submission proforma for delegated commissioning arrangements us... · the guidance includes a...

Next steps towards primary care co- commissioning: Annex B

Submission proforma for delegated commissioning arrangements

December 2014 (Final)


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Introduction The following proforma should be completed by CCGs and area teams where a CCG wishes to implement a delegated commissioning arrangement.

Part one is for completion by the CCG. It requires CCGs to:

review and revise its conflicts of interest management policy in light of new NHS England statutory guidance;

describe the intended benefits of co-commissioning arrangements;

detail the finance arrangements of the delegated budget; and

complete and sign a declaration.

Part two is for completion by the area team. It requires the area team to:

confirm that the CCG meets the required assurance thresholds;

confirm that the CCG meets the required conflicts of interest management thresholds;

confirm that the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements; and

complete and sign a declaration.

CCGs and area teams are encouraged to take note of the supporting annexes in the Next steps towards primary care co-commissioning document, specifically the model wording for constitutional changes (Annex C) and model terms of reference (incorporating the scheme of delegation) for delegated commissioning (Annex F) when completing this proforma.

CCGs and area teams should submit the following to

[email protected] by noon on Friday 9 January 2015

1. This form, with parts I and II completed 2. Conflicts of interest policy (draft or ratified version) 3. CCG governance structure, including any terms of reference and scheme of

delegation 4. Copy of the CCG„s most up to date IG Toolkit 5. CCG constitution or proposed constitutional amendment submitted

Please note that any necessary constitutional amendments should also be sent to the relevant regional office.

mailto:[email protected]

PART I: TO BE COMPLETED BY THE CCG

A Conflicts of interest

CCGs have a statutory requirement to:

Maintain one or more registers of interest of: the members of the group, members of its governing body, members of its committees or sub-committees of its governing body, and its employees.

Publish, or make arrangements to ensure that members of the public have access to these registers on request.

Make arrangements to ensure individuals declare any conflict or potential conflict in relation to a decision to be made by the group, and record them in the registers as soon as they become aware of it, and within 28 days.

Make arrangements, set out in their constitution, for managing conflicts of interest, and potential conflicts of interest in such a way as to ensure that they do not and do not appear to, affect the integrity of the group‟s decision-making processes.

Conflicts of interest, actual and perceived, need to be carefully managed within co-commissioning. New statutory guidance for conflicts of interest management in primary care co-commissioning has been developed in partnership with NHS Clinical Commissioners and with formal engagement of Monitor, HealthWatch and the National Audit Office and was published in December 2014.

The guidance includes a strengthened approach to:

the make-up of the decision-making committee;

national training for CCG lay members;

external involvement of local stakeholders;

register of interest; and

register of decisions. Further detail is also set out in of the conflicts of interest section in the Next steps towards primary care co-commissioning document.

The CCG declaration (below) confirms that the CCG has reviewed and revised its conflicts of interest management processes and procedures in light of the new NHS England statutory guidance on managing conflicts of interest to ensure that it meets the requirements.


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CCGs must attach a copy of its revised conflicts of interest policy.

Draft versions will be accepted, although confirmation that the CCG governing body has ratified the updated policy is required by 30 January 2015.

B CCG supporting statement to describe the intended benefits to patients through delegated co-commissioning arrangements

<maximum 400 words>

We will commission primary care over the next 2 years to deliver local priorities and our

clinical ambitions:

• Better GP access - by reviewing the scope of our extended hours contract and the

national DES to ensure that in each quadrant patients can access appointments in the evenings

and at weekends in ways that best meet their needs, support our demand management plans

and deliver the recommendations of the Scrutiny Committee’s report on access

• Better start in life through tailored support for vulnerable families - commissioning an

integrated and proactive early years offer with the LAs to encompass the roles of practices,

Health visitors, midwives, Childrens’ Centres, mental health and voluntary and community

services and improving the uptake of childhood immunisations

• Child-friendly environment in all practices meeting the “You’re Welcome” standards

• Better services and support for people with Long Term conditions - continuing to

improve practice detection and management and links to peer education and support focusing

on Chronic Kidney Disease in 2015

• Delivering parity of esteem by commissioning practice systems, shared care guidelines

and a primary care lifestyles programme to improve the physical health of our patients with

mental health problems

• Care plans and annual reviews for all people with Learning Disabilities and their carers

by developing a local contract to replace the national DES

• Care plans and access to local psychosocial and support services for people presenting

to their GP with medically unexplained symptoms

• More prevention, self-management and peer support initiatives, via social prescribing

and by co-commissioning with Public Health

• More equity by commissioning the Confederation to deliver uniform high quality

primary care, ensuring that all additional services are available to all patients whichever

practice they are registered with and working with our HWBBs to tailor services to meet the

needs of the different ethnic groups in our population

• Better equity by analysing current outcomes achieved by practices against contract

income - covering core and CCG contracts, commissioning behaviours, prescribing, Public

Health, London and local outcomes, QOF - and publishing these to debate about how to reduce

inequalities, how to commission improvements and how to target investment to achieve the

London Primary Care Framework

• Better disease prevention by working with our patients and practices to improve the

uptake of immunisations and of cancer screening

• More joined up services by commissioning practices to work with other community

providers to deliver patient care plans


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C Finance template for delegated budgets: to be completed by CCGs on or

before noon on 9 January 2015

Notes for completing the finance template:

1. Double click into the table to complete the excel template. 2. Please enter the notified numbers for your CCG. 3. Please enter how you intend to spend the delegated budget in

2015/16. If your proposal is approved you will need to submit the detail of your planned spend as set out in the planning guidance.

4. Please include any additional investment the CCG is planning to make in primary care services from other areas of spend.

Notified

delegated

Budget

(1)

Movement

out of GP

Services

(2)

Movement

Into GP

Services

(3)

Total

£'000 £'000 £'000 £'000

GP Services + - + +/-

General Practice - GMS 17773 0 0 17773

General Practice - PMS 6677 0 0 6677

Other list based services (APMS) 3449 0 0 3449

Premises cost reimbursements 3235 0 0 3235

Other premises costs 14 0 0 14

Enhanced services 1560 0 0 1560

QOF 2614 0 0 2614

Other GP services 751 0 0 751

Primary care NHS property services - GP 1998 0 0 1998

2015/16 growth 1118 0 0 1118

Sub Total GP services 39188 0 0 39188

N/A + - +/-

Acute services 0 0 0

Mental health services 0 0 0

Community health services 0 0 0

Primary care services 0 0 0

Continuing care services 0 0 0

Other care services 0 0 0

Sub total CCG programme costs 00 0 0

Total 39188 0 0 39188

Please provide a description in the change in spend detailed above

The CCG has planned investments in enhanced services for 2015/16 including long established contracts, the full year effect of 2014/15 initiatives and new 2015/16 schemes, which total over £11m.


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D CCG declaration

I hereby confirm that NHS City and Hackney CCG membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2015/16.

Signed on behalf of NHS City and Hackney CCG governing body:

Name: Clare Highton

Position: Chair

Date: 08.01.2015

I hereby confirm that the CCG has in place robust conflicts of interest processes which and have been reviewed in light of the CCG‟s statutory duties set out in the NHS Act 2006 (as amended by the Health and Social Care Act 2012), and the NHS England statutory guidance on managing conflicts of interest, prior to submission.

Signed by NHS City and Hackney CCG Board Lay Member &

Audit Committee Chair:

Name: Mariette Davis

Position: Board Lay member & Chair of Audit Committee

Date: 08.01.2015

Signed by NHS City and Hackney CCG Accountable Officer:

Name: Paul Haigh

Position: Chief Officer

Date: 08.01.2015


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PART II: TO BE COMPLETED BY AREA TEAM

Assurance domains

To be pre-populated by Area Team from 2014/15 Q2 data

Current Level

Domain 1: Are patients receiving clinically commissioned, high quality services?

Assured

Domain 2: Are patients and the public actively engaged and involved?

Assured

Domain 3: Are CCG plans delivering better outcomes for patients? Assured

Domain 4: Does the CCG have robust governance arrangements? Assured

Domain 5: Are CCGs working in partnership with others? Assured with support

Domain 6: Does the CCG have strong and robust leadership? Assured

Additional assurance

Area team confirms the CCG is capable of taking on delegated functions.

Area team confirms the CCG meets the required conflicts of interest management thresholds in line with the new NHS England statutory guidance.

Area team confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements.

Any additional comments


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There is a clear exposition of the advantages to patients/services of taking on delegated PCC functions, consistent with local strategy. The CCG is clear where it will work jointly with other CCGs in the North East London area. The CCG has sufficient and stable management capacity and capability. In common with all other CCGs in London seeking formal delegation of PCC arrangements, the CCG has agreed to use the London centralised GP Contracting Team (newly formed as a consequence of the OACP Review of NHS England functions) to deliver its primary care contracting function. This will be in place until at least 31 March 2016. A formal MOU for the operation of this arrangement will be developed over the coming weeks. This will significantly reduce the risk of service failure. The CCG has discussed plans with member GPs, the HWBBs and with the HWBB Chairs, at

the City & Hackney Leaders‟ Summit, with Health in Hackney Scrutiny Committee and with the

LMC; all are reported to be in support of the plans and application for delegated responsibility.

Healthwatch are an invited presence on the new Primary Care Committee and so must have

been engaged in this engagement process. There is a revised Conflicts of Interest Policy; the

current draft is consistent with new national guidance and there is a clear timeline for this

being considered by the CCG Board on 30 January 2015. The necessary constitution

changes have been prepared and are declared to be consistent with the CCG‟s obligations

and working arrangements under the terms of their constitution. The new primary Care

(decision making) Committee is chaired by a lay person and has a majority of lay people

included in its membership. The Terms of Reference appear sound.

The CCG has a strong financial surplus position partly related to its DfT position but roundly

based on sound financial management. The CCG has met business rules in 2013/14 and is

forecast to meet business rules in 2014/15. The 2015/16 refresh of the Operating Plan,

including the impact of the additional funding made available for the NHS in the Autumn

statement, is underway and the headline Operating Plan will be submitted by 13th January.

The level of QIPP ambition in the revised City & Hackney Operating Plan will be a key

assurance issue.

from target


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Area team declaration

I hereby confirm, on behalf of NHS England, that NHS City & Hackney CCG meets the required conflicts of interest management, finance and assurance thresholds to proceed with delegated commissioning arrangements.

Signed on behalf of the NHS England Area Team

Name: Paul Bennett

Position: Area Director North Central and East London

Date: 9th January 2015


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PART III: FOR NHS ENGLAND OFFICE USE ONLY

NHS England Commissioning Committee

This serves as confirmation that, following a meeting of the NHS England Commissioning Committee on [insert date], NHS [insert name] CCG has been approved to proceed with delegated commissioning arrangements for 2015/16, having met the required conflicts of interest management, finance and assurance thresholds.

Name:

Position:

Date:

Confirmation of financial arrangements

Signed on behalf of the NHS England

Name:

Position:

Date:

OUR RATIONALE

• Our plans for primary care commissioning in 2015/16 are informed by our commissioning work to date, priorities identified by our patients, members and other stakeholders and the

needs of our 5 year clinical strategy.

• Our 5 year strategy is here: http://www.cityandhackneyccg.nhs.uk/ONELCityHackney/Pages/about-us/our-plans.htm

• We are very conscious that demand to see GPs has doubled in the last fifteen years and we need to support practices to manage this alongside the increasing workload from more

services and care outside hospital. Our strategy is to ensure that practices have the capacity – both time and manpower – to care for people in the community and to offer a rapid

response and consultation service when needed and that they are supported by a range of community services working together to help them.

• We support and will commission on the basis of the three specifications in the NHSE London Strategic Commissioning Framework – proactive care, accessible care and co- ordinated

care – and in a way that meets the needs of the population of City & Hackney. We also believe that there is an equally important pillar of good primary care provision – effective

commissioning behaviours – which we will continue to support, contract for and promote.

• Over the last 12 months we have already invested an additional £8m in primary care services to deliver the following improvements for our patients and improve local outcomes

and the Board is committed to continuing this strategy to continue to deliver tangible improvements:

• Telephone access to a duty doctor arrangement in each practice during core hours to support patients and link with urgent care providers;

• Extended consultations for patients with long term conditions or cancer;

• Practice systems to support earlier detection of cancer;

• Proactive quarterly home visiting service for our vulnerable population and those at the end of life;

• Extended opening hours for primary care in the evenings and weekends;

• Supporting time and systems for practices to participate in clinical commissioning and embedding practice behaviours – audits and peer discussions, consultant outreach and

education programmes, education of juniors and locums, referral reflections, reviews of frequent A&E attenders, good prescribing practice, adoption and audit of CCG pathways;

• Identification and early diagnosis of people at risk of coronary heart disease, respiratory disease and diabetes;

• Proactively reviewing & managing people with mental health problems with 600 people with mental health problems transferred to primary care management;

• Seeing each woman during her pregnancy and after delivery to ensure that her needs are being met;

• Proactively reviewing all children with long term conditions and ensuring that care plans are in place (with a specific focus on the management of asthma) and ensuring support is

available to children and their families;

• Identifying vulnerable children and families in conjunction with Health Visitors.

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• We have also invested £3.8m in additional community based services to ensure that providers (including practices) work together to meet the needs of our vulnerable

patients as identified through their care plans to maintain independence and achieve our commissioning metrics. This is part of our out of hospital strategy and our

Better Care Fund plan and all providers, including practices via the Confederation, are part of an alliance contract to support joint working to deliver the metrics. The

Confederation has taken the lead role in coordinating community services around patients and their GPs and we are commissioning extensive OD support to embed the

changes in clinical behaviour this new model will require across clinicians and other community teams.

• We also commission a social prescribing programme with the community and voluntary sector to link patients with local health and wellbeing initiatives.

• All 43 City & Hackney practices are members of the City & Hackney GP Confederation CIC formed in Summer 2014 – the CCG contracts with the Confederation for

all additional list based services to ensure population coverage for all our services so as to reduce inequalities and improve the quality of delivery.

• The practices in City & Hackney have led the development of the Confederation themselves; the CCG outlined its commissioning strategy of wanting population coverage

for additional primary care services which informed the development of the Confederation. Beyond that and the CCG Board‟s award of the contracts the CCG has not

played any role in the development of the provider as this would be a clear conflict of interest. None of the GPs holding CCG roles also have roles in the Confederation

and vice versa and this is embedded in our Conflicts of Interest Policy.

• The Local Authority Public Health commissioners have also contracted with the Confederation for some preventative services and we are keen to explore with the

Local Authorities aligning our service specifications and contracting arrangements for primary care under delegated arrangements, particularly to deliver the prevention

specification in the London Framework.

• The Confederation is increasingly playing a key role in supporting practices with contract delivery by using some of the contractual income to employ additional salaried

GPs and Practice Nurses which is of benefit to the local population and the overall local primary care workforce. The Confederation also provides an organisation that

other providers can talk to to ensure a consistent response from primary care providers in relation to integrated care and out of hospital services.

• We have a strong history of joint collaboration with our main acute and CHS provider - the Homerton - to align clinical behaviours and ensure secondary care

consultants can work with primary care and take joint responsibility for improving the quality of out of hospital care, support patients in the community and ensure

integrated patient pathways. We have strong feedback mechanisms across the clinical interface and are committed to using clinical audit and clinical reviews to

understand current performance and drive service improvements.

• At this stage we envisage that the CCG will continue to contract with individual practices for the core contract and with the Confederation for additional services but we will increasingly seek to align these.

• The GP OOH service is provided by a local GP social enterprise – CHUHSE – and there are discussions underway to explore the creation of one in and out of

hours primary care provider for City & Hackney. All decisions relating to contracting with and investment in CHUHSE (the OOH provider) is recommended by our

Urgent Care Board/ System Resilience Group and scrutinised by our Primary Care Committee.

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OUR OPERATING MODEL

• We developed our local operating model to handle contracting with the Confederation for additional list-based services in 2014 recognising the conflicts of interest tensions and this was reviewed and ratified by our internal auditors in December 2014. We are enhancing this model for handling our delegated commissioning responsibilities.

• We established a Contracts Sub-Committee with a Lay Chair, HWBB and Healthwatch input, and no local GP membership, meeting in public to scrutinize all proposed contracts with the Confederation/ practices. This committee, with revised membership and Terms of Reference, will become our Primary Care Committee to handle delegated responsibilities.

• We have reviewed our Conflicts of Interest policy in the light of the statutory guidance issued in December 2014. The revised policy is included in Appendix A here and has been agreed by our Audit Committee on 8 January 2015 and is subject to CCG Board approval on 30 January 2015.

• The CCG operating model since our inception is that commissioning is undertaken by eight clinically-led Programme Boards who develop clinical strategy ambitions and plans for a particular area – e.g. Mental Health, Urgent Care, LTC.

• Each Programme Board is responsible for designing its delivery arrangements and contracts to achieve its plans and to ensure that these are based on delivery of outcomes across the local health economy which require providers to work together where appropriate to achieve them.

• We have introduced this approach for Practice Based Integrated Care where the providers are contracted under an alliance contract to achieve specific metrics and are extending this collaborative approach in 2015/16 to early years and mental health through joint KPIs, standards and outcomes.

• This model gives each Programme Board responsibility for articulating what it needs practices as providers to deliver to achieve their ambitions alongside all other commissioned providers and for specifying further integration of primary and community services.

• In governance terms the Programme Board will develop the specification with CCG colleagues from outcomes, Public Health contracting, quality and in conjunction with our PPI representatives. They will engage our Independent GP advisor in discussions about the service specification, metrics and expected outcomes and will also consult our member practices and LMC.

• We appointed a non-local independent GP advisor in summer 2014 to provide an independent clinical perspective to the work of our Programme Boards when developing their service specifications and to provide clinical advice to the Contracts Sub-committee which is independent of our local GPs.

• Once the final service specification has been signed off by the Programme Board, a code of conduct form (included in our Conflicts of Interest Policy) is completed to outline the process taken and how conflicts have been handled:

• If new money is required for delivery of the plan it is scrutinised by the CCG Prioritisation and Investment Sub Committee – chaired by our PPI lay member –

who make investment recommendations to the CCG Board;

• All service specifications for services from the Confederation or where practices are potential providers are scrutinised by our CCG Contracts Sub-Committee

(and our internal auditors have assessed and confirmed they are content with this process);

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FROM APRIL 2015

• The CCG‟s Primary Care Quality Programme Board (PCQB) plays a key role in taking an oversight of all contracts with the Confederation, in managing the CCGs Commissioning behaviours contract which remains with individual member practices (not the Confederation), and in the strategic development and oversight of the Confederation. The PCQB has historically looked at practice performance against quality dashboards and information and received any information about practice performance from NHSE, and we would want that input and relationship to continue.

• Our Primary Care Quality Board will take on responsibility for issues in relation to core contract delivery. It will link with our PPI Committee and the HWBBs to develop specifications and the process for handling practice vacancies and will consider the outcomes being delivered by practices against core contract income and how to ensure equity of provision for our patients and deliver the London Primary Care Framework. It will make its recommendations to the Primary Care Committee.

• Our Programme Boards will continue to develop proposals for services to be commissioned from practices via the Confederation to deliver our clinical ambitions and these will continue to be scrutinized by the Primary Care Committee.

• The CCG Board will therefore delegate responsibility to the CCG Primary Care Committee for: • Management of the core GP contract; • Managing practice vacancies; • Scrutiny, award and management of any additional list-based services to be contracted from the Confederation or practices; • Any contract where practices may be potential providers; • Any procurements where practices/the Confederation may be a potential bidder; • Approval of all non-core payments to practices/the Confederation; • Approval of all contractual arrangements with our GP out of hours provider (which is a local GP social enterprise) recommended by our Urgent

Care Board. • The Primary Care Committee is made up of all CCG Board members, except the GPs. It is chaired by the CCG Associate Lay Member and other members

are: • Our Board Lay Members representatives of our two Healthwatches, the CCG Board Secondary Care Consultant and Board Nurse, the Chief

Officer and Chief Finance Officer; • In attendance are the Director of Public Health, the CCG‟s Independent GP Advisor and the Chairs of the two HWBBs.

• The Committee meets in public, its papers are on the CCG website and it reports on its work to the CCG Board (terms of reference are in Appendix B) • The CCG Audit Committee will meet with the Primary Care Committee at least annually to review its operating model and processes to ensure these remain

robust and provide assurance to the CCG Board. • The Programme Boards use a pro-forma when recommending to the Committee all payments to the Confederation/practices as outlined in our conflicts of

interest policy. • The tenure of all lay members on the Primary Care Committee is to either July 2016 or March 2017.

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SUMMARY OF OUR OPERATING MODEL

CCG Programme Boards

Primary Care Quality Board

CCG Primary Care Committee

Clinically led Boards bringing together commissioners and providers to

develop local plans and ambitions

Define what we want to commission from practices to deliver our service models (and align delivery across

providers)

All plans subject to member and LMC

consultation

Additional services/local “DES”/local CCG contracts – via the

Confederation if list based

Chaired by Mark Rickets LMC;

Consortia; Confederation; Public

Health; NHSE

Coordination of Programme

Board plans

Oversight of core contract ££s and

outcomes

- contracts would remain with

individual practices

Proposals to deliver equity and deliver Primary Care framework

Chaired by Jamie Bishop (lay

member)

Board Consultant and Nurse; Healthwatch x 2, Two Lay members,

CO & CFO

Supported by Independent GP

Adviser, DPH,

Delegated responsibility from CCG

Board for primary care

Scrutinises and approves all contract proposals for

practices/the Confederation/ OOH provider

Scrutinises all payments to

Confederation/ practices/

OOH provider

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WORKING TOGETHER

• The CCG has worked closely with the other three CCGs in Inner North East London (Tower Hamlets, Newham and Waltham Forest) since inception and as embedded in

our constitution we have a Clinical Strategy Group to share clinical ambitions, plans and ideas and collaborate where scale is needed. The four CCGs also commission

support from the Clinical Effectiveness Group (CEG – part of QMUL) who have supported INEL practices for over 20 years with improvements in disease management and

QOF.

• Under primary care commissioning the four CCGs are keen to extend this collaboration and envisage that at least once per quarter the CSG will focus on primary care

and:

• Share ideas on interventions and initiatives to improve performance and practice;

• Develop local outcome measures and a shared balanced scorecard;

• Benchmark performance across practices and CCGs;

• Work with Health Education England on workforce planning and development (although this will increasingly be undertaken by the primary care provider

organisations).

• We do not propose to delegate any formal decision making from City and Hackney CCG to the CSG in respect of primary care commissioning - the functions outlined for

the CSG are about the clinical chairs sharing ideas and collaborative working rather than formal commissioning responsibilities and this fits with its current Terms of

Reference.

• We are also keen to explore an Inner NEL footprint for a Strategic Estates Board, working closely with our Local Authorities and other local partners to jointly plan and

explore shared opportunities to deliver our collective 5 year strategy.

• We will continue to work openly and transparently with our two HWBBs, and our Healthwatches in the development and delivery of our plans for primary care

commissioning – ensuring our plans meet the needs of our patients and the joint Health and Wellbeing strategies is as important as taking forward the clinical ambitions

of our members and Programme Boards. Having the Local Authorities' Director of Public Health on our Primary Care Committee will provide an important

strategic link as well as providing opportunities for joint commissioning and ensuring our plans will deliver health gain for our patients.

• As well as Healthwatches and the HWBBs attending our Primary Care Committee, we have patient involvement, Public Health and other clinicians embedded in all our

Programme Boards to shape and develop our plans.

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LOCAL ENGAGEMENT

• We debated with our members our plans for commissioning primary care at our Clinical Commissioning Forum in November 2014 and at an evening meeting on 19 November 2014.

• We also undertook a poll of practices on our plans.

• 90% of practices supported our proposal to take full delegated responsibility and the other 10% supported the plan subject to ensuring a due diligence process to ensure

we received sufficient budget to meet contractual commitments. We are continuing to update members via our monthly newsletter and the monthly Clinical

Commissioning Forum.

• We have also discussed our plans with the two HWBBs, with our 2 Healthwatches as part of our CCG Board discussions, and with the HWBB Chairs, at the City &

Hackney Leaders Summit, with Health in Hackney Scrutiny Committee and with the LMC and all were in support of our plans and our application for delegated

responsibility.

• In November and December 2014 the CCG Board also discussed our plans, endorsed our model and the decision to apply for full delegated commissioning

responsibility, delegating responsibility for finalizing the application to the Chair, Chief Officer and Chief Finance Officer. The Board meeting on Friday 30th

January 2015 will note the final application, receive an update on the financial due diligence work and note the recommendations of the Audit Committee meeting on

8th January 2015 in relation to the Conflicts of Interest Policy, Primary Care Committee Terms of Reference and Constitution amendments.

• We are holding a Board development session in February 2015 to test our operating model and update our risk register and Board Assurance Framework in recognition

of the additional commissioning responsibilities. We are also holding a development session in March 2015 with our Clinical Executive and Programme Boards to reflect

on our operating model and our ambitions for primary care in 2015/16.

• Members of the Primary Care Committee will take part in our leadership development programme to identify training needs and we will hold a workshop before

September 2015 to reflect on the operating model and underlying systems and processes.

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APPENDIX A

CONFLICTS OF INTEREST POLICY

Chair: Dr Clare Highton Chief Officer: Paul Haigh

AMENDED, ASSESSED, AND ENDORSED BY CCG AUDIT COMMITTEE ON 8 JANUARY 2015 SUBJECT TO FINAL CCG BOARD APPROVAL ON 30 JANUARY 2015

Conflicts of Interest policy

Jan 2015

DRAFT

Chair: Dr Clare Highton Chief Officer: Paul Haigh 1

Introduction

Transparency is an important value for our CCG, embedded in our constitution and underpinning how we work. This policy sets out how we manage conflicts of interest to:

• enable our clinicians and the CCG in our commissioning roles to demonstrate that we are acting fairly and transparently and in the best interest of our patients;

• ensure that we operate within the legal framework, but without being bound by over-prescriptive rules that risk stifling innovation and clinical leadership;

• safeguard clinically led commissioning, whilst ensuring objective investment decisions;

• provide the public, providers, Parliament and regulators with confidence in the probity, integrity and fairness of our decisions; and

• uphold the confidence and trust between patients and GP, in the recognition that individual commissioners want to behave ethically but may need support and training to understand when conflicts (whether actual or potential) may arise and how to manage them if they do.

And outlines:

• the nature of conflicts of interest; • arrangements for declaring interests; • maintaining a register of interests; • keeping a record of the steps taken to manage a conflict; • excluding individuals from decision-making where a conflict arises; and • engagement with a range of potential providers on service design.

What are conflicts of interest? A conflict of interest occurs where an individual’s ability to exercise judgment, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur.

“For the purposes of Regulation 6 [National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013], a conflict will arise where an individual’s ability to exercise judgment or act in their role in the commissioning of services is impaired or influenced by their interests in the provision of those services.”

Monitor - Substantive guidance on the Procurement, Patient Choice and Competition Regulations (December 2013)

As well as direct financial interests, conflicts can arise from an indirect financial interest (e.g. payment to a spouse) or a non-financial interest (e.g. reputation). Conflicts of loyalty may arise (e.g. in respect of an organisation of which the individual is a member or with which they have an affiliation). Conflicts can arise from personal or professional


relationships with others, e.g. where the role or interest of a family member, friend or acquaintance may influence an individual’s judgment or actions, or could be perceived to do so. Depending upon the individual circumstances, these factors can all give rise to potential or actual conflicts of interest. Gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months may constitute a conflict. Interests and gifts will be recorded on the register of interests and register of gifts and hospitality, which will be maintained by the CCG Business Coordinator on behalf of the Accountable Officer. The register will be accessible by the public and inspection of the register of CCG Board members interests will be encouraged, as appropriate. For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider. In the case of a GP involved in commissioning, an obvious example is the award of a new contract to a provider in which the individual GP has a financial stake. However, the same considerations, and the approaches set out in this guidance, apply when deciding whether to extend a contract. What are the principles we use when managing conflicts of interest? Conflicts of interest can be managed by:

• Doing business appropriately. If we get our needs assessments, consultation mechanisms, commissioning strategies and procurement procedures right from the outset, then conflicts of interest become much easier to identify, avoid and/or manage, because the rationale for all decision-making will be clear and transparent and should withstand scrutiny;

• Being proactive, not reactive. We will always seek to identify and minimise the

risk of conflicts of interest at the earliest possible opportunity, for instance by:

o considering potential conflicts of interest when electing or selecting individuals to join our governing body or take on leadership roles;

o ensuring individuals receive proper induction and training so that they understand their obligations to declare conflicts of interest.

We will establish and maintain registers of interests, and agree in advance how a range of possible situations and scenarios will be handled, rather than waiting until they arise;

• Assuming that individuals will seek to act ethically and professionally, but may not always be sensitive to all conflicts of interest. Rules should assume people will volunteer information about conflicts and, where necessary, exclude themselves from decision-making, but there should also be prompts and checks to reinforce this;


• Being balanced and proportionate. Rules should be clear and robust but

not overly prescriptive or restrictive. They should ensure that decision-making is transparent and fair, but not constrain people by making it overly complex or cumbersome;

• Openness. Ensuring early engagement with our patients and public, clinicians and other stakeholders, including local Healthwatch and Health and Wellbeing Boards, in relation to proposed commissioning plans and transacting our business in public and open to scrutiny

• Responsiveness and best practice. Ensuring that commissioning intentions

are based on local health needs and reflect evidence of best practice – securing ‘buy in’ from local stakeholders to the clinical case for change;

• Transparency. Documenting clearly the approach taken at every stage in the

commissioning cycle so that a clear audit trail is evident; • Securing expert advice. Ensuring that plans take into account advice from

appropriate health and social care professionals, e.g. through clinical senates and networks, and draw on commissioning support, for instance around formal consultations and for procurement processes;

• Engaging with providers. Early engagement with both incumbent and potential

new providers over potential changes to the services commissioned for our population;

• Creating clear and transparent commissioning specifications that reflect the

depth of engagement and set out the basis on which any contract will be awarded and on which performance will be measured;

• Following proper procurement processes and legal arrangements, including

even-handed approaches to providers; • Ensuring sound record-keeping, including up to date registers of interests;

and • A clear, recognised and easily enacted system for dispute resolution.

• Individual responsibility to record conflict - whilst individuals have a

responsibility to register their own conflicts, the CCG expect individuals to recognise their personal duty of candour in raising any perceived conflicts of other individuals, in order to ensure transparency and openness is maintained. The CCG is keen to maintain a culture of openness and support to all colleagues and stakeholders and as such is keen to uphold a culture where individuals can raise concerns and believe this supports the overarching requirement that where there is any doubt about the existence of a conflict, it is better to raise it so a declaration can be recorded. This supports our whistleblowing policy and constitutional statements that our ethos of encouraging our staff and members to feel confident in speaking out over any concerns they may have.


