Annual Report 2014-15 - North Somerset CCG · PDF fileAnnual Report 2014-15 North Somerset CCG Constitution ... North Somerset CCG website at: Self-Certiﬁ cation by the Accountable

Annual Report 2014-15

2014-15

Creating the healthiest community together

Annual Report

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Member Practices’ IntroductionNorth Somerset Clinical Commissioning Group (CCG) is a membership organisation. It has 25 member practices and serves a patient population of over 210,000 people. The area includes both urban and rural communities, spread over 140 square miles. Levels of deprivation in parts of North Somerset are amongst the highest in England.

In its second year of operation, North Somerset CCG has built upon the fi rm foundations that were laid following its formal establishment in April 2013 and is maturing as an organisation. In particular, North Somerset CCG has forged fi rm relationships with other organisations such as North Somerset Council, Healthwatch and neighbouring CCGs.

The challenges North Somerset CCG faced at formation - a diffi cult fi nancial position and disadvantageous funding stream - have not disappeared.

Nonetheless, through capable management and sound clinical leadership, the CCG has

Introduction driven change on many of the issues of substance which that our health community.

Clinicians or managers from almost one third of member practices continue to be active in leadership or constitutional bodies within the CCG, which continues to deliver on its reputation for making clinical leadership a reality.

The member practices take a keen interest in the CCG. Membership meetings continue to be very well supported, not just by GP representatives but also practice managers and doctors in training. Practices work proactively within their own locality groups with the aim of discussing and delivering specifi c services within North Somerset and to enhance joint working. Outside of the formal membership meetings, practice debate on the decision

Recognising the increased importance of technology in healthcare:• All North Somerset practices are now

using a common clinical system – EMIS Web – and it is being rolled out within our community services provider North Somerset Community Partnership (NSCP) which will support more collaborative and joined-up out-of-hospital care

• Looking to the future this system will create more opportunities for organisations to work together to provide effective patient care

• In October 2014, Map of Medicine software went live in North Somerset practices giving clinicians access to more than 280 locally customised pathways for the treatment of patients

• A telehealth pilot is being introduced to a number of residential homes in Weston to support the health of the residents and reduce unplanned and unnecessary hospital admissions.

Contents

Member Practices’ Introduction 1

Stategic Report 3

Members’ Report 22

Remuneration Report 28

Statement of the Accountable Offi cer 40

Governance Statement by the Chief Clinical Offi cer 41

Appendix 1 - North Somerset CCG Plan on a Page 52Appendix 2 - Sustainability Report 54Appendix 3 - Workforce Equality Report 55

Annual Accounts 64

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to apply for joint commissioning with NHS England was lively and considered. The application was ultimately supported by 80% of the membership in a formal vote and we hope that it will enable us to capture the benefi ts of greater GP infl uence over the wider NHS budget and to develop seamless, integrated out-of-hospital services and appropriate acute care based around the needs of our population.

The membership has long been concerned about our historic and ongoing underfunding, so welcomes the 2015-2016 fi nancial settlement that refl ects an acknowledgement of the need to fund additional monies into the North Somerset healthcare system.

Conscious that primary care is undergoing profound change, the members are beginning to explore options of working more collaboratively to deliver localised services. The CCG’s clinical leadership team has developed a strong vision for health services which, elaborated in the operational plan, refl ect some of the concerns of member practices and of our patients. Members remain concerned about the continued pressure on primary care services in North Somerset and about the ability of general practice to sustain current levels of activity whilst continuing to deliver excellent services. It is our continued expectation that the strategic developments being planned for health and social care will be accompanied by a shift of resources into primary and community services.

that the views of patients and the public are key to our success.

In 2014 we produced a two year operational plan 2014-16. We have refreshed 2015-16 version of this plan to refl ect developments since it was fi rst written, and to show how we will work towards the aspirations cited in the Five Year Forward View.

Our vision is:

“North Somerset – creating the healthiest community together”

We know that for people to be truly healthy it is not only the quality of healthcare services that matters. That is why we are committed to working together with our whole population, individuals and other organisations to create the healthiest communities. The diagram below

Strategic ReportNorth Somerset Clinical Commissioning Group is the organisation with responsibility for commissioning health services for the population of North Somerset (the same area covered by North Somerset Council).

We became a statutory organisation in 2013 following authorisation by NHS England.

We are led by the 25 GP practices in the area and these GP practices are supported by a team of other clinicians and managers. We are therefore a clinically-led organisation which puts the needs of the patient at the centre of everything we do. A Governing Body oversees the organisation to make sure that everything we do is appropriate and makes the best use of the resources available.

We are responsible for commissioning emergency and urgent care (including ambulance and GP ‘Out of Hours service’) community health services, hospital services, maternity and children’s services, mental health and learning disabilities services. Primary care services (GPs, dentists, pharmacists and opticians) and specialised hospital services are commissioned and managed by NHS England, the national NHS commissioning body.

We work closely with a wide range of stakeholders to develop and deliver our plans and believe

Life and Society in

North Somerset

Reducing inequalities

Community engagement, involvement

and leadership

Education

Employment

Health through wealth

Politics/ civic life

Vulnerable groups known

High impact families and individuals (supported)

Seamless person-centred

pathways/ networks

Integrated health and social care

Commerce

Sustainable provider networks

Flexible/ integrated deployment of

public resources across N Som

Physical environment

Life in North Somerset


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To achieve this we will:• Shift resources from services which

treat illness to those that prevent them wherever there is evidence to support this.

• Ensure that care is co-ordinated around individuals not organisations.

• Ensure that we have systems to identify those people and families who are most in need of additional support to reduce inequalities.

• Communicate with individuals and communities to ensure that their views infl uence every decision we take.

We work with patients and carers to educate, encourage and support them to stay healthy, promoting lifestyles to reduce the risks of ill health. We equip patients with the knowledge and tools they need to maintain and, if possible, improve their health. We pay just as much attention to people’s mental health needs as their physical health needs.

Our system is focussed around the needs of our population, and patients as individuals. For those who are at higher risk of illness or progression of illness, we understand their needs and develop care plans with them and their families so that they understand how to maintain quality of life, know the triggers to illness and what to do if their symptoms worsen suddenly or over time.

To achieve this we will:• Develop truly integrated health and

social care which links all our partners together to co-ordinate all the services that an individual person needs.

• Develop the model of primary care in a way that maintains high quality while enhancing its availability to those with needs it can cater for and while accommodating its functional integration with other services.

• Work with healthcare providers to reduce the number of times people need to travel to hospital for appointments.

When people need care urgently we do everything we can to provide what they need as close to home as possible. When patients require urgent or emergency care they know where to go and that fi rst point of contact is suffi ciently qualifi ed to be able to treat them, or direct them to the most appropriate tier of the system to assess, diagnose or treat.

To achieve this we will:• Develop a range of alternatives for

urgent care that provide easy access 24/7.• Develop our A&E services so that they can

meet the needs of the people that really need them.

When a patient is admitted for hospital-based care, the whole system works together to get them back home as soon as they are physically fi t enough with a plan for ongoing care. Those patients requiring rehabilitation and re-ablement services can access these close to home, with specialist advice and support to prevent further episodes of ill health.To achieve this we will:• Work with all the organisations who

provide care (including specialised services) to make sure that there is suffi cient capacity to meet the needs of individuals and that services communicate well.

• Review the numbers and types of beds available and ensure these meet the needs of the population.

shows the joined up system we are working towards.

As the system leader for local healthcare we have set out below how people will experience healthcare in North Somerset in fi ve years’ time. We have also included an overview of the things we are doing to achieve a clinically and fi nancially stable system.


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North Somerset CCG Constitution North Somerset CCG is bound by its constitution. This constitution sets out the CCG’s responsibilities for commissioning healthcare for the patients in North Somerset. It describes the governing principles, rules and procedures that North Somerset CCG has established to ensure probity and accountability in the day-to-day running; to ensure decisions are taken in an open and transparent way; and that the interests of patients and the public remain central to the goals of the group.

The constitution can be accessed from the North Somerset CCG website at: www.northsomersetccg.nhs.uk

Self-Certifi cation by the Accountable Offi cer “We certify that the Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended) except as disclosed”.

Licence Conditions of the CCG Details of the Licence Conditions of the CCG are available within the Governance Statements in this report.

Meeting our fi nancial obligationsThe Annual Report and Accounts have been prepared in accordance with the NHS Manual for Accounts as directed by the Secretary of State and NHS England Annual Reporting Guidance. The accounts have been prepared under a direction issued by the NHS Commissioning Board under the NHS Act 2006 (as amended).

As well as complying with relevant accounting standards, the CCG has a series of statutory fi nancial duties it must meet each year. Section 223H of the Health and Social Care Act 2012 sets out the duty for CCGs to break even on their commissioning budget for both revenue and capital individually. Additionally, the CCG is required not to exceed the maximum cash drawdown agreed with NHS England, which restricts the amount of cash drawings that the CCG can make in the fi nancial year. The CCG must also comply with the Better Payment

Practice Code which requires all CCGs to aim to pay all valid invoices by the due date, or within 30 days of receipt.

At the end of the 2014-15 fi nancial year, the CCG reported that it has not met its statutory fi nancial target to achieve a balanced fi nancial position. The CCG’s fi nancial opening plan for 2014-15 was for a revenue defi cit of £10m. Throughout the year the CCG has forecast delivery of this planned position.

The fi nancial statements are included in full in this report together with detailed notes.

The CCG has managed its business within the allocated cash resources available. The CCG is not a signatory to but aims to comply with the Confederation of British Industry prompt payment code. The code requires the CCG to:• Pay suppliers on time• Give clear guidance to suppliers• Encourage good practice.

In 2014-15 the CCG has met the Better Payment Performance standard which requires 95 percent of invoices to be paid within 30 days or contact terms. Details of compliance with the code are given in note 5 of the accounts.

The table below shows the summary fi nancial position; details are included in the fi nancial accounts.

Description £000Notifi ed Resource Limit 254,015

Administration CostsEmployee benefi ts 1,936Operating Costs 3,231

Programme CostsEmployee benefi ts 554Commissioned services (net of income)

258,264

(Under)/Over spend against resources

9,960

The CCG has developed a fi nancial recovery plan and strategic service plan which recognises the need for transformational reform of the health and social care economy over the next fi ve years. This plan describes recurrent fi nancial balance being achieved in year two and delivery of a surplus in year four. Throughout this period, the CCG expects to maintain a positive cash fl ow and meet the Better Payment Performance standard. On this basis the CCG considers it remains a going concern.

Nature, objectives and strategies of North Somerset CCG It is the role of the CCG to make decisions about what services our patients need, how we purchase them and work with patients and health and social care partners (e.g. local hospitals, local authorities, local community groups, etc.) to ensure services meet local needs and in helping to set the future priorities for healthcare in the area.

CCG Strategic Priorities:• Developing a model of care which is

clinically safe and sustainable• Achieving fi nancial sustainability• Improving health outcomes and reducing

inequalities.

CCG Purpose:• Ensuring an integrated health and social

care system for adults and children, driven by quality and innovation

• Commissioning healthcare for the patients of North Somerset which is cost effective and delivers health outcomes in line with the NHS Outcomes Framework

• Reducing health inequalities, working in partnership

• Giving people confi dence and skills to take care of themselves and stay as healthy as possible

• Improving patient care by ensuring there is easy access to shared information, which is up-to-date, meaningful and accurate

• Creating an environment which motivates member practices to be engaged commissioners and to deliver safe care, good patient experience and evidence based practice

• Being a successful dynamic organisation that

provides a rewarding place to work.

All 25 GP practices in North Somerset are members of the CCG and work together to assess what services are needed to meet the needs of the local population. These services cover a range of conditions including cancer, heart disease and mental illness as well as hospital operations.

The work of the CCG is led by a Governing Body, which includes managers, doctors and members of the public (called lay members), who give their views from a patient and public perspective. In common with NHS organisations across England and Wales, the CCG works closely with a variety of partners on the People and Communities Board of North Somerset Council (which acts as the Health and Wellbeing Board) and various voluntary groups.

The North Somerset mid-year estimate is for 2013 when the population was 206,135 (ONS, 2013). This is a 0.86% increase from the 2012 estimate of 204,385, which is lower than the GP registered population. The most recent GP registered population in 2014 for residents in North Somerset (regardless of where they are registered with a GP) was 214,923.

North Somerset has a high proportion of people over the age of 65, at a rate of 1 in 5, which is higher than the average for England of 1 in 6 (ONS, 2013). This is highlighted in the population pyramid over (Figure 1)


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Figure 1: Population breakdown by sex for North Somerset and England, 2013

and shows particularly high numbers of males and females in the 65-69 age category. There are 6,708 people aged over 85 in North Somerset (3.25%), which is, again, higher than the England fi gure (2.3%). The population of over 65s in North Somerset has grown by 22% since 2001 (2.2% annually), for those aged over 85 years, there has been an increase of 24% in the last 12 years (2.4% per annum).

There is an even split in North Somerset between males and females; 100,227 (49%) and 105,908 (51%) respectively (ONS, 2013). The population of North Somerset is less ethnically diverse than England and Wales with 197,076 (97%) of people living in North Somerset classifying themselves as belonging to a white ethnic group (including White Irish and Other White ethnic groups). Of those classifi ed as Black or Ethnic Minority Group, 44% were Asian and 37% were mixed race (Census, 2011).

According to the 2011 Census, there were 88,227 households in North Somerset; of which 45% were couples; 31% were one

The 2011 Census records disability as whether or not activity is limited. For North Somerset, the following information is provided:• Activity limited a lot – 17,335 (8.6%)• Activity limited a little – 21,405 (10.6%)• Activity not limited – 163,826 (80.9%).

In North Somerset the birth rate was recorded as 2,214 live births in 2013; 1,138 males and 1,076 females, with a crude birth rate of 10.7 births per 1,000 population. This is similar to the rate for the South West (10.9) and lower than the England rate of 12.3 births per 1,000 population (ONS, 2013). Figures also record a general fertility rate of 64.0% (this rate is calculated from the number of live births per 1000 women aged between 15 and 44).

Population growth predictions North Somerset faces signifi cant demographic pressures with a population which is both ageing and growing. Longer term projections suggest the population of North Somerset is set to increase, from an estimated 210,000 in 2015 to 250,000 in 2035, with a particular increase in the over 65 age group (Figure 3).

Between 2015 and 2035 in North Somerset it is projected that there will be per annum growth of 1.5% across all age groups. The largest increase will be in the 90+ age group (8.4% per annum), followed by the 85-89 age group (6.3% per annum). However, the longer the projected time horizon the more inaccurate the modelling is expected to be, so this should only be used as an indicator.

Development and performance of the CCG for 2014-15The CCG has adopted an integrated approach to performance reporting that includes quality, service performance and fi nancial performance elements. This includes regular, structured integrated performance management meetings with key providers as well integrated reports to the Membership, Clinical Leadership Group and Governing Body.In 2014-15 the North Somerset health community has:• Delivered waiting times improvements and

compliance with NHS Constitution standards at Weston Hospital

Original Re-profile Actual

350

300

250

200

150

100

50

0

01-O

ct-14

01-N

ov-1

401

-Dec

-14

01-Ja

n-15

01-Fe

b-15

01-M

ar-1

501

-Apr-1

501

-May

-1

501

-Jun-1

501

-Jul-1

501

-Aug-1

501

-Sep-1

501

-Oct-

1501

-Nov-1

501

-Dec

-15

01-Ja

n-16

01-Fe

b-15

NBT Spinal Trajectory graph

• Successfully invested additional winter monies in a broad range of hospital and out of hospital schemes

• Implemented new services to support transformation including community based admissions avoidance and community geriatric service

• Agreed the Better Care Fund plan that will support improvements in care for our patients through better integrated health and social care

• Worked with partners to support the opening of the new Southmead Hospital and work with the lead commissioner to strengthen performance in areas of concern.

During 2014-15 the CCG has been working with providers to deliver improvements in some services where we are not meeting NHS Constitution standard performance, in particular:• Long Waiting Times: plans are in place to

reduce the long waiting times for spinal services at NBT which should deliver the recovery of the waiting times position by 31 November 2015.

North Somerset Female North Somerset Male England Male England Female

g y g

85-8475-79

70-7465-6960-64

55-59

50-5445-49

40-4435-39

30-3425-29

20-2415-1910-14

5-90-4

85+

8% 7% 6% 5% 4% 3% 2% 1% 0% 1% 2% 3% 4% 5% 6% 7% 8% Source: ONS 2013 Mid Year Estimates

person households; 11% were all pensioners over the age of 65; nine percent were lone parents and fi ve percent were in other types of households (Figure 2). Household composition is determined by people who live together and their relationships to one another (Census, 2011).

Couple44%

One person31%

All aged over 65

11%

Lone parent 9%

Other 5%

Figure 2: Household composition in North Somerset, 2011


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IndicatorTarget 2013/14

Q12014/15

Q22014/15

Q32014/15

Q42014/15 2014/15 DoT

Value Value Value Value Value ValueCancer 2 Week Wait - All

93.0% 95.2% 95.4% 96.1% 96.1% 95.4% 95.8%

Cancer 31 Day fi rst treatment

96.0% 97.4% 96.3% 95.0% 96.9% 97.9% 96.4%

Cancer 62 day referral to fi rst treatment - GP referral

85.0% 82.6% 82.5% 74.9% 89.4% 78.5% 81.5%

• Mental Health Improved Access to Pyschological Therapies IAPT (below): a change to internal management of

• Diagnostic 6 Week Wait: Weston Hospital is now consistently meeting the diagnostic six week wait and additional resources are being investigated externally to

Indicator2013/14 2013/14 2014/15

Q12014/15

Q22014/15

Q32014/15

Q42014/15 2014/15 DoT

Target Value Target Value Value Value Value ValueMental Health Measure - Improved Access to Psychological Services (IAPT)

10.9% 9.2% 12.7% 8.9% 8.6% 10.0% N/A 9.2%

• Cancer Waiting Times (below): target is expected to achieve by the end of 2014/15 with continued monitoring in place with

a focus on obtaining CCG specifi c referral data, against overall provider achievement.

referrals to mental health IAPT services is being implemented from 1 April 2015.

manage poor performance due to change in delivery of services at NBT and shortfall of echocardiogram trained staff, with full recovery expected by September 2015.

