Meeting Agenda ( Open Session) Governing Body Wednesday 08 ... · CARTER, Sarah Orchid Gold Ltd Consultancy Company The company delivers services of turnaround, transformation and

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Meeting Agenda (Open Session)

Governing Body

Wednesday 08 April 2020 9:00 – 10.30

Teleconference

Time Item Presenter Reference

09.00 Introductory Items

1. Welcome, introductions and apologies Jon Towler GB/20/069 – Verbal

2. Confirmation of quoracy Jon Towler GB/20/070 – Verbal

3. Declarations of interest for any item on the agenda Jon Towler GB/20/071

4. Management of any real or perceived conflicts of interest

Jon Towler GB/20/072

5. Questions from the Public Jon Towler GB/20/073 – Verbal

6. Shared minutes from the predecessor CCGs’ meetings held in common on 5 March 2020


7. Consolidated action log from the predecessor CCGs’ Governing Body meetings


09:10 CCG Establishment

8. Establishment of NHS Nottingham and Nottinghamshire CCG

Amanda Sullivan/Lucy Branson

GB/20/076

09:20 Strategy and Leadership

9. COVID-19 Incident Response Arrangements Sarah Carter GB/20/077

10. Governance Arrangements during the Emergency Response Period

Lucy Branson GB/20/078

11. Accountable Officer and Clinical Leaders’ Report Amanda Sullivan GB/20/079 – Verbal

09.45 Commissioning Developments

12. Better Care Fund Lucy Dadge GB/20/080

13. Predecessor CCGs’ Primary Care Commissioning Committees – Highlight Report 25 March 2020

Eleri de Gilbert GB/20/081

10.00 Financial Stewardship

14. 2019/20 Financial Report Month Eleven Andrew Morton GB/20/082

10.10 Corporate Assurance

15. Predecessor CCGs’ Audit and Governance Committees – Highlight Report 27 March 2020

Sue Sunderland GB/20/083

16. Corporate Risk Report Lucy Branson GB/20/084

Chair: Jon Towler

Enquiries to: ncccg.notts - [email protected]

Agenda

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mailto:ncccg.notts%20-%[email protected]

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Time Item Presenter Reference

- Information Items

The following items are for information and will not be individually presented. Questions will be taken by exception.

17. Ratified minutes of predecessor CCGs’ committee meetings

- GB/20/085

a) Audit and Governance Committees – 16 January 2020

b) Primary Care Commissioning Committees – 19 February 2020

10.25 Closing Items

18. Any other business Jon Towler GB/20/086 – Verbal

Date of the next meeting:

03/06/2020

Venue to be confirmed

Jon Towler GB/20/087 – Verbal

Agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

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Action taken to mitigate risk

ARORA, Dr Manik Rivergreen Medical Centre GP Partner 01/04/2013 Present To be excluded from all commissioning decisions

(including procurement activities and contract

management arrangements) relating to services that are

currently, or could be, provided by GP Practices.

ARORA, Dr Manik Nottingham University Hospitals NHS Trust Honorary Consultant - facilitating HCOP ward rounds and

Frailty Unit visits (has not performed services under this

contract since November 2016)

02/10/2016 31/10/2019 Interest expired - no action required

ARORA, Dr Manik GPTeamNet Training City GP Practices on behalf of the Nottingham City GP

Alliance in the use of GP TeamNet.

01/08/2018 15/01/2020 Interest expired - no action required

ARORA, Dr Manik Clifton and Meadows Primary Care

Network

Deputy Clinical Director 01/08/2019 31/03/2020 Interest expired - no action required

BALL, Alex Sherrington Park Medical Practice Registered Patient 01/10/2018 Present This interest will be kept under review and specific

actions determined as required - as a general guide, the

individual should be able to participate in discussions

relating to this practice but be excluded from decision-

making.

BEEBE, Shaun Eastwood Primary Care Centre Family members are registered patients

-

01/03/2020 Interest expired - no action required

BEEBE, Shaun University of Nottingham Senior manager with the University of Nottingham

-

Present This interest will be kept under review and specific

actions determined as required.

BEEBE, Shaun Nottingham University Hospitals NHS Trust Patient in Ophthalmology

-



Register of Declared Interests - Governing Body

• As required by section 14O of the NHS Act 2006 (as amended), the CCG has made arrangements to manage conflicts and potential conflicts of interest to ensure

that decisions made by the CCG will be taken and seen to be taken without being unduly influenced by external or private interests.

• This document is extracted, for the purposes of this meeting, from the CCG’s full Register of Declared Interests (which is publically available on the CCG’s website).

• The register is reviewed in advance of the meeting to ensure the consideration of any known interests in relation to the meeting agenda. Where necessary

(for example, where there is a direct financial interest), members may be fully excluded from participating in an item and this will include them not receiving

the paper(s) in advance of the meeting.

• Members are reminded that they can raise an interest at the beginning of, or during discussion of, an item if they realise that they do have a potential interest

that hasn’t already been declared.

• Expired interests (as greyed out on the register) will remain on the register for six months following the date of expiry.

3.Declarations of interest for any item

on the agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

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No

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Ind

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BRANSON, Lucy St George’s Medical Practice Registered Patient 01/11/2005 Present This interest will be kept under review and specific




making.

CARTER, Sarah Orchid Gold Ltd Consultancy Company The company delivers services of turnaround, transformation

and OD consultancy for NHS organisations

01/04/2013 Present This interest will be kept under review and specific


CHALLENGER, Alison Nottingham City Council Employed as Director of Public Health 01/04/2013 Present This interest will be kept under review and specific


CHALLENGER, Alison Nottingham University Hospitals NHS Trust Relative is Speciality General Manager of Emergency

Department



CLAGUE, Sue Victoria and Mapperley Practice Registered Patient and member of Patient Participation Group 09/01/2016 Present This interest will be kept under review and specific




making.

CLAGUE, Sue University Hospitals of Derby and Burton

Hospitals NHS Foundation Trust

Family Member, Non Executive Director 31/10/2015 Present This interest will be kept under review and specific


DADGE, Lucy Mid Nottinghamshire and Greater

Nottingham Lift Co (public sector)

Director 01/10/2017 Present This interest will be kept under review and specific


DADGE, Lucy Pelham Homes Ltd – Housing provider

subsidiary of Nottinghamshire Community

Housing Association



DADGE, Lucy 3Sixty Care Ltd – GP Federation,

Northamptonshire

Chair 01/01/2017 Present This interest will be kept under review and specific


DADGE, Lucy First for Wellbeing Community Interest

Company (Health and Wellbeing

Company)



DADGE, Lucy Valley Road Surgery Registered Patient 19/06/1905 Present This interest will be kept under review and specific




making.

DADGE, Lucy Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review and specific


DE GILBERT, Eleri Middleton Lodge Surgery Husband registered patient

-Present This interest will be kept under review and specific


DE GILBERT, Eleri Middleton Lodge Surgery Registered Patient -



DE GILBERT, Eleri Middleton Lodge Surgery Son registered patient

-18/10/2019 This interest will be kept under review and specific



on the agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

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tere

sts

No

n-f

ina

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ers

on

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Inte

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Ind

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DE GILBERT, Eleri Rise Park Practice Son and Daughter in Law registered patients 18/10/2019 Present This interest will be kept under review and specific


DE GILBERT, Eleri Nottingham Bench Justice of the Peace



DE GILBERT, Eleri Sherwood and Newark Citizens Advice

Bureau

Trustee on the board 01/03/2016 07/02/2020 This interest will be kept under review and specific


DE GILBERT, Eleri Major Oak Medical Practice, Edwinstowe Son, daughter in law and grandchild registered patient

-



GRIBBIN, Jonathan Cornerstone Church Nottingham Director 01/04/2013 Present This interest will be kept under review and specific


GRIBBIN, Jonathan Nottinghamshire County Council employed as Director of Public Health 01/04/2013 Present This interest will be kept under review and specific


GRIBBIN, Jonathan Nottingham University Hospitals NHS Trust Spouse is Consultant in Obstetrics 01/04/2013 Present This interest will be kept under review and specific


HOPKINSON, Dr James Calverton Practice GP Partner 01/04/2013 Present To be excluded from all commissioning decisions


management arrangement) relating to services that are


HOPKINSON, Dr James Nottingham University Hospitals NHS Trust Wife is an Allergy Nurse Specialist 01/04/2013 Present This interest will be kept under review and specific


HOPKINSON, Dr James Faculty of Sport and Exercise Medicine (an

intercollegiate faculty of the Royal College

of Physicians of London and the Royal

College of Surgeons of Edinburgh, which

works to develop the medical specialty of

Sport and Exercise Medicine).

Fellow of 01/04/2013 Present This interest will be kept under review and specific


HOPKINSON, Dr James NEMS Healthcare Ltd Shareholder 01/04/2013 Present To be excluded from all commissioning decisions


management arrangements) in relation to services

currently provided by NEMS or NEMS CBS; and Services

where it is believed that the organisations could be

interested bidders.

HOPKINSON, Dr James Primary Integrated Care Service (PICS) Practice is a member of

-




on the agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

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sts

No

n-f

ina

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Ind

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LOVELOCK, Dr Hilary Brierley Park Medical Centre GP Partner

-

Present To be excluded from all commissioning decisions




LOVELOCK, Dr Hilary Primary Integrated Care Service (PICS) Shareholder in Primary Integrated Community Services

individually <5%.

-

Present Withdraw from all discussion and voting if organisation is

potential provider unless otherwise agreed by the

meeting chair

LOVELOCK, Dr Hilary Clinical Research Network Recruiter to Care-IS, All Heart-You, CANDID research studies,

where payment is received per recruited patient

-

Present Withdraw from all discussion and voting if organisation is

potential provider unless otherwise agreed by the

meeting chair

OKUBADEJO, Dr Adedeji University Hospitals Birmingham NHS

Foundation Trust

Employed as Associate Medical Director and Consultant in

Anaesthesia and Pain Management



OKUBADEJO, Dr Adedeji Spire Independent private clinical anaesthetic practice undertaken in

private hospitals in the Birmingham area



OKUBADEJO, Dr Adedeji BMI Independent private clinical anaesthetic practice undertaken in

private hospitals in the Birmingham area



OKUBADEJO, Dr Adedeji Transform Hospital Group Ltd (formerly

known as The Hospital Group Ltd)

Independent private clinical anaesthetic practice undertaken in

private hospitals in Bromsgrove



OKUBADEJO, Dr Adedeji Carwis Consulting Ltd – Healthcare

Management Consulting



OKUBADEJO, Dr Adedeji Transform Hospital Group Ltd Group Medical Director and Responsible Officer 01/07/2019 Present This interest will be kept under review and specific


POYNOR, Stuart No relevant interests declared Not applicable

-

Present Not applicable

SHORTT, Dr Stephen East Leake Medical Group GP partner 01/04/2013 Present To be excluded from all commissioning decisions




SHORTT, Dr Stephen Partners Health LLP (Weekend Wound

care and GP Extended Access)

GP member 01/10/2015 Present To be excluded from all commissioning decisions



currently provided by Partners Health LLP; and Services

where it is believed that Partners Health LLP could be an

interested bidder.

SHORTT, Dr Stephen East Leake Medical Group Wife is a registered patient 01/04/2013 Present This interest will be kept under review and specific


SHORTT, Dr Stephen Keyworth Medical Practice Spouse is GP partner 01/04/2013 Present This interest will be kept under review and specific


SHORTT, Dr Stephen KMP Pharmacy Wife is Director 01/04/2013 Present This interest will be kept under review and specific


SHORTT, Dr Stephen HS Primary Care Research Network Practice receives funding to host research studies and recruit

patients




on the agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

nc

ial

Pro

fes

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sts

No

n-f

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Ind

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:

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SHORTT, Dr Stephen Partners Health LLP (Community

Dermatology, Weekend Wound care and

GP Extended Access)

Wife GP member 01/10/2015 Present To be excluded from all commissioning decisions





interested bidder.

SHORTT, Dr Stephen Principia Multi-specialty Community

Provider

Member 01/10/2015 Present To be excluded from all commissioning decisions



currently provided by Principia; and Services where it is

believed that Principia could be an interested bidder.

SULLIVAN, Amanda Hillview Surgery Registered Patient 2013 Present This interest will be kept under review and specific




making.

STRATTON, Dr Richard Belvoir Health Group GP Partner To be excluded from all commissioning decisions


management arrangements) relating to services that are


STRATTON, Dr Richard PartnersHealth LLP GP member To be excluded from all commissioning decisions





interested bidder.

SUNDERLAND, Sue Joint Audit Risk Assurance Committee,

Police and Crime Commissioner (JARAC)

for Derbyshire / Derbyshire Constabulary

Chair 01/04/2018 Present This interest will be kept under review and specific


SUNDERLAND, Sue NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review and specific


SUNDERLAND, Sue Inclusion Healthcare Social Enterprise CIC

(Leicester City)

Non-Executive Director 16/12/2015 Present This interest will be kept under review and specific


THOMPSON, Gary Radcliffe on Trent Health Centre Registered Patient 01/01/2018 Present This interest will be kept under review and specific


THOMPSON, Gary Radcliffe on Trent Health Centre Spouse is a patient 01/01/2018 Present This interest will be kept under review and specific


TOWLER, Jon Sherwood Medical Practice. Registered Patient -



TOWLER, Jon Major Oak Medical Practice, Edwinstowe Family members are registered patient




on the agenda

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Name Declared

Interest

(Name of the

organisation

and nature of

business)

Nature of Interest

Fin

an

cia

l In

tere

st

No

n-f

ina

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ial

Pro

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No

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WADDINGHAM, Rosa No relevant interests declared Not applicable - - Not applicable


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Managing Conflicts of Interest at Meetings

1. A “conflict of interest” is defined as a “set of circumstances by which a reasonable person

would consider that an individual’s ability to apply judgement or act, in the context of

delivering commissioning, or assuring taxpayer funded health and care services is, or could

be, impaired or influenced by another interest they hold”.

2. An individual does not need to exploit their position or obtain an actual benefit, financial or

otherwise, for a conflict of interest to occur. In fact, a perception of wrongdoing, impaired

judgement, or undue influence can be as detrimental as any of them actually occurring. It is

important to manage these perceived conflicts in order to maintain public trust.

3. Conflicts of interest include:

Financial interests: where an individual may get direct financial benefits from the

consequences of a commissioning decision.

Non-financial professional interests: 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.

Non-financial personal interests: 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.

Indirect interests: 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.

The above categories are not exhaustive and each situation must be considered on a case

by case basis.

4. In advance of any meeting of the Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda item and how they should be

managed. This may include steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to conflicted individuals.

5. At the beginning of each formal meeting, Committee members and co-opted advisors will be

required to declare any interests that relate 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.

4.Management of any real or perceived conflicts of interest


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6. The Chair of the Committee (or Deputy Chair in their absence, or where the Chair of the

Committee is conflicted) will determine how declared interests should be managed, which is

likely to involve one the following actions:

Requiring the individual to withdraw from the meeting for that part of the discussion if the

conflict could be seen as detrimental to the Committee’s decision-making arrangements.

Allowing the individual to participate in the discussion, but not the decision-making

process.

Allowing full participation in discussion and the decision-making process, as the potential

conflict is not perceived to be material or detrimental to the Committee’s decision-making

arrangements.

4.Management of any real or perceived conflicts of interest


NHS Mansfield and Ashfield CCG Governing Body

NHS Newark and Sherwood CCG Governing Body

NHS Nottingham City CCG Governing Body

NHS Nottingham North and East CCG Governing Body

NHS Nottingham West CCG Governing Body

NHS Rushcliffe CCG Governing Body

Unratified minutes of the meetings held in common on

05/03/2020, 9.00-10.30

Birch House, Ransomwood Business Park NG21 0HJ

Organisation

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Members present:

Jon Towler Lay Chair of the Governing Body

Dr Nicole Atkinson Clinical Chair

Dr Thilan

Bartholomeuz

Clinical Chair

Sue Clague Lay Member, Patient and Public

Involvement

Lucy Dadge Chief Commissioning Officer

Eleri de Gilbert Lay Member, Quality and Performance

Dr Caitriona Kennedy GP Representative (on behalf of Dr

James Hopkinson)

Dr Hilary Lovelock Interim Clinical Chair

Julie McIntyre Lay Member, Patient and Public

Involvement

Dr Adedeji

Okubadejo

Secondary Care Doctor

Dr Hugh Porter Clinical Chair

Stuart Poynor Chief Finance Officer

Dr Stephen Shortt Clinical Chair

Sue Sunderland Lay Member, Audit and Governance

Rosa Waddingham Interim Chief Nurse

In attendance:

Dr Manik Arora GP Representative (on behalf of Dr

6.Shared minutes from meeting in common held on 5 March 2020


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Hugh Porter)

Alex Ball Director of Communication and

Engagement

Shaun Beebe Lay Member, Financial Management

Lucy Branson Associate Director of Governance

Sarah Carter Director of Transition

Sue Wass Corporate Governance Officer

(minutes)

Apologies:

Dr James Hopkinson Clinical Chair

Amanda Sullivan Accountable Officer

Apologies in Attendance:

Alison Challenger Director of Public Health, Nottingham

City

Jonathan Gribbin Director of Public Health,

Nottinghamshire County

Gary Thompson Director of Special Projects

Cumulative Record of Members Attendance (2019/20)1

Name Possible Actual Name Possible Actual

Dr Nicole Atkinson 9 4 Elaine Moss 62 4

Dr Thilan Bartholomeuz 9 6 Dr Adedeji Okubadejo 9 8

Sue Clague 9 8 Dr Hugh Porter 9 6

Lucy Dadge 9 8 Stuart Poynor 9 8

Eleri de Gilbert 9 8 Dr Stephen Shortt 9 8

Dr James Hopkinson 9 3 Amanda Sullivan 9 8

Dr Hilary Lovelock 33 3 Sue Sunderland 9 8

Dr Gavin Lunn 62 3 Jon Towler 9 9

Julie McIntyre 9 8 Rosa Waddingham 33 3 1 From commencement of new aligned governance arrangements

2 Post ended 31 December 2019

3 Post started 1 January 2020

Introductory Items

GB 20 047 Welcome and Apologies

Jon Towler welcomed everyone to the open meeting in common of the Governing

Bodies of NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS

Nottingham City CCG, NHS Nottingham North and East CCG, NHS Nottingham West

CCG and NHS Rushcliffe CCG (hereafter referred to collectively as “the Governing

Bodies” unless the item being discussed pertains to an individual CCG (or CCGs)).

