Govering Body Public Meeting Agenda Supplement 30 November ... · Governing Body – 30 November 2016 Page 1 of 4 Chair and Chief Officer Update 1. Sustainability and Transformation

Govering Body Public Meeting Agenda Supplement 30 November

Document Page

1 340 16 a Chair and CO Report 22 340 16 b CCO Report Appendix 1 IFR Update 63 340 16 c CCO Report Appendix 2 Community Declaration 94 340 16 d CCO Appendix 3 Children's Partnership Board 115 342 16 a Constitution and Governance Handbook - FS 196 342 16 b Constitution and Governance Handbook - Cover 207 342 16 c Constitution & Governance Handbook - App A 238 342 16 d Constitution & Governance Handbook - App B 279 342 16 e Constitution & Governance Handbook - App C 14410 342 16 f Constitution & Governance Handbook - App D 151

NHS Nottingham City Clinical Commissioning Group GB 340/16 Governing Body – 30 November 2016

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Chair and Chief Officer Update

1. Sustainability and Transformation Plan

A draft five-year plan for the future of health and social care in Nottingham and

Nottinghamshire has been developed.

The plan considers how we can best improve the quality of care, the health and wellbeing of

local people, and the finances of local services. This plan is a live document and will continue

to evolve.

The full Sustainability and Transformation Plan (STP) for Nottingham and Nottinghamshire,

the plan’s executive summary, and a summary guide are available here.1

2. HSJ Awards

Nottingham City CCG was a finalist in two categories of the 2016 Health Service Journal

(HSJ) Awards; CCG of the Year and Improved Partnerships between Health and Local

Government – a joint submission in association with partner organisations including

Nottingham City Council and Nottingham CityCare Partnership. The CCG was delighted to

win, alongside partners, the Improved Partnerships between Health and Local Government

award.

3. Individual Funding Requests – six monthly update

The CCG manages all individual patient funding requests using a consistent process, outlined

in the ‘Commissioning Policy for the Management of Individual Funding Requests’ (adopted

by all CCGs in the East Midlands). Most funding requests are managed by the Individual

Funding Requests Manager, or considered at the Individual Funding Requests Screening

Panel.

Attached at Appendix 1 is a report for Individual Funding Requests received from 1April – 30

September 2016.

4. CCG Assurance Process 2016/17

The CCG had its Quarter 2 assurance meeting with NHSE North Midlands on October 13

2016. The meeting focused on the key issues with respect to constitutional standards relating

to cancer and Accident and Emergency and on the CCG’s input to the development of the

Sustainable Transformation plan for Nottinghamshire. There was also a trial of conducting

the review in conjunction with the New Care Models Team which carries out assurance

meetings independently with the CCG on the Care Home Vanguards. However separate

assurance meetings with respect to the vanguard are still taking place.

1 or copy and paste the following link into your browser address bar

http://www.nottinghamcity.nhs.uk/about-us-284/publications/strategy-and-planning.html

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5. The Nottingham and Nottinghamshire Tobacco Control Declaration

Nottingham has made good progress in aspects of tobacco control, but smoking prevalence

remains significantly higher than the England average, resulting in significantly higher levels of

smoking related disease and premature mortality.

The Nottingham and Nottinghamshire Tobacco Control Declaration (supported by both Health

and Wellbeing Boards) is a commitment for local organisations to take action, a dedication to

protecting local communities from the harms caused by smoking, a demonstration of local

leadership and an acknowledgement of best practice. The Declaration seeks commitment to:

Actively support local work to reduce smoking prevalence and health inequalities

Develop plans with partners and local communities

Share action plans and commitments with communities and partners

Support government in taking action at a local level to help reduce smoking prevalence

and health inequalities

Recognise and where possible protect our tobacco control work from the vested interests

of the tobacco industry

Regularly monitor the progress of plans and commitments and share results

All key partners are encouraged to sign up to the declaration and commit to taking action on

tobacco both as individual organisations and in partnership. The Strategic Tobacco Control

Group is an established group involving a range of organisations, which works in partnership

to oversee the implementation of the Tobacco Control Strategy. Simon Castle, Assistant

Director of Commissioning – Cancer, Mental Health and Acute Contracts, currently represents

the CCG on this group.

The Governing Body is asked to agree Nottingham City CCG sign up to the Nottingham and

Nottinghamshire Community Tobacco Control Declaration (see Appendix 2) and to task

Simon Castle to lead on developing the CCG’s individual action plan. It is proposed that an

annual update on progress in implementing this plan is presented to the Governing Body.

6. RightCare – Wave 2

The CCG has been invited to participate in Wave 2 of the national roll out of RightCare. This

is a proven methodology to identify best practice and variation in care – especially planned

care. Greater Nottingham has already undertaken some work using RightCare methodology

as part of the STP development, but Wave 2 requires us to address 40% of identified

opportunities in the September 2016 RightCare pack by 2017/18 and 80% by 2018/19. As

part of this launch two introductory days are being held in London and Manchester with

clinical and managerial leads from each CCG attending to learn about the support available to

undertake this work.

7. RSA Inclusive Growth Commission

The RSA Inclusive Growth Commission is a high profile, independent inquiry chaired by

Stephanie Flanders, former Economics Editor of the BBC. Dr Hugh Porter attended the

Commission on behalf of One Nottingham on the 1 November. The Commission will seek to

identify a new model of place-based growth, ensuring as many people as possible are able to

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contribute to, and benefit from, local prosperity. Funded by Core Cities, Key Cities, LGA

(Local Government Association), JRF (Joseph Rowntree Foundation), PwC and London

Councils, the Commission strives to influence the new national government and identify how

local leaders can drive more inclusive prosperity.

8. Emergency Planning Resilience and Response - Self-Assessment Core Standards

In August the Governing Body approved the self-assessment against the core standards and

following the ‘confirm and challenge’ session with NHS England, the CCG have received “Full”

compliance. This is the same for all CCGs in Nottinghamshire who were jointly assessed.

Each year, CCGs are also required to carry out confirm and challenge sessions with providers

against the core standards, for whom they are the co-ordinating commissioner, and this was

managed by the CCG EPRR leads, Vicky Bailey, Chief Officer Rushcliffe and West CCGs and

Hazel Buchanan, Director of Operations, NNE CCG. Within Nottinghamshire, we were

required to carry out the ‘confirm and challenge’ sessions with NUH, SFH, NHT and

CityCare. The following are the outcomes of the sessions:

NUH – Full Compliance

SFH – Substantial Compliance

NHT – Full Compliance

CityCare – Substantial Compliance

A Trust receives substantial compliance when they cannot demonstrate achievement against

one to five of the standards. The standards not met by SFH and CityCare are not substantial

and both have action plans in place and are confident that they will be at Full compliance

within year.

This is a positive result for Nottinghamshire as there were providers in other areas of NHSE

North Midlands who were rated as either partially compliant or non-compliant. East Midlands

Ambulance NHS Trust Service has received “Full” compliance. The common themes that

came out of the sessions are training and how to co-ordinate more effectively across the

health system, managing evacuation and shelter and plans for pandemic flu.

9. The future of Clinical Commissioning

A paper from NHS Clinical Commissioners sets out a vision for the future of clinical

commissioning. The paper welcomes accountable care organisations and sustainability and

transformation plans, which it says will allow commissioners to work across the whole system

and deliver place-based commissioning of services for the benefit of patients.

http://www.nhscc.org/latest-news/future-of-commissioning/

10. Children’s Partnership Board

Attached at Appendix 3 are the minutes from the Children’s Partnership Board meeting held

on 31 October 2016.

Key issues discussed included:

(i) The need to meet the particular education needs and provide opportunities for Roma

children in the city.

(ii) Actions being carried out to reduce youth crime in Nottingham.

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http://www.nhscc.org/latest-news/future-of-commissioning/


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(iii) The work done with the Youth Cabinet and associated participation forums (including the

national Participation in Governance Programme) to enable and empower children and

young people to have a voice in decision making processes.

(iv) The Crime and Drugs Partnership’s intentions for commissioning the specialist young

people’s substance misuse treatment service.

(v) A proposed review of child development strategic commissioning following the transfer of

commissioning responsibilities for Health Visitors and the Family Nurse Partnership to the

City Council in October 2015.

(vi) Benefit and other support provided by the Department of Work and Pensions to young

people in Nottingham.

Dr Hugh Porter Dawn Smith

Chair Chief Officer

November 2016

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GB 340/16 Appendix 1

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Management of Individual Funding Requests Six-Monthly Report to Governing Body April to September 2016 Introduction As previously reported to Governing Body, CCGs are required to have a process for considering funding for individuals who seek NHS commissioned services outside of established commissioning policies and processes. A request for funding treatment may be received where there is no commissioning policy or where the medical condition is not included in a current policy or where the patient does not meet the criteria set out in the policy. In addition, requests are received that cover treatments within CCG commissioning policies, such as for example; Hip Arthroscopy, In Vitro Fertilisation, and treatment falling in the scope of the Procedures of Limited Clinical Value policy . By having an Individual Funding Request (IFR) process, NHS Nottingham City CCG has a robust mechanism for ensuring that all requests for funding are considered in a fair and transparent way, with decisions based on the best available evidence and in accordance with the CCG’s commissioning principles. The CCG manages all individual patient funding requests using this consistent process, contained in the ‘Commissioning Policy for the Management of Individual Funding Requests’ (adopted by all the CCGs in the East Midlands). The majority of funding requests are considered by the IFR team in accordance with CCG commissioning policies, or are considered at the IFR Screening Panel. During the first six months of 2016/17 the Screening Panel was made up of Andy Roylance (Commissioning Manager / IFR Manager) / Nick Davies (Interim Commissioning Manager) / Matt Schofield (Individual Care Packages Manager), Jack Dodson (Commissioning Support Officer), and Dr Ian Bowns (Consultant in Public Health Medicine) , supported by Public Health colleagues. The full IFR Panel was not convened for decision making purposes in the reporting period as no requests required Panel consideration. Panel members attended IFR training in July 2016 and used the September IFR Panel time slot as a developmental meeting to reflect on the training and consider a number of “practice” IFRs. Of the example IFR requests, one was a fertility request (reversal of sterilisation) and a request for Post Traumatic Stress Disorder treatment. The meeting also evaluated current processes and highlighted the need for the IFR policy to be reviewed and updated. At the subsequent regional IFR managers meeting, it was confirmed that policy review on a regional basis would follow an anticipated NHS England update for consistency., NHSE have recently launched a consultation into New Specialist Commissioning (including IFRs) – ending 15th January 2017. Following the outcome of this, new policy guidance is expected for 2017/18. In addition to the funding requests managed, the IFR team receive and manage many queries from patients, GP practices and hospital staff in relation to whether services are commissioned by the CCG, and whether individual patients are able to receive these services. Many queries relate to the CCG’s commissioning policies and patient eligibility e.g. In Vitro Fertilisation (IVF), Cosmetic Surgery, and Procedures of Limited Clinical Value. The team also manage requests for transport for patients travelling outside of the East Midlands for treatment who have a medical need for transport. In addition, the CCG’s team works

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closely with the NHS England team who manage requests for NHS funding for treatment abroad. Activity - April to September 2016 This table provides a breakdown of IFR total requests received and whether they were approved, and at which stage.

Total requests received 50

Status

Approved against policy / Service Level Agreement 36

Declined against policy / Service Level Agreement 13

Re-directed 0

Awaiting Screening (Further Information Required) 1

Outcomes

Approved at Pre-Screening against local policy 7

Approved at Screening Panel 29

Declined at Pre-Screening against local policy 2

Declined at Screening Panel 11

Awaiting Screening (Further Information Required) 1

Forwarded to IFR Panel to consider 0

Breakdown of Requests Received as IFRs

Medical Subject Number of Requests

Cardiovascular Disorders 1

Dermatology 1

Congenital Disorders 1

ENT 2

Fertility e.g. IVF, IUI, Gamete Cryopreservation 7

Gynaecology 1

Mental Health e.g. Post-Traumatic Stress Disorder (PTSD) Counselling

16 (13 PTSD)

Neuro e.g. Functional Electrical Stimulation, Epilepsy 6

Plastic Surgery e.g. ‘Exceptional’ Cosmetic Surgery requests

1

Rheumatology 4

Respiratory Medicine 2

Skeletal Disorders 6

Urology 1

Other 1

Total 50

Finance & IFR Budgets The IFR budget has funded cases totalling £16,487 for the period April-September 2016/17 (Q1/2). However, cases considered by the screening panel are also funded through other CCG budgets, considerably increasing expenditure. Patients who receive out of area treatment via an IFR do not appear in the IFR budget spend – this is accounted for via NHS out of area recharges & non-contracted activity (due to the SBS finance system coding rules).

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As well as cases approved in the current year, a number of patients are supported on an ongoing basis. As examples, we currently fund patients with Huntingdon’s disease, costing approximately £10,500 per month per patient and Cognitive Behavioural Therapy costing approx. £14,500 per year. Successful requests for fertility are funded through the budget for Fertility & IVF treatment. Complaints No complaints were received during the reporting period concerning funding decisions made by the IFR team. The team will continue to support the Patient Experience Team in relation to complaints received regarding the CCG’s commissioning policies and patient eligibility. Links to the CCG’s Commissioning Processes Where there are regular funding requests for a treatment or service, discussions are had with the relevant CCG commissioning team so that further consideration can be given to the commissioning of these, or a commissioning policy can be developed. Currently, Post Traumatic Stress Disorder (PTSD) requests form a large proportion of all requests. The 13 patients referred this year have had £16,900 allocated for their treatment. Approved requests from 2015/16 continue to have an impact on the 2016/17 budget. The Mental Health Commissioning Team is reviewing the cost effectiveness of commissioning a service, rather than considering individual requests through the IFR route. Matt Schofield Individual Care Packages Manager 11th November 2016

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Nottinghamshire County &

Nottingham City Declaration on

Tobacco Control

……………………………………. ………………………. (Insert name of organisation) acknowledge that:

Smoking is the single greatest cause of premature death and disease in our communities;

Reducing smoking in our communities significantly increases household incomes and benefits the local

economy;

Reducing smoking amongst the most disadvantaged in our communities is the single most important

means of reducing health inequalities;

Smoking is an addiction largely taken up by children and young people, two thirds of smokers start

before the age of 18; in Nottinghamshire County and Nottingham City approximately 3,600 11-15 years

olds take up smoking each year;

Smoking is an epidemic created and sustained by the tobacco industry, which promotes uptake of

smoking to replace the 1,700 people its products kill locally every year; and

The illegal trade in tobacco funds the activities of organised criminal gangs and gives children access to

cheap tobacco.

As local leaders with an interest in health we

welcome the:

Opportunity for local government and partners to lead local action to tackle smoking and secure the

health, welfare, social, economic and environmental benefits that come from reducing smoking

prevalence;

Commitment and leadership across Nottinghamshire County and Nottingham City in recognising the

importance of reducing tobacco use harm across our communities

Commitment by the government to protect the development of public health policy from the vested

interests of the tobacco industry (the World Health Organisation Framework Convention on Tobacco

Control (FCTC); and

Endorsement of this declaration by the local Health and Wellbeing Boards and partners.

From this date…………………………………………we commit to:

Declare our commitment to reducing smoking in our communities;

Act at a local level to reduce smoking prevalence and health inequalities and to raise the profile of the

harm caused by smoking to our communities;

Develop individualised actions plans to address the causes and impacts of tobacco use; and

Share actions plans and commitments with communities and partners;

Support action at a local level to help reduce smoking prevalence and health inequalities in our

communities;

Recognise and where possible protect our tobacco control work from the commercial and vested

interests of the tobacco industry; and

Regularly monitor the progress of our plans and commitments and share results.

Nottinghamshire County’s Health &

Wellbeing Board

Nottingham City’s Health & Wellbeing

Board

Endorsed by:

Signatory:

Position:

Appendix 2 GB 340/16

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NOTTINGHAM CITY COUNCIL CHILDREN'S PARTNERSHIP BOARD MINUTES of the meeting held at Loxley House, Nottingham on 31 October 2016 from 16.02 - 18.00 Cllr Mellen Portfolio Holder for Early Intervention and Early Years NCC Cllr Webster Portfolio Holder for Education, Employment and Skills NCC

Katy Ball Director of Commissioning and Procurement- NCC Alison Michalska Corporate Director of Children and Adults, NCC Helen Blackman Director of Children’s Integrated Services NCC

Patrick Fielding Sarah Fielding

Directors of Education NCC

Chris Wallbanks Strategic Commissioning Manager for Children NCC Jon Rea Engagement & Participation Lead NCC Dawnay Robinson Representative for Young People (Youth Cabinet)

Mike Manley Temporary Commander – City Division, Nottinghamshire Police Authority

Christine Oliver Commissioning Manager and Crime and Drugs Partnership

Sally Seeley Director of Quality and Personalisation NHS Nottingham City Clinical Commissioning Group

Chris Cook Independent Chair, Local Safeguarding Children Board

Julie Burton Deputy Head, National Probation Service Nottinghamshire

Jackie Newton Sally Pearce Scott Mason

Primary Schools’ representatives

David Stewart Special Schools’ representative

Sean Kelly Secondary Schools’ representative

John Yarham Chief Executive of Futures Advice, Skills and Employment Gaynor Rossiter Jobcentre Leader and Troubled Families Employment Advisor

(TFEA) Lead, DWP Job Centre Plus

Stephen McLaren Maria Ward

Voluntary Sector Representatives

Indicates present at meeting Colleagues, partners and others in attendance: Michelle Battlemuch - Nottingham CityCare Partnership Jane Daffe - Senior Achievement Consultant Bethan Hopcraft - Crime and Drugs Partnership Dot Veitch - Partnership Support Officer Phil Wye - Constitutional Services Officer

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GB 340/16APPENDIX 3

Children's Partnership Board - 31.10.16

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14 APOLOGIES FOR ABSENCE

Phyllis Brackenbury Julie Burton Scott Mason Jackie Newton Sally Seeley John Yarham 15 DECLARATIONS OF INTEREST

None. 16 MINUTES

The minutes of the meeting held on 13 July 2016 were confirmed as a true record and signed by the Chair. 17 EDUCATION AND ROMA COMMUNITIES

Jane Daffe, Senior Achievement Consultant, introduced the report, highlighting the following: (a) the Council used to have a dedicated Traveller Team, but the remit now falls under the

wider area of Vulnerable Groups;

(b) there are a number of particular issues that apply particularly to Roma communities. They have often had experience of persecution and discrimination, and so commonly do not identify themselves as Roma but as Polish or Other White Background;

(c) the highest number of Roma children are in the Forest Fields, Hyson Green and Sneinton areas, with Forest Fields primary being the school with the largest number on roll at 49. Due to the problem with ascription it is difficult to get accurate data;

(d) it is more common in Eastern Europe for children to start school at the age of 7 and so some Roma parents are reluctant to allow their children to attend school at an earlier age. At secondary age, some children are expected to take on family and carer responsibilities which take priority. Thera are also problems with accessing the school admissions process due to language and literacy problems;

(e) Roma children in Nottingham underachieve at school, particularly in writing. This is in contrast to other children with English as an additional language who are generally higher attainers in Nottingham;

(f) teenage pregnancy is a factor in the Roma community, with 21% of all school-age pregnancies in Nottingham in 2015-16 being Roma girls even though they only make up 0.4% of the school population. The age of consent in Hungary, Poland, Romania and the Czech Republic is lower, and there are traditional attitudes to sex and gender roles in the Roma community;

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(g) Roma children are 7 times as likely to be permanently excluded from school, and 6 times as likely to be excluded fixed-term. These high levels are similar to previous high levels of black Caribbean boys being excluded, so lessons that were learnt then could be applied here;

(h) possible interventions to improve the education and opportunities of Roma children in Nottingham include events for Gypsy Roma Traveller History Month (June), Schools guidance documents, transition to secondary Roma initiatives, a home/school Roma liaison worker, and Family Information Service outreach for pre-school children.

The following points were raised during the discussion which followed: (i) there are some voluntary sector organisations working in the city which work with Roma

communities and could have a role in any planned projects;

(j) in Nottingham there is a lack of understanding of the community, with people referring to Romas as Romanians for example. People see them as causing antisocial behaviour, but this is often just down to their way of life with large family groups coming together. It can be difficult to identify a leader for the community to engage with;

(k) a single point of contact has been established in the Duty Team to ensure a consistent response to the Roma community. They may not always have had access previously to good sexual health education which needs to be addressed.

RESOLVED to (1) note the findings of the report and consider the implications/ cascade across areas

of responsibility;

(2) bring an update to the Children’s Partnership Board in a year’s time. 18 REDUCING YOUTH CRIME IN NOTTINGHAM

Shelley Nicholls, Youth Offending Team (YOT), gave a presentation, highlighting the following: (a) the Nottingham YOT aims to reduce offending by young people through partnerships to

address all their needs such as health and education. This is underpinned by local and national funding;

(b) the three main key performance indicators for YOTs nationally, as set by the Youth Justice Board, are set as reducing reoffending, reducing use of custodial sentences and reducing the number of first time entrants into the criminal justice system;

(c) reoffending rates by young people have fallen in Nottingham from 31.8% in 2013/14 to 26.9% in 2014/15, which is favourable against comparative areas. Nationally there are challenges around more young people in the system presenting challenging behaviour;

(d) the use of custodial sentences in Nottingham is higher than average but partners such as the police and the judiciary have reported that these sentences are used appropriately;

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(e) there has been a significant reduction in the number of first time entrants into the criminal justice system in Nottingham, with a reduction from 1800 to 820 from 2011 to 2015. However, this is still high compared to national figures but acknowledged to be as a result of Nottingham’s demographics;

(f) a further local measure used as an indicator is the attainment of young people and the number of young people Not in Education, Employment or Training (NEETs). Performance has been maintained in this area at around 70% not NEET;

(g) the YOT was awarded the RJC’s Restorative Service Quality Mark in February 2016, recognising that the needs of victims are the focus of service delivery. There is an aim for conflicts to be resolved without criminalisation, for example amongst Children in Care where there has been a reduction in criminality from 19% to under 6%;

(h) in June the YOT was assessed as high-performing, with recognition of the removal of barriers to engagement from hard to reach children, strong management oversight and a focus on outcomes;

(i) the Youth Justice Review is on hold but this will shape the future of YOTs and any changes that will be made to them in the future;

(j) a new focus for the YOT has been early intervention, identifying young people and children most at risk of crime and antisocial behaviour through young people’s panels. Another focus is reduction of knife crime through interventions;

(k) the Priority Families approach is being embedded into the YOT in services dealing with serious organised crime and gang-related violence, looking at a whole-family approach to reduce further offending within families;

The following points were made during the discussion which followed: (l) the Youth Justice Review outcomes are likely to be presented at a convention in

November and any legislative change will happen in January. It will be unfortunate if the YOT loses its legislative status and loses funding;

(m)the reduction in Police Officers and PCSOs is concerning, but the YOT and targeted youth services are also there to help prevent crime.

19 YOUTH CABINET QUARTERLY UPDATE

Jon Rea, Engagement and Participation Lead Officer, introduced the report updating the Board on activities of the Youth Cabinet and associated work under the Participation in Governance programme, highlighting the following: (a) a calendar is produced every year that covers the main events and groups that allow the

Local Authority to engage with young people. Many partners use these forums to engage in themes and involve them in decision making;

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(b) meetings and groups that currently operate include the Youth Council, Primary Parliament, Youth Cabinet, Children in Care Council and Action for Young Carers;

(c) Youth Council is a monthly meeting for young people aged 11-19. The meetings are themed, for example the last meeting was on Learning and Earning. Primary Parliament is for year 5 and 6 pupils and is extremely popular with 34 primary schools signed up;

(d) Youth Cabinet is a meeting for more senior members of youth groups, school councils and voluntary participation projects. The Children in Care Council is a similar participation group for Children in Care and Care Leavers aged between 13 and 18;

(e) the Council tries to engage with around 1000 young people each year and hold 60 events (15 per quarter). They are successful due to the willingness of partners to engage;

(f) in November the Youth Cabinet are hosting a special conference for secondary school students to explore views and experiences around the theme of transition from primary to secondary school;

(g) Youth Cabinet are currently working with the Council’s HR team to look at how to attract more young people into the Council workforce, and help develop and retain those already in Council employment;

(h) a group of young people attended the Nottingham in Parliament day, to help make MPs aware of Nottingham children and young people, and reach out to decision makers;

The following points were raised during the discussion which followed: (i) there is still no participation group for children with Special Educational Needs (SEN).

There have been problems with tendering a contract for this, so this will be run in-house by the Council in the new year. Children with SEN do engage in some of the other engagement groups;

(j) the groups are already very diverse, but if there are any groups that members feel are under-represented they should let Jon know so that he can inform providers. The intention is to represent the diversity of the city.

RESOLVED to (1) recognise the work done by the Youth Cabinet and associated participation forums

in enabling and empowering children and young people to have a voice in decision making processes;

(2) use the Participation in Governance programme to engage with children and young people in order to involve them in decision making.

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20 CDP COMMISSIONING INTENTIONS FOR YOUNG PEOPLE’S SUBSTANCE MISUSE TREATMENT SERVICE

Christine Oliver, Head of Commissioning, introduced the report on the Crime and Drugs Partnership’s intentions for commissioning the specialist young people’s substance misuse treatment service and cementing of pathways. Christine highlighted the following: (a) the contract for young people’s substance misuse treatment services in Nottingham is

being retendered as the current contract is due to end on 30th April 2017. The current service is satisfactory but a tender is required because the contract period is ending;

(b) approval to tender has already been agreed by the Commissioning and Procurement Sub-Committee and so just any issues or queries are being sought from the Board;

(c) the number of young people coming into the service could be increased, and so referrals and communication could be made stronger, particularly between social care and the service;

(d) the service should be more flexible with the age limits that it deals with, and there is a recommendation for the age limit to be increased to 21 for those with learning disabilities and social care involvement;

RESOLVED to note the information in the report 21 CHILD DEVELOPMENT STRATEGIC COMMISSIONING REVIEW

Chris Wallbanks, Strategic Commissioning Manager, introduced the report highlighting the following: (a) the review is taking place in response to the transfer of commissioning responsibilities for

Health Visitors and the Family Nurse Partnership to the City Council in October 2015;

(b) the review will ensure a consistency of approach across the city, create a mechanism for the Small Steps, Big Changes programme to influence system change and increase integrated working to support Nottingham’s status as an Early Intervention City;

(c) the planned outcome of the review has been defined as ‘a defined universal and early help pathway for pregnant women, babies, children and young people; delivered in an integrated way, through a consistent evidence-based approach by a competent and confident workforce’;

(d) the review agrees a set of shared outcomes for children and young people from 0-19, identifies success indicators, identifies gaps in delivery, researches the evidence of best practice and makes recommendations for future delivery;

(e) the outcomes will be achieved by negotiating with existing services, agreeing a phased approach, developing monitoring and evaluation frameworks, and developing an integrated specification for future delivery;

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(f) the first phase of the review focuses on 0-5 year olds with older children and young people in later phases. The next step is tendering for an integrated contract, and shaping the delivery model with potential providers for a delivery model starting in April 2017.

Maria Ward confirmed that the voluntary sector will be more involved with later phases as not many voluntary organisations work with 0-5 year olds. RESOLVED to note the progress made on the Child Development Review to date 22 DWP: PARTNER UPDATE

Gaynor Rossiter, Jobcentre Leader, Department of Work and Pensions (DWP), gave a presentation giving an update on the Jobcentre service in Nottingham, highlighting the following: (a) the DWP has recently reorganised and now has two main city centre sites at Loxley

House and Nottingham Central on Parliament Street. Nottingham Central is one of the largest Jobcentres in the country, with approximately 12,000 claimants of Employment and Support Allowance (ESA), 3800 claimants of Income Support, 5000 claimants of Jobseekers Allowance and 1050 claimants of Universal Credit;

(b) there are 1295 young people claiming Jobseekers Allowance in Nottingham. These are supported by the following initiative:

Movement to Work, a collaboration of UK employers that provides training, new skills and experience to help unemployed 16-24 year olds into work;

Get in Go Far, a new government campaign designed to inspire young people to consider apprenticeships, traineeships and work experience as a route to a rewarding career;

Access to Work and Remploy – Supporting Apprentices: Mental Health Support Service, which provides targeted support to apprentices with a mental health condition , helping them to remain in work and continue with their apprenticeship;

Step into Work, an initiative delivered by Community Partnership Providers in Nottingham and aimed at 18-29 year olds;

(c) additional support includes specialist support for those who are Not in Employment,

Education or Training (NEET), and promoting traineeships and apprenticeships. DWP are recruiting a member of staff who will work with schools in Nottingham focussing on those students who are at risk of becoming NEET, or who may be disadvantaged in the labour market.

The following points were raised during the discussion which followed: (d) there are a number of young people who are eligible to claim benefits but do not due to

social stigmas. The Jobcentre has changed a lot but people still have a negative image of it. Priority Families and other partners may help to identify and direct young people to the support services they need;

(e) moving the Jobcentre into modern premises like Loxley House has helped to improve its image. It is now more digitally driven which is good to engage young people.

RESOLVED to thank Gaynor for the presentation

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23 FORWARD PLAN

RESOLVED to note the forward plan

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GOVERNING BODY

Meeting Date: 30 November 2016

Title of Paper: Review of Constitution and Governance Handbook

Sponsor: Lucy Branson, Director of Corporate Development

Previous Related Papers: N/A

Summary / Purpose of the Paper: To seek Governing Body approval of proposed amendments to the CCG Constitution and Governance Handbook following a detailed review of these documents.

Have All Relevant Implications Been Considered?

Further Information (If there is an implication,

briefly explain what it is or refer to the appropriate section of the paper)

Vision, Values and Strategy This was integral to the review of the Constitution and Governance Handbook

Clinical Engagement This was integral to the review of the Constitution and Governance Handbook

Collaborative Commissioning Arrangements

This was integral to the review of the Constitution and Governance Handbook

Quality Improvement / Improving Health Outcomes


Public Involvement and Patient Engagement


Equality and Diversity This was integral to the review of the Constitution and Governance Handbook

Quality, Innovation, Productivity and Prevention (QIPP)


Constitutional and Governance Arrangements

This paper details the CCG’s constitutional and governance arrangements

Financial Management This was integral to the review of the Constitution and Governance Handbook

Key Risk Implications: (please explain briefly) The CCG is not able to demonstrate compliance with relevant statutory requirements, and guidance from NHS England in respect of any audit, or that decisions are taken without appropriate delegation and are potentially subject to challenge.

Risk Assessment Consequence Likelihood Score

5 2 10

Recommendations to the Governing Body: The Governing Body is asked to:

Consider the contents of this paper and the amendments to the Constitution and Governance Handbook referred to;

Confirm that the Governing Body agrees that the changes proposed to the constitution are non-material changes and as such do not require approval of the CCG membership;

Approve the amended Constitution and Governance Handbook as drafted or subject to any proposed amendments; and

Provide Governing Body consent to approach NHS England for approval of the proposed amendments to the Constitution.

GB 342/16

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Page 1 of 3

Review of Constitution and Governance Handbook

1. Introduction

The most recent version of the CCG Constitution (version 1.3) as published on the CCG

website was last updated on 1 April 2015. The majority of amendments made at that

time reflected the CCG being granted full delegation for primary care co-commissioning.

Following recent developments, including the introduction of new statutory guidance

from NHS England in relation to the management of conflicts of interest and

organisational staff changes within the CCG, the Constitution and Governance

Handbook have been reviewed.

Further developments are currently taking place and policies are in the process of being

drafted relating to procurement, discretionary payments, and resource allocation and

prioritisation. These developments will require a review of the Detailed Financial Policies

within the Governance Handbook. A separate paper will be presented to Governing

Body in due course relating to proposed amendments to the Detailed Financial Policies.

Paragraph 1.4 of the Constitution states that the Constitution can only be varied in two

circumstances:

a) Where the CCG applies to NHS England and that application is granted; or

b) Where in the circumstances set out in legislation NHS England varies the CCG

constitution other than on application by the CCG.

An application will need to be made to NHS England in respect of the amendments

proposed in this document and the proposed changes must be made in line with the

NHS England Guidance Procedures for clinical commissioning group constitution

change, merger or dissolution (November 2016).

The CCG Scheme of Reservation and Delegation provides as follows:

Consideration and approval of applications to the

NHS Commissioning Board on any matter

concerning material changes to the Group’s

constitution, including its Standing Orders, Scheme

of Reservation and Delegation, and Prime Financial

Policies.

Reserved to the CCG

membership

Consideration and approval of applications to the

NHS Commissioning Board on non-material changes

to the Group’s constitution, including its Standing

Orders, Scheme of Reservation and Delegation, and

Prime Financial Policies (following engagement with

the Group’s membership, where appropriate).

Delegated to/reserved by

Governing Body.

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https://www.england.nhs.uk/wp-content/uploads/2016/11/guidance-constitution-mergers-dissolution-nov16.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/11/guidance-constitution-mergers-dissolution-nov16.pdf


Page 2 of 3

The changes proposed in Section 2 below are considered to be non-material changes,

and it is not considered necessary to engage with the membership of the CCG in light of

the nature of the proposed amendments.

There is no requirement for an application to be made to NHS England in respect of

amendments to the CCG’s Governance Handbook. Approval is however required from

the Governing Body in respect of these amendments, and approval is sought in relation

to the amendments set out in Section 3 below.

2. Constitution

A detailed review of the Constitution has been conducted by the Interim Head of

Corporate Assurance. A table setting out the proposed changes to the Constitution is

appended to this paper at Appendix A. A track changed version of the Constitution

showing the proposed amendments is also appended to this paper at Appendix B.

The Terms of Reference of the Audit Committee and Remuneration Committee are

appended to the Constitution. The proposed amendments to these Terms of Reference

are in line with the general changes to all Committee Terms of Reference dealt with

separately at Section 3 below. These are reflected in the attached track changed

Constitution document.

A number of minor amendments are also proposed that update the description of roles

of particular individuals, and as these amendments are considered to be minor, no

further reference is made to them in this paper.