• SWASFT below-target ambulance response times: the CCG has agreed to develop a new approach to measuring response times performance across rural areas which enables a realistic trajectory

IndicatorTarget

2013/14Q1

2014/15Q2

2014/15Q3

2014/15Q4

2014/15 2014/15 DoTValue Value Value Value Value Value

Ambulance - Category A - 19 minute transportation time

95.0% 94.9% 95.1% 94.2% 91.8% 91.7% 93.3%

Ambulance - Category A (Red 2) - 8 minute response

75.0% 72.3% 70.1% 72.7% 67.3% 64.0% 68.8%

Ambulance - Category A (Red 1) - 8 minute response

75.0% 69.9% 65.2% 72.0% 70.2% 66.7% 68.8%

• Urgent Care: the CCG is working in close partnership with co-commissioners and providers to understand and better manage system fl ow including activity in A&E

IndicatorTarget

2013/14Q1

2014/15Q2

2014/15Q3

2014/15Q4

2014/15 2014/15 DoTValue Value Value Value Value Value

RTT: Admitted (Adjusted) 18 weeks

90.0% 92.6% 91.0% 86.3% 86.0% 84.2% 87.0%

RTT: Non-admitted 18 weeks

95.0% 94.8% 94.7% 93.8% 93.0% 93.1% 93.7%

RTT: Incomplete Pathways 18 weeks

92.0% 91.8% 91.1% 90.6% 89.2% 90.2% 90.2%

Further information regarding North Somerset Performance can be found within the Governing Body minutes on the CCG website: https://www.northsomersetccg.nhs.uk/

for improvement to be implemented, whilst the trust has acknowledged staff vacancies as a contributing factor to poor delivery of service and a key performance issue.

Areas of challenging performance:

departments and non-elective admissions, including daily system conference calls, data capture and monitoring and clear escalation arrangements.

• Elective Surgery Waiting Times: additional activity will be needed in 2015-16 in both Bristol acute providers in order to meet

the 18 week referral-to-treatment standard and additional expenditure is included in the fi nancial plan.


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Looking Forward Leaders of the NHS in England have published planning guidance for the NHS, setting out the steps to be taken during 2015/16 to start delivering the NHS Five Year Forward View.

In 2014, NHS England, Monitor, the NHS Trust Development Authority, the Care Quality Commission, Public Health England and Health Education England came together to issue the joint guidance called The Forward View into action: planning for 2015/16, coordinating and establishing a fi rm foundation for longer term transformation of the NHS.

Prior to this release, NHS England published Everyone Counts: Planning for Patients 2014/15 to 2018/19. This set out the requirement for CCGs to produce a Five Year Strategic Plan with the fi rst two years giving operational detail. The requirement remains to ensure that we achieve the requirements of the NHS Mandate:• We want to prevent people from dying

prematurely, with an increase in life expectancy for all sections of society

• We want to make sure that those people with long-term conditions, including those with mental illness, get the best quality of life

• We want to ensure that patients are able to recover quickly and successfully from

episodes of ill-health or following an injury• We want to ensure that patients have a

great experience of all their care• We want to ensure that patients in our

care are kept safe and protected from all avoidable harm.

The guidance further sets out how these improvements in care are to be measured:• Securing additional years of life for the

people with treatable mental and physical health conditions

• Improving the health related quality of life of the people with one or more long-term condition, including mental health conditions

• Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital

• Increasing the proportion of older people living independently at home following discharge from hospital

• Increasing the number of people having a positive experience of hospital care

• Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community

• Making signifi cant progress towards eliminating avoidable deaths in our hospitals caused by problems in care.

Two Year Operational PlanTo deliver our vision and create a sustainable health and care system for North Somerset, we will need to continue to implement signifi cant changes to the way care is delivered. We are confi dent that our priorities from our two year operational plan, refreshed for 2015/16, will address both the fi nancial challenge we face and make signifi cant progress towards the delivery of our strategic vision. We will continue to review our systems and processes to ensure that we are delivering the ‘day job’ as effi ciently as possible through:• Robust and effective management of

contracts – including coding and counting challenges

• Performance and delivery monitoring for

quality, fi nance and activity• Root cause analysis of areas for

improvement• Driving system productivity and effi ciency.

Quality, Innovation, Productivity and Prevention (QIPP)The CCG has developed a range of QIPP schemes within its operational plan. Those deemed to be material are as follows:• Referral Management Package• Orthopaedics• Ophthalmology• Integrated Care• Specialist Older People• Admission Prevention Team• Support to Care Homes• Coordinating Support in Primary Care• Ambulatory Emergency Care• Medicines Management.

Winter resource and capacity planning Meeting the challenges of the futureIn 2014, the North Somerset health and social system was awarded £1.3m by NHS England to improve healthcare and health outcomes for patients in the area during the winter period.

North Somerset CCG, working with Weston Area Health NHS Trust, North Somerset Council and North Somerset Community Partnership and other key partners, co-ordinated the distribution of the additional funds. The progress of the schemes funded, was overseen by North Somerset Urgent Care Clinical Network (CCG chaired multi-provider network) with a particular focus on the delivery of the four-hour Emergency Department performance target at Weston Area Health NHS Trust.

North Somerset CCG also commissioned a communications campaign to support the delivery of the winter plan (opposite). The campaign linked closely with the approach for Bristol and South Gloucestershire. The key aims of the campaign included improving the knowledge amongst the general public of the alternatives to A&E, whilst also improving the awareness of the scope of primary care amongst our diverse population.

Meeting the challenges of the futureNorth Somerset CCG has a clear and articulated strategy for improving the health and wellbeing of its population.

Strategic documents can often be complex and diffi cult to understand and so North Somerset CCG has created a Plan on a Page. This plan collects together all of the top-level aims, aspirations and objectives for the CCG.

The Plan on a Page appears as Appendix 1.

Financial challenge The CCG is accountable for more than £250m of NHS spending, more than half of which is acute spending. Nearly 90% of acute spend is with local acute providers i.e. Western Area Health NHS Trust, University Hospitals Bristol NHS Foundation Trust and North Bristol NHS Trust.

The CCG has been notifi ed of its revenue allocation for the next two years and planning assumptions for the period after. By 2015/16 the CCG will receive a 7.25% increase in funding which amounts to a cash increase of £17.2m.

Although this increase is 2.6% above the national average for all CCGs, the CCG expects


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Foundation Trust, the Berwick Report into patient safety and the Keogh Review into acute hospital care.

We have considered each of these reports and fully endorse the degree of ambition and challenge that they represent for commissioners, as well as providers, of care. We are committed to driving up the quality of care including the experience of patients and carers.

We have worked in partnership with clinicians, patients, carers and their representatives to develop key priorities and ideas for improvement which apply to every service, care home or nursing home and every GP surgery from which we commission services. The values and ambitions outlined here are the entitlement of all North Somerset residents regardless of age, stage of life or condition.

Changing the way care is delivered In order to meet the challenges we are faced with, the CCG needs to develop a new, high quality and sustainable health and care system. NHS England has set out the characteristics of this system:• A completely new approach to ensuring that

citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care

• Wider primary care, provided at scale • A modern model of integrated care • Access to the highest quality urgent and

emergency care• A step-change in the productivity of elective

The CCG has developed plans for quality under eight key headings:1. Helping people to stay independent,

maximising well-being and improving health outcomes

2. Working with people to provide a positive experience of care

3. Delivering safe, high quality care and measuring impact

4. Building and strengthening leadership5. Ensuring we have the right staff, with the

right skills, in the right place6. Supporting positive staff experience7. Safeguarding of children and adults8. Seven-day working.

care• Specialised services concentrated in centres

of excellence.

North Somerset CCG has prepared its Five Year Plan which outlines our strategy for creating and maintaining the best possible healthcare system for the patients and the public of North Somerset.

The plan can be found on the North Somerset CCG website at: www.northsomersetccg.nhs.uk.

Resources, principal risks and uncertainties and relationships North Somerset CCG’s Risk Management Strategy describes key features of the risk and control framework, including the ways in which risk is identifi ed, evaluated and controlled. A risk management matrix is used to support a consistent approach to assessing and responding to risk and incidents. The management of risk is a key organisational responsibility. The Governing Body is responsible for the CCG’s risk management and control framework but with operational responsibility for effective risk management delegated to the Chief Operating Offi cer.

The Clinical Commissioning Leadership Group provides assurance on risk management and controls to the Governing Body.

The Chief Operating Offi cer is responsible for risk management and accountable for having in place an effective system of risk management and internal control. The Chief Operating Offi cer is required to have an ability to understand the CCG’s risk environment, including knowledge and understanding of the strategies that have been adapted by the CCG and the risks inherent in any transformation strategies. The Risk Management Strategy sets out the individual roles and responsibilities of the Chair of the Governing Body, other offi cers and staff. The Corporate Risk Register enables the Governing Body to understand the CCG’s risk profi le. The Corporate Risk Register is used to manage high level risks facing the CCG

from both strategic and operational risks. The threshold for risk agreed by the Governing Body, and set out in the Risk Management Strategy, is as a minimum, all risks assessed as 12 or above using the risk management matrix, are recorded and reported on the Corporate Risk Register.

The Governing Body Assurance Framework identifi es where there are risks to the CCG’s principal objectives, the controls in place to mitigate those risks and the assurances available to the Governing Body that risks are being managed. The Governing Body Assurance Framework also indicates where there are potential gaps in controls and assurances and provides a summary of the actions in place to resolve these gaps.

The CCG has submitted its application for Joint Commissioning in relation to Primary Care-Co-Commissioning. Decision making will be via a Joint Commissioning Committee. The committee will include representatives from Healthwatch and the Local Health and Wellbeing Board as non-voting attendees as well as North Somerset Council and primary care. A full assessment of risks will be undertaken following confi rmation of the application and incorporated into existing systems.

to still be under the ‘fair shares’ allocation determined by the national allocation formula, by some 4.7% (equivalent to £12.4m). As a result of this, North Somerset CCG will continue to be one of the lowest funded CCGs nationally and North Somerset Council remains one of the lowest funded authorities.

The CCG has prepared a fi nancial recovery plan which demonstrates that North Somerset CCG has made substantial progress to improve the underlying recurrent fi nancial position.

At the same time the CCG has established an ambitious and challenging programme of work for the Quality, Innovation, Productivity and Prevention (QIPP) agenda. Our work to deliver real changes in the way that patients access healthcare is linked, not just to fi nancial savings and effi ciency, but also to improved outcomes and better, safer services.

The CCG has strong relationships with key stakeholders across our community and it is through developing already established pathways; for example, our integrated health and social care services and community-based interface services, that we will help to secure sustainable and affordable services for the future.

In order to secure the scale of savings needed in the fi nancial plan, the North Somerset health community will need to undertake signifi cant transformation of services over the next fi ve years. Some of the mechanisms for this are already in place, for example, we see the Better Care Fund as an enabler for improving urgent care. In addition we are currently in procurement for community services provision from April 2016 and we have a central role in developing the service model for Weston Hospital after acquisition. However more will need to be done including how we respond to the challenges in the Five Year Forward View.

Improving quality across North Somerset The publication of a series of major reports brought the issues of quality and patient experience into focus. These reports included the publication of the second Francis Report into the events at Mid Staffordshire NHS


16 17


In support of the Risk Management Strategy, the CCG has adopted policies that describe our Standards of Business Conduct. We have also agreed Standing Financial Instructions, a critical part of our system of internal fi nancial control.

The Governing Body monitors the achievement of its objectives and management of associated risks through its reporting cycle. This includes the Integrated Performance Report, the Assurance Framework and the Corporate Risk Register.

Details of CCG premises North Somerset CCG’s head offi ce is at Castlewood in Clevedon. The building is shared with North Somerset Council, North Somerset Community Partnership and a number of other organisations.

All staff are based at Castlewood and the CCG has no additional premises.

North Somerset CCG – working with our partners

“NHS North Somerset Clinical Commissioning Group is committed to ensuring engagement and involvement of patients and public at all levels of commissioning.”

North Somerset CCG Constitution, 2013

North Somerset CCG has a range of partners with which it works to provide health services across the area. This section contains details of some of the partners who work with North Somerset CCG.

Working with hospital trusts Weston Area Health NHS Trust (WAHT) is the provider of acute trust services at Weston General Hospital. In addition to this, many of our residents access acute services at University Hospitals Bristol NHS Foundation Trust and North Bristol NHS Trust. Mental health services are provided by Avon and Wiltshire Partnership NHS Trust.

We commission services from our acute trust partners, with detailed contracts helping us monitor performance and take action when there is under-performance. Every month our Governing Body meeting, held in public, receives a comprehensive range of performance information from all of our acute trust partners.

Community providers North Somerset Community Partnership (NSCP) is the current provider of community health services and provides NHS services including district nursing, children’s community nursing, therapy services and other specialist services supporting people in their own homes. It is made up of a staff body of more than 600 healthcare support professionals who provide community healthcare services to the population of North Somerset.

The CCG is undertaking a procurement exercise for delivery of community services to North Somerset from April 2016. This process is expected to conclude with the award of a contract for a minimum period of fi ve years in the summer of 2015.

The CCG has submitted and had approved an application for joint commissioning of primary care. Under this model, decisions about primary care services will be made by a Joint Commissioning Committee. The committee will include representatives from Healthwatch and the Local Health and Wellbeing Board as non-voting attendees, as well as NHS England, North Somerset Council and primary care.

Commissioning support A variety of commissioning support services are provided by South, Central and West Commissioning Support Unit (SCWCSU),

formerly known as South West Commissioning Support (SWCS). SCWCSU supports the CCG in a number of areas including contract management, business intelligence, service redesign, performance management, HR and communications. Many members of the CSU share the offi ce space with the CCG at Castlewood. This ensures the two organisations work closely together, which is essential in commissioning services.

The CCG’s contract with SCWCSU is regularly monitored, with monthly meetings measuring and recording performance against key targets and deliverables and addressing any areas of under performance.

North Somerset Health Overview Scrutiny Panel North Somerset CCG has a well established relationship with the North Somerset Health Overview Scrutiny Panel (HOSP). CCG offi cers attend the HOSP meetings and also attend agenda-setting meetings. The HOSP has a detailed work plan which requests workshops and seminars from clinical leaders and commissioners on a range of health and care focussed topics.

HOSP councillors, as well as councillors from the wider council, are invited to a North Somerset CCG membership meeting once a year to share information and gain a greater understanding of each other’s roles in the local community. This partnership working will be continued and developed.

Healthwatch North SomersetHealthwatch North Somerset promotes and supports the involvement of local people in

the commissioning, provision and scrutiny of local health and social care services. It obtains the views and experiences of local people, monitoring services, identifying trends and providing intelligence to infl uence the quality of care.

Healthwatch North Somerset recommends changes to health and social care services that they know will benefi t people and holds those services and decision makers to account. As a statutory watchdog, the role of Healthwatch North Somerset is to ensure that health and social care services put people at the heart of their care. North Somerset CCG triangulates the information fed back from Healthwatch North Somerset with other sources of feedback, to help improve our commissioning plans and decisions.

Healthwatch North Somerset has a forum of volunteers who support their work and a health group whose role is to assist Healthwatch North Somerset to bring the voice and experiences of patients, service users, carers and families to inform the Healthwatch North Somerset’s work plan. The CCG also has a non-voting, advisory seat on the Healthwatch North Somerset Board of Directors.

Healthwatch North Somerset works closely with a number of established health and care focussed engagement groups which have been active in the North Somerset community for some years. These include, the North Somerset:• Older People’s Champions Group• Carers Partnership Group• Learning Disability Partnership Group.

North Somerset CCG wishes to continue to support the development of Healthwatch and is developing a protocol for recruiting lay people for the participation work that will be needed to support delivery of North Somerset CCG’s on-going medium and long-term strategies.

As a further support to participation locally, North Somerset CCG has service level agreements in place with the Black and Minority Ethnic Network and Voluntary Action North Somerset. Additionally, funding is also provided to support a North Somerset based Mental Health Service User Network. Weston General Hospital

Clevedon Hospital


18 19


Public, patient and carer voices at the centre of healthcare servicesAt a strategic and wider health and care community level, the North Somerset Partnership’s People and Communities Board (which includes the Health and Wellbeing Board) has agreed a joint approach to co-production. North Somerset CCG and local authority engagement leads have developed, and are currently implementing, a co-production framework. The framework details principles and practice for engaging and involving patients, service users, carers and the public, as early as possible within commissioning intervention and project design. It is important that this is both appropriate and proportionate to the scale of the work and that co-production working is implemented at all stages of the commissioning cycle.

There is strong North Somerset CCG representation on a number of sub-committees of the People and Communities Board; for example, on the Strengthening Communities Board and the Joint Commissioning Board. This is mirrored by strong representation from Healthwatch North Somerset and from Voluntary Action North Somerset (VANS), which is the local infrastructure organisation for the voluntary, community and social enterprise (VCSE) sector in North Somerset. This ensures that lay and VCSE voices from the wider community are both included and are infl uential, at strategic as well as operational levels of activity both from the whole community and within partnership working.

There are a number of local participation structures, mechanisms and tools that will be further developed and enhanced over the

life span of our strategic plan to ensure that we become more inclusive and work more smartly to achieve deeper and wider levels of participation than we have achieved to date.

Sustainability report North Somerset CCG is committed to improving patient outcomes through commissioning high-quality healthcare that is delivered in a sustainable and environmentally conscious way.

We have a strong sense of environmental sustainability and organisational leadership and have continued this throughout our work.

We share a building with North Somerset Council. The council has taken great steps to create a sustainable working environment, with the building featuring many examples of green solutions, including energy effi cient heating and ventilation systems.

The way we commission services provides the CCG with an excellent opportunity to work with our suppliers in creating sustainable solutions to challenges.

North Bristol NHS Trust and University Hospitals Bristol NHS Foundation Trust have green plans which commit to reducing the carbon footprint of its employees and buildings. The savings have been further enhanced with the opening of the new Southmead Hospital in May 2014.

South, Central and West Commissioning Support Unit, the CCG’s provider of support services supplier, has a clearly articulated sustainability plan which includes a commitment to reduce the carbon footprint of its employees and to deliver its services in a sustainable way.

North Somerset Council, a key partner in delivering our services, has a sustainability coordinator who manages its environmental impact.

North Somerset CCG encourages its staff to behave sustainably. As with other NHS organisations the CCG pays mileage for cyclists who choose to use their bike instead of their car.

In the CCG’s third full year, we hope to be able to further its sustainability work, and engage with key partners and stakeholders, in creating a more sustainable healthcare system in North Somerset.

A Sustainability Report appears as Appendix 2.

Equality Report As a commissioner of health services and an employer, North Somerset CCG is committed to eliminating discrimination, advancing equality of opportunity and fostering good relationships between all sections of our community.

In accordance with the Equality Act 2010, we do not discriminate on the grounds of age, disability, marital status, race, religion or belief, pregnancy or maternity, sexual orientation or gender re-assignment.

The Public Sector Equality Duty (PSED) is a duty placed on public authorities (such as North Somerset CCG) by the Equality Act 2010. Part of this is a general duty which requires the CCG, in carrying out its functions, to pay due regard to the need to:• eliminate unlawful discrimination,

harassment, victimisation, etc.• advance equality of opportunity• foster good relations between different

groups of people (“protected groups”).

The specifi c duty requires us to publish information to demonstrate our compliance with the general duty. As such, we have redesigned several CCG web pages to enable publication of several documents which outline North Somerset CCG’s approach to equality and diversity, as well as our progress to date. These include:• Equality Diversity and Human Rights

Strategy• Voices for Healthcare Strategy • Equality Information report 2014• Workforce Equality Monitoring Report 2013-

2014• Equality Delivery System (EDS2) performance

assessment• Equality Impact Assessments (e.g. on our

refreshed Organisational Change Policy).