There were five members of the public present. A round of introductions was

undertaken and apologies were noted as above.

GB 20 048 Confirmation of Quoracy

The meetings were declared quorate. It was noted that NHS Rushcliffe CCG was not

quorate as Dr Stephen Shortt was yet to arrive; however should the need arise, Dr Hugh



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Porter would be co-opted to vote on behalf of NHS Rushcliffe CCG.

GB 20 049 Declaration of interests for any item on the shared agenda

No interests were declared in relation to any item on the agenda. Jon Towler reminded

members of their responsibility to highlight any interests should they transpire as a

result of discussions during the meeting.

GB 20 050 Management of any real or perceived conflicts of interest

This item was not required as no interests had been declared.

GB 20 051 Questions from the Public

No questions from the public had been received.

GB 20 052 Shared minutes from the meeting in common held on 5 February 2020

The minutes of the meeting held in common on 5 February were agreed as an accurate

record of the discussions held.

GB 20 053 Action log from meeting in common held on 5 February 2020

The action log was reviewed and the following points highlighted:

a) Item GB 20 009 would be brought to the new CCG’s inaugural meeting in April.

b) Item GB 20 032 was noted as ongoing: the CCGs were currently awaiting a

response from Nottinghamshire Healthcare NHS Foundation Trust.

c) Item GB 20 033 would be added to the new CCG’s forward plan.

All other actions were noted as completed and there were no further matters arising.

Strategy and Leadership

GB 20 054 Accountable Officer and Clinical Chairs’ Report

Stuart Poynor introduced the item. The following points were highlighted:

a) The substantive appointment of two key roles for the NHS Nottingham and

Nottinghamshire CCG had been completed. Stuart had been appointed as the new

CCG’s Chief Finance Officer and Rosa Waddingham had been appointed as the

Chief Nurse. Both of these roles would take effect when the new organisation was

formally established on 1 April 2020.

b) The response to COVID-19 was discussed. There were daily operational calls with

NHS England/Improvement and evolving plans to contain the outbreak. Dedicated

resource and a consistent approach had been put in place across the East Midlands

area.

c) Following the release of the 2020/21 planning guidance, work was continuing to

develop the Operational Plan for 2020/21 and contract negotiations with partners

were continuing. The challenging targets regarding waiting time standards and

occupancy levels were noted.

At this point, Dr Stephen Shortt joined the meeting.

d) An update on the development of the Clinical Design Authority (CDA) was given by

Dr Shortt. Interviews for the CDA GPs had commenced and a number of



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appointments had been made. The CDA would bring together clinical subject matter

experts for the purpose of redesigning clinical pathways and protocols, which would

maximise clinical expertise within the new CCG.

In discussion the following points were raised:

e) Contradictory advice given from NHS111 regarding COVID-19 was raised. It was

noted that this had been due to the impact of the large number of calls being

received, with some calls being answered by out of area call centres. A regional

hub would be operational imminently.

f) Management of COVID-19 in GP surgeries and care homes was queried. It was

noted that a dedicated CCG team was co-ordinating advice working alongside the

CCGs’ Infection, Prevention and Control Team.

g) Members discussed the recent publication of ‘Health Equality in England: The

Marmot Review 10 Years On’, which had outlined widening inequalities within

Nottinghamshire. Dr Bartholomeuz noted the valuable role of the voluntary sector in

providing services in deprived areas and the need for the new CCG going forward to

be able to respond to specific areas with greater needs. The role of Primary Care

Networks to respond to this challenge was discussed, with the need to ensure they

were adequately resourced to respond to the expectations placed upon them.

h) There was a discussion regarding how learning from the Marmot Review, and also

learning from the Greater Nottingham Transformation Programme and work on

population health management could be used to structure strategic commissioning

going forward. The barriers to translating the priorities of the Integrated Care

System (ICS) into deliverables were also discussed, with a focus on how the new

CCG would be able to drive forward transformational change. The new CCG’s

Executive Team was requested to reflect on the discussion; to articulate the key

deliverable priorities for 2020/21; and to consider using a future development

session to invite key leaders from the ICS to discuss how together, as a health

system, they could drive forward the delivery of the key priorities.

The Governing Bodies:

NOTED the Accountable Officer and Clinical Chairs’ Report.

ACTION:

The Executive Team to discuss and agree key deliverable priorities for 2020/21

and to bring to the new CCG’s inaugural meeting in April for approval.

The Executive Team to consider using a future development session to invite

key leaders from the ICS to discuss how together, as a health system, they

could drive forward the delivery of the key priorities.

Commissioning Developments

GB 20 055 Patient and Public Engagement Committees – Highlight Reports

Julie McIntyre introduced this item, asking the Governing Bodies to note the following

points:

a) Good progress was being made towards the establishment of the Nottingham and

Nottinghamshire Patient and Public Engagement Committee (PPEC) from 1 May

2020.



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b) PPEC Terms of Reference had been reviewed at the meeting and would be agreed

virtually prior to submission to the new CCG’s inaugural Governing Body meeting for

approval.

c) Recruitment to PPEC membership would commence with a request for expressions

of interest from the existing members.


NOTED the Patient and Public Engagement Committees – Highlight Report.

GB 20 056 Primary Care Commissioning Committees – Highlight Report

Eleri de Gilbert introduced this item, asking the Governing Bodies to note the following

points:

a) A progress report relating to a GP Forward View initiative was discussed, with the

first Digital Champion pilot at Roundwood Surgery in Mansfield due to go live at the

end of February 2020. It was noted that all practices would have the technical ability

to do online consultations by the end of March 2020.

b) 112 GP practices had signed up to Local Enhanced Services (LES) and a

contingency plan was in place for those practices not yet signed up.

c) Whilst closing practice lists was usually seen as a last resort, last year’s approval of

a temporary list closure for Barnby Gate Practice had meant the practice had

managed to stabilise its workforce with the support of neighbouring practices and

the Primary Care Network, and would now re-open its list in April.

d) During the last quarter there had been a significant number of retirements and

resignations of GP partners and workforce plans and risks continued to be

monitored. It was agreed that further discussion with ICS workforce leads was

needed to address the issue of GP partners and to also look at contributing factors,

such as premises and their impact on practice workload.

e) As discussed previously at meetings of the Governing Bodies, the Committees

considered the issue of demand in general practice. A number of further actions

were agreed by the Committees and the issue would remain a key area of focus.

The Committees did however recognise and wish to celebrate what practices had

achieved to date, taking on new ways of working, but despite this, demand

continued to impact on workload and capacity/workforce retention.


f) Members sought assurance that services were in place for patients whose GP

practices were not providing LES services. It was noted that services would be

commissioned for those patients.

g) Members queried whether the digital champion pilot could be rolled out quickly to

support practices in responding to COVID-19. It was noted that NHS Digital was

putting in place a number of initiatives to allow GPs to work more flexibly.

h) Members queried the progress of the ICS workforce workstream and it was noted

that it was currently reporting as on track to meet its targets.


NOTED the Primary Care Commissioning Committees – Highlight Report.

Financial Stewardship



Page 6 of 10

GB 20 057 Finance Update

Finance and Turnaround Committees – Highlight Report

Shaun Beebe introduced this item. The following points were noted:

a) Further to the discussion at the February 2020 Governing Bodies’ meeting in common, a deep dive into the analysis and management of non-elective demand within urgent and proactive care was scrutinised by the Committees. It was noted that despite a significant amount of work operationally to review and mitigate the drivers of demand, activity levels continued to rise.

b) Confirmation was received that a refreshed approach to understanding the cause for this continued rise would include greater input from clinical colleagues to explore patient need and care gaps as drivers of demand.

c) The important role the new CCG would play in leading system partners to transform the health and social care system to proactively manage demand and reduce activity was emphasised.


NOTED the Finance and Turnaround Committees – Highlight Report.

Finance Report

Stuart Poynor introduced this item, highlighting the following points:

a) The forecast position was to deliver the planned £11.9 million cumulative surplus,

but there remained considerable risk to this position. For the year to date, the

combined CCGs’ position was £3.5 million adverse to plan.

b) There were currently mitigations of £4.2 million identified to offset this risk. The

previously assumed mitigation relating to receipt of additional national funding to

offset the prescribing Category M risk had now been confirmed by NHS

England/Improvement as being not available. This left the CCGs with a further £1.9

million of mitigations to identify in order to deliver the forecast position. The CCGs

continued to have conversations with regulators regarding the financial position.

c) Regarding 2020/21, there was a significant unmitigated gap; and system wide

mitigating actions were being explored with providers with the aim of closing this gap

by 31 March 2020.


NOTED the Finance Report.

Quality and Performance

GB 20 058 Quality and Performance Update

Quality, Safeguarding and Performance Committees – Highlight Report

Eleri de Gilbert introduced the report. The following points were highlighted:

a) A presentation on quality outcomes within the Nottingham and Nottinghamshire

Maternity and Neonatal system (LMNS) had been given, outlining its role, aims and

objectives. Members had noted the laudable aims of the LMNS, but had voiced

concern over the significant challenge around the considerable variation in

outcomes across Nottinghamshire.

b) The Committees had scrutinised the Quality and Performance Report and

considered the remedial actions being taken to recover performance. The next

meeting would concentrate on a thematic review of cancer performance.



Page 7 of 10


NOTED the Quality, Safeguarding and Performance Committees – Highlight Report.

Integrated Quality and Performance Report

Stuart Poynor introduced this item, highlighting the following points:

a) Concerns were reported around performance relating to A&E four- hour waiting

times; twelve hour trolley waits; Cancer 62 day performance; and the volume of

patients waiting for their first definitive treatment, which remained higher than the

planned level at both Nottinghamshire University Hospitals NHS Trust (NUH) and

Sherwood Forest Hospital NHS Foundation Trust.

b) A joint review was being commissioned with NUH to understand why the increase in

capacity had not impacted significantly on performance.

c) There continued to be a daily focus on urgent care at Accountable Officer level.

d) Work continued to revise the format of the Integrated Quality and Performance

Report.

e) Regarding quality concerns, Rosa Waddingham reported on a continuing focus on

Nottinghamshire Healthcare NHS Foundation Trust. The Trust had put actions in

place following the recent inspection by the Care Quality Commission; however

there remained concern as only limited assurance had been received to date. Areas

of risk were due to be discussed with the regulators.


f) Members noted that the cancer targets had remained below target for a

considerable length of time, with little assurance that action plans that had been put

in place were making a significant improvement on performance. It was agreed that,

following the thematic review at their next meeting, if the Quality, Safeguarding and

Performance Committees were not assured, it should be escalated to the Governing

Bodies.


NOTED the Performance Report

Corporate Assurance

GB 20 059 Staff Survey

Sarah Carter introduced this item. The following points were highlighted:

a) Although the surveys were carried out during the staffing restructure, when staff

were adjusting to their new roles, it was decided to take part in the survey in order to

gain more insight into staff wellbeing at a crucial point in the formation of the

organisation.

b) A number of important areas of learning for the new organisation were noted and an

action plan in response to the survey would be developed in partnership with the

Staff Engagement Group. The Staff Engagement Group would then take

responsibility for holding the organisation to account for the delivery of the plan.


c) Members queried leadership at a senior level of the action plan and it was noted that



Page 8 of 10

there was strong ownership by the Executive Team. It was agreed that the Staff

Engagement Group should be asked to present the action plan at the next meeting.

d) Members queried actions to ensure that appraisals were of benefit. It was noted

that the new appraisal policy had not been fully implemented at the time of the

survey.


NOTED the Staff Survey Report.

ACTIONS:

Sarah Carter to ask representatives of the Staff Engagement Group to present

the action plan in response to the Staff Survey at the April meeting of the new

Governing Body.

GB 20 060 Merger Programme Board Highlight Report

Jon Towler introduced this item. The following points were highlighted:

a) Work remained ongoing to further deliver the transition plan and each of the

workstreams remained on target.

b) The CCGs had received confirmation that the Grant of Merger should be received on

10 March 2020, at which time Accountable Officer approval would also be received.


NOTED the Merger Programme Board Highlight Report.

GB 20 061 Governing Body Assurance Framework – Year End Position

Lucy Branson introduced this item. The following points were highlighted:

a) The purpose of the report was to present the year-end position of the six Nottingham

and Nottinghamshire CCGs’ 2019/20 Joint Governing Body Assurance Framework.

b) The Assurance Framework played an important role in informing the production of

the CCGs’ Annual Governance Statements and was the main tool for ensuring that

an effective system of internal control was in place.

c) Analysis demonstrated that there were no significant gaps in the control environment

and there was an acceptable balance of internal and external controls.

d) Actions had been identified for all gaps in assurance, with clear implementation

timelines agreed. Progress in relation to actions had been routinely reported within

the Targeted Assurance Reports to the Audit and Governance Committees.


e) Members agreed that it was a robust framework.

f) Members queried whether the risk relating to Nottinghamshire Healthcare Trust

should be added to the Framework. It was noted that this issue was a time-limited

operational risk, albeit a high risk, which sat on the Corporate Risk Register. The

risks on the Assurance Framework related to the effective management of the

CCGs’ systems, policies the delivery of their objectives, which by their nature were

constant.

g) Members discussed risk nine, commissioning priorities and the need to develop the

risk was noted.

h) Members noted that the opening position for the 2020/21 Assurance Framework



Page 9 of 10

would be brought to the June meeting of the new CCG’s Governing Body.


NOTED the Governing Body Assurance Framework – Year End Position.

ACTION:

Lucy Branson/Lucy Dadge to develop risk nine for 2020/21.

GB 20 062 Corporate Risk Report

Lucy Branson introduced this item. The following points were highlighted:

a) There were currently four major operational risks in the joint Corporate Risk

Register, a reduction in three risks since the previous meeting.

b) The three reduced risks related to financial risk within this financial year and

financial risk areas for 2020/21 were currently being considered.

c) There was one increased risk; the Quality, Safeguarding and Performance

Committees had agreed, at their February meetings in common, to increase the risk

score in relation to Nottinghamshire Healthcare NHS Foundation Trust from 16 to

20.

d) A new risk relating to COVID-19 was currently being drafted.


NOTED the Corporate Risk Report.

For Information

GB 20 063-

066

Ratified Minutes of previous Governing Bodies' Sub Committees

The minutes were NOTED.

Closing Items

GB 20 067 Any other business

No other business was raised.

GB 20 068 Moving to a new organisation

The Chair and Chief Finance Officer formally acknowledged that this was the last

meeting in common of the Governing Bodies of all six CCGs and thanked all members

and staff for their hard work and dedication over the past years; and in particular

thanked Dr Porter, Dr Bartholomeuz; and Dr Atkinson, who would be stepping down

from the Governing Bodies, for their leadership. It was acknowledged that all three

would be continuing to provide clinical leadership to the ICS and the three Integrated

Care Partnerships (ICPs).

Julie McIntyre, was also stepping down from her position as Chair of the Mid

Nottinghamshire Patient and Public Engagement Committee. On behalf of the

Governing Bodies, the Chair and Chief Finance Officer formally thanked Julie for the

rigour of constructive challenge she had given the CCGs from the patient point of view,

with the ability to balance this with her corporate responsibilities as a member of the



Page 10 of 10

Governing Bodies.

Confidential Motion:

The Governing Bodies resolved that representatives of the press and other members of the

public be excluded from the remainder of this meeting in common, having regard to the

confidential nature of the business to be transacted, publicity on which would be prejudicial

to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960).



Page 1 of 3

Governing Body ACTION LOG for the predecessor meetings held on 05/03/2020

MEETING

DATE

AGENDA

REFERENCE

AGENDA ITEM ACTION LEAD DATE TO BE

COMPLETED

COMMENT

ACTIONS OUTSTANDING

05/02/2020 GB 20 032 Quality,

Safeguarding

and

Performance

Committees’

Highlight Report

To lead on arranging a Board to

Board meeting of the CCGs and

Nottinghamshire Healthcare NHS

Foundation Trust.

Amanda

Sullivan

To be confirmed A verbal update will be

provided at the April 2020

meeting.

05/03/20 GB 20 054 Accountable

Officer’s Report

To discuss and agree key deliverable

priorities for 2020/21 and to bring to

the new CCG’s inaugural meeting in

April for approval.