3. Governance Handbook

A review has been conducted by the Interim Head of Corporate Assurance of the

following parts of the Governance Handbook1:

The Governing Body committee structure; and

The Terms of Reference of the various committees contained within the Governance

Handbook.

The CCG Committee summary has been amended to insert a revised diagram of the

Committee structure to include the Primary Care Commissioning Panel. This was not

previously included in the Governance Handbook.

The CCG Inter-Practice Agreement is contained within the Governance Handbook;

however this is not currently subject to review and remains as drafted. This document

does however contain a Committee structure diagram that does not include the Primary

Care Commissioning Panel and it is proposed to replace this in line with the amendment

to the CCG Committee structure section of the Governance Handbook as set out above.

1 As stated above, the Detailed Financial Policies are also included within the Governance

Handbook. Proposed amendments to the Detailed Financial Policies will be presented to the Governing Body in a separate paper in due course.

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Page 3 of 3

A number of key changes are proposed to the Terms of Reference of the CCG

Committees. There are no proposed amendments to the delegations to each Committee

and the purpose and duties of each Committee remain as drafted.

Appendix C attached to this paper sets out the proposed changes for consideration and

approval by the Governing Body.

A draft amended Governance Handbook is also attached at Appendix D. Given the

extent and nature of the proposed amendments these are not shown in tracked changes

within the proposed amended Governance Handbook.

4. Recommendation

The Governing Body is asked to:

Consider the contents of this paper and the amendments to the Constitution and

Governance Handbook referred to;

Confirm that the Governing Body agrees that the changes proposed to the

Constitution are non-material changes and as such do not require approval of the

CCG membership;

Provide Governing Body consent to approach NHS England for approval of the

proposed amendments to the Constitution as drafted or subject to any proposed

amendments; and

Approve the amended Governance Handbook as drafted or subject to any proposed

amendments.

Dmitrije Sirovica

Constitution and Governance Handbook Review

November 2016

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NHS Nottingham City Clinical Commissioning Group GB 342/16 Governing Body – 30 November 2016 Appendix A – Proposed Amendments to CCG Constitution

1

Provision

Proposed Amendment Reason for Amendment

Paragraph

3.1.1

To remove Hartley Road Medical Centre from the list of

member GP practices.

This practice closed in March/April 2015 and the patient list was

dispersed.

Paragraph

3.1.1

To remove (NEMS) NHS Nottingham 8am-8pm Health

Centre from the list of member GP practices.

The 8-8 contract ended October 2015 when the new urgent care

centre was commissioned. This site has now become a branch of

the NEMS Platform One practice.

Paragraph

3.1.1

To remove Ndu Surgery from the list of member GP

practices.

This practice closed in July 2015 and the patient list was dispersed.

Paragraph

5.2.4(g)

To amend paragraphs 5.2.4(h) and 5.2.4(i) such that

these are to be sub-paragraphs of 5.2.4(g).

Paragraph 5.2.4(g) provides for regular reports to be provided to the

Governing Body regarding compliance with the duty around securing

continuous improvement to quality of services. Paragraph (h) and (i)

currently provide separate requirements for publishing an annual

safeguarding children declaration and annual reports on the

management of complaints, serious incidents, and infection

prevention and control. It is considered appropriate for these to form

part of the reporting duty to the Governing Body rather than these

forming separate requirements.

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2

Provision


Paragraph

5.2.7

To insert new paragraph 5.2.7(g) and 5.2.7(h), in

relation to the duty to promote the involvement of

patients, their carers and representatives in decisions

about their healthcare.

Paragraph 5.2.7(g) inserts a requirement for the CCG in developing

and implementing its commissioning strategy to do so in a way that

promotes the involvement of patients, their carers and

representatives in decisions about their healthcare. It is not currently

a specific requirement for the CCG to do so as part of it compliance

with the duty.

In addition paragraph 5.2.7(h) amends the current reporting

requirement to the Governing Body. Currently the Constitution

provides for an annual report to be provided regarding compliance

with this duty. This is amended such that a report is required

demonstrating progress on the CCG’s commissioning strategy and

annual commissioning plan. In light of the new requirement at

paragraph 5.2.7(g) for this duty to be promoted in the development

and implementation of the CCG’s commissioning strategy, these

amendments together will provide a practical and effective basis on

which the CCG’s delivery of this duty can be measured.

Paragraph

5.2.8

To insert new paragraph 5.2.8(f) and 5.2.8(g), in

relation to the duty regarding enabling patients to make

choices.

See the rationale regarding the amendments to paragraph 5.2.7

above.

Paragraph

7.2.1

To amend the document referred to in footnote 60 to

“Clinical Commissioning Group Governing Body

Members – Role Outlines, Attributes and Skills NHS

Commissioning Board Authority, October 2012”

The document currently referred to is dated July 2012. This was

superseded in October 2012 and this amendment reflects this fact.

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3

Provision


Paragraph

7.6.1

See in relation to paragraph 7.2.1. See in relation to paragraph 7.2.1.

Paragraph

7.9.1(f)

To insert as part of the role of the Lay Member lead for

financial management and audit (the Audit Committee

Chair), fulfilling the role of Conflicts of Interest Guardian

in accordance with the CCG Conflicts of Interest Policy.

The NHS England Guidance “Managing Conflicts of Interest:

Statutory Guidance for CCGs (28 June 2016)” (“the 2016 Guidance”)

requires the Audit Committee Chair to act as Conflicts of Interest

Guardian. This amendment reflects this requirement within the

Constitution.

Paragraph

7.9.1(d)

To insert as part of the role of the Lay Member lead for

financial management and audit (the Audit Committee

Chair), also acting as Chair of the Audit Panel.

This amendment has been made in order to comply with the

requirements of the Local Audit and Accountability Act 2014. See

further below.

Section

8.2 & 8.3

Amended to remove the detail relating to the

management of conflicts of interest. This section has

been reduced so as to only provide basic detail as to

the requirements for managing conflicts of interest and

referring to the Conflicts of Interest Policy in respect of

relevant detail.

The detail is included within the CCG Conflicts of Interest Policy

which reflects the requirements of the 2016 Guidance. The 2016

Guidance is statutory guidance to which the CCG is required to have

due regard.

It is not considered necessary to include all of the detail within the

Conflicts of Interest Policy in the Constitution also. To do so raises

the risk of inconsistency between the documents and potential

uncertainty as to the requirements. It is considered more appropriate

to remove the detail from the Constitution and instead to refer to the

Conflicts of Interest Policy as a single point of reference in respect of

the relevant requirements.

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4

Provision


Section 8.4

Amended to remove duplicate reference to procuring

services in an open, transparent, non-discriminatory

and fair way.

Wording is also inserted to reflect the requirement of

the 2016 Guidance that all potential bidders/contractors

are requested to declare relevant interests as part of

every procurement process.

The amended wording ensures that the requirements of the Conflicts

of Interest Policy are properly reflected in the Constitution to the

extent necessary.

Appendix C

Scheme of

Reservation

& Delegation

To include an additional function within the Scheme of

Reservation and Delegation relating to Extraordinary

Funding Requests, and confirming that these are

delegated to the Extraordinary Funding Requests

Panel.

The Extraordinary Funding Requests Panel is set out in the

Constitution as a formal committee of the Governing Body however

the Scheme of Reservation and Delegation does not currently

delegate any functions to this panel. This amendment formally

delegates the decisions relating to Extraordinary Funding Requests

to this panel.

Appendix D

Prime

Financial

Policies

Paragraph

3.3(c)

Additional wording inserted as follows:

“The CCG procures external audit services in

accordance with the Local Audit and Accountability Act

2014 and the relevant national guidance.”

Under the Local Audit and Accountability Act 2014, the CCG must

select and appoint its own external auditors and directly manage their

contracts for the audits for the financial year starting on 1 April 2017.

The CCG did this for the first time in 2016.

This amendment imposes an obligation on the Chief Finance Officer

to ensure that this obligation is met.

Appendix F

The wording of the principles of the NHS Constitution

has been amended to reflect the most up to date

version.

This reflects the wording in the July 2015 amended version of the

NHS Constitution.

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GB 342/16 APPENDIX B

NHS NOTTINGHAM CITY CLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 1.43

NHS Commissioning Board Effective Date: 1 April 2015[ ]

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[Page left intentionally blank]

28 of 200


NHS Nottingham City Clinical Commissioning Group’s Constitution Version: 1.0 | NHS Commissioning Board Effective Date: 13 May 2014[ ]

CONTENTS Part Description Page

Foreword 1

1 Introduction and Commencement 2

1.1 Name 2

1.2 Statutory Framework 2

1.3 Status of this Constitution 2

1.4 Amendment and Variation of this Constitution 3

2 Area Covered 4

3 Membership 5

3.1 Membership of the Clinical Commissioning Group 5

3.2 Eligibility 7

3.3 Inter Practice Agreement 7

4 Vision, Values and Principles of Good Governance 9

4.1 Vision 9

4.2 Values 9

4.3 Principles of Good Governance 9

4.4 Accountability 10

5 Functions and General Duties 12

5.1 Functions 12

5.2 General Duties 14

5.3 General Financial Duties 23

5.4 Other Relevant Regulations, Directions and Documents 24

6 Decision Making: The Governing Structure 26

6.1 Authority to Act 26

6.2 Overarching Scheme of Reservation and Delegation 26

6.3 General 26

6.4 Joint commissioning arrangements with other Clinical Commissioning Groups

27

6.5 Joint commissioning arrangements with NHS England for the exercise of Clinical Commissioning Group functions

29

6.6 Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions

30

6.7 Additional joint commissioning arrangements 31

6.8 The Governing Body 31

6.9 Committees of the Governing Body 33

6.10 Clinical Council 36

6.11 People’s Council 37

7 Roles and Responsibilities 38

7.1 Individual Member Practice Representatives 38

7.2 All Members of the Group’s Governing Body 38

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NHS Nottingham City Clinical Commissioning Group’s Constitution Version: 1.0 | NHS Commissioning Board Effective Date: 13 May 2014[ ]

Part Description Page

7.3 Representatives acting on behalf of Member Practices on the Governing Body

39

7.4 Chair of the Governing Body and Clinical Leader 39

7.5 Accountable Officer 40

7.6 Chief Finance Officer 41

7.7 Secondary Care Specialist Doctor 41

7.8 Registered Nurse 42

7.9 Lay Members on the Governing Body 42

7.10 Corporate Medical Lead 43

8 Standards of Business Conduct and Managing Conflicts of Interest 44

8.1 Standards of Business Conduct 44

8.2 Conflicts of Interest 44

8.3 Declaring and Registering Interests 45

8.4 Managing Conflicts of Interest: General 46

8.5 Managing Conflicts of Interest: Contractors and people who provide services to the Group

48

8.6 Managing Conflicts of Interest: GP practices as providers 48

8.7 Transparency in Procuring Services 48

9 The Group as an Employer 51

10 Transparency and Ways of Working 53

10.1 General 53

10.2 Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies

53

Appendix Description Page

A Definitions of Key Descriptions used in this Constitution 54

B Standing Orders 58

C Overarching Scheme of Reservation and Delegation 79

D Prime Financial Policies 90

E The Nolan Principles 102

F The Seven Key Principles of the NHS Constitution 103

G Audit Committee Terms of Reference 104

H Remuneration Committee Terms of Reference 108

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NHS Nottingham City Clinical Commissioning Group’s Constitution - 1 - Version: 1.42 | NHS Commissioning Board Effective Date: 13 May 2014[ ]

FOREWORD NHS Nottingham City Clinical Commissioning Group is a new statutory body that has been designed to be different from any predecessor NHS organisation. Fundamental to this new approach is the fact that the Group is a clinically-led membership organisation comprised of all GP practices in Nottingham City. The membership model ensures that the Group is uniquely placed to understand the needs of its local population and to develop and redesign healthcare services on behalf of their patients to address these needs. This constitution sets out how clinical involvement will be central to the Group’s decision-making arrangements. It describes how clinicians will drive the Group’s requirement to improve the quality of healthcare and the delivery of its vision to improve health outcomes and end health inequalities for the whole of the local population. It also details how it will make decisions in relation to the use of its commissioning budget. We have reflected within this constitution the importance that we have placed on working together with our patients and their carers, community groups, the wider public, and other key partners, such as Nottingham City Council and Public Health colleagues to deliver our vision. This constitution sets out our statutory responsibilities and outlines the structures and processes that have been developed to ensure these are met in line with the principles of good governance. It also describes the relationship between the Group’s Governing Body and its membership and the democratic processes to appoint the Group’s leadership team. Throughout this constitution there is a focus on ensuring that the Group upholds the standards of conduct outlined in the Nolan principles, with a particular focus on openness, transparency and accountability. In conclusion, this document provides the foundation for the Group’s establishment and development, acting as a reference point and guide for all it does. The Group will use it to underpin its work in years to come, thus ensuring the culture and behaviours it develops both match the principles within it, but critically also fulfils the potential that this new clinically-led organisation offers the population of Nottingham City.

Dr. Hugh Porter Chair of the Governing Body and Clinical Leader

Dawn Smith Chief Officer

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1. INTRODUCTION AND COMMENCEMENT

1.1. Name 1.1.1. The name of this Clinical Commissioning Group is NHS Nottingham City Clinical

Commissioning Group. 1.2. Statutory Framework 1.2.1. Clinical Commissioning Groups are established under the Health and Social

Care Act 2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”).2 The duties of Clinical Commissioning Groups to commission certain health services are set out in Section 3 of the 2006 Act, as amended by Section 13 of the 2012 Act, and the regulations made under that provision.3

1.2.2. The NHS Commissioning Board is responsible for determining applications from

prospective Groups to be established as Clinical Commissioning Groups4 and undertakes an annual assessment of each established Group.5 It has powers to intervene in a Clinical Commissioning Group where it is satisfied that a Group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6

1.2.3. Clinical Commissioning Groups are clinically led membership organisations

made up of general practices. The members of the Clinical Commissioning Group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.7

1.3. Status of this Constitution 1.3.1. This constitution is made between the members of NHS Nottingham City Clinical

Commissioning Group and has effect from 18 January 2013, when the NHS Commissioning Board established the Group.8

1.3.2. The constitution is published on the Group’s website at: www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by

1 See Section 1I of the 2006 Act, inserted by Section 10 of the 2012 Act 2 See Section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of Clinical Commissioning Groups to commission certain health services are set out in Section

3 of the 2006 Act, as amended by Section 13 of the 2012 Act 4 See Section 14C of the 2006 Act, inserted by Section 25 of the 2012 Act 5 See Section 14Z16 of the 2006 Act, inserted by Section 26 of the 2012 Act 6 See Sections 14Z21 and 14Z22 of the 2006 Act, inserted by Section 26 of the 2012 Act 7 See in particular Sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by Section 25 of the 2012

Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued

8 See Section 14D of the 2006 Act, inserted by Section 25 of the 2012 Act

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http://www.nottinghamcity.nhs.uk/



postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

1.4. Amendment and Variation of this Constitution 1.4.1. This constitution can only be varied in two circumstances.9

a) Where the Group applies to the NHS Commissioning Board and that application is granted;

b) Where in the circumstances set out in legislation the NHS Commissioning

Board varies the Group’s constitution other than on application by the Group.

1.4.2. The procedure to be adopted by the NHS Commissioning Board and the relevant factors to be considered are set out within The National Health Service (Clinical Commissioning Groups) Regulations 2012 S.I. 2012/1631.

9 See Sections 14E and 14F of the 2006 Act, inserted by Section 25 of the 2012 Act

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mailto:[email protected]



2. AREA COVERED 2.1. The geographical area covered by NHS Nottingham City Clinical Commissioning

Group is coterminous with the boundaries of Nottingham City Council.

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3. MEMBERSHIP 3.1. Membership of the Clinical Commissioning Group 3.1.1. The following 5760 practices comprise the members of NHS Nottingham City

Clinical Commissioning Group.

Practice Name Address

Aspley Medical Centre 509 Aspley Lane, Aspley, Nottingham NG8 5RU

Bakersfield Medical Centre 141 Oakdale Road, Bakersfield, Nottingham NG3 7EJ

Beechdale Surgery 439 Beechdale Road, Aspley, Nottingham NG8 3LF

Bilborough Medical Centre Bracebridge Drive, Bilborough, Nottingham NG8 4PN

Bilborough Surgery 112 Graylands Road, Bilborough, Nottingham NG8 4FD

Boulevard Medical Centre 635 Western Boulevard, Nottingham NG8 5GS

Bridgeway Medical Centre 1 Bridgeway Centre, The Meadows, Nottingham, NG2 2JG

Churchfields Medical Practice Old Basford Health Centre, 1 Bailey Street, Old Basford, Nottingham NG6 0HD

Clifton Medical Practice Clifton Cornerstone, Southchurch Drive, Clifton, Nottingham NG11 8EW

Dale Surgery 67 Sneinton Dale, Sneinton, Nottingham NG2 4LG

Deer Park Family Medical Practice

Wollaton Vale Health Centre, Wollaton Vale, Nottingham NG8 2GR

Derby Road Health Centre 336 Derby Road, Lenton, Nottingham NG7 2DW

Family Medical Centre 171 Carlton Road, Nottingham NG3 2FW

Grange Farm Medical Centre Tremayne Road, Bilborough, Nottingham NG8 4HQ

Greenfields Medical Centre 12 Terrace Street, Hyson Green, Nottingham NG7 6ER

Greenwood & Sneinton FMC 246 Sneinton Dale, Sneinton, Nottingham NG3 7DQ

Hartley Road Medical Centre 91 Hartley Road, Radford, Nottingham NG7 3AQ

Hucknall Road Medical Centre Off Kibworth Close, Healthfield, Nottingham NG5 1NA

John Ryle Medical Centre Clifton Cornerstone, Southchurch Drive, Clifton, Nottingham NG11 8EW

Leen View Surgery Bullwell Riverside Centre, Main Street, Bulwell, Nottingham NG6 8QJ

Lenton Medical Centre 266 Derby Road, Nottingham NG7 1PR

Lime Tree Surgery 1 Lime Tree Avenue, Cinderhill, Nottingham NG8 6AB

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Mapperley Park Medical Centre Malvern House, 41 Mapperley Road, Mapperley Park, Nottingham NG3 5AQ

Mayfield Medical Practice 12 Terrace Street, Hyson Green, Nottingham NG7 6ER

Meadows Health Centre (Dr Larner)

1 Bridgeway Centre, The Meadows, Nottingham NG2 2JG

Melbourne Park Medical Centre Melbourne Park, Aspley, Nottingham NG8 5HL

(NEMS) NHS Nottingham 8am-8pm Health Centre

79a Upper Parliament Street, Nottingham NG1 6LD

NEMS Platform One Practice Forward House, Station Street, Nottingham NG2 3AJ

Ndu Surgery St Anns Valley Centre, 2 Livingstone Road, St Anns, Nottingham NG3 3GG

Parkside Medical Practice Bullwell Riverside Centre, Main Street, Bulwell, Nottingham NG6 8QJ

Queens Bower Surgery Queens Bower Road, Bestwood Park, Nottingham NG5 5RB

Radford Health Centre Ilkeston Road, Radford, Nottingham NG7 3GW

Radford Medical Practice Radford Health Centre, Ilkeston Road, Radford, Nottingham NG7 3GW

RHR Medical Centre Calverton Drive, Strelley, Nottingham NG8 6QN

Rise Park Surgery Off Revelstoke Way, Rise Park, Nottingham NG5 5EB

Rivergreen Medical Centre 106 Southchurch Drive, Clifton, Nottingham NG11 8AD

Riverlyn Medical Centre Station Road, Bulwell, Nottingham NG6 9AA

St Albans Medical Centre Hucknall Lane, Nottingham NG6 8AQ

St Luke’s Surgery Radford Health Centre, Ilkeston Road, Radford, Nottingham NG7 3GW

St Mary’s Medical Centre Harvest Close, Top Valley, Nottingham NG5 9BW

Sherrington Park Medical Centre

402 Mansfield Road, Sherwood, Nottingham NG5 2EJ

Sherwood Health Centre Elmswood Gardens, Sherwood, Nottingham NG5 4AD

Sherwood Rise Medical Centre 31 Nottingham Road, Sherwood Rise, Nottingham NG7 7AD

Southglade Health Centre Southglade Road, Nottingham NG5 5GU

Springfield Medical Centre 301 Main Street, Bulwell, Nottingham NG6 8ED

Strelley Health Centre Strelley Road, Strelley, Nottingham NG8 6LN

Sunrise Medical Centre Radford Health Centre, Ilkeston Road, Radford, Nottingham NG7 3GW

The Alice Medical Centre 1 Carnwood Road, Bestwood Estate, Nottingham NG5 5HW

The Fairfields Practice Mary Potter Centre, Gregory Boulevard, Hyson Green, Nottingham NG7 5HY

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The Forest Practice Mary Potter Centre, Gregory Boulevard, Hyson Green, Nottingham NG7 5HY

The High Green Medical Practice

Mary Potter Centre, Gregory Boulevard, Hyson Green, Nottingham NG7 5HY

The Medical Centre 2a Zulu Road, Basford, Nottingham NG7 7DS

The University of Nottingham Health Service

Cripps Health Centre, University Park, Nottingham NG7 2QW

Tudor House Medical Practice 138 Edwards Lane, Sherwood, Nottingham NG5 3HU

Victoria and Mapperley Practice

Victoria Health Centre, Glasshouse Street, Nottingham NG1 3LW

Welbeck Surgery 481-491 Mansfield Road, Sherwood, Nottingham NG5 2JJ

Wellspring Surgery St Anns Valley Centre, 2 Livingstone Road, St Anns, Nottingham NG3 3GG

Windmill Practice Sneinton Health Centre, Beaumont Street, Sneinton, Nottingham NG2 4PJ

Wollaton Park Medical Centre 12 Harrow Road, Wollaton Park, Nottingham NG8 1FG

Wollaton Vale Health Centre Wollaton Vale, Nottingham NG8 2GR

3.2. Eligibility 3.2.1. Providers of primary medical services to a registered list of patients under a

General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract10, will be eligible to apply for membership of this Group11.

3.3. Inter Practice Agreement 3.3.1. The Group’s membership is organised into groups of GP practices (“GP

Clusters”), which are based partly on geographical location and partly on inter practice relationships and culture.

3.3.2. The GP Clusters provide a forum for groups of member practices to work

together in a shared framework to:

a) Support the development of the Group’s commissioning priorities and delivery of its commissioning strategy and annual commissioning plan;

b) Channel the knowledge and experience of member practices into service redesign and quality improvement.

3.3.3. The member practices working in each GP Cluster are responsible for electing a

GP Cluster Lead who will also represent them, and act on their behalf, on the

10

As defined within The National Health Service (Clinical Commissioning Groups) Regulations 2012 S.I. 2012/1631

11 See Section 14A(4) of the 2006 Act, inserted by Section 25 of the 2012

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Group’s Governing Body (see paragraphs 6.5.2 and 7.3 of this constitution and standing order 2.2.3 for further information).

3.3.4. An Inter Practice Agreement12 has been established by the Group’s membership

in order to govern the relationship of member practices, working in GP Clusters, with the intention of supporting the Group in undertaking clinical commissioning.

12 The Inter Practice Agreement is detailed within the Group’s Governance Handbook

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4. VISION, VALUES AND PRINCIPLES OF GOOD GOVERNANCE

4.1. Vision 4.1.1. The Group’s vision is to work together with compassion and caring to improve

health outcomes and end health inequalities through the provision of high quality, inclusive and value for money services that are patient-centred.

4.1.2. The Group will promote good governance and proper stewardship of public

resources in pursuance of its vision and in meeting its statutory duties. 4.2. Values 4.2.1. The organisational values that lie at the heart of the Group’s work are to:

a) Actively involve patients, carers, community groups and the public in

everything that it does.

b) Understand and respond to the needs of its diverse population.

c) Continually improve the quality of services through collaborative and innovative clinical commissioning.

d) Support and encourage education and training within the local workforce.

e) Secure cost effective and integrated services within available resources.

4.2.2. Good corporate governance arrangements are critical to upholding the Group’s

values. 4.3. Principles of Good Governance 4.3.1. In accordance with section 14L(2)(b) of the 2006 Act,13 the Group will at all times

observe “such generally accepted principles of good governance” in the way it conducts its business. These include:

a) The highest standards of propriety involving impartiality, integrity and

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

b) The Good Governance Standard for Public Services14.

c) The standards of behaviour published by the Committee on Standards in

Public Life (1995) known as the ‘Nolan Principles’ (see Appendix E).

13 Inserted by section 25 of the 2012 Act 14 The Good Governance Standard for Public Services, The Independent Commission on Good

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

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d) The seven key principles of the NHS Constitution (see Appendix F).

e) The Equality Act 201015.

f) The Standards for Members of NHS Boards and Governing Bodies in England16.

4.4. Accountability 4.4.1. The Group will demonstrate its accountability to its members, local people,

stakeholders and the NHS Commissioning Board in a number of ways, including by:

a) Publishing its constitution.

b) Appointing independent lay members and non GP clinicians to its Governing

Body.

c) Holding meetings of its Governing Body and Primary Care Commissioning Panel in public (except where the Group considers that it would not be in the public interest in relation to all or part of a meeting).

d) Publishing an annual commissioning plan.

e) Complying with Nottingham City Council’s health scrutiny requirements.

f) Meeting annually in public to present its annual report which must be

published.

g) Producing annual accounts in respect of each financial year which must be externally audited.

h) Having a published and clear complaints process that is compliant with the

statutory framework for complaints handling.

i) Complying with the Freedom of Information Act 2000.

j) Providing information to the NHS Commissioning Board as required. 4.4.2. In addition to these statutory requirements, the Group will demonstrate its

accountability by:

a) Having a published and clear Engagement Framework that sets out how patients, carers, community groups and the public will be involved in decisions about local health services (see paragraph 5.2.1 of this constitution for further information).

15 See http://www.legislation.gov.uk/ukpga/2010/15/contents 16 See http://www.professionalstandards.org.uk

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http://www.legislation.gov.uk/ukpga/2010/15/contents

http://www.professionalstandards.org.uk/



b) Publishing an annual report of all public and patient consultation and engagement activities.

c) Complying with the requirements of the public sector equality duty (see

paragraph 5.1.3(b) of this constitution for further information).

d) Publishing its policies for procurement, patient choice and competition, priority setting and resource allocation, and individual funding requests.

e) Having a clear and published Conflicts of Interest Policy, which sets out how

conflicts of interest are managed within the Group (see Chapter 8 of this constitution for further information).

f) Having a clear and published Gifts, Hospitality and Sponsorship Policy,

which sets out the Group’s requirements regarding gifts, hospitality and sponsorship (see Chapter 8 of this constitution for further information).

g) Publishing an annual safeguarding children compliance declaration.

h) Publishing annual reports on the management of complaints, serious

incidents, and infection prevention and control.

4.4.3. The Governing Body of the Group will throughout each year have an ongoing role in reviewing the Group’s governance arrangements to ensure that the Group continues to reflect the principles of good governance.

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

the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s The functions of Clinical Commissioning Groups. They relate to:

a) Commissioning certain health services (where the NHS Commissioning

Board is not under a duty to do so) that meet the reasonable needs of: i) All people registered with member practices;

ii) People who are usually resident within the area and are not registered

with a member of any Clinical Commissioning Group.

b) Commissioning emergency care for anyone present in the Group’s area.

c) Paying its employees’ remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the Group’s employees.

d) Determining the remuneration and travelling or other allowances of members

of its Governing Body. 5.1.2. In addition to the functions set out at 5.1.1 above, the Group is also responsible

for such primary care commissioning functions as may be delegated by the NHS Commissioning Board17.

5.1.3. In discharging its functions the Group will: a) Act18, when exercising its functions to commission health services,

consistently with the discharge by the Secretary of State for Health and the NHS Commissioning Board of their duty to promote a comprehensive health service19 and with the objectives and requirements placed on the NHS Commissioning Board through the mandate20 published by the Secretary of State for Health before the start of each financial year by:

i) Delegating responsibility for complying with this duty to its Governing

Body;

ii) Developing the Group’s commissioning strategy and annual commissioning plan to ensure promotion of a comprehensive health service in line with the Secretary of State for Health’s annual mandate;

17 See Section 13Z of the 2006 Act, inserted by Section 23 of the 2012 Act 18 See Section 3(1F) of the 2006 Act, inserted by Section 13 of the 2012 Act 19 See Section 1 of the 2006 Act, as amended by Section 1 of the 2012 Act 20 See Section 13A of the 2006 Act, inserted by Section 23 of the 2012 Act

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iii) Ensuring that the Chief Officer provides regular reports to the

Governing Body demonstrating progress on delivery of the Group’s commissioning strategy and annual commissioning plan.

b) meet the public sector equality duty21 by:

i) Delegating responsibility for ensuring the delivery of the duty to its

Governing Body;

ii) Appointing to its Governing Body a Lay Member lead for patient and public involvement and equality (see paragraphs 6.5.2 and 7.9.2 of this constitution for further information);

iii) Adopting the NHS Equality Delivery System as a tool to eliminate unlawful discrimination, harassment and victimisation, advance equality of opportunity between people who share a protected characteristic and those who do not, and foster good relations between people who share a protected characteristic and those who do not;

iv) Requiring the completion and objective evaluation of equality impact

assessments as an integral element of service planning and policy development;

v) Preparing and publishing specific and measurable equality objectives

and revising these at least every four years;

vi) Publishing, at least annually, sufficient information to demonstrate compliance with the general duty across all of the Group’s functions and measure the Group’s progress against its equality objectives;

vii) Developing and publishing a comprehensive Equality Framework and

annual equality improvement plan that set out how the Group will deliver its equality objectives;

viii) Delegating responsibility for monitoring the delivery of the annual

equality improvement plan to its Risk and Performance Committee and Quality Improvement Committee;

ix) Ensuring that the Chief Officer provides a report, at least annually, to

the Governing Body regarding compliance with the duty.

c) Work in partnership with Nottingham City Council to develop joint strategic needs assessments22 and joint health and wellbeing strategies23 by:

21 See Section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of

the 2012 Act 22 See Section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by

Section 192 of the 2012 Act

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i) Nominating appropriate representatives of the Group to be members of

the Nottingham City Health and Wellbeing Board, whose Terms of Reference define ways of working together and the expectations and responsibilities of members;

ii) Securing the provision of appropriate public health advice to the Group through the agreement of a formal memorandum of understanding with Nottingham City Council;

iii) Assigning appropriate clinical and managerial leads for each individual

chapter of Nottingham City’s joint strategic needs assessment;

iv) Establishing and maintaining an effective working relationship with the Local Healthwatch;

v) Involving the Nottingham City Health and Wellbeing Board in the

development of the Group’s commissioning strategy to ensure it reflects the joint strategic needs assessment, is aligned with the joint health and wellbeing strategy, and enables integrated commissioning.

5.2. General Duties - in discharging its functions the Group will: 5.2.1. Make arrangements to secure public involvement in the planning,

development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements24 by:

a) Delegating responsibility for ensuring the delivery of the duty to its

Governing Body.

b) Appointing to its Governing Body a Lay Member lead for patient and public involvement and equality (see paragraphs 6.5.2 and 7.9.2 of this constitution for further information).

c) Having a published and clear Engagement Framework that sets out how patients, carers, community groups and the public will be involved in decisions about local health services, of which its People’s Council (see paragraph 6.8 of this constitution for further information) will be an integral element.

d) Ensuring compliance with Nottingham City Council’s health scrutiny

requirements in relation to proposals on service change.

e) Establishing and maintaining an effective working relationship with the Local Healthwatch.

23 See Section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by

Section 193 of the 2012 Act 24 See Section 14Z2 of the 2006 Act, inserted by Section 26 of the 2012 Act

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f) Delegating responsibility to its Quality Improvement Committee for overseeing arrangements for ensuring that patient feedback and engagement are integral in commissioning decisions.

g) Ensuring that the Chief Officer provides a report, at least annually, to the

Governing Body regarding compliance with the duty.

h) Publishing on its website at www.nottinghamcity.nhs.uk and within its Patient Prospectus, a description of how patients, carers, community groups and the public can get involved in shaping NHS services.

i) Adhering to the following principles when implementing the arrangements

outlined in paragraphs 5.2.1(a) to 5.2.1(h) of this constitution:

i) Being clear about who is being engaged, the possible options, the engagement process, what is being proposed, the scope to influence and the expected costs and benefits of the proposal;

ii) Ensuring that engagement takes place in a suitable timeframe to allow decisions to be genuinely influenced by feedback received;

iii) Adapting engagement activities and methods to meet the specific needs

of different patient groups and communities;

iv) Keeping the burden of engagement to a minimum to retain continued patient and public buy-in to the process;

v) Ensuring that responses to engagement exercises are carefully analysed

with clear feedback provided to participants, which set out the decision made and the influence the results of the engagement exercise had on the final decision.

5.2.2. Promote awareness of, and act with a view to securing that health services

are provided in a way that promotes awareness of, and have regard to the NHS Constitution25 by:


Governing Body.

b) Promoting awareness of the NHS Constitution via its website at www.nottinghamcity.nhs.uk and its Patient Prospectus.

c) Adopting the NHS Equality Delivery System as a tool towards the delivery of

the equality-focused rights and pledges of the NHS Constitution.

d) Monitoring and responding to the views and experiences of the Group’s workforce as highlighted by its annual Staff Opinion Survey.