• Retrospective action and potential challenges - whilst we are endeavouring to

ensure that through robust process, any and all conflicts are registered, both at all appropriate CCG meetings and via an ongoing structure of quarterly updates of declaration forms, it is recognised that an individual may not appropriately declare their interests in good time. In this instance the Chair of the relevant committee would consider, with support from the CCG Chief Officer and/or the Audit Committee Chair, any perceived impact and the risk involved in not making the declaration and as such any required corrective action. These would then be detailed and the next committee meeting in order to maintain openness and transparency. In the event that we receive a challenge in respect to our management of conflicts or where it is believed an individual has acted outside of the guidance held within this policy or our constitution, the CCG Chief Officer would undertake to investigate the matter and ensure that any wrongdoing is appropriately managed and highlighted to the CCG Board.

Our register of interests Our operating model

• We maintain a number of registers of interest for each of our committees and Board which are all published and available on the CCG website (http://www.cityandhackneyccg.nhs.uk/ONELCityHackney/Pages/about-us/register-of-interests.htm).

• We ensure that all individuals declare any conflict or potential conflict in relation to any decision as soon as they become aware of it and we record it.

• We require all appointees or office holders to the CCG to complete a register of interests declaration which we publish and regularly review and update

• We require the CCG Board and each of our sub-committees and each Programme Board to have a register of interests of all members

We specifically exclude from either any clinical lead or formal CCG role or office any individual who holds an appointment with the City and Hackney GP Confederation and/or CHUHSE (the local GP Out of Hours provider). We require all our GPs involved in CCG roles to declare their interests in both the Confederation and CHUHSE alongside their individual practice interests. How we operate this We use the form in Appendix 1 to record all interests as follows; On appointment: Applicants for any appointment to an office in the CCG or to our governing body are asked to declare any relevant interests. When an appointment is made, a formal declaration of interests will be made and recorded and published on our website and in the register for all committees of which the individual is a member. At meetings:


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All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. The Chair also asks members to ensure their register of interests form is up to date. Declarations of interest are recorded in minutes of meetings. This applies to the CCG Board, its sub-committees and the CCG Programme Boards. Quarterly: We proactively request all appointees and office holders to review and reconfirm their interests every quarter – i.e. 1 April; 1 July; 1 October and1 January - and this is organised by Corporate Services. On changing role or responsibility: Where an individual changes role or responsibility within the CCG or our governing body, any change to the individual’s interests are declared. On any other change of circumstances: Wherever an individual’s circumstances change in a way that affects the individual’s interests (e.g. where an individual takes on a new role outside the CCG or sets up a new business or relationship), a further declaration should be made to reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or a new one materialising. Conduct of meetings The up to date register of interests for that meeting is always included in the agenda papers for each meeting. It is noted as part of the agenda. We also require at the start of each meeting that members declare any interests relevant to the business being discussed. Noting of the register and all interests declared are included in the minutes of the meeting. The Chair of any meeting has responsibility for deciding whether there is a conflict of interest and the appropriate course of corresponding action. In making such decisions, the Chair may wish to consult the CCG Chief Officer and/or the lay member for governance. All decisions, and details of how any conflict of interest issue has been managed, are recorded in the minutes of the meeting. Depending on the nature of the conflict, GPs or other practice representatives could be permitted to join in discussions at the meeting, about the proposed decision, but should not take part in any vote on the decision.


Our Register of procurement decisions On our website at http://www.cityandhackneyccg.nhs.uk/ONELCityHackney/Pages/about-us/tenders-contracts.htm we have a register of our procurement decisions taken. This includes:

• the details of the decision; • who was involved in making the decision (i.e. governing body or committee

members and others with decision-making responsibility); and • a summary of any conflicts of interest in relation to the decision and how

this was managed by the CCG. The register also includes a link to the meeting where the procurement decision was taken and the papers used to inform that decision. Making decisions Our operating model Our Programme Boards have responsibility for developing all proposals for new services and for service improvements which will improve outcomes for our patients. In doing so they will develop a pathway outlining how any new service or service development fits within existing services. We are committed to engaging our patients, our members and relevant providers, especially clinicians, in confirming that the design of service specifications will meet the needs of our patients. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest can occur if we engage selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. We seek, as far as possible, to specify the outcomes that we wish to see delivered through a new service, rather than the process by which these outcomes are to be achieved. As well as supporting innovation, this helps prevent bias towards particular providers in the specification of services. Our engagement will follow the three main principles of procurement law, namely equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all. Other steps include:

• We are explicit that a service design/re-design exercise is taking place and invite participation from our patients, stakeholders and any potential providers and other interested parties (ensuring a record is kept of all interactions);


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• as the service design develops, we engage with a wide range of providers on an ongoing basis to seek comments on the proposed design, e.g. via the work of the Programme Board and via workshops with interested parties;

• we use our engagement to help shape the requirement to meet our

patients’ needs but take care not to gear the requirement in favour of any particular provider(s);

• we engage the advice of the CCG’s Independent GP Adviser, as well as

an independent specialist clinical adviser, on the design of services;

• we are completely transparent about our procedures;

• we ensure at all stages that potential providers are aware of how the service will be commissioned; and

• we maintain commercial confidentiality of information received from providers

where appropriate but do not allow commercial confidentiality to restrict what we debate and transact in public.

When engaging our providers on service design, we recognise that we - the CCG - have ultimate responsibility for service design and for selecting the provider of services. The most obvious area in which conflicts could arise is where we commission (or continue to commission by contract extension) healthcare services, including GP services, in which a member of the CCG has a financial or other interest. This may most often arise in the context of co-commissioning of primary care, particularly with regard to delegated arrangements, but it also needs to be considered in respect of any commissioning issue where GPs are current or possible providers. The process Where a Programme Board is considering a new service to be commissioned from GPs as providers/the GP Confederation/CHUHSE or where GPs/the GP Confederation/CHUHSE may be a potential bidder, the Programme Board will go through the following steps:

1. Programme Board develops idea for a new service to be commissioned from practices.

2. Initial consultation about the idea with members via CCF/Consortia/Clinical Executive Committee. Outline direction of travel to GP Confederation if a list based service. Share plan with Primary Care Quality Board.

3. Develop service specification using following frame:- • What outcomes do we want delivered? • What is the basis of the CCG contract?


• How will we measure whether the service has been delivered? • How will we pay for delivery? Programme Board to co-develop the specification by actively engaging with: • Mike Fitchett, Independent GP Advisor on specification and outcomes; • Anna Bennett re contractual framework; • Anna Garner on outcomes and metrics; • Jenny Singleton on quality; • PPI representative – either via Programme Board or PPI Committee.

4. Test with CSU if procurement is needed or can contract with the GP

Confederation under single tender action as it’s a list-based service. Their guidance to your Board to be submitted to Primary Care Committee.

5. Consult on final version of specification with members, LMC and GP

Confederation. Consider comments and finalise specification, confirming back how comments have been incorporated.

6. Finalise service specification and formally sign off at the Programme Board

Complete Code of Conduct form. Submit to Primary Care Committee (and PCQB for information).

We have appointed an independent GP Advisor. This is a GP who does not practice within City and Hackney nor has any interest in delivering services to our patients. S/he has the following roles:

• to provide independent clinical advice to the Programme Board in the development of the service specification for any service;

• to ensure that there is independent clinical advice available to the Programme Board when local clinical leaders have a conflict of interest;

• to attend the CCG’s Primary Care Committee and provide independent clinical and GP advice to the Committee on the proposed service specifications and outcomes. A copy of the job description for this role is in Appendix 4.

Where any new service proposal needs additional funding for implementation, the Programme Board is responsible for developing a project initiation proposal which, along with the service specification, is considered by the CCG’s Prioritisation and Investment Sub-committee. For all proposed contracts with practices/the GP Confederation/CHUHSE:

• the Programme Board must submit their service specification and the signed code of conduct form in Appendix 2 to the CCG’s Primary Care Committee;

• the key considerations for the Primary Care Committee when considering the proposal are:

o Are we clear about the service, outcomes, measurement and payment which will form the basis of the contract?

o How has the Programme Board engaged with patients in co-developing the specification and how have they reflected patient feedback and comments


o Does the funding represent VFM compared to other services

commissioned from practices/the Confederation/CHUHSE and other providers?

o How does the contract align with other provider contracts? o How has the Programme Board mitigated against conflicts of interest from

GPs as providers in developing the model?

The code of conduct form in Appendix 2 has been designed to publicly demonstrate how the Programme Board has developed its service specification and how it has managed and mitigated the conflicts of interest which are inherent in clinical commissioning. The service specification and code of conduct form are published on the register of procurement decisions once the Primary Care Committee has confirmed its decision. This is to ensure that the public can see both the details of the service and how the Programme Board managed the conflicts of interest. In developing their proposals each Programme Board is required to take formal advice from NELCSU on:

• whether the service specification outlines a list based service which can only be provided by practices (and would therefore be commissioned under single tender action from the GP Confederation/practices);

• whether the service should be procured and who are the potential providers. The Programme Board is required to submit this advice and their proposed contractual arrangements along with the specification and code of conduct form to the Primary Care Committee. The rationale for the CCG to contract with the GP Confederation under single tender action for list based services is to ensure 100% population coverage – i.e. that all commissioned services are available and accessible to all patients registered with City and Hackney practices and the onus is on the Confederation as part of the CCG contract to put in place a delivery model which will provide this. Mobilising the contract Once a decision has been made to enter into a contract:

• If procurement is not required, once the service specification has been agreed by the Primary Care Committee and any funding agreed by the Prioritisation Sub-Committee, the specification should be issued;

• This will be done by the CCG Head of Contracts and Programme Board jointly, inviting the provider to respond and agree mobilisation;

• This is not an opportunity for the provider or practices to re-negotiate the service specification – the service specification is agreed by the Primary Care Committee as the definitive version;

• Once mobilisation etc. is agreed, the CCG Head of Contracts will liaise with the provider to issue the formal contractual agreement.

Making payments


We are committed to total transparency in all payments to practices/the Confederation/CHUHSE and our process is as follows:

• Each Programme Board is responsible for measuring whether the provider has delivered the contractual requirements in line with the service specification;

• In doing so they will require information from the provider on performance and how this has been evaluated and how there has been independent and objective assessment of delivery;

• When contracting with the Confederation they will also be required to outline how the contractual funding has been used in an open book way – i.e. how contract income has been used by the Confederation vs. by practices and what it has funded to support the delivery of the contract;

• Each Programme Board is required to complete the form in Appendix 3 which outlines how they have assessed contractual performance and this should be accompanied by a proposed payment schedule which has been countersigned by the CCG Deputy CFO.

• The completed pro-forma and schedule is submitted to the Primary Care Committee who will scrutinise the work of the Programme Board and confirm whether they are satisfied that payment should be made.

• The completed pro-forma and payment schedule is published by the CCG as part of the papers for the Primary Care Committee on the CCG website and therefore all payments and the rationale for these is in the public domain.

Role of Primary Care Committee We have established a Primary Care Committee which takes delegated responsibility from the CCG Board for:

• Management of the core GP contract; • Managing practice vacancies; • Scrutiny, award and management of any additional services to be contracted from

the Confederation, CHUHSE or practices; • Any contract where practices/Confederation/CHUHSE is a potential provider; • Any procurement where practices/the Confederation/CHUHSE may be a potential

bidder; • Approval of all non-core payments to practices/the Confederation/CHUHSE,

These functions recognise our plans to take delegated responsibility for primary care commissioning from NHSE in 2015. The terms of reference for this Sub-committee are in Appendix 5 This Committee plays a critical role in how we manage conflicts of interest and how we ensure transparency and objectivity in our decision making. The Committee:

• meets in public and its papers are all published on the CCG website at - Link • is chaired by an associate lay member of the CCG Board and its other formal

members are: o representatives of London Borough of Hackney and City of London

Healthwatches; o CCG Board secondary care consultant;


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o CCG Board Nurse o CCG Board lay member (Governance); o CCG Board lay member (PPI & Conflicts) o Chief Officer; o Chief Finance Officer;

• also has in attendance (i.e. participating but not voting): o the London Borough of Hackney/City of London Director of Public Health; o the CCG’s independent GP advisor; o and the Chairs of the London Borough of Hackney and City of London

HWBBs have a standing invite to attend the meetings. The terms of reference outline the arrangements for the conduct of business by the Committee and details of quoracy and decision making. The Committee reports on its work to the CCG Board, and thus to stakeholders and members, each quarter. The Committee meets with the Audit Committee at least annually to review its operating processes and how it has assessed proposals from Programme Boards and met its objectives. The Audit Committee will ask the CCG’s internal auditors to include the operation of the Committee and its operating policies within its annual work plan and may ask the internal auditors to conduct an independent "deep dive" into any particular exercise or decision and report the outcome to the Audit Committee. Scrutiny of the work of the Primary Care Committee by the CCG Audit Committee and internal auditors provides an important assurance role to the CCG Board for the risk and assurance/governance frameworks. The CCG Board decision making Although the Primary Care Committee has delegated responsibility from the CCG Board for the areas outlined in its terms of reference, there are times when the CCG Board will be considering and making a decision where the GP members have a conflict of interest. Like all committees the CCG Board maintains a register of interest which goes to each meeting for noting and is proactively updated each quarter. At the start of each meeting the Board members are asked to declare any conflicts of interest in any item of business and these are recorded in the minutes. Where the GP Board members have a conflict of interest our constitution in section 8.2.10, makes the following provision for decision making; The Chair of the CCG Board meeting has responsibility for deciding whether there is a conflict of interest and the appropriate course of corresponding action. In making such decisions, the Chair may wish to consult the CCG Chief Officer and/or the lay member for governance. All decisions, and details of how any conflict of interest issue has been managed, are recorded in the minutes of the meeting.


Depending on the nature of the conflict, GPs or other practice representatives could be permitted to join in discussions at the meeting, about the proposed decision, but should not take part in any vote on the decision. Transparency of GP earnings In line with NHSE commitments on transparency of GP earnings, there will be a new contractual requirement for GP practices to publish on their practice website by 31 March 2016, the mean net earnings of GPs in their practice (to include contractor and salaried GPs) relating to 2014/15 financial year. Alongside the mean figure, practices must publish the number of full and part time GPs associated with the published figure. The figure will include earnings from NHS England, CCGs and local authorities for the provision of GP services that relate to the contract and which would have previously been commissioned by PCTs. Costs relating to premises will not be included. Fuller details will be included in the implementation guidance for the 2015/16 GP contract, due to be published in February 2015. This is an interim solution until arrangements are finalised for publishing individual GP net earnings in 2016/17. Additional Guidance The CCG have also attached as Appendix 6, the following guidance for additional reference – ‘NHS Clinical Commissioners, Royal College of General Practitioners and British Medical Association - Shared principles on conflicts of interest when CCGs are commissioning from member practices’ Review This policy will be reviewed in January of each year and also reviewed in the light of any new guidance and the work of the CCG. We will undertake collective organisational development sessions to ensure that we embed the principles and operating model outlined in this policy in our everyday practice and all Committee and Board members will participate in our annual appraisal and review processes to reflect any learning points or areas for development and review in how we conduct our business.


Appendix 1 - Declaration of interests for members/employees template

NHS City & Hackney Clinical Commissioning Group Member / employee/ governing body member / committee or sub-committee member (including committees and sub-committees of the governing body) [delete as appropriate] declaration form: financial and other interests

This form is required to be completed in accordance with the CCG’s Constitution and section 14O of The National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition) regulations 2013 and the Substantive guidance on the Procurement, Patient Choice and Competition Regulations

Notes:

• Each CCG must make arrangements to ensure that the persons mentioned

above declare any interest which may lead to a conflict with the interests of the CCG and/or NHS England and the public for whom they commission services in relation to a decision to be made by the CCG and/or NHS England or which may affect or appear to affect the integrity of the award of any contract by the CCG and/or NHS England.

• A declaration must be made of any interest likely to lead to a conflict or potential conflict as soon as the individual becomes aware of it, and within 28 days.

• If any assistance is required in order to complete this form, then the individual should contact the CCG Business Coordinator, Matthew Knell ([email protected]).

• The completed form should be sent by both email and signed hard copy to the CCG Business Coordinator, Matthew Knell ([email protected]).

• Any changes to interests declared must also be registered within 28 days by completing and submitting a new declaration form.

• The register will be published on the CCG website and can be found via the following link - Register of interests

• Any individual – and in particular members and employees of the CCG and/or NHS England- must provide sufficient detail of the interest, and the potential for conflict with the interests of the CCG and/or NHS England and the public for whom they commission services, to enable a lay person to understand the implications and why the interest needs to be registered.

• If there is any doubt as to whether or not a conflict of interests could arise, a declaration of the interest must be made.

Interests that must be declared (whether such interests are those of the individual themselves or of a family member, close friend or other acquaintance of the individual) include:

• roles and responsibilities held within member practices; Chair: Dr Clare Highton Chief Officer: Paul Haigh

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• directorships, including non-executive directorships, held in private companies or

PLCs; • ownership or part-ownership of private companies, businesses or consultancies

likely or possibly seeking to do business with the CCG and /or with NHS England • shareholdings (more than 5%) of companies in the field of health and social care; • a position of authority in an organisation (e.g. charity or voluntary organisation) in

the field of health and social care; • any connection with a voluntary or other organisation (public or private) contracting

for NHS services; • research funding/grants that may be received by the individual or any organisation

in which they have an interest or role; • any other role or relationship which the public could perceive would impair or

otherwise influence the individual’s judgment or actions in their role within the CCG. We would also ask you to record your interests in the following orgnaisations as it is important we capture all involvement; • CHUHSE

o Individual member (GP, Community, Staff) • Working for a practice contracting with CHUHSE/GP Confederation

o Working for a practice who is a shareholder of the GP Confederation

o You may also need to indicate other associations with these organisations as described above for example employed as a GP, Board member, clinical lead etc. Undertaking any paid sessions for CHUHSE

• As we ask for LMC involvement in our commissioning, please indicate if you are member of the local LMC.

If there is any doubt as to whether or not an interest is relevant, a declaration of the interest must be made.

Declaration:

Name: Position within or relationship with, the CCG or NHS England:

Interests Type of Interest Details Personal interest or

that of a family member, close friend or other acquaintance?


Roles and responsibilities held within member practices, CHUHSE, GP CONFEDERATION

Directorships, including non- executive directorships, held in private companies or PLCs

Ownership or part- ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or with NHS England

Shareholdings (more than 5%) of companies in the field of health and social care

Positions of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care

Any connection with a voluntary or other organisation contracting for NHS services.

Research funding/grants that may be received by the individual or any organisation they have an interest or role in

Membership of CHUHSE (GP, Community, Staff)


Working for a practice who is a shareholder in the GP Confederation

Membership of LMC

Other specific interests?

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgment or actions in their role within the CCG and/or with NHS England.

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly and no longer than annually. I give my consent for the information to be used for the purposes described in the CCG’s Constitution and published accordingly.

Signed:

Date:


Appendix 2: Code of Conduct Template

Service: Programme Board:

Question Comment/Evidence

Part A - Developing the service specification

Please provide a brief description of the service:

Outline the benefits to patients if this service is commissioned:

How will this service support the delivery of the Programme Board’s commissioning intentions:

Describe how will this service will improve CCG outcomes and service quality:

How does the proposal support the priorities in the HWBBs’ health and wellbeing strategies)?


Outline how you have involved patients in the decision to commission this service and then in the development of the specification. Who has been involved?

What changes were made following consultation?

Describe the range of CCG clinicians involved in designing this proposed service and their input to the service specification:

When and how have you consulted member practices about commissioning this service:

What changes were made following consultation:

How will this proposed contract align with other contracts commissioned by the CCG and promote integrated service delivery across providers

Part B – Managing conflicts of interest

Outline from who you have obtained an independent clinical perspective / external advice on the specification and the KPIs/contract:

What changes were made as a result of their comments?


Describe how all conflicts and potential conflicts of interests have been declared in the development and agreement of the service specification:

Can you confirm how conflicts have been recorded and provide a link to these declarations?

Describe how you have mitigated the conflicts of interest declared?

Part C – Proposed contract

What is the annual value of this contract?

How have you determined that this represents value for money and developed the price for this service?

What will be the basis of the contract – on what performance and / or outcomes will payments be made?

Describe how you will assess the achievement of these outcomes in recommending payments?

How will you monitor the quality of the service commissioned?

What systems will there be to monitor and publish data on referral patterns?


PART D – List based service only

Outline why this is a list based service and the advice you have received to confirm this? (i.e. can only be provided by City and Hackney GP practices)

Please attach the advice that this is a list based service

What steps have you taken to demonstrate that there are no other providers that could deliver this service?

In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

Describe how you will evaluate the contract delivery proposals:

Describe:

• Who will be involved?

• How you will obtain independent clinical advice?

• How will you ensure there are no conflicts of interest?


What additional external involvement will there be in scrutinising the proposals?

How will you ensure that patients are aware of the full range of qualified providers from whom they can choose if appropriate?

Part E – if you are proposing procurement and practices/GP Confederation are potential bidders

Please outline the procurement process and timescale – attach the advice about this procurement process


Describe the process you will use for evaluating the bids:

Describe:

• Who will be involved?

• How you will obtain independent clinical advice?

• How will you ensure there are no conflicts of interest?

Please attach the proposed service specification

Signed by Programme Board Director:

Date:

Signed by PB Chair: Date:


APPENDIX 3: RECOMMENDING PAYMENTS PROFORMA

CCG MEMBER PRACTICES/CONFEDERATION RECOMMENDING PAYMENTS PRO-FORMA

PROGRAMME BOARD:

CONTRACT/SERVICE:

QUESTION EVIDENCE

Provide a brief description of the service under this contract:

What are the benefits of this service for our patients?

How has your Programme Board assessed the performance to make your recommendations? e.g.

• What data did you use? • How did you assess it? • How did you measure against the

service specification?

How have you mitigated the conflicts of interest in reviewing the performance of the Programme Board Chair's practice and of other practices of Programme Board GP members?


Did you identify any concerns or queries? How have you addressed these?

How are you assured of the quality of the service being provided?

What are the contractual payment arrangements to practices for this service?

When did your Programme Board debate these recommendations? What issues were raised and debated at the Board?

What members were in attendance at the PB meeting (names and designation?

What is the total value of the payment you are recommending?

How does this compare to the budget for this period?

PLEASE ATTACH A SCHEDULE INDICATING THE RECOMMENDED PAYMENTS


Signed by: Payment schedule supported by Finance Designation Date

Programme Board Director Date

Programme Board Chair Date

Corporate Services use CCG Contracts Committee Considered and recommended for payment at the meeting on (add date)

CCG Board Presented to the CCG Board for payments authorisation on (add date)



Appendix 4:- GP Advisor to City and Hackney CCG Job description

Sessional commitment: 2-3 per month (session is 3.5 hours) Responsible to: CCG Chief Officer Accountable to: CCG Chair

Role summary The post holder will provide a perspective across the governance of the CCG on issues relating to commissioned services where local GP Leads have a conflict of interest. The CCG commissions its out of hours service from a local social enterprise which is run by local GPs and of which CCG practices are members; similarly the GPs as providers are creating a GP Federation that the CCG will contract with for the provision of CCG commissioned primary care services.

Main responsibilities • To review and provide an independent clinical perspective on all service specifications

developed by CCG Programme Boards where the potential provider is practices as providers/the GP Federation;

• To ensure that the specification for any new service is robust, will deliver improvements for local residents and that there are clear KPIs for monitoring of the quality of the service being delivered;

• To support the CCG to develop a framework for evaluating all proposals from practices as providers to deliver services and provide clinical input to the development of decision making arrangements and contractual arrangements;

• To provide clinical input to the contract monitoring process and arrangements, attending contract monitoring meetings as required and ensuring that the CCG can be assured of the capacity and capability of its primary care commissioned services to improve outcomes and quality;

• To provide support to the Programme Directors to evaluate performance information and recommend whether contractual terms have been delivered and payment should be recommended;

• To attend the CCG Governing Body Board meetings as required for specific items • To attend the CCG Audit Committee as required and provide an independent clinical

perspective to the deliberations of the Audit Committee in their role of providing assurance to the CCG Board around contracting with local practices

• To be a member of the CCG Remuneration Committee and provide an independent clinical perspective on remuneration of CCG Clinical Leads and the terms of their engagement.

April 2014


PERSON SPECIFICATION

Job Title: GP Advisor

Band: Sessional rate

This is a specification of the qualifications, knowledge, experience, skills and abilities that are required to carry out effectively the responsibilities of the post (as outlined in the role description) and is the basis for selecting a candidate.

REQUIREMENTS ESSENTIAL DESIRABLE

EDUCATION AND QUALIFICATIONS

GMC Registration/ Medical licence

Not practicing in any practice which is part of City and Hackney CCG

Postgraduate qualifications/ diploma.

Postgraduate Teaching qualification.

Currently included on Medical Performers List.

MRCGP or appropriate (over 5 years) GP experience.

KNOWLEDGE

Relevant knowledge gained through previous employment, training or by other means.

Knowledge of the context in which primary care operates in City and Hackney and the local health challenges of inner cities.

Knowledge of policy and developments in primary care and of primary care contracting.

Knowledge of developing and evaluating quality standards and outcomes.


EXPERIENCE Experience of giving

GP/Primary care Clinical Advice.

Delivery of primary care services and of the potential contribution that primary care provision can make to service development.

Primary care teaching/ GP Trainer or education.

SKILLS, ABILITIES and PERSONAL QUALITIES

Ability to develop and maintain communication with people on complex matters, issues and ideas and/or in complex situations, anticipating barriers and taking action to improve communication as necessary.

Able to build constructive and supportive relationships with colleagues.

Able to develop and utilise professional and other networks. For example, identifying opportunities for partnership working in the local healthcare system, and manage stakeholder relationships in the long-term, and be a source of expertise for others.

Ability to analyse and take decisions in relation to difficult and contentious facts where there may be a number of possible courses of action.

Ability to shape new policies and set long-term objectives aligned to wider NHS and strategic objectives.

Ability to formulate long-term strategies and plans in an uncertain environment and to work in partnership with others to develop, take forward and evaluate service


improvements.

Ability to lead on, carry out, and act upon the results of equality impact assessment and contribute to the development of good and best practice in the area of equality, diversity and inclusion.

Appendix 5: CCG Primary Care Committee

Terms of Reference January 2015

Introduction The CCGs Primary Care Committee has delegated responsibility from the CCG Board for ensuring the delivery of the CCGs clinical strategy through robust contractual arrangements with general practices, the GP Confederation and the GP OOH provider, and ensuring this is transacted in a robust way to manage conflicts of interests Objectives

1. The CCG Primary Care Committee (CCG PCC) has been established to oversee the planning and development of primary care provision, to deliver the CCG strategy under delegated commissioning responsibilities from NHSE and to consider, review and agree the associated service specifications and contractual arrangements and in particular those where;

• we are potentially contracting with City and Hackney GP practices directly or through the local confederation of City and Hackney GP practices for list based services or extended primary care/out of hospital services

• we are contracting with the GP social enterprise providing our Out of Hours Service (CHUHSE)

• we are undertaking expanded primary medical care commissioning functions under delegated responsibilities from NHSE


• where practices, the GP Confederation, CHUHSE is a potential provider under any CCG procurement exercise

2. In accordance with its statutory powers under section 13Z of the National Health

Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to City and Hackney CCG. The delegation is set out in Schedule 1.

3. The CCG has established the CCG Primary Care Commissioning Committee

(“Committee”). The Committee will function as a corporate decision-making body on behalf of the CCG Board for the management of the delegated functions and the exercise of the delegated powers.

4. It is a committee comprising representatives of the following organisations:

• City and Hackney CCG

• Healthwatch City of London

• Healthwatch London Borough of Hackney

In addition to voting members being represented by the above, the following organisations are also invited as non-voting members;

• Health and Wellbeing Board – City of London

2. Health and Wellbeing Board – London Borough of Hackney

• Public Health representative

Statutory Framework

5. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

6. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.

7. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in


exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

• Management of conflicts of interest (section 14O);

• Duty to promote the NHS Constitution (section 14P);

• Duty to exercise its functions effectively, efficiently and economically (section 14Q);

• Duty as to improvement in quality of services (section 14R);

• Duty in relation to quality of primary medical services (section 14S);

• Duties as to reducing inequalities (section 14T);

• Duty to promote the involvement of each patient (section 14U);

• Duty as to patient choice (section 14V);

• Duty as to promoting integration (section 14Z1);

• Public involvement and consultation (section 14Z2).

8. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

• Duty to have regard to impact on services in certain areas (section 13O);

• Duty as respects variation in provision of health services (section 13P).

9. The Committee is established as a committee of the CCG Governing Body in accordance with Schedule 1A of the “NHS Act”.

10. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

Primary Care Commissioning Role of the Committee 11. The Committee has been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in City and Hackney, under delegated authority from NHS England


12. Primary care services in City and Hackney as part of the CCGs statutory commissioning responsibilities.

13. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and City and Hackney CCG, which will sit alongside the delegation and terms of reference and in accordance with its constitution.

14. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

15. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.

16. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/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 on ‘discretionary’ payment (e.g., returner/retainer schemes).

17. The CCG will also carry out the following activities:

• To plan, including needs assessment, primary [medical] care services in the City and Hackney;

• To undertake reviews of primary [medical] care services in City and Hackney; • To co-ordinate a common approach to the commissioning of primary care

services across the CCG; • To manage the budget for commissioning of primary [medical] care services in

City and Hackney.

Additional Remit and Responsibilities

18. The Committee has the following role on behalf of the CCG Board:


• To review service specifications and contractual proposals for all CCG commissioned services from primary care providers (either directly or via the GP Confederation)

• To ensure that the contractual proposals will achieve health improvement and represents value for money

• To ensure that in developing service specifications and contract proposals all conflicts of interest have been mitigated in line with the CCG conflicts of interest policy

• To review the contracting route for the proposals • In respect of procurement activities, review proposals from Programme Boards

around process, documentation,(including service specifications and evaluation criteria) and membership to help assure conflicts of interest have been mitigated in order for them to make recommendations to the Board

• To review procurement process after completion and ensure process was followed and endorse the recommendation to award a contract

• Take advice from audit committee and follow any framework they suggest for initiatives and/or procurement

• review and assess any key performance indicators (KPIs) and contractual metrics and the basis on which contractual payments would be made and provider performance assessed

• Consider any supporting legal advice obtained in respect to contracting matters and may request specific advise taken where the committee feels this would help their recommendations

• The Board requires the Committee to review and authorise requests for payments to be made under the GP contracts that have been entered into by the CCG. The Committee review whether the control processes (established by the CCG to ensure that services have been properly delivered by the GPs under these contracts) have been followed in practice and authorise payment.

• All decisions relating to contracting with and investment in CHUHSE (the OOH provider) will be reviewed by this committee once a recommendation has been received by our Urgent Care Board/ System Resilience Group.