We have also reaffi rmed our equality objectives to: • Improve our equalities data and intelligence • Develop an equality assurance process,

enabling us to hold providers to account over their own equality performance

• Improve awareness of NHS services, in particular amongst disabled people, those from minority ethnic backgrounds and from lesbian, gay, bisexual and transgender (LGBT) communities

• Support greater knowledge and understanding of equality, diversity and human rights among our GP member practices.

Workforce and internal governance arrangementsWe have further developed our systems and procedures which help us to comply with the Equality Act and the PSED. These now include:I. Two staff representatives, delivering a confi dential service to their colleagues via a dedicated email inbox. The staff representatives offer drop-in surgeries to discuss new policies which may have an impact on their working lives.II. The Quality Assurance Group (sub-committee of the Governing Body) which has delegated powers to approve policies and plays a role in ensuring legal compliance and encouraging best practice.III. An Equality Delivery Group, comprising senior managers from our key functional areas, which supports the CCG to achieve legal compliance and best practice. The group’s work is described in an action plan which supports delivery of the Equality, Diversity and Human Rights Strategy.IV. Implementing the NHS Equality Delivery System (EDS2) to assess our equality-related performance. This work involves working in partnership with Healthwatch and with other commissioners and providers across the Bristol, North Somerset and South Gloucestershire “NHS cluster”. Together, we recruited and trained an equality expert group of volunteers to help scrutinise performance against the national EDS2 outcomes. The North Somerset CCG was the fi rst in our cluster to implement EDS2 and, in 2014, we achieved a “developing” grade (amber).


https://www.northsomersetccg.nhs.uk/about-us/edhr/equality-and-diversity/

https://www.northsomersetccg.nhs.uk/media/medialibrary/2015/01/eds2_performance_assessment.pdf

20 21


V. Publishing our Equality Information Statement for 2014 to demonstrate how we are complying with the public sector equality duty. We will continue to publish such statements annually, along with our Workforce Equality Monitoring Report.

As a comparatively small organisation without the critical mass to sustain our own staff networks, the CCG encourages staff to join any appropriate staff equality network in the Bristol, North Somerset and South Gloucestershire area, such as Black and Minority Ethnic, disability and lesbian, gay and bisexual and transgender staff networks.

Patients and the PublicWe continue to promote and support the use of Equality Impact Assessments to ensure that our main activities pay due regard to the general duty. We have published assessments on the commissioning of future services at Clevedon Community Hospital, the procurement of Community Health Services and Specialist Children’s Community Services, and on our refreshed Safeguarding Vulnerable Adults Policy.

We also require our commissioned providers to deliver equitable services and to comply with the Equality Act 2010, the public sector Equality Duty and the equality-related provisions of the NHS standard contract. To improve our understanding of their performance, we have developed a methodology for asking providers for evidence that key information is published in an accessible way or is otherwise submitted to the commissioner for review.

North Somerset CCG works proactively to engage with community interest groups representing a range of protected characteristics. For example, we regularly engage with the North Somerset BME Network, the Older People’s Champions Group and Senior Community Links, the Disability Access Group, the Physical and Sensory Impairment Group, the Learning Disability Partnership, children and young People’s groups, parents groups and the North Somerset Lesbian, Gay, Bisexual and Transgender Group. We seek to develop these

relationships further through delivery of our Voices for Healthcare Strategy.

People who have worse outcomesNational data demonstrates that outcomes are poor for those with mental health problems, learning disabilities and certain minority ethnic communities, such as Gypsies and Travellers.

People living in poorer areas have worse health outcomes than those in more affl uent areas. North Somerset has areas in both the most and least deprived one percent of Lower Super Output Areas nationally. North Somerset ranks seventh in the country for the largest inequality gap in terms of range in deprivation scores between areas.

The health needs of the local population are assessed as part of the Joint Strategic Needs Assessment (JSNA). We use its fi ndings and recommendations to inform our priorities for commissioning.

Recently, our JSNA has focused on local health issues such as child poverty, alcohol misuse, adult drug misuse, coronary heart disease, the frail older population, suicide, the Gypsy and Traveller population, cancer, COPD, obesity and weight management. Since the leading contributor to disability in North Somerset is mental health and mental disorders, we have also looked closely at mental health in adults and older people and at children’s emotional health and wellbeing.

In 2014, North Somerset Council published a public mental health strategy to co-ordinate partnership working, with a clear focus on prevention. This complements action we are already undertaking to address known issues through the people and communities strategy for North Somerset; improving secondary mental health services, reducing the risk of suicide in key high risk groups, and improving dementia services. The CCG is also a signatory to the Crisis Care Concordat declaration and action plan, which aim to improve the local response to vulnerable people in mental health crisis.

A full copy of our Workforce Equalities Report appears in Appendix 3.


https://www.northsomersetccg.nhs.uk/media/medialibrary/2015/01/nsccg_equality_information.pdf

https://www.northsomersetccg.nhs.uk/library/equality-diversity-and-human-rights-strategies-equ/

22 23


Details of Members of the Membership Body and Governing Body Details of member practices are included on the North Somerset CCG Website at: www.northsomersetccg.nhs.uk

There are 25 GP practices in North Somerset, which are all members of the CCG. Each practice has a clinical representative for clinical commissioning and the clinical lead attends a monthly membership forum meeting.

The North Somerset CCG Governing Body provides leadership and guidance for the CCG as well as providing the formal control and expertise in administering the work of the CCG.

Members’ reportIn this section you will fi nd details of all current and previous members of the North Somerset CCG Governing Body.

There is also a clinical leadership group which engages with all of the member GP practices. The CCG’s Constitution is a good source of further information on the leadership of the organisation. The CCG website provides further details about the Governing Body and Leadership Group members.

Name Title Start and fi nish datesDr Mary Backhouse Chief Clinical Offi cer 1/4/2013Kathy Headdon Chair (Lay Member) 1/4/2013Jeanette George Chief Operating Offi cer 1/4/2013

on secondment: 23/6/2014 - 22/2/2015

Ginny Snaith Interim Chief Operating Offi cer 23/6/2014 - 22/2/2015Mike Vaughton Chief Financial Offi cer 1/4/2013Graham Nix Lay Member (Chair of Audit and

Remuneration Committees)1/4/2013

Liam Williams Interim Chief Nursing Offi cer (registered nurse)

1/4/2013 - 19/3/2015

Jacqui Chidgey-Clark Chief Nursing Offi cer (registered nurse)

16/3/2015

Kath Payne Practice Manager Representative 1/4/2013Dr Stephen Pill GP Membership Representative 1/4/2013Phil Kirby Local Medical Committee

Management Representative1/4/2013

Andrew Clarke Secondary Care Clinician 1/4/2013 - 16/1/2015Dr Miriam Ainsworth GP Representative from clinical

leaders1/4/2013

North Somerset CCG Governing Body Members

Name Title Start and fi nish datesDr Mary Backhouse Chief Clinical Offi cer 1/4/2013Dr John Heather Clinical Leader 1/4/2013Dr Kevin Haggerty Clinical Leader 1/4/2013 Dr Jeremy Maynard Clinical Leader 1/4/2013Dr Miriam Ainsworth Clinical Leader 1/4/2013Dr Mark O’Connor Clinical Leader 1/4/2013 - 30/4/2014Dr Mike Jenkins Clinical Leader 30/7/2014Dr Tony Ryan Clinical Leader 1/4/2013Sheila Smith Director of People and Communities,

North Somerset Council1/4/2013

Dr Becky Pollard Director of Public Health, North Somerset Council

1/4/2013 - 30/2/2015

Georgie Bigg North Somerset Healthwatch 1/4/2013 Julie Kell Head of Joint Commissioning 1/4/2013Debbie Campbell Head of Medicines Management 1/4/2013Jeanette George Chief Operating Offi cer 1/4/2013 on secondment:

23/6/2014 - 22/2/2015Liam Williams Chief Nursing Offi cer

(registered nurse)1/4/2013 - 19/3/2015

Jacqui Chidgey-Clark Chief Nursing Offi cer(registered nurse)

16/3/2015

Mike Vaughton Chief Finance Offi cer 1/4/2013

Jennifer Norman Head of Planning and Business Support

28/10/2013

North Somerset CCG Clinical Leadership Group Members

The North Somerset CCG Audit Committee is an operating committee of the Governing Body and provides assurance on organisation wide controls, governance arrangements and is responsible for the oversight of fi nancial reporting and disclosure. The purpose of the Audit Committee is to assist North Somerset CCG to deliver its responsibilities for the conduct of public business, and the stewardship of funds under its control.

Name TitleStart and fi nish dates

Ryan Richards

Associate Lay Member

1/8/2013

Stephen Pill GP Member of Governing Body

1/4/2013

Kath Payne Practice Manager Representative

1/4/2013 - 31/7/2013

Graham Nix Lay Member (Chair of Audit and Remuneration Committies)

01/04/2013

Audit Committee


https://www.northsomersetccg.nhs.uk/library/ccg-information/

24 25


Remuneration CommitteeThe Remuneration Committee is accountable to the group’s Governing Body and makes recommendations to the Governing Body on determinations about pay and remuneration for senior managers.

Name TitleStart and fi nish dates

Kathy Headdon

CCG Chair (Lay Member)

1/4/2013

Kath Payne Member elected Practice Manager

1/8/2013

Stephen Pill GP Member of Governing Body

01/04/2013

Miriam Ainsworth

GP Member Appointed from Clinical Leaders

01/04/2013

Graham Nix Lay Member (Chair of Audit and Remuneration Committees)

01/04/2013

Access to Governance Statements Corporate information relating to the governance of the CCG is available to the public and members of other committees and sub-committees. Details of key committees and sub-committees of North Somerset CCG can be found on the North Somerset CCG website at: www.northsomersetccg.nhs.uk.

Research and Development North Somerset CCG is an active partner in the work of the West of England Academic Health Science Network (WEAHSN) and is proud to be involved in a variety of projects across the South West which directly contributes to patient benefi t.

The CCG is part of the Avon Primary Care Research Collaborative (APCRC), with a shared vision that commissioners in Bristol, North Somerset and South Gloucestershire will achieve excellence in supporting research and in routinely using the best available evidence to commission the highest quality services and deliver better health. To realise this vision, the APCRC staff have led the following initiatives

on behalf of the CCG in 2014/15:• Implementation of the three year Research

and Development Strategy at North Somerset CCG

• Launched a new service, identifying calls for service improvement monies, and supporting applications from CCG staff to these calls

• Awarded the highest Research Capability Funding award to a CCG in England in 2013/14. The total value was £818,912*. This has been reinvested via a range of initiatives designed to support the research infrastructure and to support new NIHR research grant applications, which if successful will generate more RCF in future, thus maintaining the RCF ‘Virtuous Circle’. - Investment in a range of innovative roles to promote knowledge mobilisation and knowledge exchange, using our RCF funding- Have funded two part time researcher in residence posts who are working on health areas of relevance to all three CCGs, identifying real life issues that can be worked up into research grants, and advancing commissioner-led research ideas- The second cohort of NHS Management Fellows has been recruited and this is adding value in terms of bridging the gap between commissioning and research.

• Worked with the CCG to secure Board Level sign up to the principles of Evidence Informed Commissioning, the AMRC Research Charter, and so demonstrating the CCGs’ commitment in this arena.

• Provided evaluation support to over 50 projects covering a wide range of areas ranging from personalised health budgets, falls, friends and family test, domestic violence, integrated care teams to extra care housing.

• Won fi rst prize for two posters, entitled Evidence Informed Commissioning Toolkit, at the West of England AHSN annual conference, and Research Capability Funding: Investing in research at the Centre for Health and Care Research event at the University of the West of England

• Increased the portfolio of hosted research

External Audit The external auditor for the CCG is Grant Thornton UK LLP, Hartwell House, 55-61 Victoria Street, Bristol, BS1 6FT.

External audit has undertaken regularity and value for money audit in compliance with statutory requirements. The costs for this service are disclosed in the Annual Accounts.

Disclosure of Serious Incidents Serious incidents (SI) requiring investigation were defi ned by the National Patient Safety Agency’s (NPSA) 2010 National Framework for Reporting and Learning from Serious Incidents Requiring Investigation. In summary, this defi nition describes a serious incident as an incident that occurred during NHS funded healthcare (including in the community), which resulted in one or more of the following:• The unexpected or avoidable death of one

2014 (based on FTE workforce of 48)Total working days lost 182Total staff years 42Average working days lost per FTE 4

grants from ten to sixteen with a total value of just over £16.5 million. Seven of these, worth over £3.7 million were awarded in 2014/15. A further 16 grant applications have been submitted and are pending a decision.

• The APCRC worked in partnership with all three CCGs to progress these initiatives across the area.

Pension Liabilities Details of the pension liabilities of North Somerset CCG can be found as part of the Remuneration Report and Financial Statements contained within this annual report.

Sickness Absence DataThe CCG regularly monitors and reviews sickness absence rates and takes action where necessary in accordance with its policy. Regular reports on sickness are presented to the Quality and Assurance Group. The sickness absence rate for the year January to December 2014 for the staff of North Somerset CCG is shown below.

or more patients, staff, visitors or members of the public (where the unexpected or avoidable death is as a direct result of NHS care, where we need to understand whether an act or omission or different pathway of care may have prevented such a serious outcome)

• Serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention or major surgical/medical intervention

• Permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA defi nition of severe harm)

• A scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver healthcare services, for example actual or potential loss of personal/organisational information, damage to property, reputation or the environment or IT failure

• Allegations of abuse• Adverse media coverage or public concern

for the organisation or the wider NHS• One of the core set of ‘Never Events’ as

updated on an annual basis• Events which affect a number of patients,

i.e. rogue staff, infected healthcare worker, incorrect interpretation of specimens

• All deaths where Clostridium Diffi cile or MRSA is either the underlying cause or a contributory factor (Part 1a or Part 1b) recorded on the death certifi cate (DoH CMO 2007).

During 2014-15 there were 228 Serious Incidents reported by all providers pertaining to North Somerset patients.

Cost allocation and setting of charges for information“We certify that the CCG has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.”


26 27


Principles for remedy North Somerset CCG is committed to upholding the principles for remedy published by the Parliamentary and Health Service Ombudsman in May 2010. These have recently been combined with the Ombudsman’s principles of Good Administration and Good Complaints Handling into one document “Ombudsman’s Principles”.

These three documents all highlight the following six key principles:

1. Getting it right2. Being customer focused3. Being open and accountable4. Acting fairly and proportionately5. Putting things right6. Seeking continuous improvement.

North Somerset CCG’s complaints policy is structured around and specifi cally identifi es these six key principles.

Within the complaints policy it is highlighted that all responses should include details of any remedial action that the organisation considers to be appropriate. The complaints policy is reviewed on an annual basis and we will ensure that the Ombudsman’s Principles remain an integral part of the policy.

Ombudsman’s Principles

Employee Consultation The CCG recognises the important contribution of its staff in ensuring that the people living in North Somerset get the health services they need. As at 1 April 2015, there were 67 members of staff. The CCG needs to assure itself that staff are broadly happy in their roles, that their views are listened to and that senior managers consider, and where necessary, act upon feedback that they receive.

The organisation uses a number of different methods to do this, including one-to-one meetings, appraisals, team meetings, staff briefi ngs and staff participation events. This ensures that staff are aware of how their work contributes to the overall aims and strategies of the CCG. It also has two members of staff who are nominated as staff representatives

and have their dedicated email addresses for staff to confi dentially feed back their opinions and suggestions to senior management. This is also used for staff to comment upon new or updated policies before being presented for ratifi cation.

The CCG has for the second year taken part in the NHS annual staff survey. In 2014, the response rate of staff to the survey was 66%. This compared with 63% the year before and a national response rate from CCGs of 78%. The organisation’s key improvement areas from the previous year were around staff agreeing that their role makes a difference to service users and satisfaction with the quality of care they give. Seventy nine percent of staff who responded received an appraisal review in the last year, compared with 31% last year and 62% of respondents agreed that it helped improve their performance.

From the responses, the following areas emerged as priority areas over the forthcoming year:• Improved team working between managers

and their staff• Ensuring managers are supportive of their

staff in a personal crisis• Exploring how the CCG can help support

further development of positive and constructive relationships in the workplace.

Disabled EmployeesNorth Somerset CCG is committed to employing disabled people and ensuring that they have positive experiences of working with us. We have recently been awarded the Two Ticks “positive

about disabled people” symbol by Jobcentre Plus. This means that we have demonstrated our commitment towards employing and retaining disabled people.

Our key commitments are around: interviewing all disabled applicants who meet the minimum criteria for a job vacancy, ensuring that they can develop and use their abilities and that, should an employee become disabled, making sure they can stay in employment. The CCG’s offi ce space at Castlewood is modern and accessible to employees with mobility impairments, with dedicated parking and toilet facilities. We are committed to making reasonable adjustments for employees who require them.

The current percentage of staff declaring that they are disabled is 3%. Additional information about equality and our workforce is contained in the Workforce Equality Monitoring Report which accompanies this Annual Report as Appendix 3.

Emergency preparedness, resilience and response

The CCG works closely with NHS England and other partner organisations and has a clear and robust emergency plan enabling us to deal with emergencies throughout the year.

As a Category 2 Responder, under the Civil Contingencies Act 2004 (CCA) North Somerset CCG is required to prepare for emergencies in line with our responsibilities under the Civil Contingency Act 2004.

The Governing Body receives an annual report on the CCG’s response and action plans arising from our learning from exercises, reviews and audits. Key learning from exercises or actual incidents is also reported to our Clinical Commissioning Leadership Group and other relevant committees as well as our membership where appropriate.

“We certify that the CCG has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The CCG regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Membership Body/ Governing Body.”

Statement as to Disclosure to Auditors The Annual Report was presented to the Governing Body on 5 May 2015 and was approved in principle.

“Each individual who is a member of the Membership Body or Governing Body at the time the Members’ Report is approved confi rms: • “So far as the member is aware, that there is

no relevant audit information of which the CCG’s external auditor is unaware; and,

• “That the member has taken all the steps that they ought to have taken as a member in order to make them self-aware of any relevant audit information and to establish that the CCG’s auditor is aware of that information.”


28 29


The CCG is required to set the remuneration for all of the members of the Governing Body and for all employees. There is some national guidance available to assist in this, in particular for remuneration of senior offi cers of the CCG.

Remuneration reportThe national guidance for chief fi nance offi cers and chief operating offi cers’ pay has been considered along with a review of prevailing rates for non-offi cer members.