25 See Section 14P of the 2006 Act, inserted by Section 26 of the 2012 Act and Section 2 of the Health

Act 2009 (as amended by 2012 Act)

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e) Ensuring that the Chief Officer provides an annual report to the Governing

Body regarding compliance with the duty. 5.2.3. Act effectively, efficiently and economically26 by:

a) Its Governing Body having oversight of the appropriateness of the Group’s arrangements to exercise its functions effectively, efficiently and economically.

b) Delegating overall executive responsibility to the Chief Officer, who shall also be the Accountable Officer for ensuring that the Group exercises its functions effectively, efficiently and economically.

c) Setting out clear Standing Orders, Scheme of Reservation and Delegation

and Prime Financial Policies for the Group to ensure proper stewardship of public money and assets (see paragraph 10.2 of this constitution for further information).

d) Having a clear and published Conflicts of Interest Policy (see Chapter 8 of

this constitution for further information).

e) Maintaining robust financial procedures and controls and effective financial management and financial planning arrangements.

f) Having clear internal audit, external audit and counter fraud arrangements.

g) Developing the Group’s commissioning strategy and annual commissioning

plan to ensure value for money from the resources available to the Group.

h) Delegating responsibility to its Risk and Performance Committee for overseeing the development, implementation and monitoring of the Group’s local QIPP Programme.

i) Delegating responsibility to the Chief Finance Officer for the production of

annual accounts in respect of each financial year, which must be externally audited, and include the Accountable Officer’s Annual Governance Statement.

j) Delegating responsibility for reviewing the establishment and maintenance of

an effective system of integrated governance, risk management and internal control, across the whole of the Group’s activities to its Audit Committee (see paragraph 6.6.1a of this constitution for further information).

k) Delegating responsibility for setting the remuneration of key senior leaders of

the Group to its Remuneration Committee.

26 See Section 14Q of the 2006 Act, inserted by Section 26 of the 2012 Act

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l) Delegating responsibility for monitoring the Group’s risk and performance management arrangements to its Risk and Performance Committee.

m) Ensuring that the Chief Finance Officer provides monthly reports to the

Governing Body on financial performance, including performance against the Group’s statutory financial duties.

5.2.4. Act with a view to securing continuous improvement to the quality of

services27 by:

a) Delegating responsibility for ensuring the delivery of the duty to its Governing Body.

b) Appointing a Registered Nurse to its Governing Body to have a lead oversight role in ensuring a consistent focus on quality in all aspects of the Group’s activity.

c) Having a published and clear Quality Improvement Framework that sets out

how the Group will be assured on the quality of commissioned services and how continuous improvement in quality outcomes will be secured.

d) Promoting and encouraging continuous quality improvement through its

Clinical Council (see paragraph 6.7 of this constitution for further information).

e) Requiring the completion of quality impact assessments as an integral

element of service planning and policy development.

f) Delegating responsibility to its Quality Improvement Committee for monitoring the quality of services commissioned by the Group, including the safety and effectiveness of the treatment and care provided to patients, and the experience patients have of the treatment and care they receive.

g) Ensuring that the Chief Officer provides regular reports to the Governing

Body regarding compliance with the duty, to include:.

i) Publishing an annual safeguarding children compliance declaration; and.

ii) Publishing annual reports on the management of complaints, serious

incidents, and infection prevention and control. 5.2.5. Assist and support the NHS Commissioning Board in relation to the Board’s duty

to improve the quality of primary medical services28 by:


27 See Section 14R of the 2006 Act, inserted by Section 26 of the 2012 Act 28 See Section 14S of the 2006 Act, inserted by Section 26 of the 2012 Act

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b) Appointing a Registered Nurse to its Governing Body to have a lead

oversight role in ensuring a consistent focus on quality in all aspects of the Group’s activity.

c) Having a published and clear Quality Improvement Framework that sets out how the Group will be assured that the quality of primary medical services will be continuously improved.

d) Promoting and encouraging continuous quality improvement through its

Clinical Council (see paragraph 6.7 of this constitution for further information).

e) Establishing an annual programme of member practice performance review

and development visits, which will be peer led multi-disciplinary visits where member practices will be encouraged to share their ideas for future improvements or service changes that provide high quality cost effective care.

f) Actively supporting the education and training of the primary care workforce.

g) Delegating responsibility to its Quality Improvement Committee for

monitoring the quality of primary medical services, including the safety and effectiveness of the treatment and care provided to patients, and the experience patients have of the treatment and care they receive.

h) Ensuring that the Chief Officer provides regular reports to the Governing Body regarding compliance with the duty.

5.2.6. Have regard to the need to reduce inequalities29 by:


b) Working in partnership with the Nottingham City Health and Wellbeing Board to deliver the Joint Health and Wellbeing Strategy.

c) Assisting Nottingham City Council in maintaining Nottingham’s joint strategic

needs assessment.

d) Developing and implementing a commissioning strategy and annual commissioning plan that set out how the Group will commission services in line with the needs of the local population in order to reduce health inequalities in access to services and outcomes achieved.

e) Adopting the NHS Equality Delivery System as a tool towards delivering

reduced health inequalities.

29 See Section 14T of the 2006 Act, inserted by Section 26 of the 2012 Act

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f) Ensuring that its Clinical Council has regard to the need to reduce inequalities (see paragraph 6.7 of this constitution for further information).

g) Delegating responsibility to its Resource Allocation and Prioritisation Panel

for ensuring that the duty is taken into account when making investment and disinvestment decisions in line with the Group’s Commissioning Policy and Ethical Framework for Priority Setting and Resource Allocation.

h) Ensuring that the Chief Officer provides regular reports to the Governing

Body demonstrating progress on delivery of the Group’s commissioning strategy and annual commissioning plan.

5.2.7. Promote the involvement of patients, their carers and representatives in

decisions about their healthcare30 by:


b) Promoting and encouraging shared decision making through its Clinical Council and its People’s Council (see paragraphs 6.7 and 6.8 of this constitution for further information).

c) Engaging with patients, carers, community groups and the public through its

People’s Council (see paragraph 6.8 of this constitution for further information).

d) Establishing effective working relationships between the Group’s clinical

leaders and those of its main providers.

e) Promoting the involvement of patients (and their carers and representatives) in decisions that relate to the prevention or diagnosis of illness or their care and treatment via the Group’s website at www.nottinghamcity.nhs.uk and within its Patient Prospectus.

f) Establishing and maintaining an effective working relationship with the Local

Healthwatch.

f)g) Developing and implementing a commissioning strategy and annual commissioning plan that set out how the Group will commission services in line with the needs of the local population in order to promote the involvement of patients, their carers and representatives in decisions about their healthcare.

g)h) Ensuring that the Chief Officer provides a report, at least annually, to the Governing Body regarding demonstrating progress on delivery of the Group’s commissioning strategy and annual commissioning plan.compliance with the duty.

30 See Section 14U of the 2006 Act, inserted by Section 26 of the 2012 Act

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5.2.8. Act with a view to enabling patients to make choices31 by:


b) Promoting and encouraging patient choice through its Clinical Council (see

paragraph 6.7 of this constitution for further information).

c) Engaging with patients, carers, community groups and the public through its People’s Council (see paragraph 6.8 of this constitution for further information).

d) Promoting to patients via the Group’s website at www.nottinghamcity.nhs.uk

and within its Patient Prospectus their entitlement to choice with regards to aspects of health services provided to them.

e) Establishing and maintaining an effective working relationship with the Local Healthwatch.

e)f) Developing and implementing a commissioning strategy and annual

commissioning plan that set out how the Group will commission services in line with the needs of the local population in a way that promotes and encourages patient choice.

f)g) Ensuring that the Chief Officer provides a report, at least annually, to the

Governing Body demonstrating progress on delivery of the Group’s commissioning strategy and annual commissioning plan. regarding compliance with the duty.

5.2.9. Obtain appropriate advice32 from persons who, taken together, have a broad

range of professional expertise in healthcare and public health by:


b) Ensuring that the Group has a properly constituted Governing Body which includes a wide range of clinical and non-clinical expertise, including but not limited to GPs, a Secondary Care Specialist Doctor, a Registered Nurse, a public health consultant, experienced and capable officers and independent lay members (see paragraphs 6.5.2 and 6.5.3 of this constitution for further information).

c) Appointing a Secondary Care Specialist Doctor to its Governing Body to

have a lead oversight role in ensuring that appropriate mechanisms are in place to secure the involvement and engagement of secondary care clinicians in all aspects of the Group’s business.

31 See Section 14V of the 2006 Act, inserted by Section 26 of the 2012 Act 32 See Section 14W of the 2006 Act, inserted by Section 26 of the 2012 Act

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d) Appointing a Registered Nurse to its Governing Body to have a lead oversight role in ensuring that appropriate mechanisms are in place to secure the involvement and engagement of nursing, midwifery and allied health professionals in all aspects of the Group’s business.

e) Securing the provision of appropriate public health advice into the Group

through the agreement of a formal memorandum of understanding with Nottingham City Council.

f) Establishing effective working relationships between the Group’s clinical


g) Ensuring that its Clinical Council obtains appropriate advice (see paragraph 6.7 of this constitution for further information).

h) Ensuring multi-professional input to the development of the Group’s

commissioning strategy, annual commissioning plan, and when:

i) Planning the provision of services;

ii) Considering proposals for changes in the way services are provided;

iii) Decisions are to be made affecting the operation of services.

i) Delegating responsibility to its Resource Allocation and Prioritisation Panel for ensuring that the duty is taken into account when making investment and disinvestment decisions in line with the Group’s Commissioning Policy and Ethical Framework for Priority Setting and Resource Allocation.

j) Ensuring that the Chief Officer provides a report, at least annually, to the

Governing Body regarding compliance with the duty. 5.2.10. Promote innovation33 by:


b) Promoting and encouraging innovation through its Clinical Council (see

paragraph 6.7 of this constitution for further information) by:

i) Using an evidence based, or best practice approach to the commissioning of health services;

ii) Ensuring that services commissioned are outcome focussed in order to measure improvements in patient health and experience;

iii) Keeping abreast of new advances in technology;

33 See Section 14X of the 2006 Act, inserted by Section 26 of the 2012 Act

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iv) Being proactive in the management of medicines.

c) Embedding innovation into the development of the Group’s commissioning strategy and annual commissioning plan.

d) Establishing effective working relationships between the Group’s clinical


e) Being an active partner in the Local Academic Health Science Network.

f) Recognising the duty within the Group’s risk appetite, as documented within its Integrated Risk Management Framework.

g) Ensuring that the Chief Officer provides a report, at least annually, to the Governing Body regarding compliance with the duty.

5.2.11. Promote research and the use of research34 by:


b) Appointing a Corporate Medical Lead to its Governing Body to take a lead role in ensuring compliance with this duty.

c) Being an active partner in the Local Academic Health Science Network and

the Local NIHR Clinical Research Network.

d) Promoting and encouraging member practices to be research active through participation in the Primary Care Research Network and the Research Ready Accreditation Scheme.

e) Ensuring that the Chief Officer provides a report, at least annually, to the

Governing Body regarding compliance with the duty.

5.2.12. Have regard to the need to promote education and training35 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty36 by:


Governing Body.

b) Appointing a Corporate Medical Lead to its Governing Body to take a lead role in ensuring compliance with this duty.

34 See Section 14Y of the 2006 Act, inserted by Section 26 of the 2012 Act 35 See Section 14Z of the 2006 Act, inserted by Section 26 of the 2012 Act 36 See Section 1F(1) of the 2006 Act, inserted by Section 7 of the 2012 Act

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c) Promoting and encouraging education and training through its Clinical Council (see paragraph 6.7 of this constitution for further information).

d) Being an active partner in the Local Education and Training Board.

e) Maintaining and publishing policies on all aspects of human resources

management, including education and training matters.

f) Monitoring and responding to the views and experiences of the Group’s workforce and those of its main providers as highlighted by the annual NHS Staff Opinion Survey.

g) Delegating responsibility to its Quality Improvement Committee for

monitoring the promotion of education and training. h) Ensuring that the Chief Officer provides a report, at least annually, to the

Governing Body regarding compliance with the duty. 5.2.13. Act with a view to promoting integration of both health services with other

health services and health services with health-related and social care services where the Group considers that this would improve the quality of services or reduce inequalities37 by:


Governing Body.

b) Nominating appropriate representatives of the Group to be members of the Nottingham City Health and Wellbeing Board and contributing to the delivery of the joint health and wellbeing strategy.

c) Working in partnership with Nottingham City Council.

d) Developing and implementing a commissioning strategy and annual

commissioning plan that set out how the Group will commission integrated services.

e) Delegating responsibility to its Resource Allocation and Prioritisation Panel

for ensuring that the duty is taken into account when making investment and disinvestment decisions in line with the Group’s Commissioning Policy and Ethical Framework for Priority Setting and Resource Allocation.

f) Ensuring that the Chief Officer provides regular reports to the Governing

Body demonstrating progress on delivery of the Group’s commissioning strategy and annual commissioning plan.

5.3. General Financial Duties – the Group will perform its functions so as to:

37 See Section 14Z1 of the 2006 Act, inserted by Section 26 of the 2012 Act

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5.3.1. Ensure its expenditure does not exceed the aggregate of its allotments for the financial year38, ensure its use of resources does not exceed the amount specified by the NHS Commissioning Board for the financial year39, and take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure the Group does not exceed an amount specified by the NHS Commissioning Board 40 by:


Governing Body.

b) Setting out clear Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies for the Group to ensure proper stewardship of public money and assets (see paragraph 10.2 of this constitution for further information).

c) Maintaining robust financial procedures and controls and effective financial

management and financial planning arrangements.

d) Having effective arrangements for financial risk sharing and / or risk pooling with other organisations.

e) Having clear internal audit, external audit and counter fraud arrangements.

f) Delegating responsibility to its Audit Committee for reviewing the integrity of

the Group’s financial statements, and the adequacy and effectiveness of all risk and control related disclosure statements.

g) Delegating responsibility to its Risk and Performance Committee for

overseeing the development, implementation and monitoring of the Group’s local QIPP Programme.

h) Ensuring that the Chief Finance Officer provides monthly reports to the

Governing Body on financial performance, including performance against the Group’s statutory financial duties.

5.3.2. Publish an explanation of how the Group spent any payment in respect of

quality made to it by the NHS Commissioning Board41 by:

a) Including this information within its annual accounts in respect of each financial year (which must be externally audited) and its annual report (which must be published).

38 See Section 223H(1) of the 2006 Act, inserted by Section 27 of the 2012 Act 39 See Sections 223I(2) and 223I(3) of the 2006 Act, inserted by Section 27 of the 2012 Act 40 See Section 223J of the 2006 Act, inserted by Section 27 of the 2012 Act 41 See Section 223K(7) of the 2006 Act, inserted by Section 27 of the 2012 Act

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b) Delegating responsibility to its Audit Committee for reviewing the integrity of the Group’s financial statements, and the adequacy and effectiveness of all risk and control related disclosure statements.

5.4. Other Relevant Regulations, Directions and Documents 5.4.1. The Group will:

a) Comply with all relevant regulations;

b) Comply with directions issued by the Secretary of State for Health or the

NHS Commissioning Board;

c) Take account, as appropriate, of documents issued by the NHS Commissioning Board.

5.4.2. The Group will develop and implement the necessary systems and processes to

comply with these regulations and directions, documenting them as necessary in this constitution, its Scheme of Reservation and Delegation and other relevant Group policies and procedures.

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6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to Act 6.1.1. The Clinical Commissioning Group is accountable for exercising the statutory

functions of the Group. It may grant authority to act on its behalf to its:

a) Member practices;

b) Governing Body (and its committees);

c) Employees. 6.1.2. The extent of the authority to act of the respective bodies and individuals

depends on the powers delegated to them by the Group as expressed through:

a) The Group’s Scheme of Reservation and Delegation; and

b) For committees, their Terms of Reference. 6.2. Scheme of Reservation and Delegation 6.2.1. The Group’s Scheme of Reservation and Delegation (see Appendix C) sets out

those decisions that are:

a) Reserved for the membership as a whole;

b) The responsibilities of its Governing Body (and its committees), members of the Group who are individuals, and its employees.

6.2.2. The Clinical Commissioning Group remains accountable for all of its functions,

including those that it has delegated. 6.3. General 6.3.1. In discharging functions of the Group that have been delegated, its Governing

Body (and its committees) and individuals must:

a) Comply with the Group’s principles of good governance (see paragraph 4.3 of this constitution for further information);

b) Operate in accordance with the Group’s Scheme of Reservation and

Delegation (see Appendix C);

c) Comply with the Group’s Standing Orders and Prime Financial Policies (see Appendices B and D);

d) Comply with the Group’s arrangements for discharging its statutory duties

(see Chapter 5 of this constitution for further information);

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e) Where appropriate, ensure that member practices have had the opportunity

to contribute to the Group’s decision making process. 6.3.2. When discharging their delegated functions, committees must also operate in

accordance with their approved Terms of Reference. 6.3.3. Where delegated responsibilities are being discharged collaboratively, the joint

(collaborative) arrangements must:

a) Identify the roles and responsibilities of those Clinical Commissioning Groups who are working together.

b) Identify any pooled budgets and how these will be managed and reported in

annual accounts.

c) Specify how the risks associated with the collaborative working arrangement will be managed between the respective parties.

d) Identify how disputes will be resolved and the steps required to terminate the

working arrangements.

e) Specify how decisions are communicated to the collaborative partners. 6.4. Joint commissioning arrangements with other Clinical Commissioning

Groups

6.4.1. The Group may wish to work together with other Clinical Commissioning Groups in the exercise of its commissioning functions.

6.4.2. The Group may make arrangements with one or more Clinical Commissioning

Groups in respect of:

a) Delegating any of the Group’s commissioning functions to another Clinical Commissioning Group.

b) Exercising any of the commissioning functions of another Clinical Commissioning Groups.

c) Exercising jointly the commissioning functions of the Group and another

Clinical Commissioning Groups.

6.4.3. For the purposes of the arrangements described at paragraph 6.4.2, the Group may: a) Make payments to another Clinical Commissioning Group.

b) Receive payments from another Clinical Commissioning Group.

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c) Make the services of its employees or any other resources available to another Clinical Commissioning Group.

d) Receive the services of the employees or the resources available from

another Clinical Commissioning Group.

6.4.4. Where the Group makes arrangements that involve all the Clinical Commissioning Groups exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions.

6.4.5. For the purposes of the arrangements described at paragraph 6.4.2 above, the

Group may establish and maintain a pooled fund made up of contributions by any of the Clinical Commissioning Groups working together pursuant to paragraph 6.4.2 c) above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.4.6. Where the Group makes arrangements with another Clinical Commissioning

Group as described at paragraph 6.4.2 above, the Group shall develop and agree with that Clinical Commissioning Group an agreement setting out the arrangements for joint working, including details of:

a) How the parties will work together to carry out their commissioning functions.

b) The duties and responsibilities of the parties.

c) How risk will be managed and apportioned between the parties.

d) Financial arrangements, including, if applicable, payments towards a pooled

fund and management of that fund.

e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.4.7. The liability of the Group to carry out its functions will not be affected where the

Group enters into arrangements pursuant to paragraph 6.4.2 above.

6.4.8. The Group will act in accordance with any further guidance issued by NHS England on co-commissioning.

6.4.9. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body.

6.4.10. The Governing Body shall require, in all joint commissioning arrangements, that the lead clinician and lead manager of the lead Clinical Commissioning Group make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

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6.4.11. Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

6.5. Joint commissioning arrangements with NHS England for the exercise of

Clinical Commissioning Group functions

6.5.1. The Group may wish to work together with NHS England in the exercise of its commissioning functions.

6.5.2. The Group and NHS England may make arrangements to exercise any of the Group’s commissioning functions jointly.

6.5.3. The arrangements referred to in paragraph 6.5.2 above may include other Clinical Commissioning Groups.

6.5.4. Where joint commissioning arrangements pursuant to 6.5.2 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

6.5.5. Arrangements made pursuant to 6.5.2 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the Group.

6.5.6. Where the Group makes arrangements with NHS England (and another Clinical Commissioning Group if relevant) as described at paragraph 6.5.2 above, the Group shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of: a) How the parties will work together to carry out their commissioning functions.



d) Financial arrangements, including, if applicable, payments towards a pooled

fund and management of that fund.

e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.5.7. The liability of the Group to carry out its functions will not be affected where the

Group enters into arrangements pursuant to paragraph 6.5.2 above.



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6.5.10. The Governing Body shall require, in all joint commissioning arrangements that

the Chief Officer make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.5.11. Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

6.6. Joint commissioning arrangements with NHS England for the exercise of

NHS England’s functions

6.6.1. The Group may wish to work with NHS England and, where applicable, other Clinical Commissioning Groups, to exercise specified NHS England functions.

6.6.2. The Group may enter into arrangements with NHS England and, where applicable, other Clinical Commissioning Groups to:

a) Exercise such functions as specified by NHS England under delegated

arrangements.

b) Jointly exercise such functions as specified with NHS England.

6.6.3. Where arrangements are made for the Group and, where applicable, other Clinical Commissioning Groups to exercise functions jointly with NHS England, a joint committee may be established to exercise the functions in question.

6.6.4. Arrangements made between NHS England and the Group may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.

6.6.5. For the purposes of the arrangements described at paragraph 6.6.2 above, NHS England and the Group may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.6.6. Where the Group enters into arrangements with NHS England as described at paragraph 6.6.2 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:

a) How the parties will work together to carry out their commissioning functions.



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d) Financial arrangements, including payments towards a pooled fund and management of that fund.

e) Contributions from the parties, including details around assets, employees

and equipment to be used under the joint working arrangements.

6.6.7. The liability of NHS England to carry out its functions will not be affected where it and the Group enter into arrangements pursuant to paragraph 6.6.2 above.



6.6.10. The Governing Body shall require, in all joint commissioning arrangements that the Chief Officer make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.6.11. Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

6.7. Additional joint commissioning arrangements 6.7.1. The Group may also enter into additional joint commissioning arrangements with

a Local Authority, which will be documented within separate agreements under section 75 of the 2006 Act.

6.8. The Governing Body 6.8.1. Functions - the Governing Body has the following functions conferred on it by

sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution42. The Governing Body may also have functions of the Clinical Commissioning Group delegated to it by the Group. Where the Group has conferred additional functions on the Governing Body connected with its main functions, or has delegated any of the Group’s functions to its Governing Body, these are set out from paragraph 6.7.1(d) below. The Governing Body has responsibility for:

a) Ensuring that the Group has appropriate arrangements in place to exercise

its functions effectively, efficiently and economically and in accordance with the Group’s principles of good governance (its main function).

42

See Section 14L(3)(c) of the 2006 Act, as inserted by Section 25 of the 2012 Act

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b) Determining the remuneration, fees and other allowances payable to employees or other persons providing services to the Group and the allowances payable under any pension scheme it may establish43, other than those decisions relating to members of the Governing Body (see paragraph 6.8.1b of this constitution for further information).

c) Approving any functions of the Group that are specified in regulations44.

d) Approving arrangements for securing effective participation by each member

of the Group in exercising its functions.

e) Approving arrangements for discharging the Group’s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice, securing public involvement, and promoting innovation, research and education and training (see Chapter 5 of this constitution for further information).

f) Approving all other matters delegated to it by the Group’s membership as

detailed within the Group’s Scheme of Reservation and Delegation (see Appendix C).

g) Monitoring performance against the Group’s plans and management of

strategic risks. 6.8.2. Composition of the Governing Body45 - the Governing Body shall not have

less than 12 voting members, with a clinical majority, comprised of:

a) The Chair of the Governing Body who shall also be the Group’s Clinical Leader (to be a representative acting on behalf of member practices and a GP Cluster Lead).

b) At least three further representatives acting on behalf of member practices

who shall also be GP Cluster Leads.

c) Five Independent Members:

i) Lay Member lead for financial management and audit who shall also act as Deputy Chair of the Governing Body;

ii) Lay Member lead for patient and public involvement and equality;

iii) Lay Member lead for planning and performance;

iv) Registered Nurse;

43 See paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act 44 See Section 14L(5) of the 2006 Act, inserted by Section 25 of the 2012 Act 45

See NHS (Clinical Commissioning Group) Regulations 2012 No. 1631

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v) Secondary Care Specialist Doctor.

d) The Chief Officer who shall also be the Accountable Officer.

e) The Chief Finance Officer.

f) The Corporate Medical Lead. 6.8.3. The Governing Body may also co-opt observers and attendees with speaking

rights to attend meetings as required, including, but not limited to:

a) Director of Primary Care Development and Service IntegrationContracting and Transformation.

b) Director of Quality and DeliveryPersonalisation.

c) Associate Director of Corporate ServicesDevelopment.

d) Nottingham City Council Director of Public Health.

6.9. Committees of the Governing Body

6.9.1. The Governing Body has appointed the following committees: a) Audit Committee – the Audit Committee, which is accountable to the

Group’s Governing Body, provides the Governing Body with an independent and objective view of the Group’s financial systems, financial information

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and compliance with laws, regulations and directions governing the Group in so far as they relate to finance. The Governing Body has approved and keeps under review the Terms of Reference for the Audit Committee, which are aligned to the requirements of the NHS Audit Committee Handbook46 and includes information on the membership of the Audit Committee47. In addition the Group or its Governing Body has conferred or delegated the following functions, connected with the Governing Body’s main function48, to its Audit Committee:

i) Responsibility for reviewing the establishment and maintenance of an

effective system of integrated governance, risk management and internal control, across the whole of the Group’s activities. This will include reviewing the integrity of the Group’s financial statements, the adequacy and effectiveness of all risk and control related disclosure statements, and ensuring that the Group has effective whistle blowing and anti-fraud systems in place.

ii) Responsibility for scrutinising every instance of non-compliance with the Group’s Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies (see paragraph 10.2 of this constitution for further information) and monitoring compliance with the Group’s Conflicts of Interest Policy and Gifts, Hospitality and Sponsorship Policy.

b) Remuneration Committee – the Remuneration Committee, which is

accountable to the Group’s Governing Body, makes determinations about the remuneration, fees and other allowances for Governing Body members, and makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the Group and on determinations about allowances under any pension scheme that the Group may establish as an alternative to the NHS pension scheme. The Governing Body has approved and keeps under review the Terms of Reference for the Remuneration Committee, which includes information on the membership of the Remuneration Committee49.

c) Risk and Performance Committee – the Risk and Performance

Committee, which is accountable to the Group’s Governing Body, exists to scrutinise the robustness of the Group’s risk management and assurance processes regarding the delivery of the Group’s statutory responsibilities and to oversee the development, implementation and monitoring of the Group’s performance management arrangements and activities. The Committee will also oversee the development, implementation and monitoring of the Group’s QIPP Programme. The Governing Body has approved and keeps under review the Terms of Reference for the Risk and Performance

46

Healthcare Financial Management Association (HFMA) NHS Audit Committee Handbook 2010 47 See Appendix G for the Terms of Reference of the Audit Committee 48 See Section 14L(2) of the 2006 Act, inserted by Section 25 of the 2012 Act 49 See Appendix H for the Terms of Reference of the Remuneration Committee

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Committee, which includes information on the membership of the Risk and Performance Committee 50.

In addition the Group or its Governing Body has conferred or delegated the following functions, connected with the Governing Body’s main function51, to its Risk and Performance Committee:

i) Responsibility for approving the Group’s arrangements for business

continuity and for supporting emergency planning.

ii) Responsibility for approving arrangements for ensuring appropriate safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

iii) Responsibility for approving arrangements for handling Freedom of

Information requests.

d) Quality Improvement Committee – the Quality Improvement Committee, which is accountable to the Group’s Governing Body, exists to scrutinise arrangements for ensuring the quality of those services commissioned by the Group and to oversee the quality of primary medical services within the geographical area covered by the Group. The Quality Improvement Committee also promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience. The Governing Body has approved and keeps under review the Terms of Reference for the Quality Improvement Committee, which includes information on the membership of the Quality Improvement Committee 52.

e) Primary Care Commissioning Panel – the Primary Care Commissioning

Panel, which is accountable to the Group’s Governing Body, exists to make the Group’s decisions regarding the management of delegated primary care commissioning functions. The Governing Body has approved and keeps under review the Terms of Reference for the Primary Care Commissioning Panel, which includes information on the membership of the Primary Care Commissioning Panel53.

f) Resource Allocation and Prioritisation Panel – the Resource Allocation

and Prioritisation Panel, which is accountable to the Group’s Governing Body, exists to make the Group’s investment, disinvestment, and resource allocation decisions in line with the organisation’s Commissioning Policy and Ethical Framework for Priority Setting and Resource Allocation. The

50 The Terms of Reference of the Risk and Performance Committee are detailed within the Group’s

Governance Handbook 51 See Section 14L(2) of the 2006 Act, inserted by Section 25 of the 2012 Act 52 The Terms of Reference of the Quality Improvement Committee are detailed within the Group’s

Governance Handbook 53 The Terms of Reference of the Primary Care Commissioning Panel are detailed within the Group’s

Governance Handbook

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Governing Body has approved and keeps under review the Terms of Reference for the Resource Allocation and Prioritisation Panel, which includes information on the membership of the Resource Allocation and Prioritisation Panel54.

g) Individual Funding Request Panel – the Individual Funding Request

Panel, which is accountable to the Group’s Governing Body, exists to make the Group’s decisions on Individual Funding Requests. The Governing Body has approved and keeps under review the Terms of Reference for the Individual Funding Request Panel, which includes information on the membership of the Individual Funding Request Panel 55.

h) Extraordinary Funding Request Panel – the Extraordinary Funding Request Panel, which is accountable to the Group’s Governing Body, exists to make the Group’s decisions on requests for which there is no commissioning policy and where individuals could be disadvantaged if their case was not considered within a specific timescale. The Governing Body has approved and keeps under review the Terms of Reference for the Extraordinary Funding Request Panel, which includes information on the membership and the principles against which cases are considered56.

6.10. Clinical Council

6.10.1. The Group has established a Clinical Council, which exists as the Group’s main

forum for clinical discussions in relation to: a) The development of strategic commissioning proposals.

b) Implementation of the Group’s commissioning strategy and annual

commissioning plan.

c) Promoting and encouraging continuous quality improvement and having regard to the need to reduce inequalities.

d) Promoting and encouraging shared decision making and patient choice.

e) Obtaining appropriate advice.

f) Promoting and encouraging innovation, research, and education and

training. 6.10.2. The Clinical Council is not a formally appointed committee of the Governing

Body, and as such, does not have any delegated decision making powers.

54 The Terms of Reference of the Resource Allocation and Prioritisation Panel are detailed within the

Group’s Governance Handbook 55 The Terms of Reference of the Individual Funding Request Panel are detailed within the Group’s

Governance Handbook 56 The Terms of Reference of the Extraordinary Funding Request Panel are detailed within the Group’s

Governance Handbook

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Instead, it operates in a clinical leadership and advisory capacity to the Governing Body (and its committees) and provides a clear mechanism for individual member practice and GP Cluster views to be fed into the Group’s decision making processes.

6.10.3. The Clinical Council is comprised of representatives from each of the Group’s GP Clusters, proportionate to their overall registered patient list sizes. The Group’s senior management team also attend meetings, as required.

6.10.4. The Governing Body has approved and keeps under review the Terms of

Reference for the Clinical Council57. 6.11. People’s Council

6.11.1. The Group has established a People’s Council, which exists as the Group’s main

forum for: a) Securing public involvement in the planning, development and consideration

of proposals for changes and decisions affecting the operation of commissioning arrangements.

b) Capturing data, including patient views, experiences and feedback, to support the Group’s arrangements for monitoring the quality of services commissioned by the Group and the quality of primary medical services, including but not limited to the:

i) Safety and effectiveness of the treatment and care provided to patients.

ii) Experience patients have of the treatment and care they receive.

c) Promoting and encouraging shared decision making and patient choice.

d) Capturing early warning signs of areas and services where patient

experience is deteriorating and quality standards may be compromised. 6.11.2. The People’s Council is not a formally appointed committee of the Governing

Body, and as such, does not have any delegated decision making powers. Instead, it operates in an advisory capacity to the Governing Body (and its committees) and provides a clear mechanism for the views of patients, carers, community groups and the public to be fed into the Group’s decision making processes.

6.11.3. The People’s Council is comprised of patient, carer and community group representatives that reflect the demographic of Nottingham City’s population. The Group’s senior management team also attend meetings, as required.

6.11.4. The Governing Body has approved and keeps under review the Terms of Reference for the People’s Council58.

57 The Terms of Reference of the Clinical Council are detailed within the Group’s Governance Handbook

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7. ROLES AND RESPONSIBILITIES

7.1. Individual Member Practice Representatives 7.1.1. Each member practice is required to nominate one practice representative to act

on its behalf in the dealings between it and the Group59.

7.1.2. Practice representatives are an essential element to ensuring effective participation by each of the Group’s member practices in exercising the Group’s functions. The role of each practice representative is to:

a) Represent their practice’s views and act on behalf of their practice in all

aspects of the Group’s commissioning activities, which necessitates working effectively with GPs (including sessional and locum GPs) and with other practice staff, to ensure that the views of the practice as a whole are obtained and input to discussions.

b) Maintain awareness of the Group’s work through the Group’s communication channels, attendance at meetings and discussion of commissioning at practice and patient group meetings, and to ensure dissemination of information to member practice staff relating to the Group's work and their responsibilities to the Group.

c) Enable and facilitate two-way communications between their practice, their

GP Cluster and the Group, particularly in relation to:

i) Feedback from patients and carers, particularly in relation to individual patient choices and any early warning signs of quality issues or failing services that might inform commissioning decisions.

ii) Workforce issues that might influence the ability of the member practice to fulfil its duties effectively.

d) Ensure the member practice participates in agreed specific pathway

redevelopments, providing insight and feedback as appropriate.

e) Assist the Group in taking forward developments and improvements in relation to primary care services, including improving the performance of primary care services within the geographical area covered by the Group.

7.2. All Members of the Group’s Governing Body 7.2.1. Guidance on the roles of members of the Group’s Governing Body is set out in a

separate document60.

58 The Terms of Reference of the People’s Council are detailed within the Group’s Governance

Handbook 59

See Sections 89 and 94 of the 2006 Act (as amended by Section 28 of the 2012 Act) 60 Clinical Commissioning Group Governing Body Members – Role Outlines, Attributes and Skills, NHS

Commissioning Board Authority, OctoberJuly 2012

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7.2.2. In summary, each member of the Governing Body has a shared responsibility as

part of a team to ensure that the Group exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience. Additional specific responsibilities of each Governing Body Member are set out within paragraphs 7.3 to 7.10 of this constitution.