Geographical Coverage

19. The Committee will cover the City and Hackney CCG locality.

Membership

20. The committee shall consist of the following voting members;

• CCG Board Associate Lay Member - (Currently Jaime Bishop) Chair • CCG Board Lay Member (Governance) • CCG Board Lay Member (PPI and Conflicts) • CCG Board Associate Lay member • Secondary Care consultant CCG Board Member • Nurse CCG board member


• Healthwatch - City of London • Healthwatch - LBH

• Chief Officer • Chief Financial Officer • Schedule 3 details individual members

Attenance (without voting rights)

• Representatives from the following organisations will be in attendance although not voting members;

• Chair of the Health and Wellbeing Board – City of London • Chair of the Health and Wellbeing Board – London Borough of Hackney • Director of Public Health representing the CCG locality • Independent GP adviser to the CCG

21. Other representatives may be invited by the Chair in order to maintain a balance of

representation.

22. The clinical chairs of the CCG Programme Boards (and other CCG staff) will be invited to attend meetings of the committee to outline their proposals and clinical strategy. However they will not be present when the committee debates the plans or makes its decisions

Chair

The Committee is chaired by the Associate Lay member, Jaime Bishop as his role does not require him to attend the Audit Committee.

In his absence, the role of Chair can be covered by the other Associate Lay member or the Lay Member PPI and Conflicts.

Meetings and Voting

23. The Committee will operate in accordance with the CCG’s Standing Orders.

24. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member no later than 7 days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

25. Notification of meetings and meeting papers will be published on the CCG website.

26. Each voting member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair


having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible

Secretary

27. Administrative support to the PCC will be provided by the CCGs Business Co-ordinator who also manages the CCGs business cycle.

Quorum 28. The quorum needed for the transaction of business is:

• 1 CCG Board Lay Member (can include Associate Lay Member) • 1 of either the secondary care consultant Board Member or Nurse Board Member • 1 Healthwatch representative • 1 CCG Officer

Frequency of meetings 29. The CCG Primary Care Committee will meet bi-monthly during the calendar year and more regularly if required however will be stood down if there is no business to transact.

Transparency

30. Meetings of the committee shall:

a) be held in public, subject to the application of 23(b);

b) the 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.

31. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavor to reach a collective view.


32. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

33. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s constitution.

34. The Committee will present its minutes to London area team of NHS England and the governing body of City and Hackney CCG after each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 29 above.

35. The CCG will also comply with any reporting requirements set out in its constitution.

36. The committee meeting dates will be communicated well in advance of the meeting date and the arrangements for public attendance clear and transparent.

Conflicts of Interest

37. Where a member has an interest, or becomes aware of an interest which could lead to a conflict of interest in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this Constitution and the CCG’s Conflicts of Interest policy.

38. The Chair will, at the beginning of all committee meetings, ask for members to highlight any conflicts of interest as well as reminding members to ensure their register of interests is up to date.

39. A register of interests will be completed by all members and is updated at least quarterly and is available on our website for public scrutiny.

40. The register of interests will be available at each meeting.

Review


41. It is envisaged that these Terms of Reference will be reviewed from time to time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee 42. The constitution and standing orders have been amended to reflect that the

committee has received delegated responsibility to make decisions on behalf of the Governing Body. Standing Financial Instructions will be amended to reflect this.

Procurement of Agreed Services 43. The detailed arrangements regarding procurement will be set out in the delegation

agreement which will be attached under schedule 1 & 2.

Decisions 44. The Committee will make decisions within the bounds of its remit.

45. The decisions of the Committee shall be binding on NHS England and City and Hackney CCG.

46. The Committee will produce an executive summary report which will be presented to the London regional team of NHS England and the governing body of City and Hackney CCG after each meeting for information.

Schedule 1 – Delegation-to be added when final arrangements confirmed Schedule 2 – Delegated functions-to be added when final arrangements confirmed Schedule 3 - List of Members Members

• CCG Board Associate Lay Member - Jaime Bishop (Chair) • CCG Board Associate Lay Member - Honor Rhodes • CCG Board Lay Member (PPI and Conflicts) - Catherine Macadam • CCG board Lay Member (Governance) – Mariette Davis • Consultant Board Member - Christine Blanshard • Nurse Board Member – Siobhan Clarke • Healthwatch City of London – Invitation sent asking for nomination • Healthwatch LBH – Invitation sent asking for nomination • Chief Officer – Paul Haigh • Chief Financial Officer – Philippa Lowe

In attendance

• Health and Wellbeing Chair, LBH – Councilor Jonathan McShane


• Health and Wellbeing Chair, City of London – Reverend Martin Dudley • Public Health Director, LBH & CoL – Penny Bevan • Independent GP advisor – Mike Fitchett

January 2015

Appendix 6: NHS Clinical Commissioners, Royal College of General Practitioners and British Medical Association - Shared principles on conflicts of interest when CCGs are commissioning from member practices December 2014 1. Introduction

The ability for CCGs to become involved in co-commissioning General Practice and primary care services has the potential to bring many benefits but it also brings with it the potential for perceived and actual conflicts of interest. NHS Clinical Commissioners (NHSCC), the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) have decided to collectively outline their high level starting principles in managing conflicts of interest when CCGs commission from member practices. In large part this has brought together principles articulated in previous lines/guidance/steer from the above organisations and NHS England. Our principles are applicable to each of the three primary care commissioning models


open to CCGs and should not be seen as being directive or be interpreted to mean that we prefer one model over another. These decisions need to remain a local, professionally led, decision. In developing these shared principles we would like them to sit alongside NHS England’s updated guidance on Managing Conflicts of Interest (December 2014). We are on a journey regarding the co-commissioning of primary care and we will review these principles when needed and as CCGs work through the guidance. It should be noted that this paper is not designed to address the issue of perceived or actual conflicts of interest in CCGs holding and performance managing GP contracts under co-commissioning arrangements.

2. Our headline shared principles around conflicts of interest We collectively agree the following in relation to managing conflicts of interest when CCGs commission from member practices:

• If CCGs are doing business properly (needs assessments, consultation mechanisms, commissioning strategies and procurement procedures), then the rationale for what and how they are commissioning is clearer and easier to withstand scrutiny. Decisions regarding resource allocation should be evidence-based, and there should be robust mechanisms to ensure open and transparent decision making.

• CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.

• CCGs should assume that those making commissioning decisions will behave ethically, but individuals may not realise that they are conflicted, or lack awareness of rules and procedures. To mitigate against this, CCGs should ensure that formal prompts, training and checks are implemented to make sure people are complying with the rules. As a rule of thumb, ‘if in doubt, disclose’

• CCGs should anticipate many possible conflicts when electing/selecting individuals to commissioning roles, and where necessary provide commissioners with training to ensure individuals understand and agree in advance how different scenarios will be dealt with.

• It is important to be balanced and proportionate – the purpose of these tools is not to constrain decision-making to be complex or slow.

3. Addressing perceived as well as actual conflicts of interest

Conflicts of interest in the NHS are not new and they are not always avoidable. The documents we reviewed to produce this paper were all clear that the existence of a conflict is not the same as impropriety and focus on how to avoid potential or perceived wrongdoing. Most importantly all acknowledge that perceived wrongdoing can be as detrimental as actual wrongdoing, and risks losing confidence in the probity of CCGs and


the integrity of wider clinicians such as GPs in networks/federations, individual practices and partners. The RCGP/NHS Confederation also notes evidence from the BMJ that people think they aren’t biased by potential conflicts but often are so the common theme is - if in any

doubt it’s important to disclose. The RCGP/NHS Confederation and NHS England Guidance identify four types of potential conflict of interest:

• direct financial; • indirect financial (for example a spouse has a financial interest in a provider); • non-financial (i.e. reputation) and; • loyalty (i.e., to professional bodies).

The BMA recognises that for CCGs there will be situations where the best decision for the population and taxpayers is not in the best interest of individual patients (for whom GPs are required to advocate) and that this can create a perceived conflict. The RCGP/NHS Confederation paper acknowledges this but in terms of the governance when commissioning services. 4. Planning for populations

CCGs must always demonstrate that their commissioned services meet the needs of their local populations, as such CCGs will need to work with their Health and Wellbeing Board’s or other local strategic bodies to ensure there is alignment to local strategic plans. What is clear from all the existing guidance is that CCGs will need to identify the situations where they are involving their governing body clinicians to strategically plan for their population, and situations where their governing body clinicians need to be separated from procurement, planning and decision-making processes. In the former it is critically important to secure clinical expertise. In the latter, the CCG will need to manage risks around perceived and actual conflicts in relation to the tendering of services. The BMA outlines that decisions regarding resource allocation should be evidence based, and there should be robust mechanisms to ensure open and transparent decision making. As such, GP involvement must be agreed at each stage of the commissioning and procurement process so that potential risks of conflicts are appropriately defined and mitigated early on. 5. Good practice – for CCGs

All the guidance suggests CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians.


The RCGP/NHS Confederation suggests using existing NHS guidance as a starting point: • Identify potential conflicts • Declare interests in a register

Exclude individuals from discussion or decision making if financial interest exceeds 1% equity in the provider organisation - depending on the nature of the discussion (we would also add that includes considering the share of the contract value to make sure there are no loopholes, this might also apply to practices with profit sharing arrangements).

• Continue to manage conflicts post-decision i.e. contract managing (carefully separating overall strategy development for populations from individual procurement processes. The former will be important for CCG lay involvement will be important and include secondary care clinicians and non-executive Board nurses, the latter can be managed by managers).

NHS England guidance also says that an individual with a ‘material interest’ in an organisation which provides or is likely to provide significant business should not be member of CCG governing body. The BMA suggests anything above 5% equity is a material interest. The RCGP/NHS Confederation reference this threshold but also say that something lower than a 1% stake could also be a material interest (if the size of the bid is significant). Clearly these thresholds need to be considered in relation to individual practices and GP partners once co-commissioning is in place. The perceived risks must be recognised early on and we feel some worked case study examples would be helpful for CCGs as they work through the updated guidance. NHSCC, the RCGP and the BMA are planning to work with NHS England and Monitor to identify these examples. NHSCC believe that CCG lay members, secondary care doctors and nurses on governing bodies play a vital role in both the design, implementation, leadership and monitoring of conflicts of interest systems and processes. They can provide robust challenge and ultimately a protection for GPs working in both the commissioning and provision of health care. Enabling them to carry out their roles in this regard is vital. CCGs should also be proactive in their approach when considering conflicts when electing/selecting people, doing a proper induction (i.e. include continuous training and review at both Governing Body and membership (assembly level) and ensuring understanding from individuals, and agree in advance how different scenarios will be dealt with. The CCG should ensure individuals are prompted to declare an interest but not absolved from their responsibility to declare as well. Again, CCG lay members, secondary care doctors and nurse members of the governing body have a critical role in this process, as an independent arbiter and as those providing appropriate scrutiny and oversight. NHS England’s Code of Conduct guidance specifically explores when CCGs are commissioning services from their own GP member practices. When CCGs are commissioning from federations of practices, the same guidance should apply. As practical support NHS England have also produced an updated code of conduct

http://www.england.nhs.uk/wp-content/uploads/2012/09/c-of-c-conflicts-of-interest.pdf


template for use when drawing up local plans (see their updated guidance). The template asks a series of questions to provide assurance to Health and Wellbeing Boards that the service meets local needs, and to the Audit Committee or external auditors that robust process was used to commission the service, select the appropriate procurement route and address potential conflicts of interest. 6. Good practice - for individuals

The current guidance suggests that individuals making decisions in CCGs do so with the Nolan principles of public life in mind: selflessness, integrity, objectivity, accountability, openness, honesty, and leadership. They also refer to the guidance the General Medical Council (GMC) has produced for doctors including: • You must not allow any interests you have to affect the way you prescribe for,

treat, refer or commission services for patients. • If you are faced with a conflict of interest, you must be open about the conflict,

declaring your interest informally, and you should be prepared to exclude yourself from decision making.

• You must not try to influence patients’ choice of healthcare services to benefit you, someone close to you, or your employer. If you plan to refer a patient for investigation, treatment or care at an organization in.

NHS England guidance indicates that individuals must declare an interest as soon as they come aware of it, and within 28 days. More informally, the RCGP/NHS Confederation also suggested the simple ‘Paxman test’ - whether explaining the situation to an investigative reporter/journalist like Jeremy Paxman would cause embarrassment. We think it would be helpful to develop this type of text into a tool for CCGs to use locally. NHS England guidance indicates that individuals must declare an interest as soon as they come aware of it, and within 28 days. Finally, the BMA suggested that commissioner doctors:

• Declare all interests, even if they are potential conflicts or the individual is unsure whether it counts as a conflict, as soon as possible.

• Update a register of interests every three months. • Doctors must be familiar with their organisation’s formal guidance. • If individual doctors have any questions, they should seek advice from

colleagues, err on the side of being open about conflicts of interest, or seek external advice from professional or regulatory bodies.

In addition to the above, the RCGP suggests there should also be a requirement to update the register of interests if a material difference arises in the circumstances of an individual at any point. 7. Procurement processes – CCGs and member practices

http://www.gmc-uk.org/guidance/ethical_guidance/21161.asp


According to the BMA guidance, when CCGs are procuring community level services, these contracts are often below threshold requiring a competitive tender process. There are a number of procurement options for CCGs in this situation – for example a few may include:

1. Competitive tender where GP practices are likely to bid 2. AQP where GP providers are likely to be among the qualified providers 3. Single tender from GP practices

From the guidance that exists, different questions arise around conflicts of interest when the above procurement processes are used. For example:

• Identifying whether approaches such as AQP are being used with the safeguards to ensure that patients are aware of the choices available to them.

• If single tender is the route used, CCGs will need to demonstrate a few things depending on the nature of the procurement. For example that there are no other capable providers, why the successful bid was preferred to the others and the impact of disproportionate tendering costs. (Monitor’s procurement guidance provides many useful steers on what CCGs will need to demonstrate)

For primary care co-commissioning, NHSCC believes one of the elements to include on procurement processes are the issues around standing financial orders and schemes of delegation which should not allow CCGs to divide primary care budgets into smaller budgets to circumvent the procurement process. NHSCC’s lay member network will have examples/steer on the correct wording to use from previous local experiences. Regardless of what the local application is the most important part of this process is transparency. NHS England says to set out the details, including the value of all contracts on the CCG website. If they are using AQP, the types and prices of services they are commissioning should be on the website. All of this information should also be in the CCG’s annual report. When making procurement decisions, the current guidance suggests that anyone with a perceived or material conflict should be excluded from decision making, either both excluded from voting or from discussion and voting. What is not clear in the guidance is how far back this rule goes – i.e. to the planning stage or just the development of the specification and procurement. CCGs will need to agree that line locally. According to the reviewed guidance if all GPs and practice representatives due to make a decision are conflicted, then the CCG should be:

• Referring decisions to the governing body, so that lay members / the nurse / the secondary care doctor can make the final decision. However this may weaken GP clinical input into decision making.

• Co-opting individuals from the HWB or another CCG onto the governing body, or invite the HWB / another CCG to review proposal to provide additional scrutiny

https://www.gov.uk/government/publications/procurement-patient-choice-and-competition-regulations-guidance




(these individuals would only be able to participate in decision making if this was set out in the CCG constitution)

• Ensure that quoracy rules enable decisions to be made in this circumstance • Plan ahead to ensure that agreed processes are followed. • Use an appropriately constituted arms-length external scrutiny committee to

ensure probity (recommended by the BMA)

CCGs can use commissioning support services (CSS) to reduce potential conflicts, for example a CSS can help select the best procurement route and prepare bids etc. However, this cannot completely eliminate the conflict as CCGs are responsible for signing off specification and evaluation criteria, signing off which providers to invite to tender, and making the final decision on the selection of the provider. The CCG is responsible for ensuring that their CSS or other third parties are compliant with regulations in the same way that the CCG must be. NHS England also suggest any questions about the service going beyond the scope of the GP contract should be discussed with NHS England area teams, clearly that would need review in light of new delegated co-commissioning arrangements. Networks and Federations We note that the increasing number of GP networks and federations could potentially present an added complication to local procurement processes. If most or all CCG member practices are part of the local federation, then this could mean that a practice not part of the federation/excluded from a federation may not have the opportunity to win contracts through competitive tender – because the process is more suited to federated organisations. One way to mitigate this would be for the CCG to always design and procure service specifications according to best practice (with openness and transparency), thereby supporting all practices to bid. One area to be careful about is when all the GPs on a governing body have a declared interest in local federations – this makes decision making and accountability complex and the CCG will need to work that through carefully with the input of its lay members and wider clinicians on the governing body. Again, an external scrutiny committee with non-conflicted clinicians such as from a neighbouring CCG may be helpful. 8. Local engagement

Separately, the BMA suggests that LMCs should be involved in CCGs either by formal consultation, a non-voting seat on governing body, or as an observer on governing body. They indicate that a non-voting governing body seat would be the best option. Neither of the other two papers we reviewed address this. 9. Other conflicts of interest issues for consideration

Personal conflict The RCGP/NHS Confederation highlight that in CCG governing bodies a personal conflict can arise because CCG leaders are elected by their constituent GP members. There could be a perception that CCG governing bodies are favouring the most vocal or


influential of their GP practice members. Related to this is the potential indirect interest for elected GPs to build a constituency of supporters within their CCG. The CCG is responsible for ensuring that their CSS or other third parties are compliant with regulations in the same way that the CCG must be. NHS England guidance suggests that in the case of every GP governing body member being conflicted, the lay members, registered nurse and secondary care doctor make the decision (and that the constitution is written so that this is quorate). This could however mean that decisions would be taken without a GP perspective. Alternatively, CCGs may bring in members of the Health and Wellbeing Board or another CCG to provide oversight, or as the BMA suggests use an external scrutiny committee to make decisions. Use of primary care incentive schemes In its guidance, the BMA highlights its concerns about the professional and ethical implications of CCGs applying incentive schemes to reduce referral or prescribing activity. The BMA urges any doctor, whether commissioner or provider, to consider the schemes carefully and ensure that scheme is based on clinical evidence. NHSCC suggests that one solution is to ensure the expertise of secondary care clinicians and nurses on governing bodies plays an important part in providing clinical input and lay members can scrutinize commercial/ financial and performance data.

The RCGP acknowledge that it is not ethical to under-treat or under-refer for financial gain, but is not unethical to ‘review and reflect’ on variations in referral/prescribing rates and try to reduce referrals in line with evidence or best practice. Note to the reader:

This paper has been developed from a review of three guidance documents and brings together previous lines/guidance from NHSCC, NHS England, the RCGP and the BMA. 10. BMA ‘Conflicts of interest in the new commissioning system: Doctors in commissioning roles’ April 2013 11. RCGP/NHS Confederation ‘Managing conflicts of interest in clinical commissioning groups’ September 2011 12. NHS England ‘Managing conflicts of interest: guidance for clinical commissioning groups.’ March 2013 (includes Commissioning Board Document that precedes it). We have also read across the paper to the new version of this document published December 2014. NHSCC have also supplemented the principles raised in this paper with some points for steer that have been raised by members of its lay member network.

http://bma.org.uk/-/media/files/pdfs/practical%2520advice%2520at%2520work/commissioning/conflictsofinterestdoctorsascommissioners.pdf

http://www.rcgp.org.uk/policy/%257e/media/files/circ/managing_conflicts_of_interest.ashx

http://www.england.nhs.uk/wp-content/uploads/2013/03/manage-con-int.pdf


APPENDIX B

TERMS OF REFERENCE

PRIMARY CARE COMMITTEE

Initial draft agreed by CCG Board in November 2014 This version agreed by Audit Committee on 8 January 2015 Subject to final CCG Board approval on 30 January 2015

CCG Primary Care Committee Terms of Reference

January 2015 Introduction The CCGs Primary Care Committee has delegated responsibility from the CCG Board for ensuring the delivery of the CCGs clinical strategy through robust contractual arrangements with general practices, the GP Confederation and the GP OOH provider, and ensuring this is transacted in a robust way to manage conflicts of interests Objectives

1. The CCG Primary Care Committee (CCG PCC) has been established to oversee the planning and development of primary care provision, to deliver the CCG strategy under delegated commissioning responsibilities from NHSE and to consider, review and agree the associated service specifications and contractual arrangements and in particular those where; • we are potentially contracting with City and Hackney GP practices

directly or through the local confederation of City and Hackney GP practices for list based services or extended primary care/out of hospital services

• we are contracting with the GP social enterprise providing our Out of Hours Service (CHUHSE)

• we are undertaking expanded primary medical care commissioning functions under delegated responsibilities from NHSE

• where practices, the GP Confederation, CHUHSE is a potential provider under any CCG procurement exercise

2. In accordance with its statutory powers under section 13Z of the National

Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to City and Hackney CCG. The delegation is set out in Schedule 1.

3. The CCG has established the CCG Primary Care Commissioning

Committee (“Committee”). The Committee will function as a corporate

decision-making body on behalf of the CCG Board for the management of the delegated functions and the exercise of the delegated powers.

4. It is a committee comprising representatives of the following organisations:

• City and Hackney CCG

• Healthwatch City of London

• Healthwatch London Borough of Hackney

In addition to voting members being represented by the above, the following organisations are also invited as non-voting members;

• Health and Wellbeing Board – City of London

• Health and Wellbeing Board – London Borough of Hackney

• Public Health representative

Statutory Framework

5. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

6. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.

7. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

8. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:

• Duty to have regard to impact on services in certain areas (section 13O);

• Duty as respects variation in provision of health services (section 13P).

9. The Committee is established as a committee of the CCG Governing Body

in accordance with Schedule 1A of the “NHS Act”.

10. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

Primary Care Commissioning Role of the Committee 11. The Committee has been established in accordance with the above

statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in City and Hackney, under delegated authority from NHS England

12. Primary care services in City and Hackney as part of the CCGs statutory commissioning responsibilities.

13. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and City and Hackney CCG, which will sit alongside the delegation and terms of reference and in accordance with its constitution.

14. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

15. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.

16. This includes the following:


• 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; • Handling of practice vacancies arising from death, retirement,

resignation or any other reason; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner/retainer

schemes).

17. The CCG will also carry out the following activities:

• To plan, including needs assessment, primary [medical] care services in the City and Hackney;

• To undertake reviews of primary [medical] care services in City and Hackney;

• To co-ordinate a common approach to the commissioning of primary care services across the CCG;

• To manage the budget for commissioning of primary [medical] care services in City and Hackney.

Additional Remit and Responsibilities

18. The Committee has the following role on behalf of the CCG Board:

• To review service specifications and contractual proposals for all CCG commissioned services from primary care providers (either directly or via the GP Confederation)

• To ensure that the contractual proposals will achieve health improvement and represents value for money

• To ensure that in developing service specifications and contract proposals all conflicts of interest have been mitigated in line with the CCG conflicts of interest policy

• To review the contracting route for the proposals • In respect of procurement activities, review proposals from Programme

Boards around process, documentation,(including service specifications and evaluation criteria) and membership to help assure conflicts of

interest have been mitigated in order for them to make recommendations to the Board

• To review procurement process after completion and ensure process was followed and endorse the recommendation to award a contract

• Take advice from audit committee and follow any framework they suggest for initiatives and/or procurement

• review and assess any key performance indicators (KPIs) and contractual metrics and the basis on which contractual payments would be made and provider performance assessed

• Consider any supporting legal advice obtained in respect to contracting matters and may request specific advise taken where the committee feels this would help their recommendations

• The Board requires the Committee to review and authorise requests for payments to be made under the GP contracts that have been entered into by the CCG. The Committee review whether the control processes (established by the CCG to ensure that services have been properly delivered by the GPs under these contracts) have been followed in practice and authorise payment. • All decisions relating to contracting with and investment in CHUHSE (the OOH provider) will be reviewed by this committee once a recommendation has been received by our Urgent Care Board/ System Resilience Group.

Geographical Coverage

19. The Committee will cover the City and Hackney CCG locality.

Membership

20. The committee shall consist of the following voting members;

• CCG Board Associate Lay Member - (Currently Jaime Bishop) Chair • CCG Board Lay Member (Governance) • CCG Board Lay Member (PPI and Conflicts) • CCG Board Associate Lay member • Secondary Care consultant CCG Board Member • Nurse CCG board member • Healthwatch - City of London • Healthwatch - LBH • Chief Officer • Chief Financial Officer • Schedule 3 details individual members

Attenance (without voting rights)

• Representatives from the following organisations will be in attendance although not voting members;

• Chair of the Health and Wellbeing Board – City of London

• Chair of the Health and Wellbeing Board – London Borough of Hackney

• Director of Public Health representing the CCG locality • Independent GP adviser to the CCG

21. Other representatives may be invited by the Chair in order to maintain a

balance of representation.

22. The clinical chairs of the CCG Programme Boards (and other CCG staff) will be invited to attend meetings of the committee to outline their proposals and clinical strategy. However they will not be present when the committee debates the plans or makes its decisions

Chair

The Committee is chaired by the Associate Lay member, Jaime Bishop as his role does not require him to attend the Audit Committee.

In his absence, the role of Chair can be covered by the other Associate Lay member or the Lay Member PPI and Conflicts.

Meetings and Voting

23. The Committee will operate in accordance with the CCG’s Standing Orders.

24. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member no later than 7 days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

25. Notification of meetings and meeting papers will be published on the CCG website.

26. Each voting member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of

the Committee will be to achieve consensus decision-making wherever possible

Secretary

27. Administrative support to the PCC will be provided by the CCGs Business Co-ordinator who also manages the CCGs business cycle.

Quorum

28. The quorum needed for the transaction of business is:

• 1 CCG Board Lay Member (can include Associate Lay Member) • 1 of either the secondary care consultant Board Member or Nurse Board

Member • 1 Healthwatch representative • 1 CCG Officer

Frequency of meetings

29. The CCG Primary Care Committee will meet bi-monthly during the calendar year and more regularly if required however will be stood down if there is no business to transact.

Transparency

30. Meetings of the committee shall:

a) be held in public, subject to the application of 23(b);

b) the 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.

31. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavor to reach a collective view.

32. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations

are consistent with the parties’ relevant governance arrangements, are

recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

33. Members of the Committee shall respect confidentiality requirements as set

out in the CCG’s constitution.

34. The Committee will present its minutes to London area team of NHS England and the governing body of City and Hackney CCG after each meeting for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 29 above.

35. The CCG will also comply with any reporting requirements set out in its constitution.

36. The committee meeting dates will be communicated well in advance of the meeting date and the arrangements for public attendance clear and transparent.

Conflicts of Interest

37. Where a member has an interest, or becomes aware of an interest which could lead to a conflict of interest in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this Constitution and the

CCG’s Conflicts of Interest policy.

38. The Chair will, at the beginning of all committee meetings, ask for members to highlight any conflicts of interest as well as reminding members to ensure their register of interests is up to date.

39. A register of interests will be completed by all members and is updated at least quarterly and is available on our website for public scrutiny.

40. The register of interests will be available at each meeting.

Review

41. It is envisaged that these Terms of Reference will be reviewed from time to

time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee 42. The constitution and standing orders have been amended to reflect that the

committee has received delegated responsibility to make decisions on behalf of the Governing Body. Standing Financial Instructions will be amended to reflect this.

Procurement of Agreed Services 43. The detailed arrangements regarding procurement will be set out in the

delegation agreement which will be attached under schedule 1 & 2.

Decisions 44. The Committee will make decisions within the bounds of its remit.

45. The decisions of the Committee shall be binding on NHS England and City and Hackney CCG.

46. The Committee will produce an executive summary report which will be presented to the London regional team of NHS England and the governing body of City and Hackney CCG after each meeting for information.

Schedule 1 – Delegation-to be added when final arrangements confirmed Schedule 2 – Delegated functions-to be added when final arrangements confirmed Schedule 3 - List of Members Members

• CCG Board Associate Lay Member - Jaime Bishop (Chair) • CCG Board Associate Lay Member - Honor Rhodes • CCG Board Lay Member (PPI and Conflicts) - Catherine Macadam • CCG board Lay Member (Governance) – Mariette Davis

• Consultant Board Member - Christine Blanshard • Nurse Board Member – Siobhan Clarke

• Healthwatch City of London – Invitation sent asking for nomination

• Healthwatch LBH – Invitation sent asking for nomination

• Chief Officer – Paul Haigh

• Chief Financial Officer – Philippa Lowe In attendance

• Health and Wellbeing Chair, LBH – Councilor Jonathan McShane

• Health and Wellbeing Chair, City of London – Reverend Martin Dudley

• Public Health Director, LBH & CoL – Penny Bevan

• Independent GP advisor – Mike Fitchett January 2015


APPENDIX C

INFORMATION GOVERNANCE

TOOLKIT

INFORMATION GOVERNANCE REPORT

1. Introduction

Information is a vital asset, both in terms of the clinical management of indvidual patients and the efficient organisation of services and resources. NHS City and Hackney Clinical Commissioning Group aims to safeguard patient confidentiality and maintain data security whilst empowering staff within the CCG to perform their role using key information governance principles.

1.1 What is Information Governance

Information Governance (IG) is the way in which the NHS handles all of its information, and in particular, the personal and sensitive information relating to patients and employees. It provides a framework to ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver the best possible care.

1.2 NHS City and Hackney Clinical Commissioning Group

NHS City and Hackney Clinical Commissioning Group (CCG) is a new NHS organisation. CCGs are led by GPs, which means that they are better placed to assess, understand and meet the health needs of their patients, ensuring effective and accessible healthcare for all. City and Hackney CCG is made up is made up of 43 GP practices.

We are responsible for:

• understanding the health needs of the population • facilitating the design and redesign of services • buying services • Measuring the impact of services and how well they are provided.

The CCG is overseen by NHS England, which ensures we have the capacity and capability to commission services successfully and to meet our financial responsibilities.

2. Why Information Governance (IG) compliance is required

Information Governance (IG) is the way in which the NHS handles all of its information, in particular the personal and sensitive information relating to patients and employees. It provides a framework to ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver the best possible care. It also offers NHS employees a clear structure to deal consistently with the many different rules about how information is handled,

3. Information Governance Toolkit

The Information Governance Toolkit is a Department of Health (DH) Policy delivery vehicle that the Health and Social Care Information Centre (HSCIC) is commissioned to develop and maintain. It draws together the legal rules and central guidance set out by DH policy and presents them in in a single standard as a set of information governance requirements. The organisations in scope of this are required to carry out self-assessments of their compliance against the IG requirements.

Author: Keith James – Information Governance Resource 1 Created: December 2014

http://www.cityandhackneyccg.nhs.uk/about-us/member-gp-practices.htm


There are different sets of information governance requirements for different organisational types. However all organisations have to assess themselves against requirements for:

• Management structures and responsibilities (e.g. assigning responsibility for carrying out the IG assessment, providing staff training, etc).

• Confidentiality and data protection. • Information security.