Amanda

Sullivan



meeting.

05/03/20 GB 20 054 Accountable

Officer’s Report

To consider using a future

development session to invite key

leaders from the ICS to discuss how

together, as a health system, they

could drive forward the delivery of the

key priorities.

Amanda

Sullivan



meeting.

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MEETING

DATE

AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS ONGOING / NOT YET DUE

09/01/2020 GB 20 009 Statutory

Equality Duties

To ensure the new Equality, Diversity

and Inclusion Policy includes

reference to the role and

responsibilities of lay members.

Rosa

Waddingham

3 June 2020 Due to the CCG’s required

incident response to

COVID-19, the new policy

has been deferred and will

now be presented to the

June 2020 meeting of the

Governing Body.

05/02/2020 GB 20 033 Organisational

Development

Report

To provide an update on actions to

improve diversity within the CCGs’

workforce as part of the next

scheduled workforce report.

Sarah Carter To be confirmed To be added to the annual

work programme for the

CCG’s Governing Body,

which will be developed

during April 2020.

05/03/20 GB 20 059 Staff Survey To ask representatives of the Staff

Engagement Group to present the

action plan in response to the Staff

Survey at the April meeting of the

new Governing Body.

Sarah Carter 3 June 2020 Due to the CCG’s required

incident response to

COVID-19, the staff survey

action plan has been

deferred and will now be

presented to the June 2020

meeting of the Governing

Body.

05/03/20 GB 20 061 Assurance

Framework

Lucy Branson/Lucy Dadge to develop

risk nine for 2020/21

Lucy Branson

3 June 2020 Not yet due, scheduled for

presentation in June 2020

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MEETING

DATE

AGENDA

REFERENCE


COMPLETED

COMMENT

ACTIONS COMPLETE

No completed actions to report.

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1

Meeting Title: Governing Body (Open Session) Date: 08 April 2020

Paper Title: Establishment of NHS Nottingham and Nottinghamshire CCG

Paper Reference:

GB 20 076

Sponsor:

Presenter:

Amanda Sullivan, Accountable Officer Attachments/ Appendices:

A: Grant of Merger

B: Property transfer Scheme

C: Staff Transfer Scheme

D: Constitution

E: Delegation Agreement

F: Governance Handbook

G: Organisational Policies

H: Core Values and Behaviours

Lucy Branson, Associate Director of Governance

Purpose: Approve ☒ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☒

Executive Summary

On 1 April 2020, the six Clinical Commissioning Groups (CCG) in Nottingham and Nottinghamshire (NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham City CCG, NHS Nottingham North and East CCG, NHS Nottingham West CCG and NHS Rushcliffe CCG (hereafter referred to as the “predecessor CCGs”)) formally merged to become NHS Nottingham and Nottinghamshire CCG.

The purpose of this report is to present the Governing Body with the documentation that establishes and will subsequently govern the new CCG.

Relevant CCG priorities/objectives:

Compliance with Statutory Duties ☒ Wider system architecture development (e.g. ICP, PCN development)

☐

Financial Management ☒ Cultural and/or Organisational Development

☒

Performance Management ☐ Procurement and/or Contract Management ☐

Strategic Planning ☐

Establishment of NHS Nottingham and Nottinghamshire CCG


2

Conflicts of Interest:

☒ No conflict identified

☐ Conflict noted, conflicted party can participate in discussion and decision

☐ Conflict noted, conflicted party can participate in discussion, but not decision

☐ Conflict noted, conflicted party can remain, but not participate in discussion or decision

☐ Conflict noted, conflicted party to be excluded from meeting

Completion of Impact Assessments:

Equality / Quality Impact Assessment (EQIA)

Yes ☐ No ☐ N/A ☒ Not applicable to this item

Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

1. ADOPT: The organisational policies listed at Appendix G.

2. RECEIVE: The Grant of Merger and Property and Staff Transfer Schemes.

3. ADOPT: The CCG’s Constitution, as endorsed by the CCG’s Member Practices and approved by NHS England

4. RECEIVE: The Delegation Agreement for Commissioning of Primary Medical Services.

5. APPROVE: The Governance Handbook and support the areas for further enhancement to be re-presented in June 2020.

6. ADOPT: The organisational policies listed at Appendix G.

7. APPROVE: The CCG’s core values and behaviours.



3


1. Introduction

1.1 On 1 April 2020, the six Clinical Commissioning Groups (CCG) in Nottingham and Nottinghamshire (NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham City CCG, NHS Nottingham North and East CCG, NHS Nottingham West CCG and NHS Rushcliffe CCG (hereafter referred to as the “predecessor CCGs”)) formally merged to become NHS Nottingham and Nottinghamshire CCG.

1.2 The purpose of this report is to present the Governing Body with the documentation that establishes and will subsequently govern the new CCG.

2. CCG Establishment

2.1 The six predecessor CCGs’ were formally dissolved and the new NHS Nottingham and Nottinghamshire CCG established on 1 April 2020. This was enacted via a Grant of Merger by NHS England utilising the powers conferred on it by Section 14G of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) – see Appendix A.

2.2 At this time, NHS England also utilised its powers under Section 14I of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) to transfer the property and staff of the six predecessor CCGs to the new CCG. This was enacted via a Property Transfer Scheme and a Staff Transfer Scheme for each predecessor CCG –see Appendices B and C for the transfer schemes relevant to NHS Rushcliffe CCG. These are presented as examples for the Governing Body’s information, as all transfer schemes are identical in content.

2.3 The Property Transfer Schemes cover property (such as buildings and equipment) in addition to all assets and liabilities (including data and the rights to use and hold data)and all contracts and the rights to claim under contracts. The liabilities transferred alsoinclude claims and any obligations arising under contracts. The property transfer scheme also provides the ability for the new CCG to rely on actions previously taken by the predecessor CCGs; for example, notices given on contracts or procurement processes which have already commenced.

2.4 The Staff Transfer Schemes cover the transfer of all employees from the predecessor CCGs, including staff on long-term leave (e.g. sick leave, maternity leave, etc.) and any staff currently on secondment. Employees have transferred over in line with TUPE (Transfer of Undertakings (Protection of Employment) Regulations).

2.5 The above transfer schemes were underpinned by a robust due diligence exercise that was completed to ensure that the new CCG is fully aware of the assets and liabilities it is taking on. This exercise was overseen by the Audit and Governance Committees of the predecessor CCGs and no significant issues or risks were highlighted as part of this work.



4

2.6 Alongside notification of the Grant of Merger and transfer schemes, Amanda Sullivan’s appointment as Accountable Officer has also been formally confirmed from 1 April 2020 by Sir Simon Stevens, Chief Executive Officer of the NHS.

3. Nottingham and Nottinghamshire CCG Constitution

3.1 All CCGs are required to have a Constitution that describes the governing principles, rules and procedures that the CCG has to ensure probity and accountability in the day-to-day running of the organisation.

3.2 The Constitution for NHS Nottingham and Nottinghamshire CCG, as endorsed by its Member Practices and approved by NHS England, is attached at Appendix D. Please note that this version will require minor amendments to insert relevant links to the CCG’s website.

3.3 The Constitution includes the CCG’s Standing Orders and Standing Financial Instructions. Together they set out:

a) The name of the CCG, the geographical area it covers and a list of its Member Practices.

b) The statutory framework in which the CCG will operate and how it will demonstrate its accountability to its Member Practices, local people, stakeholders and NHS England.

c) The role of the Governing Body, its membership and how Governing Body members will be appointed, along with details of their terms of office.

d) How the CCG will conduct its business and how it will make decisions, including arrangements for meetings and how conflicts of interest will be managed.

e) The roles of statutory and mandatory committees and requirements for joint commissioning arrangements with other CCGs, local authorities and NHS England.

f) How the CCG’s financial affairs will be managed and the delegated limits for financial commitments on behalf of the CCG.

4. Delegated Commissioning of Primary Medical Services

4.1 NHS Nottingham and Nottinghamshire CCG has been approved by NHS England to take on delegated responsibility for the commissioning of primary medical services from 1 April 2020.

4.2 The Delegation Agreement is attached at Appendix E for information. It sets out the primary medical services functions that have been delegated to the CCG and how these are required to be exercised. It is a national standard agreement and its content is the same as the predecessor CCGs’ agreements, with the exception of some minor changes to reflect the latest rules around data protection and data sharing.



5

5. Governance Handbook

5.1 The CCG’s Constitution is supported by a comprehensive Governance Handbook, which includes:

a) The Terms of Reference for each of the Governing Body’s appointed committees.

b) The CCG’s Scheme of Reservation and Delegation, which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCG’s Governing Body (and its committees) and employees.

5.2 The Governance Handbook is provided at Appendix F for approval. It should be noted that further work is required to the Governance Handbook in order to fully implement the outcome from the recently completed governance review and to incorporate a number of sections required by the CCG’s Constitution. It is proposed that this work will be completed during April and May to enable an updated Governance Handbook to be presented for approval in June 2020.

6. Organisational Policies

6.1 A complete list of the CCG’s organisational policies is provided at Appendix G. These policies have been reviewed, aligned and approved by the six predecessor CCGs during 2019/20 as part of merger preparations. The policies have now been amended as relevant to the new CCG and the Governing Body is requested to adopt these policies to be the organisational policies for NHS Nottingham and Nottinghamshire CCG.

6.2 Policy review dates have been staggered over a three-year period to minimise operational impact. However, policy authors are able update policies in advance of review dates if needed (e.g. to reflect legislative changes).

6.3 Future policy approvals will be undertaken by the Governing Body, or appropriate Governing Body Committee, as outlined within the CCG’s Policy for the Development and Management of Policy Documents.

7. Core Values and Behaviours

7.1 The CCG’s core values and behaviours have been developed by the CCG’s staff and discussed and supported at a development session of the predecessor CCGs’ Governing Bodies.

7.2 The core values and behaviours, which are aligned to the NHS Constitution Values, are presented at Appendix H for approval.



6

8. Recommendations

8.1 The Governing Body is requested to:

a) RECEIVE: The Grant of Merger and Property and Staff Transfer Schemes.

b) ADOPT: The CCG’s Constitution, as endorsed by the CCG’s Member Practices and approved by NHS England.

c) RECEIVE: The Delegation Agreement for Commissioning of Primary Medical Services.

d) APPROVE: The Governance Handbook and support the areas for further enhancement to be re-presented in June 2020.

e) ADOPT: The organisational policies listed at Appendix G.

f) APPROVE: The CCG’s core values and behaviours.

Lucy BransonAssociate Director of GovernanceApril 2020



















NHS NOTTINGHAM AND

NOTTINGHAMSHIRE

CLINICAL COMMISSIONING GROUP

CONSTITUTION



NHS Nottingham and Nottinghamshire Clinical Commissioning Group Constitution

Version Effective

Date

Changes

1.0 1 April 2020 First version Constitution on establishment of the CCG



Contents

1 Introduction ....................................................................................................... 1

1.1 Name ............................................................................................................... 1

1.2 Statutory framework ........................................................................................ 1

1.3 Status of this Constitution ................................................................................ 2

1.4 Amendment and variation of this Constitution ................................................. 2

1.5 Related documents .......................................................................................... 2

1.6 Accountability and transparency ...................................................................... 3

1.7 Liability and indemnity ..................................................................................... 5

2 Area Covered by the CCG ................................................................................ 6

3 Membership Matters ......................................................................................... 7

3.1 Membership of the Clinical Commissioning Group .......................................... 7

3.2 Nature of membership and relationship with CCG ........................................... 7

3.3 Member Practice Meetings .............................................................................. 7

3.4 Member Practice Representatives ................................................................... 7

4 Arrangements for the Exercise of our Functions ........................................... 9

4.1 Good governance ............................................................................................ 9

4.2 General ............................................................................................................ 9

4.3 Authority to Act: the CCG .............................................................................. 10

4.4 Authority to Act: the Governing Body ............................................................. 10

5 Procedures for Making Decisions ................................................................. 11

5.1 Scheme of Reservation and Delegation (SoRD) ........................................... 11

5.2 Standing Orders ............................................................................................ 11

5.3 Standing Financial Instructions (SFIs) ........................................................... 11

5.4 The Governing Body: Its Role and Functions ................................................ 12

5.5 Composition of the Governing Body .............................................................. 13

5.6 Additional Attendees at the Governing Body Meetings .................................. 14

5.7 Appointments to the Governing Body ............................................................ 14

5.8 Committees and Sub-Committees ................................................................. 15

5.9 Committees of the Governing Body ............................................................... 15

5.10 Collaborative Commissioning Arrangements ............................................. 16



5.11 Joint Commissioning Arrangements with Local Authority Partners ............ 17

5.12 Joint Commissioning Arrangements – Other CCGs ................................... 18

5.13 Joint Commissioning Arrangements with NHS England ............................ 20

6 Provisions for Conflicts of Interest Management and Standards of

Business Conduct .................................................................................................. 22

6.1 Conflicts of Interest ........................................................................................ 22

6.2 Declaring and Registering Interests ............................................................... 23

6.3 Training in Relation to Conflicts of Interest .................................................... 24

6.4 Standards of Business Conduct .................................................................... 24

Appendix 1: Definitions of Terms Used in This Constitution ............................. 25

Appendix 2: Nottinghamshire County Council Lower-layer Super Output Areas

(LSOAs) covered by the CCG ................................................................................ 29

Appendix 3: Member Practices ............................................................................. 32

Appendix 4: Committee Terms of Reference ....................................................... 41

Audit and Governance Committee ........................................................................ 41

Remuneration and Terms of Service Committee .................................................. 48

Primary Care Commissioning Committee ............................................................. 52

Appendix 5: Standing Orders ................................................................................ 72

1. Statutory Framework and Status ................................................................... 72

2. Composition of Membership, Key Roles and Appointment Processes .......... 73

3 Member Practice Meetings and Decision Making .......................................... 83

4 Meetings of the Governing Body ................................................................... 85

5 Use of Seal and Authorisation of Documents ................................................ 89

6 Duty to Report Non-Compliance with Standing Orders ................................. 90

7 Suspension of Standing Orders ..................................................................... 90

Appendix 6: Standing Financial Instructions ...................................................... 91

1. Introduction .................................................................................................... 91

2 Internal Control and Audit .............................................................................. 93

3 Fraud, Bribery and Corruption (Economic Crime) .......................................... 96

4 Security Management .................................................................................... 97

5 Resource Limits, Allocations, Planning, Budgets, Budgetary Control ............ 97



6 Annual Report and Accounts ....................................................................... 101

7 Banking Arrangements ................................................................................ 101

8 Fees and Charges, Payable orders and other Negotiable Instruments ....... 103

9 Terms of Service, Allowances and Payment of Members, Employees,

Volunteers, Off Payroll Workers, Non-Executive Directors and Non-Employed

Officers ............................................................................................................... 105

10 Revenue Expenditure, Commercial, Procurement and Payments ............... 107

11 Capital Investment, Private Finance, Asset Register and Security of Assets

110

12 Payment of Accounts ................................................................................... 113

13 Stores and Receipt of Goods ...................................................................... 115

14 Disposals and Condemnations .................................................................... 116

15 Losses and Special Payments ..................................................................... 116

16 Information Technology (IT)......................................................................... 119

17 Information Governance .............................................................................. 121

18 Funds Held on Trust, Including Charitable Funds ........................................ 121

19 Retention of Records ................................................................................... 122

20 Risk Management and Insurance ................................................................ 122

21 Delegated Financial Limits .......................................................................... 125



1

1 Introduction

1.1 Name

1.1.1 The name of this Clinical Commissioning Group is NHS Nottingham and

Nottinghamshire Clinical Commissioning Group (“the CCG”).

1.1.2 The CCG was formed through the merger of NHS Mansfield and Ashfield

CCG, NHS Newark and Sherwood CCG, NHS Nottingham City CCG,

NHS Nottingham North and East CCG, NHS Nottingham West CCG and

NHS Rushcliffe CCG.

1.2 Statutory framework

1.2.1 CCGs are established under the NHS Act 2006 (“the 2006 Act”), as

amended by the Health and Social Care Act 2012. The CCG is a statutory

body with the function of commissioning health services in England and is

treated as an NHS body for the purposes of the 2006 Act. The powers

and duties of the CCG to commission certain health services are set out in

sections 3 and 3A of the 2006 Act. These provisions are supplemented by

other statutory powers and duties that apply to CCGs, as well as by

regulations and directions (including, but not limited to, those issued under

the 2006 Act).

1.2.2 When exercising its commissioning role, the CCG must act in a way that

is consistent with its statutory functions. Many of these statutory functions

are set out in the 2006 Act but there are also other specific pieces of

legislation that apply to CCGs, including the Equality Act 2010 and the

Children Acts. Some of the statutory functions that apply to CCGs take the

form of statutory duties, which the CCG must comply with when exercising

its functions. These duties include things like:

a) Acting in a way that promotes the NHS Constitution (section 14P of

the 2006 Act);

b) Exercising its functions effectively, efficiently and economically

(section 14Q of the 2006 Act);

c) Financial duties (under sections 223G-K of the 2006 Act);

d) Child safeguarding (under the Children Acts 2004,1989);

e) Adult safeguarding (under the Care Act 2014);

f) Equality, including the public-sector equality duty (under the Equality

Act 2010); and

g) Information law (for instance under data protection laws, such as the

EU General Data Protection Regulation 2016/679, the Data

Protection Act 2018 and the Freedom of Information Act 2000).



