health and Wellbeing Board representative will foster strengthened relationships between health and social care agencies. Their input will support alignment in decision making across the local health and social care system and ensure that there is a more rounded local perspective offered in all PCJC discussions.

The role of the Local authority member of the Health and Wellbeing Board attendee is to provide information regarding the health and wellbeing needs of the community

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as reflected in Borough and Council JSNAs, and ensure that the outputs of the PCJC are fed back into their respective organisations.

Role of Healthwatch

The PCJC will include a representative from Healthwatch and Local authority member of the Health and Wellbeing Board as mandated in the NHS England guidance on primary care co-commissioning. Healthwatch is under no obligation to nominate a representative, but there would be mutual benefits from their involvement including greater transparency and wider use of local intelligence.

The Healthwatch representative will ensure that the patient and public voice is considered in any decision making undertaken at the PCJC level, including, but not limited to, those with direct or indirect implications for service change. They will represent the best interests of patients and ensure that the patient is central to all decision making.

It will be a responsibility of the Healthwatch representative to promote and provide robust challenge to initiatives aimed at improving the patient experience and health inequalities.

The role of the Healthwatch attendee is to ensure that the outputs of the PCJC are fed back into their respective organisation.

Role of Local Medical Committee

The PCJC will include a representative from the relevant Local Medical Committee and will represent the interests of GP providers who may be impacted by decisions taken at the PCJC. The LMC representative will promote a greater understanding of commissioning and associated commissioner responsibilities amongst the primary care workforce they represent.

Voting Process The JC should aim wherever possible to make decisions by consensus. However, where this is not achieved, the voting process will be determined by a simple majority of members present as agreed in the PCJCs’ Terms of Reference.

5. Governance arrangements

Conflicts of Interest

The PCJC will resolve all matters relating to conflicts of interest in line with the relevant CCG Conflicts of Interest Policy.

The PCJC (through the governance support) will establish and maintain a Register of Interests for all Members and regular attendees of the PCJC and its working groups. The Register will be made available for public scrutiny at each PCJC Meeting.

Each organisation will be responsible for ensuring that the entries for its representatives are accurate and up to date

At the start of each meeting the Chair of the meeting will ask for declarations of new interests and for declarations of interests relating to items on that meeting’s Agenda. All declarations will be recorded in the minutes of the meeting.

Any conflicts that are identified will be managed in line with the relevant CCG’s Policy.

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Chair of the meeting Where the more than one JCPC is meeting together the Chairs of those committees will nominate and agree a single Chair for the meeting

Standing Orders The JC will adopt the Standing Orders set out in the PCJC Terms of Reference.

PCJC work plan PCJC work plan will be developed and provided by NHS England and each CCG. This will be developed by the PCJC governance support in Quarter four of each year for the following year and signed off by the PCJC. Accountability and risk sharing arrangements including statutory roles In joint commissioning arrangements (level 2) individual CCGs and NHS England always remain accountable for meeting their own statutory duties, for instance in relation to quality, financial resources, equality, health inequalities and public participation. Therefore the PCJC will not replace the accountabilities of the individual organisations but will participate in joint decision making between NHS England and the CCG in regards to the agreed relevant functions of the PCJC. Financial accountability of co-commissioning primary care will rest with NHS England. NHS England will remain that statutory body who will hold the budget for Primary Care Medical Services. All decisions (for the functions outlined in figure 1) including those with financial implications, will be ratified in the PCJC or recommended where appropriate to the relevant sovereign body.

Reporting into the PCJC All papers are to be submitted through the PCJC governance support for each CCG. Reports must be presented to the PCJC through the normal reporting cycle and by the agreed deadlines. Late papers and tabled papers may only be submitted with the prior agreement of their individual CCG Chief Officer and the relevant PCJC Chair. Reports generated by the PCJC and/ working groups must be signed off by the executive lead for the working or delegated decision making group. The report must be presented to the PCJC through the normal reporting cycle and by the agreed deadlines. Late papers and tabled papers may only be submitted with the prior agreement of the executive lead of the individual working or delegated decision making group and the PCJC Chair. Reporting Out from the PCJC The minutes of Part 1 of each PCJC will be provided to voting members and non-voting attendees. This will allow minutes to be included in CCG Governing Body papers. Part 2 information will only be shared by members of the PCJC on a strict need to know basis and in keeping with the requirements of the Data Protection Act 1998 and the Freedom of Information Act 2000.