Each CCG as a membership organisation is responsible for agreeing its own remuneration with all the duties and freedoms that that implies. There are few nationally mandated guidelines to which we have to adhere. There

Name Title Start date

End date Actual (WTE)

Actual Salary (bands

of £5,000)

Taxable benefi ts (Rounded to the

nearest £000)

Annual Performance Related Bonuses (bands of £5,000)

Long-term performnce related bonuses

(bands of £5,000)

All Pension Related Benefi ts

(bands of £2,500)

Total(bands of £5,000)

J George Chief Operating Offi cer 1/4/2013 1.00 80-85 0 0 0 0 80-85M Backhouse Chief Clinical Offi cer 1/4/2013 0.60 80-85 0 0 0 0-2.5 80-85M Vaughton Chief Financial Offi cer 1/4/2013 1.00 100-105 0 0 0 62.5-65 165-170S Pill GP Membership Representative 1/4/2013 0.05 5-10 0 0 0 0 5-10

K Headdon Chair (Lay Member) 1/4/2013 0.40 30-35 0 0 0 - 30-35M Ainsworth GP Representative from clinical

leaders, Clinical Leader1/4/2013 0.30 35-40 0 0 0 5-7.5 40-45

A Clarke Secondary Care Clinician 1/4/2013 16/1/2015 0.05 5-10 0 0 0 - 5-10T Ryan Clinical Leader 1/4/2013 0.15 15-20 0 0 0 0 15-20JM Jenkins Clinical Leader - Mental Health 3/7/2014 0.15 10-15 0 0 0 310-312.5 320-325K Haggerty Clinical Leader 1/4/2013 0.20 20-25 0 0 0 0 20-25P Kirby* Local Medical Committee

Management Representative1/10/2014 - - 0 0 0 - -

G Nix Audit & Remuneration Committee Chair (Lay Member)

1/4/2013 0.20 10-15 0 0 0 - 10-15

L Williams Interim Chief Nursing Offi cer (registered nurse)

1/4/2013 20/3/2015 - 130-135 0 0 0 - 130-135

K Payne Member elected Practice Manager Representative

1/4/2013 0.05 0-5 0 0 0 10-12.5 10-15

M O’Connor Clinical Leader 1/4/2013 30/4/2014 0.20 0-5 0 0 0 0 0-5J Maynard Clinical Leader 1/4/2013 0.25 30-35 0 0 0 0 30-35J Heather Clinical Leader 1/4/2013 0.20 20-25 0 0 0 0 20-25D Penney Practice Manager on CCLG 3/7/2014 0.16 5-10 0 0 0 - 5-10D Campbell Head of Medicines Management 1/4/2014 1.00 70-75 0 0 0 10-12.5 80-85G Snaith Interim Chief Operating Offi cer 14/7/2014 28/2/2015 - 80-85 0 0 0 - 80-85

Salary Disclosure 2014-15 (subject to audit)

are some pieces of national guidance that exist namely national guidance on the remuneration of chief offi cers and nationally-set pay rates for all those organisations using Agenda for Change as the basis of employment of staff.

Notes: No senior manager waived his/her remuneration. No annual and long-term performance related bonus payments were made to any senior managers in 2014/15. No

benefi ts-in-kind were received by any senior manager in 2014/15. No compensation was paid to any former senior managers. *P Kirby is employed through Avon Local Medical Committee (not subject to audit)


30 31


Salary disclosure 2013-14 (subject to audit)

Name Title Start date

End date

Actual (WTE)

Actual Salary

(bands of £5,000)

Taxable benefi ts (Rounded to the

nearest £000)

Annual Performance Related Bonuses (bands of £5,000)

Long-term performnce related bonuses

(bands of £5,000)

All Pension Related Benefi ts

(bands of £2,500)

Total(bands of £5,000)

J George Chief Operating Offi cer 1/4/13 1.00 80-85 0 0 0 65-67.5 150-155M Backhouse Chief Clinical Offi cer 1/4/13 0.60 80-85 0 0 0 342.5-345 420-425M Vaughton Chief Financial Offi cer 1/4/13 1.00 80-85 0 0 0 17.5-20 100-105S Pill GP Membership Representative 1/4/13 0.05 5-10 0 0 0 212.5-215 220-225K Headdon Chair (Lay Member) 1/4/13 0.40 30-35 0 0 0 - 30-35M Ainsworth GP Representative from clinical

leaders, Clinical Leader1/4/13 0.30 35-40 0 0 0 227.5-230 265-270

A Clarke Secondary Care Clinician 1/4/13 0.05 5-10 0 0 0 - 5-10T Ryan** Clinical Leader 1/4/13 0.15 15-20 0 0 0 152.5-155 170-175K Haggerty Clinical Leader 1/4/13 0.20 20-25 0 0 0 267.5-270 390-395P Kirby* Local Medical Committee

Management Representative1/10/14 - 0 0 0 - -


1/4/13 0.20 10-15 0 0 0 - 10-15


1/4/13 - 125-130 0 0 0 - 125-130


1/4/13 0.05 0-5 0 0 0 - 0-5

M O’Connor Clinical Leader 1/4/13 0.20 20-25 0 0 0 175-177.5 200-205J Maynard Clinical Leader 1/4/13 0.25 30-35 0 0 0 175-177.5 205-210J Heather Clinical Leader 1/4/13 0.20 20-25 0 0 0 105-107.5 130-135

Notes: No senior manager waived his/her remuneration. No annual and long-term performance related bonus payments were made to any senior managers in 2013/14. No benefi ts in kind were received by any senior

It is essential that the process followed is transparent and consistent (especially given the lack of detailed national guidance in some areas). The CCG is committed to publishing the full-time equivalent earnings of all its senior employees and Governing Body members. This report supports that commitment.

The majority of employees are on permanent contacts and the terms and conditions are in line with national guidance for Very Senior Managers and Agenda for Change.

The Remuneration Committee has met twice during the year.

Senior Managers Salaries and Other RemunerationFor the purpose of this report, senior managers are defi ned as being: ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the CCG. This means those who infl uence the decisions of the organisation as a whole rather than the decisions of individual directorates or departments’. Senior managers (excluding Lay Members) are generally employed on permanent contracts with a three month period of notice.

The CCG’s remuneration committee is chaired by the chairman of the Governing Body. It is the remuneration committee that determines

the reward packages of executive directors, whilst taking account of the pay framework for Very Senior Managers (VSM) published by the Department of Health.

The chairman of the Governing Body and the GP membership representatives are appointed by the CCG membership. The Secondary Care Clinical Member and two lay members are appointed by the CCG.

Pay Multiples (subject to audit)Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director in their organisation and the median remuneration of the organisation’s workforce.

manager in 2013/14. No compensation was paid to any former senior managers. *P Kirby is employed through Avon Local Medical Committee (not subject to audit)**T Ryan’s 2012/13 & 2013/14 fi gures have been revised by NHSBSA.

The banded remuneration of the highest paid member of the Governing Body in North Somerset CCG in the fi nancial year £130-135k (2013-14 - £135-140k). This was 3.33 times (2013-14 - 3.4 times) the median remuneration of the workforce, which was £40k (2013-14 £41k).

In 2014-15 no (2013-14 none) employees received remuneration in excess of the highest paid director. Remuneration ranged from £9,500 to £133,200 (2013-14, £2,400 - £134,700).

Total remuneration includes salary, non-consolidated performance related pay, benefi t-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.

Exit Packages (subject to audit)There were no exit packages made during 2014-15 (2013-14 - two totaling £85k).


32 33


Senior Manager Pension Benefi ts (subject to audit)

Name Title Real increase in pension at age 60 (bands of

£2,500)

Real increase in pension lump sum at age 60

(bands of £2,500)

Total accrued pension at age 60 at 31 March 2015 (bands of

5,000)

Lump sum at age 60 related to

accrued pension at 31 March 2015 (bands of 5,000)

Cash Equivalent Transfer Value at 31 March 2014

(bands of £5,000)


(bands of £5,000)

Real increase in Cash Equivalent Transfer Value

Employer’s contribution

to partnership pension

£000 £000 £000 £000 £000 £000 £000 £000J George Chief Operating Offi cer 0-2.5 0-2.5 25-30 75-80 539 562 23 -M Backhouse Chief Clinical Offi cer 0-2.5 0-2.5 15-20 50-55 358* 381 23 -M Vaughton Chief Financial Offi cer 2.5-5 7.5-10 10-15 35-40 191 263 72 -S Pill GP Membership Representative 0-2.5 0-2.5 10-15 30-35 229 236 7 -K Headdon Chair (Lay Member) - - - - - - - -M Ainsworth GP Representative from clinical

leaders, Clinical Leader0-2.5 0-2.5 10-15 35-40 247 265 18 -

A Clarke Secondary Care Clinician - - - - - - - -T Ryan Clinical Leader 0-2.5 0-2.5 5-10* 20-25* 143 147 4 -JM Jenkins Clinical Leader - Mental Health 12.5-15 40-42.5 15-20 50-55 44 215 171K Haggerty Clinical Leader - - - - - - - -P Kirby Local Medical Committee

Management Representative- - - - - - - -


- - - - - - - -


- - - - - - - -

G Snaith Interim Chief Operating Offi cer - - - - - - - -K Payne** Member elected Practice Manager

Representative0-2.5 0-2.5 5-10 15-20 77 87 10 -

M O’Connor Clinical Leader (0-2.5) (0-2.5) 5-10 25-30 185 188 3 -J Maynard*** Clinical Leader 0-2.5 0-2.5 10-15 30-35 163 173 10 -J Heather Clinical Leader - - - - - - - -D Penney Practice Manager on CCLG - - - - - - - -D Campbell Head of Medicines Management 0-2.5 2.5-5 15-20 45-50 247 268 21 -

*M Backhouse’s CETV has been restated to amend an error in the 2013/14 fi gure stated. T Ryan’s total accrued pension/lump sum/CETV have been restated to amend an error in the 2013/14 fi gures stated. **K Payne has been included with thepension disclosure this year - no information was sup-plied by NHSBSA in 2013/14.***J Maynard’s prior year CETV value has been restated by NHSBSA


34 35


Senior Manager Pension Benefi ts (subject to audit)

Cash Equivalent Transfer ValuesCash Equivalent Transfer Values (CETV) is the actuarially assessed capital value of the pension scheme benefi ts accrued by a member at a particular point in time. The benefi ts valued are the member’s accrued benefi ts and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by

a pension scheme or arrangement to secure pension benefi ts in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefi ts accrued in their former scheme. The pension fi gures shown relate to the benefi ts that the individual has accrued as a consequence of their membership of the pension scheme. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). The CETV fi gures and the other pension details include the value of any pension benefi ts in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefi t accrued to the member as a result of their purchasing additional years of pension service

Notes: 1. Lay members do not receive pensionable remuneration 2. These benefi ts include all Offi cer NHS Pension Scheme membership, but excludes any Practitioner (i.e. GP) pension benefi ts.*T Ryan’s fi gures for 2012/13 have been restated by NHSBSA**J Maynard’s 2013/14 CETV value has been restated by NHSBSA.

Name Title Real increase in pension at age 60 (bands of

£2,500)

Real increase in pension lump sum at age 60

(bands of £2,500)

Total accrued pension at age 60 at 31 March 2014 (bands of

5,000)

Lump sum at age 60 related to

accrued pension at 31 March 2014 (bands of 5,000)


(bands of £5,000)


(bands of £5,000)

Real increase in Cash Equivalent Transfer Value

Employer’s contribution

to partnership pension

£000 £000 £000 £000 £000 £000 £000 £000J George Chief Operating Offi cer 2.5-5 7.5-10 25-30 75-80 444 525 81 -M Backhouse Chief Clinical Offi cer 15-17.5 45-47.5 15-20 50-55 73 860 787 -M Vaughton Chief Financial Offi cer 0-2.5 2.5-5 5-10 25-30 157 187 30 -S Pill GP Membership Representative 7.5-10 27.5-30 10-15 30-35 49 223 174 -

K Headdon Chair (Lay Member) - - - - - - - -M Ainsworth GP Representative from clinical

leaders, Clinical Leader10-12.5 30-32.5 10-15 35-40 60 240 180 -

A Clarke Secondary Care Clinician - - - - - - - -T Ryan Clinical Leader 0-2.5 2.5-5 40-45 120-125 20 143 123 -K Haggerty Clinical Leader 10-12.5 35-37.5 10-15 35-40 28 250 222 -P Kirby Local Medical Committee

Management Representative- - - - - - - -


- - - - - - - -


- - - - - - - -


- - - - - - - -

M O’Connor Clinical Leader 7.5-10 22.5-25 5-10 25-30 49 180 131 -J Maynard Clinical Leader 7.5-10 22.5-25 10-15 30-35 64 163 99 -J Heather Clinical Leader 2.5-5 12.5-15 5-10 15-20 14 107 93 -

in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real increase in CETVThis refl ects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to infl ation, contributions paid by the employee (including the value of any benefi ts transferred from another scheme or arrangement) and uses common market value factors for the start and end of the period.


36 37


NumberNumber of new engagements, or those that reached six months duration, between 1 April 2014 and 31 March 2015

0

Number of the above which include contractual clauses giving the department North Somerset CCG the right to request assurance in relation to income tax and National Insurance obligations

0

Number of whom assurance has been requested

0

Of which, the number assurance has been received

0

Of which, the number assurance has not been received

0

engagements terminated as a result of assurance not being received, or ended before assurance received

0

All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.

NumberNumber of off-payroll engagements of Governing Body members, and/or senior offi cials with signifi cant fi nancial responsibility, during the fi nancial year

2

Number of individuals that have been deemed “Governing Body members, and or senior offi cials with signifi cant fi nancial responsibility”, during the fi nancial year (this fi gure includes both off-payroll and on-payroll engagements)

19

Name Role Type of Interest Details of Interest Who interest is held by

Kathy Headdon

Lay Chair Other role or relationship

Consultant services Capita Property and Infrastructure

Personal interest

Other role or relationship

Husband is a director at University Hospitals Bristol NHS Foundation Trust

Interest of close family member

Dr Mary Backhouse

Chief Clinical Offi cer

Role or responsibility in Member Practice

GP Partner - Nailsea Family Practice

Personal interest


Woodspring Healthcare Doctor (company owning Tower House Medical Centre, Nailsea)

Personal interest


Tower House Pharmacy, Nailsea is owned and operated by Nailsea Healthcare LLP which is a joint venture between the GP Partners and Community Pharmacies (UL) LTD

Personal interest

Directorship Wellspring Counselling, Nailsea (Director and Trustee)

Personal interest

Directorship Company Director West of England Academic Health Science Network Ltd

Personal interest

Jeanette George

Chief Operating Offi cer

No interests to declare

No interests to declare Personal interest

Ginny Snaith

Interim Chief Operating Offi cer

Directorship Director of New Springs Management Ltd - Healthcare Management Consultancy

Personal interest

Jacqui Chidgey-Clark

Director of Nursing and Quality

Directorship Director of the JCC Partnership LTD. The Company provides - consultancy to health and social care organisations. - specialist consultancy in end of life care- provides advice and preparation for CQC inspections

Personal interest

Directorship Director of the JCC Partnership LTD. The Company provides - consultancy to health and social care organisations. - specialist consultancy in end of life care- provides advice and preparation for CQC inspections.This is currently provided by Dr Jayne Chidgey-Clark


Declarations of Interest

The number that have existed Numberfor less than one year at the time of reporting

1

for between one and two years at the time of reporting

1

for between two and three years at the time of reporting

0

for between three and four years at the time of reporting

0

for four or more years at the time of reporting

0

Off-payroll engagement during 2014-15, for more than £220 per day and that last longer than six months

Off-payroll Engagements (not subject to audit) NHS bodies are required to include disclosures in 2014/15 about their off-payroll engagements, and the details for North Somerset CCG are set out in the tables below.


38 39



Liam Williams

Interim Chief Nursing Offi cer

Directorship Director of LG Williams Interim Management and Consultancy

Personal interest

Other Specifi c Interest

Member of the Royal Society of Medicine

Personal interest


Member of the Royal College of Nursing

Personal interest

Connection with organisation contracting NHS Services

Additional work for South West CSU supporting ambulance service commissioning

Personal interest


Committee member of Community Hospitals Association

Personal interest

Graham Nix

Lay Member, Chair of Audit


Trustee Above and Beyond Charities (Charitable Trustees for the University Hospitals Bristol NHS Foundation Trust)

Personal interest

Directorship Director - Education Centre Management Ltd

Personal interest

Directorship Chair and Director - Above and Beyond Appeal 5512432

Personal interest


National Finance Committee, St John’s Ambulance for England and the Isles

Personal interest


Part of a sub group of Healthwatch who are evaluating the pre-qualifying questionnaire for the community health services re-procurement project


Michael Vaughton

Chief Finance Offi cer

No interests to declare

No interests to declare Personal interest

Kath Payne

Practice Manager Representative


Practice Manager (employee) of Portishead Medical Group

Personal interest

Dr Stephen Pill

GP Membership Representative


GP partner at Clevedon Riverside Group


GP Care Shareholder Personal interest


Provider of medical care at Clevedon Cottage Hospital

Personal interest

Shareholdings in Health and Social Care

Member/ Shareholder of LAWCY Group, a federation of four GP Practices. LAWCY has established WorkDoctors, an occupational health business based in the four practices

Personal interest


Phil Kirby Non-voting attendee from Avon Local Medical Committee


Chief Executive Avon Local Medical Committee

Personal interest


Chief Executive Avon Local Medical Committee Limited

Personal interest

Directorship Director Avon LMC Services Limited Personal interest

Directorship Director Avon GP Education Limited Personal interest

Directorship Director Avon GP Education CPD Limited

Personal interest

Directorship Director Bristol GP Education Limited Personal interest

Directorship Director Bristol GP Education CPD Limited

Personal interest

Dr Miriam Ainsworth

GP Representative (Clinical Leader)


GP Partner at Graham Road Surgery, Weston-super-Mare

Personal interest


Shares in GP practice Personal interest

Directorship Director of Avon LMC Personal interest


Practice owns shares in GP Care Personal interest

Andrew Clarke

Secondary Care Clinician


Consultant at Taunton & Somerset NHS Foundation Trust

Personal interest

Dr Tony Ryan

Clinical Leader Role or responsibility in Member Practice

GP at Portishead Medical Practice Personal interest

Dr Kevin Haggerty


GP Partner at Longton Grove Surgery Personal interest

Directorship Wife is a medical director for BNSSSG Area Team, NHS England


M O’Connor


GP Partner at Long Ashton Surgery Personal interest

Dr Jeremy Maynard


GP (salaried) Nailsea Family Practice Personal interest

John Heather


Partner at New Court Surgery Personal interest

Mike Jenkins


GP Partner, Riverbank Medical Centre, Worle. (Riverbank Medical Centre has shares in GP Care)

Personal interest

The Annual Accounts and supporting notes explain how pension liabilities have been treated.


40 41


The National Health Service Act 2006 (as amended) states that each CCG shall have an Accountable Offi cer and that offi cer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Dr Mary Backhouse to be the Accountable Offi cer of North Somerset CCG.