7.3. Representatives acting on behalf of Member Practices on the Governing

Body who shall also be GP Cluster Leads 7.3.1. The representatives acting on behalf of Member Practices on the Governing

Body will also be the lead for their GP Cluster and be responsible for:

a) Ensuring the effective participation of each member practice in order to develop and sustain high-quality commissioning arrangements, which includes facilitation of a two-way dialogue to bring local views and experiences from practice consultations into the work of the Group, particularly in relation to individual patient choices and any early warning signs of quality issues or failing services.

b) Ensuring that member practices contribute to the development of an understanding of local health needs to help inform the development of the Group’s commissioning strategy and the Joint Health and Wellbeing Strategy.

c) Promoting and encouraging continuous quality improvement, shared

decision making, patient choice, innovation, research and education and training through the Group’s clinical commissioning activities, whilst having due regard to the need to obtain appropriate advice and reduce inequalities.

d) Establishing effective working arrangements with the clinical leaders of the

Group’s main providers to achieve improved health outcomes for patients and the public in Nottingham City.

e) Providing clinical leadership to the Group’s commissioning priority areas,

leading on clinical service redesign, performance management and QIPP programmes for the relevant area.

7.4. Chair of the Governing Body and Clinical Leader 7.4.1. In addition to the responsibilities of being a representative acting on behalf of

member practices (see paragraph 7.3 of this constitution for further information), the Chair of the Governing Body is responsible for:

a) Leading the Governing Body, ensuring it remains continuously able to

discharge its duties and responsibilities as set out in this constitution.

b) Building and developing the Group’s Governing Body and its individual members.

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c) Ensuring that the Group has proper constitutional and governance

arrangements in place.

d) Ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties.

e) Supporting the Chief Officer in discharging the responsibilities of the organisation.

f) Contributing to building a shared vision of the aims, values and culture of the organisation.

g) Leading and influencing to achieve clinical and organisational change to enable the Group to deliver its commissioning responsibilities.

h) Overseeing governance and particularly ensuring that the Governing Body and the wider Group behave with the utmost transparency and responsiveness at all times;

i) Ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met.

j) Ensuring that the organisation is able to account to its local patients, stakeholders and the NHS Commissioning Board.

k) Ensuring that the Group builds and maintains effective relationships, particularly with the individuals involved in health scrutiny from Nottingham City Council.

l) Approving all other matters delegated to the Chair of the Governing Body by

the Group’s membership as detailed within the Group’s Scheme of Reservation and Delegation (see Appendix C).

7.4.2. The Chair of the Governing Body is also the Group’s Clinical Leader who

represents the clinical voice of the Group’s member practices and leads in interactions with the Group’s stakeholders, including the NHS Commissioning Board.

7.5. The Chief Officer who shall also be the Accountable Officer 7.5.1. The Chief Officer is responsible for:

a) Ensuring that the Group fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money.

b) At all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that nationally

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recognised good practice is embodied and that safeguarding of funds is ensured through effective financial and management systems.

c) Working closely with the Chair of the Governing Body, the Chief Officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its members and staff.

d) Approving all other matters delegated to the Chief Officer by the Group’s membership as detailed within the Group’s Scheme of Reservation and Delegation (see Appendix C).

7.6. Chief Finance Officer 7.6.1. The Chief Finance Officer is responsible for61:

a) Being the Governing Body’s professional expert on finance and advising the

Accountable Officer and Governing Body on the effective, efficient and economic use of the Group’s allocation to remain within that allocation and deliver required financial targets and duties.

b) Establishing robust financial procedures and controls and effective financial management and financial planning arrangements.

c) Establishing effective arrangements for financial risk sharing and / or risk

pooling with other organisations.

d) Securing appropriate internal audit, external audit and counter fraud arrangements.

e) Producing the financial statements for audit and publication in accordance with the Group’s statutory requirements to demonstrate effective stewardship of public money and accountability to the NHS Commissioning Board.

7.7. Secondary Care Specialist Doctor

7.7.1. The Secondary Care Specialist Doctor is responsible for:

a) Providing an external view of the work of the Group that is removed from the

day-to-day running of the organisation, bringing insight and impartiality to the Governing Body and providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

61 Clinical Commissioning Group Governing Body Members – Role Outlines, Attributes and Skills, NHS

Commissioning Board Authority, OctoberJuly 2012

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b) Bringing a broader view on health and care issues to underpin the work of the Group, in particular bringing to the Governing Body an understanding of patient care in the secondary care setting.

c) Having a lead oversight role in ensuring that appropriate mechanisms are in

place within the Group to secure the involvement and engagement of secondary care clinicians in all aspects of the Group’s commissioning activity.

7.8. Registered Nurse 7.8.1. The Registered Nurse is responsible for:

a) Providing an external view of the work of the Group that is removed from the day-to-day running of the organisation, bringing insight and impartiality to the Governing Body and providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

b) Bringing a broader view on health and care issues to underpin the work of the Group, in particular bringing to the Governing Body an understanding of the role of nurses in securing the best possible outcomes for patients.

c) Having a lead oversight role in ensuring that appropriate mechanisms are in place within the Group to secure the involvement and engagement of nursing, midwifery and allied health professionals in all aspects of the Group’s commissioning activity.

7.9. Lay Members on the Governing Body

7.9.1. The Lay Member lead for financial management and audit is responsible for:


day-to-day running of the organisation, bringing a strategic insight and impartiality to the Governing Body and providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

b) Overseeing key elements of governance, including audit, remuneration and conflicts of interest.

c) Having a lead oversight role in ensuring that the Governing Body and the

wider Group behave with the utmost probity at all times.

d) Chairing the Group’s Audit Committee and Audit Panel (see paragraph 6.8.1a of this constitution for further information).

d) Fulfilling the role of Deputy Chair of the Governing Body and deputising for the Chair when he or she has a conflict of interest or is otherwise unable to act.

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e) As Deputy Chair, being responsible for appraisal and development of the other Independent Members of the Governing Body (and its committees).

e)f) Fulfilling the role of Conflicts of Interest Guardian in accordance with

the Group’s Conflicts of Interest Policy. 7.9.2. The Lay Member lead for patient and public involvement and equality is

responsible for:

a) Providing an external view of the work of the Group that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality to the Governing Body and providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

b) Having a lead oversight role in ensuring that the diverse voice of the local population is heard in all aspects of the Group’s business, and that equal opportunities are created and protected for patient and public involvement and engagement in all aspects of the Group’s commissioning activity. Particularly ensuring that:

i) Patient and community groups are at the heart of discussions and

decision making arrangements, ensuring that the Group responds in an effective and timely way to feedback and recommendations;

ii) The Group builds and maintains an effective relationship with current involvement and engagement fora and with the Local Healthwatch.

7.9.3. The Lay Member lead for planning and performance is responsible for:


day-to-day running of the organisation, bringing a strategic insight and impartiality to the Governing Body and providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

b) Bringing significant or senior level experience to the Governing Body in planning and risk and performance management.

7.10. Corporate Medical Lead

7.10.1. The Corporate Medical Lead is responsible for:

a) Bringing significant knowledge and experience to underpin the work of the

Group in line with its delegated primary care commissioning functions.

b) Having a lead role in overseeing the Group’s arrangements for ensuring effective clinical involvement and engagement in commissioning decisions.

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c) Having a lead role in ensuring compliance with the Group’s safeguarding duties and those relating to the promotion of research and education and training.

8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

8.1. Standards of Business Conduct

8.1.1. Employees, members of the Group who are individuals and members of the

Governing Body (and its committees) will at all times comply with this constitution and be aware of their responsibilities as outlined within it. They should act in good faith and in the interests of the Group and should follow the Seven Principles of Public Life, set out by the Committee on Standards in Public Life (the Nolan Principles). The Nolan Principles are incorporated into this constitution at Appendix E.

8.1.2. They must comply with the requirements set out in the Group’s Conflicts of Interest Policy and Gifts, Hospitality and Sponsorship Policy. These policies will be available on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

8.1.3. Individuals contracted to work on behalf of the Group or otherwise providing services or facilities to the Group will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.1.4. Members of the Governing Body (and its committees) must at all times comply

with the expectations set out in the Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England62.

8.2. Conflicts of Interest 8.2.1. As required by section 14O of the 2006 Act, as inserted by section 25 of the

2012 Act, the Group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the Group will be taken and seen to be taken without any possibility of the influence of external or private interest.

8.2.2. Where an individual (i.e. an employee, a member of the Group who is an individual, a member of the Governing Body or a member of a committee) has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the Group considering an action or decision in relation to

62 http://www.professionalstandards.org.uk

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http://www.professionalstandards.org.uk/



that interest, that must be considered as a potential conflict, and is subject to the provisions of this constitution.

8.2.3.8.2.2. A conflict of interest will include:

a) A direct pecuniary interest: where an individual may financially benefit from

the consequences of a commissioning decision (for example, as a provider of services);financial interest: where an individual may get financial benefits from the consequences of a commissioning decision;

b) An indirect pecuniary interest: for example, where an individual is a partner,

member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision; non-financial professional interest: where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their reputation or status or promoting their professional career;

c) A non-pecuniary interest: where an individual holds a non-remunerative or

not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract); non-financial personal interest: where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit;

d) An non-pecuniary personal benefit: where an individual may enjoy a

qualitative benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual’s house); indirect interest: where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision.

e) Where an individual is closely related to, or in a relationship, including

friendship, with an individual in the above categories. 8.2.4. If in doubt, the individual concerned should assume that a potential conflict of

interest exists.

8.2.5.8.2.3. Requirements for declaring, registering and managing conflicts of interest will be set out within the Group’s Conflicts of Interest Policy, which will be agreed by the Group’s Governing Body. The Audit Committee will have will delegated responsibility for scrutinising compliance with the stated requirements within the policy, which will include reference to those matters detailed within paragraphs 8.3, 8.4 and 8.5 of this constitution..

8.3. Declaring and Registersing of Declared Interests 8.3.1. The Group will maintain a register(s) of interests of:

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a) Its member practices.

b) The members of its Governing Body (and of its committees).

c) Its employees.

c)d) Any other individuals directly involved in the business or decision-making of

the Group. 8.3.2. The register(s) will be published on the Group’s website at

www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

8.3.3. Individuals will declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of the Group, in writing to the Group’s Associate Director of Corporate Services, as soon as they are aware of it and in any event no later than 28 days after becoming aware.

8.3.4. Where an individual is unable to provide a declaration in writing, for example, if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

8.3.5. The Associate Director of Corporate Services will ensure that the register of

interests is reviewed regularly, and updated as necessary. 8.4. Managing Conflicts of Interest: General 8.4.1. Members of the Group who are individuals, members of the Governing Body

(and its committees) and employees will comply with the arrangements determined by the Group for managing conflicts or potential conflicts of interest.

8.4.2. The Associate Director of Corporate Services will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the Group’s decision making processes.

8.4.3. The arrangements for managing each individual conflict of interests, or potential

conflict of interest, will be put in writing to the relevant individual within a week of declaration. The arrangements will confirm the following:

a) When an individual should withdraw from a specified activity, on a temporary

or permanent basis;

b) Monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

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8.5. Where an interest has been declared, either in writing or by oral declaration, the declarer will ensure that before participating in any activity connected with the Group’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Associate Director of Corporate Services.

8.5.1. Where members of the Group who are individuals, members of the Governing

Body (or its committees) or employees are aware of an interest which:

a) Has not been declared, either in the register or orally, they will declare this at the start of the meeting;

b) Has previously been declared, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests.

The chair of the meeting will then determine how this should be managed and inform the member of their decision. Where no arrangements have been confirmed, the chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.

8.5.2. Where the chair of any meeting of the Group, including meetings of its Governing

Body (and its committees), has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

8.5.3. Any declarations of interests, and arrangements agreed in any meeting of the

Group, including meetings of its Governing Body (and its committees), will be recorded in the minutes of the meeting.

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

from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed.

8.5.5. In making this decision the chair will consider whether the meeting is quorate, in

accordance with the number and balance of membership as defined within the relevant Terms of Reference. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of

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interest or potential conflicts of interests, the chair of the meeting shall consult with the Associate Director of Corporate Services on the action to be taken.

8.5.6. This may include:

a) Requiring another of the Group’s decision-making forums, including its

Governing Body and committees of its Governing Body (as appropriate), which can be quorate to progress the item of business, or if this is not possible.

b) Inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee in question) so that the Group can progress the item of business:

i) A member of the Group who is an individual;

ii) An individual appointed by a member to act on its behalf in the dealings

between it and the Group;

iii) A member of the relevant Health and Wellbeing Board;

iv) A member of a Governing Body of another Clinical Commissioning Group.

These arrangements must be recorded in the minutes.

8.5.7. In any transaction undertaken in support of the Group’s exercise of its

commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and formally declare the interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Associate Director of Corporate Services of the transaction.

8.5.8. The Associate Director of Corporate Services will take such steps as deemed appropriate, and request information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared.

8.5.9. 8.5.10. Managing Conflicts of Interest: Contractors and people who provide

services to the Group 8.5.11. 8.5.12. Anyone seeking information in relation to a procurement, or participating in a

procurement, or otherwise engaging with the Group in relation to the potential provision of services or facilities to the Group, will be required to make a declaration of any relevant conflict or potential conflict of interest.

8.5.13.

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8.5.14. Anyone contracted to provide services or facilities directly to the Group will be subject to the same provisions of this constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.5.15. 8.5.16. Managing Conflicts of Interest: GP practices as providers 8.5.17. 8.5.18. The Group will comply with all statutory requirements regarding the management

of conflicts of interest where GP practices are potential providers of services commissioned by the Group63.

8.6.8.4. Transparency in Procuring Services 8.6.1.8.4.1. The Group recognises the importance in making decisions about the services

it procures in a way that does not call into question the motives behind the procurement decision that has been made. The Group will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

8.6.2.8.4.2. The Group will publish a Procurement, Patient Choice and Competition Policy,

approved by its Governing Body, which will ensure that:

a) All relevant clinicians (not just members of the Group) and potential providers, together with local members of the public, are engaged in the decision-making processes used to procure services;

b) Service redesign and procurement processes are conducted in an open,

transparent, non-discriminatory and fair way;

b)c) All potential bidders/contractors are requested to declare relevant interests as part of every procurement process..

8.6.3.8.4.3. Copies of this Procurement, Patient Choice and Competition Policy will be

available on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

8.6.4.8.4.4. The Group will maintain a register of procurement decisions taken, including:

a) The details of the decision;

b) Who was involved in making the decision;

c) A summary of any conflicts of interest in relation to the decision and how this was managed by the Group.

63 Managing Conflicts of Interest: Revised Statutory Guidance for CCGs, NHS Commissioning Board,

December June 20164

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8.6.5.8.4.5. The register of procurement decisions will be updated whenever a

procurement decision is taken.

8.6.6.8.4.6. The register of procurement decisions will be published on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

8.6.7.8.4.7. Details of all contracts awarded will be published on the Group’s website as

soon as contracts are agreed, including:

a) The name of the provider and the address of its registered office or principal place of business;

b) A description of the services to be provided;

c) The total amount to be paid or, where the total amount is not known, the amounts payable to the provider under the contract;

d) The dates between which the contract provides for the services to be

provided;

e) A description of the process adopted for selecting the provider. 8.7.8 Where the Group decides to commission services through Any Qualified

Provider, it will publish on its website the type of services commissioned, the agreed price for each service and the names of the providers who qualify to provide the service.

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9. THE GROUP AS AN EMPLOYER 9.1. The Group recognises that its most valuable asset is its people. It will seek to

enhance their skills and experience and is committed to their development in all ways relevant to the work of the Group.

9.2. The Group will seek to set an example of best practice as an employer and is

committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

9.3. The Group will ensure that it employs suitably qualified and experienced staff

who will discharge their responsibilities in accordance with the high standards expected of staff employed by the Group. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.4. The Group will maintain and publish policies and procedures (as appropriate) on

the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The Group will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters.

9.5. The Group will ensure that its rules for recruitment and management of staff

provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

9.6. The Group will ensure that employees' behaviour reflects the values, aims and

principles set out within this constitution. 9.7. The Group will ensure that it complies with all aspects of employment law. 9.8. The Group will ensure that its employees have access to such expert advice and

training opportunities as they may require in order to effectively discharge their responsibilities.

9.9. The Group will maintain and promote effective 'whistleblowing' procedures to

ensure that concerned staff have means through which their concerns can be voiced. The Group recognises and confirms that nothing in or referred to in this constitution will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the Group, any member of its Governing Body or the Committees of its Governing Body, or any employee of the Group or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.

9.10. Copies of the policies and procedures outlined in this chapter, will be available

on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row,

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Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

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10. TRANSPARENCY AND WAYS OF WORKING 10.1. General 10.1.1. The Group will publish an annual commissioning plan and an annual report,

presenting the Group’s annual report to a public meeting. The annual report will include details of senior employees’ salary and allowances64.

10.1.2. Key communications issued by the Group, including the notices of procurements, public consultations, Governing Body meeting dates, times, venues, and certain papers will be published on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

10.1.3. The Group may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public.

10.2. Standing Orders, Scheme of Reservation and Delegation and Prime

Financial Policies 10.2.1. This constitution is also informed by a number of documents which provide

further details on how the Group will operate. They are the Group’s:

a) Standing Orders (Appendix B) – which set out the arrangements for meetings and the appointment processes for the Group’s representatives and Governing Body members;

b) Scheme of Reservation and Delegation (Appendix C) – which sets out

those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the Group’s Governing Body (and its committees) and employees;

c) Prime Financial Policies (Appendix D) – which set out the arrangements

for managing the Group’s financial affairs.

64

As required by The National Health Service (Clinical Commissioning Groups) Regulations 2012 S.I. 2012/1631

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APPENDIX A – DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Accountable Officer An individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by the NHS Commissioning Board, with responsibility for ensuring the Group:

Complies with its obligations under:

- Sections 14Q and 14R of the 2006 Act (as inserted by Section 26 of the 2012 Act)

- Sections 223H to 223J of the 2006 Act (as inserted by Section 27 of the 2012 Act)

- Paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act)

- Any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Board for that purpose

Exercises its functions in a way which provides good value for money

Area The geographical area that the Group has responsibility for, as defined in Chapter 2 of this constitution

Chair of the Governing Body

The individual appointed by the Group to act as Chair of the Governing Body

Chief Finance Officer The qualified accountant employed by the Group with responsibility for financial strategy, financial management and financial governance

Clinical Commissioning Group

A body corporate established by the NHS Commissioning Board in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act)

Committee A committee or sub-committee created and appointed by:

The membership of the Group

A committee / sub-committee created by a committee created / appointed by the membership of the Group

A committee / sub-committee created / appointed by the Governing Body

Financial year This usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a Clinical Commissioning Group is established until the following 31 March

GP General Practitioner

GP Cluster A group of GP practices within Nottingham City who by choice work together in a shared framework to engage member practices in defining and delivering the objectives of NHS Nottingham City Clinical Commissioning Group

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Group NHS Nottingham City Clinical Commissioning Group, whose constitution this is

Governing Body The body appointed under Section 14L of the NHS Act 2006 (as inserted by Section 25 of the 2012 Act), with the main function of ensuring that a Clinical Commissioning Group has made appropriate arrangements for ensuring that it complies with:

Its obligations under Section 14Q under the NHS Act 2006 (as inserted by Section 26 of the 2012 Act)

Such generally accepted principles of good governance as are relevant to it

Governing Body Member

Any member appointed to the Governing Body of the Group

Healthcare Professional

An individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002

Independent Members

Members of the Governing body who are removed from the day-to-day running of the organisation and able to bring insight and impartiality to the Governing Body, providing constructive challenge to discussions at meetings of the Governing Body (and its committees) to support the Group’s decision making arrangements.

Individual Funding Requests

Requests from individuals who are seeking funding for NHS commissioned services outside established commissioning policies. There are in general two types of requests, namely:

Requests for funding for treatments for medical conditions where the Group has no established commissioning policy.

Requests for funding for treatments for medical conditions where the Group does have an established commissioning policy for that condition, but where the requested individual treatment is not in the Group’s policy or does not meet the criteria set out in the policy.

Lay Member A lay member of the Governing Body, appointed by the Group. A lay member is an individual who is not a member of the Group or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations)

Local Academic Health Science Network

Academic Health Science Networks provide a systematic delivery mechanism for the local NHS, universities, public health and social care to work with industry to transform the identification, adoption and spread of proven innovations and best practice. They are partnership organisations in which the partners are committed to working together to improve the quality and productivity of health care resulting in better patient outcomes and population health.

Local Authority The local office of government, a democratic organisation, comprised of elected councillors in line with the Local Government Act 2000.

Local Education and Training Board

A committee of Health Education England responsible for planning and commissioning education and training for the local healthcare workforce.

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Local HealthWatch An independent organisation, funded by the Local Authority, able to employ its own staff and involve volunteers, so it can become the influential and effective voice of the public. The aim of Local Healthwatch will be to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality

Local NIHR Clinical Research Network

The National Institute for Health Research (NIHR) Clinical Research Network makes it possible for all patients and health professionals across England to participate in relevant clinical trials. The aims of the NIHR Clinical Research Network is to:

Ensure patients and healthcare professionals from all parts of the country are able to participate in and benefit from clinical research.

Integrate health research and patient care.

Improve the quality, speed and co-ordination of clinical research.

Increase collaboration with industry partners and ensure that the NHS can meet the health research needs of industry.

Member A provider of primary medical services to a registered patient list, who is a member of this Group (see table in Chapter 3)

Nottingham City Council

The Local Authority for the City of Nottingham.

Practice Representatives

An individual appointed by a practice (who is a member of the Group) to act on its behalf in the dealings between it and the Group, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act)

Primary Care Research Network

The Primary Care Research Network is part of the National Institute for Health Research (NIRH) Clinical Research Network and is funded by the Department of Health. It provides researchers with the practical support they need to make clinical studies happen in a primary care setting in the NHS, so that more research takes place across England, and more patients can take part.

QIPP Quality, Innovation, Productivity and Prevention – is a large scale transformational programme for the NHS, involving all NHS staff, clinicians, patients and the voluntary sector. It will improve the quality of care the NHS delivers while making up to £20 billion of efficiency savings by 2014-15, which will be reinvested in frontline care.

Register of interests A register a Group is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of:

The members of the Group

The members of its Governing Body (and its committees)

Its employees

Research Ready Accreditation Scheme

Research Ready is an online self-accreditation tool developed by the Royal College of General Practitioners (RCGP) covering the minimum requirements of the Research Governance Framework for undertaking primary care research in the UK.

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Specified Reserved Matters

Those matters reserved by the Group’s membership that require a higher voting threshold than a simple majority and which cannot be dealt with by a written resolution outside of a Members’ Meeting.

Terms of Reference Terms of reference describe the purpose and structure of a committee.

Working Day Any day of the week excluding weekends and bank holidays.

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APPENDIX B – STANDING ORDERS 1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction 1.1.1. These Standing Orders have been drawn up to regulate the proceedings of the

NHS Nottingham City Clinical Commissioning Group so that the Group can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the Group is established.

1.1.2. The Standing Orders, together with the Group’s Scheme of Reservation and Delegation (see Appendix C) and the Group’s Prime Financial Policies (see Appendix D), provide a procedural framework within which the Group discharges its business. They set out:

a) The arrangements for conducting the business of the Group.

b) The process for electing / appointing members of the Governing Body.

c) The procedure to be followed at meetings of the Group, the Governing Body

and any committees of the Governing Body.

d) The process to delegate powers.

e) The declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate65 of any relevant guidance.

1.1.3. The Standing Orders, Scheme of Reservation and Delegation and Prime

Financial Policies have effect as if incorporated into the Group’s constitution. Group members, employees, members of the Governing Body, members of the Governing Body’s committees and persons working on behalf of the Group should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions.

1.1.4. Failure to comply with the Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies may be regarded as a disciplinary matter that could result in dismissal.

65 Under some legislative provisions the Group is obliged to have regard to particular guidance but

under other circumstances guidance is issued as best practice guidance.

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1.2. Schedule of matters reserved to the Group’s membership as a whole and the Scheme of Reservation and Delegation

1.2.1. The 2006 Act (as amended by the 2012 Act) provides the Group with powers to delegate the Group’s functions and those of its Governing Body to certain bodies (such as committees) and certain persons. The Group has decided that certain decisions are reserved to the Group’s membership as a whole. These decisions and also those delegated are contained in the Group’s Scheme of Reservation and Delegation (see Appendix C).

2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP AND APPOINTMENT PROCESSES FOR KEY ROLES

2.1. Composition of Membership

2.1.1. Chapter 3 of the Group’s constitution provides details of the membership of the

Group.

2.1.2. Chapter 6 of the Group’s constitution provides details of the governing structure used in the Group’s decision-making processes.

2.2. Appointment Processes for Key Roles

2.2.1. Paragraph 6.7.2 of the Group’s constitution sets out the composition of the

Group’s Governing Body, whilst Chapter 7 of the Group’s constitution identifies certain key roles within the Group and its Governing Body. These Standing Orders set out how the Group elects / appoints individuals to these key roles. The responsibilities of each of these key roles are not included within these Standing Orders as they are set out in Chapter 7 of the Group’s constitution.

2.2.2. Individuals of the descriptions set out within Schedule 5 of The National Health Service (Clinical Commissioning Groups) Regulations 2012 S.I. 2012/1631 are automatically disqualified from membership of the Group’s Governing Body.

2.2.3. Individuals’ interests will be considered as part of the appointment process for

these key roles to determine whether there are any conflicts that warrant individuals being excluded from appointment to the Governing Body. The following general principles will be applied:

a) An assessment of the materiality of the interests, in particular whether the

individual (or a family member or business partner) could benefit from any decision the Governing Body might make;

b) An assessment of the extent of the interests and whether they are related to a business area significant enough that the individual would be unable to make a full and proper contribution to the Governing Body.

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2.2.4. Further disqualification criteria specific to individual roles are detailed within standing orders 2.2.5 to 2.2.12.

2.2.5. Four Representatives acting on behalf of Member Practices on the

Governing Body (as listed in paragraph 7.3 of the Group’s constitution) will be appointed – one for each GP Cluster within the Group that has a population of at least 25,000 registered patients (a “GP Representative”). A GP Cluster with fewer than 25,000 registered patients will not have an automatic right to elect a GP representative to the Group’s Governing Body. A decision on such a matter will be required to be put to a vote of the Group’s membership. If at any time there are less than four GP Clusters within the Group that are entitled to elect a GP Representative, then the remaining GP Representatives (“Additional GP Representatives”) will be elected to represent all member practices within the Group to ensure that there will always be four GP Representatives on the Governing Body. These roles are subject to the following appointment process: a) Nominations and Eligibility – Any GP from within the relevant GP Cluster

(including any aligned locum GP) who is on the Nottingham City GP Performer List, and has performed services in the geographical area covered by the Group for a minimum of 12 months, may nominate themselves for this role when advertised. In the case of an Additional GP Representative, any GP from within the Group (including any locum GP) who is on the Nottingham City GP Performer List, and has performed services in the geographical area covered by the Group for a minimum of 12 months, may nominate themselves for this role when advertised.

b) Appointment process – Appointments will be made as a result of:

i) A formal competency assessment against the specific criteria for the role,

which will be conducted by the Group;

ii) Subsequent election by the member practices of the relevant GP Cluster, or in the case of an Additional GP Representative, by all member practices within the Group.

The election process will be co-ordinated by the Nottinghamshire Local Medical Committee using the principle of one vote per GP, including salaried and locum GPs. Locum GPs will be required to align themselves to a single GP Cluster for voting purposes.

c) Term of office – The normal term of office for a GP Representative is three

years. However, based on the Group’s requirements at the time of appointment, normal terms of office may be varied to ensure that continuity is maintained between transitions.

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d) Eligibility for reappointment – At the end of each term of office, these roles will be subject to the nomination and appointment processes set out at 2.2.5 a) and 2.2.5 b). Incumbent post holders are free to nominate themselves for re-election at the time the roles are advertised, but they have no right to be re-elected. For incumbent post holders, the formal competency assessment will take the form of a satisfactory annual performance appraisal. This will include an expectation that they will have upheld the Nolan Principles and their professional Codes of Conduct.

There is no limit to the number of terms of office that can be served, whether consecutively or otherwise, as long as the person continues to have the support of the GPs from the relevant GP Cluster (for GP Representatives) or the support of the GPs within the Group (for Additional GP Representatives).

e) Grounds for removal from office – The following are grounds for removal

from office for these roles:

i) Gross misconduct;

ii) Becoming disqualified from office (see standing order 2.2.2);

iii) Ceasing to fulfil the eligibility criteria for the role of GP Representative set out at standing order 2.2.5(a) above;

iv) Losing General Medical Council registration and license to practice;

v) Not attending Governing Body meetings for three consecutive months (except under extenuating circumstances, such as illness);

vi) Failing to disclose a pecuniary interest regarding matters under discussion within the organisation or the introduction of a conflict of interests that would warrant an individual being excluded from appointment to the Governing Body in line with standing order 2.2.3;

vii) Following the passing of a vote of no confidence by member practices within the relevant GP Cluster at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

f) Notice period – A GP Representative may resign from the Governing Body

with immediate effect by giving written notice to the Governing Body at any time.

2.2.6. The Chair of the Governing Body (as listed in paragraph 7.4 of the Group’s

constitution) is subject to the following appointment process:

a) Nominations and Eligibility – Any elected GP Representative or Additional GP Representative on the Governing Body can nominate themselves for this role when advertised.

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b) Appointment process – This appointment will be made as a result of:

i) A formal competency assessment against the specific criteria for the role, which will be conducted by the Group;

ii) Subsequent election by the members of the Governing Body (in line with standing order 4.8).

c) Term of office – The normal term of office for this role is three years.

However, based on the Group’s requirements at the time of appointment, normal terms of office may be varied to ensure that continuity is maintained between transitions.

d) Eligibility for reappointment – At the end of each term of office, this role

will be subject to the nomination and appointment processes set out at 2.2.6 a) and 2.2.6 b). The incumbent post holder is free to nominate themself for re-election at the time the role is advertised, but they have no right to be re-elected. For the incumbent post holder, the formal competency assessment will take the form of a satisfactory annual performance appraisal. This will include an expectation that they will have upheld the Nolan Principles and their professional Codes of Conduct.

There is no limit to the number of terms of office that can be served, whether consecutively or otherwise, as long as the person continues to have the support of the Governing Body.


from office for this role:



iii) Ceasing to be a GP Representative on the Governing Body;




vii) Following the passing of a vote of no confidence by member practices at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

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f) Notice period – The Chair may resign from office with immediate effect by giving written notice to the Governing Body at any time. Any such resignation shall not affect their continuing role as a GP Representative on the Governing Body.

2.2.7. The Chief Officer (who shall also be the Group’s Accountable Officer as listed

in paragraph 7.5 of the Group’s constitution) is subject to the following appointment process:

a) Nominations and Eligibility – Any individual with the qualifications,

expertise and experience to ensure that the Group fulfils its duties and exercises its functions effectively, efficiently and economically may apply for this role when advertised.

b) Appointment process – This role will be appointed in line with national

NHS recruitment and selection policies and guidance, subject to formal confirmation from the NHS Commissioning Board66.

c) Grounds for removal from office – The following are grounds for removal


i) Termination of employment in accordance with the Chief Officer’s contract of employment;

ii) Following the passing of a vote of no confidence by member practices within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

d) Notice period – As determined by the contract of employment.

2.2.8. The Chief Finance Officer (as listed in paragraph 7.6 of the Group’s constitution) is subject to the following appointment process:

a) Nominations and Eligibility – Any individual with the necessary

professional accountancy qualifications and the expertise or experience to lead the financial management of the Group may apply for this role when advertised.

b) Appointment process –This appointment will be subject to national NHS

recruitment and selection policies and guidance.

c) Grounds for removal from office – The following are grounds for removal from office for this role:

i) Termination of employment in accordance with the Chief Finance

Officer’s contract of employment;

66

See paragraph 12(2) of Schedule 1A to the 2006 Act as amended by Section 25(2) of, and Schedule 2 to, the 2012 Act

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ii) Following the passing of a vote of no confidence by member practices

within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).


2.2.9. The Secondary Care Specialist Doctor (as listed in paragraph 7.7 of the

Group’s constitution) is subject to the following appointment process:

a) Nominations and Eligibility – Any individual who is a registered medical practitioner who is, or has been within the last five years, an individual who fulfils all of the following conditions can apply for this role when advertised: i) The individual’s name must be included in the Specialist Register kept

by the General Medical Council under section 34D of the Medical Act 1983(c), or the individual is eligible to be included in that Register by virtue of the scheme referred to in subsection (2)(b) of that section;

ii) The individual must hold a post as an NHS consultant or in a medical specialty in the armed forces;

iii) The individual’s name must not be included in the General Practitioner Register kept by the General Medical Council under section 34C of the Medical Act 1983;

iv) Individuals must not be an employee or member (including shareholder)

of, or a partner in, a provider of primary medical services for the purposes of Chapter A2 of the 2006 Act, or a body that provides any relevant service to a person for whom the Group has responsibility.

b) Appointment process – This appointment will be made in line with the NHS

Commissioning Board’s best practice toolkit for the appointment of lay members.




will be subject to the appointment process set out at 2.2.9 b). The incumbent post holder is free to submit an application for re-appointment at the time the role is advertised, but they have no right to be re-appointed. They will be expected to have upheld the Nolan Principles and their professional Codes of Conduct, demonstrated through a satisfactory annual performance appraisal.

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A person cannot be appointed to the role of Secondary Care Specialist Doctor on the Governing Body for more than nine consecutive years in office, which will include any years served in equivalent roles for the Group’s predecessor organisation.





iii) Ceasing to fulfil the eligibility criteria for the role of Secondary Care Specialist Doctor as set out at standing order 2.2.9(a) above;


v) Not attending Governing Body meetings for three consecutive months

(except under extenuating circumstances, such as illness);


vii) Following the passing of a vote of no confidence by member practices within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

f) Notice period – The Secondary Care Doctor may resign from the governing

Body by giving not less than six months’ written notice to the Governing Body at any time.