2

1.2.3 Our status as a CCG is determined by NHS England. All CCGs are

required to have a Constitution and to publish it.

1.2.4 The CCG is subject to an annual assessment of its performance by NHS

England which has powers to provide support or to intervene where it is

satisfied that a CCG is failing, or has failed, to discharge any of our

functions or that there is a significant risk that it will fail to do so.

1.2.5 CCGs are clinically-led membership organisations made up of general

practices. The CCG’s Member Practices are responsible for determining

the governing arrangements for the CCG, including arrangements for

clinical leadership, which are set out in this Constitution.

1.3 Status of this Constitution

1.3.1 This CCG was first authorised on 1 April 2020.

1.3.2 Changes to this Constitution are effective from the date of approval by

NHS England.

1.3.3 The Constitution is published on the CCG website at [insert link on new

CCG’s website].

1.4 Amendment and variation of this Constitution

1.4.1 This Constitution can only be varied in two circumstances:

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

granted; and

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

varies the Constitution other than on application by the CCG.

1.4.2 The Accountable Officer may periodically propose amendments to the

Constitution which shall be considered and approved by the Governing

Body unless:

a) Changes are thought to have a material impact;

b) Changes are proposed to the Reserved Powers of the Member

Practices; or

c) At least half (50%) of all the Governing Body Members formally

request that the amendments be put before the Member Practices

for approval.

1.5 Related documents

1.5.1 This Constitution is also informed by a number of documents which

provide further details on how the CCG will operate. With the exception of

the Standing Orders and the Standing Financial Instructions, these



3

documents do not form part of the Constitution for the purposes of 1.4

above. They are the CCG’s:

a) Standing Orders – which set out the arrangements for meetings

and the appointment processes for the CCG’s Governing Body

Members.

b) Standing Financial Instructions – which set out the arrangements

for managing the CCG’s financial affairs and the delegated limits for

financial commitments on behalf of the CCG.

c) Governance Handbook – which includes, as a minimum, the:

i) Terms of Reference – for all of the CCG’s Committees, Sub-

Committees and Joint Committees, and the terms of reference

for all of the Governing Body’s Committees, Sub-Committees

and Joint Committees; and

ii) Scheme of Reservation and Delegation – which sets out

those decisions that are reserved for the Member Practices as

a whole and those decisions that are the responsibilities of the

CCG’s Governing Body (and its Committees, Sub-Committees

and Joint Committees) and employees.

The Governance Handbook is available on the CCG’s website at

[insert link on new CCG’s website]

d) Standards of business conduct policies – which include policies

on the CCG’s arrangements for managing of conflicts of interests

and the CCG’s requirements regarding gifts, hospitality and

sponsorship.

1.6 Accountability and transparency

1.6.1 The CCG will demonstrate its accountability to its Member Practices, local

people, stakeholders and NHS England in a number of ways, including by

being transparent. We will meet our statutory requirements to:

a) Publish our Constitution and other key documents including the

CCG’s:

i) Governance Handbook; and

ii) Standards of business conduct policies.

b) Appoint independent lay persons and non-GP clinicians as members

of our Governing Body;

c) Manage actual or potential conflicts of interest in line with NHS

England’s statutory guidance Managing Conflicts of Interest: Revised



4

Statutory Guidance for CCGs 2017 and expected standards of good

practice (see also Chapter 6 of this Constitution);

d) Hold Governing Body meetings in public (except where we believe

that it would not be in the public interest);

e) Publish an annual commissioning strategy that takes account of

priorities in the health and wellbeing strategy;

f) Procure services in a manner that is open, transparent, non-

discriminatory and fair to all potential providers and publish a

Procurement Strategy;

g) Involve the public, in accordance with our duties under section 14Z2

of the 2006 Act, and as set out in more detail in the CCG’s

Communication and Engagement Strategy;

h) When discharging our duties under section 14Z2, the CCG will

adhere to the following principles:

i) Being clear about who is being engaged, the possible options,

the engagement process, what is being proposed and the

scope to influence;

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; and

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.

i) Comply with local authority health overview and scrutiny

requirements;

j) Meet annually in public to present an Annual Report, which is then

published;

k) Produce Annual Accounts which are externally audited;

l) Publish a clear complaints process;

m) Comply with the Freedom of Information Act 2000 and with the

Information Commissioner Office requirements regarding the

publication of information relating to the CCG;

n) Provide information to NHS England as required; and



5

o) Be an active member of local Health and Wellbeing Boards.

1.6.2 In addition to these statutory requirements, the CCG will demonstrate its

accountability by publishing useful documents and information on its

website at [insert link on new CCG’s website]. This includes:

a) The CCG’s policies;

b) Annual Reports, which include Governance Statements;

c) Minutes and papers of open meetings of the Governing Body and

Primary Care Commissioning Committee;

d) Details of the CCG’s strategies and plans;

e) Details of all contracts awarded;

f) Details of all expenditure over £25,000;

g) Register of declared interests;

h) Register of gifts, hospitality and sponsorship; and

i) Register of procurement decisions.

1.7 Liability and indemnity

1.7.1 The CCG is a body corporate established and existing under the 2006

Act. All financial or legal liability for decisions or actions of the CCG

resides with the CCG as a public statutory body and not with its Member

Practices. No Member Practice or former Member Practice, nor any

person who is at any time a proprietor, officer or employee of any Member

Practice or former Member Practice, shall be:

a) Liable (whether as a Member Practice or as an individual) for the

debts, liabilities, acts or omissions, howsoever caused by the CCG in

discharging its statutory functions.

b) Liable on any winding-up or dissolution of the CCG to contribute to

the assets of the CCG, whether for the payment of its debts and

liabilities or the expenses of its winding-up or otherwise.

The CCG may indemnify any Member Practice Representative or other

officer or individual exercising powers or duties on behalf of the CCG in

respect of any civil liability incurred in the exercise of the CCG’s business,

provided that the person indemnified shall not have acted recklessly or

with gross negligence.



6

2 Area Covered by the CCG

2.1.1 The Area covered by the CCG:

a) Incorporates the geographical boundaries of Nottingham City

Council; and

b) Largely incorporates the geographical boundaries of

Nottinghamshire County Council, with the exception of Bassetlaw in

the north of the county (see Appendix 2 for details of the Lower-layer

Super Output Areas (LSOAs) within the Nottinghamshire County

Council geographic area that are covered by the CCG).



7

3 Membership Matters

3.1 Membership of the Clinical Commissioning Group

3.1.1 The CCG is a membership organisation.

3.1.2 All practices that provide primary medical services to a registered list of

patients under a General Medical Services, Personal Medical Services or

Alternative Provider Medical Services contract in our Area are eligible for

membership of this CCG.

3.1.3 The CCG’s Member Practices are organised into groupings of GP

practices (“Places”), which are based on three geographical locations:

a) Mid-Nottinghamshire, which covers the boroughs/districts of

Mansfield, Newark and Sherwood, and partly covers the district of

Ashfield;

b) South Nottinghamshire, which covers the boroughs/districts of

Broxtowe, Gedling and Rushcliffe, and partly covers the district of

Ashfield; and

c) Nottingham City.

3.1.4 The CCG’s 131 Member Practices are listed at Appendix 3.

3.2 Nature of membership and relationship with CCG

3.2.1 The CCG’s Member Practices are integral to the functioning of the CCG.

Those exercising delegated functions on behalf of the Member Practices,

including the Governing Body, remain accountable to the Member

Practices.

3.3 Member Practice Meetings

3.3.1 The CCG’s Member Practices will meet on at least an annual basis to

ensure that engagement, involvement and communication with Member

Practices is effective and appropriately maintained.

3.3.2 These meetings will also be used to confirm the continued support of

Member Practices for the CCG’s Constitution.

3.3.3 The detailed procedures for the Member Practice Meetings are set out in

the Standing Orders.

3.4 Member Practice Representatives

3.4.1 Each Member Practice has a nominated lead Healthcare Professional

who represents the Member Practice in the dealings with the CCG.



8

3.4.2 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. The role of each Member Practice

Representative is to:

a) Represent their Member Practice’s views and act on behalf of their

Member 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 Member Practice as a whole are obtained and

input to discussions.

b) Maintain awareness of the CCG’s work through the CCG’s

communication channels.

c) Enable and facilitate two-way communications between their

Member Practice and the CCG, 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) 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.



9

4 Arrangements for the Exercise of our Functions

4.1 Good governance

4.1.1 The CCG will, at all times, observe generally accepted principles of good

governance. 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 Services;

c) The standards of behaviour published by the Committee on

Standards in Public Life (1995) known as the ‘Nolan Principles’;

d) The seven key principles of the NHS Constitution;

e) Relevant legislation, including the Equality Act 2010; and

f) The standards set out in the Professional Standard Authority’s

guidance Standards for Members of NHS Boards and Clinical

Commissioning Group Governing Bodies in England.

4.1.2 The CCG has established appropriate arrangements for whistleblowing

concerns, relating to the activities of the CCG, to be raised and responded

to. The Deputy Chair of the Governing Body has been appointed to be the

CCG’s Freedom to Speak Up Guardian.

4.2 General

4.2.1 The CCG will:

a) Comply with all relevant laws, including regulations;

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

NHS England;

c) Have regard to statutory guidance including that issued by NHS

England; and

d) Take account, as appropriate, of other documents, advice and

guidance.

4.2.2 The CCG will develop and implement the necessary systems and

processes to comply with a) to d) above, documenting them as necessary

in this Constitution, its Scheme of Reservation and Delegation and other

relevant policies and procedures, as appropriate.



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4.3 Authority to Act: the CCG

4.3.1 The CCG is accountable for exercising its statutory functions. It may grant

authority to act on its behalf to:

a) Any of its Member Practices;

b) Its Governing Body;

c) A Committee or Sub-Committee of the CCG; and

d) Any of its employees.

4.4 Authority to Act: the Governing Body

4.4.1 The Governing Body may grant authority to act on its behalf to:

a) Any Member of the Governing Body;

b) A Committee or Sub-Committee of the Governing Body;

c) A Member of the CCG who is an individual (but not a Member of the

Governing Body); and

d) Any other individual who may be from outside the organisation and

who can provide assistance to the CCG in delivering its functions.



11

5 Procedures for Making Decisions

5.1 Scheme of Reservation and Delegation (SoRD)

5.1.1 The CCG has agreed a Scheme of Reservation and Delegation (SoRD),

which is included within the CCG’s Governance Handbook.

5.1.2 The CCG’s SoRD sets out:

a) Those decisions that are reserved for the Member Practices as a

whole; and

b) Those decisions that that are the responsibilities of the CCG’s

Governing Body (and its Committees, Sub-Committees and Joint

Committees) and its employees and appointees.

5.1.3 The Accountable Officer may periodically propose amendments to the

SoRD, which shall be considered and approved by the Governing Body

unless:

a) Changes are proposed to the Reserved Powers; or

b) At least half (50%) of all the Governing Body Members formally

request that the amendments be put before the Member Practices

for approval.

5.1.4 The CCG remains accountable for all of its functions, including those that

it has delegated. All those with delegated authority, including the

Governing Body, are accountable to the Member Practices for the

exercise of their delegated functions.

5.2 Standing Orders

5.2.1 The CCG has agreed a set of Standing Orders, which describe the

processes that are employed to undertake its business. They include

arrangements for meetings and the appointment processes for the CCG’s

Governing Body Members.

5.2.2 A full copy of the Standing Orders is included at Appendix 5. The Standing

Orders form part of this Constitution for the purpose of the arrangements

described at 1.4.

5.3 Standing Financial Instructions (SFIs)

5.3.1 The CCG has agreed a set of Standing Financial Instructions (SFIs),

which include the delegated financial limits for decision-making on behalf

of the CCG.

5.3.2 A full copy of the SFIs is included at Appendix 6. The SFIs form part of

this Constitution for the purpose of the arrangements described at 1.4.



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5.4 The Governing Body: Its Role and Functions

5.4.1 The Governing Body has statutory responsibility for:

a) Ensuring that the CCG has appropriate arrangements in place to

exercise its functions effectively, efficiently and economically and in

accordance with the CCG’s principles of good governance (its main

function); and

b) Determining the remuneration, fees and other allowances payable to

employees or other persons providing services to the CCG and the

allowances payable under any pension scheme established.

5.4.2 The CCG has also delegated the following additional functions to the

Governing Body which are also set out in the SoRD. Any delegated

functions must be exercised within the procedural framework established

by the CCG and primarily set out in the Standing Orders and SFIs:

a) Approval of proposed amendments to the CCG’s Constitution (with

the exception of those thought to have a material impact, those

relating to the Reserved Powers of the Member Practices, or if at

least half of all Governing Body Members request that the proposed

amendments be put before the Member Practices for approval).

b) Approval of proposed amendment to the Scheme of Reservation and

Delegation (with the exception of those relating to the Reserved

Powers of the Member Practices or if at least half of all Governing

Body Members request that the proposed amendments be put

before the Member Practices for approval).

c) Approve arrangements for securing effective participation by each of

the CCG’s Member Practices in exercising its functions.

d) Approval of the establishment of Committees, Sub-Committees and

Joint Committees of the Governing Body (including agreement of

associated terms of reference).

e) Approval of the arrangements for discharging the CCG’s

commissioning functions and the statutory duties associated with its

commissioning functions.

f) Approval of arrangements for meeting the public sector equality duty.

g) Agreeing the vision, values and strategic objectives of the CCG.

h) Approval of the CCG’s commissioning strategies and plans.

i) Approval of the CCG’s finance strategy and annual financial budgets

to meet its statutory financial duties.

j) Approval of variations to the approved budget where variation would

have a significant impact on the overall approved levels of income



13

and expenditure or the CCG’s ability to achieve its agreed strategic

objectives.

k) Approve arrangements for ratification of the CCG’s internal policies

and procedures.

l) Approval of the CCG’s risk management arrangements.

m) Approval of the arrangements for discharging the CCG’s statutory

duties as an employer.

n) Approval of decisions that individual members, employees or

appointees of the CCG can make when participating in joint

arrangements on behalf of the CCG.

o) Approval of decisions delegated to Joint Committees established

under sections 14Z3, 14Z9 and 75 of the NHS 2006 Act (as

amended).

p) Approval of arrangements for financial risk sharing and/or risk

pooling with other organisations (for example arrangements for

pooled funds with other CCGs or pooled budget arrangements under

section 75 of the NHS Act 2006).

5.4.3 The detailed procedures for the Governing Body, including voting

arrangements, are set out in the Standing Orders.

5.5 Composition of the Governing Body

5.5.1 This part of the Constitution describes the make-up of the Governing Body

roles. Further information about the individuals who fulfil these roles can

be found on our website at [insert link on new CCG’s website].

5.5.2 The National Health Service (Clinical Commissioning Groups) Regulations

2012 set out a minimum membership requirement of the Governing Body

of:

a) The Chair (referred to as “the Clinical Chair” and who will be joint

Clinical Leader of the CCG with the Lead GP for the Nottingham and

Nottinghamshire Clinical Design Authority);

b) The Accountable Officer;

c) The Chief Finance Officer;

d) A secondary care specialist;

e) A registered nurse (who will be the CCG’s Chief Nurse); and

f) Two lay members (referred to as “Non-Executive Directors”):



14

i) One who has qualifications expertise or experience to enable

them to lead on financial management and audit matters and

who is Chair of the Audit and Governance Committee; and

ii) One who has knowledge about the CCG area enabling them to

express an informed view about discharge of the CCG’s

functions.

5.5.3 The CCG has agreed the following additional members:

a) The Lead GP for the Nottingham and Nottinghamshire Clinical

Design Authority (who will be joint Clinical Leader of the CCG with

the Clinical Chair);

b) Three GPs drawn from Member Practices, one per geographical

Place;

c) A third lay member (referred to as a “Non-Executive Director”) who is

Deputy Chair of the Governing Body and Chair of the Remuneration

and Terms of Service Committee;

d) A fourth lay member (referred to as a “Non-Executive Director”) who

is Chair of the Primary Care Commissioning Committee;

e) A fifth lay member (referred to as a “Non-Executive Director”); and

f) The Chief Commissioning Officer.

5.5.4 The operational division of roles and responsibilities between the Non-

Executive Directors is set out within the CCG’s Governance Handbook.

5.5.5 The operational division of roles and responsibilities between the joint

Clinical Leaders is set out within the CCG’s Governance Handbook.

5.6 Additional Attendees at the Governing Body Meetings

5.6.1 The CCG Governing Body may invite other person(s) to attend all or any

of its meetings, or part(s) of a meeting, in order to assist it in its decision-

making and in its discharge of its functions as it sees fit. Any such person

may be invited by the Chair to speak and participate in debate, but may

not vote.

5.7 Appointments to the Governing Body

5.7.1 The processes for appointing Governing Body Members are set out in the

Standing Orders.

5.7.2 Also set out in Standing Orders are the details regarding the tenure of

office for each role and the procedures for resignation and removal from

office.



15

5.8 Committees and Sub-Committees

5.8.1 The CCG may establish Committees and Sub-Committees of the CCG.

5.8.2 The Governing Body may establish Committees and Sub-Committees.

5.8.3 Each Committee and Sub-Committee established by either the CCG or

the Governing Body operates under terms of reference and membership

agreed by the CCG’s Member Practices or the Governing Body, as

relevant. Appropriate reporting and assurance mechanisms must be

developed as part of agreeing terms of reference for Committees and

Sub-Committees.