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The PCJC will provide a regular report to each meeting of the CCG Governing Body in public as a minimum and to non-voting attendees. The Report should include the relevant activities of and decisions made by the Committee. The minutes of the committee will also be made available at each meeting of the Governing Body in public. The Chief Officer of each CCG (or in their absence, another of the CCGs voting members of the PCJC) will provide a verbal summary of the work of the PCJC at each CCG Governing Body. Outside of the Governing Body meeting cycle the voting members of the PCJC will establish local arrangements for briefing their Governing Body colleagues, and other colleagues, as appropriate.

Decision making versus advisory role The decision making powers of the JC are set out in the PCJC Terms of Reference. Committees and any working groups do not have decision making powers and may only advise the PCJC unless otherwise determined by the Terms of Reference of the PCJC. Where a matter arises requiring urgent decision before the next timetabled PCJC meeting, but where a decision is not required within a week, then a decision may be made by a working group as outlined in the Future Operating Model: Co-commissioning of Primary Care v5, NHS England. Where this is required, the working group must act as an agent for the committee and their decisions should be reviewed after the fact to ensure that they appropriately reflect the decision which the committee would have made. CCG constitutional amendments allowing formation of a PCJC As part of the application process for joint commissioning each CCG ensured that their individual constitution enabled the formation and operation of the PCJC. CCGs will ensure, when making future amendments to their constitution, that their CCG will be made aware of any implications in regards to the operation of PCJC and not to make any amendments to their constitution which may have unintended consequences regarding the operation and governance of the PCJC. Procurement NHS England London Region will continue to provide specialist advice regarding primary care regulation and the contractual framework through joint working with the CCGs. Specialist procurement support will be required to be appropriately sourced by the responsible commissioning organisation for specific tendering actions. FOI requests and complaints handling The NHS England London Regional Team will remain responsible for managing primary care FOI Requests and Complaints. The team will receive and respond to enquiries and information requests on a daily basis. This includes but is not limited to:

Freedom of Information (FOI) requests

Complaints

Practice enquires

Core contract requirements

Calculating Quality Reporting Service (CQRS) support / claims enquires

Directly Enhanced Service (DES) enquiries

Patient enquiries

Internal enquiries / internal and external information requests

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Seeking legal advice as and when required.

Safeguarding Arrangements will be in accordance and compliant with national guidance on safeguarding, including:

Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework, March 2013, NHS Commissioning Board

Working Together to Safeguard Children, 2015, HM Government Information Governance The principles under which all members and non-voting attendees of the JC will operate in general are:

They will endorse, support and promote the accurate, timely, secure, effective and legal sharing of information to support the work of the CCG and are fully committed to ensuring that any handling of information by the committee and its initiatives is in accordance with their legal, statutory and common law duties.

Each individual committee member commits to ensuring they have robust information governance framework within their own organisation covering information security, confidentiality and compliance with key information legislation such as Data protection (1998), common law and human rights Act (1998). This also includes compliance with NHS standards and guidance such as Information Governance Toolkit, Caldicott principles and other codes of practices for handling information.

Where there are specific data requirements to support projects, services or functions resulting from the work of the joint committee and their working groups, the following is recommended ( To cover Direct Care or Indirect Care purposes);

o The specifications of the data requirements of the project, service or function will be referred to the relevant individual CCG IG lead in the first instance

o The CCG leads will undertake appropriate IG assessment , provide advice and guidance and make recommendations ( a central coordination may be required to coordinate efforts and this can be agreed as appropriate)

o The relevant IG leads are responsible for ensuring data flows of the project/service/function are mapped, legal basis is established correctly, Data controllership is identified and the necessary IG arrangements are put in place as appropriate

o Where the actions from the recommendations need to be carried out jointly, a central coordination will be decided upon to ensure efforts are coordinated appropriately (this may include implementing data processing contracts, deed of processing, sharing agreements, agreeing general conditions for processing or supporting providers)

Part 1 of the PCJC will be held in public and no confidential information, person identifiable or commercially sensitive information will be presented in the papers or discussed in this part of the meeting. This information will be discussed in Part 2 of the PCJC after the PCJC has resolved at the end of Part 1 that the public should be excluded from Part 2 while the remaining business is under consideration.