2.2.10. The Registered Nurse (as listed in paragraph 7.8 of the Group’s constitution) is

subject to the following appointment process:

a) Nominations and Eligibility – Any individual who is a registered nurse can apply for this role when advertised other than those that are an employee or member (including shareholder) of, or a partner in, a provider of primary medical services for the purposes of Chapter A2 of the 2006 Act, or a body that provides any relevant service to a person for whom the Group has responsibility.

b) Appointment process – This appointment will be made in line with the NHS

Commissioning Board’s best practice toolkit for the appointment of lay members.


However, based on the Group’s requirements at the time of appointment,

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normal terms of office may be varied to ensure that continuity is maintained between transitions.


will be subject to the appointment process set out at 2.2.10 b). The incumbent post holder is free to submit an application for re-appointment at the time the role is advertised, but they have no right to be re-appointed. They will be expected to have upheld the Nolan Principles and their professional Codes of Conduct, demonstrated through a satisfactory annual performance appraisal.

A person cannot be appointed to the role of Registered Nurse on the Governing Body for more than nine consecutive years in office, which will include any years served in equivalent roles for the Group’s predecessor organisation.





iii) Ceasing to fulfil the eligibility criteria for the role of Registered Nurse on the Governing Body as set out at standing order 2.2.10(a) above;

iv) Losing Nursing and Midwifery Council registration;



vii) Following the passing of a vote of no confidence by member practices within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

f) Notice period – The Registered Nurse may resign from the governing Body

by giving not less than six months’ written notice to the Governing Body at any time.

2.2.11. Lay Members (as listed in paragraph 7.9 of the Group’s constitution) are subject

to the following appointment process:

a) Nominations and Eligibility – Any individual with the expertise and experience to provide constructive challenge to Governing Body discussions

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can apply for these roles when advertised other than those that meet the descriptions set out within Schedule 4 of The National Health Service (Clinical Commissioning Groups) Regulations 2012 S.I. 2012/1631 who are excluded from being Lay Members of the Group’s Governing Body.

The Lay Member leading on financial management and audit must have qualifications, expertise or experience such as to enable the person to express informed views about financial management and audit matters. The Lay Member leading on patient and public involvement and equality must be a person who has knowledge about the City of Nottingham such as to enable the person to express informed views about the discharge of the Group’s functions.

b) Appointment process – These appointments will be made in line with the

NHS Commissioning Board’s best practice toolkit for the appointment of lay members.



d) Eligibility for reappointment – At the end of each term of office, these

roles will be subject to the appointment process set out at 2.2.11 b). The incumbent post holders are free to submit an application for re-appointment at the time the role is advertised, but they have no right to be re-appointed. They will be expected to have upheld the Nolan Principles and their professional Codes of Conduct, demonstrated through a satisfactory annual performance appraisal.

A person cannot be appointed to the role of Lay Member on the Governing Body for more than nine consecutive years in office, which will include any years served in equivalent roles for the Group’s predecessor organisation.


from office for these roles:



iii) Ceasing to fulfil the eligibility criteria for the role of Lay Member on the Governing Body as set out at standing order 2.2.11(a) above;

iv) Not attending Governing Body meetings for three consecutive months

(except under extenuating circumstances, such as illness);

v) Failing to disclose a pecuniary interest regarding matters under discussion within the organisation or the introduction of a conflict of

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interests that would warrant an individual being excluded from appointment to the Governing Body in line with standing order 2.2.3;

vi) Following the passing of a vote of no confidence by member practices within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).

f) Notice period – A Lay Member may resign from the governing Body by

giving not less than six months’ written notice to the Governing Body at any time.

2.2.12. The Corporate Medical Lead (as listed in paragraph 7.10 of the Group’s constitution) is subject to the following appointment process:

a) Nominations and Eligibility – Any individual with the necessary medical

qualifications and experience of working in general practice within the last five years may apply for this role when advertised, other than those that are on the Nottingham City GP Performer List.

b) Appointment process –This appointment will be subject to national NHS

recruitment and selection policies and guidance.

c) Grounds for removal from office – The following are grounds for removal from office for this role:

iii) Termination of employment in accordance with the Corporate Medical

Lead’s contract of employment;

iv) Following the passing of a vote of no confidence by member practices within the Group at a meeting duly convened in accordance with standing order 3 below (Meetings and Resolutions of the Clinical Commissioning Group).


3. MEETINGS AND RESOLUTIONS OF THE CLINICAL COMMISSIONING GROUP

3.1. A formal meeting of the Group’s membership as a whole (a “Members’ Meeting”) will be held on at least a biannual basis at such times and places as the Group may determine.

3.2. In normal circumstances, members will be given not less than two months’ notice in writing of any Members’ Meetings to be held. However: a) The Chair of the Governing Body as the Group’s Clinical Leader (“the

Chair”) may call a Members’ Meeting at any time by giving not less than fifteen Working Days’ notice in writing.

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b) The Group’s membership may request the Chair to convene a Members’

Meeting by notice in writing to the Chair signed by Member Practice Representatives representing not less than one third of the member practices, specifying in reasonable detail the matters that the petitioners wish to be considered at the meeting. If the Chair refuses, or fails, to call a Members’ Meeting within five Working Days of such a request being presented, the Member Practice Representatives signing the requisition may forthwith call a Members’ Meeting by giving not less than fifteen Working Days’ notice in writing to all member practices specifying the matters which the petitioners wish to be considered at the meeting.

3.3. Agenda, supporting papers and business to be transacted

3.3.1. Items of business to be transacted for inclusion on the agenda of a Members’

Meeting need to be notified to the Associate Director of Corporate Services Development at least ten Working Days before the meeting takes place.

3.3.2. The Associate Director of Corporate Services Development will be responsible for drawing up and agreeing the agenda for each Members’ Meeting with the Chair. Where a notice requesting a Members’ Meeting to be convened has been received by the Chair in accordance with standing order 3.2(b), the Chair shall include the matters specified in the notice on the agenda of the next Members’ Meeting.

3.3.3. Supporting papers for all items need to be submitted at least five Working Days before the meeting takes place.

3.3.4. Before each Members’ Meeting, the agenda and supporting papers will be circulated to all member practices, so as to be available to member practices at least three Working Days before the date of the meeting taking place.

3.3.5. Subject to the agreement of the Chair, any Member Practice Representative may

give written notice of an emergency motion up to one hour before the time fixed for a Members’ Meeting. The notice shall state the grounds of urgency. If in order, it shall be declared to the members at the commencement of the business of the meeting as an additional item included in the agenda. The Chair's decision to include the item will be final.

3.4. Every person who is employed or engaged as a healthcare professional at a

member practice as at the date of the relevant Members’ Meeting shall be entitled to attend and speak at a Members’ Meeting. However only the Member Practice Representative or, in their absence, an authorised deputy (subject to standing order 3.5), for each member practice will be entitled to vote at a Members’ Meeting.

3.5. A Member Practice Representative who is unable to attend a Members’ Meeting must notify the Chair in writing before the start of the meeting if they wish to appoint a deputy to attend the meeting who is authorised to cast a vote on behalf of the relevant member practice.

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3.6. No business shall be conducted at a Members’ Meeting unless a quorum is

present. A quorum will be two thirds’ of member practices present by their Member Practice Representative or their authorised deputy.

3.7. The Chair of the Governing Body as the Group’s Clinical Leader will preside at all Members’ Meetings. If the Chair is absent from the meeting, a GP member of the Governing Body will be chosen by the Member Practice Representatives (including authorised deputies) present, or by a majority of them, and will preside.

3.8. Generally it is expected that decisions will be reached by consensus at Members’ Meetings. Should this not be possible then a vote of the Member Practice Representatives (including authorised deputies) will be required, with the votes to be cast by each Member Practice Representative (or authorised deputy) weighted according to registered list size, as follows: a) Each Member Practice Representative (or their authorised deputy)

representing a member practice with 2,500 registered patients or less shall be entitled to cast one vote;

b) Each Member Practice Representative (or their authorised deputy) representing a member practice with between 2,501 and 5,000 registered patients shall be entitled to cast two votes;

c) Each Member Practice Representative (or their authorised deputy) representing a member practice with between 5,001 and 7,500 registered patients shall be entitled to cast three votes;

d) Each Member Practice Representative (or their authorised deputy) representing a member practice with between 7,501 and 10,00 registered patients shall be entitled to cast four votes;

e) For each additional 5,000 patients thereafter a further vote will be allocated

to the relevant Member Practice Representative (or their authorised deputy).

3.9. The process for voting at a Members’ Meeting is set out below: a) Eligibility – Each Member Practice Representative (or their authorised

deputy) will be eligible to vote on behalf of their member practice on every resolution which is put to a vote at the meeting;

b) Majority necessary to pass a resolution:

i) If the resolution relates to a Specified Reserved Matter then the resolution will only be passed if at least seventy five per cent of the votes which are cast on the resolution are cast in favour of it;

ii) If the resolution relates to any other matter then it will be passed if more votes are cast for the resolution than against it.

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c) Casting vote – if an equal number of votes are cast for and against a

resolution which does not relate to a Specified Reserved Matter then the Chair will have a casting vote. For the avoidance of doubt the Chair is not entitled to a casting vote in relation to a resolution which relates to a Specified Reserved Matter.

3.10. Should a vote be taken on a resolution the outcome of the vote, and any

dissenting views, must be recorded in the minutes of the meeting.

3.11. A resolution in writing signed by Member Practice Representatives who are between them entitled to cast a majority of the votes capable of being cast in aggregate by all Member Practice Representatives shall be deemed to be passed as if that resolution had been proposed and passed at a duly convened Members’ Meeting, provided the resolution does not relate to a Specified Reserved Matter. For the avoidance of doubt a resolution which relates to a Specified Reserved Matter can only be passed at a Members’ Meeting in accordance with standing order 3.9.

3.12. The names of the all Member Practice Representatives (or authorised deputies)

present at a Members’ Meeting, including the Chair of the meeting, will be recorded within the minutes of the meeting. The minutes of the proceedings of a meeting will be drawn up and circulated in accordance with members' wishes.

4. MEETINGS OF THE GOVERNING BODY

4.1. Calling meetings

4.1.1. Ordinary meetings of the Governing Body will be held at regular intervals at such

times and places as the Group may determine.

4.1.2. In normal circumstances, each member of the Governing Body will be given not less than twenty Working Days’ notice in writing of any meeting of the Governing Body to be held. However:

a) The Chair of the Governing Body may call a meeting at any time by giving

not less than ten Working Days’ notice in writing;

b) The members of the Governing Body may request the Chair to convene a meeting by notice in writing signed by not less than one third of the members of the Governing Body, specifying in reasonable detail the matters that the petitioners wish to be considered at the meeting. If the Chair refuses, or fails, to call a meeting within five Working Days of such a request being presented, the Governing Body members signing the requisition may forthwith call a meeting by giving not less than ten Working Days’ notice in writing to all members of the Governing Body specifying the matters which the petitioners wish to be considered at the meeting.

4.2. Agenda, supporting papers and business to be transacted

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4.2.1. Items of business to be transacted for inclusion on the agenda of a meeting need

to be notified to the Associate Director of Corporate Services Development at least fifteen Working Days before the meeting takes place.

4.2.2. The Associate Director of Corporate Services Development will be responsible for drawing up and agreeing the agenda for each meeting with the Chair.

4.2.3. Supporting papers for all items need to be submitted at least ten Working Days before the meeting takes place. The agenda and supporting papers will be circulated to all members of the Governing Body at least three Working Days before the date the meeting will take place.

4.2.4. Agendas and papers for meetings open to the public, including details about

meeting dates, times and venues, will be published on the Group’s website at www.nottinghamcity.nhs.uk.

4.3. Petitions

4.3.1. Where a notice requesting to convene a meeting of the Governing Body has been received by the Chair of the Governing Body in accordance with standing order 4.1.2(b), the Chair shall include the matters specified in the notice on the agenda of the next meeting of the Governing Body.

4.4. Resolutions of the Governing Body

4.4.1. Any member of the Governing Body wishing to propose a resolution (other than

one associated with the business mentioned on the agenda for the next meeting) will send a written notice to the Chair of the Governing Body at least fifteen Working Days before the meeting. All such notices received that are in order and permissible under governing regulations will be included in the agenda for the meeting.

4.4.2. Subject to the agreement of the Chair, any member of the Governing Body may give written notice of an emergency resolution up to one hour before the time fixed for the meeting. The notice shall state the grounds of urgency. If in order, it shall be declared to the Governing Body at the commencement of the business of the meeting as an additional item included in the agenda. The Chair's decision to include the item will be final.

4.4.3. During the course of a Governing Body meeting, a resolution may be proposed by any member present. It must also be seconded by another member. The Chair may exclude from the debate at his/her discretion any such resolution other than a resolution relating to:

a) The reception of a report;

b) Consideration of any item of business before the Governing Body;

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c) The accuracy of minutes;

d) That the Governing Body proceed to next business;

e) That the Governing Body adjourn;

f) That the question be now put to a vote.

4.4.4. Any resolution that has been duly proposed and seconded in accordance with standing order 4.4.3 may only be amended or withdrawn with the consent of the member who proposed the resolution.

4.5. Chair of a meeting of the Governing Body

4.5.1. The Chair will preside at all meetings of the Group’s Governing Body if present.

4.5.2. If the Chair is absent from the meeting, the Deputy Chair, shall preside.

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

the Deputy Chair, if present, shall preside.

4.5.4. If both the Chair and Deputy Chair are absent, or are disqualified from participating, a member of the Governing Body will be chosen by the members present, or by a majority of them, and will preside.

4.6. Chair's ruling

4.6.1. The decision of the Chair of the Governing Body (or Deputy Chair) on questions of order, relevancy and regularity and their interpretation of the constitution, Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies at the meeting, shall be final.

4.7. Nominated Deputies 4.7.1. With the permission of the Chair of the Governing Body, GP Representatives

and Additional GP Representatives are able to nominate a deputy to attend a meeting of the Governing Body that they are unable to attend, to speak and vote on their behalf.

4.7.2. GP Representatives and Additional GP Representatives are required to notify

the Chair of the Governing Body in writing before the start of the meeting if they wish to nominate a deputy. The decision of Chair regarding authorisation of nominated deputies is final.

4.8. Quorum

4.8.1. A quorum will be five members (including deputies authorised in accordance with

standing order 4.7), including:

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a) At least three clinically qualified members (which includes the GP Representatives and Additional GP Representatives, the Secondary Care Doctor, the Registered Nurse and the Corporate Medical Lead);

b) One independent member (which includes the three Lay Members, the Secondary Care Doctor and the Registered Nurse);

c) Either the Chief Officer or Chief Finance Officer.

4.8.2. If the Chair or any other member of the Governing Body has been disqualified

from participating in the discussion on any matter and/or from voting on any motion by reason of a declaration of a conflict of interest, that person shall no longer count towards the quorum. If a quorum is then not available for the discussion and/or the passing of a motion on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting.

4.9. Decision making

4.9.1. Chapter 6 of the Group’s constitution, together with the Scheme of Reservation

and Delegation, sets out the governing structure for the exercise of the Group’s statutory functions. Generally it is expected that at the Governing Body’s meetings, decisions will be reached by consensus. Should this not be possible then a vote of the Governing Body members will be required, the process for which is set out below: a) Eligibility – All members of the Governing Body as defined within paragraph

6.7.2 of the Group’s constitution (or their authorised deputy) who are present at the meeting will be eligible to cast one vote each on any resolution. In no circumstances may an absent member vote by proxy. Absence is defined as being absent at the time of the vote. For the sake of clarity, any co-opted observers or advisors (as detailed within paragraph 6.7.3 of the Group’s constitution) will not have voting rights.

b) Majority necessary to pass a resolution – A resolution will be passed if

more votes are cast for the resolution than against it.

c) Casting vote – If an equal number of votes are cast for and against a resolution, then the Chair (or Deputy Chair) will have a casting vote.

4.9.2. Should a vote be taken, the outcome of the vote, and any dissenting views, must

be recorded in the minutes of the meeting. 4.10. Emergency powers and urgent decisions

4.10.1. The powers of the Group which are reserved or delegated to the Governing Body

may in emergency or for an urgent decision be exercised by the Chief Officer and the Chair after having consulted at least one GP Representative or

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Additional GP Representative on the Governing Body and two Independent Members. The exercise of such powers by the Chief Officer and the Chair will be reported to the next formal meeting of the Governing Body in public session for formal ratification.

4.11. Suspension of Standing Orders

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

by the Secretary of State for Health or the NHS Commissioning Board, any part of these Standing Orders may be suspended at any meeting, provided at least two thirds of Governing Body members are in agreement.

4.11.2. A decision to suspend Standing Orders together with the reasons for doing so shall be recorded in the minutes of the meeting.

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

These records shall be made available to the Audit Committee for review of the reasonableness of the decision to suspend Standing Orders.

4.12. Minutes

4.12.1. The names of all members of the Governing Body present at each meeting shall

be recorded in the minutes of the Governing Body meetings. 4.12.2. The minutes of the proceedings of a meeting will be drawn up and submitted for

agreement at the next meeting where they will be signed by the person presiding at it. No discussion shall take place upon the minutes except upon their accuracy or where the Chair of the meeting considers discussion appropriate.

4.12.3. Minutes shall be circulated to members of the Governing Body in accordance with the reasonable requirements of each member. Where providing a record of a public meeting the minutes shall be made available to the public as required by the Code of Practice on Openness in the NHS.

4.13. Admission of public and the press

4.13.1. Subject to standing order 4.13.2 below, meetings of the Governing Body will be

open to the public.

4.13.2. The Governing Body may, by resolution, exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) wherever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

4.13.3. In the event the public could be excluded from a meeting of the Governing Body,

the Group shall consider whether the subject matter of the meeting would in any

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event be subject to disclosure under the Freedom of Information Act 2000, and if so, whether the public should be excluded in such circumstances.

4.13.4. The Chair (or Deputy Chair) or the person presiding over the meeting shall give

such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Governing Body’s business shall be conducted without interruption and disruption.

4.13.5. The Governing Body may resolve (as permitted by Section 1(8) Public Bodies

(Admissions to Meetings) Act 1960 as amended from time to time) to exclude the public from a meeting (whether during whole or part of the proceedings) to suppress or prevent disorderly conduct or behaviour.

4.13.6. Matters to be dealt with by the Governing Body following the exclusion of representatives of the press, and other members of the public shall be confidential to the members of the Governing Body.

4.13.7. Members of the Governing Body and any member or employee of the Group in

attendance or who receives any such minutes or papers in advance of or following a meeting shall not reveal or disclose the contents of papers marked 'In Confidence' or minutes headed 'Items Taken in Private' outside of the Governing Body, without the express permission of the Governing Body. This will apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers.

5. APPOINTMENT OF COMMITTEES 5.1. Committees of the Governing Body are included in Chapter 6 of the Group’s

constitution.

5.2. Other than where there are statutory requirements, such as in relation to the Audit Committee, Remuneration Committee or Primary Care Commissioning Panel, the Governing Body will determine the membership and Terms of Reference of committees and in doing so will specifically consider the requirements of standing order 2.2.3 to determine whether any individuals should be excluded from committee duties due to their declared interests. The Governing Body will receive and consider reports of such committees at the next appropriate meeting of the Governing Body.

5.3. The provisions of these Standing Orders shall apply where relevant to the

operation of all Governing Body committees unless stated otherwise in the committee’s Terms of Reference.

5.4. Terms of Reference for committees will detail the quorum for these meetings and status of representatives. The process for holding a vote will also be set out in the appropriate Terms of Reference. Terms of Reference for the Audit Committee and the Remuneration Committee will have effect as if incorporated

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into the Group’s constitution and shall be added to this document as an appendix.

5.5. The names of the all members present, including the Chair, will be recorded in minutes of committee meetings. The minutes of the proceedings of a meeting will be drawn up and submitted for agreement at the next meeting. Minutes shall be circulated to committee members in accordance with the reasonable requirements of each member.

6. DUTY TO REPORT NON-COMPLIANCE WITH STANDING

ORDERS AND PRIME FINANCIAL POLICIES

6.1. If for any reason these Standing Orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the Group and staff have a duty to disclose any non-compliance with these Standing Orders to the Accountable Officer as soon as possible.

7. CUSTODY OF SEAL, SEALING OF DOCUMENTS AND SIGNATURE OF DOCUMENTS

7.1. Clinical Commissioning Group’s seal 7.1.1. The Group will have a seal for executing documents where necessary67. The

following individuals or officers are authorised to authenticate its use by their signature: a) The Chair of the Governing Body;

b) The Chief Officer;

c) The Chief Finance Officer.

7.1.2. The Group’s seal will be kept by the Associate Director of Corporate Services

Development in a secure place.

7.1.3. The Associate Director of Corporate Services Development will keep a register in which a record of the sealing of every document will be entered. Details of this register will be reported to the Governing Body at least annually.

7.2. Execution of a document by signature

7.2.1. The following individuals or officers are authorised to execute a document on

behalf of the Group by their signature:

67

See paragraph 21 of Schedule 1A of the 2006 Act, as amended by paragraph 21 of Schedule 2 of the 2012 Act

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a) The Chair of the Governing Body;

b) The Chief Officer;

c) The Chief Finance Officer.

8. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS

8.1. Policy statements: general principles

8.1.1. The Group will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS Nottingham City Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate Group minute and will be deemed where appropriate to be an integral part of the Group’s Standing Orders.

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NHS Nottingham City Clinical Commissioning Group’s Constitution - 79 - Version: 1.21.4 | NHS Commissioning Board Effective Date: 13 May 2014[ ]

APPENDIX C – SCHEME OF RESERVATION AND DELEGATION The arrangements made by the Group as set out in this Scheme of Reservation and Delegation shall have effect as if incorporated in the Group’s constitution. The Clinical Commissioning Group remains accountable for all of its functions, including those that it has delegated.

Policy Area Decision Reserved to the

Membership

Delegated to / Reserved by

Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee

Remuneration Committee

Resource Allocation

and Prioritisation

Panel

Primary Care Commissioning

Panel

Risk and Performance Committee

IFR Panel

EFR Panel

REGULATION AND CONTROL

Determine the arrangements by which the members of the Group approve those decisions that are reserved for the membership.


Specific Reserved Matter: Consideration and approval of applications to the NHS Commissioning Board on any matter concerning material changes to the Group’s constitution, including its Standing Orders, Scheme of Reservation and Delegation, and Prime Financial Policies.


Specific Reserved Matter: Consideration and approval of requests from GP Clusters with fewer than 25,000 registered patients to be entitled to elect a GP representative to the Governing Body.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel


Specific Reserved Matter: Consideration and approval of the Group’s Inter Practice

Agreement68

.


Consideration and approval of applications to the NHS Commissioning Board on non-material changes to the Group’s constitution, including its Standing Orders, Scheme of Reservation and Delegation, and Prime Financial Policies (following engagement with the Group’s membership, where appropriate).


Approve the Group’s detailed

financial policies69

(that underpin the Group’s Prime Financial Policies) And schedule of delegated

financial authority70

(that underpins the Group’s Scheme of Reservation and Delegation).

68 The Inter Practice Agreement is detailed within the Group’s Governance Handbook 69 The detailed financial policies are detailed within the Group’s Governance Handbook 70 The schedule of delegated financial authority is detailed within the Group’s Governance Handbook

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel


Approve arrangements for ratification of the Group’s internal policies and procedures, including but not limited to human resources, quality and patent safety, operational and risk management, information governance, and health and safety policies and procedures.


Exercise or delegation of those functions of the Clinical Commissioning Group which have not been retained as reserved by the Group, delegated to the Governing Body, delegated to a committee or sub-committee of the Group or to one of its members or employees.

PRACTICE MEMBER

REPRESENTATIVES AND MEMBERS OF THE GOVERNING

BODY

Specific Reserved Matter: Approve the arrangements for electing the representatives acting on behalf of Member Practices on the Governing Body.

PRACTICE MEMBER


BODY

Specific Reserved Matter: To remove from office a member of the Governing Body via the passing of a vote of no confidence.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel

PRACTICE MEMBER


BODY

Approve arrangements for securing effective participation by each member of the Group in exercising its functions

PRACTICE MEMBER


BODY

Approve arrangements for identifying the Group’s proposed Accountable Officer (following membership consultation).

PRACTICE MEMBER


BODY

Approve the process for recruiting non-elected members to the Governing Body (subject to any regulatory requirements) and succession planning.

STRATEGY AND PLANNING

Agree the vision, values and overall strategic direction of the Group (following membership consultation).


Approval of the Group’s staffing structure.


Approval of the Group’s commissioning plan.


Approval of the Group’s aggregate budgets that meet the financial duties as set out in paragraph 5.3 of the main body of the constitution.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel


Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the Group’s ability to achieve its agreed strategic aims.

COMMISSIONING AND

CONTRACTING FOR CLINICAL

SERVICES

Approval of the arrangements for discharging the Group’s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice, securing public involvement, and promoting innovation, research and education and training.

COMMISSIONING AND


SERVICES

Approving arrangements for meeting the public sector equality duty.

COMMISSIONING AND


SERVICES

Approving arrangements for co-ordinating the commissioning of services with other Clinical Commissioning Groups and Nottingham City Council.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel

COMMISSIONING AND


SERVICES

Approving the Group’s arrangements for the prioritisation of existing or planned healthcare.

COMMISSIONING AND


SERVICES

Approval of investment, disinvestment, and resource allocation proposals (in line with the Group’s vision, values and strategic direction).

COMMISSIONING AND


SERVICES

Approving arrangements for managing individual funding requests.

COMMISSIONING AND


SERVICES

Approval of individual funding requests.

COMMISSIONING AND


SERVICES

Approval of extraordinary funding requests.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel

COMMISSIONING AND


SERVICES

Approving arrangements for supporting the NHS Commissioning Board in discharging its responsibilities in relation to:

Securing continuous improvement in the quality of general medical services.

Improve the quality of specialised services.

ANNUAL REPORTS AND ACCOUNTS

Determine arrangements for approval of the Group’s annual report and annual accounts. Approval rights will normally be retained by the Governing Body other than in instances where it is considered expedient to delegate approval rights to the Audit Committee in order to meet nationally determined submission timescales.

HUMAN RESOURCES

Approval of the arrangements for discharging the Group’s statutory duties as an employer.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel

HUMAN RESOURCES

Determine the remuneration, fees and other allowances payable to employees or other persons providing services to the Group and the allowances payable under any pension scheme it may establish, other than those decisions relating to members of the Governing Body.

HUMAN RESOURCES

Approve the terms and conditions, remuneration and travelling or other allowances for Governing Body members, including pensions and gratuities.

OPERATIONAL AND RISK

MANAGEMENT

Approval of the Group’s risk management arrangements.


MANAGEMENT

Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other Clinical Commissioning Groups or pooled budget arrangements under section 75 of the NHS Act 2006).


MANAGEMENT

Approve the Group’s internal audit arrangements.

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel


MANAGEMENT

Approve the Group’s counter fraud and security management arrangements.


MANAGEMENT

Approve proposals for action on litigation against or on behalf of the Clinical Commissioning Group.


MANAGEMENT

Approve the Group’s arrangements for business continuity and for supporting emergency planning.

INFORMATION GOVERNANCE

Approving arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

INFORMATION GOVERNANCE

Approving arrangements for handling Freedom of Information requests.

TENDERING AND CONTRACTING

Approval of the Group’s arrangements for any commissioning support.

TENDERING AND CONTRACTING

Approval of the Group’s arrangements for corporate support (for example finance provision).

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Membership


Governing Body

Chair of the

Governing Body

Chief Officer

Audit Committee


Resource Allocation

and Prioritisation

Panel


Panel


IFR Panel

EFR Panel

PARTNERSHIP WORKING

Approve decisions that individual members or employees of the Group can make when participating in joint arrangements on behalf of the Group.

PARTNERSHIP WORKING

Approve decisions delegated to joint committees established under section 75 of the 2006 Act.

PRIMARY CARE COMMISSIONING

Approve arrangements for the management of GMS, PMS and APMS contracts.


Approve all proposals to commission services on a direct award or AQP basis where GP practices are providers.


Approve any local incentive schemes designed as an alternative to the Quality Outcomes Framework (QOF)


Approve the establishment of new or replacement GP practices in Nottingham City.


Approve GP practice mergers.


Approve arrangements for the authorisation of ‘discretionary’ payments.

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CHIEF OFFICER – SCHEDULE OF FUNCTIONS DELEGATED TO INDIVIDUALS

Delegated Matter Authority Delegated To

Patient and Relatives’ Complaints: a) Overall responsibility for ensuring that all complaints are dealt with effectively

b) Responsibility for ensuring that complaints relating to a directorate are

investigated thoroughly. c) Medico – Legal Complaints: Co-ordination of their management

Assistant Director of Quality Governance, Children and Learning Disabilities Assistant Director of Quality Governance, Children and Learning Disabilities Assistant Director of Quality Governance, Children and Learning Disabilities

Relationships with the press

Associate Director of Corporate ServicesDevelopment

Review of Fire Precautions


Review of compliance with relevant Health and Safety legislation


Review of compliance with the Data Protection Act and other relevant Information Governance legislation


Monitor proposals for contractual arrangements between the Group and outside bodies

Director of Primary Care Development and Service IntegrationContracting and Transformation / Director of Quality and DeliveryPersonalisation

Maintenance of a Register of Interests and Register of Procurement Decisions


Maintenance of a Gifts and Hospitality Register


Safe-keeping of the Group’s Seal / Maintenance of a Register of Sealings


Execution of a document by signature

Chair of the Governing Body

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Delegated Matter Authority Delegated To

Chief Officer Chief Finance Officer

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APPENDIX D – PRIME FINANCIAL POLICIES

1. INTRODUCTION

1.1. General

1.1.1. These Prime Financial Policies and supporting detailed financial policies shall have effect as if incorporated into the Group’s constitution.

1.1.2. The Prime Financial Policies are part of the Group’s control environment for

managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities, and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and Chief Finance Officer to effectively perform their responsibilities. They should be used in conjunction with the overarching Scheme of Reservation and Delegation found at Appendix C.

1.1.3. In support of these Prime Financial Policies, the Group has prepared more

detailed policies, approved by its Governing Body, known as detailed financial policies. The Group refers to these prime and detailed financial policies together as the Clinical Commissioning Group’s financial policies.

1.1.4. These Prime Financial Policies identify the financial responsibilities which apply

to the Group’s members, employees, members of the Governing Body, members of the Governing Body’s committees and persons working on behalf of the Group. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies.

1.1.5. A list of the Group’s detailed financial policies will be published and maintained on the Group’s website at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

1.1.6. Should any difficulties arise regarding the interpretation or application of any of the Prime Financial Policies then the advice of the Chief Finance Officer must be sought before acting. The user of these Prime Financial Policies should also be familiar with and comply with the provisions of the Group’s constitution, Standing Orders and Scheme of Reservation and Delegation.

1.1.7. Failure to comply with Prime Financial Policies and Standing Orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

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1.2. Overriding Prime Financial Policies

1.2.1. If for any reason these Prime Financial Policies are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Audit Committee for referring action or ratification. All of the Group’s members and employees have a duty to disclose any non-compliance with these Prime Financial Policies to the Chief Finance Officer as soon as possible.

1.3. Responsibilities and delegation

1.3.1. The roles and responsibilities of the Group’s members, employees, members of the Governing Body, members of the Governing Body’s committees and persons working on behalf of the Group are set out in Chapters 6 and 7 of the Group’s constitution.

1.3.2. The financial decisions delegated by members of the Group are set out in the

Group’s overarching Scheme of Reservation and Delegation and supporting operational scheme of delegation (see Appendix C).

1.4. Contractors and their employees

1.4.1. Any contractor or employee of a contractor who is empowered by the Group to commit the Group to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Accountable Officer to ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies

1.5.1. To ensure that these Prime Financial Policies remain up-to-date and relevant,

the Chief Finance Officer will review them at least annually.

1.5.2. Following consultation with the Accountable Officer and scrutiny by the Audit Committee, the Chief Finance Officer will recommend amendments, as fitting, to the Governing Body for approval.

1.5.3. As these Prime Financial Policies are an integral part of the Group’s constitution,

any amendment will not come into force until the Group applies to the NHS Commissioning Board and that application is granted.

2. INTERNAL CONTROL

POLICY – the Group will put in place a suitable control environment and effective internal controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity and compliance with laws and policies

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2.1. The Governing Body is required to establish an Audit Committee with Terms of Reference agreed by the Governing Body (see paragraph 6.8. of the Group’s constitution for further information).

2.2. The Accountable Officer has overall responsibility for the Group’s systems of

internal control.

2.3. The Chief Finance Officer will ensure that:

a) Financial policies are considered for review and update annually;

b) A system is in place for proper checking and reporting of all breaches of financial policies; and

c) A proper procedure is in place for regular checking of the adequacy and

effectiveness of the control environment.

3. AUDIT

POLICY – the Group will keep an effective and independent internal audit function and fully comply with the requirements of external audit and other statutory reviews

3.1. In line with the Terms of Reference for the Audit Committee, the person

appointed by the Group to be responsible for internal audit (the Head of Internal Audit) and the appointed external auditor will have direct and unrestricted access to Audit Committee Members and the Chair of the Governing Body, Accountable Officer and Chief Finance Officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2. All Audit Committee Members, the Chair of the Governing Body and the

Accountable Officer will have direct and unrestricted access to the Head of Internal Audit and the external auditor.

3.3. The Chief Finance Officer will ensure that:

a) The Group has a professional and technically competent internal audit function; and

b) The Audit Committee approves any changes to the provision or delivery of assurance services to the Group; and

c) . The CCG procures external audit services in accordance with the Local

Audit and Accountability Act 2014 and the relevant national guidance.