5.8.4 With the exception of the Remuneration and Terms of Service Committee,

any Committee or Sub-Committee established in accordance with clause

5.8 may consist of or include persons other than Members, employees or

appointees of the CCG.

5.8.5 All members of the Remuneration and Terms of Service Committee will be

members of the CCG Governing Body.

5.8.6 The CCG may establish key roles to support the operation of a CCG or

Governing Body Committee or Sub-Committee. Any such roles will be

appointed to in line with the process set out at Standing Order 2.2.13.

5.9 Committees of the Governing Body

5.9.1 The Governing Body will maintain the following statutory or mandated

Committees:

5.9.2 Audit and Governance Committee: This Committee is accountable to

the Governing Body and provides the Governing Body with an

independent and objective view of the CCG’s compliance with its statutory

responsibilities. The Committee is responsible for arranging appropriate

internal and external audit.

5.9.3 The Audit and Governance Committee will be chaired by a Non-Executive

Director who has qualifications, expertise or experience to enable them to

lead on finance and audit matters and members of the Audit and

Governance Committee may include people who are not Governing Body

Members.

5.9.4 Remuneration and Terms of Service Committee: This Committee is

accountable to the Governing Body and makes recommendations to the

Governing Body about the remuneration, fees and other allowances

(including pension schemes) for employees and other individuals who

provide services to the CCG.

5.9.5 The Remuneration and Terms of Service Committee will be chaired by a

Non-Executive Director other than the Audit and Governance Committee



16

Chair and only members of the Governing Body may be members of the

Remuneration and Terms of Service Committee.

5.9.6 Primary Care Commissioning Committee: This Committee is required

by the terms of the delegation from NHS England in relation to primary

care commissioning functions. The Primary Care Commissioning

Committee reports to the Governing Body and to NHS England.

Membership of the Committee is determined in accordance with the

requirements of Managing Conflicts of Interest: Revised statutory

Guidance for CCGs 2017. This includes the requirement for a lay chair

and lay deputy chair1.

5.9.7 None of the above Committees may operate on a joint committee basis

with another CCG(s).

5.9.8 The terms of reference for each of the above Committees are included in

Appendix 4 to this Constitution and form part of the Constitution.

5.9.9 The Governing Body has also established a number of other Committees

to assist it with the discharge of its functions. The CCG’s Governance

Handbook provides detailed information about these Committees,

including their terms of reference and, where applicable, the decisions

delegated to them as set out in the SoRD.

5.9.10 Committees of the Governing Body will only be able to establish their own

Sub-Committees to assist them in discharging their respective

responsibilities if this power has been delegated to them by the Governing

Body and detailed within their terms of reference.

5.10 Collaborative Commissioning Arrangements

5.10.1 The CCG wishes to work collaboratively with its partner organisations in

order to assist it with meeting its statutory duties, particularly those

relating to integration. The following provisions set out the framework that

will apply to such arrangements.

5.10.2 In addition to the formal joint working mechanisms envisaged below, the

Governing Body may enter into strategic or other transformation

discussions with its partner organisations, on behalf of the CCG.

5.10.3 The Governing Body must ensure that appropriate reporting and

assurance mechanisms are developed as part of any partnership or other

collaborative arrangements. This will include:

a) Reporting arrangements to the Governing Body, at appropriate

intervals;

1 These requirements will be met by the CCG’s Non-Executive Directors.



17

b) Engagement events or other review sessions to consider the aims,

objectives, strategy and progress of the arrangements; and

c) Progress reporting against identified objectives.

5.10.4 When delegated responsibilities are being discharged collaboratively, the

collaborative arrangements, whether formal joint working or informal

collaboration, must:

a) Identify the roles and responsibilities of those CCGs or other partner

organisations that have agreed to work together and, if formal joint

working is being used, the legal basis for such arrangements;

b) Specify how performance will be monitored and assurance provided

to the Governing Body on the discharge of responsibilities, so as to

enable the Governing Body to have appropriate oversight as to how

system integration and strategic intentions are being implemented;

c) Set out any financial arrangements that have been agreed in relation

to the collaborative arrangements, including identifying any pooled

budgets and how these will be managed and reported in annual

accounts;

d) Specify under which of the CCG’s supporting policies the

collaborative working arrangements will operate;

e) Specify how the risks associated with the collaborative working

arrangement will be managed and apportioned between the

respective parties;

f) Set out how contributions from the parties, including details around

assets, employees and equipment to be used, will be agreed and

managed;

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

safely terminate the working arrangements; and

h) Specify how decisions are communicated to the collaborative

partners.

5.11 Joint Commissioning Arrangements with Local Authority

Partners

5.11.1 The CCG will work in partnership with its Local Authority partners to

reduce health and social inequalities and to promote greater integration of

health and social care.

5.11.2 Partnership working between the CCG and its Local Authority partners

might include collaborative commissioning arrangements, including joint

commissioning under section 75 of the 2006 Act, where permitted by law.

In this instance, and to the extent permitted by law, the CCG delegates to



18

the Governing Body the ability to enter into arrangements with one or

more Local Authority partners in respect of:

a) Delegating specified Commissioning Functions to the Local

Authority;

b) Exercising specified Commissioning Functions jointly with the Local

Authority; or

c) Exercising any specified health-related functions on behalf of the

Local Authority.

5.11.3 For purposes of the arrangements described in 5.11.2, the Governing

Body may:

a) Agree formal and legal arrangements to make payments to, or

receive payments from, its Local Authority partners, or pool funds for

the purpose of joint commissioning;

b) Make the services of its employees or any other resources available

to its Local Authority partners; and

c) Receive the services of the employees or the resources from its

Local Authority partners.

5.11.4 Where the Governing Body makes an agreement with one or more Local

Authority as described above, the agreement will set 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, and the legal basis for

such arrangements;

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

d) Financial arrangements, including payments towards a pooled fund

and management of that fund;

e) Contributions from each party, including details of any assets,

employees and equipment to be used under the joint working

arrangements; and

f) The liability of the CCG to carry out its functions, notwithstanding any

joint arrangements entered into.

5.11.5 The liability of the CCG to carry out its functions will not be affected where

the CCG enters into arrangements pursuant to paragraph 5.11.2 above.

5.12 Joint Commissioning Arrangements – Other CCGs



19

5.12.1 The CCG may work together with other CCGs in the exercise of its

Commissioning Functions under section 14Z3 of the NHS 2006 Act (as

amended).

5.12.2 The CCG delegates its powers and duties under 5.12 to the Governing

Body and all references in this part to the CCG should be read as the

Governing Body, except to the extent that they relate to the continuing

liability of the CCG under any joint arrangements.

5.12.3 The CCG may make arrangements with one or more other CCGs in

respect of:

a) Delegating any of the CCG’s Commissioning Functions to another

CCG;

b) Exercising any of the Commissioning Functions of another CCG; or

c) Exercising jointly the Commissioning Functions of the CCG and

another CCG.

5.12.4 For the purposes of the arrangements described at 5.12.3, the CCG may:

a) Make payments to another CCG;

b) Receive payments from another CCG;

c) Make the services of its employees or any other resources available

to another CCG; and

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

another CCG.

5.12.5 Where the CCG makes arrangements which involve all the CCGs

exercising any of their Commissioning Functions jointly, a Joint

Committee may be established to exercise those functions.

5.12.6 For the purposes of the arrangements described above, the CCG may

establish and maintain a pooled fund made up of contributions by all of

the CCGs working together jointly pursuant to paragraph 5.12.3 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.

5.12.7 Where the CCG makes arrangements with another CCG as described at

paragraph 5.12.3 above, the CCG shall develop and agree with that CCG

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;


such arrangements;



20


d) Financial arrangements, including payments towards a pooled fund

and management of that fund;

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


arrangements.

5.12.8 The responsibility of the CCG to carry out its Commissioning Functions

will not be affected where the CCG enters into arrangements pursuant to

paragraph 5.12.3 above.

5.12.9 The liability of the CCG to carry out its Commissioning Functions will not

be affected where the CCG enters into arrangements pursuant to

paragraph 5.12.3 above.

5.12.10 Only arrangements that are safe and in the interests of patients registered

with Member Practices will be approved by the Governing Body.

5.12.11 The Governing Body shall require, in all joint commissioning

arrangements, that the lead Governing Body Member for the joint

arrangements:

a) Make a quarterly written report to the Governing Body;

b) Hold at least one annual engagement event to review the aims,

objectives, strategy and progress of the joint commissioning

arrangements; and

c) Publish an annual report on progress made against objectives.

5.12.12 Should a joint commissioning arrangement prove to be unsatisfactory the

Governing Body of the CCG can decide to withdraw from the

arrangement, but has to give six months’ notice to partners to allow for

credible alternative arrangements to be put in place, with new

arrangements starting from the beginning of the next new financial year

after the expiration of the six month notice period.

5.13 Joint Commissioning Arrangements with NHS England

5.13.1 The CCG may work together with NHS England. This can take the form of

joint working in relation to the CCG’s Commissioning Functions or in

relation to NHS England’s Commissioning Functions under section 14Z9

of the NHS 2006 Act (as amended).

5.13.2 The CCG delegates its powers and duties under 5.13 to the Governing

Body and all references in this part to the CCG should be read as the

Governing Body, except to the extent that they relate to the continuing

liability of the CCG under any joint arrangements.



21

5.13.3 In terms of either the CCG’s Commissioning Functions or NHS England’s

Commissioning Functions, the CCG and NHS England may make

arrangements to exercise any of their specified Commissioning Functions

jointly.

5.13.4 The arrangements referred to in paragraph 5.13.3 above may include

other CCGs, a combined authority or a local authority.

5.13.5 Where joint commissioning arrangements pursuant to 5.13.3 above are

entered into, the parties may establish a Joint Committee to exercise the

Commissioning Functions in question. For the avoidance of doubt, this

provision does not apply to any Commissioning Functions fully delegated

to the CCG by NHS England, including but not limited to those relating to

primary care commissioning.

5.13.6 Arrangements made pursuant to 5.13.3 above may be on such terms and

conditions (including terms as to payment) as may be agreed between

NHS England and the CCG.

5.13.7 Where the CCG makes arrangements with NHS England (and another

CCG if relevant) as described at paragraph 5.13.3 above, the CCG 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;


such arrangements;


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

pooled fund and management of that fund; and

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


arrangements.

5.13.8 Where any joint arrangements entered into relate to the CCG’s

Commissioning Functions, the liability of the CCG to carry out its functions

will not be affected where the CCG enters into arrangements pursuant to

paragraph 5.13.3 above. Similarly, where the arrangements relate to NHS

England’s Commissioning Functions, the liability of NHS England to carry

out its functions will not be affected where it and the CCG enter into joint

arrangements pursuant to 5.13.

5.13.9 The CCG will act in accordance with any further guidance issued by NHS

England on co-commissioning.



22

5.13.10 Only arrangements that are safe and in the interests of patients registered

with Member Practices will be approved by the Governing Body.

5.13.11 The Governing Body of the CCG shall require, in all joint commissioning

arrangements that the lead Governing Body Member for the joint

arrangements:

a) Make a quarterly written report to the Governing Body;

b) Hold at least one annual engagement event to review the aims,

objectives, strategy and progress of the joint commissioning

arrangements; and

c) Publish an annual report on progress made against objectives.

5.13.12 Should a joint commissioning arrangement prove to be unsatisfactory the

Governing Body of the CCG can decide to withdraw from the arrangement

but has to give six months’ notice to partners to allow for credible

alternative arrangements to be put in place, with new arrangements

starting from the beginning of the next new financial year after the

expiration of the six months’ notice period.

6 Provisions for Conflicts of Interest Management

and Standards of Business Conduct

6.1 Conflicts of Interest

6.1.1 As required by section 14O of the 2006 Act, the CCG has made

arrangements to manage conflicts and potential conflicts of interest to

ensure that decisions made by the CCG will be taken and seen to be

taken without being unduly influenced by external or private interest.

6.1.2 The CCG has agreed policies and procedures for the identification and

management of conflicts of interest. The CCG’s policy on conflicts of

interest is published on the CCG website at [insert link on new CCG’s

website].

6.1.3 Employees, Members, Committee and Sub-Committee members of the

CCG and members of the Governing Body (and its Committees, Sub-

Committees, Joint Committees) will comply with the CCG’s standards of

business conduct policies. Where an individual, including any individual

directly involved with the business or decision-making of the CCG and not

otherwise covered by one of the categories above, has an interest, or

becomes aware of an interest which could lead to a conflict of interests in

the event of the CCG considering an action or decision in relation to that

interest, that must be considered as a potential conflict, and is subject to

the provisions of this Constitution and the CCG’s standards of business

conduct policies.



23

6.1.4 The CCG has appointed the Chair of the Audit and Governance

Committee to be the Conflicts of Interest Guardian. In collaboration with

the CCG’s governance lead, their role is to:

a) Act as a conduit for GP practice staff, members of the public and

Healthcare Professionals who have any concerns with regards to

conflicts of interest;

b) Be a safe point of contact for employees or workers of the CCG to

raise any concerns in relation to conflicts of interest;

c) Support the rigorous application of conflict of interest principles and

policies;

d) Provide independent advice and judgment to staff and members

where there is any doubt about how to apply conflicts of interest

policies and principles in an individual situation; and

e) Provide advice on minimising the risks of conflicts of interest.

6.2 Declaring and Registering Interests

6.2.1 The CCG will maintain registers of the interests of those individuals listed

in the CCG’s policy on conflicts of interest.

6.2.2 The CCG will, as a minimum, publish the registers of conflicts of interest

and gifts and hospitality of decision making staff at least annually on the

CCG’s website and make them available at our headquarters upon

request.

6.2.3 All relevant persons for the purposes of NHS England’s statutory

guidance Managing Conflicts of Interest: Revised Statutory Guidance for

CCGs 2017 must declare any interests. Declarations should be made as

soon as reasonably practicable and by law within 28 days after the

interest arises. This could include interests an individual is pursuing.

Interests will also be declared on appointment and during relevant

discussion in meetings.

6.2.4 The CCG will ensure that, as a matter of course, declarations of interest

are made and confirmed, or updated at least annually. All persons

required to, must declare any interests as soon as reasonably practicable

and by law within 28 days after the interest arises.

6.2.5 Interests (including gifts and hospitality) of decision making staff will

remain on the public register for a minimum of six months. In addition, the

CCG will retain a record of historic interests and offers/receipt of gifts and

hospitality for a minimum of six years after the date on which it expired.

The CCG’s published register of interests states that historic interests are

retained by the CCG for the specified timeframe and details of whom to

contact to submit a request for this information.



24

6.2.6 Activities funded in whole or in part by third parties who may have an

interest in CCG business, such as sponsored events, posts and research,

will be managed in accordance with the CCG’s standards of business

conduct policies to ensure transparency and that any potential for conflicts

of interest are well-managed.

6.3 Training in Relation to Conflicts of Interest

6.3.1 The CCG ensures that relevant staff and all Governing Body Members

receive training on the identification and management of conflicts of

interest and that relevant staff undertake the NHS England mandatory

training.

6.4 Standards of Business Conduct

6.4.1 Employees, Members, Committee and Sub-Committee members of the


Committees, Joint Committees) will at all times comply with this

Constitution and be aware of their responsibilities as outlined in it. They

should:

a) Act in good faith and in the interests of the CCG;

b) Follow the Seven Principles of Public Life; set out by the Committee

on Standards in Public Life (the Nolan Principles);

c) Comply with the standards set out in the Professional Standards

Authority guidance - Standards for Members of NHS Boards and

Clinical Commissioning Group Governing Bodies in England; and

d) Comply with the CCG’s standards of business conduct policies,

including the requirements set out in the policy on conflicts of

interest, which is available on the CCG’s website and will be made

available on request.

6.4.2 Individuals contracted to work on behalf of the CCG or otherwise

providing services or facilities to the CCG will be made aware of their

obligation with regard to declaring conflicts or potential conflicts of

interest. This requirement will be written into their contract for services

and is also outlined in the CCG’s policy on conflicts of interest.



25

Appendix 1: Definitions of Terms Used in This Constitution

2006 Act National Health Service Act 2006.

Accountable Officer An individual, as defined under paragraph 12 of Schedule 1A

of the 2006 Act, appointed by NHS England, with

responsibility for ensuring the CCG:

a) Complies with its obligations under:

i) Sections 14Q and 14R of the 2006 Act;

ii) Sections 223H to 223J of the 2006 Act,;

iii) Paragraphs 17 to 19 of Schedule 1A of the NHS

Act 2006; and

iv) Any other provision of the 2006 Act specified in a

document published by the Board for that

purpose.

b) Exercises its functions in a way which provides good

value for money.

Area The geographical area that the CCG has responsibility for,

as defined in Chapter 2 of this Constitution.

Chair The individual appointed to be the CCG’s Statutory Chair.

Chief Finance

Officer

An employee of the CCG who has a professional

qualification in accountancy and the expertise or experience

to lead the financial management of the CCG.

Clinical

Commissioning

Group (CCG)

A body corporate established by NHS England in

accordance with Chapter A2 of Part 2 of the 2006 Act.