The responsibilities of an Accountable Offi cer, including responsibilities for the propriety and regularity of the public fi nances for which the Accountable Offi cer is answerable; for keeping proper accounting records (which disclose with reasonable accuracy at any time the fi nancial position of the CCG and enable it to ensure that the accounts comply with the requirements of the Accounts Direction); and for safeguarding the CCG’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the CCG Accountable Offi cer Appointment Letter.

Under the National Health Service Act 2006 (as amended), NHS England has directed each CCG to prepare each year fi nancial statements in the form and on the basis set out in the Accounts Direction. The fi nancial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the CCG and of its net expenditure, changes in taxpayers’ equity and cash fl ows for the fi nancial year.In preparing the fi nancial statements, the Accountable Offi cer is required to comply with

Statement of the Accountable Offi cer

the requirements of the Manual for Accounts issued by the Department of Health and in particular to:• Observe the Accounts Direction issued

by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis

• Make judgements and estimates on a reasonable basis

• State whether applicable accounting standards as set out in the Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the fi nancial statements

• Prepare the fi nancial statements on an ongoing concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my CCG Accountable Offi cer Appointment Letter.

Dr Mary BackhouseAccountable Offi cer26 May 2015

Statement of Accountable Offi cer’s ResponsibilitiesNorth Somerset CCG was licensed from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012 which amended the National Health Services Act 2006. As at 1 April 2014, the CCG was licensed with no conditions.

At the end of the 2014-15 fi nancial year the CCG reported that it has not met its statutory fi nancial target to achieve a balanced fi nancial position. The CCG’s fi nancial opening plan for 2014-15 was for a revenue defi cit of £10m. Throughout the year the CCG has forecast delivery of this planned position.

The Financial Statements are included in full in this report together with detailed notes.

The 2015-16 service and fi nance plan requires the CCG to deliver savings of over £10m. Pro-gress to develop schemes has meant the CCG has yet to fi nd some £3m not identifi ed.

The CCG identifi es and monitors on a regular basis any strategic challenges it faces. In doing this, it undertakes developing its commissioning function in order to work through these challenges, examples of which are given below:• Working with commissioners and providers

of both health and social care to ensure clinically safe and sustainable services are in place at all times for patients and the local population during a period of signifi cant fi nancial challenge and system change.

• Working with commissioners and providers to maintain effective safeguarding systems for children, young people and vulnerable adults as organisational and legislative changes are made to the operating environment.

• Meeting rising demand with limited resources - it is vital that every pound spent provides best value and new resources are applied in support of excellent service delivery. The CCG undertakes constant

Governance Statementreview of service and fi nancial performance, including benchmarking of services.

• In 2014/15 the CCG secured £1.3m for winter pressures which has been used to support a range of initiatives. This was used in full and provided an environment in which the whole health and social care system demonstrated increased capability to support patients and collectively deliver improvements in services.

• Securing a safe and sustainable provider base – integrated contract performance meetings for the CCG’s main providers cover quality, service performance, activity and fi nance in a way that links all aspects of delivery and enable effective and joined up performance management of the system.

• Delivering fi nancial balance – the CCG has published a fi ve year strategic Financial Recovery Plan which describes the changes needed to secure safe and sustainable services for the future.

• Supporting a challenged social care system – North Somerset CCG and the local authority have agreed the investment in the Better Care Fund for 2015-16. Enablement and re-ablement services have been successfully delivered with North Somerset Council and work to further develop existing integration of Health and Social Care teams has been progressed.

• In making transformational change happen, the CCG needs to undertake signifi cant stakeholder engagement and formal consultation. During the year the CCG has had both positive and negative experiences in relatively small scale changes and needs to consider how to ensure the learning from these experiences are applied.

• Transforming acute care – the CCG understands that the health service needs to change the healthcare delivery model in North Somerset to meet the changing needs of our population and secure high quality


42 43


and sustainable services while also working within the available fi nancial resources. This requires the CCG to provide clarity to acute Trusts on how it expects to commission inpatient, diagnostic and specialist services in the future. It also requires the CCG to ensure that the local population recognises the increased shift towards community and primary care for service delivery which may be in confl ict with their expectations of access.

• Transforming primary care – a key challenge is to ensure that primary care feels confi dent to take the necessary steps to make rapid progress in meeting national challenges to consider their future model of delivery. In addition, primary care needs to consider how they will rapidly increase workforce expertise and capacity to meet the increased levels of community and primary care the CCG expects to commission.

• Primary Care Co-Commissioning – The CCG has recently had its application for joint commissioning approved. The CCG has followed a rigorous process in reaching this stage and involvement & engagement has continuously been sought from the Governing Body and Membership with careful consideration

given to confl icts of interest. Decision making for co-commissioning will be via a Joint Commissioning Committee. The committee will include representatives from Healthwatch and the Local Health and Wellbeing Board as non-voting attendees as well as North Somerset Council and primary care.

• Ensuring membership understanding and support of the requirements set out in the fi ve year plan for primary care – The Quality and Assurance Group and the Clinical Commissioning Leadership Group provide an effective basis for working with GP leaders and the Provider Forum and Practice Nurse Forum are being actively engaged with to extend that engagement. The CCG has developed a process for agreeing service development schemes under the national policy for investing in patients. As a part of this the CCG has initiated and developed a locality structure and as a way of progressing local priorities.

• Shifting care into the community and closing beds – North Somerset has been at the forefront of innovation of community services, for example establishing community wards. The appointment of a Community Geriatrician team, an Admissions

Avoidance Team and a Learning Disabilities Intensive Support Team during 2014-15 are further examples of the signifi cant transformation work that the CCG has progressed.

During the year the CCG faced a number of challenges to its control systems:• System leadership – the CCG has actively

engaged with the system leadership work at Chief Offi cer and Chief Finance Offi cer levels.

• Staff survey – the 2012/13 staff survey highlighted a number of areas for further development including staff appraisals, training and development, listening to staff and involving them in decision-making, improving awareness of incident report and health and safety policies. The CCG developed an action plan to respond to these and, where appropriate, incorporated specifi c objectives within the CCGs organisational development plan to address these areas. The outcome of the 2013/14 staff survey has demonstrated improvements in these areas, although challenges remain. Further work will be undertaken in 2014-15, particularly in relation to improving team working between managers and staff, promoting the health and wellbeing of staff, particularly in relation to the work environment. A review of the CCG’s organisational development plan will support this.

• CCG Partnership – prior to establishment, the CCG established a collaborative agreement with Bristol and South Gloucestershire CCGs underpinned by a formal Memorandum of Understanding. This agreement has enabled the CCGs to work together on a number of challenges including establishing a shared response for emergency planning, resilience and response, system management when under pressure, management of the relationship with the South West Commissioning Support (SWCS) and effective commissioning arrangements with acute trusts and other providers with which the CCGs share contractual arrangements.

• Weston Area Health NHS Trust – the Trust Development Agency (TDA) is seeking an operator for Weston Area Healthcare

NHS Trust (WAHT) through acquisition by another NHS provider. The preferred provider is Taunton and Somerset NHS Foundation Trust who are preparing a full business case for acquisition.

• As the principal commissioners of Weston General Hospital, North Somerset CCG, along with Somerset CCG, has been participating and co-operating with the acquisition process as a vehicle to secure the future sustainability of high quality services to local patients. The CCG recognises that in order to secure best value for patients and taxpayers it will be important to set out a clear picture of the type of services commissioners would expect to purchase from WAHT in the future.

• During 2015/16 the CCG will need to further consider the challenges faced by Weston Area Healthcare NHS Trust in delivering a Type 2 Emergency Department Service. In addition to workforce issues currently experienced and diversions of activity to ensure appropriate specialist care for patients in alternative venues, the CCG will review national recommendations from NHSE on provision of safe and effective emergency and urgent care.

• In line with national policy the CCG will seek to re-procure support services during 2015-16 using the Lead Provider Framework announced by NHS England in February.

• The CCG has invested additional money during 2014-15 to improve waiting times for elective procedures for our patients. Waiting times for some operations are longer than we want and longer than the NHS Constitution requirement, and the CCG has planned for further investment in 2015-16 to address this.

• The CCG has invested in the urgent care system to help improve the patient experience and avoid admission to hospital where appropriate. Some of the initiatives implemented included the community based Geriatrician and Specialist Older People’s Team. In 2015-16 the CCG will have a focus on ensuring a partnership approach across primary, community and secondary care

• Complaints and Freedom of Information (FOI) requests – management of the complaints and Freedom of Information


44 45


Scope of Responsibility As Accountable Offi cer, I have responsibility for maintaining a sound system of internal control which supports the achievement of the CCG’s policies, aims and objectives, while safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my CCG Accountable Offi cer Appointment Letter.

I am responsible for ensuring that the CCG is administered prudently and economically and that resources are applied effi ciently and effectively, safeguarding fi nancial propriety and regularity. Compliance with the UK Corporate Governance Code While the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is

view of the fi nancial position of North Somerset CCG for the period in question

• Affairs are managed to secure economic, effi cient and effective use of resources

• Reasonable steps are taken to prevent and detect fraud and other irregularities.

Remuneration CommitteeThe Remuneration Committee makes recommendations to the Governing Body on determinations about pay and remuneration for:

• Employees of the CCG• People who provide service to the CCG• Allowances under any pension scheme

it might establish as an alternative to the NHS pension scheme.

Quality and Assurance GroupThe Quality and Assurance Group is responsible for:

• Ensuring quality of all commissioned services

• Ensuring quality of primary care services including Local Enhanced Services held by the CCG

• Assurance of compliance with Equality Delivery System

• Clinical governance

The Governing Body’s functions:• Ensuring that the CCG has appropriate

arrangements in place to exercise its functions effectively, effi ciently and economically and in accordance with the group’s principles of good governance.

• Determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowance payable under any pension scheme it may establish.

• Approving any functions of the group that are specifi ed in regulations.

• Leading and setting of the vision and strategy.

• Signing off the annual commissioning plan which sets out how it proposes to discharge its fi nancial duties.

• Monitoring performance against plan.• Providing assurance of strategic risk.

(FOI) process has been commissioned from South, Central and West Commissioning Support (SCWCSU). Work has been on-going throughout the year on further development of procedures and on ensuring the robustness of the process to improve the CCG’s responsiveness and compliance with its duties under the legislation which governs these processes. Performance has improved throughout the year

• Managing confl icts of interest – North Somerset CCG’s establishment of a Decision Scrutiny Panel which continues to scrutinise and consider the CCG’s arrangements for the management of confl icts of interest and the implementation and compliance with these arrangements, continues. The CCG has also recently reviewed its procedures to ensure alignment with the latest confl ict of interests guidance and to incorporate primary care co-commissioning arrangements. This work continues as the organisation moves forward, following approval of its application for Joint Commissioning.

• Patient and public engagement and experience

• Safeguarding • Integrated governance assurance.

Clinical Commissioning Leadership GroupThe Clinical Commissioning Leadership Group is responsible for:

• Development of the Annual Commissioning Plan and deciding priorities to meet the health needs of the population

• Service redesign and transformation including contracting new services

• Agreeing procurement and disinvestment within delegated limits

• Engagement of membership• Continuous improvement across the

whole system• Monitoring performance against plan –

fi nancial, activity and quality• Risk management and mitigating

actions• Involvement of patients and public.

Decision Scrutiny PanelThe Decision Scrutiny Panel provides the Governing Body and the public with assurance that decisions are scrutinised, confl icts of interest are managed and that behaviours meet the code of conduct for public bodies.

Details of the membership and terms of reference of the Governing Body and its committees are available from North Somerset CCG website. The Governing Body, Audit Committee, Clinical Commissioning Leadership Group and the Quality and Assurance Group have all undertaken self-assessments of their performance which show the committees to be working as would be expected with no signifi cant areas of concern identifi ed.

The purpose of the Membership Forum is to ensure that the member practices are fully engaged and take ownership of the work of the CCG. The Membership Forum meetings are held monthly with a minimum of ten meetings per year. Member practice representatives are required to maintain at least a 75% attendance level at Membership Forum meetings.

considered to be good practice. However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice.

The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:“The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it.”

North Somerset CCG is a membership organisation. Members include all providers of primary medical care serviced to the registered list of patients under a GMS, PMS or APMS contract.

Each member practice has an appointed practice representative (GP or other healthcare professional) who attends the Membership Forum meetings, the purpose of which is to ensure that the member practices are fully engaged and take ownership of the work of the CCG. Practice Managers from the member practices are also invited to attend the Membership Forum meeting.

A number of committees of the Governing Body have been established and these are listed opposite with a summary of their purpose and functions.

Audit CommitteeThe purpose of the Audit Committee is to assist CCG to deliver its responsibilities for the conduct of public business, and the stewardship of funds under its control. In particular, the committee will seek to provide assurance to the Governing Body that an appropriate system of internal control is in place to ensure that:

• Business is conducted in accordance with the law and proper standards

• Public money is safeguarded and properly accounted for

• Financial statements are prepared in a timely fashion and give a true and fair


46 47


North Somerset CCG has entered into collaborative arrangements with Bristol CCG and South Gloucestershire CCG. These joint arrangements are referred to as the Bristol, North Somerset and South Gloucestershire (BNSSG) Partnership Group and are outline in the Memorandum of Understanding.

The Clinical Commissioning Group Risk Management FrameworkThe Governing Body-approved Risk Management Strategy defi nes the structures for the management and ownership of risk. It encapsulates the CCG’s attitude to risk and defi nes how risks are dealt with and by whom. Integrated Governance is assured through the Quality and Assurance Group with the exception of fi nancial governance which is the responsibility of the Audit Committee and the Governing Body. The Governing Body and the Audit Committee receive the minutes of the Quality and Assurance Group and the Governing Body also receives the minutes of the Audit Committee.

The Assurance Framework covers all the organisation’s main activities and identifi es signifi cant risks, or “gaps”. It identifi es the CCG’s objectives, the risks to the achievement of these goals, the internal controls to manage those risks and any gaps in the assurances. The Assurance Framework is regularly reviewed by the Senior Offi cers and is considered by the Governing Body on a quarterly basis.

The assessment of risk is embedded within the reporting arrangements for the Governing Body and its committees as part of the standard template.

The CCG regards risk management as an essential component of day-to-day business. The CCG committee structure is serviced and administrated by the use of an established set of reporting templates which directs authors to detail their risk assessments for papers for submission. Alongside risk assessments, equality impact assessments are also required. It is recognised that in assessing policies, strategies, papers and proposals, in terms of the protected characteristics of individuals and groups, risks that were not immediately apparent can be

brought to the fore together with mitigation plans and proposals to reduce risk.

Training in risk assessment and management and equality impact assessments is a core requirement for many of the organisation’s staff. These staff are trained to recognise and report risk using an agreed format and reporting tool.

The CCG has the opportunity to feedback performance on risk and equality impact assessment at management and business team meetings to ensure that quality of reporting is maintained.

North Somerset CCG, working in partnership with North Somerset Council, has adopted and implemented a joint co-production framework. The framework sets out principles for engaging with our stakeholders, including lay and public representation, from the earliest possible point of any commissioning project or activity. Stakeholders are involved, either as individuals or groups. Working in this way, allows for strategic intelligence regarding the organisation’s risk environment to be identifi ed. Risk issues arise from patient, carer and service-user experience concerning clinical aspects of care and patient safety, as well as social, economic and political factors in the local community.

In addition, our Voices for Healthcare Communication, Engagement and Experience Strategy also provides the organisation with mechanisms to identify issues and challenges, as well as providing opportunities to gather feedback and respond. This is done through a number of engagement channels, including patient participation groups, community groups, media and social media.

Among the key questions which can be answered by engaging with stakeholders on such issues are:• What is the issue or problem?• How complex is it?• What is its scope?• What is working and what is not working in

the current approach?• What could be accomplished by engaging

others in the dialogue?

The resultant intelligence then guides a solution-focussed approach to minimising identifi ed risk through action planning and monitoring. The Purpose of the System of Internal Control A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. The assurance framework is designed to identify and prioritise risks; to evaluate the likelihood of those risks being realised and the impact should they be realised; and to manage them effi ciently, effectively and economically. The Assurance framework is supported by a robust risk management system.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable, and not absolute, assurance of effectiveness.

Standing Financial Instruction and the scheme of delegation approved by the Governing Body in March 2013 ensures compliance with statutory requirements placed on the CCG for management of governance. Internal audit and the counter-fraud service provide an independent review of our internal controls.

The system of internal control has been in place in the CCG for the year ended 31 March 2015 and up to the date of approval of the Annual Report and Accounts. To date there have been no breaches to the system of internal control.

Business Critical Models“NHS North Somerset is considering the implications of the Macpherson Report on quality assurance of Government analytical models, noting that it relates to the work of government departments and arms length bodies, rather than CCGs”.Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal confi dential data. The NHS Information Governance Framework is supported by an information

governance toolkit and the annual submission process provides assurances to the CCG, other organisations and to individuals that personal information is dealt with legally, securely, effi ciently and effectively.

We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information.

Risks to information are managed and controlled with a comprehensive set of controls set out in the CCG’s Information Governance Management System (IGMS). The IGMS is a comprehensive set of policies, processes and guidance used across the CCG to manage all aspects of information, ranging from confi dentiality, communication and technical security, to data quality and managing records.

All staff are required to undertake annual information governance training. There are processes in place for incident reporting and investigation of serious incidents.

Regular reports on information governance are received by the Quality and Assurance Group. Performance is measured by the information governance self-assessments (information governance toolkit) for which the CCG achieved a satisfactory compliance position. Active ‘expertise’ is provided by the Information Governance Team of South, Central and West Commissioning Support Unit, which runs education for all staff, assesses new developments, provides advice and query resolution and compliance monitoring

Pension Obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.


48 49


Equality, Diversity and Human Rights Obligations Control measures are in place to ensure that the CCG complies with the required public sector equality duty set out in the Equality Act 2010.

Sustainable Development ObligationsThe CCG is required to report its progress in delivering against sustainable development indicators.

The CCG continues to develop plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and commissioning.

The CCG will continue to comply with its obligations under the Climate Change Act 2008, including the Adaption Reporting Power, and the Public Services (Social Value) Act 2012.

Risk Assessment in Relation to Governance, Risk Management and Internal Control North Somerset CCG has identifi ed a number of key risks throughout the year which are assessed and regularly monitored in line with the risk management strategy, ensuring that they are actively monitored and mitigating actions are detailed. Topics identifi ed in these risks include fi nancial performance, system reform, Weston Area Health NHS Trust (WAHT) procurement, re-procurement of community and support services and implementation of the Better Care Fund.

The risk assessment process identifi es risks and grades them in accordance with NHS advice using a “fi ve-by-fi ve” scoring system. Each risk is assigned to a named senior offi cer. The Risk Register has been reviewed regularly by the Clinical Commissioning Leadership Group and Governing Body throughout the year. This review work includes an examination of progress to mitigate risks, challenge on the timeliness and impact of corrective actions and

consideration of the strategic and operational impacts of the expected outcomes.