4. FRAUD AND CORRUPTION

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POLICY – the Group requires all staff to always act honestly and with integrity to safeguard the public resources they are responsible for. The Group will not tolerate any fraud perpetrated against it and will actively chase any loss suffered

4.1. The Audit Committee will satisfy itself that the Group has adequate

arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

4.2. The Audit Committee will ensure that the Group has arrangements in place to

work effectively with NHS Protect.

5. EXPENDITURE CONTROL

5.1. The Group is required by statutory provisions71 to ensure that its expenditure does not exceed the aggregate of allotments from the NHS Commissioning Board and any other sums it has received and is legally allowed to spend.

5.2. The Accountable Officer has overall executive responsibility for ensuring that the Group complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

5.3. The Chief Finance Officer will:

a) Provide reports in the form required by the NHS Commissioning Board;

b) Ensure money drawn from the NHS Commissioning Board is required for

approved expenditure only, is drawn down only at the time of need, and follows best practice;

c) Be responsible for ensuring that an adequate system of monitoring financial

performance is in place to enable the Group to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of the NHS Commissioning Board.

6. ALLOTMENTS72

6.1. The Group’s Chief Finance Officer will: a) Periodically review the basis and assumptions used by the NHS

Commissioning Board for distributing allotments and ensure that these are reasonable and realistic and secure the Group’s entitlement to funds;

b) Prior to the start of each financial year submit to the Governing Body for approval, a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

71 See Section 223H of the 2006 Act, inserted by Section 27 of the 2012 Act 72 See Section 223(G) of the 2006 Act, inserted by Section 27 of the 2012 Act.

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c) Regularly update the Governing Body on significant changes to the initial

allocation and the uses of such funds.

7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING

POLICY – the Group will produce and publish an annual commissioning plan73 that explains how it proposes to discharge its financial duties. The Group will support this with comprehensive medium term financial plans and annual budgets

7.1. The Accountable Officer will compile and submit to the Governing Body a

commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.2. Prior to the start of each financial year, the Chief Finance Officer will, on behalf

of the Accountable Officer, prepare and submit budgets for approval by the Governing Body.

7.3. The Chief Financial Officer shall monitor and review financial performance

against budget and plan, and report to the Group’s Governing Body. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets.

7.4. The Accountable Officer is responsible for ensuring that information relating to

the Group’s accounts or to its income or expenditure, or its use of resources is provided to the NHS Commissioning Board as requested.

7.5. The Accountable Officer will approve consultation arrangements for the Group’s commissioning plan74.

8. ANNUAL ACCOUNTS AND REPORTS

POLICY – the Group will produce and submit to the NHS Commissioning Board accounts and reports in accordance with all statutory obligations75, relevant accounting standards and accounting best practice in the form and content and at the time required by the NHS Commissioning Board

8.1. The Chief Finance Officer will ensure the Group:

a) Prepares a timetable for producing the annual report and accounts and

agrees it with external auditors and the Audit Committee;

73 See Section 14Z11 of the 2006 Act, inserted by Section 26 of the 2012 Act. 74 See Section 14Z13 of the 2006 Act, inserted by Section 26 of the 2012 Act 75 See paragraph 17 of Schedule 1A of the 2006 Act, as inserted by Schedule 2 of the 2012 Act.

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b) Prepares the accounts according to the timetable approved by the Audit Committee;

c) Complies with statutory requirements and relevant directions for the

publication of annual report;

d) Considers the external auditor’s management letter and fully address all issues within agreed timescales; and

e) Publishes the external auditor’s management letter on the Group’s website

at www.nottinghamcity.nhs.uk. Hard copy documents are also available from the Group’s headquarters (1 Standard Court, Park Row, Nottingham, NG1 6GN), by postal request to the Group’s Associate Director of Corporate Services Development at the above address, or by emailing [email protected]).

9. INFORMATION TECHNOLOGY

POLICY – the Group will ensure the accuracy and security of the Group’s computerised financial data

9.1. The Chief Finance Officer is responsible for the accuracy and security of the

Group’s computerised financial data and shall:

a) Devise and implement any necessary procedures to ensure adequate (reasonable) protection of the Group's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

b) Ensure that adequate (reasonable) controls exist over data entry,

processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

c) Ensure that adequate controls exist such that the computer operation is

separated from development, maintenance and amendment;

d) Ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the Chief Finance Officer may consider necessary are being carried out.

9.2. In addition the Chief Finance Officer shall ensure that new financial systems and

amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

10. ACCOUNTING SYSTEMS

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POLICY – the Group will run an accounting system that creates management and financial accounts

10.1. The Chief Finance Officer will ensure:

a) The Group has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of the NHS Commissioning Board;

b) That contracts for computer services for financial applications with another

health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.

10.2. Where another health organisation or any other agency provides a computer

service for financial applications, the Chief Finance Officer shall periodically seek assurances that adequate controls are in operation.

11. BANK ACCOUNTS

POLICY – the Group will keep enough liquidity to meet its current commitments


a) Review the banking arrangements of the Group at regular intervals to ensure they are in accordance with Secretary of State directions76, best practice and represent best value for money;

b) Manage the Group's banking arrangements and advise the Group on the

provision of banking services and operation of accounts;

c) Prepare detailed instructions on the operation of bank accounts.

11.2. The Accountable Officer shall approve the banking arrangements.

12. INCOME, FEES AND CHARGES AND SECURITY OF CASH,

CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS.

POLICY – the Group will:

Operate a sound system for prompt recording, invoicing and collection of all monies due

Seek to maximise its potential to raise additional income only to the extent that it does not interfere with the performance of the Group or its functions77

76 See Section 223H(3) of the NHS Act 2006, inserted by Section 27 of the 2012 Act

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Ensure its power to make grants and loans is used to discharge its functions effectively78

12.1. The Chief Financial Officer is responsible for:

a) Designing, maintaining and ensuring compliance with systems for the proper

recording, invoicing, and collection and coding of all monies due;

b) Establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments;

c) Approving and regularly reviewing the level of all fees and charges other

than those determined by the NHS Commissioning Board or by statute. Independent professional advice on matters of valuation shall be taken as necessary;

d) Developing effective arrangements for making grants or loans.

13. TENDERING AND CONTRACTING PROCEDURE

POLICY – the Group:

Will ensure proper competition that is legally compliant within all purchasing to ensure it incurs only budgeted, approved and necessary spending;

Will seek value for money for all goods and services;

Shall ensure that competitive quotations and tenders are invited for the: - Supply of goods, materials and manufactured articles; - Rendering of services including all forms of management consultancy

services (other than specialised services sought from or provided by the Department of Health);

- Design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals.

13.1. Approved limits for quotations and tenders are prescribed within the Group’s

detailed financial policies and will be reviewed at least annually (see Section 17 of these Prime Financial Policies for further information).

13.2. The Group shall ensure that the firms / individuals invited to tender (and where appropriate, quote) are first selected from approved lists or framework agreements. Where no such list or agreement exists, then the responsible director will approve the invitation to tender method in line with the Group’s procurement framework.

13.3. The Group may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with:

77 See Section 14Z5 of the 2006 Act, inserted by Section 26 of the 2012 Act. 78 See Section 14Z6 of the 2006 Act, inserted by Section 26 of the 2012 Act.

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a) The Group’s Standing Orders;

b) The Public Contracts Regulation 2006, any successor legislation and any

other applicable law;

c) Take into account as appropriate any applicable NHS Commissioning Board or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (b) above.

13.4. In all contracts entered into, the Group shall endeavour to obtain best value for

money. The Accountable Officer shall nominate an individual who shall oversee and manage each contract on behalf of the Group.

14. COMMISSIONING

POLICY – working in partnership with relevant national and local stakeholders, the Group will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility

14.1. The Group will coordinate its work with the NHS Commissioning Board, other

Clinical Commissioning Groups, local providers of services, the Local Authority, including through Health and Wellbeing Boards, patients and their carers and the voluntary sector, and others as appropriate to develop robust commissioning plans.

14.2. The Accountable Officer will establish arrangements to ensure that regular reports are provided to the Governing Body detailing actual and forecast expenditure and activity for each contract.

14.3. The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

15. RISK MANAGEMENT AND INSURANCE

POLICY – the Group will put arrangements in place for evaluation and management of its risks

15.1. The Accountable Officer will ensure that the Group has an integrated risk

management framework, in accordance with current Department of Health assurance framework requirements, which must be approved by the Governing Body and monitored by the Risk and Performance Committee.

15.2. The integrated risk management framework will include: a) A process for identifying and quantifying risks and potential liabilities;

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b) Engendering among all levels of staff a positive attitude towards the control of

risk;

c) Management processes to ensure all significant risks and potential liabilities are addressed;

d) Arrangements to review the integrated risk management framework.

15.3. The existence, integration and evaluation of the above elements will assist in providing a basis to make an Annual Governance Statement within the Annual Report and Accounts as required by Department of Health guidance.

15.4. The Chief Finance Officer will arrange an appropriate level of insurance for the Group.

16. PAYROLL

POLICY – the Group will put arrangements in place for an effective payroll service

16.1. The Chief Finance Officer will ensure that the payroll service selected:

a) Is supported by appropriate (i.e. contracted) terms and conditions; b) Has adequate internal controls and audit review processes;

c) Has suitable arrangements for the collection of payroll deductions and

payment of these to appropriate bodies. 16.2. In addition the Chief Finance Officer will set out comprehensive procedures for

the effective processing of payroll.

17. NON-PAY EXPENDITURE

POLICY – the Group will seek to obtain the best value for money goods and services received

17.1. The Governing Body will approve the level of non-pay expenditure on an annual

basis and the Accountable Officer will determine the level of delegation to budget managers.

17.2. The Accountable Officer will set out procedures on the seeking of professional advice regarding the supply of goods and services.


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a) Advise the Governing Body on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the detailed financial policies.

b) Be responsible for the prompt payment of all properly authorised accounts and claims.

c) Be responsible for designing and maintaining a system of verification,

recording and payment of all amounts payable.

18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS

POLICY – the Group will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of the Group’s fixed assets

18.1. The Accountable Officer will

a) Ensure that there is an adequate appraisal and approval process in place for

determining capital expenditure priorities and the effect of each proposal upon plans;

b) Be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) Shall ensure that the capital investment is not undertaken without

confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges;

d) Be responsible for the maintenance of registers of assets, taking account of

the advice of the Chief Finance Officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted periodically.

18.2. The Chief Finance Officer will prepare detailed procedures for the disposals of

assets.

19. RETENTION OF RECORDS

POLICY – the Group will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance

19.1. The Accountable Officer will:

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a) Be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

b) Ensure that arrangements are in place for effective responses to Freedom of

Information requests;

c) Publish and maintain a Freedom of Information Publication Scheme.

20. TRUST FUNDS AND TRUSTEES

POLICY – the Group will put arrangements in place to provide for the appointment of trustees if the Group holds property on trust

20.1. The Chief Finance Officer will ensure that each trust fund that the Group is

responsible for managing is managed appropriately with regard to its purpose and to its requirements.

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APPENDIX E - NOLAN PRINCIPLES The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties. The seven principles are: a) Selflessness – Holders of public office should act solely in terms of the public

interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any financial

or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public appointments,

awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their decisions and

actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about all the

decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private interests

relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these principles

by leadership and example. Source: The First Report of the Committee on Standards in Public Life (1995)79

79

Available at http://www.public-standards.gov.uk/

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APPENDIX F – NHS CONSTITUTION The NHS Constitution sets out seven key principles that guide the NHS in all it does: 1. The NHS provides a comprehensive service, available to all - It is available to all

irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population

2. Access to NHS services is based on clinical need, not an individual’s ability to pay -

NHS services are free of charge, except in limited circumstances sanctioned by Parliament. 3. The NHS aspires to the highest standards of excellence and professionalism - It

provides high quality care that is safe, effective and focused on patient experience; in the people it employs, and in the support, education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion, conduct and use of research to improve the current and future health and care of the population. Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.in the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.

4. NHS services must reflect the needs and preferences of patients, their families and

their carersThe patient will be at the heart of everything the NHS does - It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. As part of this, the NHS will ensure that in line with the Armed Forces Covenant, those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.

5. The NHS works across organisational boundaries and in partnership with other

organisations in the interest of patients, local communities and the wider population - It works in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution. The NHS is

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committed to working jointly with other local authority services, other public sector organisations and a wide range of private and voluntary sector organisations to provide and deliver improvements in health and wellbeing.the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being

6. The NHS is committed to providing best value for taxpayers’ money and the most

cost-effective, fair and sustainable use of finite resources - It is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. The NHS is accountable to the public, communities and patients that it serves - the

NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose

Source: The NHS Constitution: The NHS belongs to us all (March 2012July 2015)

80

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APPENDIX G – Audit Committee Terms of Reference 1. Purpose

The Audit Committee is established in accordance with NHS Nottingham City CCG’s constitution and is a statutory committee of, and accountable to, the Group’s Governing Body. The Audit Committee exists to:

Provide the Governing Body with an independent and objective view of the Ggroup’s financial systems, financial information and compliance with the laws, regulations and directions governing the Group in as far as they relate to finance.

Review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the Group’s activities that support the achievement of the Group’s objectives.

Scrutinise every instance of non-compliance with the Group’s Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies and monitoring compliance with the Group’s Conflicts of Interest Policy and Gifts, Hospitality and Sponsorship Policy.

Review the annual financial statements prior to submission to the Governing Body.

The Committee is authorised by the Governing Body to investigate any activity within its Terms of Reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or other independent advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary. The Committee will act as the Group’s Auditor Panel. It will formally record when it is acting as the Auditor Panel. The Committee is authorised to create task and finish sub-groups in order to take forward specific programmes of work as considered necessary by the Committee’s membership.

2. Membership

The membership of the Audit Committee will be made up of the following:

Lay Member – Financial Management and Audit Lead (who is an independent member)

Lay Member – Planning and Performance Lead (who is an independent member)

Registered Nurse on the Governing Body (who is an independent member)Associate Lay Members x 2

The membership of the Committee will be as set out above when acting as the Group’s Auditor Panel. For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the Group that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s committees to support the Group’s decision making arrangements.

Attendees:

Chief Finance Officer

Associate Director of Corporate ServicesHead of Corporate Assurance

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Internal Audit

External Audit

Local Counter Fraud Specialist. Other officers may be invited to attend meetings when the Committee is discussing areas of risk or operation that fall within their areas of responsibility. This will include the CCG’s Chief Officer and Clinical Leader being invited to attend, at least annually, to discuss with the Committee the process for assurance that supports the Annual Governance Statement. The Chief Officer will be invited to attend, at least annually, to discuss with the Committee the process for assurance that supports the Annual Governance Statement.

3. Chair and Deputy

The Lay Member – Financial Management and Audit Lead will Chair the committee. In the event of the Chair of the committee being unable to attend all or part of the meeting, a replacement from within the membership will be nominated to deputise for that meeting.

4. Quorum

The Audit Committee will be quorate with two members present.

5. Frequency of Meetings

The Audit Committee will meet no less than six times per year at appropriate times in the reporting and audit cycle. The External Auditor or the Head of Internal Audit may request a meeting if they consider that one is necessary. The Committee may also wish to meet privately with the internal and external auditors at least once during the year.

6. Conduct of Business

Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the Audit Committee. Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair.

The Audit Committee agenda will be agreed with the Chair prior to the meeting.

7. Minutes of Meetings

Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Committee. The minutes will be ratified by agreement of the Committee at the following meeting. The Chair of the Audit Committee will agree minutes if they are to be submitted to the Governing Body prior to formal ratification.

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8. Declarations of Interest

At the beginning of each formal meeting, members will be required to declare any personal interest if it relates specifically to a particular issue under consideration. If the existence of an interest becomes apparent during a meeting then this must be declared at the point at which it arises. Any such declaration will be formally recorded in the minutes for the meeting. All declared interests are required to be managed in line with the requirements of the CCG’s Constitution (Chapter 8) and Conflicts of Interest Policy including in relation to any further participation in discussions / decisions.

98. Duties

Integrated Governance, Risk Management & Internal Control

The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control across the whole of the organisation.

In particular the Committee will review the adequacy and integrity of:

All risk and control related disclosure statements (in particular the Governance Statement) together with any accompanying Head of Internal Audit Statement, external audit opinion or other appropriate independent assurances prior to endorsement by the Governing Body.

The underlying assurance processes that indicate the degree of achievement of the Group’s objectives and the effectiveness of the management of principal risks facing the organisation.

Assurances available from other Ccommittees of the organisation.

Compliance with Standing Orders, Standing Financial Instructions and Scheme of Delegation, including review of all waivers.

The policies for ensuring compliance with relevant regulatory, legal, and code of conduct requirements and associated monitoring and reporting.

The policies and procedures for all work related to fraud and corruption (as set out in Secretary of State Directions and as required by the Counter Fraud Service), ensuring that the Group has effective and whistle blowing and anti-fraud systems in place.

The Committee will also be responsible for the approval and monitoring of policies within its remit, in accordance with the Groups’ Policy on the Development and Management of Organisational Documents.

In carrying out this work the Committee will utilise the work of internal and external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from Directors and managers as appropriate. The Committee will use the Governing Body Assurance Framework to guide its work and that of the audit and assurance functions that report to it. Financial Reporting

The Audit Committee shall monitor the integrity of the financial statements of the Group and any formal announcements relating to the organisation’s financial performance. The Committee shall ensure that the systems for financial reporting to the Group, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the organisation.

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The Audit Committee shall review the annual report and financial statements before submission to the Governing Body, focusing particularly on:

The wording in the Annual Ggovernance Sstatement and other relevant disclosures;

Changes in, and compliance with, accounting policies and practices;

Unadjusted mis-statements in the financial statements;

Significant judgements in preparing of the financial statements;

Significant adjustments resulting from the audit process;

Letter of representation; and

Qualitative aspects of financial reporting.

Internal Audit

The Committee shall ensure that there is an effective internal audit function established by management that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Committee, Chief Officer and Governing Body. This will be achieved by:

Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.

Review and approval of the Strategic Internal Audit Plan and more detailed annual programme of work, ensuring that this is consistent with the audit needs of the organisation (as identified in the Governing Body Assurance Framework).

Consideration of the major findings of internal audit work and the appropriateness of management responses.

Ensuring that the internal audit function is adequately resourced and has appropriate standing within the organisation.

An annual review of the effectiveness of internal audit.

External Audit

The Committee shall review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

Consideration of the performance of the external auditors, as far as the rules governing the appointment permit.

Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

Discussion with the external auditors of their local evaluation of audit risks and assessment of the clinical commissioning group and associated impact on the audit fee.

Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the clinical commissioning group and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

Auditor Panel

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In its capacity as the Group’s Auditor Panel the Committee shall be responsible for providing advice to the Governing Body on the selection, appointment and removal of external auditors and on maintaining an independent relationship with them, in accordance with the requirements of the Local Audit and Accountability Act 2014.

The Committee will also advise the Governing Body on the maintenance of an independent relationship with the appointed external auditor.

Counter Fraud

The Committee shall satisfy itself that the organisation has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It will also approve the counter fraud work programme.

109. Reporting Responsibilities

The Audit Committee will report to the Governing Body through regular submission of minutes from its meetings. Any items of specific concern, or which require Governing Body approval, will be the subject of a separate report. The Committee will report to the Governing Body annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Governing Body Assurance Framework, the completeness and embedment of risk management in the organisation and the integration of governance arrangements.

110. Review of Terms of Reference

These Terms of Reference will be formally reviewed on an annual basis, but may be amended at any time in order to adapt to any national guidance as and when issued. Any proposed amendments to the Terms of Reference will be submitted to the Governing Body for approval.

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APPENDIX H – Remuneration Committee Terms of Reference

1. Purpose

The Remuneration Committee is established in accordance with NHS Nottingham City CCG’s constitution and is a statutory committee of, and accountable to, the Group’s Governing Body. The Committee exists to make determinations about the remuneration, fees and other allowances for Governing Body members, and make recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the Group and on determinations about allowances under any pension scheme that the Group may establish as an alternative to the NHS pension scheme

2. Membership

The membership of the Remuneration Committee will be determined on the basis of the matters to be discussed at each meeting, ensuring that no member of the Committee is involved in discussions and decisions about their own remuneration. Membership will be drawn from the following:

Lay Member – Financial Management and Audit Lead (who is an independent member of the Governing Body)

Lay Member – Planning and Performance Lead (who is an independent member of the Governing Body)

Lay Member – Patient and Public Involvement and Equality Lead (who is an independent member of the Governing Body)

Registered Independent Nurse on the Governing Body (who is an independent member of the Governing Body)

Independent Secondary Care Specialist Doctor (who is an independent member of the Governing Body)

GP Cluster Leads x 4 For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the Group that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s committees to support the Group’s decision making arrangements.

Attendees Officers with expertise in the following areas may be invited to attend meetings in an advisory capacity:

Human Resources

Finance

3. Chair and Deputy

The Lay Member – Financial Management and Audit Lead will Chair the Remuneration Committee. In the event of the Chair of the committee being unable to attend all or part of the meeting, a replacement from within the membership will be nominated to deputise for that meeting.

4. Quorum & Voting Arrangements

The Remuneration Committee will be quorate with a minimum of three members.

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Committee members will seek to reach decisions by consensus where possible. Should this not be possible then a vote of Committee members will be required, the process for which is required to be aligned with that set out within Standing Order 4.9 (decision making of the Governing Body).


The Remuneration Committee will meet as required, with a minimum of one meeting per year.


Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the Remuneration Committee. Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Remuneration Committee agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, which state the issues considered, decisions and resolutions made, and the rationale for these decisions. The minutes will be presented according the corporate style, and circulated to members of the Committee. The minutes will be ratified by agreement of the Committee at the following meeting.



9. Duties

To advise the Governing Body about appropriate remuneration, allowances, and terms of service for Governing Body Members, and other senior managers on Very Senior Managers Pay.

Advice toTo advise the Governing Body on remuneration will be guided by NHS policy and best practice and will include all aspects of salary as well as arrangements for termination of employment and other contractual terms.

To ensure that Very Senior Managers are fairly motivated and rewarded for their individual contribution to the organisation, whilst ensuring proper regard to the organisation’s circumstances and performance and to the provision of national arrangements.

To make recommendations to the Governing Body on the performance, development and succession planning of Governing Body Members.

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To advise the Governing Body and oversee appropriate contractual arrangements for Governing Body Members, including the proper calculation and scrutiny of termination payments taking account of such national guidance as appropriate.


The Remuneration Committee will report its decisions to the Governing Body.



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NHS Nottingham City Clinical Commissioning Group GB 342/16 Governing Body – 30 November 2016 Appendix C – Proposed Amendments to Terms of Reference

1

Committee Proposed Amendment Reason for Amendment

All

To amend the membership of all Committees in line

with current practice within the CCG.

The membership of all Committees was reviewed in early 2016 to

take account of organisational changes. The Terms of Reference

have now been amended to reflect the change in membership of the

Committees. The Terms of Reference as amended reflect the

current practice within the CCG.

All

To include the following wording relating to conflicts of

interest:

“At the beginning of each formal meeting, members

will be required to declare any personal interest if it

relates specifically to a particular issue under

consideration. If the existence of an interest becomes

apparent during a meeting then this must be declared

at the point at which it arises. Any such declaration

will be formally recorded in the minutes for the

meeting.

All declared interests are required to be managed in

line with the requirements of the CCG’s Constitution

(Chapter 8) and Conflicts of Interest Policy including in

relation to any further participation in discussions /

decisions.”

The Terms of Reference for a number of the Committees do not

include any reference to the management of conflicts of interest at

meetings. In respect of Committees where reference is made to the

management of conflicts of interest, the wording does not currently

refer to the Conflicts of Interest Policy but only Chapter 8 of the

Constitution.

It is proposed to amend the Constitution so as to limit the amount of

detail relating to the management of conflicts of interest, and to

include this detail within the Conflicts of Interest Policy. Reference

is therefore made to both the appropriate chapter within the

Constitution and the Conflicts of Interest Policy.

Risk &

Performance

Committee,

Quality

Improvement

Committee,

To amend the membership requirements of these

Committees to reduce the number of GP Leads to a

single member.

The Terms of Reference for these Committees currently provide for

two GP Leads to be included in their membership. It is not

considered to be necessary to require two GP Leads to be included

within the membership of each Committee and it is proposed to

reduce the requirement to a single GP Lead in respect of each of

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and Resource

Allocation &

Prioritisation

Panel

these Committees.

Risk &

Performance

Committee,

Quality

Improvement

Committee,

and Resource

Allocation &

Prioritisation

Panel

To amend the quoracy requirements of each of the

Committees such that they are not dependent on GP

representation. Further, to increase the required

independent representation to two members.

Removing the GP Leads from the quoracy requirement will ensure

that the business of each Committee can be conducted without

requiring a GP Lead to be present. It is considered that the nature

of the business of each Committee is such that it should be possible

for this to be conducted absent a GP Lead if necessary.

The GP Lead on each Committee will still be able to count towards

the quorum of each meeting, but the quorum will not be dependent

on the presence of the GP Lead.

It is considered appropriate to increase the quoracy requirement

relating to independent members from a single member to two

members. These Committees are chaired by independent

members, and to require a further independent member to be

present, aside from the role as Chair, is considered to be

appropriate to ensure the effectiveness of the Committees. It is

noted that the purpose of the independent members is to provide an

external view of the work of the CCG that is removed from the day-

to-day running of the organisation, to bring a strategic insight and

impartiality and to provide constructive challenge to discussions and

support decision making arrangements.

Audit

Committee

To appoint the Audit Committee as the Auditor Panel

for the purposes of the Local Audit and Accountability

Act 2014 (“the 2014 Act”), and to include reference to

Due to changes brought about by the 2014 Act from 2017/18

onwards the CCGs are being required to establish an Auditor Panel

to advise their Governing Bodies on the appointment of their

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relevant duties of the Audit Committee as Auditor

Panel pursuant to the 2014 Act.

external auditors.

The 2014 Act specifies how all local public bodies must have auditor

panels to advise them on the selection and the appointment of their

auditor and maintaining an independent relationship with their

auditor. The Department of Health has advised that they expect

CCG’s to appoint existing audit committees to act as auditor panels.

In April 2016 a paper was presented to the Audit Committee by the

Interim Assistant Director of Finance, Planning & Performance

recommending that a proposal is made to Governing Body that the

Audit Committee act as the Audit Panel. The Audit Committee

agreed to make this recommendation.

The Local Audit (Health Service Bodies Auditor Panel and

Independence) Regulations 2015 sets out constitutional

requirements relating to an Audit Panel’s membership and

independence. The Audit Committee meets these requirements.

Primary Care

Commissioning

Panel

To include within the membership of the Primary Care

Commissioning Panel an “out of area GP”.

The NHS England “Managing Conflicts of Interest: Revised

Statutory Guidance for CCGs” (June 2016) (“the 2016 Guidance”)

provides that GPs can, and should, be members of the Primary

Care Commissioning Panel to ensure sufficient clinical input. It

further provides that CCGs may wish to consider appointing retired

GPs or out-of area GPs to the Panel to ensure clinical input whilst

minimising the risk of conflicts of interest.

Currently clinical input on the Panel is achieved by including in the

Panel membership an Independent Nurse and the Corporate

Medical Lead. It is considered that this accords entirely with the

requirements set out explicitly in the 2016 Guidance, and also the

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4


spirit of the 2016 Guidance overall. Both of these positions ensure

that necessary clinical input is provided whilst minimising the risk of

a conflict of interest arising by avoiding the involvement of any

current practising GP.

The Panel has considered appointing an out of area GP to the

membership of the Panel. This is considered to be of benefit given

that there is currently no representation on the Panel from a

practising GP. This would also provide further clinical

representation on the Panel from a source where conflicts of interest

are less likely to arise.

The Panel has supported the appointment of an out of area GP to

the Panel membership, subject to approval of the Governing Body.

Primary Care

Commissioning

Panel

To provide for the Primary Care Commissioning Panel

to make decisions on an urgent basis outside of the

usual meeting cycle.

The Primary Care Commissioning Panel has identified a need for

decisions to be made outside of the usual meeting cycle. The Panel

has considered a draft additional section of the Terms of Reference

and supports the amendments, subject to formal approval by the

Governing Body. The following matters have been considered:

Quorum

The proposed quorum requirements reflect those of the Panel

generally.

Process

It is recognised that it may not be possible for members to meet

face to face on an urgent basis, and provision is made for meetings

by telephone conference. A process has been established and

tested for arranging quorate meetings at short notice.

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Reporting & Ratification

Decisions made using this procedure may be such that they would

otherwise be dealt with in public session. Any such decisions will

therefore be reported to the next formal meeting of the Panel for

ratification.

Definition of “Urgent”

This procedure must be reserved to those matters which are truly

urgent in the sense that they relate to issues that arise between

meetings and require a decision which must be taken in advance of

the next scheduled Panel meeting. This procedure is not proposed

to enable “interim” decisions to be made. The proposed

amendments have been drafted accordingly.

Individual

Funding

Requests

Panel

To amend the Terms of Reference to the current

format of the CCG Terms of Reference, and to include

the Terms of Reference within the Governance

Handbook.

The Terms of Reference of the Individual Funding Requests Panel

are not currently contained within the Governance Handbook. The

Panel is a formal Committee of the Governing Body with delegated

functions and should be included in the Governance Handbook.

The Terms of Reference are currently contained in Appendix F of

the CCG’s Commissioning Policy for the Management of Individual

Funding Requests. It is not proposed to amend the substance of

the Terms of Reference (subject to the points below relating to

membership and quoracy) given that these are currently contained

within and referred to by a policy relating to individual funding

requests.

Individual

Funding

To amend the membership of the Panel to refer

explicitly to the individuals nominated as members of

The Terms of Reference appended to the CCG’s Commissioning

Policy for the Management of Individual Funding Requests refer to

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Requests

Panel

the Individual Funding Requests Panel. the following as members of the Panel:

Director of Public Health or nominated deputy

Executive Director or nominated deputy

Clinical Member of the Clinical Council

Lay Representative

This is amended to reflect the practice of the CCG, as follows:

Director of Quality and Personalisation

Director of Public Health (or nominated deputy)

GP Lead

Lay Member – Planning and Performance Lead (who is an

independent member)

Associate Lay Member (who is an independent member)

Individual

Funding

Requests

Panel

To amend the quoracy requirements of the Individual

Funding Requests Panel to require a lay member in

addition to the Director of Public Health (or nominated

deputy) and GP Lead.

There is a requirement for a lay representative in the membership of

the Individual Funding Requests Panel. As such it is considered

appropriate for lay representation to be required when decisions are

made.

There is provision within the CCG’s Commissioning Policy for the

Management of Individual Funding Requests for “extraordinary”

meetings of the Panel to be held. In these circumstances, due to

the nature of these meetings and the terms of the policy, it is not

proposed to amend the quoracy requirements. Such decision may

be made by a senior Public Health professional, nominated by the

Director of Public Health, and a GP Lead, in accordance with the

policy.

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Individual

Funding

Requests

Panel

To amend the requirements of the current Terms of

Reference which provide for quarterly review meetings

to evaluate the process of the Panel’s decision making

and consider improvements that can be made.

This requirement is removed as it is not considered to be necessary

or appropriate given the frequency with which the Panel is required

to meet.

An annual report to the Governing Body is required setting out an

evaluation of the Individual Funding Requests process and any

improvements, to be produced by the IFR Officer. This is in line

with the reporting requirements of the current Terms of Reference.

Extraordinary

Funding

Requests

Panel

To include Terms of Reference for the Extraordinary

Funding Requests Panel.

The Extraordinary Funding Requests Panel is a formal Committee

of the Governing Body with delegated responsibilities. As such it

requires Terms of Reference, and these should be included within

the Governance Handbook. These have now been drafted and

approved by the Director of Quality and Personalisation and are

included in the Governance Handbook.

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GB 342/16 Appendix D

This is a controlled document and whilst this procedure may be printed, the electronic version available on the CCG’s document management system is the only true copy. As a controlled document, this document should not be saved onto local or network drives.

Governance Handbook November 2016 (Draft)

CONTROL RECORD

Version

1.3

Owner

Director of Corporate

Development

Purpose

This handbook is referenced in the CCG’s Constitution and contains key documents in relation to the CCG’s governance processes.

Amendments November 2016 – amendments made to Terms of Reference.

Approving Body Governing Body Date approved N/A

Date of Issue [ ] Review Date N/A

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NCCCG policies and procedural documents can be made available on request in

a range of languages, large print, Braille, audio, electronic and other accessible

formats from the CCG Communications Team at:

[email protected]

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Contents

1. Introduction ........................................................................................................... 1

2. Committee Summary............................................................................................. 1

3. The NHS Nottingham City Clinical Commissioning Group Governing Body

Committee Structure .................................................................................................. 3

4. Terms of Reference:

Risk and Performance Committee ................................................................................ 4

Quality Improvement Committee .................................................................................. 9

Resource Allocation and Prioritisation Panel .............................................................. 13

Primary Care Commissioning Panel ........................................................................... 16

Clinical Council ........................................................................................................... 20

People’s Council ......................................................................................................... 23

Individual Funding Requests Panel ……………………………………………………….26

Extraordinary Funding Requests Panel ……………………………………………….….29

NHS Nottingham City CCG Inter Practice Agreement ........................................... 32

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Page | 1

1. Introduction

This Governance Handbook has been developed as an accompaniment to the NHS Nottingham

City Clinical Commissioning Group (“CCG”) Constitution (“Constitution”) and contains the

following key governance information and documents:

The CCG’s Governing Body committee structure and individual committee terms of

reference

As described in the constitution the governing body has delegated a number of its decision-

making and monitoring responsibilities to its appointed committees. The Scheme of

Reservation and Delegation (Appendix C of the Constitution) sets out which functions have

been delegated to which committee. The terms of reference contained within this handbook

details the specific duties of each committee and how they will operate in accordance with

the CCG’s Standing Orders (Appendix B of the Constitution).

The Inter Practice Agreement

The Inter Practice Agreement has been established by the CCG’s membership in order to

govern the relationship of member practices, working in GP Clusters, with the intention of

supporting the CCG in undertaking clinical commissioning.