Commissioning

Functions

The CCG’s statutory duties and legal powers (together

referred to as functions) that relate to the CCG’s

commissioning responsibilities.

Committee A Committee created and appointed by the membership of

the CCG or the Governing Body.



26

Governing Body The body appointed under section 14L of the NHS Act 2006,

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, and such generally accepted

principles of good governance as are relevant to it.

Governing Body

Member Any individual appointed to the Governing Body of the CCG.

Healthcare

Professional

A Member of a profession that is regulated by one of the

following bodies:

a) The General Medical Council;

b) The General Dental Council;

c) The General Optical Council;

d) The General Osteopathic Council;

e) The General Chiropractic Council;

f) The General Pharmaceutical Council;

g) The Pharmaceutical Society of Northern Ireland;

h) The Nursing and Midwifery Council;

i) The Health and Care Professions Council; and

j) Any other regulatory body established by an Order in

Council under Section 60 of the Health Act 1999.

Independent GP

Advisor

A recently retired or out-of-area GP, who is a member of the

Primary Care Commissioning Committee (as recommended

by NHS England’s Managing Conflicts of Interest: Revised

Statutory Guidance for CCGs 2017).

Joint Committee Committees from two or more organisations that work

together with delegated authority from both organisations to

enable joint decision-making.

Member Practice

Representative

Member Practices appoint a Healthcare Professional to act

as their practice representative in dealings between it and

the CCG, under regulations made under section 89 or 94 of

the 2006 Act or directions under section 98A of the 2006 Act.



27

Member/ Member

Practice

A provider of primary medical services to a registered patient

list, who is a Member Practice of this CCG.

NHS England The operational name for the National Health Service

Commissioning Board.

Non-Executive

Director

A lay member of the CCG’s Governing Body, appointed by

the CCG in line with The National Health Service (Clinical

Commissioning Groups) Regulations 2012.

An individual who is not a Member of the CCG or a

Healthcare Professional (as defined above) or as otherwise

defined in law.

Nottingham and

Nottinghamshire

Clinical Design

Authority

The Nottingham and Nottinghamshire Clinical Design

Authority (CDA) is a clinical care management function that

supports clinical transformation across Nottingham and

Nottinghamshire.

Place A geographical location within the CCG’s Area, as defined in

Chapter 3.

Primary Care

Commissioning

Committee

A Committee required by the terms of the delegation from

NHS England in relation to primary care commissioning

functions. The Primary Care Commissioning Committee

reports to NHS England and the Governing Body.

Professional

Standards Authority

An independent body accountable to the UK Parliament

which helps Parliament monitor and improve the protection

of the public. Published Standards for Members of NHS

Boards and Clinical Commissioning Group Governing Bodies

in England in 2013.

Registers of

Interests

Registers a CCG is required to maintain and make publicly

available under section 14O of the 2006 Act and the

statutory guidance issues by NHS England, of the interests

of:

a) The Members of the CCG;

b) The Members of its CCG Governing Body;

c) The Members of its Committees or Sub-Committees



28

and Committees or Sub-Committees of its CCG

Governing Body; and

d) Its employees.

Reserved Powers The decision-making powers reserved to the CCG’s Member

Practices.

Sub-Committee A Committee created by and reporting to a Committee.



29

Appendix 2: Nottinghamshire County Council Lower-layer

Super Output Areas (LSOAs) covered by the CCG

E01027925 E01028083 E01028172 E01028259 E01028348

E01027926 E01028084 E01028173 E01028260 E01028349

E01027927 E01028085 E01028174 E01028261 E01028350

E01027928 E01028086 E01028175 E01028262 E01028351

E01027929 E01028087 E01028176 E01028263 E01028352

E01027930 E01028088 E01028177 E01028264 E01028353

E01027931 E01028089 E01028178 E01028267 E01028354

E01027932 E01028090 E01028179 E01028268 E01028355

E01027933 E01028091 E01028180 E01028269 E01028356

E01027934 E01028092 E01028181 E01028270 E01028357

E01027935 E01028093 E01028182 E01028271 E01028358

E01027936 E01028094 E01028183 E01028272 E01028359

E01027937 E01028095 E01028184 E01028273 E01028360

E01027938 E01028096 E01028185 E01028274 E01028361

E01027939 E01028097 E01028186 E01028275 E01028362

E01027940 E01028098 E01028187 E01028276 E01028363

E01027941 E01028099 E01028188 E01028277 E01028364

E01027942 E01028100 E01028189 E01028278 E01028365

E01027943 E01028101 E01028190 E01028279 E01028366

E01027944 E01028102 E01028191 E01028280 E01028367

E01027945 E01028103 E01028192 E01028281 E01028368

E01027946 E01028104 E01028193 E01028282 E01028369

E01027947 E01028105 E01028194 E01028283 E01028370

E01027948 E01028106 E01028195 E01028284 E01028371

E01027949 E01028107 E01028196 E01028285 E01028372

E01027950 E01028108 E01028197 E01028286 E01028373

E01027951 E01028109 E01028198 E01028287 E01028374

E01027952 E01028110 E01028199 E01028288 E01028375

E01027953 E01028111 E01028200 E01028289 E01028376

E01027954 E01028112 E01028201 E01028290 E01028377

E01027955 E01028113 E01028202 E01028291 E01028378

E01027956 E01028114 E01028203 E01028292 E01028379



30

E01027957 E01028115 E01028204 E01028293 E01028380

E01027958 E01028116 E01028205 E01028294 E01028381

E01027959 E01028117 E01028206 E01028295 E01028382

E01027960 E01028118 E01028207 E01028296 E01028383

E01027961 E01028119 E01028208 E01028297 E01028384

E01027962 E01028120 E01028209 E01028298 E01028385

E01027963 E01028121 E01028210 E01028299 E01028386

E01027964 E01028122 E01028211 E01028300 E01028387

E01027965 E01028123 E01028212 E01028301 E01028388

E01027966 E01028124 E01028213 E01028302 E01028389

E01027967 E01028125 E01028214 E01028303 E01028390

E01027968 E01028126 E01028215 E01028304 E01028391

E01027969 E01028127 E01028216 E01028305 E01028392

E01027970 E01028128 E01028217 E01028306 E01028393

E01027971 E01028129 E01028218 E01028307 E01028394

E01027972 E01028130 E01028219 E01028308 E01028395

E01027973 E01028131 E01028220 E01028309 E01028396

E01027974 E01028132 E01028222 E01028310 E01028397

E01027975 E01028133 E01028223 E01028311 E01028398

E01027976 E01028134 E01028224 E01028312 E01028399

E01027977 E01028135 E01028225 E01028313 E01028400

E01027978 E01028136 E01028226 E01028314 E01028401

E01027979 E01028137 E01028227 E01028315 E01028402

E01027980 E01028138 E01028228 E01028316 E01028403

E01027981 E01028139 E01028229 E01028317 E01028404

E01027982 E01028142 E01028230 E01028318 E01028405

E01027983 E01028143 E01028231 E01028319 E01028406

E01027984 E01028144 E01028232 E01028320 E01028407

E01027985 E01028146 E01028233 E01028321 E01028408

E01027986 E01028147 E01028234 E01028322 E01028409

E01027987 E01028148 E01028235 E01028323 E01028410

E01027988 E01028149 E01028236 E01028325 E01028411

E01027989 E01028150 E01028237 E01028326 E01028412

E01027990 E01028151 E01028238 E01028327 E01028413



31

E01027991 E01028152 E01028239 E01028328 E01028414

E01027992 E01028153 E01028240 E01028329 E01028415

E01027993 E01028154 E01028241 E01028330 E01028416

E01027994 E01028155 E01028242 E01028331 E01028417

E01027995 E01028156 E01028243 E01028332 E01028418

E01027996 E01028157 E01028244 E01028333 E01028419

E01027997 E01028158 E01028245 E01028334 E01028420

E01027998 E01028159 E01028246 E01028335 E01028421

E01028069 E01028160 E01028247 E01028336 E01032622

E01028070 E01028161 E01028248 E01028337 E01033389

E01028073 E01028162 E01028249 E01028338 E01033390

E01028074 E01028163 E01028250 E01028339 E01033391

E01028075 E01028164 E01028251 E01028340 E01033392

E01028076 E01028165 E01028252 E01028341 E01033393

E01028077 E01028166 E01028253 E01028342 E01033394

E01028078 E01028167 E01028254 E01028343 E01033412

E01028079 E01028168 E01028255 E01028344 E01033413

E01028080 E01028169 E01028256 E01028345

E01028081 E01028170 E01028257 E01028346

E01028082 E01028171 E01028258 E01028347



32

Appendix 3: Member Practices

Practice Name Address Place

Abbey Medical Centre 63 Central Avenue, Beeston,

Nottingham, NG9 2QP

South

Nottinghamshire

Abbey Medical Group 59 Mansfield Road, Blidworth,

Nottinghamshire, NG21 0RB

Mid-Nottinghamshire

Acorn Medical Practice 11-13 Wood Street, Mansfield,

NG18 1QA

Mid-Nottinghamshire

Ashfield House 194 Forest Road, Annesley

Woodhouse, NG17 9JB

Mid-Nottinghamshire

Aspley Medical Centre 509 Aspley Lane, Aspley,

Nottingham, NG8 5RU

Nottingham City

Bakersfield Medical Centre 141 Oakdale Road,

Bakersfield, Nottingham, NG3

7EJ

Nottingham City

Balderton Primary Care

Centre

Lowfield Lane, Balderton,

Nottinghamshire, NG24 3HG

Mid-Nottinghamshire

Barnby Gate Surgery 50 Barnby Gate, Newark,

Nottinghamshire, NG24 1QD

Mid-Nottinghamshire

Beechdale Surgery 439 Beechdale Road, Aspley,

Nottingham, NG8 3LF

Nottingham City

Belvoir Health Group The Surgery, Fern Road,

Cropwell Bishop, Nottingham,

NG12 3BU

South

Nottinghamshire

Bilborough Medical Centre Bracebridge Drive,

Bilborough, Nottingham, NG8

4PN

Nottingham City

Bilborough Surgery 112 Graylands Road,

Bilborough, Nottingham, NG8

4FD

Nottingham City

Bilsthorpe Surgery 35 Mickledale Lane,

Bilsthorpe, Newark,

Nottinghamshire, NG22 8QB

Mid-Nottinghamshire

Bramcote Surgery 2a Hanley Avenue, Bramcote,

Nottingham, NG9 3HF

South

Nottinghamshire

Bridgeway Medical Centre 1 Bridgeway Centre, The

Meadows, Nottingham, NG2

2JG

Nottingham City



33


Brierley Park Medical

Centre

127 Sutton Road, Huthwaite,

NG17 2NF

Mid-Nottinghamshire

Bull Farm Primary Care

Resource Centre

Concorde Way, Millennium

Business Park, Mansfield,

NG19 7JZ

Mid-Nottinghamshire

Calverton Practice 2A St Wilfrid’s Square,

Calverton, Nottingham, NG14

6FP

South

Nottinghamshire

Castle Healthcare Practice Embankment Primary Care

Centre, 50-60 Wilford Lane,

West Bridgford, Nottingham,

NG2 7SD

South

Nottinghamshire

Churchfields Medical

Practice

Old Basford Health Centre, 1

Bailey Street, Old Basford,

Nottingham, NG6 0HD

Nottingham City

Churchside Medical

Practice (Ward and

Pearce)