3.1 Current

The CCG will maintain the compliant score of 68% that was achieved 2013/14 for this current year.

3.2 IG Toolkit There have been some minor changes in the CCG Information Governance toolkit requirements. There are still 28 requirements but the changes are in the CCG ability to mark them as a non-requirement, this means that the requirement does not happen within the CCG or as in requirement 347 Policy and procedures are in place to ensure that Information Communication Technology (ICT) networks operate securely – this is managed by North East London Commissioning Support Unit (NELCSU).

Req No Description Past Level

Current Level

Target Level

Information Governance Management

12-130 There is an adequate Information Governance Management Framework to support the current and evolving Information Governance agenda

3 3 3

12-131 There are approved and comprehensive Information Governance Policies with associated strategies and/or improvement plans

2 2 2

12-132 Formal contractual arrangements that include compliance with information governance requirements, are in place with all contractors and support organisations

2 2 2

12-133 Employment contracts which include compliance with information governance standards are in place for all individuals carrying out work on behalf of the organisation

2 2 2

12-134 Information Governance awareness and mandatory training procedures are in place and all staff are appropriately trained

2 2 2

Confidentiality and Data Protection Assurance

12-230 The Information Governance agenda is supported by adequate confidentiality and data protection skills, knowledge and experience which meet the organisation’s assessed needs

2 2 2

12-231 Staff are provided with clear guidance on keeping personal information secure, on respecting the confidentiality of service users, and on the duty to share information for care purposes

2 NR 2



12-232 Personal information is only used in ways that do not directly contribute to the delivery of care where there is a lawful basis to do so and objections to the disclosure of confidential personal information are appropriately respected

2 2 2

12-234 There are appropriate procedures for recognising and responding to individuals’ requests for access to their personal data

2 2 2

12-235 There are appropriate confidentiality audit procedures to monitor access to confidential personal information

2 2 2

12-236 All person identifiable data processed outside of the UK complies with the Data Protection Act 1998 and Department of Health guidelines

nr NR 2

12-237 All new processes, services, information systems, and other relevant information assets are developed and implemented in a secure and structured manner, and comply with IG security accreditation, information quality and confidentiality and data protection requirements

2 2 2

12-250 Individuals are informed about the proposed uses of their personal information

2 2 2

Information Security Assurance

12-340 The Information Governance agenda is supported by adequate information security skills, knowledge and experience which meet the organisation’s assessed needs

2 2 2

12-341 A formal information security risk assessment and management programme for key Information Assets has been documented, implemented and reviewed

2 2 2

12-342 There are established business processes and procedures that satisfy the organisation’s obligations as a Registration Authority

nr NR nr

12-343 Monitoring and enforcement processes are in place to ensure NHS national application Smartcard users comply with the terms and conditions of use

nr NR 2

12-344 Operating and application information systems (under the organisation’s control) support appropriate access control functionality and documented and managed access rights are in place for all users of these systems

2 2 2

12-345 An effectively supported Senior Information Risk Owner takes ownership of the organisation’s information risk policy and information risk management strategy

2 2 2

12-346 Business continuity plans are up to date and tested for all critical information assets (data processing facilities, communications services and data) and service - specific measures are in place

2 2 2

12-347 Policy and procedures are in place to ensure that Information Communication Technology (ICT) networks operate securely

2 NR 2

12-348 Policy and procedures ensure that mobile computing and teleworking are secure

2 2 2

12-349 There are documented incident management and reporting procedures

2 2 2



12-350 All transfers of hardcopy and digital personal and sensitive information have been identified, mapped and risk assessed; technical and organisational measures adequately secure these transfers

2 2 2

12-351 All information assets that hold, or are, personal data are protected by appropriate organisational and technical measures

2 2 2

12-352 The confidentiality of service user information is protected through use of pseudonymisation and anonymisation techniques where appropriate

2 NR 2

Clinical Information Assurance

12-420 The Information Governance agenda is supported by adequate information quality and records management skills, knowledge and experience

2 2 2

12-421 There is consistent and comprehensive use of the NHS Number in line with National Patient Safety Agency requirements

2 2 2

3.3 IG Toolkit – some requirements in detail

3.3.1 IG Requirement 132 There are 80 contracts with third parties in place in the CCG.. All Contracts captured within the folder - I:\ELIC\Contracts and Agreements have been reviewed and all contain IG Clauses. 3.3.2 IG Requirement 234 Subject Access Requests The CCG has in place a Subject access request policy and advice is provided to individuals on the privacy page of the CCG website: http://www.cityandhackneyccg.nhs.uk/privacy.htm The CCG has received no subject access requests from individuals this financial year – April 2014 to December 2014.

3.3.3 IG Requirement 236 Data Flow Mapping

• There is a defined and maintained Safe Haven Fax • There are 3 routine flows of Personal Confidential Data (PCD)

Finance Human Resources – provided by NEL CSU ICT – provided by NEL CSU

• All information flows are heavily controlled and monitored with no information allowed on or off site without the agreement of all those involved in the data exchange and utilising NHS Mail.

• There are no flows of PCD out of the United Kingdom.

3.3.4 IG Requirement 341 Information Asset Register

The CCG has 3 information assets that each has delegated Information asset owners Complaints repository Finance system - Oracle HR Files – paper copies

• Appropriate access controls are in place • Business continuity plans are up to date and tested.


http://www.cityandhackneyccg.nhs.uk/privacy.htm


4. Assurance

Given that the CCG is currently based on 1 site that also has significant physical access controls in place a high level of assurance can be provided

Keith James Information Governance Manager

7.1.15



APPENDIX D

CHANGES TO CONSTITUTION

Agreed at Members Forum on January 8th 2014

NHS CITY and HACKNEY CLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 0.24

Version control version Date Author Changes Circulation 0.1 June Paul Amendments to standard format Clare, Paul, 0.2 July Paul Incorporation of LMV versions,

removal of unnecessary detail Karl, Sue

0.3 & 0.4 26th July Karl After a review with Sue Assar, amendments made to some wording, format and order of detail

Clare/Paul to review prior to wider circulation – due to holiday this may go out to LMC and Greg Carns if no comments received by Monday 30.07.12

0.5 30th July Matt Formatting Paul, Clare, LMC 0.6 August Matt Amendment to wording Paul 0.7 29 August Matt New content following latest

consultation Paul, Karl, Clare

0.8 13 September

Matt Consultation changes accepted, SFIs updated

CCG, external consultation & legal advice

0.8 17 September

Matt Updated following Governing Body special session

0.991 18 September

Karl Update following additional review by AO and advise from solicitor

Paul, LMC

.10 24 Sep. 12 Hempsons Paul, Karl, Matt

.11 26 Sep. 12 Hempsons Paul, Karl, Matt

.12 26 Sep. 12 Hempsons Paul, Karl, Matt, Clare

.13 26 Sep. 12 Karl Paul, Karl, Matt, Clare

.14 04 Oct. 12 Karl Amended based on additional LMC feedback

Paul

.15 08 Oct 12 Hempsons Karl

.16 08 Oct 12 Karl Paul and Clare

.17 12 Oct Karl/Anna LMC feedback, Audit detail

.18 23.10.12 & Karl Changes to Finance structure Karl

version Date Author Changes Circulation 15 Nov 12 and minor amendments

.19 20 Mch Matt formatting Karl

.20 28 June James & Karl

Constitutional change and formatting

Members Forum NHSE Paul Haigh Clare Highton

.21 09 June 2014

Karl Change to deputy chair relating to conflicts

Members Forum NHSE Paul Haigh Clare Highton Philippa Lowe

.22 29 July 2014

Karl Change regarding Remuneration TOR Kiv – associate lay member??

.23 26/11/14 Karl Amendments regarding associate lay members and additions of sub committees Amendments of reference to NCB and other changes. Closed practice removed.

Paul Haigh Philippa Lowe Members Forum NHSE

.24 15/12/14 Karl Primary Care Co Commissioning changes Model wording added for joint arrangements Further amendments to the primary care committee incorporating co commissioning

Paul Haigh Philippa Lowe Members Forum Audit Committee CCG Board NHSE

[Page left intentionally blank]

NHS City & Hackney Clinical Commissioning Group’s Constitution - 1 - Version: 2.0 NHS Commissioning Governing Body Effective Date: 01/04/2013

CONTENTS Part Description Page Foreword 4 1 Introduction and Commencement 5 1.1 Name 5 1.2 Statutory framework 5 1.3 Status of this Constitution 5 1.4 Amendment and variation of this Constitution 6 2 Area Covered 6 3 Membership 6 3.1 Membership of the CCG 6 3.2 Eligibility 6 4 Mission, Values and Aims 7 4.1 What do we believe in? 7 4.2 How will we do this 8 4.3 Principles of good governance 8 4.4 Accountability 9 5 Our Functions and General Duties 11 5.1 Functions 11 5.2 General duties 12 5.3 General financial duties 13 5.4 Other relevant regulations, directions and documents 13 6 Decision Making: Our Governing Structure 14 6.1 Authority to act 14 6.2 Scheme of reservation and delegation 14 6.3 General 14 6.4 Consortia 15 6.5 Consortia Leads 15 6.6 Committees of The Group 16 6.7 Joint Arrangements 16 6.8 The CCG Governing Body 16 6.9 Lay Members 18 6.10 Nurse Members 18 6.11 Hospital Consultant 19 6.12 Board Disqualification Guidance 20 6.13 Committees of The Governing Body 20 6.14 Membership of The Clinical Executive Committee 23 6.15 Disputes 23 7 Roles and Responsibilities 23 7.1 Practice representatives 23 7.2 Clinical Commissioning Forum 25 7.3 Consortia 25


Part Description Page 7.4 Consortium Lead 25 7.5 Members Forum 25 7.6 All Members of the CCG’s Governing Body 25 7.7 The Chair 26 7.8 The Deputy Chair 26 7.9 Accountable Officer 27 7.10 Chief Finance Officer 27 7.11 The role of The Governing Body 28 7.12 Joint appointments with other organisations 29 8 Standards of Business Conduct and Managing Conflicts of Interest 30 8.1 Standards of business conduct 30 8.2 Conflicts of interest 30 8.3 Interests and gifts 33 8.4 Managing conflicts of interest: contractors and people who provide

services to the CCG 33

8.5 Transparency in procuring services 33 9 The CCG as Employer 35 10 Transparency, Ways of Working and Standing Orders 36 10.1 General 36 10.2 Standing orders 38 Appendix Description Page A Definitions of Key Descriptions used in this Constitution 39 B List of Member and Consortium Practices 41 C Standing Orders 44 D Scheme of Reservation and Delegation 58 E Prime Financial Policies 71 F The Nolan Principles 83 G The Seven Key Principles of the NHS Constitution 84 H Joint Arrangements 85


FOREWORD

The Constitution sets out the arrangements made by NHS City and Hackney Clinical Commissioning Group (CCG) to meet our responsibilities for commissioning care for our patients and the principles we will operate by with our partners. It describes the governing principles, rules and procedures that we will establish to ensure probity and accountability in the day-to-day running of the CCG to ensure that decisions are made in an open and transparent way with the interests of our patients and clinicians central to our goals and ambitions.

Who we serve

The City of London and Hackney face a significant health and wellbeing challenge. Hackney is the second most deprived borough in England and although the City of London has low levels of deprivation overall, there is considerable variation between wards, with Portsoken classified within the most deprived 20% of wards in the UK. In Hackney, male life expectancy is lower than the national average and female life expectancy varies by 4.6 years when comparing the most and least deprived wards. In addition, there are a number of pressing health needs in the area, including high levels of childhood obesity, prevalence of severe mental health conditions, late presentation for cancer and deaths from heart disease and stroke. The Hackney population is young and growing with a large turnover each year. The City population is ageing but is also characterised by the significant number of commuters travelling into the City each working day.

Who we are

Our CCG has grown from 2 highly successful clinical commissioning Consortia who have been working together with our 44 practices since 2005 to improve services for local people and have so far been successful in containing the rise in costs. We think this is the result of some excellent joint work with our provider clinicians across clinical pathways over the last five years, our joint commitment to improving the quality and productivity of services and to doing what’s best for patients. Our pathways are widely used and audited across primary and secondary care, helping to raise quality and increase efficiency.

Our challenge

The next 3 years will be challenging for health services in City and Hackney because there is no longer growth money to cover increased costs, while our population faces an increase in poverty and chronic long term conditions, with rising unemployment and loss of welfare benefits. We expect increased ill health and higher demand, including for mental health services. Our Joint Strategic Needs Assessment details the local health challenges and we look forward to working with our constituents and partners to address these, building on all our work to date.


1. INTRODUCTION 1.1. Name 1.1.1. The name of our Clinical Commissioning Group is NHS City and Hackney Clinical

Commissioning Group (CCG). 1.2. Statutory Framework 1.2.1. Our CCG is established under the National Health Service Act 20061. We are a

statutory body which has the function of commissioning services for the purposes of the health service in England and are treated as an NHS body for the purposes of the 2006 Act2. The duties of our CCG are to commission certain health services set out in section 3 of the 2006 Act, as amended by section 13 of the Health and Social Care Act 2012, and the regulations made under that provision3.

1.2.2. Our CCG will primarily be required to commission secondary care health services

within the City of London and the London Borough of Hackney to: a) All patients registered with members who are GP practices (as per 3.2.1); b) Individuals who are resident within the City of London and the London

Borough of Hackney but not registered with members who are GP practices. 1.2.3. NHS England (NHSE), formally the NHS Commissioning Board (NCB) will

undertake an annual assessment of the CCG4. It has powers to intervene where it is satisfied that the CCG is failing or has failed to discharge any of its functions or that there is a significant risk that it will do so5.

1.2.4. We are a clinically led membership organisation made up of general practices.

The members of our CCG are responsible for determining the governing arrangements for the CCG, which we are required to set out in this Constitution6.

1.3. Status of this Constitution 1.3.1. This Constitution is made between the CCG’s members of City and Hackney CCG

and has effect from 1st day of April 2013 when the NCB established the CCG7. This Constitution is published on our website.

1.3.2. It is also available by post from; NHS City and Hackney CCG, 3rd Floor, A Block,

St Leonards Hospital, Nuttall Street, London N1 5LZ.

1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act 4 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 5 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued 7 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act


1.4. Amendment and Variation of this Constitution 1.4.1. This Constitution can only be varied in two circumstances8:

a) Where our members and the Governing Body apply to NHSE and that application is granted;

b) Where, in the circumstances set out in legislation, NHSE varies our Constitution other than on application by our members.

1.4.2. Any consortium representative, on behalf of their constituent members can call a

meeting of the Members’ Forum to discuss changes and amendments to this Constitution.

1.4.3. If 51% of those voting at a meeting of the Members’ Forum agree with the proposed

amendments the Governing Body is bound by this decision and will apply to NHSE on behalf of members for the constitution to be amended.

2. AREA COVERED 2.1. The geographical area (the Area) covered by NHS City & Hackney CCG is:

a) The London Borough of Hackney; b) The City of London Corporation.

3. MEMBERSHIP 3.1. Membership of the CCG 3.1.1. Appendix B of this Constitution lists the members of our CCG. 3.1.2. There are six consortia (each a consortium and together the consortia) being

South West Consortium, North West Consortium, North East Consortium, R&S Consortium, Well Consortium and Klear Consortium.

3.1.3. Each member shall belong to one of the CCG’s six consortia as shown in Appendix B.

3.2. Eligibility 3.2.1. A body which is a provider of primary care services (holding a General Medical

Services (GMS), Personal Medical Services (PMS) or Alternative Personal Medical Services (APMS) Contract) in the locality may apply to become a Member of the CCG under the following conditions: a) If the provider holds a contract for the provision of primary medical services; b) It is a primary care services provider in City and Hackney; c) It has duly submitted an application to NHSE for membership to City and

Hackney CCG, such membership having been approved.

8 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued


3.2.2. Once our CCG is established and an application is received from an eligible

provider of primary care services as defined in 3.2.1, the Members’ Forum will ask the Governing Body to apply to NHSE to amend the Constitution to admit the proposed new member.

3.3. Each member shall nominate a practice representative to represent their

practice's views and act on behalf of the practice in matters relating to the CCG. 4. VISION, VALUES AND AIMS 4.1. What do we believe in? 4.1.1. We will transform the way services are delivered so that we can reduce health

inequalities for our patients at the same time as improving quality and access, aspiring to provide the best healthcare to those living in the City of London and Hackney.

4.1.2. We want to ensure that our patients have easy access to a full range of services

each of which delivers a consistently high standard of patient experience and clinical outcome.

4.1.3. We will adopt a whole person approach to what we commission, integrating NHS

and social services where this makes clinical and financial sense and commit to commissioning and procuring services in a fair and ethical manner.

4.1.4. We will commission patient centred treatment and care that is grounded in dignity

and mutual respect. 4.1.5. We will ensure that all our plans and decisions will benefit our patients and that all

the work we engage in will really make a difference. 4.1.6. We will work together to protect and continue the strengths, ethos and values on

which the NHS was founded. 4.1.7. We will work with our member practices, external partners and providers and our

local communities to reduce health inequalities and improve quality for our patients.

4.1.8. We will play an active role in shaping, supporting and providing education both for

members of our CCG and more widely for the NHS and the health and social care system.

4.1.9. We will make our decisions and conduct our business in an open and transparent

fashion. 4.1.10. We will work to ensure clinicians and patients are motivated and inspired by what

we do, and so will want to get involved and really influence our thinking.


4.1.11. We will work to ensure that patient choice is not restricted by the way we commission services and that the healthcare needs of different groups are considered equally and fairly.

4.1.12. We will ensure sustainability principles are embedded across our commissioned

services thus preserving resources for future generations and ensuring public money is spent in the most effective and sustainable way possible.

4.1.13. We will play an active role in supporting and stimulating research and in ensuring

that robust evidence from research is translated into clinical practice. 4.2. How will we do this? 4.2.1. By creating a strong and equal partnership between our patients, public and

clinicians, working in an open and transparent manner. 4.2.2. By operating in an open and democratic manner, with GP consortia and other

representative groups electing their representatives and involving all interested parties at all stages of our thinking and our decisions.

4.2.3. By committing to promoting and celebrating diversity and equality and to

combatting racism, homophobia, sexism, discrimination against people with disabilities and similar behaviours and attitudes which undermine social cohesion and social justice.

4.2.4. By only commissioning services from providers who can demonstrate a

commitment to their social responsibilities and to sustainability principles. 4.2.5. By working openly, transparently and extensively with our local providers to

ensure we can stay in financial balance. 4.2.6. By debating and declaring conflicts of interest and anything that might be viewed

as a conflict openly to ensure that we do not undermine the trust of our patients. 4.2.7. By committing to involving the public, patients and our members in our decisions,

consulting and testing out our plans and ideas via our website, formal consultation, meetings and other appropriate routes.

4.2.8. By being receptive to all the feedback and views that we receive and explaining

what we have done in response. 4.2.9. By publishing our Board papers and decisions in minutes on our website and

documenting contract decisions in line with the Information Commissioner’s Office Model Publication Scheme.

4.2.10. By being transparent in the decisions we make and how we make them, making

as many decisions as possible in public and resisting being bound by conditions of commercial confidentiality.


4.2.11. By working with our Health and Wellbeing Boards (HWBs) and our patients, clinicians and partners to ensure that we collectively address the needs identified in both the Joint Strategic Needs Assessment (JSNA) and those raised by our patients, clinicians and partners.

4.2.12. By continually challenging our assumptions and initiatives through robust review of

data, clinical evidence, best practice, research, clinical audit, patient and clinician views and experiences, patient and clinical outcomes, quality measures and benchmarked performance information.

4.2.13. By working with and always considering the needs of City and Hackneys unique

communities and residents. 4.2.14. By working together with the public, patients, clinicians and local organisations,

learning from and challenging each other and sharing ideas and best practice, promoting a culture of constructive challenge.

4.2.15. By promoting good governance and proper stewardship of public money in

pursuing our goals and meeting our statutory responsibilities. 4.3. Principles of Good Governance 4.3.1. In accordance with section 14L (2)(b) of the 2006 Act9, we will at all times observe

“such generally accepted principles of good governance” in the way we conduct our business. These include: a) The highest standards of propriety involving impartiality, integrity and

objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

b) The Good Governance Standard for Public Services10; c) The standards of behaviour published by the Committee on Standards in

Public Life (1995) known as the ‘Nolan Principles’11; d) The seven key principles of the NHS Constitution12; e) The Equality Act 201013.

4.4. Accountability 4.4.1. We will demonstrate accountability to our members, local people, stakeholders

and NHSE in a number of ways, including by: a) Publishing our Constitution; b) Appointing independent lay members and non GP clinicians to our Governing

Body; c) Holding meetings of our Governing Body in public on a monthly basis (except

where we consider that it would not be in the public interest in relation to all or

9 Inserted by section 25 of the 2012 Act 10 The Good Governance Standard for Public Services, The Independent Commission on Good Governance

in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004

11 See Appendix F 12 See Appendix G 13 See http://www.legislation.gov.uk/ukpga/2010/15/contents


part of a meeting) that will be communicated well in advance of the meeting date not only through the CCG website and social media, but also via GP surgeries and the local press;

d) Production of an extensive website, detailing our role, ways of working, policies, performance information, tender, contract, procurement and service details as well as Board papers, consultations, decisions, local pathways, educational material and a Freedom of Information log and responses;

e) Disclosing on request all information that can lawfully be disclosed and flagging for inclusion on the website’s Freedom of Information log;

f) Consulting our constituent practices, patients and the public, representative groups and local organisations and getting their ideas and input via our Consortia, representative groups, the monthly Clinical Commissioning Forum (CCF) and monthly newsletter;

g) Consulting on and publishing an annual commissioning plan developed with our practices and partners;

h) Complying with Local Authority health overview and scrutiny requirements; i) Working with the Health and Wellbeing Boards; j) Meeting at least annually in public in an annual general meeting (AGM) to

publish and present our annual report; k) Producing annual accounts in respect of each financial year which must be

externally audited; l) Having a published and clear complaints process; m) Complying with the Freedom of Information Act 2000; n) Through our patient and public engagement strategy available on our website; o) Providing information to NHSE as required; p) Calling a Members’ Forum meeting.

4.4.2. The Governing Body of the CCG will, throughout each year, have an ongoing role

in reviewing our governance arrangements to ensure that we continue to reflect the principles of good governance and reflect on our experiences.

4.4.3. We recognise the role of the City and Hackney Local Medical Committee (LMC) in

representing the professional interests of our GPs. We therefore are committed to maintaining a strong, open, effective and collaborative relationship with the LMC.

4.4.4. We will do this by:

a) Ensuring senior CCG representatives attend meetings of the City and Hackney LMC;

b) Keeping the LMC fully briefed on potential issues related to the delivery of services in practices as providers arising from the commissioning and activities of the CCG;

c) Sharing the Governing Body and Clinical Executive papers with the LMC prior to each meeting and invite a representative to attend;

d) Recognising that LMC representatives have the opportunity to raise issues at consortia meetings and/or a Members’ Forum meeting, as well as through the Chair or Accountable Officer;

e) Asking the LMC to oversee GP election processes.


5. OUR FUNCTIONS AND GENERAL DUTIES 5.1. Functions 5.1.1. The functions that we are responsible for exercising are largely set out in the 2006

Act, as amended by the 2012 Act. An outline of these appears in the Department of Health's ‘Functions of CCGs’14. They relate to: a) Commissioning certain health services (where NHSE is not under a duty to do

so) that meet the reasonable needs of: i) All people registered with member practices; ii) People who are usually resident within the area and are not registered

with a member of any CCG. b) Commissioning emergency care for anyone present in the CCGs area; c) Paying its employees' remuneration, fees and allowances in accordance with

the determinations made by its Governing Body and determining any other terms and conditions of service of the CCGs employees;

d) Determining the remuneration and travelling or other allowances of members of its Governing Body.

5.1.2. The CCG delegates to the Governing Body and its committees the performance of

its functions set out in Clause 5.1.1. 5.1.3. In discharging its functions, the CCG and the Governing Body on its behalf will:

a) Act15, when exercising our functions to commission health services, consistently with the discharge by the Secretary of State and the NHS Commissioning Board of their duty to promote a comprehensive health service16 and with the objectives and requirements placed on the NHS Commissioning Board through the mandate17 published by the Secretary of State before the start of each financial year by: i) Delegating responsibility for exercising and ensuring compliance with this

function to the Governing Body and its sub committees as laid out in the Standing Orders and in line with the vision, values and aims as laid out in section 4 of the Constitution.

b) Meet the public sector equality duty18 by delegating responsibility for this function to the Governing Body to ensure the CCG operates with due regard to: i) Elimination of unlawful discrimination, harassment and victimisation and

other conduct prohibited by the 2010 Act; ii) Advancing equality of opportunity between people who share a protected

characteristic and those who do not; iii) Fostering good relations between people who share a protected

characteristic and those who do not. c) Work in partnership with Local Authorities to develop joint strategic needs

assessments19 and joint health and wellbeing strategies20 by:

14 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570 15 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 16 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 17 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act 18 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act


http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134570

i) Membership of the City of London Corporation and London Borough of Hackney Health and Wellbeing Boards.

5.2. General Duties 5.2.1. We are responsible for making arrangements to:

a) Secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements21. These duties are delegated to our Governing Body who will abide by the following principles: i) Working in partnership with patients, carers and the local community to

secure the best care for them; ii) Adapting engagement activities to meet the specific needs of different

patient groups and communities; iii) Publishing information about health services on the CCGs website and

through other media; iv) Encouraging and acting on feedback; v) Developing a Communications and Patient Public Involvement strategy

that expands on these principles, details how we will implement them and how we will monitor and report compliance.

5.2.2. The CCG will fulfil the following general duties by delegating responsibility for

exercising and ensuring compliance to the Governing Body and its sub committees as laid out in the Standing Orders and in line with the vision, values and aims as laid out in section 4 of the Constitution: a) Promote awareness of, and act with a view to securing that health services

are provided in a way that promotes awareness of, and have regard to the NHS Constitution22;

b) Act effectively, efficiently and economically23; c) Act with a view to securing continuous improvement to the quality of

services24; d) Assist and support NHSE in relation to the Governing Body's duty to improve

the quality of primary medical services25 and specialist commissioning, working in collaboration with the HWBBs;

e) Have regard to the need to reduce inequalities26; f) Promote the involvement of patients, their carers and representatives in

decisions about their healthcare27; g) Act with a view to enabling patients to make choices28;

19 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act 20 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act 21 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act 22 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act) 23 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 24 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act 25 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 26 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act 27 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act


h) Obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in healthcare and public health29;

i) Promote innovation30; j) Promote research and the use of research31; k) Have regard to the need to promote education and training32 for persons who

are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty33;

l) Act with a view to promoting integration of both health services and social care services where the CCG considers that this would improve the quality of services or reduce inequalities34;

m) Collaborate with NHSE regarding specialist commissioning. 5.3. General Financial Duties 5.3.1. The CCG will fulfil the following financial duties by delegating responsibility for

exercising and ensuring compliance to the Governing Body and its sub committees as laid out in the Standing Orders and in line with the vision, values and aims as laid out in section 4 of the Constitution: a) Ensure its expenditure does not exceed the aggregate of its allocations for the

financial year35; b) Ensure its use of resources (both its capital resource use and revenue

resource use) does not exceed the amount specified by NHSE for the financial year36;

c) Take account of any directions issued by NHSE, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHSE37;

d) Publish an explanation of how the CCG spent any payment in respect of quality made to it by NHSE38.

5.4. Other Relevant Regulations, Directions and Documents 5.4.1. The CCG will:

a) Comply with all relevant regulations; b) Comply with directions issued by the Secretary of State for Health or NHSE; c) Take account, as appropriate, of documents issued by NHSE d) Develop, consult on and implement the necessary systems and processes to

comply with these regulations and directions, documenting them as necessary

28 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act 29 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act 30 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act 31 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act 32 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 33 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act 34 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act 35 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act 36 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act 37 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act 38 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act


in this Constitution, its scheme of reservation and delegation and other relevant CCG policies and procedures.

6. DECISION MAKING: OUR GOVERNING STRUCTURE 6.1. Authority to act 6.1.1. The CCG is accountable for exercising the statutory functions of the CCG. It may

grant authority to act on its behalf to: a) Any of its members; b) Its Governing Body and its committees; c) Employees; d) A committee or sub-committee of the CCG.

6.1.2. The extent of the authority to act of the respective bodies and individuals depends

on the powers delegated to them by the CCG as expressed through: a) The CCG’s scheme of reservation and delegation; b) For committees, their terms of reference.

6.2. Scheme of Reservation and Delegation39 6.2.1. Our scheme of reservation and delegation is detailed in appendix D and sets out;

a) Those decisions that are reserved for the membership as a whole; b) Those decisions that are the responsibilities of our Governing Body (and its

committees), the CCGs committees and sub-committees, individual members and employees.

6.2.2. The CCG remains accountable for all of its functions, including those that it has

delegated. 6.3. General 6.3.1. In discharging the functions of the CCG that have been delegated to its Governing

Body (and its committees), all individual committee members are expected to: a) Comply with the CCGs principles of good governance40; b) Operate in accordance with our scheme of reservation and delegation41; c) Comply with our standing orders42; d) Comply with our arrangements for discharging our statutory duties43; e) Where appropriate, ensure that member practices have had the opportunity to

contribute to our decision making process. 6.3.2. When discharging their delegated functions, committees and individuals must also

operate in accordance with the approved terms of reference.

39 See Appendix D 40 See section 4.3 on Principles of Good Governance above 41 See appendix D 42 See appendix C 43 See chapter 5 above


6.3.3. Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) Identify the roles and responsibilities of those CCGs who are working

together; b) Identify any pooled budgets and how these will be managed and reported in

annual accounts; c) Specify under which CCGs scheme of reservation and delegation and

supporting policies the collaborative working arrangements will operate; d) Specify how the risks associated with the collaborative working arrangement

will be managed between the respective parties; e) Identify how disputes will be resolved and the steps required to terminate the

working arrangements; f) Specify how decisions are communicated to the collaborative partners.

6.4. Consortia 6.4.1. The CCG has six members’ Consortia as listed in appendix B of this Constitution. 6.4.2. Application to join or change Consortium is made in writing by the lead practice

GP to the Lead of the Consortium they wish to join. 6.4.3. The Consortium members consider the application collectively and agree their

decision which is communicated to the applying practice and to the CCG within 4 weeks of the receipt of the application.

6.4.4. New Consortium membership is ratified by the Members’ Forum. 6.5. Consortia Leads 6.5.1. Each Consortium has a Lead that must be a GP and as such:

a) Be either an active partner, a sessional GP or locum of a member; b) Shall not be eligible if they are, or subsequently are retired from the member,

suspended by either the General Medical Council (GMC) or NHSE or any successor body;

c) If the individual is a sessional GP, they shall not be eligible in the event that they are suspended from their employment or subject to grievance or disciplinary proceedings;

d) For those individuals (including those stated at (c) above) who are not party to direct contractual arrangements for the provision of primary medical services, they must be on the NHSE Performers List.

e) The Chair and Vice Chair of the Local Medical Committee (LMC) cannot be a Consortium representative and consequently cannot be a Governing Body member or Clinical Executive Committee member.