The Detailed Financial Policies and Schedule of Delegated Authority

The Detailed Financial Policies supplement the CCG’s Prime Financial Policies (Appendix

D of the Constitution) and provide specific procedural advice in the following key areas of

financial governance:

Budgetary delegation, budgetary control & reporting

Tendering & contracting

Payroll

Non-pay

Disposals & condemnations, losses & special payments

Operational Scheme of Delegation

The Schedule of Delegated Authority, which summarises the matters delegated by the

Accountable Officer, and to whom they are delegated

2. Committee Summary

The Following table briefly describes the roles of each of the committees reporting to the

Governing Body.

Committee Purpose


This is a statutory committee that makes determinations about the remuneration, fees and other allowances for Governing Body members, Clinical Leads and other Senior Managers.

Audit Committee The Audit Committee is a statutory committee and provides the Governing Body with an independent and objective view of internal control systems. This includes internal and external audit services, Counter Fraud, financial reporting, integrated governance and risk management arrangements.

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Committee Purpose


The Risk and Performance Committee scrutinises the CCG’s risk management processes and monitors the organisation’s performance management arrangements and QIPP programme. The Committee also oversees the arrangements in place to ensure compliance with the information governance agenda, sustainability and corporate social responsibility, equality performance in relation to the CCG’s workforce and health and safety legislation.

Quality Improvement Committee

The Quality Improvement Committee exists to scrutinise arrangements for ensuring the quality of commissioned services. The committee also promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience; and monitors equality performance in relation to health outcomes, patient access and experience.

Primary Care Commissioning Panel

The Primary Care Commissioning Panel has been established to operate as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

Resource Allocation and Prioritisation Panel

The Resource Allocation and Prioritisation Panel’s purpose is to make the CCG’s investment, disinvestment and resource allocation decisions in line with the organisation’s Commissioning Policy.

Individual Funding Request Panel

The purpose of the Individual Funding Request panel is to consider individual requests for NHS commissioned and funded treatment, in line with the organisation’s Individual Funding Review Policy

Extraordinary Funding Request Panel

The Extraordinary Funding Request Panel is to consider requests for which there is no commissioning policy and where individuals could be disadvantaged if their case was not considered within a specific timescale.

Clinical Council The Clinical Council is not a formally appointed committee of the Governing Body but has been established to ensure that there is a clear mechanism for the views of GP Clusters and individual member practices to be fed into the CCG’s decision-making processes.

People’s Council The People’s Council is not a formally appointed committee of the Governing Body but has been established to ensure that the views of patients, carers, community groups and the public are fed into the CCG’s decision-making processes.

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3. The NHS Nottingham City Clinical Commissioning Group Governing Body Committee Structure

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Risk and Performance Committee Terms of Reference

1. Purpose

The Risk and Performance Committee is established in accordance with NHS Nottingham City CCG’s Constitution and is a committee of, and accountable to, the Governing Body. The Committee exists to scrutinise the robustness of the CCG’s risk management and assurance processes regarding the delivery of the organisation’s statutory responsibilities. The Committee will also oversee the development, implementation and monitoring of the CCG’s performance management arrangements and local QIPP Programme. The Committee is authorised to create task and finish sub-groups in order to take forward specific programmes of work as considered necessary by the Committee’s membership.

2. Membership

The membership of the Risk and Performance Committee will be made up of the following:


Associate Lay Members x 2 (who are an independent members)

GP Lead

Director of Corporate Development

Deputy Chief Finance Officer

Assistant Director of Medicines Management

Assistant Director of Planning, Performance and QIPP

Assistant Director of Commissioning – Community Services

For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the CCG that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s Committees to support the CCG’s decision making arrangements.

Attendees

The Head of Corporate Assurance will be a routine attendee at meetings.

Officers with expertise in the following areas may also be invited to attend meetings for relevant items when required:

Information Governance

Equality and Diversity

Workforce

Business Continuity

Health and Safety

Sustainability Other officers may also be invited to attend meetings when the Committee is discussing items that fall within their areas of responsibility.

3. Chair and Deputy

The Lay Member – Planning and Performance Lead will Chair the Risk and Performance Committee, with one of the other independent members being nominated to deputise in the Chair’s absence.

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4. Quorum

The Risk and Performance Committee will be quorate with a minimum of five members, to include two independent members. Any member that has declared a conflict of interest in relation to any matter being discussed will not count towards the quorum.


The Risk and Performance Committee will meet no less than nine times per year. Meetings of the Risk and Performance Committee, other than those regularly scheduled above, shall be summoned by the secretary to the Risk and Performance Committee at the request of the Chair.


Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the Risk and Performance Committee. Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Risk and Performance Committee agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Committee. The minutes will be ratified by agreement of the Committee at the following meeting. The Chair of the Risk and Performance Committee will agree minutes if they are to be submitted to the Governing Body prior to formal ratification.



9. Duties

Risk Management

To oversee the development, implementation and monitoring of the CCG’s risk management arrangements (including corporate, clinical, financial and information risks).

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To scrutinise the Governing Body Assurance Framework and Organisational Risk Register by monitoring progress regarding the implementation of management action plans to mitigate risks and address gaps in control and assurance.

To ensure that the CCG remains aware of, and proactive in, the management of risks through the delivery of appropriate training programmes for all levels of staff.

To oversee the development, implementation and monitoring of the CCG’s incident management arrangements

Performance Management

To oversee the CCG’s performance management framework, scrutinising the monthly Integrated Performance Reports prior to their submission to the Governing Body.

To consider all nationally and locally defined performance targets, monitor performance against those targets (including scrutiny of identified action plans to address shortfalls), and make recommendations for further action in areas of poor performance.

To consider specific areas of performance, focussing in detail on specific issues where provider performance is showing deterioration, or where there are issues of concern. In instances where such areas of poor performance include a quality dimension, then the Quality Improvement Committee will be requested to take these forward through the completion of ‘deep-dive’ reviews.

To oversee the benchmarking of key aspects of performance against other relevant organisations.

To oversee arrangements for data quality so that the Governing Body may have confidence in the performance information being used for monitoring and reporting purposes.

To seek assurance on the robustness of the CCG’s collaborative commissioning arrangements in terms of all aspects of provider performance management.

Quality, Innovation, Productivity and Prevention (QIPP)

To oversee the development, implementation and monitoring of the CCG’s QIPP programme, ensuring that all QIPP schemes are embedded within the organisation’s strategic commissioning plans.

To provide assurance to the Governing Body on progress of the QIPP programme, advising on any significant risks that may affect the organisation in the delivery of its QIPP programme.

To scrutinise the appropriateness of recovery plans that are developed in response to under-performance against savings targets.

To scrutinise arrangements for assessing and monitoring the ongoing impact of QIPP schemes (in terms of quality, equality and privacy).

To oversee alignment of the CCG QIPP programme with other local, regional and national QIPP programmes.

Information Governance

To scrutinise the extent to which the principles and primary objectives of information governance are embedded within the CCG (including information governance management, confidentiality and data protection assurance, information security assurance, secondary use assurance and corporate information assurance).

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To approve the arrangements for ensuring appropriate safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

To monitor the implementation of improvements in all aspects of information security and confidentiality and ensure compliance with the Data Protection Act 1998. This will include the receipt of reports relating to any information governance serious incidents.

To monitor compliance with the requirements of the Freedom of Information Act 2000 and the Environmental Information Regulations 2004 and approve arrangements in relation to the handling of Freedom of Information requests.

To monitor progress in achieving full compliance with the requirements of the Information Governance Toolkit.

Statutory Requirements and Further Assurance

To monitor delivery of the CCG’s Operational Plan.

To monitor delivery of the organisation’s annual equality improvement plan in relation to Goals 3 and 4 of the NHS Equality Delivery System (Empowered, engaged and included staff / Inclusive leadership at all levels).

To monitor the extent to which the CCG is meeting its statutory and mandatory training requirements in relation to its workforce and for monitoring the delivery of annual staff appraisals.

To monitor delivery of staff rights and pledges within the NHS Constitution and oversee arrangements for responding to the views and experiences of the CCG’s workforce, as highlighted by the annual NHS Staff Survey.

To oversee the delivery of all statutory and mandatory requirements of the Health and Safety at Work Act 1974.

To review the implications for the CCG in relation to relevant national studies / in-depth reviews and legislative guidance.

To scrutinise the extent to which a culture of sustainable development and corporate social responsibility is embedded within the CCG.

To monitor and scrutinise progress in delivering the CCG’s Carbon Reduction Plan.

To be responsible for the approval and monitoring of policies within the Committee’s remit, in accordance with the CCG’s Policy for the Development and Management of Policy Documents.

To monitor progress against the CCG’s overarching Policy Work Programme.

To review and monitor the CCG’s arrangements for business continuity and for supporting emergency planning.


The Risk and Performance Committee will report to the Governing Body through regular submission of minutes from its meetings. Any items of specific concern, or which require Governing Body approval, will be the subject of a separate report. The Committee will provide an annual report to the Governing Body setting out progress made and future developments.

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Quality Improvement Committee Terms of Reference

1. Purpose

The Quality Improvement Committee is established in accordance with NHS Nottingham City CCG’s Constitution and is a committee of, and accountable to, the Governing Body. The Committee exists to scrutinise arrangements for ensuring the quality of services commissioned by the CCG and will have oversight of the quality of primary medical services, including those commissioned under the delegation agreement, within the geographical area covered by the organisation. The Quality Improvement Committee will also promote a culture of continuous improvement and innovation in the areas of:

The safety of the treatment and care provided to patients.

The effectiveness of the treatment and care provided to patients.

The experience patients have of the treatment and care they receive. The Committee is authorised to create task and finish sub-groups in order to take forward specific programmes of work as considered necessary by the Committee’s membership.

2. Membership

The membership of the Quality Improvement Committee will be made up of the following:

Independent Nurse (who is an independent member)

Associate Lay Members x 2 (who are independent members)

GP Lead


Director of Corporate Development

Assistant Director of Quality Governance, Children and Learning Disabilities

Assistant Director of Commissioning – Mental Health, Cancer and Acute Contracting

Assistant Director of Commissioning – Primary Care


Attendees

The Head of Quality Governance will be a routine attendee at meetings.

Officers with expertise in the following areas may also be invited to attend meetings for relevant items when required:

Patient Engagement and Complaints

Infection, Prevention and Control

Management of Serious Incidents

Safeguarding

Equality and Diversity Other officers may also be invited to attend meetings when the Committee is discussing items that fall within their areas of responsibility. This will include the lead GPs for each provider contract being invited to attend Quality Improvement Committee meetings when provider Quality Accounts are being reviewed.

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3. Chair and Deputy

The Independent Nurse will Chair the Committee, with one of the other independent members being nominated to deputise in the Chair’s absence.

4. Quorum

The Quality Improvement Committee will be quorate with a minimum of five members, to include two independent members. Any member that has declared a conflict of interest in relation to any matter being discussed will not count towards the quorum.


The Quality Improvement Committee will meet no less than nine times per year. Meetings of the Quality Improvement Committee, other than those regularly scheduled above, shall be summoned by the secretary to the Committee at the request of the Chair.


Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the Quality Improvement Committee. Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Quality Improvement Committee agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Committee. The minutes will be ratified by agreement of the Committee at the following meeting. The Chair of the Quality Improvement Committee will agree minutes if they are to be submitted to the Governing Body prior to formal ratification.



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9. Duties

To oversee the CCG’s approach to ensuring that principles of clinical and quality governance are integral to the commissioning cycle, with a particular focus on ensuring that provider quality schedules are informed by clinical benchmarks, clinical evidence, patient reported outcome measures and patient experience.

To oversee arrangements for ensuring that patient feedback and engagement are integral in commissioning decisions.

To monitor serious incidents, complaints and patient experience data, national and local audit findings and infection prevention and control to identify areas of non-compliance, themes and trends and recommend changes in practice through the commissioning process.

To scrutinise the robustness of the CCG’s arrangements for safeguarding adults and children.

To scrutinise the robustness of the CCG’s arrangements for clinical effectiveness and clinical audit.

To monitor delivery of the organisation’s annual equality improvement plan in relation to Goals 1 and 2 of the NHS Equality Delivery System (Better health outcomes for all / Improved patient access and experience).

To oversee systems regarding the development of local CQUIN targets and local Quality Premium targets, including scrutiny of all such proposed targets in terms of their potential to deliver improvements in the safety, clinical effectiveness and patient experience of commissioned services and the extent to which the targets are challenging and realistic.

To seek assurance that quality outcomes and benefits in commissioned and contracted services are being achieved through a range of processes, highlighting good practice, areas of concern, and any potential reputational risk to the CCG.

To oversee and scrutinise the CCG’s arrangements for identifying and addressing variations in clinical practice, ensuring that clinical intervention is based upon best available evidence.

To seek assurance that local healthcare services are being delivered by staff with the appropriate level of skills and training in order to continuously improve and promote high standards of quality and care.

To conduct ‘deep-dive’ reviews into areas of poor provider performance as highlighted by the Risk and Performance Committee, ensuring that appropriate interventions have been made where quality is compromised or below acceptable levels.

To seek assurance on the robustness of the CCG’s collaborative commissioning arrangements in terms of the quality elements of provider management.

To review the annual Quality Accounts prepared by the CCG’s main providers prior to presentation to the Governing Body for final sign off.

To oversee and scrutinise the CCG’s response to all relevant Directives, Regulations, policies, reports, reviews and approved codes of practice as issued by the Department of Health, NHS England and other regulatory bodies / external agencies (e.g. Care Quality Commission, NICE) to gain assurance that the appropriate actions are being undertaken and are effective.

To be responsible for the approval and monitoring of policies within the Committee’s remit, in accordance with the CCG’s Policy for the Development and Management of Policy Documents.

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The Quality Improvement Committee will report to the Governing Body through regular submission of minutes from its meetings. Any items of specific concern, or which require Governing Body approval, will be the subject of a separate report.

The Committee will provide an annual report to the Governing Body setting out progress made and future developments.



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Resource Allocation and Prioritisation Panel Terms of Reference

1. Purpose

The Resource Allocation and Prioritisation Panel is established in accordance with NHS Nottingham City CCG’s Constitution and is accountable to the Governing Body. The Panel’s primary purpose is to make the CCG’s investment, disinvestment, and resource allocation decisions in line with the organisation’s Prioritisation and Resource Allocation Policy. The Panel is responsible for other key decision-making areas as delegated by the Governing Body.

2. Membership

The membership of the Resource Allocation and Prioritisation Panel will be made up of the following:


Lay Member – Financial Management and Audit (who is an independent member)

Lay Member – Patient and Public Involvement and Equality (who is an independent member)

GP Lead

Chief Officer

Chief Finance Officer

Public Health Consultant For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the CCG that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s Committees to support the CCG’s decision making arrangements.

Attendees:

Deputy Director of Planning, Performance and QIPP

Head of Corporate Assurance Other officers may be invited to attend meetings when the Panel is discussing items that fall within their areas of responsibility. All members are required to undergo mandatory induction training, which will cover the legal and ethical framework for decision making, the organisation’s commissioning processes and structures, and the technical aspects of interpreting clinical evidence and research. This training will be regularly refreshed to ensure that all members maintain the appropriate skills and expertise to function effectively.

3. Chair and Deputy

The Associate Lay Member will Chair the Resource Allocation and Prioritisation Panel, with another independent member deputising in the Chair’s absence.

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4. Quorum and Voting Arrangements

The Resource Allocation and Prioritisation Panel will be quorate with a minimum of four members, to include two independent members. Any issues of quoracy resulting from declared interests should be managed in line with the CCG’s arrangements for managing conflicts of interest (see Chapter 8 of the Constitution). All such arrangements must be recorded in the Panel’s minutes. Panel members will seek to reach decisions by consensus where possible. Should this not be possible then a vote of Panel members will be required, the process for which is required to be aligned with that set out within Standing Order 4.9 (decision making of the Governing Body).


Meetings of the Resource Allocation and Prioritisation Panel will be scheduled on a monthly basis, and held as required. Meetings of the Resource Allocation and Prioritisation Panel, other than those regularly scheduled above, shall be summoned by the secretary to the Panel at the request of the Chair.


Agendas and supporting papers will be circulated no later than three working days in advance of meetings and will be distributed by the secretary to the Resource Allocation and Prioritisation Panel. Any items to be placed on the agenda are to be sent to the secretary no later than five working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Resource Allocation and Prioritisation Panel agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Panel. The minutes will be ratified by agreement of the Panel at the following meeting. Investment and disinvestment decisions made by the Panel will be recorded in line with requirements set out within the CCG’s Prioritisation and Resource Allocation Policy. The Chair of the Resource Allocation and Prioritisation Panel will agree minutes if they are to be submitted to the Governing Body prior to formal ratification.



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9. Duties

Resource Allocation and Prioritisation

To routinely consider in line with the CCG’s Prioritisation and Resource Allocation Policy:

- All significant new investment proposals.

- All significant disinvestment proposals.

- Major shifts in baseline spending.

- New technologies not covered by NICE technology appraisals.

- Major shifts in spend within disease or care groups.

- Significant spend areas in infrastructure that contribute to productivity and efficiency such as IT and estates.

To review activity on a quarterly basis to ensure the consistency of decision making and to consider potential improvements to the prioritisation process.

To make recommendations to the Governing Body on matters arising that may require policy or strategy changes for the organisation.

To escalate to the Governing Body any significant risks that may impact the organisation as a result of prioritisation decisions.

Other Duties

To review and make funding decisions on applications for excess treatment costs for non-commercially funded research, that relate to the commissioning responsibilities of the CCG.

To consider on an individual basis proposals for non-implementation or partial implementation of NICE guidance and standards.

The Panel will also be responsible for the approval and monitoring of policies within the Panel’s remit, in accordance with the CCG’s Policy for the Development and Management of Policy Documents.


The Resource Allocation and Prioritisation Panel will report to the Governing Body through regular submission of minutes from its meetings. Any items of specific concern, or which require Governing Body approval, will be the subject of a separate report. The Panel will provide an annual report to the Governing Body setting out progress made and future developments.


These Terms of Reference will be formally reviewed on annual basis, but may be amended at any time in order to adapt to any national guidance as and when issued. Any proposed amendments to the Terms of Reference will be submitted to the Governing Body.

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Primary Care Commissioning Panel

Terms of Reference

1. Purpose

A formal delegation agreement has been issued by NHS England to empower NHS Nottingham City CCG to commission primary care medical services for the people of Nottingham City. The Primary Care Commissioning Panel has been established in accordance with NHS Nottingham City CCG’s Constitution and will operate as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers. The Primary Care Commissioning Panel is accountable to the Governing Body. The Primary Care Commissioning Panel is subject to any directions made by NHS England or by the Secretary of State.

2. Membership

The membership of the Primary Care Commissioning Panel will be made up of the following lay and executive members:

Independent Nurse (who is both an independent member and clinically qualified)

Associate Lay Members x 2 (who are independent members)

Chief Officer (who is a management representative)

Chief Finance Officer (who is a management representative)

Director of Contracting and Transformation (who is a management representative)

Corporate Medical Lead (who is both clinically qualified and a management representative)

Out-of-Area GP (who is both an independent member and clinically qualified) For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the CCG that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s Committees to support the CCG’s decision making arrangements.

Attendees:

Healthwatch Nottingham Representative

Nottingham City Health and Wellbeing Board Representative


Head of Corporate Assurance Other officers may be invited to attend meetings when the Primary Care Commissioning Panel is discussing items that fall within their areas of responsibility.

3. Chair and Deputy

The Primary Care Commissioning Panel will be chaired by one of the Associate Lay Members, with another independent member deputising in the Chair’s absence.

4. Quorum and Voting Arrangements

The Primary Care Commissioning Panel will be quorate with a minimum of four members, to include one independent member, one clinically qualified member and one management representative.

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Any issues of quoracy resulting from declared interests should be managed in line with the CCG’s arrangements for managing conflicts of interest (see Chapter 8 of the Constitution). All such arrangements must be recorded in the Panel’s minutes. Panel members will seek to reach decisions by consensus where possible. Should this not be possible then a vote of Panel members will be required, the process for which is required to be aligned with that set out within Standing Order 4.9 (Decision making of the Governing Body).


Meetings of the Primary Care Commissioning Panel will be scheduled on a monthly basis and held as required. Meetings of the Primary Care Commissioning Panel, other than those regularly scheduled above, shall be summoned by the secretary to the Panel at the request of the Chair. Meetings of the Primary Care Commissioning Panel will be open to the public in accordance with the arrangements set out for Governing Body meetings within Standing Order 4.13 (Admission of public and the press).

6. Urgent Decisions

The Primary Care Commissioning Panel may be required to take urgent decisions. An urgent decision is one where the requirement for the decision to be made arises between the scheduled monthly meetings of the Primary Care Commissioning Panel and in relation to which a decision must be made prior to the next scheduled meeting. Where an urgent decision is required a supporting paper will be circulated to Panel members by the secretary to the Primary Care Commissioning Panel. The Primary Care Commissioning Panel will be quorate with a minimum of four members, to include one independent member, one clinical member and one management representative. The Panel members may meet either in person or via telephone conference to take an urgent decision. A minute of the discussion and decision will be taken by the secretary to the Primary Care Commissioning Panel and will be reported to the next meeting of the Primary Care Commissioning Panel for formal ratification.


Agendas and supporting papers will be circulated no later than three working days in advance of meetings and will be distributed by the secretary to the Primary Care Commissioning Panel. Any items to be placed on the agenda are to be sent to the secretary no later than five working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Primary Care Commissioning Panel agenda will be agreed with the Chair prior to the meeting.

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Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Panel. The minutes will be ratified by agreement of the Panel at the following meeting. The Chair of the Primary Care Commissioning Panel will agree minutes if they are to be submitted to the Governing Body prior to formal ratification.



10. Duties

The Primary Care Commissioning Panel will oversee the delivery of the delegated functions and powers relating to the commissioning of primary medical services. This will include:

Approving and overseeing the implementation of arrangements for the management of GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract). This will include the establishment of the Primary Care Commissioning Panel’s escalation and reporting requirements, which will include oversight of delivery against key milestones and targets, ensuring that issues and concerns are escalated as appropriate. The requirements will also stipulate oversight of: Planning, including needs assessment, of primary medical care services in

Nottingham City; Reviewing primary medical care services in Nottingham City; Co-ordinating a common approach to the commissioning of primary care services

generally; Management of the budget from commissioning of primary medical care services in

Nottingham City.

Approving all proposals to commission services on a direct award or AQP basis where GP practices are providers. This will include newly designed enhanced services. In instances where additional investment is required, this will need to have received prior approval from the Resource Allocation and Prioritisation Panel

Approving any local incentive schemes designed as an alternative to the Quality Outcomes Framework (QOF). In instances where additional investment is required, this will need to have received prior approval from the Resource Allocation and Prioritisation Panel

Approving the establishment of new or replacement GP practices in Nottingham City.

Approving GP practice mergers.

Approving arrangements for the authorisation of ‘discretionary’ payments, which will include the establishment of the Primary Care Commissioning Panel’s reporting requirements.

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The Primary Care Commissioning Panel will report to the Governing Body through regular submission of minutes from its meetings. Any items of specific concern will be the subject of a separate report. The Primary Care Commissioning Panel will provide an annual report to the Governing Body setting out progress made and future developments.


These Terms of Reference will be formally reviewed on an annual basis, but may be amended at any time in order to adapt to any national guidance as and when issued. Any proposed amendments to the Terms of Reference will be submitted to the Governing

Body for approval.

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Clinical Council Terms of Reference

1. Purpose

The Clinical Council is established in accordance with NHS Nottingham City CCG’s Constitution and acts in a clinical leadership and advisory capacity to the Governing Body (and its Committees). The Clinical Council provides a clear mechanism for individual member practice and GP Cluster views to be fed into the CCG’s decision making processes. The Clinical Council is not a formally appointed committee of the Governing Body, and as such, does not have any delegated decision making powers.

2. Membership

The membership of the Clinical Council will be made up of the following:

Corporate Medical Lead

All GP Cluster Leads

All appointed GP Leads

Practice Nurse Lead Attendees

Management representatives and other officers will attend to give updates in their areas, as requested.

3. Chair and Deputy

The CCG’s Corporate Medical Lead will Chair the Clinical Council. In the event of the Chair being unable to attend all or part of the meeting, a replacement from within the Council’s membership will be nominated to deputise for that meeting.

4. Quorum

As the Clinical Council is not a formally appointed committee of the Governing Body, quoracy does not impact on its business. The Chair will decide on whether the meeting should be reconvened in the event of high numbers of member absence.


The Clinical Council will meet no less than nine times per year. Meetings of the Clinical Council, other than those scheduled as above, shall be summoned by the secretary to the Clinical Council at the request of the Chair.


Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the Clinical Council.

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Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The Clinical Council agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Council. The minutes will be ratified by agreement of the Council at the following meeting. Minutes will not be routinely presented to the Governing Body, but information for consideration by the Governing Body will be presented through appropriate Governing Body papers.



9. Duties

The Clinical Council exists as the CCG’s main forum for clinical discussions in relation to:

The development of strategic commissioning proposals.

The development of Clinical Innovation Fund proposals for CCG-wide initiatives in line with the defined criteria set out within the CCG’s Inter Practice Agreement, and taking into consideration the local initiatives approved by GP Cluster Management Boards.

Implementation of the CCG’s commissioning strategy and annual commissioning plan.

Promoting and encouraging continuous quality improvement and having regard to the need to reduce inequalities.

Promoting and encouraging shared decision making and patient choice.

Obtaining appropriate advice.

Promoting and encouraging innovation, research, and education and training.


The Clinical Council will report items for consideration by the Governing Body and its Committees through the submission of papers and reports to relevant meetings.

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People’s Council Terms of Reference

1. Purpose

The People’s Council is established in accordance with NHS Nottingham City CCG’s Constitution and acts in an advisory capacity to the Governing Body (and its Committees). The People’s Council provides a clear mechanism for the views of patients, carers, community groups and the public to be fed into the CCG’s decision making processes. The People’s Council is not a formally appointed committee of the Governing Body, and as such, does not have any delegated decision making powers.

2. Membership

The membership of the People’s Council will be made up of the following:

Lay Member – Patient and Public Involvement and Equality Lead

Associate Lay Member

Sufficient Patient Leaders and Voluntary and Community Sector Representatives to ensure that the demographic of Nottingham City’s population is adequately represented.

Attendees

The Director of Corporate Development and Head of Engagement and Communications will be routine attendees at meetings.

The CCG’s Clinical Leads, Directors, senior managers and other officers will be invited to attend meetings as required.

3. Chair and Deputy

The Lay Member (Patient and Public Involvement and Equality Lead) will Chair the People’s Council with the Associate Lay Member deputising in the Chair’s absence.

4. Quorum

As the People’s Council is not a formally appointed Committee of the Governing Body, quoracy does not impact on its business. The Chair will decide on whether the meeting should be reconvened in the event of high numbers of member absence.


The People’s Council will be scheduled to meet on a bi-monthly basis. Meetings of the People’s Council, other than those regularly scheduled above, shall be summoned by the secretary to the People’s Council at the request of the Chair.


Agendas and supporting papers will be circulated no later than 3 working days in advance of meetings and will be distributed by the secretary to the People’s Council.

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Any items to be placed on the agenda are to be sent to the secretary no later than 5 working days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair. The People’s Council agenda will be agreed with the Chair prior to the meeting.


Minutes will be taken at all meetings, presented according the corporate style, and circulated to members of the Council. The minutes will be ratified by agreement of the Council at the following meeting. Minutes will not be routinely presented to the Governing Body, but information for consideration by the Governing Body will be presented through appropriate Governing Body papers.



9. Duties

The People’s Council exists as the CCG’s main forum for patient, carer and community group discussions in relation to:

Securing public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements.

Capturing data, including patient views, experiences and feedback, to support the organisation’s arrangements for monitoring the quality of services commissioned by the CCG and the quality of primary medical services, including but not limited to the:

- Safety and effectiveness of the treatment and care provided to patients.

- Experience patients have of the treatment and care they receive.

Promoting and encouraging shared decision making and patient choice.

Capturing early warning signs of areas and services where patient experience is deteriorating and quality standards may be compromised.

Obtaining feedback from the City’s population on commissioned services and the extent to which these improve their health or support them to manage their condition.


The People’s Council will report items for consideration by the Governing Body and its Committees through the submission of papers and reports to relevant meetings.

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Individual Funding Requests Panel Terms of Reference

1. Purpose

The Individual Funding Requests Panel is established in accordance with NHS Nottingham City CCG’s Constitution and is accountable to the Governing Body. The purpose of the Individual Funding Requests Panel is to consider individual requests for NHS commissioned and funded treatment. Each individual funding request will be handled by following the individual funding request process, contained in the CCG’s Commissioning Policy for the Management of Individual Funding Requests, which will ensure the request is considered in a fair and transparent way, with decisions based on the best available evidence and the CCG’s commissioning principles.

2. Membership

The membership of the Individual Funding Requests Panel will be made up of the following:



GP Lead


Associate Lay Member (who is an independent member) For the purpose of clarity, ‘independent members’ are responsible for providing an external view of the work of the CCG that is removed from the day-to-day running of the organisation, bringing a strategic insight and impartiality and providing constructive challenge to discussions at meetings of the Governing Body’s Committees to support the CCG’s decision making arrangements.

Attendees

The Individual Care Packages Commissioning Manager (Commissioning Manager) will attend each meeting of the Panel to record the decision of the Panel against each of the questions in the Decision Framework Document appended to the CCG’s Commissioning Policy for the Management of Individual Funding Requests. Other individuals with specific expertise and skills may also be invited to attend meetings as required in order to ensure effective and robust decision making. Any clinical representative that has had any clinical involvement with an individual case must not attend a meeting of the Panel in relation to that request. All members are required to undergo mandatory induction training, which will cover the legal and ethical framework for Individual Funding Request decision making, the organisation’s commissioning processes and structures, and the technical aspects of interpreting clinical evidence and research. This training will be regularly refreshed to ensure that all members maintain the appropriate skills and expertise to function effectively.

3. Chair and Deputy

At each meeting of the Individual Funding Requests Panel the members will determine who is to act as Chair for that meeting.

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4. Quorum

The Individual Funding Requests Panel will be quorate with a minimum of three members, to include one independent member, a GP Lead and the Director of Public Health (or nominated deputy). For urgent cases requiring an “extraordinary” Individual Funding Request meeting, the meeting will be quorate if the membership consists of a senior Public Health professional, nominated by the Director of Public Health, and a GP Lead. Any issues of quoracy resulting from declared interests should be managed in line with the CCG’s arrangements for managing conflicts of interest (see Chapter 8 of the Constitution and the Conflicts of Interest Policy). All such arrangements must be recorded in the Panel’s minutes. Panel members will seek to reach decisions by consensus where possible. Should this not be possible then a vote of Panel members will be required, the process for which is required to be aligned with that set out within Standing Order 4.9 (Decision making of the Governing Body).


Meetings of the Individual Funding Requests Panel will be scheduled monthly and held as necessary. A case may need to be considered urgently between formal meetings on the advice of the Director of Public Health after consultation with the patient’s clinician(s). The timing of any urgent meeting of the Panel will be informed by the individual clinical circumstances of the case and the risk of an adverse clinical outcome if a funding decision relating to treatment is delayed. An “extraordinary” Individual Funding Request meeting can be convened of a senior Public Health professional, nominated by the Director of Public Health, and a GP Lead, as a minimum membership, with other Panel members attending if available in order to reach an immediate decision. Ideally, all urgent cases will be considered by a face-to-face meeting, but, exceptionally, where the clinical urgency makes this impossible, communication by phone or email will be deemed appropriate.


Individual Funding Requests will be date stamped and logged onto the CCG’s Individual Funding Requests database by the Commissioning Manager. It is the responsibility of this post to manage all requests received and correspondence relating to each case. All cases will be anonymised before consideration by the Individual Funding Requests Panel. The Commissioning Manager will produce a summary of the key information using the Decision Framework Document which will be considered by the Panel. All other documentation that has been received regarding the case will also be available to the Panel. Patients will be encouraged to set out their views in writing to the Panel. Save to the extent that is required to ensure anonymity is preserved, the Commissioning Manager shall not be entitled to redact any written material provided by the patient. However the Commissioning Manager shall be entitled to put any observations in writing before the Panel that they may have concerning material submitted by a patient, including:

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Observations on any areas where issues are raised which do not appear to be supported by the clinical evidence; and

Advice to the Panel concerning any social, caring or other personal factors raised by the patient which the Panel are not entitled to consider under the CCG’s Commissioning Policy for the Management of Individual Funding Requests.

The patient shall be entitled on request to a copy of any observations by the Commissioning Manager. Patients will not be permitted to attend Panel meetings in person or be represented by any person at the meeting.


The Commissioning Manager will record the decision of the Individual Funding Requests Panel against each of the questions in the Decision Framework Document. The completed Decision Framework Document, together with the record of attendance, will form the minutes of an individual case. Decisions made urgently at meetings outside a formal Panel meeting will be presented to the next formal meeting of the Panel for formal ratification.



9. Duties

The Individual Funding Requests Panel is a committee of the CCG Governing Body and has delegated authority to make decisions in respect of funding of individual cases. It is not the role of the Panel to make commissioning policy on behalf of the CCG.


The Panel will provide an annual report to the Governing Body setting out an evaluation of the Individual Funding Requests process and any improvements, to be produced by the Commissioning Manager.


These Terms of Reference will be formally reviewed on an annual basis, but may be amended at any time in order to adapt to any national guidance as and when issued. Any proposed amendments to the Terms of Reference will be submitted to the Governing Body for

approval.

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Extraordinary Funding Requests Panel

Terms of Reference

1. Purpose

The Extraordinary Funding Requests Panel is established in accordance with NHS Nottingham City CCG’s Constitution and is accountable to the Governing Body. The purpose of the Panel is to make all decisions on requests for which there is no commissioning policy and where individuals could be disadvantaged if their case was not considered within a specific timescale.