Wood Street, Mansfield, NG18

1QB

Mid-Nottinghamshire

Clifton Medical Practice Clifton Cornerstone,

Southchurch Drive, Clifton,

Nottingham, NG11 8EW

Nottingham City

Collingham Medical Centre High Street, Collingham,

Nottinghamshire, NG23 7LB

Mid-Nottinghamshire

Daybrook Medical Practice Salop Street, Daybrook,

Nottingham, NG5 6HP

South

Nottinghamshire

Deer Park Family Medical

Practice

Wollaton Vale Health Centre,

Wollaton Vale, Nottingham,

NG8 2GR

Nottingham City

Derby Road Health Centre 336 Derby Road, Lenton,

Nottingham, NG7 2DW

Nottingham City

East Bridgford Medical

Centre

2 Butt Lane, East Bridgford,

Nottingham, NG13 8NY

South

Nottinghamshire

East Leake Medical Group Gotham Road, East Leake,

Loughborough, LE12 6JG

South

Nottinghamshire

Eastwood Primary Care

Centre

Church Walk, Eastwood,

Nottingham, NG16 3BH

South

Nottinghamshire



34


Elmswood Surgery Sherwood Health Centre,

Elmswood Gardens,

Sherwood, Nottingham, NG5

4AD

Nottingham City

Family Medical Centre 171 Carlton Road,

Nottingham, NG3 2FW

Nottingham City

Forest Medical Rosemary Street, Mansfield,

NG19 6AB

Jubilee Way South, Mansfield,

NG18 3SF

Mid-Nottinghamshire

Fountain Medical Centre Sherwood Avenue, Newark,

Nottinghamshire, NG24 1QH

Mid-Nottinghamshire

Gamston Medical Centre Gamston District Centre,

Gamston, Nottingham, NG2

6PS

South

Nottinghamshire

Giltbrook Surgery 492 Nottingham Road,

Giltbrook, Nottingham, NH16

2GE

South

Nottinghamshire

Grange Farm Medical

Centre

Tremayne Road, Bilborough,

Nottingham, NG8 4HQ

Nottingham City

Greendale Primary Care

Centre

249 Sneinton Dale, Sneinton,

Nottingham, NG3 7DQ

Nottingham City

Greenfields Medical

Centre

12 Terrace Street, Hyson

Green, Nottingham, NG7 6ER

Nottingham City

Hama Medical Centre 11a Nottingham Road,

Kimberley, Nottingham, NG16

2NP

South

Nottinghamshire

Hickings Lane Medical

Centre

Ryecroft Street, Stapleford,

Nottingham, NG9 8PN

South

Nottinghamshire

Highcroft Surgery High Street, Arnold,

Nottingham, NG5 7BQ

South

Nottinghamshire

Hill View Surgery Kirklington Road, Rainworth,

Nottinghamshire, NG21 0JP

Mid-Nottinghamshire

Hounsfield Surgery The Surgery, Hounsfield

Way, Sutton on Trent,

Nottinghamshire, NG23 6PX

Mid-Nottinghamshire



35


Hucknall Road Medical

Centre

Off Kibworth Close,

Healthfield, Nottingham, NG5

1NA

Nottingham City

Jacksdale Medical Centre Main Road, Jacksdale, NG16

5JW

Mid-Nottinghamshire

John Ryle Medical Centre Clifton Cornerstone,

Southchurch Drive, Clifton,

Nottingham, NG11 8EW

Nottingham City

Keyworth Medical Practice Bunny Lane, Keyworth,

Nottingham, NG12 5JU

South

Nottinghamshire

King’s Medical Centre King Street, Sutton in Ashfield,

NG17 1AT

Mid-Nottinghamshire

Kirkby Community Primary

Care Centre

Ashfield Health Village,

Portland Street, Kirkby in

Ashfield, NG17 7AE

Mid-Nottinghamshire

Kirkby Health Care

Complex

52 Lowmoor Road, Kirkby in

Ashfield, NG17 7BG

Mid-Nottinghamshire

Kirkby Health Centre Lowmoor Road, Kirkby in

Ashfield, NG17 7LG

Mid-Nottinghamshire

Leen View Surgery Bullwell Riverside Centre,

Main Street, Bulwell,

Nottingham, NG6 8QJ

Nottingham City

Lime Tree Surgery 1 Lime Tree Avenue,

Cinderhill, Nottingham, NG8

6AB

Nottingham City

Linden Medical Group Stapleford Care Centre,

Church Street, Stapleford,

Nottingham, NG9 8DB

South

Nottinghamshire

Lombard Medical Centre 2 Portland Street, Newark,

Nottinghamshire, NG24 4XG

Mid-Nottinghamshire

Lowmoor Road Surgery Lowmoor Road, Kirkby in

Ashfield, NG17 7BQ

Mid-Nottinghamshire

Major Oak Surgery High Street, Edwinstowe,

Nottinghamshire, NG21 9QS

Mid-Nottinghamshire

Mayfield Medical Practice 12 Terrace Street, Hyson

Green, Nottingham, NG7 6ER

Nottingham City



36


Meadows Health Centre 1 Bridgeway Centre, The

Meadows, Nottingham, NG2

2JG

Nottingham City

Meden Medical Services Warsop Primary Care Centre,

Church Street, Warsop, NG21

0BP

Mid-Nottinghamshire

Melbourne Park Medical

Centre

Melbourne Park, Aspley,

Nottingham, NG8 5HL

Nottingham City

Middleton Lodge Practice Church Circle, New Ollerton,

Nottinghamshire, NG22 9SZ

Mid-Nottinghamshire

Mill View Surgery 1a Goldsmith Street,

Mansfield, NG18 5PF

Mid-Nottinghamshire

Musters Medical Practice Embankment Primary Care

Centre, 50-60 Wilford Lane,

West Bridgford, Nottingham,

NG2 7SD

South

Nottinghamshire

NEMS Platform One

Practice

Forward House, Station

Street, Nottingham, NG2 3AJ

Nottingham City

Newthorpe Medical Centre Chewton Street, Eastwood,

Nottingham, NG16 3HB

South

Nottinghamshire

Oakenhall Medical

Practice

Bolsover Street, Hucknall,

Nottingham, NG15 7UA

South

Nottinghamshire

Oakwood Surgery Church Street, Mansfield,

NG19 8BL

Mid-Nottinghamshire

Orchard Medical Practice Stockwell Gate, Mansfield,

NG18 5GG

Mid-Nottinghamshire

Orchard Surgery The Dragwell, Kegworth,

Derby, DE74 2EL

South

Nottinghamshire

Park House Medical

Centre

61 Burton Road, Carlton,

Nottingham, NG4 3DQ

South

Nottinghamshire

Parkside Medical Practice Bullwell Riverside Centre,

Main Street, Bulwell,

Nottingham, NG6 8QJ

Nottingham City

Peacock Healthcare 428 Carlton Hill, Nottingham,

NG4 1HQ

South

Nottinghamshire

Plains View Surgery 57 Plains Road, Mapperley,

Nottingham, NG3 5LB

South

Nottinghamshire



37


Pleasley Surgery Chesterfield Road, Pleasley,

NG19 7PE

Mid-Nottinghamshire

Queens Bower Surgery Queens Bower Road,

Bestwood Park, Nottingham,

NG5 5RB

Nottingham City

Radcliffe-on-Trent Health

Centre

Main Road, Radcliffe-on-

Trent, Nottingham, NG12 2GD

South

Nottinghamshire

Radford Health Centre Ilkeston Road, Radford,

Nottingham, NG7 3GW

Nottingham City

Radford Medical Practice Radford Health Centre,

Ilkeston Road, Radford,

Nottingham, NG7 3GW

Nottingham City

Rainworth Health Centre Warsop Lane, Rainworth,

Nottinghamshire, NG21 0AD

Mid-Nottinghamshire

RHR Medical Centre Calverton Drive, Strelley,

Nottingham, NG8 6QN

Nottingham City

Rise Park Surgery Off Revelstoke Way, Rise

Park, Nottingham, NG5 5EB

Nottingham City

Riverbank Medical

Services

Church Street, Warsop, NG20

0BP

Mid-Nottinghamshire

Rivergreen Medical Centre 106 Southchurch Drive,

Clifton, Nottingham, NG11

8AD

Nottingham City

Riverlyn Medical Centre Station Road, Bulwell,

Nottingham, NG6 9AA

Nottingham City

Roundwood Surgery Wood Street, Mansfield, NG18

1QQ

Mid-Nottinghamshire

Ruddington Medical

Centre

Church Street, Ruddington,

Nottingham, NG11 6HD

South

Nottinghamshire

Sandy Lane Surgery Sandy Lane, Mansfield, NG18

2LT

Mid-Nottinghamshire

Saxon Cross Surgery Stapleford Care Centre,

Church Street, Stapleford,

Nottingham, NG9 8DB

South

Nottinghamshire



38


Selston Surgery 139 Nottingham Road,

Selston, NG16 6BT

Mid-Nottinghamshire

Sherrington Park Medical

Centre

402 Mansfield Road,


2EJ

Nottingham City

Sherwood Medical

Partnership including the

following two sites:

Crown Medical Centre

Farnsfield Surgery

a) Crown Farm Way, Forest

Town, Mansfield, NG19

0FW

b) Station Lane, Farnsfield,

Newark, NG22 8LA

Mid-Nottinghamshire

Sherwood Rise Medical

Centre

31 Nottingham Road,

Sherwood Rise, Nottingham,

NG7 7AD

Nottingham City

Skegby Family Medical

Centre

Mansfield Road, Skegby,

NG17 3EE

Mid-Nottinghamshire

Southglade Health Centre Southglade Road, Nottingham

NG5 5GU

Nottingham City

Southwell Medical Centre The Ropewalk, Southwell,

Nottinghamshire, NG25 0AL

Mid-Nottinghamshire

Springfield Medical Centre 301 Main Street, Bulwell,

Nottingham, NG6 8ED

Nottingham City

St Albans Medical Centre Hucknall Lane, Nottingham,

NG6 8AQ

Nottingham City

St Georges Medical

Practice

93 Musters Road, West

Bridgford, Nottingham, NG2

7PG

South

Nottinghamshire

St Luke’s Surgery Radford Health Centre,


Nottingham, NG7 3GW

Nottingham City

St Peter’s Medical Practice Commercial Street, Mansfield,

Nottinghamshire, NG18 1EE

Mid-Nottinghamshire

Stenhouse Medical Centre 66 Furlong Street, Arnold,

Nottingham, NG5 7BP

South

Nottinghamshire

Sunrise Medical Centre Radford Health Centre,


Nottingham, NG7 3GW

Nottingham City



39


The Alice Medical Centre 1 Carnwood Road, Bestwood

Estate, Nottingham, NG5 5HW

Nottingham City

The Fairfields Practice Mary Potter Centre, Gregory

Boulevard, Hyson Green,

Nottingham, NG7 5HY

Nottingham City

The Family Medical Centre 56a Lowmoor Road, Kirkby in

Ashfield, NG17 7BG

Mid-Nottinghamshire

The Forest Practice Mary Potter Centre, Gregory


Nottingham, NG7 5HY

Nottingham City

The High Green Medical

Practice

Mary Potter Centre, Gregory


Nottingham, NG7 5HY

Nottingham City

The Ivy Medical Group 6 Lambley Lane, Burton

Joyce, Nottingham, NG14

5BG

South

Nottinghamshire

The Jubilee Practice Lowdham Medical Centre,

Francklin Road, Lowdham,

Nottingham, NG14 7BG

South

Nottinghamshire

The Manor Surgery Middle Street, Beeston,

Nottingham, NG9 1GA

South

Nottinghamshire

The Medical Centre 2a Zulu Road, Basford,

Nottingham, NG7 7DS

Nottingham City

The Oaks Medical Centre 20 Villa Street, Beeston,

Nottingham, NG9 2NY

South

Nottinghamshire

The Om Surgery 112 Watnall Road, Hucknall,

Nottingham, NG15 7JP

South

Nottinghamshire

The University of

Nottingham Health Service

Cripps Health Centre,

University Park, Nottingham,

NG7 2QW

Nottingham City

The Valley Surgery 81 Bramcote Lane, Chilwell,

Nottingham, NG9 4ET

South

Nottinghamshire

Torkard Hill Medical

Centre

Farleys Lane, Hucknall,

Nottingham, NG15 6DY

South

Nottinghamshire

Trentside Medical Group Netherfield Medical Centre, 2a

Forester Street, Netherfield,

Nottingham, NG4 2NJ

South

Nottinghamshire



40


Tudor House Medical

Practice

138 Edwards Lane,


3HU

Nottingham City

Unity Surgery 318 Westdale Lane,

Mapperley, Nottingham, NG3

6EU

South

Nottinghamshire

Victoria and Mapperley

Practice

Victoria Health Centre,

Glasshouse Street,

Nottingham, NG1 3LW

Nottingham City

Welbeck Surgery 481-491 Mansfield Road,


2JJ

Nottingham City

Wellspring Surgery St Anns Valley Centre, 2

Livingstone Road, St Ann’s,

Nottingham, NG3 3GG

Nottingham City

West Bridgford Medical

Centre

97 Musters Road, West

Bridgford, Nottingham, NG2

7PX

South

Nottinghamshire

West Oak Surgery 319 Westdale Lane,

Mapperley, Nottingham, NG3

6EW

South

Nottinghamshire

Westdale Lane Surgery 20-22 Westdale Lane,

Gedling, Nottingham, NG4

3JA

South

Nottinghamshire

Whyburn Medical Practice The Health Centre, Curtis

Street, Hucknall, Nottingham,

NG15 7JE

South

Nottinghamshire

Willowbrook Medical

Practice

Brook Street, Sutton in

Ashfield, NG17 1ES

Mid-Nottinghamshire

Windmill Practice Sneinton Health Centre,

Beaumont Street, Sneinton,

Nottingham, NG2 4PJ

Nottingham City

Wollaton Park Medical

Centre

12 Harrow Road, Wollaton

Park, Nottingham, NG8 1FG

Nottingham City

Woodlands Medical

Practice

Bluebell Wood Way, Sutton in

Ashfield, NG17 1JW

Mid-Nottinghamshire



41

Appendix 4: Committee Terms of Reference

Audit and Governance Committee

1. Purpose The Audit and Governance Committee exists to:

a) Provide the Governing Body with an independent and

objective view of the CCG’s financial systems, financial

information and compliance with the laws, regulations and

directions governing the CCG in as far as they relate to

finance.

b) Review the establishment and maintenance of an effective

system of integrated governance, risk management and

internal control, across the whole of the CCG’s activities

that supports the achievement of the organisation’s

objectives.

c) Scrutinise every instance of non-compliance with the

CCG’s Standing Orders, Scheme of Reservation and

Delegation and Standing Financial Instructions and

monitoring compliance with the CCG’s Conflicts of Interest

Policy and Gifts, Hospitality and Sponsorship Policy.

d) Approve the CCG’s Annual Report and Accounts.

2. Status The Audit and Governance Committee is established in

accordance with the National Health Service Act 2006 (as

amended) and the CCG’s Constitution. It is a statutory

committee of, and accountable to, the Governing Body.

The Governing Body has authorised the Committee to:

a) Investigate any activity within its terms of reference.

b) Seek any information it requires from any employee and all

employees are directed to co-operate with any request

made by the Committee.

c) Obtain outside legal or other independent advice and to

secure the attendance of individuals with relevant

experience and expertise if it considers this necessary.

d) Create task and finish sub-groups in order to take forward

specific programmes of work as considered necessary by

the Committee’s membership. The Committee shall

determine the membership and terms of reference of any

such task and finish sub-groups.

3. Duties Integrated governance, risk management and internal control

a) The Committee will review the establishment and

maintenance of an effective system of integrated



42

governance, risk management and internal control across

the whole of the CCG’s activities, which supports the

achievement of its objectives. In particular the Committee

will:

i) Review the adequacy and effectiveness of the CCG’s

risk management arrangements and all risk and control

related disclosure statements (in particular the annual

governance statement) together with any

accompanying head of internal audit opinion, external

audit opinion or other appropriate independent

assurances.

ii) Review the adequacy and effectiveness of the

underlying assurance processes that indicate the

degree of achievement of the CCG’s objectives, the

effectiveness of the management of principal risks and

the appropriateness of the above disclosure

statements.

iii) Scrutinise all instances on non-compliance with

Standing Orders, Scheme of Reservation and

Delegation and Standing Financial Instructions.

iv) Approve and monitor compliance with standards of

business conduct policies and any related reporting and

self-certifications.

v) Approve and monitor arrangements in place for

allowing staff to raise concerns (in confidence) about

possible improprieties, ensuring that any such concerns

are investigated proportionately and independently.

vi) Approve and monitor the policies and procedures for all

work related to counter fraud, bribery and corruption as

required by the NHS Counter Fraud Authority.

vii) Scrutinise compliance with legislative and regulatory

requirements relating to information governance and

the extent to which associated systems and processes

are effective and embedded within the CCGs. This will

include approval of associated policies.

viii) Monitor progress against the CCG’s overarching Policy

Work Programme.

b) In carrying out this work the Committee will primarily utilise

the work of internal audit, 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.



43

c) 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.

Internal audit

d) The Committee will ensure that there is an effective

internal audit function established by management that

meets the Public Sector Internal Audit Standards 2017 and

provides appropriate independent assurance to the

Committee, Accountable Officer and Governing Body. This

will be achieved by:

i) Considering the provision of the internal audit service

and the costs involved.

ii) Reviewing and approving of the annual internal audit

plan and more detailed programme of work, ensuring

that this is consistent with the audit needs of the CCG

(as identified in the Governing Body Assurance

Framework).

iii) Considering the major findings of internal audit work

(and management’s response), and ensuring co-

ordination between the internal and external auditors to

optimise the use of audit resources.

iv) Ensuring that the internal audit function is adequately

resourced and has appropriate standing within the

organisation.

v) Monitoring the effectiveness of internal audit and

completing an annual review.

External audit

e) The Committee will 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:

i) Considering the appointment and performance of the

external auditors, as far as the rules governing the

appointment permits (and make recommendations to

the Governing Body when appropriate).

ii) Discussing and agreeing with the external auditors,

before the audit commences, the nature and scope of

the audit as set out in the annual plan.

iii) Discussing with the external auditors their local

evaluation of audit risks and assessment of the

organisation and the impact on the audit fee.



44

iv) Review of all external audit reports, including the report

to those charged with governance and any work

undertaken outside of the audit plan, together with the

appropriateness of management responses.

v) Ensuring that there is in place a clear protocol for the

engagement of external auditors to supply non-audit

services.

Counter fraud

f) The Committee will satisfy itself that the organisation has

adequate arrangements in place for counter fraud, bribery

and corruption that meet NHS Counter Fraud Authority’s

standards and will review the outcomes of work in these

areas. This will include approving the counter fraud work

programme.

g) The Committee will refer any suspicions of fraud, bribery

and corruption to the NHS Counter Fraud Authority.

Financial reporting

h) The Committee will monitor the integrity of the financial

statements of the CCG and any formal announcements

relating to the organisation’s financial performance.

i) The Committee will ensure that the systems for financial

reporting to the Governing Body, including those of

budgetary control, are subject to review as to

completeness and accuracy of the information provided.

j) The Committee will review and approve the annual report

and accounts, focusing particularly on:

i) The wording in the annual governance statement and

other disclosures.

ii) Changes in, and compliance with, accounting policies,

practices and estimation techniques.

iii) Unadjusted mis-statements in the financial statements.

iv) Significant judgements in preparation of the financial

statements.

v) Significant adjustments resulting from the audit.

vi) Letters of representation.

vii) Explanations for significant variances.

4. Membership The Audit and Governance Committee’s membership will be

comprised of three Non-Executive Directors of the Governing

Body.

Attendees



45

The following will be routine attendees at Audit and

Governance Committee meetings:

a) Chief Finance Officer

b) Associate Director of Governance

c) Internal Audit

d) External Audit

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:

e) The Accountable Officer being invited to attend, at least

annually, to discuss with the Committee the process for

assurance that supports the annual governance statement.

f) The Local Counter Fraud Specialist being invited to attend

at least twice per year.

5. Chair and Deputy The Audit and Governance Committee will be chaired by a

Non-Executive Director who has qualifications, expertise or

experience to enable them to lead on finance and audit

matters.

In the event of the Chair being unable to attend all or part of

the meeting, a replacement from within the Committee’s

membership will be nominated to deputise for that meeting.

6. Quorum and

Decision-making

Arrangements

The Audit and Governance Committee will be quorate with a

minimum of two members present.

If any Committee member has been disqualified from

participating in the discussion and/or decision-making for an

item on the agenda, by reason of a declaration of a conflict of

interest, then that individual shall no longer count towards the

quorum.

If the quorum has not been reached, then the meeting may

proceed if those attending agree, but no decisions may be

taken.

For the sake of clarity, no person can act in more than one

capacity when determining the quorum.

Committee members will seek to reach decisions by

consensus where possible. If a consensus agreement cannot

be reached, then the item will be escalated to the Governing

Body for a decision.

7. Frequency of

Meetings

The Audit and Governance Committee will meet no less than

six times per year at appropriate times in the reporting and

audit cycle.



46

The Head of Internal Audit and representatives from external

audit have a right of direct access to the Chair of the

Committee and may request a meeting if they consider that

one is necessary. The Committee will meet privately with the

internal and external auditors at least once during the year.

Meetings of the Committee, other than those regularly

scheduled above, shall be summoned by the secretary to the

Committee at the request of the Chair.

8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Audit and

Governance Committee to ensure the day to day work of the

Committee is proceeding satisfactorily.

Agendas and supporting papers will be circulated no later than

five calendar days in advance of meetings and will be

distributed by the secretary to the Committee.

Any items to be placed on the agenda are to be sent to the

secretary no later than seven calendar 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 Committee agenda will be agreed with the Chair prior to

the meeting.

9. Minutes of

Meetings

Minutes will be taken at all meetings and presented according

the corporate style.

The minutes will be ratified by agreement of the Audit and

Governance Committee at the following meeting.

The Chair of the Committee will agree minutes if they are to

be submitted to the Governing Body prior to formal ratification.

10. Conflicts of

Interest

Management

In advance of any meeting of the Audit and Governance

Committee, consideration will be given as to whether conflicts

of interest are likely to arise in relation to any agenda item and

how they should be managed. This may include steps to be

taken prior to the meeting, such as ensuring that supporting

papers for a particular agenda item are not sent to conflicted

individuals.

At the beginning of each Committee meeting, members and

attendees will be required to declare any interests that relate

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 declarations will be formally recorded in the minutes for

the meeting.



47

The Chair of the Committee will determine how declared

interests should be managed, which is likely to involve one the

following actions:

a) Requiring the individual to withdraw from the meeting for

that part of the discussion if the conflict could be seen as

detrimental to the Committee’s decision-making

arrangements.

b) Allowing the individual to participate in the discussion, but

not the decision-making process.

c) Allowing full participation in discussion and the decision-

making process, as the potential conflict is not perceived to

be material or detrimental to the Committee’s decision-

making arrangements.

11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Audit and Governance 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 to provide assurance that it is effectively discharging its

delegated responsibilities, as set out in these terms of

reference. The Committee will conduct an annual review of its

effectiveness to inform this report.

12. 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.