6.5.2. The constituent members of each Consortium decide how to appoint their

Consortia Lead and Deputy. 6.5.3. The Consortium members choose, by a simple majority, to:

a) Have a Lead and a Deputy or a job share Lead; b) Elect or appoint their Lead(s);


c) Election and/or selection process for the Leads; d) Constituency - i.e. who can stand - for each position.

6.5.4. Consortia should inform the LMC and governing body of their election/selection

process. 6.5.5. A Consortium Lead is required to notify the Governing Body of their election

providing evidence that the process detailed in 6.5.3 and the criteria in 6.5.1 of this Constitution have been followed.

6.5.6. Each Consortium Lead has a term of office of 2 years. 6.5.7. Three months’ notice should be given on resigning from the role of Consortium

Lead. 6.5.8. If at least 51% of a Consortium’s members express that they no longer have

confidence in their Consortium Lead, they can commence a new selection/election process at any time during their term of office.

6.5.9. The Consortia Leads feed in the views of their constituent Members to inform the

CCG’s decision making, policies and processes. 6.5.10. Any Consortium representative can request, in writing to the CCG Chair that an

item is discussed and addressed at the next meeting of the Governing Body. 6.6. Committees of the Group 6.6.1. The Group shall have a committee called the Members’ Forum which shall

comprise all of the Practice Representatives at any one time. If a resolution is passed by the Members’ Forum by a majority of at least 51% of all the Practice Representatives, the Governing Body is required to abide by the decision of the Forum.

6.6.2. The Group may, on or after its establishment, appoint such other committees as it

considers appropriate. 6.7. Joint arrangements 6.7.1. The CCG may enter into joint arrangements with other CCGs including the joint

arrangements detailed in Appendix H. 6.7.2. The group may establish joint committees with one or more local authorities as it

considers may be appropriate.

6.7.3. The CCG may enter into joint commissioning arrangements with NHSE in respect of Primary care commissioning as detailed in Appendix H

6.8. The CCG Governing Body 6.8.1. The Governing Body shall not have less than 9 members and comprises of:


a) Three GP members, one of whom will be the Chair of the Governing Body; b) Two lay members:

i) One to lead on audit and remuneration. ; ii) One to lead on patient and public involvement and conflict of interest

matters. iii) Additional lay members may be appointed to provide additional

independent representation as agreed by the Governing Body. c) One registered nurse; d) One secondary care specialist doctor; e) The Accountable Officer; f) The Chief Finance Officer; g) Other attendees as invited, including LINks / Health Watch representatives

from the City of London and London Borough of Hackney and Commissioning Support Service (CSS) and the Local Medical Council representative, to provide advice and support, not as formal members of the Governing Body.

h) Associate lay members may be appointed to provide additional lay perspective and management of conflicts for committees or sub committees.

6.8.2. Three months notice should be given on resigning from any Board post. 6.8.3. Any member of the Governing Body, including the Chair may be removed by a

majority vote of no-confidence by the Governing Body requiring at least one third of votes available.

6.8.4. Selecting the GPs for the Governing Body:

a) Each of the Consortia Leads is eligible to be one of the three GP members of the Governing Body;

b) A Consortium Lead who applies to be a GP member of the Governing Body shall be assessed in accordance with an assessment process to be recommended by the Remuneration Committee and approved by the Members Forum;

c) The Governing Body will decide if the Consortium Lead has satisfactorily completed the assessment such that he or she is a suitable person to be one of the three GP members of the Governing Body;

d) The Consortia Leads shall decide by a simple majority the process by which they are selected to be GP members of the Governing Body but a Consortium Lead may go forward for selection only if the Governing Body has decided that he or she is a suitable person to be one of the three GP members of the Governing Body;

e) If a ballot is required, then the Consortia Leads can decide who should vote (i.e. just the Consortia Leads or the wider GP membership);

f) Any election process involving the wider GP membership will need to be ratified by a majority vote of the Members’ Forum.

g) A Consortium Lead’s appointment or election as a GP member of the Governing Body will be subject to ratification by a majority vote of the Members’ Forum.

6.8.5. Selecting the Chair of the Governing Body:

a) One of the 3 GP members of the Governing Body will be the Chair of the Governing Body;


b) The Chair of the Governing Body will be appointed by majority vote of the members of the Governing Body;

c) The appointment of the Chair of the Governing Body will be subject to ratification by a majority vote of the Members’ Forum;

d) Once the Chair has been agreed, that GP relinquishes their post as lead for the Consortium and the relevant Consortium chooses another GP representative for the CEC;

e) One of the other 2 GP members of the Governing Body is appointed by majority vote of the Governing Body as Clinical Vice Chair.

f) The Deputy Chair shall be one of the members of the Governing Body who is a lay person and shall be appointed by majority vote of the Governing Body.

g) All GP positions on the Governing Body and CEC are for a 2 year period; h) After 2 years the positions are subject to election. No Chair/Vice Chair shall

serve for a period of more than 3 terms without a break of at least 2 years. 6.9. Lay Members 6.9.1. The lay members (as listed in 6.8.1.b) of this Constitution are subject to the

following appointment process: a) They will be recruited following national advert, shortlisting and interview as

recommended by the Remuneration Committee and approved by the Members’ Forum.

b) Following ratification by a majority vote of the Members’ Forum, they will be appointed for a two year period.

c) Subject to satisfactory performance, the Remuneration Committee may recommend them for a second term without having to reapply via open competition but the Remuneration Committee must consult the Members’ Forum and take account of any views expressed collectively or individually by the Members.

d) They cannot undertake more than 2 consecutive terms of office. e) They may be removed by a vote of no-confidence by the Governing Body

requiring at least one third of votes available. 6.9.2. Associate lay members attending the Board will not be voting members unless

they are asked to cover for an absent voting lay member and will be subject to the same appointment process as lay members. In addition, voting lay members; a) May be invited to attend the Board on a regular basis in order to provide

additional lay input b) May be invited to attend or Chair Committees, sub committees or other

meetings of the CCG c) When covering for a voting lay member, will not be able to undertake the

role of the PPI/Governance Lay Member if they are being asked to stand in as Chair of the Board in the event of a conflict as highlighted in the Conflicts of Interest section - 8.2.5 and the Standing Orders, appendix C - 3.4.2.

6.10. Nurse Member 6.10.1. The independent nurse member of the Governing Body must have at least 5 years

of post qualification experience and will be recruited following national advert, shortlisting and interview as recommended by the Remuneration Committee and approved by the Members’ Forum.


6.10.2. Subject to ratification by a majority vote of the Members’ Forum, they will be appointed for a two year period.

6.10.3. Subject to the exceptions stated in Clause 6.10.4, the independent nurse member

cannot: a) Be an employee or member (including shareholder) of or a partner in a

provider of primary care medical services, or a provider with whom the CCG has made commissioning arrangements.

b) Cannot work for more than 50% of their time for a non NHS organisation. 6.10.4. The exceptions are where the CCG has made an arrangement with a provider,

subsequent to a patient exercising choice, and where the CCG has made an arrangement with a provider in special circumstances to meet the specific needs of a patient (for example, where there is a very limited choice of provider for a highly specialised service). This is especially in relation to this particular role and does not preclude practice nurses from being members of the Governing Body in other capacities.

6.10.5. The independent nurse member may be removed by, in addition to that covered in

6.8.3: a) If they are not registered with the Nursing and Midwifery Council under the

Nursing and Midwifery Order 2001; b) Are no-longer practising for another reason.

6.10.6. Subject to satisfactory performance, the Remuneration Committee may

recommend to the Members’ Forum the appointment of the independent nurse member for a second term without having to reapply via open competition. The Remuneration Committee must consult the Members’ Forum and take account of any views expressed collectively or individually by the Members.

6.11. Hospital Consultant 6.11.1. The hospital consultant member of the Governing Body must have at least 5 years

experience as a consultant and will be recruited following national advert, short listing and interview as recommended by the Remuneration Committee and approved by the members Forum

6.11.2. Subject to ratification by a majority vote of the Members’ Forum, they will be

appointed for a two year period. 6.11.3. Whilst the individual may well no longer practise medicine, they will need to

demonstrate that they still have a relevant understanding of care in the secondary setting.

6.11.4. The secondary care specialist:

a) Cannot be an employee or member (including shareholder) of, or a partner in a provider of primary medical services, or a provider with whom the CCG has made commissioning arrangements.

b) Cannot work for more than 50% of their time for a non NHS organisation


6.11.5. The exceptions are where the CCG has made an arrangement with a provider, subsequent to a patient exercising choice, and where the CCG has made an arrangement with a provider in special circumstances to meet the specific needs of a patient (for example, where there is a very limited choice of provider for a highly specialised service).

6.11.6. The hospital consultant member may be removed by, in addition to that covered in

6.8.3: a) If they lose their license to practice; b) Are no-longer practicing for another reason.

6.11.7. They will be appointed for a term of two years. 6.11.8. Subject to satisfactory performance, the Remuneration Committee may

recommend to the Members’ Forum the appointment of the hospital consultant member for a second term without having to reapply via open competition. The Remuneration Committee must consult the Members’ Forum and take account of any views expressed collectively or individually by the Members.

6.12. Board Disqualification Guidance 6.12.1. Regulations provide that some individuals are not eligible to be appointed to CCG

governing bodies. Full details are included in schedule 5 of The National Health Service (Clinical Commissioning Groups) Regulations 2012.

6.13. Committees of the Governing Body

6.13.1. The Governing Body shall appoint the following committees at its first meeting:

a) Audit Committee - which is accountable to the CCGs Governing Body, provides the Governing Body with an independent and objective view of the CCGs financial systems, mitigation of major risks to delivery, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to finance and governance. The Governing Body shall approve and keep under review the terms of reference for the Audit Committee, which including information on the membership of the Committee44;

b) Remuneration Committee - which is accountable to the CCGs Governing Body makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The Governing Body shall approve and keep under review the terms of reference for the Remuneration Committee, including information on the membership of the Committee45;

6.13.2. The Governing Body may appoint such other committees as it considers may be

appropriate including:

44 See appendix [insert] for the terms of reference of the Audit Committee 45 See appendix [insert] for the terms of reference of the remuneration committee


a) Clinical Executive Committee (CEC) - which is accountable to the CCGs Governing Body, the Governing Body has approved and keeps under review the terms of reference for the Clinical Executive which includes information on the membership of the Executive Committee46. The CEC has the following role on behalf of the Governing Body: i) Development and implementation of the CCGs clinical strategy,

Commissioning Strategic Plan (CSP) and Quality, Innovation, Productivity and Prevention (QIPP) targets;

ii) Ensuring the effective discharge of the functions of the CCG; iii) Oversee the work of the CCGs Programme Boards which are responsible

for development and delivery of the annual CSP; iv) Ensuring effective consultation and discussion with member practices

about the CCGs clinical plans. b) Finance and Performance Committee (FPC) - which is accountable to the

CCGs Governing Body. The Governing Body has approved and keeps under review the terms of reference for the FPC which includes information on the membership of the Finance and Performance Committee. The FPC has the following role: i) To receive the monthly finance, activity and KPI reports produced by the

CSU; ii) To receive a monthly report on progress with implementation of the

Quality, Innovation, Productivity and Prevention (QIPP) plans; iii) To agree responsibilities and implement action plans and reporting

arrangements for variances or areas of performance identified; iv) The CCGs CFO will ensure that remedial actions plans are reported to the

Governing Body as part of the performance reporting arrangements and that progress is monitored.

c) Patient and Public Involvement (PPI) Committee – which is accountable to the CCGs Governing Body. The Governing Body has approved and keeps under review the terms of reference for the PPI which includes information on the membership of the PPI Sub Committee. The PPI Committee has the following role: i) To develop and deliver the CCGs engagement plans which are consistent

with para 5.2.1; ii) To oversee and coordinate the various sources of patient, carer and public

views and issues on the services which the CCG commissions and ensure that the CCG has a comprehensive understanding of these;

iii) To make recommendations to the Governing Body, Programme Boards and Clinical Executive on changes to our commissioning plans to address these issues satisfactorily;

iv) To ensure that learning from complaints takes place and is reflected in our commissioning plans to ensure that the complaints management service received from the CSS is robust and meets the specification;

v) To ensure that we communicate back to our patients and public on what we have done about the issues they have raised.

d) Prioritisation & Investment Committee - which is accountable to the CCGs Governing Body. The Governing Body has approved and keeps under review the terms of reference for the PIC which includes information on the

46 See appendix [insert] for the terms of reference of the [Insert name] Committee


membership of the PIC Sub Committee. The PIC Committee has the following role:

i) To recommend to the CCG Board all proposals for use of recurrent and non-recurrent investment

ii) To receive advice from the Accountable Officer and Chief Financial Officer on resources available and the CCG Chair on Clinical ambitions and strategy

iii) To assess bids, score and prioritise against the agreed prioritisation framework.

iv) Proposals received in the form of Project Initiation Documents (PIDs) will be assessed to ensure value for money, impact on patients and outcomes and to ensure they are in line with the CCG clinical and financial strategy

v) To consider service specifications, key performance indicators, metrics and the proposed contractual arrangements

vi) To recommend investment to the CCG Board e) Primary Care Committee

i) The CCGs Primary Care Committee has delegated responsibility from the CCG Board for ensuring the delivery of the CCGs clinical strategy through robust contractual arrangements with general practices, the GP Confederation and the GP OOH provider, and ensuring this is transacted in a robust way to manage conflicts of interests

ii) The CCG Primary Care Committee (CCG PCC) has been established to oversee the planning and development of primary care provision, to deliver the CCG strategy under delegated commissioning responsibilities from NHSE and to consider, review and agree the associated service specifications and contractual arrangements and in particular those where;

iii) we are potentially contracting with City and Hackney GP practices directly or through the local confederation of City and Hackney GP practices for list based services or extended primary care/out of hospital services;

iv) we are contracting with the GP social enterprise providing our Out of Hours Service (CHUHSE);

v) we are undertaking expanded primary medical care commissioning functions under delegated responsibilities from NHSE and;

vi) where practices, the GP Confederation, CHUHSE is a potential provider under any CCG procurement exercise

f) The Prioritisation & Investment Committee and Primary Care Committee will

meet in public, except where it would not be in the public interest in relation to all or part of a meeting. This disclaimer will only be used in instances of commercial confidentiality or sensitive discussions and when we receive legal advice forcing a closed session of the Governing Body. The committee meeting dates will be communicated well in advance of the meeting date and the arrangements for public attendance clear and transparent. Details will be provided on the CCG website.

6.13.3. The Audit Committee may include individuals who are not members of the

Governing Body.


6.13.4. Other committees of the Governing Body may include individuals who are not members of the Governing Body but are: a) Members, officers or governing body members of the Group or another

Clinical Commissioning Group; b) Partners or employees of Members of the Group or another Clinical

Commissioning Group. 6.13.5. Committees of the Governing Body will only be able to establish their own sub-

committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the Governing Body or the committee they are accountable to.

6.13.6. All decisions taken in good faith at a meeting of the Governing Body or any

committee or sub-committee of it shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting, or the appointment of a member attending the meeting.

6.14. Membership of the Clinical Executive Committee 6.14.1. In addition to the 6 Consortia leads, the other members of the Clinical Executive

Committee (CEC) are: a) A representative of the Members’ Practice Managers (the Practice Managers’

representative); b) A representative of the Members’ Practice Nurses (the Practice Nurses’

representative); c) The CCG’s lay member with an interest in PPI; d) The Accountable Officer (AO); e) The Chief Finance Officer(CFO); f) The Chair of the Governing Body.

6.14.2. A representative of Commissioning Support Unit (CSU) may be invited to attend to provide advice and support, but not as a formal member of the Committee.

6.14.3. In addition, the CCG Clinical Chairs of the Programme Boards and LMC Chair will

receive papers for the Committee and be invited to attend to provide advice and support, but not as formal members of the Committee.

6.14.4. The CCG lay member for PPI, Accountable Officer and CFO are members of the

CEC in an ex-officio capacity. 6.14.5. The practice managers and nurses from members listed in Appendix B can decide

how to appoint their respective representatives onto the CEC. They can choose, by a simple majority: a) To elect or appoint their lead(s); b) The election and/or selection process for the leads; c) Eligibility criteria for each position.

6.14.6. Subject to ratification by a majority vote of the Members’ Forum, the Governing

Body will appoint them for a two year period.


6.14.7. If at least 51% of practice managers or nurses express that they no longer have confidence in their respective representative in a meeting, they can commence a new selection/election process at any time during their term of office.

6.14.8. The GP elected as clinical vice chair of the Board becomes the Chair of the

clinical executive. The deputy/job share for that GP then joins the clinical executive to represent that consortium.

6.15. Disputes 6.15.1. We are committed to engaging with our Members around all strategic proposals

and developments using the Clinical Commissioning Forum and Consortia for consultation and feedback. However where a member finds they have a dispute or grievance with the CCG, or its Governing Body or committees to whom it has delegated powers about: a) Matters of eligibility for membership; b) The interpretation and application of their respective powers and obligations

under this Constitution or; c) A decision which the CCG has made on behalf of its members or; d) Any other relevant matter that the CCG considers fair and equitable to be the

subject of a grievance or of a complaint it will follow the dispute resolution process set out as follows.

6.15.2. All CCG policies and decisions which involve payments to members by the CCG

will have a documented formal approach process. 6.15.3. It is anticipated that most disputes will be resolved at the consortium level by a

member raising the issue with the consortium lead in writing within 60 days of the issue arising.

6.15.4. The consortium lead will respond to the member in writing within 30 days. If the

lead is absent they can ask their deputy or the CCG Chair to resolve the issue. In this case the CCG Chair can direct any other consortium lead to receive and resolve the issue.

6.15.5. If the consortium lead is unable to resolve the issue the member may write to the

CCG Chair (or if the Chair is unavailable, to the Vice Chair/lay member) clearly outlining the issue. The Chair in conjunction with the Accountable Officer where appropriate will contact the member within 30 days and resolve the dispute.

6.15.6. Where the dispute is unable to be resolved in 6.15.4, the parties may decide at

their own cost to refer to mediation. The independent third party member, being approved by the Centre for Effective Dispute Resolution.

6.15.7. A member practice can also request that the LMC raise the matter on their behalf

and step 16.15.2 to 16.15.5 will apply. 6.15.8. Members also have the ability to call a members forum via their Consortium lead.


7. Roles and Responsibilities 7.1. Practice Representative 7.1.1. Practice Representatives represent their Member’s views and act on behalf of the

Member in matters relating to the Group. 7.1.2. The role of each practice representative is to:

a) Ensure effective two way communications between the CCG and the Member; b) Engage in Consortia, Clinical Commissioning Forum (CCF) and other

activities; c) Ensure democracy and input to CCG decisions; d) To be a member of the Members’ Forum as detailed in section 7.5

7.2. Clinical Commissioning Forum 7.2.1. The CCG will use the monthly Clinical Commissioning Forum, which is open to all

GPs working for a City and Hackney practice, as well as Consortia meetings, to consult and engage all member practices to debate our clinical plans, for early involvement from practices in shaping our plans, service models and strategies and for testing out ideas.

7.3. Consortia 7.3.1. Each Consortium plays a key role in providing a peer support network for

constituent practices, for communication and input to CCG plans thinking and decisions.

7.4. Consortium Lead 7.4.1. The role of the elected Consortium lead is to undertake the following on behalf of

the CCG: a) Support the work of the Consortia; b) Represent the Consortium rather than represent their own individual practices; c) Chair the Consortium meetings; d) Ensure effective two way communications with constituent practices,

representing their views at CCG meetings; e) Provide input to the CCGs clinical plans and represent the Consortium via

membership of the Clinical Executive Committee (CEC). 7.5. Members’ Forum 7.5.1. The role of the Members’ Forum is to:

a) consider and agree any changes to the Constitution as laid out in 1.4 including changes in membership of the CCG;

b) confirm the appointments process for Governing Body members; c) ratify all appointments to the Governing Body;


d) consider any issue of no confidence in Governing Body members either individually or collectively;

e) debate any concerns regarding discussions and decisions by the Governing Body

7.6. All Members of the CCGs’ governing body 7.6.1. Each member of the governing body should share responsibility as part of a team

to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. Each brings their unique perspective, informed by their expertise and experience.

7.7. The Chair 7.7.1. The Chair of the governing body, in conjunction with the governing body is

responsible for: a) Leading the governing body, ensuring it remains continuously able to

discharge its duties and responsibilities as set out in this Constitution; b) Providing clinical leadership; c) Taking account of the views of member practices when making decisions; d) Building and developing the Governing Body and its individual members; e) Ensuring that the CCG has proper constitutional and governance

arrangements in place; f) Ensuring that, through the appropriate support, information and evidence, the

Governing Body is able to discharge its duties; g) Supporting the Accountable Officer in discharging the responsibilities of the

organisation; h) Contributing to building a shared vision of the aims, values and culture of the

organisation; i) Leading and influencing to achieve clinical and organisational change to

enable the CCG to deliver its commissioning responsibilities; j) Overseeing governance and particularly ensuring that the Governing Body

and the wider CCG behaves with the utmost transparency and responsiveness at all times;

k) Ensuring that public and patients' views are heard and their expectations understood and, where appropriate as far as possible, met;

l) Ensuring that the organisation is able to account to its local patients, stakeholders and NHSE;

m) Ensuring that the CCG builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant Local Authorities.

7.7.2. Where the Chair of the governing body is also the senior clinical voice of the CCG

they will take the lead in interactions with stakeholders, including NHSE. 7.8. The Deputy Chair 7.8.1. The Deputy Chair of the governing body deputises for the Chair of the governing

body where he or she has a conflict of interest or is otherwise unable to act.


7.8.2. The Deputy Chair is the lay member for patient and public involvement and

matters of conflict of interest as per 6.8.1bii. 7.9. The Accountable Officer 7.9.1. The Accountable Officer is subject to an appointment process by interview and

other requirement as may be set out in guidelines or regulation or the CCG’s HR policy and varied from time to time.

7.9.2. The Accountable Officer may be removed in line with their contract of

employment. 7.9.3. The Accountable Officer:

a) Is responsible for ensuring that the CCG fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

b) Will at all times ensure that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems;

c) By working closely with the Chair of the Governing Body, ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation's ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the development of its members and staff.

7.10. Chief Finance Officer 7.10.1. The Chief Finance Officer is subject to an appointment process of interview and

other requirement as may be set out in guidelines or regulation or the CCGs HR policy and varied from time to time.

7.10.2. The Chief Finance Officer may be removed in line with their contract of

employment. 7.10.3. The Chief Finance Officer is a member of the Governing Body and is responsible

for providing financial advice to the CCG and for supervising financial control and accounting systems.

7.10.4. This Chief Finance Officer is responsible for:

a) Being the Governing Body's professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged;

b) Making appropriate arrangements to support, monitor the CCGs finances; c) Overseeing robust audit and governance arrangements leading to propriety in

the use of the CCGs resources;


d) Being able to advise the Governing Body on the effective, efficient and economic use of the CCGs allocation to remain within that allocation and deliver required financial targets and duties;

e) Producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHSE.

7.11. The Role of the Governing Body 7.11.1. The functions of the Governing Body shall include:

a) Ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCGs principles of good governance47 (its main function);

b) Ensuring effective engagement of member practices, patients and the public in consultation and decision making;

c) Ensure that all providers of primary medical services in the locality are members of the CCG, and shall keep up to date registers of the same;

d) Determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

e) Approving any functions of the CCG that are specified in regulations48; f) Monitoring the clinical quality and safety of all commissioned services through

regular reports produced by CSS; g) Assuring decision making arrangements; h) Oversight of the arrangements for dealing with conflicts of interest; i) Leading the setting out of our vision and strategy and ensuring that these are

followed j) Approving commissioning plans and strategies on behalf of the CCG; k) Facilitating the delivery and implementation of any guidance or standards

issued by any relevant regulatory body including, but not limited to, the Care Quality Commission (CQC) or any successor bodies or their authorised assignees;

l) Ensuring that there are robust plans and responsibilities assigned to manage staff engagement, external relationships and communications;

m) Approving the annual budget; n) Monitoring performance against the plan and budget; o) Supporting a variety of diverse approaches to commissioning, particularly for

practices to work proactively to improve efficiency and value; p) Encouraging innovation by enabling and supporting practices and clinicians in

creating change; q) Working with all local stakeholders to achieve delivery of the targets, policies

and standards; r) Working collaboratively to deliver the outcomes and milestones set out in any

Local Delivery Plan;

47 See section 4.3 on Principles of Good Governance above 48 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act


s) Exercising and/or delegating functions which have not otherwise been expressly delegated under the Constitution

t) Complying with all relevant procurement law and policy and adhering to the obligations placed on the governing Board and CCG with regard to all providers applying the following principles of: i) Transparency and openness; ii) Support, assistance and training so as to permit compliance with

procurement law, competition law and any relevant policies; iii) Application of guidance within the 'procurement guide for commissioners

of NHS funded services' and the 'principles and rules for co-operation and competition';

iv) Equality of treatment. u) Providing assurance of strategic risks.

7.11.2. The Governing Body shall:

a) Ensure that all decisions made in relation to commissioning are fully recorded and auditable;

b) Be engaged in the day to day management and application of commissioning and related activity in the locality and shall operate in good faith using all due skill and diligence;

c) Provide reports of all activity including financial activity at all meetings. The reports shall be available to all governing body members prior to the governing body meetings and form part of the main agenda;

d) Ensure that all the CCGs policies and procedures with regard to the involvement and consultation of patients and practices and other relevant bodies are fully complied with at all times;

e) Fairly and equitably advertise any specific salaried posts; f) Adhere to any other obligations as set out in statute, regulation and/or

direction; g) Implement all processes required to comply with any regulation, direction or

internal governance where relevant; h) Keep an up-to-date list of all committees, sub-committees and joint working

arrangements; i) Agree a set of standing orders (set out in appendix C) which shall dictate

processes by which the CCG shall operate, including but not limited to any election process, quorum and frequency of elections.

7.12. Joint Appointments with other Organisations 7.12.1. The Group may agree joint appointments with other Clinical Commissioning

Groups as it considers may be appropriate. 7.12.2. All joint appointments shall be supported by a memorandum of understanding

between the organisations who are party to them, outlining: a) Who will be the statutory employer of the individual(s) working across

organisations; b) Confirmation that the statutory employer's policies will apply in all matters

concerning the employment of the individual;


c) The arrangements for funding, including funding for any temporary or acting arrangements in the event of absence, funding of redundancy costs and funding for training and development etc;

d) The arrangements for approval of annual and special leave of the individual; e) The arrangements for performance appraisal; f) How disciplinary matters will be handled; g) Risk sharing arrangements in respect of liability issues or redundancy /

dismissal costs. 8. Standards of Business Conduct and Managing Conflicts of Interest 8.1. Standards of Business Conduct 8.1.1. Employees, members, committee and sub-committee members of the CCG and

members of the Governing Body (and its committees) will at all times comply with this Constitution and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCG and should follow the seven principles of public life, set out by the Committee on Standards in Public Life (the Nolan Principles). The Nolan Principles are incorporated into this Constitution at Appendix F.

8.1.2. They must comply with the CCGs policy on business conduct, including the

requirements set out in the Conflicts of Interest Policy. This policy will be available on the CCGs website.

8.1.3. Individuals contracted to work on behalf of the CCG or otherwise providing

services or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.2. Conflicts of Interest 8.2.1. A conflict of interest occurs where an individual’s ability to exercise judgment, or

act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur. “For the purposes of Regulation 6 [National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 20137], a conflict will arise where an individual’s ability to exercise judgment or act in their role in the commissioning of services is impaired or influenced by their interests in the provision of those services.” (Source - Monitor - Substantive guidance on the Procurement, Patient Choice and Competition Regulations, December 2013) As well as direct financial interests, conflicts can arise from an indirect financial interest (e.g. payment to a spouse) or a non-financial interest (e.g. reputation). Conflicts of loyalty may arise (e.g. in respect of an organisation of which the individual is a member or with which they have an affiliation). Conflicts can arise from personal or professional relationships with others, e.g. where the role or


interest of a family member, friend or acquaintance may influence an individual’s judgement or actions, or could be perceived to do so. Depending upon the individual circumstances, these factors can all give rise to potential or actual conflicts of interest. For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider. In the case of a GP involved in commissioning, an obvious example is the award of a new contract to a provider in which the individual GP has a financial stake. However, the same considerations, and the approaches set out in this guidance, apply when deciding whether to extend a contract. We will abide by the safeguards set out NHS England’s guidance and the CCG’s Conflicts of Interest policy.

8.2.2. Where an individual who is a CCG employee, CCG member, member of the

Governing Body or a member of a committee or a sub-committee of the CCG or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this Constitution and the CCG’s Conflicts of Interest policy.

8.2.3. The aim is to protect both the CCG and the individuals involved from any

appearance of impropriety and demonstrate our culture of openness and transparency to the public and other interested parties.

8.2.4. The Governing Body’s members have ultimate responsibility for all actions carried

out by staff and committees throughout the CCG’s activities. This responsibility includes the stewardship of significant public resources and the commissioning of healthcare to the community. We will therefore ensure the organisation inspires confidence and trust amongst its partners and members by demonstrating integrity and avoiding any potential or real situations of undue bias or influence in the decision-making of the CCG.

8.2.5. Where the Chair of any meeting of the CCG, including committees, sub-

committees, or the Governing Body and the Governing Body's committees and sub-committees, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy Chair will act as Chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the Chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy Chair may require the Chair to withdraw from the meeting or part of it. Where there is no deputy Chair, the members of the meeting will select one.

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

a meeting or part of it, owing to the arrangements agreed for the management of


conflicts of interests or potential conflicts of interests, the Chair (or deputy) will determine whether or not the discussion can proceed.

8.2.7. In making this decision, the Chair will consider whether the meeting is quorate, in

accordance with the number and balance of membership set out in the CCGs standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the Accountable Officer on the action to be taken.

8.2.8. This may include:

a) Requiring another of the CCGs committees or sub-committees, the CCGs Governing Body or the Governing Body's committees or sub-committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible;

b) Inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the CCG can progress the item of business: i) A member of the CCG who is an individual; ii) An individual appointed by a member to act on their behalf in the dealings

between them and the CCG; iii) A member of a relevant Health and Wellbeing Board; iv) A member of a Governing Body of another CCG.

c) These arrangements must be recorded in the minutes. 8.2.9. Where the Governing Body is discussing and deciding on commissioning services

from GP providers, (including where we are commissioning primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours service, the GP Governing Body members must recuse themselves from the Governing Body and decisions made by a quorum of 1 lay member, 1 clinician and 1 manager representative. These specific decisions cannot be challenged by the Members’ Forum.