Review of Economy, Effi ciency and Effectiveness of the Use of Resources The CCG Governing Body receives monthly integrated performance reports which include use of comparative analysis including benchmarking to assess performance. Regular contract management processes are established with main providers to link service quality, performance and fi nancial management.

Review of the Effectiveness of Governance, Risk Management and Internal ControlAs Accountable Offi cer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG.

Review of the Effectiveness of Governance, Risk Management and Internal Control As Accountable Offi cer I have responsibility for reviewing the effectiveness of the system of internal control within the CCG.

Capacity to Handle Risk It is the policy of the CCG to identify, minimise, control and, where possible, eliminate risks that may have an adverse impact on patients, staff and the organisation. As Accountable Offi cer, I carry ultimate responsibility for all risks within the CCG. The CCG’s Risk Management Strategy defi nes the responsibilities for risk management within the organisation. Staff are required to undertake training for risks where relevant.

Training sessions are held and e-learning is available including for key topics such as health and safety, manual handling, basic life support, infection control, fi re safety, confl ict resolution and information governance. North Somerset CCG employees must attend the courses or undertake e-learning on an annual, bi-annual, or three-yearly basis, as appropriate to their role. A report on training is provided to the Quality and Assurance Group on a six monthly basis, which shows the staff uptake on the mandatory training programme.

The Risk Management Strategy requires identifi cation, management and minimisation of events or activities which could result in unnecessary risks to patients, staff, visitors and members of the public. North Somerset CCG is committed to possessing the attributes associated with an active learning organisation where lessons learned are embedded into the organisation’s culture and practice.

The CCG stance on risk levels (‘Risk Appetite’) varies throughout the organisation with an overall aim for an ‘open appetite’ in which risk of varying levels is considered and, where appropriate accepted and managed, particularly when there is a benefi t to patients. Wherever possible the CCG will mitigate and control risk and will be open and honest about the risk and rewards.

Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, the executive managers and clinical leads within the CCG, who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports.

The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the CCG achieving its principle objectives, have been reviewed.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and Quality and Assurance Group and a plan to address weaknesses and ensure continuous improvement of the system, is in place.• The Audit Committee agrees an annual plan

for work to be undertaken by internal audit focusing on areas of particular concern or risk. Reports are made to the committee on audit fi ndings with assurance and recommendations being given. Discussions are also held with the external auditors regarding their audit plans and regular reports are made to the audit committee on

progress and fi ndings.• The Clinical Commissioning Leadership

provides a bridge between the clinical leaders and senior CCG management. It represents the clinical expertise of the CCG and considers, for example, development and delivery of Quality, Innovation, Productivity and Prevention (QIPP); service redesign and transformation of health and social care system; development of the Annual Commissioning Plan to refl ect health needs of the population; and the CCG’s vision and strategy, overseeing and being assured that effective risk management is in place including the monitoring of mitigating actions, monitoring of fi nancial performance, activity and quality against the local plan.

• The Quality and Assurance Group reports to the Governing Body on the development, implementation and monitoring of integrated governance by providing assurance on the systems and processes by which the CCG leads, directs and controls its function in order to achieve organisational objectives, safety and quality of services, and in which they relate to the wider community and partner organisations.

• Internal Audit and the Counter Fraud Service provide assurances through their reports on various aspects of internal control to the Audit Committee. These reports also provide assurances and support for the work undertaken by the external auditors.

• The Governing Body receives regular reports on signifi cant risks identifi ed through the risk register, assurance framework reports, clinical and non-clinical incident reports, monthly fi nancial reports, monthly performance reports and minutes from each of the committees.

• The Clinical Commissioning Leadership Group, Audit Committee and Quality and Assurance Group undertake an annual self assessment of performance which is reviewed by the Governing Body.

• The CCG purchases a range of fi nancial support services from South, Central and West Commissioning Support Unit. An Independent Service Auditor’s ISAE 3402 third party assurance report has been provided for the period 1 April 2014 to 1 March 2015.


50 51


• Apart from the specifi c areas highlighted below, the 2014/15 Independent Service Auditor’s report provided by Deloitte to NHS England, dated 17 November 2014, provides assurance in respect of the services provided by SCWCSU for the period between 1 April 2014 and 30 September 2014, which supports the CCG’s Annual Governance Statement.

• The controls related to the following control objectives were not achieved during the period from 1 April 2014 to 30 September 2014:- Clinical providers managed by the CSU

on the CCGs’ behalf are paid only for services delivered in accordance with the approved contract or SLA.

- New users for Windows Active Directory are authorised, and leavers are removed in a timely manner.

- Changes to CCG staff grades, hours, and spinal point data are valid and appropriate

- General ledger balances are accurate and appropriate

- Access to ISFE is appropriate and in line with CCG requirements

- Sales invoices raised are valid and appropriate

- Credit notes raised are valid and appropriate

- Cash fl ow forecasts are reasonable and up to date

- The quality and patient safety information reported to CCG Quality and Governance Committees is quality

checked prior to submission to CCG

• Apart from the specifi c areas highlighted below, the 2014/15 Independent Service Auditor’s report provided by Deloitte to NHS England, dated 17 May 2015, provides assurance in respect of the services provided by SWCSU for the period between 1 October 2014 and 31 March 2015, which supports the CCG’s Annual Governance Statement.

• The controls related to the following control objectives were not achieved during the period from 1 October 2014 to 31 March 2015:- CCG new starters added to the payroll

are valid and added in a timely manner- Changes to CCG staff grades, hours

and spinal point data are valid and appropriate

- Access to ISFE is appropriate and in line with CCG requirements.

- Updates on quality management and responsibilities are provided to the Quality and Patient Safety team.

- The quality and patient safety information reported to CCG Quality and Governance Committees is quality checked prior to submission to CCG.

- Physical access to computer networks and equipment is restricted to authorised individuals

- Access to Windows Active Directory including access by administrators is restricted to authorised individuals.

Following completion of the planned audit work for the fi nancial year for the CCG, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the CCG’s system of risk management, governance and internal control. The Head of Internal Audit concluded that signifi cant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design and/or inconsistent application of controls put the achievement of particular objectives at risk.

In providing an opinion for the 2014/15

fi nancial year, it is important to refl ect on the environment in which the CCG has been required to function and the impact such an unprecedented period of change and development will have on the operation of control. However, the system of internal control is designed to manage risk to a reasonable level rather than eliminate all risk of failure.

Data Quality The CCG has developed an integrated performance report which includes service quality, contract performance, fi nancial performance and progress against Quality, Innovation, Prevention and Productivity (QIPP) initiatives.

South, Central and West Commissioning Support Unit provides a business intelligence service to the CCG which supports the management of contract and other data and the production of performance information. This service includes data validation and contract challenges which are then refl ected in the reported positions.

Data Security North Somerset CCG has achieved a satisfactory level of compliance with information governance standards as measured by the information governance toolkit. This includes training for staff and having appropriate policies and procedures in place during the year.

Discharge of Statutory Functions Following the Harris Review, the CCG reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislation and regulations. I can confi rm that the CCG remains clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restriction on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead offi cer. Offi cers have confi rmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties, supported where appropriate by resources

commissioned from the CSU.

North Somerset CCG has failed to achieve its statutory duty in regard to fi nancial performance in 2014/15.

The measures implemented in 2014-15 in support of fi nancial recovery are largely non-recurrent and therefore the CCG has developed a strategic service plan that recognises the need for transformational reform of the health and social care economy over the next fi ve years. This plan describes recurrent balance being achieved in year three and delivery of a surplus in year fi ve. Throughout this period the CCG expects to have a positive cash fl ow and maintain compliance with the Better Payment Performance standard. On this basis the CCG can demonstrate it remains a going concern.

Signifi cant Control Issues The external auditors have issued a report under section 19 of the Audit Commission Act 1998 to Secretary of State for Health because they had a reason to believe that North Somerset CCG expected to breach its revenue resource limit for the year ending 31 March 2015.

At the end of the 2014-15 fi nancial year the CCG reported that it has not met its statutory fi nancial target to achieve a balanced fi nancial position. The CCG’s fi nancial plan for 2014-15 was for a revenue defi cit of £10m. During the year the CCG has consistently forecast a defi cit of £10m and the actual position reported is an overspend of £9.96m.

ConclusionWith the exception of the above issue no signifi cant internal control issues have been identifi ed.

Dr Mary BackhouseAccountable Offi cer26 May 2015


52 53


Proactive Care and Prevention Planned Care Urgent CareObjectives • Working with people to help them manage their own health

Working with North Somerset Council to extend the health and social care offer

• Effective information sharing between providers, community services and the public

• Increased working with the Third Sector

• Developing new pathways of care

• Developing alternatives to referral

• Reducing the amount of referrals

• Reducing variation in referrals

• Ensuring everyone knows guidelines

• Everyone knows how to access urgent care and has easy access to appropriate services

• Consider Keogh A&E Care Review and put plans in place for local implementation of recommendations

• Patients are consistently managed at the right time in the right place

• Increased number of patients appropriately supported in the community

• Reduced number of unplanned admissions

Two Year Plan Proactive Interventions• Integrated health and social care• Specialist Older People Team • Improving End of Life pathway• Review single point of access to include children’s and mental health services• Appropriate use of residential/nursing homes beds with nursing and therapy

support available to reduce length of stay and avoid admission to hospital• Rehabilitation and reablement• Extension of health and social care provision including seven day working

provision• Supporting carers• Increasing our level of support to those with mental health needs and

learning disabilities• Mental health and dementia pathways• Work with primary care in developing community locality schemes• Development of the Community Triage Support Team• Increasing number of specialist teams/expertise – mental health nurse, IV

teams• Children and maternity pathways• Increasing our commissioning with the third sector and voluntary sector• Improving dementia care at home• Improving adult mental healthcare at home• Risk profi ling and proactive care

Planned Interventions• Development and delivery

of Map of Medicine pathway and referral system across all areas

• Mental health and dementia pathways

• Ophthalmology pathways• Review dermatology

pathway• Trauma and orthopaedics/

MSK new model• BNSSG spinal review• Diabetes new model• New pathway for DVT• Expand use of advice and

guidance• INNF – extension• Review of RSS• Improved access to

diagnostics• Reduced elective capacity

Urgent Interventions• Sustain high quality services that meet urgent and emergency

care needs• Ensure effective contracting for and clinical use of ambulatory

emergency care • ED Front Door – 30% reduction of ED attendances• Maximise potential impact of Frail Older People Team as part

of whole system support to clinical care of older people• Determine most effective model for clinical support to

residential and nursing care homes • Develop consistent approach to shared records through –

“Connecting Care” and PMCF• Develop consistent approach to LTC Care Planning, specifi cally

Advanced Care Plans• Maintain strong focus on system performance management• Consider how primary care capacity can be enhanced through

co-commissioning and PMCF• Ensure effective delivery of NHS 111• Enhance community support to hospital discharges by

commissioning rehabilitation and NWB pathways seven day working

Key Groups Older people, mental health, learning disabilities, childrenFive Year Plan Key Interventions

Centre of Excellence Maternity Urgent Care Centre

Enablers • Building sustainability • Performance management• Patient experience• Quality monitoring• Medicine Management/ optimisation• Organisational Development• Governance – IG and Clinical• Knowledge Management, research and evidence - Work with Science

Network• Training/ education• Business and Administrative Support

• Primary Care development• Co-commissioning • Communication plan/ Engagement/ Relationship Management• BNSSG working• Working with Local Authority/ Transformation Challenge• IT – operational and strategy/ programmes/ Assistive Technology• Developing workforce• Utilising NHS capital assets• Ensuring equality and diversity• Risk stratifi cation• Clinical Audits

Appendix 1: Plan on a Page Strategic Priorities:Developing a model of care which is clinically safe and sustainable Achieving fi nancial sustainabilityImproving health outcomes and reducing inequalities Make the most effective use of limited resources


54 55


Appendix 2: Sustainability Report

Introduction Sustainability has become increasingly important as the impact of peoples’ lifestyles and business choices are changing the world in which we live. We acknowledge this responsibility to our patients, local communities and the environment by working hard to minimise our footprint.

Policies In order to embed sustainability within our business it is important to explain where in our process and procedures sustainability features.

In January 2014, the Sustainable Development Unit (SDU) published a strategy for the Health, Public Health and Social Care Systems. The strategy describes a vision for a sustainable health and care system by reducing carbon emissions, protecting natural resources, preparing communities for extreme weather events and promoting healthy living and environments.

An integrated metrics approach-measurement allows both an understanding of the scale of progress and an understanding of economic, environmental and social benefi ts. The SDU has proposed an approach that is aligned across the NHS, public health and social care and which provides an understanding across the whole system of where there are opportunities, actions and gaps. A consultation document was produced in May 2014 and the metrics module in January 2015. The CCG continues to work with key stakeholders including Public Health and Social Care to develop a joint plan for the wider health and care system.

AreaIs sustainability considered?

Travel YesProcurement (environmental) YesProcurement (social impact) YesSuppliers’ impact Yes

One of the ways in which an organisation can embed sustainability is through the use of a Sustainable Development Management Plan (SDMP). The CCG also continues to develop a this piece of work.

Climate change brings new challenges to our business both in direct effects to the healthcare estates, but also to patient health. Examples of recent years include the effects of heat waves, extreme temperatures and prolonged periods of cold, fl oods, droughts, etc. The organisation aims to work proactively in regard to planning for future climate change risks affecting our area.

Appendix 3: Workforce Equality Report

The following report is an analysis of workforce data held on employees of North Somerset Clinical Commissioning Group (CCG) as at March 2015. The focus is on seven of the nine characteristics protected by the Equality Act 2010, namely: race (ethnic origin); disability; sex; gender identity; sexual orientation; religion or belief and age. No analysis has been attempted on two of the protected characteristics: marriage/civil partnership and pregnancy/maternity.

North Somerset CCG employed 67 people in March 2015. This total includes Governing Body members who do not have a standard contract of employment, but are remunerated as contractors. For convenience, such individuals are treated as employees in this report. The report is organised into the following sections:

1. Workforce profi le as at 10 March 20152. Recruitment monitoring: 1 April 2014 to 31

March 20153. Leavers: 1 April 2014 to 31 March 20154. Employee experiences5. Conclusions.

Generally speaking, the information on which this report is based has been given voluntarily by individuals when applying for a post with the organisation. This information is recorded on the NHS Jobs recruitment database. Once an applicant is appointed, the information is transferred onto another database, the Electronic Staff Record (ESR).

Due to the small numbers involved, it is important to treat the percentages given with some caution - a small change in number could lead to a large change in the percentage. 1. Workforce profi le as at 10 March 2015North Somerset Clinical Commisioning Group employed 67 people on 10 March 2015. The following table illustrates the state of statistical information held on the ESR database for these employees. Where the cells are shaded, there is insuffi cient information to carry out any meaningful analysis. The focus, then, must be to try to increase the level of employee disclosure against these characteristics.

NB: “Working age”, for the purposes of this table, means 16-64 years.

Group descriptionAnaylsis of work-

force as at 10 March 2015

North Somerset population

(fi gures for 2011)

Characteristic Total Workforce or Population100%

(67 employees)100%

(202,566 people)

Ethnic Origin

White British 82.1%94.1% (all ages)

93.3% (working age)Black or Minority Ethnic (excluding ‘White Irish’ or ‘Other White’ groups)

Less than 2.7%2.7% (all ages)

2.9% (working age)White Irish or Other White Ethnic Origin

Less than 3.2%3.2% (all ages)

3.8% (working age)

Unknown Ethnic Origin 14.9%0%

0% (working age)

Disability

People with a limiting long-term illness on Electronic Staff Record

3%19.2% (all ages)

13% (working age)Unknown 41.8% 0%

People with limiting long-term illness in staff survey (Sept-Dec 2014)

15% (survey response 66%)

13% (working age)


56 57


*2005 Treasury estimate for the UK population, reported on Stonewall’s website (2013)

Group descriptionAnaylsis of work-

force as at 10 March 2015

North Somerset population

(fi gures for 2011)

Sex All population, all ages20.9% male

79.1% female49% male

51% femaleGender Identity

Transgender populationInformation not

availableInformation not

available

Sexual Orientation

Lesbian, Gay or Bisexual 0% 6.0%*Heterosexual 49.3% 94%*Unknown 50.8% 0%

Religion or belief

Christian 34.3% 61%Other religion or belief 3.0% 1.5%No religion or belief 7.5% 30%Unknown 55.2% 7.5%

AgeAged 0-15 0% 18.1%Aged 16-64 100% 60.9%Aged 65+ (Aged 85+) 0% 21.0% (3.2%)

Ethnic origin and data qualityThe table above shows that we have robust workforce data on age and sex only (unshaded cells). The percentage of employees identify themselves as Black or Minority Ethnic (BME) is below the BME population fi gure of 2.7%. This is the same for the “White Irish or Other White” group (2011 National Census). Such small numbers shoud be treated with some caution, however, especially since the ethnic origin of around 15% of employees is unknown. On a positive note, 15% represents a signifi cant reduction from the 23% “unknown ethnic origin” recorded a year ago (March 2014).

This improvement in data quality is a result of the data validation exercise carried out, on behalf of the CCG, by South West Commissioning Support. Signifi cant improvements have also been achieved in relation to the proportion of employees with “unknown” characteristics in relation to:• Disability (down from 77 to 42%)• Religion or belief (down from 89 to 55%)• Sexual orientation (down from 86 to 51%).

DisabilityFor people with a limiting long-term illness, information available on the ESR still contains

too many “Unknowns” to be useful (42%). However, in the most recent (2014) staff survey (completion rate 66%), 15% of employees reported having a limiting long-term illness. This is the same rate as that reported in the 2013 staff survey and is approximately in line with the proportion of North Somerset’s working age population with a limiting long-term illness. Of the small number of employees requiring adjustments to enable them to carry out their work, 25% said that they had been made.

This response rate suggests that, under suitable conditions, employees are prepared to disclose their disability status. Similarly, only 15% of respondents to the staff survey preferred not to disclose their religion or belief and 12% chose not to disclose their sexual orientation; this compares with 55% and 51% respectively of employees on the ESR.

Head count and percentage breakdown by sex

14 Males21%

53 Females79%

Source: ESR 0

20

40

60

80

100Bands 8, 9, VSM

Bands 5-7

Bands 1-4

All Staff %Male %Female %

Sex and payband

30 29 22

26

71

28

4943G

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ipti

on Analysis of Workforce as at

10 March 2015

No

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So

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on

(fi g

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All staff

Senior Managers (staff in

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Very Senior

Managers (staff on non-AfC grades

Female 79% 90% 38.5% 51%Male 21% 10% 61.5% 49%

Women have traditionally formed the majority of the NHS workforce and this is equally true for CCGs. Such overrepresentation can be seen as a positive, as the NHS offers opportunities which appear to be less available to women in many other sectors of the UK economy. Such opportunities include: professional careers, managerial roles, fl exible working, relative job security and competitive terms and conditions.

It is revealing, however, to analyse the distribution of female and male employees throughout the different paybands.