2. Membership

The membership of the Individual Funding Requests Panel will be made up of the following:



GP Lead




Attendees The Individual Care Packages Commissioning Manager (Commissioning Manager) will attend each meeting of the Panel to record the decision of the Panel against each of the questions in the EFR Decision Framework Document appended to the CCG policy on Extraordinary Funding Requests. Other individuals with specific expertise and skills may also be invited to attend meetings as required in order to ensure effective and robust decision making. Any clinical representative that has had any clinical involvement with an individual case must not attend a meeting of the Panel in relation to that request. All members are required to undergo mandatory induction training, which will cover the legal and ethical framework for decision making, the organisation’s commissioning processes and structures, and the technical aspects of interpreting clinical evidence and research. This training will be regularly refreshed to ensure that all members maintain the appropriate skills and expertise to function effectively.

3. Chair and Deputy

The Lay Member – Planning and Performance Lead will Chair the Extraordinary Funding Requests Panel, with the Associate Lay Member deputising in the Chair’s absence.

4. Quorum

The Extraordinary Funding Requests Panel will be quorate with a minimum of three members, to include one independent member, a GP Lead and the Director of Public Health (or nominated deputy).

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For cases requiring an urgent Extraordinary Funding Request meeting, the meeting will be quorate if the membership consists of a senior Public Health professional, nominated by the Director of Public Health, and a GP Lead. Any issues of quoracy resulting from declared interests should be managed in line with the CCG’s arrangements for managing conflicts of interest (see Chapter 8 of the Constitution and the Conflicts of Interest Policy). All such arrangements must be recorded in the Panel’s minutes. Panel members will seek to reach decisions by consensus where possible. Should this not be possible then a vote of Panel members will be required, the process for which is required to be aligned with that set out within Standing Order 4.9 (Decision making of the Governing Body).


Meetings of the Extraordinary Funding Requests Panel will be held as necessary. A case may need to be considered urgently on the advice of the Director of Public Health after consultation with the patient’s clinician(s). The timing of any urgent meeting of the Panel will be informed by the individual clinical circumstances of the case and the risk of an adverse clinical outcome if a funding decision relating to treatment is delayed. Ideally, all urgent cases will be considered by a face-to-face meeting, but, exceptionally, where the clinical urgency makes this impossible, communication by phone or email will be deemed appropriate.


It is the responsibility of the Commissioning Manager to manage all requests received and correspondence relating to each Extraordinary Funding Request. All cases will be anonymised before consideration by the Extraordinary Funding Requests Panel. The Commissioning Manager will produce a summary of the key information using the EFR Decision Framework Document which will be considered by the Panel. All other documentation that has been received regarding the case will also be available to the Panel. Patients will be encouraged to set out their views in writing to the Panel. Save to the extent that is required to ensure anonymity is preserved, the Commissioning Manager shall not be entitled to redact any written material provided by the patient. However the Commissioning Manager shall be entitled to put any observations in writing before the Panel that the Commissioning Manager may have concerning material submitted by a patient, including:

Observations on any areas where issues are raised which do not appear to be supported by the clinical evidence; and

Advice to the Panel concerning any social, caring or other personal factors raised by the patient which the Panel are not entitled to consider.

The patient shall be entitled on request to a copy of any observations by the Commissioning Manager. Patients will not be permitted to attend Panel meetings in person or be represented by any person at the meeting.


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The Commissioning Manager will record the decision of the Extraordinary Funding Requests Panel against each of the questions in the EFR Decision Framework Document. The completed EFR Decision Framework Document, together with the record of attendance, will form the minutes of an individual case.



9. Duties

The Extraordinary Funding Requests Panel is a committee of the CCG Governing Body and has delegated authority to make all decisions relating to Extraordinary Funding Requests.


The Extraordinary Funding Requests Panel will provide an annual report to the Governing Body setting out an evaluation of the Individual Funding Requests process and any improvements.



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NHS Nottingham City CCG Inter Practice Agreement

Contents

1 Introduction and Commencement .................................................................. 33

2 Member Practice Commitments ...................................................................... 33

3 Member Practice Representatives .................................................................. 34

4 Overarching Structure of the Clinical Commissioning Group ..................... 35

5 GP Cluster Management Boards ..................................................................... 35

6 Annual GP Cluster Meetings ........................................................................... 38

7 Movement of Member Practices between GP Clusters ................................. 38

8 Budget Setting Methodology........................................................................... 38

9 Budget Management ........................................................................................ 39

10 Principles of Financial Risk Sharing .............................................................. 39

11 Financial Risk Management ............................................................................ 39

12 Clinical Innovation Fund .................................................................................. 40

13 Practice Performance and Development ........................................................ 40

14 Dispute Resolution ........................................................................................... 41

Annex 1: Definitions of Key Descriptions used in this Inter Practice Agreement42

Annex 2: Extract from Standing Orders – Voting Arrangements ......................... 43

Annex 3: Assessment Criteria for Clinical Innovation Fund Business Cases ..... 44

Annex 4: Dispute Resolution Procedure................................................................. 45

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1 Introduction and Commencement

1.1 The Clinical Commissioning Group’s (the “CCG”) membership is organised into groups of GP practices (“GP Clusters”), which are based partly on geographical location and partly on inter practice relationships and culture.

1.2 This Inter Practice Agreement has been established by the CCG’s membership in order to

govern the relationship of Member Practices, working in GP Clusters, with the intention of supporting the CCG in undertaking clinical commissioning.

1.3 All Member Practices, as detailed within Chapter 3 of the CCG’s Constitution, have agreed

that they will work in accordance with this Inter Practice Agreement, which has effect from 18 January 2013, when the NHS Commissioning Board established the CCG.

1.4 No variation to this Inter Practice Agreement shall be effected unless agreed at a formal meeting of the CCG’s membership as a whole (a “Members’ Meeting”) in line with the voting process set out within Section 3 of the CCG’s Standing Orders. Members’ Meetings will take place bi-annually. Arrangements governing these meetings are also set out in Section 3 of the CCG’s Standing Orders.

2 Member Practice Commitments

2.1 The CCG’s Member Practices are committed to:

a) Recognising and valuing the diverse needs of its practice population and that of its GP Cluster and the CCG as a whole, specifically the limitations and constraints that these bring when seeking to achieve financial balance.

b) Valuing changes in clinical behaviour that deliver better value for money and better outcomes for patients.

c) The development of close working relationships with other Member Practices and their staff at all levels.

d) Actively engaging with and supporting the CCG to design and commission integrated health and social care services around the needs and expectations of patients, carers, community groups and the public.

e) Working to achieve the best value for money through the use of appropriate developmental mechanisms such as new clinical pathways.

f) The development of good communication and cultural processes, which enable the effective delivery of clinical commissioning in an open and trusting environment.

g) Working to recognise and resolve any differences, conflicts, or disputes between Member Practices, or between Member Practices and their GP Clusters or the CCG, at an early stage.

h) Exhibiting professionalism when engaged in work on behalf of, or when discussing, the CCG in any public forum.

2.2 The CCG’s Member Practices support the following principles in terms of how GPs will engage in clinical commissioning:

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a) GPs must continue to make the care of their patients their first concern in keeping with

the General Medical Council’s document Good Medical Practice: Duties of a Doctor1.

b) GPs must always work in partnership with patients, respecting their dignity and right to confidentiality, making good use of the resources available.

c) GPs must always provide patients with advice, investigations or treatment where necessary. The investigations or treatment provided and arranged must be based on the assessment of needs and priorities, and on clinical judgement about the likely effectiveness of the treatment options.

d) GPs must always refer a patient to another practitioner where this is in the patient’s best interest.

e) GPs must give priority to the investigation and treatment of patients on the basis of clinical need, when such decisions are within their power. If inadequate resources, policies or systems preclude this and patient safety is, or may be, seriously compromised, the matter will be drawn to the attention of the CCG’s Governing Body.

3 Member Practice Representatives

3.1 Each Member Practice is required to nominate one practice representative to act on its behalf in the dealings between it and the CCG (a “Member Practice Representative”).

3.2 Member Practice Representatives are an essential element to ensuring effective participation by each of the CCG’s Member Practices in exercising the CCG’s functions. As defined within Chapter 7 of the CCG’s Constitution, the role of each Member Practice Representative is to:

a) Represent their practice’s views and act on behalf of their practice in all aspects of the

CCG’s commissioning activities, which necessitates working effectively with GPs (including sessional and locum GPs) and with other practice staff, to ensure that the views of the practice as a whole are obtained and input to discussions.

b) Maintain awareness of the CCG’s work through the CCG’s communication channels,

attendance at meetings and discussion of commissioning at practice and patient group meetings, and to ensure dissemination of information to Member Practice staff relating to the CCG's work and their responsibilities to the CCG.

c) Enable and facilitate two-way communications between their practice, their GP Cluster

and the CCG, particularly in relation to:

Feedback from patients and carers, particularly in relation to individual patient choices and any early warning signs of quality issues or failing services that might inform commissioning decisions.

Workforce issues that might influence the ability of the Member Practice to fulfil its duties effectively.

d) Ensure the Member Practice participates in agreed specific pathway redevelopments, providing insight and feedback as appropriate.

1 http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

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e) Assist the CCG in taking forward developments and improvements in relation to primary

care services, including improving the performance of primary care services within the geographical area covered by the CCG.

3.3 The name of each Member Practice Representative is required to be submitted in writing to

the Director of Contracting and Transformation by an authorised representative of the relevant practice. There is no specified notice period for this role. However, for the avoidance of doubt, the CCG will be entitled to treat any Member Practice Representative as having the continuing authority given to him or her until such time as the Director of Contracting and Transformation is notified in writing of the removal of that Member Practice Representative by an authorised representative of the relevant practice.

3.4 Member Practice Representatives will be required to attend the CCG’s formal Members’

Meetings (see Section 3 of the CCG’s Constitution for further information). 4 Overarching Structure of the Clinical Commissioning Group

4.1 The CCG’s overarching structure is illustrated below. Section 6 of the CCG’s Constitution sets out in detail the CCG’s governing structure and decision making arrangements.

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5 GP Cluster Management Boards

5.1 Member Practices agree that the day-to-day affairs of each GP Cluster will be overseen by a Management Board, which will be accountable to the relevant Member Practices.

Role and Responsibilities

5.2 The role of each Management Board is to:

a) Support the development of the CCG’s commissioning priorities, ensuring that Member Practices contribute to the development of an understanding of local health needs.

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b) Support the delivery of the CCG’s commissioning strategy and annual commissioning

plan.

c) Support the development and implementation of the CCG’s local QIPP Programme in order to continuously improve the quality of services and value for money, as well as reducing health inequalities.

d) Provide a lead role in analysing, auditing and reviewing Member Practice performance

both across primary care provision and commissioned services to:

Assist Member Practices in improving the appropriateness of referrals, reducing clinical variation, and enhancing the quality of care and experience.

Support the GP Cluster in meeting its allocated budget, which will in turn support the CCG in meeting its statutory financial duties.

e) Channel the knowledge and experience of Member Practices into innovative proposals

to deliver improved health outcomes by redesigning pathways of care.

f) Ensure that local views and experiences from practice consultations are fed into the work of the CCG, particularly in relation to individual patient choices and any early warning signs of quality issues or failing services.

g) Provide a forum for the CCG’s Governing Body and Clinical Council to feedback and

discuss local and national developments.

h) Promote and encourage patient choice and the involvement of patients (and their carers) in decisions about their healthcare.

i) Support the CCG in securing the involvement and engagement of a wide range of

clinicians in all aspects of the CCG’s business, including but not limited to nursing, midwifery and allied health professionals and secondary care doctors.

j) Actively supporting the education and training of the primary care workforce.

k) Promoting and encouraging Member Practices to be research active through participation in the Primary Care Research Network and the Research Ready Accreditation Scheme.

Composition of Management Boards

5.3 The Member Practices working in each GP Cluster are responsible for electing a GP Cluster Lead who will be Chair of their Management Board and also represent the GP Cluster on the CCG’s Governing Body. The process for appointing the GP Cluster Lead, which will involve a formal competency assessment and subsequent election, is detailed within Section 2 of the CCG’s Standing Orders.

5.4 The GP Cluster Lead can be removed from office following a formal vote of no confidence

undertaken in accordance with Section 2 of the CCG’s Standing Orders (standing order 2.2.3e).

5.5 The composition of each Management Board will be determined by the Member Practices working in each GP Cluster in line with the following principles:

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a) The composition should be such that it ensures that all Member Practices are kept

informed of GP Cluster and CCG business and decisions. b) Allowing for maintaining a GP majority, the Management Board should co-opt the

following additional members:

At least one patient representative.

At least one nurse representative.

At least one practice management representative. c) Each Management Board may also co-opt additional non-voting members including, but

not limited to:

One social services representative.

One secondary care representative.

One pharmacy representative.

Other Allied Healthcare Professionals.

5.6 Each GP Cluster Management Board will formally document its agreed composition.

5.7 All co-opted members of GP Cluster Management Boards will be required to comply with the CCG’s Standards of Business Conduct Policy.

Management Board Meetings

5.8 A meeting of each GP Cluster’s Management Board will be held at least once every two months.

5.9 The GP Cluster Lead will be responsible for drawing up and agreeing the agenda for each Management Board meeting with support from the relevant Primary Care Development and Support Manager.

5.10 Before each Management Board meeting, the agenda and supporting papers will be

circulated to all members, so as to be available at least five Working Days before the date of the meeting taking place. Members wishing to make representations to the Management Board about agenda items may do so in writing up to one working day in advance of the meeting.

5.11 A member who is unable to attend a Management Board meeting may nominate an appropriate deputy to attend the meeting who is authorised to cast a vote on their behalf.

5.12 Management Board meetings will be quorate when 51% of members (or authorised

deputies) are present.

5.13 GP Cluster Leads will preside at Management Board meetings. If a GP Cluster Lead is absent from a meeting, then a GP member of the Management Board will be chosen by members present (including authorised deputies), or by a majority of them, who will preside.

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5.14 The names of all Management Board members (or authorised deputies) present at a

Management Board meeting, including the Chair of the meeting, will be recorded within the minutes of the meeting. The minutes of the proceedings of a meeting will be drawn up and circulated in accordance with members' wishes.

Resolutions at Management Board Meetings

5.15 Generally it is expected that decisions will be reached by consensus at Management Board meetings. Should this not be possible then a vote of the Management Board’s members will be required, the process for which will be aligned to that set out within Section 3 of the CCG’s Standing Orders (see Annex 2 for relevant extract).

6 Annual GP Cluster Meetings

6.1 Within two months of the end of each Financial Year, and on not less than 21 days written

notice to the relevant Member Practices, each Management Board will convene an Annual GP Cluster Meeting in order to review performance and plan for the forthcoming year.

6.2 The business of the Annual GP Cluster Meeting will be determined by the Management

Board, with the agenda and papers being circulated at least ten Working Days in advance of the meeting.

7 Movement of Member Practices between GP Clusters 7.1 Any Member Practice may voluntarily leave its GP Cluster giving not less than three

months’ notice of withdrawal to the Management Board, such notice expiring no earlier than the last day of the third complete calendar month after notice is given.

7.2 Any Member Practice wishing to join another GP Cluster must submit a formal written

request and supporting information to the relevant GP Cluster Lead by 31 December of same year. If accepted, the Member Practice will join the GP Cluster at the start of the following Financial Year.

The written request and supporting information will be considered at the next scheduled meeting of the relevant GP Cluster’s Management Board, following which all of the GP Cluster’s Member Practices will be asked to vote on whether the request should be approved. The voting process will be aligned to that set out within Section 3 of the CCG’s Standing Orders (see Annex 2 for relevant extract) and co-ordinated by the Local Medical Committee, where necessary.

8 Budget Setting Methodology

8.1 In order to support the CCG in the delivery of its financial targets, budgets for

commissioned services are required to be set at Member Practice level and will be aggregated to form the overall GP Cluster and CCG budgets.

8.2 Budgets will be calculated in accordance with the latest national guidance and approved by

the CCG’s Governing Body by 30 April each year. 8.3 Member Practices with materially atypical populations will be reviewed in accordance with

national guidance to determine an appropriate budget level to be offered to and agreed with each Member Practice.

8.4 On a quarterly basis, budget fair shares will be refreshed to reflect variations in list size.

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9 Budget Management

9.1 Budgets will be managed in accordance with the processes, instructions and directions that

are set out within the CCG’s Standing Orders and Prime Financial Policies.

9.2 Member Practices have an individual and collective responsibility to ensure that the CCG meets its statutory financial duties on an annual basis. Therefore, there is a commitment from Member Practices to:

a) Comply with the financial risk sharing principles set out within this Inter Practice

Agreement.

b) Deliver the necessary financial targets for the CCG as a whole.

c) Work with their GP Clusters and the CCG on reasonable rectification plans where necessary.

9.3 If the CCG’s cumulative financial position is showing an in-year or forecast breach of its resource position, then the Governing Body will agree and implement, in conjunction with the GP Cluster Management Boards, a remedial plan to achieve break-even within the required timescale.

10 Principles of Financial Risk Sharing

10.1 It is acknowledged by Member Practices that the impact of high cost patients requiring

extraordinary and necessary health care treatment should not impact adversely on the performance of an individual Member Practice. A key benefit of the multi-Cluster arrangement within Nottingham City is that it provides opportunity to mitigate the impact of such patients across a wider resource base so that risk is shared amongst all of the CCG’s Member Practices, and in some cases beyond, based on the financial risk sharing agreement in place.

11 Financial Risk Management

11.1 The CCG will manage financial risks through:

a) The production and approval of a robust financial strategy and operational plan including sensitivity analysis and an appropriate level of in-year contingency provision to mitigate unplanned or exceptional in-year risk.

b) The provision of regular (monthly) financial and performance monitoring information to Member Practices and meetings of GP Cluster Management Boards, which shows performance against budgets for the year to date and, where appropriate, forecast for the year.

c) The charging of high cost/low volume services or those where units of measurement

are viewed as unreliable, on the basis of fair shares in accordance with agreed risk sharing principles.

11.2 Each GP Cluster will manage financial risks through:

a) Monitoring and discussing monthly financial and performance information at GP Cluster

Management Board meetings.

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b) Ensuring that Member Practices support ways of working that have been agreed at a GP Cluster or CCG level including, but not limited to, the adoption of agreed care pathways, use of the Clinical Assessment Service, or other demand management systems agreed by the GP Cluster or CCG.

c) Working with Member Practices to identify and, where appropriate, reduce clinical variation down to individual clinician level.

d) Working with the CCG’s Medicines Management Team to secure financial gain by best

practice prescribing in line with local and national recommendations. 12 Clinical Innovation Fund

12.1 The CCG’s Clinical Innovation Fund has been established to support small scale, short

term, clinically-led initiatives aimed at changing clinical practice or clinical pathways. All funded initiatives will be subject to a formal evaluation, led by the CCG’s Clinical Council to determine whether they should be funded on an ongoing basis.

12.2 50% of the fund will be used for local deployment at GP Cluster level, with the residual amount being available for CCG-wide initiatives.

12.3 The amount available to the Clinical Innovation Fund each year will be determined by the

CCG’s Governing Body, based on any surplus delivered by the CCG for the prior Financial Year (i.e. the aggregate year-end position of all GP Clusters).

12.4 The proportion of the Clinical Innovation Fund for local deployment will be distributed in line

with each GP Cluster’s prior-year surplus. Where this exceeds the aggregate surplus of the CCG as a whole for that prior year, then the under spends will be abated pro-rata. If the CCG delivers an annual overspend position for any Financial Year, then the Clinical Innovation Fund will not be available in the following Financial Year.

12.5 GP Cluster Management Boards will approve the use of their allocated Clinical Innovation

Fund subject to:

a) Compliance with all requirements of the CCG’s Constitution regarding standards of business conduct, specifically in relation to managing conflicts of interest and required procurement processes (see Chapter 8 of the CCG’s Constitution and its Prime Financial Policies for further details).

b) Business cases for proposed initiatives being assessed against the criteria set out at

Annex 3. 12.6 Proposals for the residual under spend retained for CCG-wide initiatives will be developed

by the CCG’s Clinical Council and subsequently approved by the CCG’s Resource Allocation and Prioritisation Committee as part of the annual planning process. The Resource Allocation and Prioritisation Committee will also review the appropriateness of all initiatives approved by GP Cluster Management Boards.

13 Practice Performance and Development

Practice Visits Programme

13.1 In addition to being routinely provided with monitoring information, all Member Practices will receive at least annually a peer led multi-disciplinary visit that provides the opportunity for constructive dialogue between the Member Practice, their GP Cluster and the CCG. Member Practices will be encouraged to share their ideas for future improvements or

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service changes that provide high quality cost effective care. The visits will be supported by a range of indicators that benchmark practice performance across a number of areas including referral rates, waiting times, prescribing trends, finance and such other indicators as may be relevant in order to inform discussion.

13.2 If performance opportunities are identified as a result of practice visits, then a development

plan will be agreed between the Member Practice, its GP Cluster and the CCG. Progress against the plan will be monitored at regular intervals with additional visits arranged as necessary.

13.3 Member Practices will work with their GP Cluster and the CCG’s clinical and managerial

representatives to analyse, audit and review practice performance and seek to reach agreement on any changes required to reduce clinical variation.

13.4 GP Clusters and the CCG’s clinical and managerial representatives will:

a) Work with Member Practices in a fair, open and transparent way.

b) Support Member Practices to achieve the clinical changes required to deliver the CCG’s

vision and commissioning strategy, recognising the diverse needs of the population of Nottingham City, which the budget allocation methodology may not always be sensitive enough to reflect.

c) Ensure that Member Practices are provided with opportunities to share ideas and potential innovations towards improving the quality of healthcare services provided to their patients.

Quality Improvement in Primary Medical Services

13.5 The CCG, whilst not responsible for commissioning primary care, does have a statutory duty to assist the NHS Commissioning Board in its duty to continually improve the quality of local primary medical care services.

13.6 A locally agreed escalation process has been established, which outlines how any identified

issues that compromise quality standards in primary care medical services will be managed.

13.7 The CCG’s Primary Care Development and Service Integration Team will work supportively

with Member Practices to implement any required quality improvements.

13.8 Where this does not result in the required standards being achieved, or in instances where patients may be at immediate risk of harm, then the CCG will be required to notify the NHS Commissioning Board’s Local Area Team.

14 Dispute Resolution

14.1 Member Practices will make every effort to resolve disputes locally. However, in the event

of any unresolved dispute arising from this Inter Practice Agreement, the dispute shall be dealt with in accordance with the CCG’s Disputes Resolution Procedure (see Annex 4).

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Annex 1: Definitions of Key Descriptions used in this Inter Practice Agreement

2006 Act National Health Service Act 2006.

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act).

Clinical

Commissioning

Group

A body corporate established by the NHS Commissioning Board in

accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section

10 of the 2012 Act).

Constitution The governing document that establishes the CCG as a statutory body in

accordance with Part 1 of Schedule 1A of the 2012 Act.

Financial Year This usually runs from 1 April to 31 March, but under paragraph 17 of

Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can

for the purposes of audit and accounts run from when a Clinical

Commissioning Group is established until the following 31 March

GP General Practitioner

GP Cluster

A group of GP practices within Nottingham City who by choice work together

in a shared framework to engage Member Practices in defining and

delivering the objectives of NHS Nottingham City Clinical Commissioning

Group

Governing Body The body appointed under Section 14L of the NHS Act 2006 (as inserted by

Section 25 of the 2012 Act), with the main function of ensuring that a Clinical

Commissioning Group has made appropriate arrangements for ensuring that

it complies with:

Its obligations under Section 14Q under the NHS Act 2006 (as inserted by Section 26 of the 2012 Act)

Such generally accepted principles of good governance as are relevant to it

Member Practice A provider of primary medical services to a registered patient list, who is a

member of this CCG (see table in Chapter 3)

Practice

Representatives

An individual appointed by a practice (who is a member of the CCG) to act

on its behalf in the dealings between it and the CCG, under regulations made

under section 89 or 94 of the 2006 Act (as amended by section 28 of the

2012 Act) or directions under section 98A of the 2006 Act (as inserted by

section 49 of the 2012 Act)

QIPP Quality, Innovation, Productivity and Prevention – is a large scale

transformational programme for the NHS, involving all NHS staff, clinicians,

patients and the voluntary sector. It will improve the quality of care the NHS

delivers while making up to £20 billion of efficiency savings by 2014-15,

which will be reinvested in frontline care.

Working Day Any day of the week excluding weekends and bank holidays.

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Annex 2: Extract from Standing Orders – Voting Arrangements a) Votes will be weighted according to registered list size, as follows:

Each Member Practice with 2,500 registered patients or less shall be entitled to cast one vote.

Each Member Practice with between 2,501 and 5,000 registered patients shall be entitled to cast two votes.

Each Member Practice with between 5,001 and 7,500 registered patients shall be entitled to cast three votes.

Each Member Practice with between 7,501 and 10,000 registered patients shall be entitled to cast four votes.

For each additional 5,000 patients thereafter a further vote will be allocated to the relevant Member Practice.

b) Resolutions will be passed if more votes are cast for the resolution than against it.

c) If an equal number of votes are cast for and against a resolution then the GP Cluster Lead

will have a casting vote.

d) The outcome of the vote, and any dissenting views, must be recorded in the minutes of the relevant GP Cluster Management Board meeting.

e) A resolution in writing signed by Management Board members who are between them

entitled to cast a majority of the votes capable of being cast shall be deemed to be passed as if that resolution had been proposed and passed at a duly convened Management Board meeting.

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Annex 3: Assessment Criteria for Clinical Innovation Fund Business Cases All Clinical Innovation Fund Business Cases will be assessed against the following criteria:

a) Strategic fit with national and local commissioning priorities. b) The anticipated health gains, expected improvements in efficiency, effectiveness and any

other benefits to patients and to the health improvement of the GP Cluster’s (or CCG’s) population.

c) Evidence of how clinical safety, quality and governance issues have been considered and

an indication of the methods by which the quality of redesigned services will be assured / demonstrated.

d) Evidence of appropriate involvement with relevant patients, carers and community groups,

and that their views have been taken into account in the development of the business case.

e) Evidence of how the specific needs of the relevant patient groups and communities have been taken into account.

f) A description of how the proposed service changes will contribute towards: demand

management; the provision of care in the most appropriate setting; meeting the 18 week wait target; reducing health inequalities; and the overall financial position of the CCG.

g) Evidence that consideration has been given to the extent to which the proposal impacts on

any related service areas.

h) A breakdown of resources required to implement the business case, including clinical and management capacity, support from the CCG and prospective costs and anticipated savings.

i) Evidence of clinical effectiveness.

j) An assessment and proposed management of risks relating to the service redesign process.

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Annex 4: Dispute Resolution Procedure 1. Principles

The CCG’s Inter Practice Agreement requires Member Practices to seek to recognise and resolve

any differences, conflicts, or disputes between Member Practices at an early stage. Similarly,

where the area of dispute is between a Member Practice and its GP Cluster or the CCG, the GP

Cluster / CCG and the Member Practice will seek to resolve this at an early stage without the need

to invoke either informal or formal processes.

The CCG will encourage Member Practices to engage with the Local Medical Committee (LMC) to

assist in the resolution of differences, conflicts and disputes. Representation of practices by the

LMC will be supported at all stages whether this is attendance at informal meetings or formal

panels.

2. Informal Stage

In order to facilitate early resolution, the following procedure is available for use at local level:

a) In the first instance, the Member Practice / GP Cluster should seek to resolve any dispute

through discussion with their Primary Care Development and Service Integration Manager and,

where appropriate, a member of the CCG’s Clinical Council (from their GP Cluster, but where

possible not be the Chair of the GP Cluster’s Management Board).

b) By agreement, other staff members from the CCG (usually below Assistant Director Level) will

also be asked to contribute to the informal discussion where their specialist knowledge can add

value to the discussion. Similarly, by agreement, a member of the CCG’s Clinical Council (from

another GP Cluster) may also be invited to contribute.

c) If the Member Practice / GP Cluster is not happy with the outcome of these discussions, they

should put their case in writing (by letter or email) to the Head of Primary Care Development

and Service Integration, ensuring that the area of dispute is set out as clearly as possible.

d) The Assistant Director of Commissioning – Primary Care will acknowledge receipt of the above in writing (by letter or email) as soon as possible. This should be done within seven working days wherever reasonably practicable.

e) This acknowledgement will invite the Member Practice / GP Cluster to submit a detailed

briefing, although this is not a requirement as the Member Practice / GP Cluster will have

already set out its case at stage c) above. If a detailed briefing is to be submitted, this should

be done in writing (by letter or email) within seven working days of receipt of the

acknowledgement wherever reasonably practicable.

f) The Assistant Director of Commissioning – Primary Care will prepare a written report to be

submitted to the Director of Contracting and Transformation to be supported by the Member

Practice / GP Cluster briefing (if one is submitted).

g) The Director of Contracting and Transformation will convene an independent and informal

panel at the earliest opportunity and ensure that the Member Practice / GP Cluster is made

aware of the membership of the panel and the proposed date of the meeting, which will provide

a minimum notice period of seven working days.

h) If the Member Practice / GP Cluster objects to the membership of the panel, this should be

communicated in writing (by letter or email) within three working days of notification being

received. It is for the Director of Contracting and Transformation to assess whether the Member

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Practice / GP Cluster has a reasonable basis for the objection and hence make the decision as

to whether to amend the membership accordingly.

i) The informal panel will consider the written report of the Assistant Director of Commissioning –

Primary Care and where relevant the supporting Member Practice / GP Cluster briefing.

j) Normally the informal panel decision will be based on the written report put before it, but in

exceptional cases (for example when the evidence is particularly complex) and with the

agreement of the Director of Contracting and Transformation, both the Member Practice / GP

Cluster and their Primary Care Development and Service Integration Manager will be invited to

attend to present their respective cases.

k) The decision of the informal panel along with reasons for the decision will be communicated to

the Member Practice / GP Cluster in writing (by letter or email) within seven working days of the

meeting taking place.

l) If the Member Practice / GP Cluster is not satisfied with the outcome from the informal panel it

can appeal the decision. Details of this process and how to submit an appeal will be provided

to the Member Practice / GP Cluster at the time of communicating the informal panel decision.

3. Formal Stage

The Disputes Resolution Group (DRG) will determine all appeals from Member Practices / GP

Clusters in relation to disputes that cannot be resolved informally. The process for the formal stage

is as follows:

a) The Member Practice / GP Cluster request for an appeal should be notified in writing (by letter

or email) to the Director of Corporate Development within ten working days of the Member

Practice / GP Cluster having been notified of the outcome of the informal stage of the disputes

process.

b) The Director of Corporate Development will acknowledge receipt of the request in writing (by

letter or email) as soon as possible. This should be done within seven working days wherever

reasonably practicable. The acknowledgement will also advise the Member Practice / GP

Cluster of the process and set out alternative options, including conciliation.

c) The Member Practice / GP Cluster should notify the Director of Corporate Development of its

preferred option in writing (by letter or email) within seven working days of receipt of the

acknowledgement wherever reasonably practicable.

d) If conciliation is preferred, then the dispute is suspended, although the Member Practice / GP

Cluster can opt to proceed to stage e) of this process at any point if it notifies the Director of

Corporate Development in writing (by letter or email).

e) Where the decision of the DRG is required, the Member Practice / GP Cluster will submit the

detail of its case within ten working days of notifying the Director of Corporate Development

that it wishes the DRG to consider its case.

f) Wherever reasonably practicable, the DRG will be convened to consider the appeal within thirty

working days of the Member Practice / GP Cluster notifying the Director of Corporate

Development that it is required.

g) The Director of Corporate Development will liaise with the Member Practice / GP Cluster in

order to make reasonable attempts to agree a mutually convenient date for the appeal to be

heard. As a minimum, two dates will be offered to the Member Practice / GP Cluster, which will

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provide a minimum notice period of seven working days. At this time, the Director of Corporate

Development will also inform the Member Practice / GP Cluster of the proposed membership of

the DRG.

h) If the Member Practice / GP Cluster objects to the membership of the DRG, this should be

communicated in writing (by letter or email) within three working days of notification being

received. It is for the Director of Corporate Development to assess whether the Member

Practice / GP Cluster has a reasonable basis for the objection and hence make the decision as

to whether to amend the membership accordingly.

i) The Member Practice / GP Cluster will be invited to present its own case but it is not a

requirement that it does so.

j) The decision of the DRG, along with reasons for the decision, will be communicated in writing

(by letter or email) to the Member Practice / GP Cluster within seven working days of the

meeting taking place.

k) In instances where disputes remain unresolved, unless a further extension of timescale or

process can be agreed by both the Member Practice and the DRG, then the matter will be

referred to the Local Area Team of the NHS Commissioning Board who shall determine the

matter within an agreed timeframe.

l) The decision of the Local Area Team of the NHS CBA will be final.

4. Membership of Panels

It is an important principle that each stage of the decision making process in relation to the

resolution of disputes remains separate and that panel members have not been involved in any

earlier decision on the same issue.

The informal panel will normally consist of:

Director of Contracting and Transformation

One member of the CCG’s Clinical Council or one of the CCG’s Directors

One of the CCG’s Assistant Directors

Membership of the DRG will normally consist of:

Chair of the CCG’s Governing Body (its Clinical Leader) or Chief Officer

One member of the CCG’s Clinical Council or one of the CCG’s Directors

One independent member of the CCG’s Governing Body

5. Role and Responsibilities of the Disputes Resolution Group

a) To act as the final level of the decision making process for Member Practice disputes relating

to participation in the CCG and to be accountable for those decisions (i.e. understanding the

implications of agreeing/refusing the dispute).

b) To ensure that where possible other methods of resolution have been exhausted (including

conciliation) and that appropriate liaison with the LMC takes place.

c) To ensure that all decision making is fair, consistent, transparent and well documented.

d) To ensure that Member Practices are kept informed within the agreed timeframes wherever

possible, and that confidentiality is maintained at all times.

The DRG is accountable to the CCG’s Governing Body.

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