During Part 2 of the JC, it may be inappropriate for non-voting attendees to be present for the consideration of certain confidential information. In these occasions,

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the JC members along with the governance team will decide if non-voting attendees should be excluded from Part 2 of the JC. This would be on the grounds that publicity would be prejudicial to the public interest, by reason of the confidential nature of the business to be transacted.

Part 2 will not be used to shield sensitive issues that are not confidential and that are publically discloseable from discussion in public.

Incident Reporting NHS England London Regional Team will co-ordinate incident reporting for primary care, and specifically general practice, through national arrangements (Patient Safety E-form) and any locally implemented systems. CCGs will encourage practices to appropriately report incidents:

All primary providers will be expected to participate in incident reporting and peer review

All providers will be fully engaged in reporting untoward incidents in primary care

Robust processes for the reporting of untoward incidents will be developed

Reporting for Serious Incidents that are required to be reported through StEIS will continue to be managed by the Nursing Directorate of NHSE London.

NHS England London Regional Team will provide the JC with an incident report on a periodic basis, the content and frequency to be agreed at JC.

6. Operations

The PCJC will meet on a bi-monthly basis, and no less than four times a year. In cases where a particularly significant matter or urgent matter arises, there may be a need for additional meetings and this will be agreed between NHS England London Regional Team, the Chair and governance support. Urgent decisions will be taken in line with the process outlined in the Future Operating Model: Co-commissioning of Primary Care v5, NHS England. Actions arising from additional meetings should be reported at the next scheduled meeting of the JC. Where responses are required from members of the PCJC, requests should be submitted by email and should allow members to respond within a minimum of 24 hours. Openness and transparency will be fundamental principles of the governance and operations of the PCJC, and should be upheld by the membership. Each organisation is responsible for bringing to the PCJC information, data and intelligence, to allow the JC to function. All information to be considered at the JC will be provided in advance. Supporting groups to the PCJC Each CCG PCJC will be supported by reports and supporting action undertaken in three areas for each borough: Contractual Action, Performance and Commissioning. The arrangements and groups that support their undertaking are outlined in more detail at appendix A to this document and are summarised here: Contractual Action All relevant areas of contractual action will be progressed and worked up by a single South East London Contractual Action Group. This group will be hosted by NHS

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England and will met very frequently (likely to be weekly) to manage all contractual matters on behalf of the committee. It will arrange its agenda on a by-borough basis and CCG commissioners, at Executive level, will be invited to participate or engage in those issues that pertain to their borough. The group will be chaired by the Director of Primary Care, NHS England (London Region) or by a senior nominated deputy and will act in accordance with the terms outlined in this and related documents. The group will provide a consolidated report to the meetings of the SEL PCJCs either making recommendations for decision, reporting decisions taken in accordance with policy or reporting, on the rare occasion they are required, any urgent decisions taken within the terms of this document. It is likely, again in accordance with these terms, that the reports made be made to public and private sessions of the committee meeting depending on the nature of the decision. Performance The committees will receive regular finance and performance reports generated by NHS England RT. These reports will be considered at borough level by the most relevant Integrated Governance and Performance or equivalent committee or group hosted by the CCG and NHS England commissioners will either inform or join those meetings as required. In most cases CCG’s hold those committees on a monthly basis and they will provide commissioners with the opportunity to review primary care matters in the context of the wider commissioning portfolio. Again the NHS England derived reports will be made to each committee meeting and any recommendations to the committee will be made either jointly by NHS England and the relevant CCG following local discussion, or by one or other party depending upon the nature of those actions or recommendations. Commissioning As with performance it is expected that the committee will receive reports and recommendations regarding commissioning action related to primary care, either separately or in the context of wider commissioning strategies. The CCG will utilise its existing forum for commissioning development and design and engage NHS England commissioners at these local forums. On the whole the recommendations and reports received by the PCJC will either be borough based, developed by the CCG or the CCG and NHS England commissioners, or committees will receive south east London derived commissioning recommendations through the Community Based Care Delivery Group of Our Healthier South East London (OHSEL) strategy programme. In either scenario the recommendations will be made in a borough context and will have been locally owned. Both local CCG and OHSEL commissioning groups will draw upon and utilise the borough or South east London key enabler groups relating to estates, workforce, IT and commissioning and contracting models. South East London Co-commissioning development forum In addition to the working groups outlined above and described in Appendix A, the committees will also be supported by the above forum that will be sponsored by the CCG Chief Officers’ group and will comprise executive leads from each of the six CCGs and NHS England RT. This group will undertake two broad roles:

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To ensure the effective management of the support arrangement to the PCJCs and the resources required to undertake it

To review the overall development of co-commissioning arrangements in South East London and work up recommendations for changes to existing arrangements including any process through which CCGs consider and develop proposals for ‘Full Delegation’ of co-commissioning of primary care services in future

7. Financial Management of Primary Care Medical Services Allocation In joint commissioning arrangements (level 2), individual CCGs and NHS England remain accountable for meeting their own statutory duties in relation to financial resources. The PCJC will not replace the accountabilities of the individual organisations but will provide the forum for joint consideration, decision making (where appropriate) and assurance The PCJC will review the financial performance at borough level. For information the south east London wide position will also be summarised. Financial accountability and financial reporting of co-commissioning primary care will rest with NHS England. NHS England shall remain that statutory body who will hold the budget for Primary Care Medical Services. All decisions (for the above named functions) including those with financial implications, shall be ratified through the PCJC and in line with the it’s Terms of Reference. Decisions that require CCG funding in future years must be signed off by the individual CCG. JC members will provide monthly reports on financial performance of the primary care medical services allocation to the PCJC, including (i) details of QIPP plans and delivery and (ii) key risks and mitigations. The PCJC will expect transparency on London-wide budgets and reserves in the contexts of financial management of borough primary care allocations. The PCJC will receive advice from the CCG Lead CFO on key issues and risks associated with moving to full delegation of primary care commissioning and recommendations on: a. proposed allocations b. risk pooling where appropriate and c. financial administration of the primary care contracts.

The South East London Co-commissioning forum will establish a Finance Sub-Group to allow preparation for full delegation of primary care allocations should that be its recommendation.

8. Performance monitoring

Performance monitoring is the responsibility of NHS England London Regional Team. This will be undertaken by the contractual action working group in line with the statutory responsibility of NHS England.

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9. Assurance and evaluation of outcomes The NHS England CCG Assurance Framework for 2015/16 states that for joint commissioning functions, CCGs will be required to prepare a quarterly self-certification of compliance against five key areas:

governance and the management of potential conflicts of interest

procurement

expiry of contracts

availability of services

outcomes The self-certification of joint commissioning arrangements of CCGs and NHS England London Regional Team will be approved by the PCJC.

Enc K - Appendix A

CCG Governing Body

Primary Care Joint Committee

SEL Contractual Action Group (Single meeting with Borough

sections)

Led operationally by NHS England London Regional Team through their weekly contracting and performance management meetings.

Report to voting members regularly by email, highlighting any matters arising which may be contentious for respective CCGs.

NHS England London Regional Team is responsible for discussing actions with each CCG working group where decisions affect either an individual practice or small group of practices.

NHS England London Regional Team is responsible for discussing decisions and actions with CCG working groups where these affect a large group of practices in each CCG. They should discuss these decisions and actions with the governance support to confirm whether to pursue the urgent decision making process as outlined in the Future Operating Model: Co-commissioning of Primary Care v5, NHS England.

CCG Commissioning Development Group

Led by CCG with attendance from

NHS England (co-commissioners) to consider the generation of commissioning intentions, strategic development, innovation and delivery of local plans including enhanced out of hospital care

This forum would consider and make recommendations with NHS England for commissioning action

CCG Integrated Governance & Performance Committee /

Group

Led by CCG with attendance from NHS England (co-commissioners as required) through their usual committee Structure

The CCG will consider the Quality, Performance and Financial aspects of primary care in their borough as part of their routine BAU processes for their commissioning portfolio

This will provide a forum for the consideration of issues arising from the NHS England finance and performance reports and will inform work with NHS England to address areas of concern or to oversee implementation of commissioning activity

CCG and OHSEL Key Enabler working Groups Work in areas including Estates, IM&T, Commissioning and Contracting models and

Workforce

OHSEL Community Based Care Delivery Group

South East London wide forum

including six CCGs and NHS England

commissioners to secure co-

ordination and delivery of the CBC

elements at borough level in the

context of OHSEL

Financial and Performance

Reporting

Commissioning Performance

SEL Co-commissioning development forum

Working group to ensure the on-going

development and effectiveness of primary care

co-commissioning

Evaluation of existing arrangements and

development of proposals for Full delegation

New Group / Report

CCG Existing group

OHSEL Existing Group

Key:

NHS England