8.2.10. The Governing Body has delegated responsibility for deciding on commissioning services where GP are providers, as detailed in the Standing Orders 3.6.5 and the scheme of delegation and reservation, and as such will ordinarily rely upon the Primary Care Committee to make these decisions. As with the Governing Body, the decisions of the Primary Care Committee cannot be challenged by the members’ Forum.

8.2.11. When the CCG commissions services from GP practices, provider consortia or

organisations in which Members have a financial interest, then the CCG’s template for commissioning such services must be completed in order to satisfy the requirement to give assurance to the Primary Care Committee.

8.2.12. Board members should not use confidential information acquired in the pursuit of

their role to benefit themselves or another connected person.


8.2.13. We have a legal obligation to act in the best interests of the CCG and in

accordance with this Constitution and terms of establishment created by NHSE and to avoid situations where there may be a potential conflict of interest.

8.2.14. We will ensure that all employees and decision-makers are aware of the existence

of the Conflicts of Interest policy and Register of Interests which are both published on our website. The following will be undertaken to ensure awareness: a) Introduction to the policy during local induction for new starters to the

organisation; b) Annual reminder of the existence and importance of the policy via internal

communication methods; c) Quarterly reminder to update declaration forms sent to all Board members; d) At each meeting of the Governing Body or a committee or subcommittee of

the Governing Body, the individuals present must declare any material interest which must be recorded in the minutes and (if not already registered) the register of interests in accordance with Clause 8.3.

8.2.15. Further details of our responsibilities and details of how conflicts of interest are

identified, declared, recorded, communicated and acted on are contained in the conflicts of interest policy document.

8.3. Interests and gifts 8.3.1. Interests and gifts will be recorded on the register of interests and register of gifts

and hospitality, which will be maintained by the Accountable Officer. The register will be accessible by the public and inspection of the register of Board members interests will be encouraged, as appropriate.

8.4. Managing Conflicts of Interest: contractors and service providers 8.4.1. Anyone seeking information in relation to procurement, or participating in a

procurement, or otherwise engaging with the CCG in relation to the potential provision of services or facilities to the CCG, will be required to make a declaration of any relevant conflict / potential conflict of interest compliant with the CCGs policy.

8.4.2. Anyone contracted to provide services or facilities directly to the CCG will be

subject to the same provisions of this Constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.5. Transparency in Procuring Services 8.5.1. The CCG recognises the importance in making decisions about the services it

procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.


8.5.2. The CCG will publish a procurement strategy approved by its Governing Body which will ensure that: a) All relevant clinicians (not just members of the CCG) and potential providers,

together with local members of the public, are engaged in the decision-making processes used to procure services;

b) Service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way and ensure that this is undertaken within the framework of our conflicts of interest policy

8.5.3. The CCG will conduct procurement activities compliant and in line with the

following principles, expanded on in the procurement strategy: a) We will, consistently with our obligations under, inter alia, the Public Contracts

Regulations 2006 and applicable Community law, ascertain whether it is necessary, desirable or appropriate to invite competition when purchasing in order to ensure it will incur only budgeted, approved and necessary spending;

b) We will seek value for money for all goods and services by reference to the optimum combination of whole life cost and quality;

c) We shall ensure that, subject to the threshold provisions of the Public Contracts Regulations 2006, competitive tenders are invited for: i) The supply of goods, materials and manufactured articles; ii) The rendering of services including all forms of management consultancy

services (other than specialised services sought from or provided by the Department of Health or National Commissioning Board);

iii) For the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals.

d) We will, in relation to each purchasing decision concerning health care and social services: i) Consider the extent to which the Public Contract Regulations 2006 require

any form of competition and consider the most appropriate process and procedure for awarding the relevant contract or contracts;

ii) In that regard give consideration to whether the use of a framework agreement, including the use of approved lists, is the most appropriate means of appointing providers.

e) We shall, wherever possible and where it is consistent with legal requirements, ensure that contractual provisions, procurement procedures and selection and award criteria are designed to ensure that contractors and providers are: i) Good employers who comply with all relevant employment legislation,

including the Public Interest Disclosure Act 1998; ii) Maintain acceptable standards of health and safety and comply fully with

all legal obligations; iii) Meet all tax and national insurance obligations; iv) Meet all equal opportunities legislation; v) Reputable in their standards of business conduct; vi) Respect the environment and take appropriate steps to ensure that they

minimise their environmental impact; vii) Can evidence a track record of providing high quality services and meeting

the above points on a consistent basis.


f) We will, in each procurement and consistently with the relevant law, exclude companies which have been convicted of offences, or whose director(s) or any other person or company who has powers of representation, decision or control of the company has or have been convicted of offences in the conduct of their business or committed an act of grave professional misconduct in the conduct of their business, such as breaches of employment, equal opportunities or environmental legislation. However, any corrective/remedial action taken by the company in response to such an offence should also be taken into account in determining its suitability as a bidder;

g) We will, in each procurement and consistently with relevant EU and international law, ensure that contractual provisions, procurement procedures and selection and award criteria prohibit or restrict contractors’ use of offshore jurisdictions and/or improper tax avoidance schemes or arrangements and/or exclude companies which use such jurisdictions and/or such schemes or arrangements;

h) We may only negotiate contracts on behalf of the CCG, and the CCG may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with: i) The CCGs standing orders; ii) The Public Contracts Regulation 2006, any successor legislation and any

other applicable law; iii) Take into account as appropriate any applicable NHS England or the

Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (ii) above.

iv) In all contracts entered into, the CCG shall endeavour to obtain best value for money. The Accountable Officer shall nominate an individual who shall oversee and manage each contract on behalf of the CCG.

8.5.4. Copies of the Procurement Strategy will be available on the CCGs website. 8.5.5. Records of contracts awarded are published on the CCG website. 9. THE CCG AS EMPLOYER 9.1. The CCG recognises that its most valuable asset is its people. It will seek to

enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCG.

9.2. The CCG will seek to set an example of best practice as an employer and is

committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally and will work with the CCG Staff Council, of which all staff are members, to develop and review its policies and procedures

9.3. The governing Board shall be permitted to employ or engage the services of any

individual if it reasonably believes that the employment or engagement of such an individual shall be of benefit to the CCG as a whole.


9.4. In the event of such employment or engagement, the Remuneration Committee shall reasonably decide and agree the remuneration with such an individual or organisation on a case by case basis.

9.5. The Remuneration Committee shall be permitted to reasonably decide the

remuneration payable in respect of the duties undertaken by the Accountable Officer, new direct reports to the Accountable Officer, Governing Body members and all clinicians providing services and clinical leadership to the CCG.

9.6. The CCG will ensure that it employs suitably qualified and experienced staff who

will discharge their responsibilities in accordance with the high standards expected of staff employed by the CCG. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.7. The CCG will ensure that it complies with all aspects of employment law. 9.8. The CCG will ensure that its employees have access to such expert advice and

training opportunities as they may require in order to exercise their responsibilities effectively.

9.9. The CCG recognises and confirms that nothing in or referred to in this Constitution

(including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the group, any member of its governing body, any member of any of its committees or sub-committees or the committees or sub-committees of its governing body, or any employee of the group or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.

9.10. Copies of this Code of Conduct, together with the other policies and procedures

outlined in this chapter, will be available on the CCGs website. 10. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS 10.1. General 10.1.1. The CCG will publish this Constitution and its policies and strategies (including

communications and public patient engagement strategy), detailing any changes or updates to the document on our website.

10.1.2. The CCG will publish annually a commissioning plan and a report, including

accounts which will be externally audited, presenting the CCGs annual report to one of its public meetings.

10.1.3. Key communications issued by the CCG will be published on our website,

including: a) Conflicts of Interest policy;


b) Register of interests; c) Tenders and notices of procurements; d) Contract details; e) Service details; f) Policies, strategies and ways of working, including a conflicts of interest policy,

the CCG’s complaints process, communications strategy and public and patient engagement strategy;

g) Performance and financial information; h) Public consultations; i) Governing Board meeting dates, times and venues; j) Board papers and decisions; k) A Freedom of Information log, including responses to all requests. l) Any committees held in public, meeting dates, times and venues

10.1.4. The governing Board will meet in public on a monthly basis, except where it would

not be in the public interest in relation to all or part of a meeting. This disclaimer will only be used in instances of commercial confidentiality or sensitive discussions and when we receive legal advice forcing a closed session of the Governing Body. The Governing Body meeting dates will be communicated well in advance of the meeting date and the arrangements for public attendance clear and transparent.

10.1.5. The CCG will appoint independent lay members and non GP clinicians to the

Governing Body and will actively seek to have patient views and opinions represented at all levels of decision making within the CCG (where clinically appropriate).

10.1.6. We will disclose all information that can lawfully be disclosed and make any

requests that were not previously available on our website accessible to all in the Freedom of Information log.

10.1.7. We may use other means of communication, including circulating information by

post, or making information available in venues or services accessible to the public to include local GP surgeries and local press and by working with our local authority communications teams.

10.1.8. We will consult widely, openly and routinely, actively seeking to involve our

constituent practices, patients and the public, local authorities, local representative CCGs and other organisations. We will use our monthly Clinical Commissioning Forum, Consortia meetings and newsletter for all consultations and seek to find the most appropriate ways of working with all interested parties to gather information and views, including, but not limited to: a) Public meetings and forums, whether hosted by the CCG or via CCG

attendance at other organisations’ meetings; b) Public notices, not only on our website, but in local GP surgeries, local press

and distributed via local authority communications routes that can provide valuable in-roads into the areas diverse communities.


10.1.9. We will work closely with, and provide information to, local authorities and the National Commissioning Board, including the Health and Wellbeing Boards and complying with the requirements of Health Scrutiny overview panels.

10.2. Standing Orders 10.2.1. This Constitution is also informed by a number of documents which provide further

details on how we will operate. They are our: a) Standing Orders (appendix C) - which sets out the arrangements for meetings

and the appointment processes to elect our representatives and appoint to the CCGs committees, including the Governing Body;

b) Scheme of Reservation and Delegation (appendix D) - which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCGs Governing Body, the Governing Body's committees and sub-committees, the CCGs committees and sub-committees, individual members and employees;

c) Prime Financial Policies (appendix E) - which sets out the arrangements for managing our financial affairs.


APPENDIX A DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Accountable Officer an individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by the NHS Commissioning Board, with responsibility for ensuring the CCG: • complies with its obligations under: • sections 14Q and 14R of the 2006 Act (as inserted by section 26

of the 2012 Act), • sections 223H to 223J of the 2006 Act (as inserted by section 27

of the 2012 Act), • paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as

inserted by Schedule 2 of the 2012 Act), and • any other provision of the 2006 Act (as amended by the 2012

Act) specified in a document published by the Governing Body for that purpose;

• exercises its functions in a way which provides good value for money.

Area the geographical area that the CCG has responsibility for, as defined in Chapter 2 of this Constitution

Chair of the Governing Body

the individual appointed by the CCG to act as Chair of the Governing Body

Chief finance officer the qualified accountant employed by the CCG with responsibility for financial strategy, financial management and financial governance

Clinical commissioning forum

the body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a CCG has made appropriate arrangements for ensuring that it complies with: • its obligations under section 14Q under the NHS Act 2006 (as

inserted by section 26 of the 2012 Act), and such generally accepted principles of good governance as are relevant to it.

Clinical Commissioning Group (CCG)

a body corporate established by the NHS Commissioning Board in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act)

Committee a committee or sub-committee created and appointed by: • the membership of the CCG • a committee / sub-committee created by a committee created /

appointed by the membership of the CCG • a committee / sub-committee created / appointed by the


Governing Body

Financial year this usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a CCG is established until the following 31 March

Governing body any member appointed to the Governing Body of the CCG

Lay member any member of the Governing Body, appointed by the CCG. A lay member is an individual who is not a member of the CCG or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations

Member a provider of primary medical services to a registered patient list, who is a members of this CCG (see tables in Chapter 3 and Appendix B)

Practice a provider of primary medical services to a registered patient list, who is a members of this CCG (see tables in Chapter 3 and Appendix B)

Practice representatives

an individual appointed by a practice (who is a member of the CCG) to act on its behalf in the dealings between it and the CCG, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act)

Register of interests Registers a CCG is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of: • the members of the CCG; • the members of its Governing Body; • the members of its committees or sub-committees and

committees or sub-committees of its Governing Body; and • its employees.


Appendix B – Member and Consortium Practices Practice Name Address GP Lead South West Consortium Dr G Marlow/ Dr P Kelland DeBeauvoir Practice 30 Hertford Road,

London, N1 5QT Dr G Marlowe

Hoxton Surgery 12 Rushton Street, London, N1 5DR

Dr A Forman

The Lawson Practice 85 Nuttall Street, London, N1 5HZ

Dr D Colvin

Neaman Practice 15 Half Moon Court, London, EC1A 7HF

Dr D Vasserman

Queensbridge Group Practice

24 Holly Street, London, E8 3XP

Dr G Kelvin

Shoreditch Park Surgery 10 Rushton Street, London, N1 5DR

Dr P Kelland

North West Consortium Dr M Rickets Barton House Health Centre

233 Albion Road, London, N16 9JT

Dr M Bench

Cedar Practice John Scott Health Centre, Green Lanes, London, N4 2NU

Dr D Shier

Heron Practice John Scott Health Centre, Green Lanes, London N4 2NU

Dr M Krishnamurthy

Statham Grove Surgery Statham Grove, Stoke Newington, London, N16 9DP

Dr N Singer

Spitzer 62 Cranwich Road, London, N16 5JF

Dr J Spitzer

Springfield Medical Centre 19-21 Oldhill Street, London, N16 6LU

Dr V Holt

North East Consortium Dr N Katiyar Elm Practice 1a Fountayne Road,

London, N16 7EA Dr S Kiernan

Gangola 6 Barretts Grove, London, N16 8AR

Dr M Gangola

Nightingale Practice 10 Kenninghall Road, London, E5 8BY

Dr J Brown

Stamford Hill Group practice

2 Egerton Road, London, N16 6UA

Dr C Marks

Somerford Grove Practice Somerford Grove, Stoke Newington, London, N16 7UA

Dr D Keene

The Allerton Rd Surgery 34a Allerton Road, Stoke Newington, London, N16 5UF

Dr L Jayapal

R&S Consortium Dr A Pathan Gadhvi Practice 1a Fountayne Road, Dr A H Pathan


London, N16 7EA Rosewood Practice 1a Fountayne Road,

London, N16 7EA Dr S Shariff

Athena Medical Centre 21 Atherden Road, London, E5 0QP

Dr A Okoreaffia

Clapton Surgery Theydon Road HC, 14 Urban Hive, Theydon Road, London, E5 9BQ

Dr Ben Bradley

Southgate Road 101-103 Southgate Road, London, N1 3JS

Dr R P Tahalani

Sandringham Practice 1 Madinah Road, London, E8 1PG

Dr Emegi

Beechwood Medical Centre

86-86a Dalston Lane, London, E8 3AH

Dr I Nathans

Well Consortium Dr M Cahill/ Dr A Kumar Well Street Surgery 28 Shore Road, London,

E9 7TA Dr J Heyman

Elsdale Street Surgery 28 Elsdale Street, London, E9 6QY

Dr H Charles

London Fields Medical Centre

38-44 Broadway Market, London, E8 4QJ

Dr M Cahill

Lower Clapton Health Centre

36 Lower Clapton Road, London, E5 OPD

Dr C Highton

Wick Health Centre 200 Wick Road, London, E9 5AN

Dr J Osen

Trowbridge Practice 18 Merriam Av, London, E9 5NE

Dr T Radwan

Sorsby Health Centre 3 Mandeville Street, London, E5 0DH

Dr N Brewer

Green House Health 19 Tudor Road, Hackney, London, E9 7SN

Dr A C Burnett

Klear Consortium Dr H Patel Latimer Health Centre 4 Homerton Terrace,

London, E9 6RT Dr Haren Patel

Kingsmead Health Centre 4 Kingsmead Way, London, E9 9QG

Dr Gorur Anantha

Richmond Road Medical Centre

136 Richmond Road, London, E8 3HN

Dr Suresh Tibrewal

Riverside Surgery, Theydon Road Health Centre

14 Urban Hive, Theydon Road, E5 9BQ

Dr Rajiv Goel

Tollgate Lodge Primary Care Centre

57 Stamford Hill, London, N16 5SR

Dr Suresh Pandy

Abney House Medical Centre

2 Defoe Road, London, N16 0EP

Dr Haluk Salih

Dr SN Prasad 40 Brooke Road, London, N16 7LR

Dr SN Prasad

The Lea Surgery Alfred Heath Centre, 186 Homerton High St,

Dr Ajay Goel


London, E9 6AG Healey 200 Upper Clapton Road,

London, E5 9DH Dr Manjeet Duggal

The Dalston Practice 1B Madinah Road, London, E8 1PG

Dr Patel


APPENDIX C – STANDING ORDERS 1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction 1.1.1. These standing orders have been drawn up to regulate the proceedings of the

NHS City & Hackney Clinical Commissioning CCG so that we can fulfil our obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the CCG is established.

1.1.2. The standing orders, together with the CCGs scheme of reservation and

delegation49 and the CCGs prime financial policies50, provide a procedural framework within which the CCG discharges its business. They set out:

a) the arrangements for conducting the business of the CCG; b) the appointment of member practice representatives; c) the procedure to be followed at meetings of the CCG, the Governing Body

and any committees or sub-committees of the CCG or the Governing Body; d) the process to delegate powers, e) the declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate51 of any relevant guidance.

1.1.3. The standing orders, scheme of reservation and delegation and prime financial

policies have effect as if incorporated into the CCGs Constitution. CCG members, employees, members of the Governing Body, members of the Governing Body’s committees and sub-committees, and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.

1.2. Schedule of matters reserved to the CCG and the scheme of reservation and

delegation 1.2.1. The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to

delegate the CCGs functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The CCG has decided that certain decisions may only be exercised by the Members’ Forum. These decisions and

49 See Appendix D 50 See Appendix E 51 Under some legislative provisions the group is obliged to have regard to particular guidance but under

other circumstances guidance is issued as best practice guidance.


also those delegated are contained in the CCGs scheme of reservation and delegation (see Appendix D).

2. THE CCG: COMPOSITION OF MEMBERSHIP, KEY ROLES AND

APPOINTMENT PROCESS 2.1. Composition of membership 2.1.1. Chapter 6 of the CCG’s Constitution provides details of the membership of the

CCG (also see Appendix B). 2.1.2. Chapters 6 and 7 of the CCGs Constitution provide details of the governing

structure used in the CCGs decision-making processes, whilst Chapter 7 of the Constitution outlines certain key roles and responsibilities within the CCG and its Governing Body, including the role of practice representatives (section 7.1 of the Constitution).

2.1.3. Members of the Governing Body shall be appointed in accordance with the

Constitution save that the initial members of the Governing Body shall be as follows for their respective initial terms of office:

Position Member’s name Initial term of office

a) The Chair Clare Highton 2 years

b) GP Haren Patel 2 years

c) GP Gary Marlowe 2 years

d) Accountable Officer Paul Haigh 2 years

e) Chief Finance Officer Philippa Lowe 2 years

f) Lay member Catherine Macadam 2 years

g) Lay member

h) Lay member

Mariette Davis

tba

2 years

2 years

i) Secondary care specialist

Christine Blanshard

2 years

j) Independent nurse

k) Associate Lay member

l) Associate Lay member

Siobhan Clarke

Jaime Bishop

Honor Rhodes

2 years

2 years

2 years


3. MEETINGS OF THE GOVERNING BODY 3.1. Calling meetings 3.1.1 Ordinary meetings of the Governing Body shall be held at regular intervals at

such times and places as the Governing Body may determine. 3.1.2 The Chair may call a meeting of the Governing Body at any time. 3.1.3 One-third or more members of the Governing Body may requisition a meeting in

writing. If the Chair refuses, or fails, to call a meeting within seven days of a requisition being presented, the members signing the requisition may forthwith call a meeting.

3.1.4 Before each meeting of the Governing Body a written notice specifying the

business proposed to be transacted shall be delivered to every member, or sent by post to the usual place of residence of each member, so as to be available to members at least three clear days before the meeting. The notice shall be signed by the Chair or by the Company Secretary. Want of service of such a notice on any member shall not affect the validity of a meeting.

3.1.5 A member desiring a matter to be included on an agenda shall make his/her

request in writing to the Chair at least fifteen clear days before the meeting. The request should state whether the item of business is proposed to be transacted in the presence of the public and should include appropriate supporting information. Requests made less than fifteen days before a meeting may be included on the agenda at the discretion of the Chair.

3.1.6 Any Consortia representative can request, in writing to the CCG Chair, with at

least fifteen clear days before the meeting that an item is discussed and addressed at the next Governing Body. The request should state whether the item of business is proposed to be transacted in the presence of the public and should include appropriate supporting information.

3.1.7 Before each meeting of the Governing Body a public notice of the time and place

of the meeting, and the public part of the agenda, shall be displayed at the principal office at least three clear days before the meeting, (required by the Public Bodies (Admission to Meetings) Act 1960 Section 1 (4) (a)).

3.2 Agenda, supporting papers and business to be transacted. 3.2.1 Items of business to be transacted for inclusion on the agenda need to be

notified to the Accountable Officer at least fifteen clear days before the meeting takes place.

3.2.2 Supporting papers for such items need to be submitted at least 10 working days

before the meeting takes place.


3.2.3 The agenda and supporting papers will be sent to members five working days before the meeting, whenever possible, but will certainly be despatched no later than three clear working days before the meeting, save in emergency. The Governing Body may determine that certain matters shall appear on every agenda for a meeting and shall be addressed prior to any other business being conducted. (Such matters may be identified within these Standing Orders or, following subsequent resolution, shall be listed in an Appendix to the Standing Orders).

3.2.4 Agenda and certain papers for the CCGs Governing Body – including details

about meeting dates, times and venues – will be published on the CCGs website and distributed to key partner organisations, including the LMC.

3.2.5 Copies of Board papers and other key documents will be made available on

request for inspection at the CCG principal office or by email on request. 3.3 Petitions 3.3.1 Where a Members’ petition has been received by the CCG, the Chair of the

Governing Body shall include the petition as an item for the agenda of the next meeting of the Governing Body.

3.3.2 Conflicts of Interest 3.3.3 Members will be required to declare any new material interest within 28 days of

being aware of its existence and in any event at the start of the next meeting after they were aware of it, and therefore a standing item to prompt this will be identified. Members will be asked to review and update as necessary quarterly.

3.4 Chair of a meeting 3.4.1 At any meeting of the CCG or its Governing Body or of a committee or sub-

committee, the Chair of the CCGs, Governing Body, committee or sub-committee, if any and if present, shall preside. If the Chair is absent from the meeting, the clinical vice Chair, if any, or nominated Chair shall preside.

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

the lay member for PPI and conflicts of interest, if present, shall preside. If both the Chair and deputy Chair are absent, or are disqualified from participating, or there is neither a Chair or deputy a member of the CCG, Governing Body committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

3.5 Chair’s ruling 3.5.1 The decision of the Chair of the Governing Body, in conjunction with the lay

members for governance and patient and public involvement on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial


policies at the meeting shall be final, except in cases of Members’ Forum intervention.

3.6 Quorum 3.6.1 No business shall be transacted at a meeting unless at least one-third of the

whole number of the Chair and members (including at least two GPs, one lay member and one executive officer) is present.

3.6.2 An Executive in attendance for an Executive Director (Executive Member) but

without formal acting up status may not count towards the quorum. 3.6.3 If the Chair or member has been disqualified from participating in the discussion

on any matter and/or from voting on any resolution by reason of a declaration of a conflict of interest (see SO No.3.4.2) that person shall no longer count towards the quorum. If a quorum is then not available for the discussion and/or the passing of a resolution on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting. The meeting must then proceed to the next business.

3.6.4 For all of the CCGs committees and sub-committees, including the Governing

Body’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference.

3.6.5 An exception to the arrangements set out in SO No. 3.6.1 to 3.6.4 above is where the Governing Body is discussing and deciding on commissioning services from GP providers, (including where we are commissioning primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours service). In this situation, the GP Governing Body members must recuse themselves from the Governing Body and decisions made by a quorum of 1 lay member, 1 clinician and 1 manager representative. These specific decisions cannot be challenged by the Members’ Forum.

3.6.6 The Governing Body has delegated responsibility for deciding on commissioning services where GP are providers, as detailed in SO 3.6.5, and as such will ordinarily rely upon the Primary Care Committee to make these decisions. As with the Governing Body, the decisions of the Primary Care Committee cannot be challenged by the members’ Forum.

3.6.7 A template has been developed for use when commissioning services from GP

practices, provider consortia or organisations where GPs have a financial interest and this must be completed in order to satisfy the requirement to give assurance to the Primary Care Committee.

3.7 Decision making 3.7.1 Chapter 6 of the CCGs Constitution, together with the scheme of reservation and

delegation, sets out the governing structure for the exercise of the CCGs


statutory functions. Generally it is expected that at the CCGs meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required, the process for which is set out below:

a) Eligibility

i) The list below outlines all voting members of the Governing Body: • Elected GPs • 2 Lay members (PPI and Governance) • Additional lay members as recruited • Nurse member • Hospital consultant • Accountable Officer • Chief finance officer

ii) A manager who has been formally appointed to act up for a non GP or Lay

Executive Member during a period of incapacity or temporarily to fill an Executive Director vacancy shall be entitled to exercise the voting rights of the Executive Member.

iii) A manager attending the Governing Body meeting to represent a non GP or

Lay Executive Member during a period of incapacity or temporary absence without formal acting up status may not exercise the voting rights of the Executive Member. An Executive’s status when attending a meeting shall be recorded in the minutes.

iv) In no circumstances may an absent member vote by proxy. Absence is

defined as being absent at the time of the vote.

b) Majority necessary to confirm a decision

At least one-third of the Governing Body membership is required in order to make a formal board decision.

c) Casting vote

In the case of an equal vote, the Chair of the meeting shall have a second, and casting vote.

d) Dissenting views

Dissenting views will be recorded in the minutes of the meeting. 3.7.2 Should a vote be taken then the outcome of the vote and dissenting views must

be recorded in the minutes. 3.7.3 For all other of the CCGs committees and sub-committees, including the

Governing Body’s committees, the details of the process for holding a vote are set out in the appropriate terms of reference.


3.8 Emergency powers and urgent decisions 3.8.1 In an emergency or if an urgent decision is required, the Accountable Officer and

the Chair, after having consulted at least one lay member and one Board GP, can make a decision on behalf of the Governing Body. The exercise of such powers by the Accountable Officer and Chair shall be reported to the next formal meeting of the Governing Body for formal ratification.

3.8.2 Emergency meetings maybe called in accordance with SO No. 3.1.2 and 3.1.3. 3.8.2 In the case of a meeting called by members in default of the Chair calling the

meeting, the notice shall be signed by those members. 3.8.3 No business shall be transacted at the meeting other than that specified on the

agenda. 3.9 Suspension of Standing Orders 3.9.1 Except where it would contravene any statutory provision or any direction made

by the Secretary of State for Health or the NHS Commissioning Board, any part of these standing orders may be suspended at any meeting, providing at least one third of the CCG members are in agreement.

3.9.2 A decision to suspend the standing orders together with the reasons for doing so

shall be recorded in the minutes of the meeting. 3.9.3 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.

3.10 Record of Attendance 3.10.1 The names of all members of the meeting present at the meeting shall be

recorded in the minutes of the CCGs meetings. The names of all members of the Governing Body present shall be recorded in the minutes of the Governing Body meetings. The names of all members of the Governing Body’s committees / sub-committees present shall be recorded in the minutes of the respective Governing Body committee / sub-committee meetings.

3.11 Minutes 3.11.1 The minutes of the proceedings of a meeting shall be drawn up and submitted

for agreement at the next ensuing meeting where they shall be signed by the person presiding at it.

3.11.2 Free discussion shall take place upon the minutes, for example upon their

accuracy or where the Chair wishes to draw the Governing Body’s attention. Minutes shall be circulated in a timely manner after Board meeting, in advance of the following months meeting at the latest.


3.11.3 Where providing a record of a public meeting the minutes shall be made

available to the public as required by Code of Practice on Openness in the NHS and published on the CCGs website.

3.12 Admission of public and the press 3.12.1 Admission and exclusion on grounds of confidentiality of business to be

transacted

The public and representatives of the press may attend all meetings of the Governing Body and are invited to ask questions of the Governing Body at the designated time on the agenda, but shall be asked to withdraw upon the Governing Body resolving as follows: 'that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest'.

3.12.2 General disturbances

The Chair or the person presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that business shall be conducted without interruption and disruption and, without prejudice to the power to exclude on grounds of the confidential nature of the business to be transacted, the public will be required to withdraw upon the Governing Body resolving as follows: `That in the interests of public order the meeting adjourn for (the period to be specified) to enable the Governing Body to complete its business without the presence of the public'.

3.12.3 Business proposed to be transacted when the press and public have been

excluded from a meeting

a) Matters to be dealt with by the Governing Body following the exclusion of representatives of the press, and other members of the public, as provided in (3.12.1) and ) (3.12.2) above on grounds of the confidential nature of the business to be transacted, shall be confidential to the members of the Governing Body. b) Members and Executives or any employee in attendance shall not reveal or disclose the contents of papers marked 'In Confidence' or minutes headed 'Items Taken in Private' outside of NHS City & Hackney CCG, without the express permission of the NHS City & Hackney CCG Board. This prohibition shall apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers.

3.12.4 Use of Mechanical or Electrical Equipment for Recording or Transmission of

Meetings


Nothing in these Standing Orders shall be construed as permitting the introduction by the public, or press representatives, of recording, transmitting, video or similar apparatus into meetings of the Governing Body or Committee thereof. Such permission shall be granted only upon resolution of the Governing Body.

3.12.5 Observers at meetings

The Governing Body will decide what arrangements and terms and conditions it feels are appropriate to offer in extending an invitation to observers to attend and address any of the Governing Body's meetings and may change, alter or vary these terms and conditions as it deems fit.

4A. MEETINGS OF THE MEMBERS’ FORUM

4A.1. Calling and Notice of General Meetings

4A.1.1. A Consortium lead may call a General Meeting of the Members’ Forum at any time by giving notice in accordance with this SO No.4A.

4A.1.2. Every notice calling a General Meeting must specify the location, date and time of the meeting and the general nature of the business to be transacted. Any resolution to be passed must be set out in full. The location must be publicly accessible premises within the Group’s Area.

4A.1.3. The Consortium lead who calls a General Meeting must give at least 15 clear days’ written notice before the date of it to all Practice Representatives and all members of the Governing Body.