Sex and paybandIn the following table: • “AfC” means Agenda for Change• AfC Bands 8A and above are usually

described as senior management grades, although there is a signifi cant range in pay rates between the bottom of Band 8A and the top of Band 9

• “Staff on non-AfC grades” refers to very

senior managers and those on ad hoc salary grades: this group would include clinical leads.

Women make up 79% of the total workforce and 90% of senior managers; but only 38.5% of Very Senior Managers/Clinical Leads (staff on non AfC grades).

This is an indication of occupational segregation which sees women slightly overrepresented at senior management levels but signifi cantly underrepresented at very senior levels. For example, most of the CCG’s clinical leads are men.

Occupational segregation by sex is further evidenced by a more detailed analysis of the grades and working patterns of female and male employees (see charts).

Female employees are more evenly distributed throughout the paybands than male employees. The majority of the CCG’s male employees (71%) are on senior management or VSM/ad hoc salary grades. Only 43% of female employees are on these grades.

All other men (29%) are employed at paybands 5-7. There are no men at the lower paybands (1-4).

Thirty percent of women are employed at paybands 3 and 4 (there are no employees at paybands 1 and 2).

Source: ESR


58 59


Sex and hours workedMen are much more likely to work part-time than women (64% of men vs 43% of women). However, all of the part-time male employees are on the VSM/ad hoc salary grades, e.g. clinicians who spend part of their time working with the CCG and the rest of their time in practice. Part-time female employees are more evenly distributed throughout the paybands.

Ethnic origin and paybandAbout half of all staff are employed at senior management or VSM/ad hoc salary grades; the other half are employed at bands 1-7. Since the ethnic origin of 15% of employees is unknown, and the number of non-White employees is very small, any breakdown of payband by ethnic origin would be misleading.2. Recruitment monitoring: 1 April 2014

to 31 March 2015During 2014-2015, there were 222 job applicants to the CCG, 94 of whom were shortlisted for interview. Twenty shortlisted candidates were appointed.

Recruitment success of job applicants by ethnic originThe percentage of appointed applicants with an “unknown” ethnic origin has reduced dramatically from 60% in 2013-14 to 5% in 2014-15. This helps us to analyse the comparative success of different ethnic groups in being appointed following shortlisting and interview (see the chart below).

Looking at the shortlisting success rates, White British applicants were disproportionately likely to be shortlisted for interview during the

0

20

40

60

80

100Full time

Part time

Male %Female %

Sex and hours worked

57

4364

36

Source: ESR

0

20

40

60

80

100 Unknown ethnic origin

BME

White Irish or Other

White British

Appointed %Shortlisted %Applications %

Recruitment success of job applicants by ethnic origin

75

10132 1

811

80 90

5

50

Source: NHS Jobs

year, making up 75% of applicants and 80% of shortlisted candidates (the equivalent fi gures for the previous year were 70% and 86%).

White Irish and Other White applicants were the next most successful group (10% of applicants and 11% of shortlisted candidates). At 10%, the proportion of applicants is much higher than the 3.8% representation of this group in North Somerset’s working age population (2011 National Census).

Although Black and Minority Ethnic (BME) communities make up just 2.9% of North Somerset’s working age population, BME applicants to the CCG made up 13% of the total. The BME success rate was comparatively low, making up only 8% of those shortlisted for interview; however, this is up from the 4.5% shortlisted during the previous year.

For many of the BME subgroups, it is not possible to say what proportion of applicants was excluded from being shortlisted because of ineligibility to work in the UK under immigration rules. This factor is likely to have helped to lower the percentage of BME applicants counted as being shortlisted.

Ninety percent of those appointed following interview described themselves as White British

(compared with 80% of shortlisted candidates). No BME applicants were appointed and 5% of appointees were White Irish or Other White.

Recruitment success of job applicants by sexWomen, at 72% of the total, were more likely to apply to the CCG than men (27%). Female and male applicants were equally likely to be shortlisted; with male applicants being much less likely to be appointed, at 10% of all appointments.

Recruitment success of job applicants by disability statusApplications were received from people with physical impairments, sensory impairments, mental health conditions, learning diffi culties and long-standing illnesses. In all, disabled applicants made up 8% of the total and were more successful at being shortlisted (12%) than non-disabled applicants. However, only 5% of candidates appointed following interview identifi ed themselves as disabled.

Only 2% of applicants and 5% of new starters did not disclose their disability status (compared with 42% of current employees for whom disability status is unknown).

0

20

40

60

80

100Unknown

Female

Male


Recruitment success of job applicants by sex

1 1 5

72 73 85

27 2610

Source: NHS Jobs


60 61


Source: NHS Jobs

0

20

40

60

80

100Unknown

Not disabled

Disabled


Recruitment success of job applicants by disability status

8 12 5

90 86 90

522

Recruitment success of job applicants by age groupTen percent of applicants were aged under 25 (up from 1.9% the previous year). Six percent of shortlisted applicants fell into this age group, as did 5% of those appointed. Therefore, compared to other age groups, younger applicants were relatively unsuccessful at being appointed.

Four percent of applicants were aged 60+ (up from less than one percent the previous year). Four percent of shortlisted applicants fell into this age group, as did 5% percent of those appointed.

Recruitment success of job applicants by sexual orientationOnly 6% of applicants and 5% of new starters chose not to disclose their sexual orientation, signifi cantly down from 12% and 70% the previous year (see the chart opposite).

This helps us to analyse the comparative success of applicants, according to their sexual orientation, in being appointed following shortlisting and interview.

Four percent of applicants described themselves as lesbian, gay or bisexual (LGB). Their shortlisting success rate was relatively low

0

20

40

60

80

10060+

25-60

18-24


Recruitment success of job applicants by age group

4 4 5

86 90 90

10 6 5

Source: NHS Jobs

Source: NHS Jobs

Source: NHS Jobs

0

20

40

60

80

100 Unknown

Atheism

Other religion or belief

Christianity

Appointed % Shortlisted %Applications %

Recruitment success of job applicants by religion or belief

50 55 70

19 16519 19 15

12 10 10

(2%), compared with heterosexual applicants. However, LGB candidates were very successful at being appointed (5%), approximately in line with their application rate.

Recruitment success of job applicants by religion or beliefTwelve percent of applicants and 10% of new starters chose not to disclose their religion or belief, signifi cantly down from 15% and 75% the previous year.

These fi gures also compare very favourably with the 55% of current employees for whom religion or belief is unknown; helping us to analyse the comparative success of candidates in being appointed following shortlisting and interview. However, some caution is required,

0

20

40

60

80

100Unknown

Heterosexual

Lesbian, gay or bisexual

Appointed %Shortlisted %Applications %4

90

6 5

93

2 5

90

5

Recruitment success of job applicants by sexual orientation

given the still-signifi cant levels of “unknown” data (see chart below).

Roughly half of all applicants and shortlisted candidates described their religion as Christianity. The fi gures indicate that Christians were the most successful at being shortlisted, with those identifying with other religions and beliefs being slightly less successful.

Within the “Other religion or belief” category (19% of applicants), individuals identifi ed their beliefs as Buddhism, Islam, Hinduism, Sikhism and “Other”. Apart from Sikhism, each of these faiths was represented amongst the shortlisted candidates.


62 63


At 70%, Christians were signifi cantly overrepresented amongst candidates appointed following interview. At fi ve percent, those with an “Other religion or belief” were signifi cantly less successful at being appointed than candidates who identifi ed with Christianity or Atheism.

3. Leavers: 1 April 2014 to 31 March 2015There were 20 leavers during this period:• Fifteen of the 20 identifi ed themselves

as White British; three were from either another White background or they identifi ed as Black or Minority Ethnic (BME); with two not stating their ethnic origin

• Two identifi ed themselves as disabled; fi ve as not disabled; with 13 being undefi ned or unknown.

As with applicants, new starters and current employees, leavers can choose whether or not to disclose their personal characteristics. Compared to 2013-14:• the proportion of employees for whom

ethnic origin is unknown fell from 22% to 10%

• the proportion for whom disability status is unknown rose slightly from 55% to 65%.

From what data is available, there is no evidence that the equality profi le of the North Somerset CCG workforce is being signifi cantly affected by the profi le of leavers. However, the missing information highlights where an improvement in available information is desired.

4. Employee experiencesThe new NHS Workforce Race Equality Standard does not currently apply to CCGs, so there is no requirement to publish comparative data on the following aspects of the workplace experience. However, the following discussion presents a useful indicator of the CCG’s current ability to comply with any future requirement.

Relative likelihood of staff entering the formal disciplinary processThis is measured as “…entry into a formal disciplinary investigation (based on data from a two year rolling average of the current year

and the previous year)”.

As at 6 March 2015, North Somerset CCG had had no formal disciplinary hearings in two years. There were two investigations: one involved a White, non-disabled female and one involved a White, non-disabled male.

Relative likelihood of accessing non-mandatory training and continuing professional development (CPD)We are unable to comment meaningfully on this metric because:a. non-mandatory training is generally

provided by external providers and is not recorded on the CCG’s learning and development management system

b. there is only a small percentage of staff from a Black or Minority Ethnic background (or identifying as disabled).

The procedure for approving training requests is detailed in a policy and is subject to scrutiny. Although we do not currently monitor outcomes, we would hope that the likelihood of accessing training would be the same for every member of staff, regardless of any protected characteristic.

Harassment, bullying or abuseIn the 2014 NHS Staff Survey:• Nineteen percent of staff reported

experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months (compared to 8% for all commissioning organisations participating in the survey)

• Twenty two percent of staff reported experiencing harassment, bullying or abuse from managers or other colleagues in last 12 months (compared to 17% for all commissioning organisations)

• a breakdown of experiences by ethnic origin is not available in the Staff Survey Report for North Somerset CCG.

Equal opportunities and discriminationIn the 2014 NHS Staff Survey:• Ninety one percent of staff who expressed

an opinion believed that the organisation provides equal opportunities for career progression or promotion (compared to 89% for all commissioning organisations)

• a breakdown of experiences by ethnic origin is not available in the Staff Survey Report for North Somerset CCG

• no staff reported personally experiencing discrimination at work from their manager/team leader or other colleagues in the last 12 months (compared to 3% for all commissioning organisations).

5. ConclusionsThe high proportion of applicants, shortlisted candidates, new starters and current employees for whom equality information is not recorded, has been dramatically reduced, compared with one year ago. This was achieved by looking at the way equality profi le information is gathered and recorded.

A direct appeal was made to employees, explaining how the information given by individuals is used to produce high-level analyses, sharing with them our current workforce profi le, highlighting our data gaps, and providing reassurance about how personal information is handled confi dentially. Further improvements to data quality are being sought in relation to:• the ethnic origin, disability status, sexual

orientation and religion or belief of current employees registered on the ESR

• the religion or belief of applicants and new starters

• the ethnic origin and disability status of leavers.

As reported for 2013-14, it remains a concern that, whilst 13% of applicants to the CCG came from BME communities, only 8% of shortlisted candidates were from these communities and none were appointed. Also, whilst 10% of applicants came from White Irish or Other White communities, only 5% of appointments were from these communities.

Some work is required to uncover the causes of these discrepancies. As with the rest of the NHS, part of the reason will be that applicants with no right to work in the UK, many of whom will identify as BME or Other White, are automatically excluded from being shortlisted.

The CCG takes measures to prevent personal

characteristics, such as race, being considered in the shortlisting and interview processes; e.g. shortlisters do not see the part of the online application form which asks for this information. However, this does not prevent applicants from revealing such information in the “additional information” section of the form; neither does it prevent shortlisters from making assumptions based on applicants’ qualifi cations, place of study, previous employers, etc.

With 13% of the working age population having a limiting long-term illness, it is disappointing that the application rate for disabled applicants is only 8%, with an appointment rate of only 5%. The CCG has successfully applied for the disability “Two Ticks” standard, as a means of ensuring that any recruitment barriers for disabled people are identifi ed and addressed.

The proportion of applications from lesbian, gay, bisexual groups also appears to be lower than expected.

NHS England is currently discussing, with CCGs, the application of the Workforce Race Equality Standard to them (it currently applies to large, NHS provider organisations). It is unlikely that the standard will be applied in its current form, since the relatively low numbers employed by CCGs make the meaningful collection and analysis of these metrics problematic.

Generally speaking, a breakdown of employee experiences by ethnic origin is not available in the Staff Survey Report for North Somerset CCG. A more detailed report would be required in future if the CCG was to be in a position to publish these metrics.


64 65


Annual Accounts 2014-15

Entity name: North Somerset Clinical Commissioning GroupThis year 2014-15This year ended 31 March 2015This year commencing: 1 April 2014

ContentsThe Primary Statements: PageStatement of Comprehensive Net Expenditure for the year ended 31 March 2015 65Statement of Financial Position as at 31 March 2015 66Statement of Changes in Taxpayers’ Equity for the year ended 31 March 2015 67Statement of Cash Flows for the year ended 31 March 2015 68

Notes to the Accounts NoteAccounting policies 1 68FInancial performance targets 2 72Employee benefi ts and staff numbers 3 73Operating expenses 4 76Better payment practice code 5 77Operating leases 6 77Trade and other receivables 7 77Cash and cash equivalents 8 78Trade and other payables 9 79Financial instruments 10 79Operating segments 11 81Intra-government and other balances 12 82Related party transactions 13 83Losses and special payments 14 85

Statement of Comprehensive Net Expenditure for the year ended 31 March 2015

2014-15 2013-14Note £000 £000

Total Income and ExpenditureEmployee benefi ts 3.1.1 2,480 2,287Operating Expenses 4 261,552 247,994Other operating revenue (57) (123)Total Net Expenditure for the year 263,975 250,158

Of which:Administration Income and ExpenditureEmployee benefi ts 3.1.1 1,936 1,898Operating Expenses 4 3,231 3,177Other operating revenue 0 0Net administration costs before interest 5,167 5,075

Programme Income and ExpenditureEmployee benefi ts 3.1.1 544 389

Operating Expenses 4 258,321 244,817Other operating revenue 2 (57) (123)Net programme expenditure before interest 258,808 245,083

2014-15 2013-14£000 £000

Total comprehensive net expenditure for the year 263,975 250,158

The notes on pages 68 to 85 form part of this statement.

Description £000Notifi ed Resource Limit 254,015

Administration CostsEmployee benefi ts 1,936Operating Costs 3,231

Programme CostsEmployee benefi ts 554Commissioned services (net of income)

258,264

(Under)/Over spend against resources

9,960

Summary Financial Position

fourthdraft.indd 66-67fourthdraft.indd 66-67 05/06/2015 08:54:5205/06/2015 08:54:52

66 67


31 March 2015 31 March 2014Note £000 £000

Non-current assets: 0 0

Total non-current assetsCurrent assets:Trade and other receivables 7 1,228 3,956Cash and cash equivalents 8 51 12Total current assets 1,279 3,968

Total assets 1,279 3,968

Current liabilitiesTrade and other payables 9 (13,987) (18,193)Total current liabilities (13,987) (18,193)

Non-Current Assets plus/less Net Current Assets/Liabilities (12,708) (14,225)

Assets less liabilities (12,708) (14,225)

Fiananced by Taxpayers’ EquityGeneral fund (12,708) (14,225)

Total taxpayers’equity: (12,708) (14,225)

The CCG has held no non-current assets in 2014/15, these were impaired by the CCG during 2013-14.

The notes on pages 68 to 85 form part of this statement.

The fi nancial statements and the notes on pages 65 to 85 were approved by the Governing Body on 26 May 2015 and signed on its behalf by:

Chief Accountable Offi cerDr Mary Backhouse

Statement of Financial Position as at 31 March 2015

General fund

Total reserves

£000 £000Balance at 1 April 2014 (14,225) (14,225)Adjusted NHS CCG balance at 1 April 2014 (14,225) (14,225)

Changes in NHS CCG taxpayers’ equity for 2014-15

Net operating expenditure for the fi nancial year (263,975) (263,975)Net Recognised NHS CCG Expenditure for the Financial Year

(263,975) (263,975)Net funding 265,492 265,492Balance at 31 March 2015 (12,708) (12,708)

General fund

Total reserves

£000 £000

Changes in taxpayers’ equity for 2013-14

Balance at 1 April 2013 0 0

Changes in NHS CCG taxpayers’ equity for 2013-14Net operating costs for the fi nancial year (250,158) (250,158)Transfers by absorption to (from) other bodies 127 127Net Recognised NHS CCG Expenditure for the Financial Year (250,031) (250,031)Net funding 235,806 235,806Balance at 31 March 2014 (14,225) (14,225)

Statement of Changes in Taxpayers Equity for the year ended 31 March 2015


68 69


2014-15 2013-14Note £000 £000

Cash Flows from Operating ActivitiesNet operating expenditure for the fi nancial year (263,975) (250,158)Impairments and reversals 4 0 127(Increase)/decrease in trade and other receivables 7 2,728 (3,956)Increase/(decrease) in trade and other payables 9 (4,206) 18,193Net Cash Infl ow (Outfl ow) from Operating Activities before Financing (265,453) (235,794)

Cash Flows from Financing ActivitiesParliamentary Funding Funding Received 265,492 235,806Net Cash Infl ow (Outfl ow) from Financing Activities 265,492 235,806Net Increase (Decrease) in Cash & Cash Equivalents 8 39 12

Cash and Cash Equivalents at the Beginning of the Financial Year 12 0Cash and Cash Equivalents (including bank over-drafts) at the End of the Financial Year 51 12

The following notes on pages 68 to 85 form part of this statement

Statement of Cash Flows for the year ended 31 March 2015

Notes to the fi nancial statements

1. Accounting PoliciesNHS England has directed that the fi nancial statements of CCGs shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following fi nancial statements have been prepared in accordance with the Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to CCGs, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate

to the particular circumstances of the CCG for the purpose of giving a true and fair view has been selected. The particular policies adopted by the CCG are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going ConcernThe CCG did not meet its breakeven duty of fi nancial plan for 2014-15 but delivered the out-turn agreed with NHS England recognising its inherited fi nancial defi cit. For 2015-16, the CCG does not expect to achieve its breakeven duty but has agreed a defi cit fi nancial plan with NHS England. These accounts have been prepared on the going concern basis despite the issue of a report to the Secretary of State

for Health under Section 19 of the Audit Commission Act 1998 for the anticipated or actual breach of fi nancial duties.

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of fi nancial provision for that service in published documents.

Where a CCG ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the fi nal set of Financial Statements. If services will continue to be provided the fi nancial statements are prepared on the going concern basis.

1.2 Accounting ConventionThese accounts have been prepared under the historical cost convention.

1.3 Critical Accounting Judgements & Key Sources of Estimation UncertaintyIn the application of the CCG’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.3.1 Critical Judgements in Applying Accounting PoliciesCritical accounting judgements are continually evaluated and are based on historical experience and other relevant factors, including expectations of future.

1.3.2 Key Sources of Estimation UncertaintyThere are no other sources of estimation uncertainty that have a signifi cant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next fi nancial year that require disclosure.