4A.1.4. On the calling of a General Meeting the Chair shall forthwith arrange to give notice of it at the offices of the Group and on the Group’s website.

4A.2. AGENDA AND PAPERS FOR GENERAL MEETINGS

4A.2.1. The Chair shall arrange for the agenda and papers to be prepared for a General meeting.

4A.2.2. The agenda and any papers for a General Meeting must be circulated at least 5 clear days prior to the General Meeting to each Practice Representative and each member of the Governing Body.

4A.2.3. Any papers relating to items that are to be discussed in private at a General Meeting shall not be made public.

4A.3. ATTENDANCE AND SPEAKING AT GENERAL MEETINGS

4A.3.1. The Chair may make whatever arrangements he or she considers appropriate to enable those attending a General Meeting to listen and contribute including to exercise their rights to speak or vote.

4A.3.2. Any Partner or salaried GP of a Member and any member of the Governing Body may attend and speak at a General Meeting.


4A.3.3. Other attendees may ask questions by invitation of the Chair.

4A.3.4. The accidental omission to give notice of a meeting to, or the non-receipt of notice of a meeting, agenda or papers by, any person entitled to receive notice shall not invalidate proceedings at that meeting.

4A.4. QUORUM

4A.4.1. No business other than the appointment of the Chair of the meeting is to be transacted at a General Meeting if the persons attending do not constitute a quorum.

4A.4.2. For a General Meeting to be quorate, at least 51% of the Practice Representatives (or their proxies) must attend.

4A.5. CHAIRING OF GENERAL MEETINGS

4A.5.1. The Chair of the Governing Body shall chair General Meetings if present. If not present the Deputy Chair shall chair the General Meeting if present.

4A.5.2. If the Chair and Deputy Chair are not present or are not present within 10 minutes of the time at which a General Meeting was due to start the Practice Representatives present at the meeting shall on a majority vote appoint one of them to chair the meeting.

4A.5.3. If the persons attending a General Meeting within half an hour of the time at which the meeting was due to start do not constitute a quorum, or if during a meeting a quorum ceases to be present, the Chair of the meeting must adjourn it.

4A.5.4. The Chair of a quorate General Meeting may adjourn it if:

a) the meeting consents to an adjournment, or

b) it appears to the Chair of the meeting that an adjournment is necessary to ensure that the business of the meeting is conducted in an orderly manner.

4A.5.5. The Chair of a General Meeting must adjourn it if directed to do so by Practice Representatives holding a simple majority of the nominated voting rights allocated to the Practice Representatives present at the meeting.

4A.5.6. When adjourning a General Meeting, the Chair of the meeting must:

a) either specify the time and place to which it is adjourned or state that it is to continue at a time and place to be fixed by the Governing Body

b) have regard to any directions as to the time and place of any adjournment which have been given by the meeting.

4A.5.7. If the continuation of an adjourned meeting is to take place more than 14 days after it was adjourned, the Chair must give at least 14 clear days notice of it:


a) to the same persons to whom notice of a General Meeting is required to be given

b) containing the same information which such notice is required to contain.

4A.5.8. At an adjourned General Meeting only that business which formed the business to be transacted at the original meeting can be transacted.

4A.6. DECISION MAKING AT GENERAL MEETINGS

4A.6.1. All matters requiring a decision at a General Meeting shall be decided by a vote of the Practice Representative who shall each have one vote. But a vote will be carried only if at least 51% of the Practice Representatives (or their proxies) vote in favour of it.

4A.6.2. Only the Practice Representatives (or their proxies) shall be eligible to vote at a General Meeting save that in the case of an equality of votes, the Chair of the meeting shall be entitled to a casting vote.

4A.6.3. The decision of the Chair of the meeting on questions of order, relevancy and regularity and their interpretation of the constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

4A.7. ERRORS AND DISPUTES

4A.7.1. No objection may be raised to the qualification of any person voting at a General Meeting except at the meeting or adjourned meeting at which the vote objected to is tendered, and every vote allowed at the meeting is valid.

4A.7.2. Any such objection must be referred to the Chair of the meeting whose decision is final.

4A.8. CONTENT OF PROXY NOTICES

4A.8.1. Proxies may only validly be appointed by a notice in writing (a “proxy notice”) which:

a) states the name and address of the Practice Representative appointing the proxy;

b) identifies the person appointed to be that Practice Representative’s proxy and the General Meeting in relation to which that person is appointed;

c) is signed by or on behalf of the Practice Representative appointing the proxy, or is authenticated by the relevant Member;

d) is delivered to the Governing Body in accordance with the Constitution and any instructions contained in the notice of the General Meeting to which they relate.


4A.8.2. The Governing Body may require proxy notices to be delivered in a particular form, and may specify different forms for different purposes.

4A.8.3. Proxy notices may specify how the proxy appointed under them is to vote (or that the proxy is to abstain from voting) on one or more resolutions.

4A.8.4. Unless a proxy notice indicates otherwise, it must be treated as

a) allowing the person appointed under it as a proxy discretion as to how to vote on any ancillary or procedural resolutions put to the meeting;

b) appointing that person as a proxy in relation to any adjournment of the General Meeting to which it relates as well as the meeting itself.

4A.8.5. An appointment under a proxy notice may be revoked by delivering to the Governing Body a notice in writing given by or on behalf of the Practice Representative by whom or on whose behalf the proxy notice was given.

4A.8.6. A notice revoking a proxy appointment only takes effect if it is delivered before the start of the meeting or adjourned meeting to which it relates.

4A.8.7. If a proxy notice is not executed by the Practice Representative appointing the proxy, it must be accompanied by written evidence of the authority of the person who executed it to execute it on the relevant Member’s behalf.

4B. ANNUAL GENERAL MEETING

4B.1.1. The Governing Body shall call and hold an Annual General Meeting (AGM) of the Group:

a) once in each year provided that not more than 15 months shall elapse between the date of one Annual General Meeting and that of the next;

b) on a Business Day;

c) at such a time and place as the Governing Body shall determine no later than September 30th of any year and in publicly accessible premises within the Group’s Area.

4B.1.2. The matters to be discussed at the AGM shall be set out in the notice, and shall include the consideration and, if thought fit, approval of:

a) the Group accounts;

b) the Group Annual Report;

c) the Group Report on Public Involvement;

d) the Group Annual Plan;

e) the transaction of any other business included in the notice convening the meeting;


f) any matters reserved to the Members’ Forum;

g) the appointment or approval of appointment of members to the Governing Body, where applicable.

4B.1.3. The AGM shall be open to the public.

4B.1.4. Notice of the AGM will be published at least 15 clear days prior to the meeting.

4B.1.5. Standing Orders 4A.3 to 4A.8 will apply to an Annual General Meeting.

4B.2. MINUTES

4B.2.1. Minutes of a General Meeting and the Annual General Meeting will be drawn up and signed by the Chair

4B.2.2. The names of all practices leads and their practices present at the meeting shall be recorded in the minutes of a General Meeting.

4B.2.3. Minutes of the Annual General Meeting and (except insofar as it is held in private) a General Meeting shall be a public document that will be circulated to all Members and to all members of the Governing Body and published on the CCG website within 3 days of the meeting having taken place.

4 APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES 4.1 In addition to the Members’ Forum, and subject to any regulations made by the

Secretary of State52, the CCG may appoint other committees and sub-committees of the CCG and the Governing Body may appoint committees and sub-committees of the Governing Body.

4.1.2 Other than where there are statutory requirements, such as in relation to the

Governing Body’s audit committee or remuneration committee, the CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG.

4.1.3 The provisions of these standing orders shall apply where relevant to the

operation of the Governing Body, the Governing Body’s committees and sub-committee and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.

4.3 DELEGATION OF POWERS BY COMMITTEES TO SUB-COMMITTEES 4.3.1 Where committees are authorised to establish sub-committees they may not

delegate executive powers to the sub-committee unless expressly authorised by the CCG or the Governing Body on its behalf.

52 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act


4.4 APPROVAL OF APPOINTMENTS TO COMMITTEES AND SUB-COMMITTEES 4.4.1 The CCG or the Governing Body on its behalf shall approve the appointments to

each of the committees and sub-committees which it has formally constituted including those the Governing Body. The CCG shall agree such travelling or other allowances as it considers appropriate.

5 DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND

PRIME FINANCIAL POLICIES 5.1 If for any reason these standing orders are not complied with, full details of the

non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body and Audit Committee for action or ratification. All members of the CCG and staff have a duty to disclose any non-compliance with these standing orders to the Accountable Officer as soon as possible.

6 USE OF SEAL AND AUTHORISATION OF DOCUMENTS 6.1 CCG seal 6.1.1 The CCG may have a seal for executing documents where necessary. The

following individuals or officers are authorised to authenticate its use by their signature:

a) the Accountable Officer;

b) the Chair of the Governing Body;

c) the Chief Finance Officer.

6.1.2 The use of the seal shall be reported to the Governing Body 7 OVERLAP WITH OTHER CCG POLICY STATEMENTS / PROCEDURES AND

REGULATIONS 7.1 Policy statements: general principles 7.1.1 The CCG will from time to time agree and approve policy statements /

procedures which will apply to all or specific groups of staff employed by NHS City & Hackney CCG. The decisions to approve such policies and procedures will be recorded in an appropriate CCG minute and will be deemed where appropriate to be an integral part of the CCGs standing orders.


APPENDIX D – SCHEME OF RESERVATION & DELEGATION

1. SCHEDULE OF MATTERS RESERVED TO THE CCG AND SCHEME OF DELEGATION

1.1. The arrangements made by the CCG as set out in this scheme of reservation

and delegation of decisions shall have effect as if incorporated in the CCGs Constitution.

1.2. The CCG remains accountable for all of its functions, including those that it has

delegated.


Ref The Governing Body

Decisions taken by the Governing Body

1 The Governing Body

GENERAL ENABLING PROVISION 1. The Governing Body may determine any matter, for which it has delegated or statutory authority, it wishes in full session within its statutory powers.


OVERARCHING SCHEME OF RESERVATION AND DELEGATION 1. Approval of the CCGs overarching scheme of reservation and delegation.


REGULATIONS AND CONTROL 1. Approve Standing Orders (SOs), a schedule of matters reserved to the Governing Body and Standing Financial Instructions for the regulation of its proceedings and business. 2. Require and receive the declaration of Board members’ interests which may conflict with those of the CCG and, taking account of any waiver which the Secretary of State for Health may have made in any case, determining the extent to which that member may remain involved with the matter under consideration. 3. Require and receive the declaration of officers’ interests that may conflict with those of the CCG. 4. Approve arrangements for dealing with complaints. 5. Adopt the organisation structures, processes and procedures to facilitate the discharge of business by the CCG and to agree modifications thereto. 6. Receive reports from committees including those that the CCG is required by the Secretary of State or other regulation to establish and to action appropriately. 7. Confirm the recommendations of the CCGs committees where the committees do not have executive powers. 8. Approve arrangements relating to the discharge of the CCGs responsibilities as a corporate trustee for funds held on trust. 9. Establish terms of reference and reporting arrangements of all committees and sub-committees that are established by the Governing Body. 10. Authorise use of the seal. 11. Discipline members of the Governing Body or employees who are in breach of statutory requirements or SOs. 12. Approve any urgent decisions taken by the Chair of the CCG and Accountable

NHS City & Hackney Clinical Commissioning Group’s Constitution - 59 - Version: 2.0 | NHS Commissioning Board Effective Date: 01/04/2013



Officer for ratification by the CCG in public session. 4 The Governing

Body APPOINTMENTS/ DISMISSAL 1. Appoint the Vice Chair of the Governing Body. 2. Appoint and dismiss other committees (and individual members) that are directly

accountable to the Governing Body. 3. Confirm appointment of members of any committee of the CCG as representatives

on outside bodies. 4. Prepare detailed financial policies that underpin the CCGs prime financial policies. 5. Approve detailed financial policies. 6. Delegate responsibility to the remuneration committee advising to make any

changes to remuneration, allowances and other payments for individual Governing Body Members.


STRATEGY, LOCAL DELIVERY PLAN AND BUDGETS 1. Define the strategic aims and objectives of the CCG. 2. Identify the key strategic risks, evaluate them and ensure adequate responses are in place and are monitored. 3. Approve plans in respect of the application of available financial resources to support the agreed Commissioning Strategy Plan (Operating Plan/QIPP). 4. Approve proposals for ensuring quality and developing clinical governance in services provided by the CCG or its constituent practices, having regard to any guidance issued by the Secretary of State. 5. Approve (with any necessary appropriate modification) the CCGs commissioning strategy or plan. 6. Approve annually (with any necessary appropriate modification) the CCGs CSP and Operating Plan/QIPP. 7. Approve the CCGs policies and procedures for the management of risk. 8. Approve budgets. 9. Approve annually CCGs proposed organisational development proposals. 10. Ratify CCG Executive Committee’s proposals for strategic development, including the CSP and associated delivery and incentivisation processes. 11. Ratify proposals for acquisition, disposal or change of use of land and/or buildings. 12. Approve the opening of bank accounts.




13. Approve proposals on individual contracts (other than NHS contracts) of a capital or revenue nature amounting to, or likely to amount to over £250,000 over a 3 year period or the period of the contract if longer. 14. Approve proposals in individual cases for the write off of losses or making of special payments above the limits of delegation to the Accountable Officer and the Chief Finance Officer (for losses and special payments) previously approved by the Governing Body. 15. Approve individual compensation payments above delegated limits. 16. Approve proposals for action on litigation against or on behalf of the CCG. 17.Approve proposals for CCG or Practice incentive schemes, having regard to guidance by the Secretary of State. 18. Approve arrangements for managing exceptional funding requests. 19. Agree the vision, values and overall strategic direction of the CCG. 20. Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the CCGs ability to achieve its agreed strategic aims.


POLICY DETERMINATION 1. Approve management policies including personnel policies incorporating the arrangements for the appointment, removal and remuneration of staff. Policies so adopted shall be listed and appended to this document [by the Secretary].


AUDIT 1. Receive the annual management letter received from the External Auditor, taking account of the advice, where appropriate, of the Audit Committee. 2. Receive an annual report from the Internal Auditor and agree action on recommendations where appropriate of the Audit Committee.


ANNUAL REPORTS AND ACCOUNTS 1. Receipt and approval of the CCGs Annual Report and Annual Accounts. 2. Receipt and approval of the Annual Report and Accounts for funds held on trust, which may be incorporated within the CCGs annual report.




9 The Governing

Body TENDERING AND CONTRACTING 1. Approval of the CCGs contracts for any commissioning support. 2. Approval of the CCGs contracts for corporate support (for example finance provision)


COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES 1. Approval of the arrangements for discharging the CCGs statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation. 2. Approve arrangements for co-ordinating the commissioning of services with other CCGs and/or with the local authority(ies), where appropriate.


OPERATIONAL AND RISK MANAGEMENT 1. Approve the CCGs counter fraud and security management arrangements. 2. Approval of the CCGs risk management arrangements. 3. Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other CCGs or pooled budget arrangements under section 75 of the NHS Act 2006). 4. Approve proposals for action on litigation against or on behalf of the CCG. 5. Approve the CCGs arrangements for business continuity and emergency planning.


QUALITY AND SAFETY 1. Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes. 2. Approve arrangements for supporting the NHS Commissioning Governing Body in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services.

13 The Governing PARTNERSHIP WORKING




Body 1. Approve decisions that individual members or employees of the CCG participating in joint arrangements on behalf of the CCG can make. Such delegated decisions must be disclosed in this scheme of reservation and delegation. 2. Approve decisions delegated to joint committees established under section 75 of the 2006 Act.


INFORMATION GOVERNANCE 1. Approve the CCGs arrangements for handling complaints. 2. Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data.


1 Chair Appraise practice representative Governing Body members.

2 Chair Approves all communications to practices from the Governing Body. 1 Accountable

Officer OPERATIONAL SCHEME OF DELEGATION 1. Prepare and recommend the CCGs operational scheme of delegation, which sets out those key operational decisions delegated to individual employees of the CCG, not for inclusion in the CCGs Constitution. 2. Approval of the CCGs operational scheme of delegation that underpins the CCGs ‘overarching scheme of reservation and delegation’ as set out in its Constitution.

2 Accountable Officer

COMPREHENSIVE SYSTEM OF INTERNAL CONTROL 1. Approval of a comprehensive system of internal control, including budgetary control that underpins the effective, efficient and economic operation of the CCG.


Decisions/duties delegated by the Governing Body to committees Ref Committee Decisions/duties delegated by the Governing Body to committees 1 Audit committee

The Committee will assist the Governing Body in the discharge of its function under s.14L(2) of the 2006 Act as follows: 1. Advise the Governing Body on internal and external audit services. 2. Review the establishment and maintenance of an effective system of integrated

governance, mitigation of major risks to delivery and internal control across the whole of the organisation’s activities that supports the achievement of the organisation’s objectives.

3. Monitor compliance with Standing Orders and Standing Financial Instructions. 4. Review schedules of losses and compensations making recommendations to the Governing Body; 5. Review the annual financial statements prior to submission to the Governing Body. 6. Approve the appointment (and where necessary the dismissal) of internal auditors and advise the Audit Commission on the appointment of external auditors, including arrangements for the separate audit of funds held on trust. 7. Receive the annual management letter received from the External Auditor. The Committee’s detailed Terms of Reference are on the CCGs website.

1 Remuneration committee

The Committee has the function of making recommendations to the Governing Body as to the discharge of its functions under s.14L(3)(a) and (b) of the 2006 Act and in addition has other functions connected with the Governing Body’s function under s.14L(2) of the 2006 Act as follows: 1. Advise the Governing Body about appropriate remuneration, fees, allowances and terms of service for employees of the CCG and to other persons providing services to it, including: • all aspects of salary (including any performance-related elements/bonuses); • provisions for other benefits, including pensions and cars;


Ref Committee Decisions/duties delegated by the Governing Body to committees • arrangements for termination of employment and other contractual terms; ensuring that employees are fairly rewarded for their individual contribution to the

CCG - having proper regard to the CCG’s circumstances and performance and to the provisions of any national arrangements for such staff.

2. Making decisions and advising the Governing Body on any changes to remuneration, allowances and other payments for individual Governing Body Members.

3. Proper calculation and scrutiny of termination payments taking account of such national guidance as is appropriate advising on and overseeing appropriate contractual arrangements for such staff;

4. Reporting in writing to the Governing Body the basis for its decisions. 5. Determining the appointments process for all members to the Governing Body 6. Taking external HR specialist advise to support remuneration decisions The Committee’s detailed Terms of Reference are on the CCGs website

1 Clinical Executive Committee

The Committee will: Develop and implement the C&H CCG Clinical Strategy, Commissioning Strategic Plan (CSP) and Quality, Innovation, Productivity and Prevention (QIPP) targets; • Ensure the effective discharge of the functions of C&H CCG; • Oversee the work of the CCGs Programme Boards which are responsible for development and delivery of the annual CSP; • Ensure effective consultation and discussion with member practices of C&H CCG about the CCGs clinical plans. The Committee’s detailed Terms of Reference are on the CCGs website

1 Finance and Performance Committee

The Committee will: • Receive the monthly finance, activity and KPI reports produced by the CSS; • Receive a monthly report on progress with implementation of the Quality, Innovation,

Productivity and Prevention (QIPP) plans; • Agree responsibilities and implement action plans and reporting arrangements for


Ref Committee Decisions/duties delegated by the Governing Body to committees variances or areas of performance identified;

• The CCGs CFO will ensure that remedial actions plans are reported to the Governing Body as part of the performance reporting arrangements and that progress is monitored.

The Committee’s detailed Terms of Reference are on the CCGs website

1 Members’ Forum The Members’ Forum will: • Consider and agree any changes to the Constitution as laid out in 1.4.2 including

changes in membership of the CCG; • Confirm the appointments process for Governing Body members • Ratify all appointments to the Governing Body; • Consider any issue of no confidence in Governing Body members either individually

or collectively; • Debate any concerns regarding discussions and decisions by the Governing Body. If a resolution is passed by the Members’ Forum by a majority of at least 51% of all the Practice Representatives, the Governing Body is required to abide by the decision of the Forum. • As detailed in the constitution, section 8.2.9 and 8.2.10, the members forum cannot

challenge decisions of the Governing Body or Primary Care Committee relating to the commissioning of primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours services.

1 Patient and Public Involvement

The PPI has the following role: • To develop and deliver the CCGs engagement plans which are consistent with

section 5.2.1 within the constitution. • To oversee and coordinate the various sources of patient carer and public views and

issues on the services which the ccg commissions and ensure that the ccg has a comprehensive understanding of these.

• To make recommendations to the Governing Body and via our Programme Boards and clinical executive on changes to our commissioning plans to address these issues satisfactorily.

• To ensure that learning from complaints takes place and is reflected in our NHS City & Hackney Clinical Commissioning Group’s Constitution - 67 - Version: 2.0 | NHS Commissioning Board Effective Date: 01/04/2013

Ref Committee Decisions/duties delegated by the Governing Body to committees commissioning plans and to ensure that the complaints management service received from the CSS is robust and meeting the specification.

• To ensure that we communicate back to our patients and public on what we have done about the issues they have raised.

1 Prioritisation & Investment Committee

The PIC has the following role: • To recommend to the CCG Board all proposals for use of recurrent and non-

recurrent investment • To receive advice from the Accountable Officer and Chief Financial Officer on

resources available and the CCG Chair on Clinical ambitions and strategy • To assess bids, score and prioritise against the agreed prioritisation framework. • Proposals received in the form of Project Initiation Documents (PIDs) will be

assessed to ensure value for money, impact on patients and outcomes and to ensure they are in line with the CCG clinical and financial strategy

• To consider service specifications, key performance indicators, metrics and the proposed contractual arrangements

• To recommend investment to the CCG Board 1 Primary Care

Committee COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES PROVIDED BY GP providers, (including where we are commissioning primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours service, 1. Approval of the arrangements for discharging the CCGs statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation. 2. Approve arrangements for co-ordinating the commissioning of services with other CCGs and/or with the local authority(ies), where appropriate. 3. Approve proposals on individual contracts The CCGs Primary Care Committee has delegated responsibility from the CCG Board for ensuring the delivery of the CCGs clinical strategy through robust contractual arrangements with general practices, the GP Confederation and the GP OOH provider,


Ref Committee Decisions/duties delegated by the Governing Body to committees and ensuring this is transacted in a robust way to manage conflicts of interests

2 Primary Care Committee

• Function as a corporate decision-making body for the management of the NHSE delegated functions and the exercise of the delegated powers in respect of primary care commissioning under section 83 of the NHS Act.

This includes the following:


• 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 on ‘discretionary’ payment (e.g., returner/retainer schemes). In addition the committee will also undertake the following in respect to any commissioning where GPs are providers; • To review service specifications for new investment in primary care providers • To ensure that investment represents value for money • Review the contracting route for the proposals • In respect of procurement activities, review proposals from Programme Boards

around process, documentation,(including service specifications and evaluation criteria) and membership to help assure conflicts have been mitigated in order for them to make recommendations to the Board


Ref Committee Decisions/duties delegated by the Governing Body to committees • To review procurement process after completion and ensure process was followed

and endorse the recommendation to award a contract • In respect to contracting arrangement for renewal or new contracts, the committee

will also be required to review and assess any incorporated key performance indicators (KPIs) and the basis on which contractual payments would be made and provider performance assessed

• All decisions relating to contracting with and investment in CHUHSE (the OOH provider) will be reviewed by the committee once a recommendation has been received by our Urgent Care Board/ System Resilience Group.


APPENDIX E – PRIME FINANCIAL POLICIES 1. INTRODUCTION 1.1. GENERAL 1.1.1. These Prime Financial Policies and supporting Detailed Financial Policies shall

have effect as if incorporated in the Constitution. 1.1.2. The Prime Financial Policies are part of the CCGs control environment for

managing the organisation's financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration; lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and Chief Finance Officer to effectively perform their responsibilities. They should be used in conjunction with the Scheme of Reservation and Delegation adopted by the CCG.

1.1.3. In support of these Prime Financial Policies, there are more detailed policies,

approved by the Accountable Officer and Chief Finance Officer (CFO), known as Detailed Financial Policies. The Prime and Detailed Financial Policies are referred together as the CCGs Financial Policies.

1.1.4. These Prime Financial Policies identify the financial responsibilities which apply to everyone working for the CCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the Detailed Financial Policies. The Accountable Officer and Chief Finance Officer are responsible for preparing all Detailed Financial Policies which will be approved in accordance with the CCGs Scheme of Reservation and Delegation.

1.1.5. Should any difficulties arise regarding the interpretation or application of any of the Prime Financial Policies then the advice of the Accountable Officer and Chief Finance Officer must be sought before acting. The user of these Prime Financial Policies should also be familiar with and comply with the provisions of the CCGs Constitution, Standing Orders and Scheme of Reservation and Delegation.

1.1.6. Failure to comply with Prime Financial Policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2. OVERRIDING PRIME FINANCIAL POLICIES 1.2.1. If for any reason these Prime Financial Policies are not complied with, full

details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Audit Committee for referring action or ratification. All members of the CCG and staff have a duty to disclose any non-compliance with these Prime Financial Policies to the Chief Finance Officer as soon as possible.


1.3. RESPONSIBILITIES AND DELEGATION 1.3.1. The roles and responsibilities of Members of the CCG, the Governing Body, its

Committees and Sub-Committees are set out in the main body of the CCG constitution and the CCGs Scheme of Reservation and Delegation.

1.4. DELEGATED FINANCIAL DECISIONS 1.4.1 The financial decisions delegated by Members of the CCG are set out in the

CCGs Scheme of Reservation and Delegation. 1.5. CONTRACTORS AND THEIR EMPLOYEES

1.5.1. Any contractor or employee of a contractor who is empowered by the CCG to

commit the CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Accountable Officer to ensure that such persons are made aware of this.

1.6. AMENDMENT OF PRIME FINANCIAL POLICIES 1.6.1. To ensure that these policies remain up-to-date and relevant, the Chief Finance

Officer will review them annually. Following consultation with the Accountable Officer and scrutiny by the Audit Committee, the Chief Finance Officer will recommend amendments, as fitting, to the appropriate body as set out in the Scheme of Reservation and Delegation.

2. INTERNAL CONTROL 2.1. The CCG will put in place a suitable control environment and effective internal

controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity and compliance with laws and policies.

2.2. The Governing Body will set up an Audit Committee with terms of reference

agreed by the Governing Body.

2.3. The Accountable Officer has overall responsibility for the CCGs systems of internal control.

2.4. The Chief Finance Officer will ensure that:

a) financial policies are considered for review and update annually; b) a system is in place for proper checking and reporting of all breaches of

financial policies; and c) a proper procedure is in place for regular checking of the adequacy and

effectiveness of the control environment. 3. AUDIT

3.1. The CCG will keep an effective and independent internal audit function and fully

comply with the requirements of external audit and other statutory reviews.


3.2. In line with the Audit Committee Term of Reference, the Head of Internal Audit and the CCGs appointed external auditor will have direct and unrestricted access to Audit Committee members and the CCGs Chair and Accountable Officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.3. The Head of internal Audit and external auditor will have access to the Audit

Committee and the Accountable Officer to review audit issues as appropriate. All Audit Committee Members, the Chair of the CCG and the Accountable Officer will have direct and unrestricted access to the Head of Internal Audit and external auditors.

3.4. The Chief Finance Officer will ensure that:

a) the CCG has a professional and technically competent internal audit function;

b) the Audit Committee approves any changes to the provision or delivery of assurance services to the CCG.

4. FRAUD AND CORRUPTION

4.1. The CCG requires all staff to always act honestly and with integrity to safeguard

the public resources they are responsible for. The CCG will not tolerate any fraud perpetrated against it and will actively chase any loss suffered.

4.2. The Audit Committee will satisfy itself that the CCG has adequate arrangements

in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme previously reviewed by and agreed with the CFO.

5. EXPENDITURE CONTROL 5.1. The CCG is required by statutory provisions to ensure that its expenditure does

not exceed the aggregate of allocations from the NHS Commissioning Board and any other sums it has received and is legally allowed to spend. The Accountable Officer has overall executive responsibility for ensuring that the CCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

5.2. The Chief Finance Officer will: provide reports in the form required by the NHS

Commissioning Board; ensure money drawn from the Commissioning Board is required for approved expenditure only is drawn down only at the time of need and follows best practice; be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the CCG to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of the NHS Commissioning Board.


6. ALLOCATIONS

6.1. The Chief Finance Officer of the CCG will:

a) periodically review the basis and assumptions used by the NHS Commissioning Board for distributing allocations of funds to CCGs and ensure that these are reasonable and realistic and secure the CCGs full entitlement to funds;

b) prior to the start of each financial year submit to the CCG Governing Body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

c) regularly update the CCG Governing Body on significant changes to the initial allocation and the uses of such funds.

7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND

MONITORING 7.1. The CCG will produce and publish an annual commissioning plan that explains

how it proposes to discharge its financial duties. The plan will be supported by comprehensive medium term financial plans and annual budgets.

7.2. The Accountable Officer will compile and submit to the Governing Body a

commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.3. Prior to the start of the financial year the Chief Finance Officer will, on behalf of

the Accountable Officer, prepare and submit budgets for approval by the Governing Body under the terms of the Scheme of Reservation & Delegation.

7.4. The Chief Finance Officer shall monitor financial performance against budget

and plan, periodically review them, and report to the Governing Body. This report shall include explanations for significant variances or anticipated risks.

7.5. The Accountable Officer is responsible for ensuring that information relating to

the CCGs accounts or to its income or expenditure, or its use of resources is provided to the NHS Commissioning Board as requested.

7.6. The Chief Finance Officer shall approve all virements which have not been

reserved for decision by the Governing Body.

7.7. Non-recurrent funds must not be used to support any activity of a recurrent nature.

7.8. All permanent appointments must be approved by the Accountable Officer.

7.9. The Accountable Officer is responsible for identifying cost improvements and

savings plans in accordance with the requirements identified in the annual financial plan.


8. ANNUAL ACCOUNTS AND REPORTS 8.1. The Chief Finance Officer will ensure the CCG:

a) prepares a timetable for producing the annual report and accounts and agrees it with external auditors and the Governing Body;

b) prepares the accounts according to the timetable approved by the Governing Body;

c) complies with statutory requirements and relevant directions for the publication of annual report;

d) considers the external auditor's management letter and fully address all issues within agreed timescales;

e) publishes the external auditor's management letter on the CCGs internet site.

9. ACCOUNTING SYSTEMS

9.1. The CCG will ensure it has in place an accounting system that creates

management and financial accounts. 9.2. The CFO will ensure the CCG has suitable financial and other software to enable

it to comply with these policies and any consolidation requirements of the NHS Commissioning Board.

10. BANK ACCOUNTS 10.1. The Chief Finance Officer will review the banking arrangements of the CCG at

regular intervals to ensure they reflect any Secretary of State directions, best practice and represent best value for money.

10.2. The Chief Finance Officer will manage the CCGs banking arrangements and

advise the CCG on the provision of banking services and operation of accounts. 10.3. The Accountable Officer shall approve the banking arrangements. 10.4. The Chief Finance Officer will prepare detailed instructions on the operation of

bank accounts. 10.5. The CCG will keep enough liquidity to meet its current commitments. 11. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND

OTHER NEGOTIABLE INSTRUMENTS. 11.1. The CCG will operate a sound system for prompt recording, invoicing and

collection of all monies due.


11.2. The CCG will seek to maximise its potential to raise additional income only to the extent that it does not conflict with its overall aims and objectives as set out in its Constitution.

11.3. The CCG will ensure its power to make grants and loans is used to discharge its

functions effectively. 11.4. The Chief Finance Officer is responsible for developing effective arrangements

for making grants or loans 11.5. The Chief Finance Officer is responsible for designing, maintaining and ensuring

compliance with systems for the proper recording, invoicing, and collection and coding of all monies due.

11.6. The Chief Finance Officer will establish and maintain systems and procedures

for the secure handling of all cash and other negotiable instruments. 11.7. The Chief Finance Officer is responsible for approving and regularly reviewing

the level of all fees and charges other than those determined by the NHS Commissioning Board or by statute.

12. TENDERING AND CONTRACTING PROCEDURE 12.1. The CCG will ensure compliance with all legal and statutory requirements for

competition within all purchasing and that only budgeted, approved and necessary spending is incurred.

12.2. The CCG will seek value for money for all goods and services. 12.3. The CCG shall ensure that competitive tenders are invited for:

a) the supply of goods, materials and manufactured articles; b) the rendering of services including all forms of management consultancy

services (other than specialised services sought from or provided by the DH);

c) the purchase or disposal of fixed assets. 12.4. The Governing Body may only negotiate contracts on behalf of the CCG, and the

CCG enter into contracts, within the statutory framework set up under the Health and Social Care Bill 2012. These contracts shall comply with:

a) The CCGs Standing Orders; b) The Public Contracts Regulation 2006, any successor legislation and any

other applicable law; and any applicable Commissioning Board or Monitor instruction that is legally enforceable.

12.5. The Accountable Officer shall nominate an officer who shall oversee and

manage each contract on behalf of the CCG including those being managed by a third party on behalf of the CCG.


12.6. The Accountable Officer shall put in place effective systems to ensure the CCG

is compliant with the requirements of the Bribery Act 2010. 12.7. The Governing Body shall agree limits whereby tendering may be waived or

circumstances under which tendering may not be applied. All waivers should be reported to the Audit Committee.

12.8. The Chief Finance Officer shall establish formal procedures for tendering which

shall be made available to all staff involved in tendering activities.

13. COMMISSIONING 13.1. Working in partnership with relevant national and local stakeholders, the CCG

will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility within the resource allocated.

13.2. The CCG will coordinate its work with the NHS Commissioning Board, local NHS

Trusts, other CCGs, NHS Trusts and Foundation Trusts, the local authority, including through Health & Wellbeing Boards, users, carers and the voluntary sector to develop its commissioning plans.

13.3. The Accountable Officer will establish arrangements to ensure that regular

reports are provided to the Finance and Performance Committee detailing actual and forecast expenditure and activity for each SLA and ensure the Governing Body are made aware of any significant variations to the annual plan.

13.4. Where the CCG makes arrangements for the provision of services by non-NHS

providers it is the Accountable Officer who is responsible for ensuring that the agreements put in place have due regard to the quality and cost-effectiveness of services provided. Before making any agreement with non-NHS providers, the CCG should explore fully the scope to make maximum cost-effective use of NHS facilities.

13.5. The Chief Finance Officer will maintain a system of financial monitoring to ensure

the effective accounting of expenditure under agreements. This should provide a suitable audit trail for all payments made under the agreements whilst maintaining patient confidentiality.

14. RISK MANAGEMENT AND INSURANCE 14.1. The CCG will put arrangements in place for evaluation and management of its

risks. 14.2. The Accountable Officer will ensure effective arrangements are put in place to

identify, assess, record, manage and mitigate risks. 14.3. The CCG will ensure arrangements for reporting risks to the Governing Body.


15. NON-PAY EXPENDITURE 15.1. The Accountable Officer will approve the level of non-pay expenditure on an

annual basis and the Accountable Officer will determine the level of delegation to budget managers within any overall CCG Scheme of Reservation and Delegation.

15.2. The Accountable Officer shall set out procedures on the seeking of professional

advice regarding the supply of goods and services. 15.3. The Chief Finance Officer will:

a) advise the Accountable Officer and Governing Body on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the CCGs Scheme of Reservation and Delegation;

b) be responsible for the prompt payment of all properly authorised accounts and claims;

c) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable.

15.4. The CCG will ensure it has in place arrangements to seek to obtain the best

value for money goods and services received. 16. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF

ASSETS 16.1. Within the statutory powers of the CCG for acquisition, disposal and holding of

assets, the Accountable Officer: a) shall ensure that there is an adequate appraisal and approval process in

place for determining capital expenditure priorities and the effect of each proposal upon plans;

b) is responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without confirmation that the revenue consequences, including capital charges, are affordable within the CCGs projected allocations and medium term financial plan.

16.2. The CCG shall maintain an asset register recording fixed assets. The

Accountable Officer is responsible for the maintenance of registers of assets, taking account of the advice of the Chief Finance Officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

16.3. The Accountable Officer is responsible for establishing and maintaining effective

arrangements with NHS Property Co. or its successor bodies.


17. AUDIT COMMITTEE 17.1.1. In accordance with Standing Orders the Governing Body shall formally establish

an Audit Committee, with clearly defined terms of reference and following guidance from the NHS Audit Committee Handbook to perform the following reviews:

a) reviewing the establishment and maintenance of an effective system of

governance, risk management and internal control, across the whole of the CCGs activities;

b) ensuring there is an effective internal audit function established by management, that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and Board;

c) reviewing the work and findings of the appointed external auditor and considering the implications of and management's responses to their work;

d) reviewing the findings of other significant assurance functions, both internal and external to the organisation, and considering the implications for the governance of the CCG;

e) reviewing the systems for financial reporting to the Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Governing Body;

f) reviewing financial and information systems and monitoring the integrity of the financial statements and reviewing significant financial reporting judgments;

g) monitoring compliance with Standing Orders and Standing Financial Instructions;

h) reviewing schedules of losses and compensations and making recommendations to the Governing Body;

i) reviewing schedules of aged debtors and creditors balances over 6 months; j) review the annual report and financial statements prior to submission to the

Governing Body focusing particularly on: i) the wording in the Statement of Internal Control and other relevant

disclosures; ii) changes in, and compliance with, accounting policies and practices; iii) unadjusted mis-statements in the financial statements; iv) major judgmental areas; v) significant adjustments resulting from audit.

k) reviewing the annual financial statements and recommend their approval to the Governing Body;

l) reviewing the external auditor's report on the financial statements and the annual

m) management letter; n) reviewing any incident of fraud or corruption or possible breach of ethical

standards, conflicts of interest or legal or statutory requirements that could have a significant impact on the CCGs financial accounts or reputation;

o) reviewing any objectives and effectiveness of the internal audit services including its


p) working relationship with external auditors; q) reviewing major findings from internal and external audit reports and ensure

appropriate action is taken; r) investigating any matter within its terms of reference, having the right of

access to any information relating to the particular matter under investigation;

s) reviewing waivers to Standing Orders. t) reviewing templates completed where GP practices are potential providers

of CCG-commissioned services in order to gain assurance that a robust process has been followed.

17.2. CHIEF FINANCE OFFICER 17.2.1. The Chief Finance Officer is responsible for:

a) ensuring there are arrangements to review, evaluate and report on the effectiveness of internal financial control including the establishment of an effective Internal Audit function;

b) ensuring that the Internal Audit function meets the NHS mandatory audit standards and provides sufficient independent and objective assurance to the Audit Committee and the Accountable Officer;

c) deciding at what stage to involve the police in cases of misappropriation and other irregularities not involving fraud or corruption.

d) ensuring that an annual Internal Audit report is prepared for the consideration of the Audit Committee;

17.2.2. The Chief Finance Officer or designated internal or external auditor is entitled

without necessarily giving prior notice to require and receive: a) access to all records, documents and correspondence relating to any

financial or other relevant transactions, including documents of a confidential nature;

b) explanations concerning any matter under investigation. 17.3. ROLE OF INTERNAL AUDIT 17.3.1. Internal Audit is an independent and objective appraisal service within an

organisation which provide: a) an independent and objective opinion to the Accountable Officer, the

Governing Body, and the Audit Committee on the degree to which risk management, control and governance, support the achievement of the organisation's agreed objectives;

b) an independent and objective service to help improve the organisation's risk management, control and governance arrangements.

17.3.2. Internal Audit will review, appraise and report upon policies, procedures and

operations in place to; a) identify, assess and manage the risks to achieving the organisation's

objectives; b) ensure the economical, effective and efficient use of resources; c) ensure compliance with established policies procedures, laws and

regulations;


d) safeguard the organisation's assets and interests from losses of all kinds, including those arising from fraud, irregularity or corruption;

e) ensure the integrity and reliability of information, accounts and data, including internal and external reporting and accountability processes.

17.3.3. The Head of Internal Audit will provide to the Audit Committee:

a) A risk-based plan of internal audit work, agreed with management; b) Regular updates on the progress against plan; c) Reports of management's progress on the implementation of action agreed

as a result of internal audit findings; d) An annual opinion, based upon and limited to the work performed, on the

overall adequacy and effectiveness of the organisation's risk management, control and governance processes (i.e. the organisation's system of internal control);

e) Additional reports as requested by the Audit Committee. 17.3.4. Whenever any matter arises which involves, or is thought to concern any

suspected irregularity the Chief Finance Officer must be notified immediately. 17.3.5. The Head of Internal Audit will normally attend Audit Committee meetings and

has a right of access to all Audit Committee members, the Chair and Accountable Officer.

17.3.6. The Head of Internal Audit reports to the Audit Committee and is managed by

the Chief Finance Officer. 17.3.7. The appointment and termination of the Head of Internal Audit and/or the Internal

Audit Service must be approved by the Audit Committee. 17.4. EXTERNAL AUDIT 17.4.1. The External Auditor is appointed to the CCG. 17.4.2. The Audit Committee must ensure a cost-efficient service. If there are any

problems relating to the service provided by the External Auditor, then this should be raised with the External Auditor.

17.5. FRAUD AND CORRUPTION 17.5.1. In line with their responsibilities, the Accountable Officer and Chief Finance

Officer shall monitor and ensure compliance with Directions issued by the Secretary of State for Health on fraud and corruption.

17.5.2. The CCG shall nominate a suitable person to carry out the duties of the Local

Counter Fraud Specialist (LCFS) as specified by the NHS Counter Fraud and Corruption Manual, and guidance.

17.5.3. The LCFS shall report to the Chief Finance Officer.


17.5.4. The LCFS will provide a written report, at least annually to the Audit Committee, on counter fraud work. The LCFS will be entitled to attend any Audit Committee meetings and have a right of access to all Audit Committee members and to the Chair and Accountable Officer of the NHS body.

17.5.5. The LCFS will undertake as specified by the Accountable Officer or Chief

Finance Officer, proactive work to detect cases of fraud and corruption.

18. SHARED SERVICE ARRANGEMENTS 18.1. The Accountable Officer shall ensure that any commissioning, financial or other

activity which is performed by a Shared Service Organisation shall have in place a service level agreement to cover the functions being performed.

19. INFORMATION TECHNOLOGY 19.1 Any computerised systems established or operated by the CCG must comply

with all legal requirements. The Chief Finance Officer will ensure that contracts for computer services for financial applications with another health organisation or agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes and shall periodically seek assurances that adequate controls are in operation.

20. PAYROLL 20.1 The CCG will put arrangements in place for an effective payroll service. The

CFO will ensure that the payroll service meets NHS requirements, is supported by a service level agreement or contract which ensures compliance with requirements for tax and deductions, data security and provides assurance on internal controls and audit.

21. TRUST FUNDS AND TRUSTEES 21.1. The chief finance officer shall oversee the setting up of trust funds and ensure

that each trust fund which the group is responsible for managing is managed appropriately with regard to its purpose and to its requirements.


APPENDIX F - NOLAN PRINCIPLES

1. The ‘Nolan Principles’ set out the ways in which holders of public office should

behave in discharging their duties. The seven principles are:

a) Selflessness – Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any

financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public

appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their decisions

and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about all

the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private

interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these

principles by leadership and example. Source: The First Report of the Committee on Standards in Public Life (1995)53

53 Available at http://www.public-standards.gov.uk/


http://www.public-standards.gov.uk/

APPENDIX G – NHS CONSTITUTION The NHS Constitution sets out seven key principles that guide the NHS in all it does: 1. the NHS provides a comprehensive service, available to all - irrespective of

gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population

2. access to NHS services is based on clinical need, not an individual’s ability to

pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. the NHS aspires to the highest standards of excellence and professionalism - in

the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.

4. NHS services must reflect the needs and preferences of patients, their families

and their carers - patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.

5. the NHS works across organisational boundaries and in partnership with other

organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being

6. the NHS is committed to providing best value for taxpayers’ money and the most

cost-effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. the NHS is accountable to the public, communities and patients that it serves -

the NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose


Source: The NHS Constitution: The NHS belongs to us all (March 2012)54

APPENDIX H – Joint Arrangements 1. The CCG may enter into joint arrangements with other CCGs including the

following:

Name of joint arrangement Name(s) of the CCGs this arrangement is with

Delegated coordinating commissioner for London PCTs/CCGs - Homerton University Hospital Foundation Trust

All London CCGs with delegated authority for acute commissioning (or their host PCTs) acting as coordinating commissioner/associates to the contract.

Delegated coordinating commissioner for ELC PCTs/CCGs – University College London Hospitals Foundation Trust

Associates to the contract: Tower Hamlets CCG Newham CCG

Delegated coordinating commissioner for London PCTs/CCGs – East London Foundation Trust


Associate commissioner – Barts Health


Associate commissioner – Great Ormond Street Hospital NHS Trust


Associate commissioner – London North West Healthcare


Associate commissioner – Imperial College Healthcare NHS Trust


Associate commissioner – North Middlesex NHS Trust

All London CCGs with delegated authority for acute commissioning (or their host PCTs) acting as coordinating

54 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961


http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

commissioner/associates to the contract.

Associate commissioner – Whittington NHS Trust


Associate commissioner – Royal Free


Associate commissioner – Royal National Orthopaedic Hospital NHS Trust


Associate commissioner – Barking Havering and Redbridge University NHS Trust


Associate commissioner – St Georges Hospital NHS Trust


Associate commissioner – Royal Brompton and Harefield Foundation Trust


Associate commissioner – Royal Marsden Foundation Trust


Associate commissioner – Moorfields Foundation Trust


Associate commissioner – Guys and St Thomas’ Foundation Trust


Associate commissioner – Chelsea & Westminster Foundation Trust

All London CCGs with delegated authority for acute commissioning (or their host PCTs) acting as coordinating


commissioner/associates to the contract.

Associate commissioner – Kings College Foundation Trust


Associate commissioner – Barnet Enfield and Haringey Mental Health Trust


Associate commissioner – North East London Foundation Trust


Associate commissioner – Camden & Islington Foundation Trust


Associate commissioner – BMI Healthcare Limited


Associate commissioner – InHealth Limited


Associate commissioner – London Ambulance Service


Associate commissioner – St Georges NHS Trust Community Services (Community and Prosthetics) NB. Recent information from the DH suggests that Prosthetics will move to the NHSCB

Surrey, Berkshire (East and West), Hampshire, West Sussex and all London CCGs with delegated authority for commissioning (or their host PCTs) as coordinating commissioner/associates to the contract.

2. The group may establish joint committees with one or more local authorities as it

considers may be appropriate including the following:

Name of joint arrangement Name(s) of the local authority(ies)


this joint committee with Section 75 Executive Committee London Borough of Hackney Section 75 Executive Committee London Borough of Hackney Section 75 for Joint Care (Reablement)

London Borough of Hackney

Section 75 for LD London Borough of Hackney Section 256 for Carers London Borough of Hackney Section 256 for DOL London Borough of Hackney Section 256 for Dementia Services London Borough of Hackney Section 256 for DeafPlus London Borough of Hackney Section 256 for Dementia Community Memory Services

London Borough of Hackney

Section 256 – Physical Disabilities London Borough of Hackney 3. In preparation for Co-commissioning of primary care the following recommended guidance has been incorporated to allow for all options available; Joint commissioning arrangements with other Clinical Commissioning Groups [1.1] The clinical commissioning group (CCG) may wish to work together with other CCGs

in the exercise of its commissioning functions. [1.2] The CCG may make arrangements with one or more CCG in respect of: [1.2.1] delegating any of the CCG’s commissioning functions to another CCG; [1.2.2] exercising any of the commissioning functions of another CCG; or [1.2.3] exercising jointly the commissioning functions of the CCG and anotquarterlyer CCG [1.3] For the purposes of the arrangements described at paragraph [1.2], the CCG may: [1.3.1] make payments to another CCG; [1.3.2] receive payments from another CCG; [1.3.3] make the services of its employees or any other resources available to another

CCG; or [1.3.4] receive the services of the employees or the resources available to another CCG. [1.4] Where the CCG makes arrangements which involve all the CCGs exercising any of

their commissioning functions jointly, a joint committee may be established to exercise those functions.

[1.5] For the purposes of the arrangements described at paragraph [1.2] above, the CCG

may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 1.2.3 above. Any Model wording


for amendments to CCGs’ constitutions such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

[1.6] Where the CCG makes arrangements with another CCG as described at paragraph

[1.2] above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning

functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a • pooled fund and management of that fund; • Contributions from the parties, including details around assets, employees • and equipment to be used under the joint working arrangements.

[1.7] The liability of the CCG to carry out its functions will not be affected where the CCG

enters into arrangements pursuant to paragraph [1.2] above. [1.8] The CCG will act in accordance with any further guidance issued by NHS England on

co-commissioning. [1.9] Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body. [1.10] The governing body of the CCG shall require, in all joint commissioning

arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. Model wording for amendments to CCGs’ constitutions

[1.11] Should a joint commissioning arrangement prove to be unsatisfactory the governing

body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

Joint commissioning arrangements with NHS England for the exercise of CCG functions [2.1] The CCG may wish to work together with NHS England in the exercise of its

commissioning functions. [2.2] The CCG and NHS England may make arrangements to exercise any of the CCG’s

commissioning functions jointly. [2.3] The arrangements referred to in paragraph [2.2] above may include other CCGs.


[2.4] Where joint commissioning arrangements pursuant to [2.2] above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

[2.5] Arrangements made pursuant to [2.2] above may be on such terms and conditions

(including terms as to payment) as may be agreed between NHS England and the CCG.

[2.6] Where the CCG makes arrangements with NHS England (and another CCG if

relevant) as described at paragraph [2.2] above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning • functions; • Model wording for amendments to CCGs’ constitutions • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a • pooled fund and management of that fund; • Contributions from the parties, including details around assets, employees • and equipment to be used under the joint working arrangements; and

[2.7] The liability of the CCG to carry out its functions will not be affected where the CCG

enters into arrangements pursuant to paragraph [2.2] above. [2.8] The CCG will act in accordance with any further guidance issued by NHS England on

co-commissioning. [2.9] Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body. [2.10] The governing body of the CCG shall require, in all joint commissioning

arrangements that the Accountable Officer of the CCG make a quarterly written eport to

the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.


body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

Joint commissioning arrangements with NHS England for the exercise of

NHS England’s functions


[3.1] The CCG may wish to work with NHS England and, where applicable, other CCGs, to

exercise specified NHS England functions.

[3.2] The CCG may enter into arrangements with NHS England and, where applicable,

other CCGs to:

• Exercise such functions as specified by NHS England under delegated

arrangements;

• Jointly exercise such functions as specified with NHS England.

[3.3] Where arrangements are made for the CCG and, where applicable, other CCGs to

exercise functions jointly with NHS England a joint committee may be established to

exercise the functions in question.

[3.4] Arrangements made between NHS England and the CCG may be on such terms

and conditions (including terms as to payment) as may be agreed between the

parties.

[3.5] For the purposes of the arrangements described at paragraph [3.2] above, NHS

England and the CCG may establish and maintain a pooled fund made up of

contributions by the parties working together. Any such pooled fund may be used to

make payments towards expenditure incurred in the discharge of any of the

commissioning functions in respect of which the arrangements are made.

[3.6] Where the CCG enters into arrangements with NHS England as described at

paragraph [3.2] above, the parties will develop and agree a framework setting out the

arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning functions;

• The duties and responsibilities of the parties;

• How risk will be managed and apportioned between the parties;

• Financial arrangements, including payments towards a pooled fund and

management of that fund;


• Contributions from the parties, including details around assets, employees and

equipment to be used under the joint working arrangements.

[3.7] The liability of NHS England to carry out its functions will not be affected where it and

the CCG enter into arrangements pursuant to paragraph [3.2] above.

[3.8] The CCG will act in accordance with any further guidance issued by NHS England

on co-commissioning.

[3.9] Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body.

[3.10] The governing body of the CCG shall require, in all joint commissioning

arrangements that the Accountable Officer of the CCG make a quarterly written

report to the governing body and hold at least annual engagement events to review

aims, objectives, strategy and progress and publish an annual report on progress

made against objectives.


body of the CCG can decide to withdraw from the arrangement, but has to give six

months’ notice to partners, with new arrangements starting from the beginning of the

next new financial year after the expiration of the six months’ notice period.


CCG Constitution Review – January 2015 review window – Application Checklist CCG name: City and Hackney CCG

Type and brief description of Constitution Change (mark all that apply)

Variations to CCG Constitution

(excluding CCG mergers or dissolutions):

Amendments relating to the delegation of primary care Co-Commissioning.

CCG Merger: N/A

Dissolution of CCG: N/A

APPLICATION CHECKLIST

Criteria Contained in application (Y/N)?

The reason why a variation is being sought Yes

The proposed varied constitution with the amended clauses clearly signposted

Yes

Assurance that member practices have agreed to the proposed change(s) Yes

Assurance that stakeholders have been consulted if required Yes

A self-certification by the Chair or Accountable Officer, on behalf of the CCG, that the revised constitution continues to meet the requirements of the Act.

Yes

Assurance that the CCG has considered the need for legal advice on the implications of the proposed changes, including whether advice has been sought.

Yes

A completed impact assessment of the changes, which should cover as a minimum the factors required to be considered by NHS England set out below.

N/A

Factors for NHSE to consider

Considerations CCG Response:

Does the constitution meet the requirements of legislation and is otherwise appropriate?

Yes

Is each of the members a provider of primary medical services?

Yes

Is the area appropriate (i.e. that there are no overlapping CCGs and no gaps)?

Yes

Is the proposed Accountable Officer appropriate? Yes

Has the CCG has made appropriate arrangements to ensure it is able to discharge its functions?

Yes

Has the CCG made arrangements to ensure that its governing body is correctly constituted and otherwise appropriate?

Yes

The likely impact of the requested variation on the persons for whom the CCG has responsibility – the registered and resident population of the CCG been considered? (What is the likely impact?)

Improved management of conflicts in decision making.

Will there be an impact on financial allocations for the financial year in which the variation would take effect? (if yes please provide further details)

Yes

Will the change impact on NHS England’s function? (if yes please provide further details)

Yes – see guidance from NHSE

Has the CCG sought and taken into account the views of the following;

• any local authority whose area covers the whole or any part of the CCG’s area;

• any other CCG which would be affected; and • any other person or body which in the CCG’s view

might be affected by the variation requested,

Discussed with; CCG members Governing Body Healthwatch Health and Wellbeing Chairs

Has the CCG(s) suitably sought and taken into account the views of patients and the public?

Yes

How often has the CCG applied for variation(s) of this kind before?

None

MEMBERS FORUM 2 OCTOBER- CONSTITUTION CHANGE REQUEST

The City and Hackney constitution undertook rigorous consultation in its development and therefore in order to make any changes, they must be agreed by NHSE, the CCG Board and most importantly by our members.

Members are asked to authorise the following recommendations that we reviewed and supported by the CCG Board on Friday 26th September;

CHANGE (1) – New Committees

In early 2014, the CCG Board delegated responsibility to two new committees in order to strengthen our governance arrangements – CCG Contracts Committee and Prioritisation and Investment Committee.

WHY?

With the CCG contracting more and more with our local GP practices and the new GP Confederation, it is important to manage conflicts and ensure we have appropriate membership within committees to focus on key areas.

• CCG Contracts Committee

• The committee has been established to review commissioned services where we are contracting with City and Hackney practices directly and/or through the local GP Confederation of City and Hackney practices.

• Responsible for service specifications, the contracting route and the basis payments are made to GPs and the GP confederation.

• Chaired by an Associate lay member and with representation from Healthwatch, our independent GP advisor and non GP Board members.

• Meets quarterly although may be required to meet virtually or ad-hoc depending upon requirements.

• Prioritisation and Investment Committee

• The committee has been established to undertake a thorough assessment of bids enabling scoring to support their prioritisation.

• Makes recommendations to the Board in respect to investment proposals • Chaired by a lay Board member and with representation from key

stakeholders, Board members including GPs. • Meets quarterly based on current requirements but could meet ad-hoc if

required.

The committees have previously met and the CCG Board has received helpful recommendations from both of them.

BENEFITS OF DOING THIS

Incorporates an improved governance framework within our constitution

CHANGE (2) – Associate Lay Members covering for voting Lay Members

Recognising the challenge of being quorate with only two voting CCG Board lay members, it is recommended that we allow either Associate lay member (Jaime Bishop or Honor Rhodes) to replace an absent voting CCG Board lay member.

WHY?

The Board requires at least one voting lay member to be present when making decisions. This change will allow associates lay members to cover an absent lay member. We will still only have two voting lay members at any one time.

Importantly, in the event of a conflict and the need for the PPI Chair lay member taking the role of Board Chair, in their absence, Associate lay members cannot take up the role of chair.

BENEFITS OF DOING THIS

We will have created increased coverage.

In restricting them to only being a voting member and not covering for the Chair in the event of conflict, our existing governance arrangements, ensuring the PPI Lay member Chairs, remain intact.

Karl Thompson

Head of Corporate Services

City and Hackney CCG

2nd October 2014

MEMBERS FORUM 8 JANUARY 2015

CONSTITUTION CHANGE REQUEST

The City and Hackney constitution undertook rigorous consultation in its development and sets out various matters detailing how it will discharge its responsibilities.

In order to make any changes, they must be agreed by NHSE, the CCG Board and most importantly by our members.

Members are asked to vote on the following;

Change

The following summarises the high level changes being made to the constitution;

• Flexibility incorporated to allow joint and delegated commissioning arrangements for primary care, including the option to take delegated responsibility from NHSE.

• Flexibility to appoint additional associate Board members to the CCG Board. o Introduction of an additional voting lay Board member to provide additional support

to committees. • The formation of the Primary Care Committee, originally set up as the Contracts Committee.

o As recommended, the CCG Board has delegated responsibility to this committee to make all decisions in respect of commissioning where GPs are providers (including where we are commissioning primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours service).

o As with the CCG Board currently, these decisions cannot be challenged by the members forum

o Meetings will be held in public with a lay membership bias as all non GP Board members will be PCC members.

• Amendments to our Conflicts of Interest guidance, taking into account recent NHSE advice in respect to the commissioning of primary care.

o Whilst minimal change has been made to the constitution, we have developed a new policy based on the NSHE template clearly defining the management of conflicts particularly in respect to commissioning where GPs are providers.

Members are reminded that the following changes agreed in October 2014 continue to support the desire to conduct business in an open and transparent manner.

• Prioritisation Committee formation and for meetings to be held in public • Associate lay members voting rights

The only amendment from October is the changes to the formation of the Contracts Committee as this now becomes the Primary Care Committee, with increased responsibility for primary care commissioning.

Why?

Primary Care Co-Commissioning requires us to review a number of processes and in particular we have needed to look closely at ensuring openness and transparency in the decision making of the CCG and our arrangements for managing conflicts of interest.

The changes adopted form part of our application for commissioning primary care and are required to strengthen our governance and decision making

Benefits of doing this

Whilst we will continue to be a clinically led organisation and ensure that we involve the opinions of our members and clinicians, commissioning decision making must reflect the need to be open and transparent and the avoidance of conflict.

The changes help to ensure we continue to work with our members in developing services for our patients whilst managing the increased complications of conflict

Karl Thompson



Constitutional change request

To: NHSE

Re: Primary Care Co-Commissioning

In order to strengthen our existing arrangement for the management of conflicts, particularly where GPs are providers, we have made a number of previous amendments and are further changing the constitution to again improve the openness and transparency of our decision making.

All of the changes are linked to the recent guidance provided by NHSE and have been highlighted in yellow in our constitution for ease of reference.

You will see that we had started to prepare for these changes last year and had originally consulted with our membership to amend the associate lay member responsibility and to formalise two new committees of the Governing Body – Prioritisation and Investment and Contracts Committee.

The Contracts Committee has now become the Primary Care Committee and the Prioritisation and Investment Committee is where we review new initiatives and service developments.

The following summarises the high level changes being made to the constitution;

• Flexibility incorporated to allow joint and delegated commissioning arrangements for primary care, including the option to take delegated responsibility from NHSE.

• Flexibility to appoint additional lay Board members to the CCG Board. o Introduction of an additional voting lay Board member to provide additional support

to committees, as we move some existing responsibilities and membership of Board members.

• The formation of the Primary Care Committee, originally set up as the Contracts Committee. o As recommended, the CCG Board has delegated responsibility to this committee to

make all decisions in respect of commissioning where GPs are providers (including where we are commissioning primary care services or services from the local GP Confederation or the GP Social Enterprise that provide GP Out of Hours service).

o As with the CCG Board currently, these decisions cannot be challenged by the members forum

o Meetings will be held in public with a lay membership bias. • Amendments to our Conflicts of Interest guidance, taking into account recent NHSE advice in

respect to the commissioning of primary care. o Whilst minimal change has been made to the constitution, we have developed a

new policy based on the NSHE template clearly defining the management of conflicts particularly in respect to commissioning where GPs are providers.

Some changes were agreed in October 2014 and so have the associated supporting documentation.

• Prioritisation Committee formation and for meetings to be held in public • Associate lay members voting rights

The only amendment from October is the changes to the formation of the Contracts Committee as this now becomes the Primary Care Committee, with increased responsibility for primary care commissioning.

The following are attached in support of our requested changes to the constitution;

• Summary notes from the members forum in October 14 and January 15 (agreement was given by our membership)

• NHSE checklist

Final agreement will be received from the CC Board 30th January 2015.

Karl

Karl Thompson