1.4 RevenueRevenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.

Where income is received for a specifi c activity that is to be delivered in the following year, that income is deferred.

1.5 Employee Benefi ts1.5.1 Short-term Employee Benefi tsSalaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is recognised in the fi nancial statements to the extent that employees are permitted to carry forward leave into the following period.

1.5.2 Retirement Benefi t CostsPast and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defi ned benefi t scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defi ned contribution scheme: the cost to the CCG of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is


70 71


charged to expenditure at the time the CCG commits itself to the retirement, regardless of the method of payment.

1.6 Other expensesOther operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

Expenses and liabilities in respect of grants are recognised when the CCG has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.

1.7 Leases Leases are classifi ed as fi nance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classifi ed as operating leases.

1.7.1 The Clinical Commissioning Group as LesseeOperating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or fi nance leases.

1.8 Cash and Cash EquivalentsCash is cash in hand and deposits with any fi nancial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignifi cant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the CCG’s cash management.

1.9 Clinical Negligence CostsThe NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with the CCG.

1.10 Continuing healthcare risk poolingIn 2014-15 a risk pool scheme has been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme CCGs contribute annually to a pooled fund, which is used to settle the claims.

1.11 Financial AssetsFinancial assets are recognised when the CCG becomes party to the fi nancial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are classifi ed into the following categories:• Financial assets at fair value through profi t

and loss;• Held to maturity investments;• Available for sale fi nancial assets; and,• Loans and receivables.

The classifi cation depends on the nature and purpose of the fi nancial assets and is determined at the time of initial recognition.

1.11.1 ReceivablesReceivables are non-derivative fi nancial assets with fi xed or determinable payments which are not quoted in an active market.

1.12 Financial LiabilitiesFinancial liabilities are recognised on the statement of fi nancial position when the CCG becomes party to the contractual provisions of the fi nancial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised

when the liability has been discharged, that is, the liability has been paid or has expired.

1.13 TaxationThe CCG is not liable to pay corporation tax. Expenditure is shown net of recoverable Value Added Tax (VAT). Irrecoverable VAT is charged to the most appropriate expenditure heading or capitalised if it relates to an asset.

1.14 Losses & Special PaymentsLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.15 Accounting Standards That Have Been Issued But Have Not Yet Been AdoptedThe Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2014-15, all of which are subject to consultation:• IFRS 9: Financial Instruments• IFRS 13: Fair Value Measurement• IFRS 14: Regulatory Deferral Accounts• IFRS 15: Revenue for Contract with

CustomersThe application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year.


72 73


3. Employee benefi ts and staff members

3.1.1 Employee Benefi ts 2014-15

Total Admin Programme

Total

Perm

anen

t Em

plo

yees

Oth

er

Tota

l

Perm

anen

t Em

plo

yees

Oth

er

Tota

l

Perm

anen

t Em

plo

yees

Oth

er

£000 £000 £000 £000 £000 £000 £000 £000Employee benefi tsSalaries and wages 2,099 1,819 280 1,642 1,375 267 457 444 13Social security costs 157 157 0 128 128 0 29 29 0Employer contributions to NHS pension scheme 224 224 0 166 166 0 58 58 0Gross employee benefi ts expenditure 2,480 2,200 280 1,936 1,669 267 544 531 13

Total - Net admin employee benefi ts 2,480 2,200 280 1,936 1,669 267 544 531 13

2014-15 2014-15

Du

ty A

chie

ved

?

2013-14 2013-14

Du

ty A

chie

ved

?TargetPe

rfo

rman

ce Variance Target

Perf

orm

ance Variance

£000 £000 £000 £000 £000 £000Expenditure not to exceed income 254,072 264,032 (9,960) No 246,285 250,281 (3,996) NoRevenue resource use does not exceed the amount specifi ed in directions 254,015 263,975 (9,960) No 246,162 250,158 (3,996) NoRevenue administration resource use does not exceed the amount specifi ed in directions 5,178 5,168 11 Yes 5,150 5,075 75 Yes

2. Financial performance targets

NHS North Somerset CCCG have a number of fi nancial duties under the NHS Act 2006 (as amended).

NHS North Somerset CCG performance against those duties was as follows:

The CCG’s external auditors have written to the Secretary of State under Section 19 of the Audit Commission Act which was reported in public session at the Governing Body. This is because the CCG has not met its target revenue resource specifi ed in Directions to breakeven and has recorded a £9.96m defi cit against its Revenue Resource Limit of £254.015m.

Against its administration resource limit of £5.178m identifi ed for running costs, the CCG has underspent by £0.011m. During the fi nancial year 2014-15 the CCG did not receive any capital resource limit or incur any capital expenditure (2013-14 - Nil).

2013-14

Total Admin Programme

Total

Perm

anen

t Em

plo

yees

Oth

er

Tota

l

Perm

anen

t Em

plo

yees

Oth

er

Tota

l

Perm

anen

t Em

plo

yees

Oth

er

£000 £000 £000 £000 £000 £000 £000 £000Employee benefi tsSalaries and wages 1,921 1,753 168 1,606 1,438 168 315 315 0Social security costs 148 148 0 121 121 0 27 27 0Employer contributions to NHS pension scheme 218 218 0 171 171 0 47 47 0Gross employee benefi t expenditure 2,287 2,119 168 1,898 1,730 168 389 389 0

Total - Net admin employee benefi ts 2,287 2,119 168 1,898 1,730 168 389 389 0


74 75


Totalnumber

2014-15Permanently

employed

2013-14Other

numberTotal

Total 48 46 2 43

2014-15Number

2013-14Number

Total days lost 182 220Total staff years 42 38Average working days lost 4 6

2013-14 2013-14Compulsory

redundanciesTotal

Number £ Number £

£10,001 to £25,000 1 11,390 1 11,390

£50,001 to £100,000 1 73,455 1 73,455

Total 2 84,845 2 84,845

3.5.1 Accounting valuationA valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and fi nancial data for the current reporting period, and are accepted as providing suitably robust fi gures for fi nancial reporting purposes. The valuation of the scheme liability as at 31 March 2015, is based on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer contributions could continue at the existing rate of 14% of Pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their Pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to refl ect changes in the scheme’s liabilities.

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Offi ce.

3.5.3 Full actuarial (funding) valuationThe purpose of this valuation is to assess the level of liability in respect of the benefi ts due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates.

3.2 Average number of people employed

3.3 Staff sickness absence and ill health requirements

4.4 Exit packages agreed in the fi nancial year

This disclosure reports the number and value of exit packages taken by staff leaving in the year. All the above exit packages were in accordance with the provisions of NHS Staff Terms and Conditions or agreed under the national Mutually Agreed Resignation Scheme (MARS). MARS was developed in partnership with the Social Partnership Forum to help NHS employers manage cost reductions and the workforce implications of redesigning services. Where the Clinical Commissioning Group had agreed early retirements, the additional costs were met by the Clinical Commissioning Group and not by the NHS Pensions Scheme. Any Ill-health retirement costs would be met by the NHS Pensions Scheme.

Exit costs are accounted for in full in the year of departure.

3.5 Pension costsPast and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefi ts payable under these

provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defi ned benefi t scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defi ned contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

In order that the defi ned benefi t obligations recognised in the fi nancial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

There were no exit packages in 2014-15

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012.

The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

3.5.3 Scheme ProvisionsThe NHS Pension Scheme provided defi ned benefi ts, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefi ts provided by the Scheme or the specifi c conditions that must be met before these benefi ts can be obtained:

The Scheme is a “fi nal salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defi ned by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defi ned by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the 12 months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced by the Retail Prices Index (RPI).

Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of fulfi lling their duties effectively through illness or infi rmity. A death gratuity of twice fi nal year’s pensionable pay


76 77


for death in service, and fi ve times their annual pension for death after retirement is payable.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to

the employer.

Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

4. Operating expenses 2014-15Total

2014-15Admin

2014-15Programme

2013-14Total

£000 £000 £000 £000Gross employee benefi tsEmployee benefi ts excluding governing body members 2,029 1,485 544 1,883Executive governing body members 451 451 0 444Total gross employee benefi ts 2,480 1,936 554 2,287

Other costsServices from other CCGs and NHS England 3,271 2,699 573 2,529Services from foundation trusts 47,583 31 47,552 47,723Services from other NHS trusts 115,229 0 115,229 112,345Services from other NHS bodies 231 0 231 227Purchase of healthcare from non-NHS bodies 53,616 0 53,616 46,729Supplies and services - clinical 1,894 0 1,894 1,879Supplies and services - general 15 3 12 59Consultancy services 40 40 0 26Establishment 798 147 651 283Transport 137 0 137 236

Premises 209 162 47 566Impairments and reversals of property, plant and equipment 0 0 0 127Audit fees 81 81 0 73Other non statutory audit expenditure• Other services 31 31 0 0Prescribing costs 30,813 0 30,813 29,969GPMS/APMS and PCTMS 1,714 0 1,714 2,172Other professional fees excl. audit 40 36 4 74Grants to other public bodies 5,429 0 5,429 2,910Research and development (excluding staff costs) 54 0 54 52Education and training 10 1 9 15CHC Risk Pool contributions 356 0 356 0Total other costs 261,552 3,231 258,321 247,994

Total operating expenses 264,032 5,167 258,865 250,281

Capital Grants have been reclassifi ed since 2013/14 and the comparative fi gures are now

shown under Grants to other public bodies.

2014-15Number

2014-15£000

2014-15Number

2013-14£000

Measure of complianceNon NHS PayablesTotal non-NHS trade invoices paid in the year 3,896 61,955 3,503 52,664Total non-NHS trade invoices paid within target 3,775 61,318 3,344 51,903Percentage of non-NHS trade invoices paid within target 96.89% 98.97% 95.46% 98.55%

NHS PayablesTotal NHS trade invoices paid in the year 2,167 176,084 1,644 165,158Total NHS trade invoices paid within target 2,151 175,111 1,639 165,062Percentage of NHS trade invoices paid within target 99.26% 99.45% 99.70% 99.94%

5. Better Payment Practice Code

6. Operating Leases

6.1 As lessee6.1.1 Payments recognised as an expensePayments to NHS Property Services for the Building Lease were £125k in 2014/15 (2013/14 - £571k). While our arrangements with Community Health Partnerships Ltd and NHS Property Services Ltd fall within the defi nition of operating leases, the rental charge for future years has not yet been agreed. Consequently, this note does not include future minimum lease payments for these arrangements.

Current2014-15

Current2013-14

£000 £000NHS receivables: Revenue 190 826NHS payments and accrued income 748 759Non-NHS receivables: Revenue 141 95Non-NHS prepayments and accrued income 115 2,264VAT 16 12Other receivables 18 0Total trade and other receivables 1,228 3,956

Total current and non current 1,228 3,956

7. Trade and other receivables


78 79


2014-15 2013-14

£000 £000By up to three months 81 0By three to six months 22 0By more than six months 36 0Total 139 0

7.1 Receivables past their due date but not impaired

£86,205 of the amount above has subsequently been recovered post the statement of fi nancial position date.

2014-15 2013-14

£000 £000Balance at 1 April 2014 12 0Net change in year 39 12Balance at 31 March 2015 51 12

Made up of:Cash with the Government Banking Service 51 12Cash in hand 0 0Cash and cash equivalents as in statement of fi nancial position 51 12

Bank overdraft: Government Banking Service 0 0Total bank overdrafts 0 0

Balance at 31 March 2015 51 12

8. Cash and cash equivalents

Current2014-15

Current2013-14

£000 £000NHS payables: revenue 2,369 5,303NHS accruals and deferred income 1,657 1,922Non-NHS payables: revenue 534 581Non-NHS payables: capital 0 0Non-NHS accruals and deferred income: 9,339 10,237Social security costs 26 22Tax 26 23Payments received on account (1) 1Other payables 37 104Total trade and other payables 13,987 18,193

Total current and non-current 13,987 18,193

9 Trade and other payables

All payables are due within one year and are therefore current. Other payables include £36k (2013/14 - £28k) outstanding pension contributions at 31 March 2015.

10. Financial Instruments

10.1 Financial risk managementFinancial reporting standard IFRS 7 requires disclosure of the role that fi nancial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because NHS Clinical Commissioning Group is fi nanced through parliamentary funding, it is not exposed to the degree of fi nancial risk faced by business entities. Also, fi nancial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the fi nancial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and fi nancial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the fi nance department, within parameters defi ned formally within the NHS Clinical Commissioning Group standing fi nancial instructions and policies agreed by

the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

10.1.1 Credit riskBecause the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the fi nancial year are in receivables from customers, as disclosed in the trade and other receivables note.

10.1.2 Liquidity riskNHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are fi nanced from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to signifi cant liquidity risks.


80 81


Receivables Total2014-15 2014-15

£000 £000Receivables:• NHS 190 190• Non-NHS 141 141Cash at bank and in hand 51 51Other fi nancial assets 18 18Total at 31 March 2015 400 400

Receivables Total2013-14 2013-14

Receivables:• NHS 826 826• Non-NHS 95 95Cash at bank and in hand 12 12Other fi nancial assets 0 0Total at 31March 2014 933 933

10.2 Financial assets

Payables Total

2014-15 2014-15£000 £000

Payables:• NHS 4,025 4,025• Non-NHS 9,910 9,910Total at 31 March 2015 13,935 13,935

Other Total2013-14 2013-14

Receivables:• NHS 7,225 7,225• Non-NHS 10,818 10,818Cash at bank and in hand 0 0Other fi nancial assets 0 0Total at 31March 2014 18,043 18,043

Payables to other bodies Total

£000 £000In one year or less 13,935 13,935Total CCG at 31 March 2015 13,935 13,935

2014/15 Gross expenditure

Income Net expenditure

Total assets

Total liabilities

Net assets

£000 £000 £000 £000 £000 £000Commissioning of healthcare services 263,975 0 263,975 1,279 (13,987) (12,708)Total 263,975 0 263,975 1,279 (13,987) (12,708)

Reconciliation between Operating Segments and SoCNE 31 March 2015

31 March 2014

£000 £000Total net expenditure reported for operating segments 263,975 250,158Reconciling items: 0 0Total net expenditure per the Statement of Comprehensive Net Expenditure 263,975 250,158

Reconciliation between Operating Segments and SoFP 31 March 2015

31 March 2014

£000 £000Total assets reported for operating segments 1,279 3,968Reconciling items: 0 0Total assets per Statement of Financial position 1,279 3,968

31 March 2015

31 March 2014

£000 £000Total liabilities reported for operating segments (13,987) (18,193)Reconciling items: 0 0Total liabilities per Statement of Financial position (13,987) (18,193)

11 Operating segments

2013/14 Gross expenditure

Income Net expenditure

Total assets

Total liabilities

Net assets

£000 £000 £000 £000 £000 £000Commissioning of healthcare services 250,158 0 250,158 3,968 (18,193) (14,225)Total 250,158 0 250,158 3,968 (18,193) (14,225)


82 83


CurrentReceivables

CurrentPayables

2014-15 2014-15£000 £000

Balances with:• Other Central Government bodies 16 119• Local Authorities 71 568

Balances with NHS bodies:• NHS bodies outside the Departmental Group 347 1,426• NHS Trusts and Foundation Trusts 591 2,599Total of balances with NHS bodies 938 4,025• Bodies external to Government 203 9,275Total balances at 31 March 2015 1,228 13,987

12 Intra-government and other balances

CurrentReceivables

CurrentPayables

2013-14 2013-14£000 £000

Balances with:• Other central government bodies 257 746• Local Authorities 0 5

Balances with NHS bodies:• NHS bodies outside the Departmental Group 1,205 2,206• NHS Trusts and Foundation Trusts 380 5,019Total of balances with NHS bodies 1,585 7,225• Bodies external to Government 2,114 10,217Total balances at 31 March 2015 3,956 18,193

2014/15

Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from Related Party

£000 £000 £000 £000J Maynard Nailsea Family Practice 1,386 0 0 0

GP Care 143 0 0 0K Payne Portishead Medical Practice 2,049 0 0 0M Backhouse Nailsea Family Practice 1,386 0 0 0

GP Care 143 0 0 0T Ryan Portishead Medical Practice 2,049 0 0 0M Ainsworth Graham Road Surgery 1,415 0 0 0

GP Care 143 0 0 0K Haggerty Longton Grove Surgery 970 0 0 0J Heather New Court Surgery 1,788 0 0 0S Pill Clevedon Riverside Group 1,195 0 0 0

GP Care 143 0 0 0M O’Connor Long Ashton Surgery 690 0 0 0

GP Care 143 0 0 0J M Jenkins Riverbank Medical Centre 1,042 0 0 0

GP Care 143 0 0 0L Williams LG Williams Interim

Management & Consultancy 162 0 0 0G Snaith New Springs Management 99 0 0 0

13 Related party transactions


84 85


Total Number of Cases

Total Value of Cases


Total Value of

Cases2014-15 2014-15 2013-14 2013-14Number £000 Number £000

Claims abandoned 1 0 0 0Total 1 0 0 0


Total Value of Cases


Total Value of

Cases2014-15 2014-15 2013-14 2013-14Number £000 Number £000

Ex-gratia payments 1 6 0 0Total 1 6 0 0

2013/14

Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£000 £000 £000 £000

J Maynard Nailsea Family Practice 1,637 0 0 0GP Care 128 0 28 0

K Payne Portishead Medical Practice 2,450 0 15 0M Backhouse Nailsea Family Practice 1,637 0 0 0

GP Care 128 0 28 0T Ryan Portishead Medical Practice 2,450 0 15 0M Ainsworth Graham Road Surgery 1,693 0 0 0

GP Care 128 0 28 0K Haggerty Longton Grove Surgery 1,085 0 0 0J Heather New Court Surgery 2,108 0 0 0S Pill Clevedon Riverside Group 1,439 0 0 0

GP Care 128 0 28 0M O’Connor Long Ashton Surgery 849 0 0 0

GP Care 128 0 28 0J M Jenkins Riverbank Medical Centre 1,192 0 0 0

GP Care 128 0 28 0L Williams LG Williams Interim

Management & Consultancy 128 0 0 0

The Department of Health is regarded as a related party. During the year the Clinical Commissioning Group has had a signifi cant number of material transactions with entities for which the Department is regarded as the parent Department.

For example:• NHS England• NHS Foundation Trusts• NHS Trust• NHS Litigation Authority• NHS Business Services Authority.

In addition, the CCG has had a number of material transactions with other government departments and other central and local government bodies including North Somerset Council.

14. Losses and special payments

14.1 LossesThe total number of NHS North Somerset CCG losses and special payments cases, and their total value were:

14.2 Special Payments


North Somerset Clinical Commissioning Groupwww.northsomersetccg.nhs.uk01275 546770

If you need this document in another format, please contact the CCG on 01275 546770.

June 2015

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Annual Report 2014-15 - North Somerset CCG · PDF fileAnnual Report 2014-15 North Somerset CCG Constitution ... North Somerset CCG website at: Self-Certiﬁ cation by the Accountable