48

Remuneration and Terms of Service Committee

1. Purpose The Remuneration and Terms of Service Committee exists to

make recommendations to the Governing Body in relation to:

a) The remuneration, fees and allowances payable to

employees of the CCG and to other persons providing

services to it; and

b) Any determinations about allowances payable under

pension schemes established by the CCG.

In addition, the Governing Body has delegated a number of

functions to the Committee relating to the Governing Body’s

duty to ensure that the CCG has appropriate arrangements in

place to exercise its functions effectively, efficiently and

economically and in accordance with the principles of good

governance (as set out in section 3 below).

2. Status The Remuneration and Terms of Service Committee is

established in accordance with the National Health Service

Act 2006 (as amended) and the CCG’s constitution. It is a

statutory committee of, and accountable to, the Governing

Body.


a) Seek such independent information as may be necessary

to inform their recommendations.

b) Create task and finish sub-groups in order to take forward

specific programmes of work as considered necessary by

the Committee’s membership. The Committee shall

determine the membership and terms of reference of any

such task and finish sub-groups.

3. Duties a) Make recommendations to the Governing Body about

appropriate remuneration, fees and allowances for

Governing Body members (who are employees) and all

senior managers on Very Senior Managers pay. This will

include all aspects of salary (including any performance-

related elements and other benefits, such as lease cars).

Recommendations will be guided by national NHS policy

and best practice and 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.

b) Make recommendations to the Governing Body about

allowances payable under pension schemes established



49

by the CCG.

c) Make recommendations to the Governing Body about

termination payments (including redundancy and

severance payments) and any special payments following

scrutiny of their proper calculation and taking account of

such national guidance as appropriate.

d) Make recommendations to the Governing Body about

contractual terms and conditions for senior managers on

Very Senior Managers pay.

e) Determine the allowances to be paid to:

i) Governing Body GPs who are not employees (i.e. the

Clinical Chair, the Lead GP for the Nottingham and

Nottinghamshire Clinical Design Authority and the GPs

drawn from Member Practices);

ii) Other Governing Body members who are not

employees (excluding Non-Executive Directors); and

iii) Other clinical roles who are not employees.

NOTE: Non-Executive Director allowances are determined

by the Governing Body (non-conflicted members) in line

with the Scheme of Reservation and Delegation and

Standing Orders.

f) Approve all human resources policies for CCG employees.

g) Oversee compliance with the requirements set out in the

Equality Act 2010 (Specific Duties and Public Authorities)

Regulations 2017, as necessary.

h) Oversee the identification and management of risks

relating to the Committee’s remit.

4. Membership The Remuneration and Terms of Service Committee’s

membership will be comprised of four Non-Executive Directors

of the Governing Body.

Senior Managers may be invited to attend for all or part of the

meeting (providing their own remuneration is not being

discussed).

5. Chair and Deputy The Remuneration and Terms of Service Committee will be

chaired by a Non-Executive Director other than the Audit and

Governance Committee Chair.


the meeting, a replacement from within the Committee’s


6. Quorum and The Remuneration and Terms of Service Committee will be



50

Decision-making

Arrangements

quorate with a minimum of three members present.




interest, then that individual shall no longer count towards the

quorum.



taken.



Committee members will seek to reach decisions by

consensus where possible. If a consensus agreement cannot

be reached, then the item will be escalated to the Governing

Body for a decision.

7. Frequency of

Meetings

The Remuneration and Terms of Service Committee will meet

as required, with a minimum of one meeting per year.

8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Remuneration and

Terms of Service Committee to ensure the day to day work of

the Committee is proceeding satisfactorily.

Agendas and supporting papers will be circulated no later than

five calendar days in advance of meetings and will be





agenda may be added on receipt of permission from the

Chair.


the meeting.

9. Minutes of

Meetings

Minutes will be taken at all meetings and presented according

the corporate style.

The minutes will be ratified by agreement of the Remuneration

and Terms of Service Committee at the following meeting.

10. Conflicts of

Interest

Management

In advance of any meeting of the Remuneration and Terms of

Service Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda

item and how they should be managed. This may include

steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to



51

conflicted individuals.







the meeting.


interests should be managed, which is likely to involve one the

following actions:




arrangements.




making process, as the potential conflict is not perceived to

be material or detrimental to the Committee’s decision-


11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Remuneration and Terms of Service Committee will

submit reports to the Governing Body following each of its

meetings. These will include any items of specific concern, or

which require Governing Body approval.

The Committee will provide an annual report to the Governing

Body to provide assurance that it is effectively discharging its

delegated responsibilities, as set out in these terms of

reference. The Committee will conduct an annual review of its

effectiveness to inform this report.

12. Review of Terms

of Reference








52

Primary Care Commissioning Committee

1. Introduction /

Statutory

Framework

In accordance with its statutory powers under section 13Z of

the National Health Service Act 2006 (as amended), NHS

England has delegated the exercise of the primary care

commissioning functions specified in Schedule 1 to these

Terms of Reference to NHS Nottingham and

Nottinghamshire CCG. More detailed information on the

specific and general obligations relating to the delegated

functions are also set out in Schedule 1. Details of those

functions reserved to NHS England are set out at Schedule

2.

Arrangements made under section 13Z may be on such

terms and conditions (including terms as to payment) as may

be agreed between NHS England and the CCG.

Arrangements made under section 13Z do not affect the

liability of NHS England for the exercise of any of its

functions. However, the CCG acknowledges that in

exercising its functions (including those delegated to it), it

must comply with the statutory duties set out in Chapter A2

of the NHS Act and including:

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

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

c) Duty to exercise its functions effectively, efficiently and

economically (section 14Q);

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

14R);

e) Duty in relation to quality of primary medical services

(section 14S);

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

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

14U);

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

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

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

The CCG will also need to specifically, in respect of the

delegated functions from NHS England, exercise those in

accordance with the relevant provisions of section 13 of the

NHS Act.

The Committee is subject to any directions made by NHS

England or by the Secretary of State.



53

The Primary Care Commissioning Committee has been

established in accordance with the CCG’s Constitution. The

Committee will function as a corporate decision-making body

for the management of the delegated functions and the

exercise of the delegated powers.

The Committee may delegate tasks to such individuals, sub-

committees or individual members as it shall see fit, provided

that any such delegations are consistent with the parties’

relevant governance arrangements, are recorded in a

scheme of delegation, are governed by terms of reference as

appropriate and reflect appropriate arrangements for the

management of conflicts of interest.

For the avoidance of doubt, in the event of any conflict

between the terms of the Delegation Agreement in place

between NHS England and NHS Nottingham and

Nottinghamshire CCG, these terms of reference for the

Primary Care Commissioning Committee and the CCG’s

Standing Orders or Standing Financial Instructions, then the

Delegation Agreement will prevail.

2. Duties The Committee has been established in accordance with the

above statutory provisions to enable the Committee to make

collective decisions on the review, planning and procurement

of primary care services in Nottingham and Nottinghamshire,

under delegated authority from NHS England.

In performing its role the Committee will exercise its

management of the functions in accordance with the

agreement entered into between NHS England and NHS

Nottingham and Nottinghamshire CCG, which will sit

alongside the delegation and the Terms of Reference.

The functions of the Committee are undertaken in the

context of a desire to promote increased co-commissioning

to increase quality, efficiency, productivity and value for

money and to remove administrative barriers.

The role of the Committee shall be to carry out the functions

relating to the commissioning of primary medical services

under section 83 of the NHS Act.

This includes the following:

a) Decisions in relation to the commissioning, procurement

and 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



54

contract), including but not limited to the following

activities:

i) Decisions in relation to Enhanced Services;

ii) Decisions in relation to Local Incentive Schemes

(including the design of such schemes);

iii) Decisions in relation to the establishment of new GP

practices (including branch surgeries) and closure of

GP practices;

iv) Decisions about ‘discretionary’ payments;

v) Decisions about commissioning urgent care (including

home visits as required) for out of area registered

patients;

b) The approval of practice mergers;

c) Planning primary medical care services in Nottingham

and Nottinghamshire, including carrying out needs

assessments;

d) Undertaking reviews of primary medical care services in

Nottingham and Nottinghamshire;

e) Decisions in relation to the management of poorly

performing GP practices and including, without limitation,

decisions and liaison with the CQC where the CQC has

reported non-compliance with standards (but excluding

any decisions in relation to the performers list);

f) Management of the delegated funds for primary care

medical services;

g) Making decisions on premises costs directions functions;

and

h) Co-ordinating a common approach to the commissioning

of primary care services generally.

The Committee will also:

i) Oversee delivery of the General Practice Forward View;

j) Review and approve policies specific to the Committee’s

remit; and

k) Oversee the identification and management of risks

relating to the Committee’s remit.

3. Membership The Primary Care Commissioning Committee will have ten

members, comprised as follows:

Non-Executive Members

a) Three Non-Executive Directors



55

Clinical Members

b) GP Representative

c) An Independent GP Advisor

d) Deputy Chief Nurse

Managerial Members

e) Chief Commissioning Officer

f) Associate Director of Primary Care

g) Associate Director of Primary Care Development

h) Operational Director of Finance

There will be a standing invitation to the following to offer

representation in a non-voting capacity on the Committee:

a) Locality Directors for Mid-Nottinghamshire, Nottingham

City and South Nottinghamshire

b) Nottinghamshire Local Medical Committee

c) Healthwatch Nottingham and Nottinghamshire

d) Nottingham City Health and Wellbeing Board

e) Nottinghamshire County Health and Wellbeing Board

Other CCG officers may be invited to attend meetings when

the Committee is discussing items that fall within their areas

of expertise and/or responsibility.

4. Chair and

Deputy

The Primary Care Commissioning Committee will be chaired

by a Non-Executive Director other than the Audit and

Governance Committee Chair.


the meeting, a replacement from within the Committee’s non-

executive membership will be nominated to deputise for that

meeting. In such circumstances, care will be taken to ensure

that the Audit and Governance Committee Chair’s role of

Conflicts of Interest Guardian is not compromised.

5. Quorum The Primary Care Commissioning Committee will be quorate

with a minimum of five members, to include:

a) Two Non-Executive Directors;

b) Either the Independent GP Advisor or the Deputy Chief

Nurse; and

c) Either the Chief Commissioning Officer or the Associate

Director of Primary Care.

To ensure that the quorum can be maintained, Committee

members are able nominate a suitable deputy to attend a



56

meeting of the Committee that they are unable to attend to

speak and vote on their behalf. Committee members are

responsible for fully briefing their nominated deputies and for

informing the secretariat so that the quorum can be

maintained.




interest, then that individual shall no longer count towards

the quorum.



taken.



6. Decision-making Arrangements

Each member of the Committee shall have one vote. The

Committee shall reach decisions by a simple majority of

members present, but with the Chair having a second and

deciding vote, if necessary. However, the aim of the

Committee will be to achieve consensus decision-making

wherever possible.

The Committee will make decisions within the bounds of its

remit.

The decisions of the Committee shall be binding on NHS

England and NHS Nottingham and Nottinghamshire CCG.

On occasion, the Committee 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 Committee 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 Committee members by the secretary to the

Committee.

The Committee members may meet either in person, via

telephone conference or communicate by email to take an

urgent decision. The quorum, as described in section 5, must

be adhered to for urgent decisions.

A minute of the discussion (including those performed

virtually) and decision will be taken by the secretary to the

Committee and will be reported to the next meeting of the

Committee for formal ratification.



57

7. Frequency of

Meetings

Meetings of the Primary Care Commissioning Committee will

be scheduled on a monthly basis and the Committee will

meet, as a minimum, on a bi-monthly basis.

Meetings of the Primary Care Commissioning Committee,

other than those regularly scheduled above, shall be

summoned by the secretary to the Committee at the request

of the Chair. When the Chair of the Committee deems it

necessary in light of urgent circumstances to call a meeting

at short notice, the notice period shall be such as s/he shall

specify.

8. Admission of public and the press


normally be open to the public.

However, the Committee 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.

In the event the public could be excluded from a meeting of

the Committee, the CCG shall consider whether the subject

matter of the meeting would in any event be subject to

disclosure under the Freedom of Information Act 2000, and if

so, whether the public should be excluded in such

circumstances.

The Committee 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.

The Chair (or Deputy Chair) as 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 Committee’s business shall

be conducted without interruption and disruption.

Matters to be dealt with by the Committee following the

exclusion of representatives of the press, and other

members of the public shall be confidential to the members



58

of the Committee.

Members of the Committee and any member or employee of

the CCG 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

Committee, without the express permission of the

Committee. This will apply equally to the content of any

discussion during the Committee meeting which may take

place on such reports or papers.

9. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Primary Care

Commissioning Committee to ensure the day to day work of

the Committee is proceeding satisfactorily.

Agendas and supporting papers will be circulated no later

than five calendar days in advance of meetings and will be



secretary no later than seven calendar 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 meeting.

Members of the Committee have a collective responsibility

for the operation of the Committee. They will participate in

discussion, review evidence and provide objective expert

input to the best of their knowledge and ability, and

endeavour to reach a collective view.

10. Minutes of

Meetings

Minutes will be taken at all meetings and presented

according the corporate style.

The minutes will be ratified by agreement of the Primary

Care Commissioning Committee at the following meeting.

The Chair of the Committee will agree minutes if they are to

be submitted to the Governing Body prior to formal

ratification.

11. Conflicts of

Interest

Management

In advance of any meeting of the Primary Care

Commissioning Committee, consideration will be given as to

whether conflicts of interest are likely to arise in relation to

any agenda item and how they should be managed. This

may include steps to be taken prior to the meeting, such as

ensuring that supporting papers for a particular agenda item



59

are not sent to conflicted individuals.







the meeting.


interests should be managed, which is likely to involve one

the following actions:




arrangements.




making process, as the potential conflict is not perceived

to be material or detrimental to the Committee’s decision-


12. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Primary Care Commissioning Committee will report to

the Governing Body through regular submission of minutes

from its meetings (and those of any sub-committees to which

responsibilities have been delegated), accompanied by

executive summary reports. Any items of specific concern,

or which require Governing Body approval, will be the

subject of a separate report.

The Committee will provide minutes and reports to NHS

England for information, at a frequency determined by the

NHS England Local Team.

The Committee will provide an annual report to the

Governing Body to provide assurance that it is effectively

discharging its delegated responsibilities, as set out in these

terms of reference. The Committee will conduct an annual

review of its effectiveness to inform this report.

13. Review of Terms

of Reference








60

Schedule 1 - Delegated Functions

Part 1: Specific obligations regarding the carrying out of each of the delegated functions.

Delegated Function Specific Obligations

1. Primary Medical

Services Contract

Management

The CCG must:

a) Manage the Primary Medical Services Contracts on behalf of NHS England and perform all of NHS

England’s obligations under each of the Primary Medical Services Contracts in accordance with the terms

of the Primary Medical Services Contracts as if it were named in the contract in place of NHS England;

b) Actively manage the performance of the counter-party to the Primary Medical Services Contracts in order to

secure the needs of people who use the services, improve the quality of services and improve efficiency in

the provision of the services including by taking timely action to enforce contractual breaches and serve

notice;

c) Ensure that it obtains value for money under the Primary Medical Services Contracts on behalf of NHS

England and avoids making any double payments under any Primary Medical Services Contracts;

d) Comply with all current and future relevant national Guidance regarding PMS reviews and the management

of practices receiving Minimum Practice Income Guarantee (MPIG) (including without limitation the

Framework for Personal Medical Services (PMS) Contracts Review guidance published by NHS England in

September 2014 (http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance-

sept14.pdf));

e) Notify NHS England immediately (or in any event within two (2) Operational Days) of any breach by the

CCG of its obligations to perform any of NHS England’s obligations under the Primary Medical Services

Contracts;

f) Keep a record of all of the Primary Medical Services Contracts that the CCG manages on behalf of NHS

England setting out the following details in relation to each Primary Medical Services Contract:

Name of counter-party;

Location of provision of services; and

Amounts payable under the contract (if a contract sum is payable) or amount payable in respect of each

patient (if there is no contract sum).

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g) For the avoidance of doubt, all Primary Medical Services Contracts will be in the name of NHS England.

h) The CCG must comply with any Guidance in relation to the issuing and signing of Primary Medical Services

Contracts in the name of NHS England.

i) The CCG must actively manage each of the relevant Primary Medical Services Contracts including by:

Managing the relevant Primary Medical Services Contract, including in respect of quality standards,

incentives and the QOF, observance of service specifications, and monitoring of activity and finance;

Assessing quality and outcomes (including clinical effectiveness, patient experience and patient safety);

Managing variations to the relevant Primary Medical Services Contract or services in accordance with

national policy, service user needs and clinical developments;

Agreeing information and reporting requirements and managing information breaches (which will

include use of the HSCIC IG Toolkit SIRI system);

Agreeing local prices, managing agreements or proposals for local variations and local modifications;

Conducting review meetings and undertaking contract management including the issuing of contract

queries and agreeing any remedial action plan or related contract management processes; and

Complying with and implementing any relevant Guidance issued from time to time.

j) In relation to any new Primary Medical Services Contract to be entered into, the CCG must:

Consider and use the form of Primary Medical Services Contract that will ensure compliance with NHS

England’s obligations under Law including the Public Contracts Regulations 2015/102 and the National

Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013/500 taking into

account the persons to whom such Primary Medical Services Contracts may be awarded;

Provide to NHS England confirmation as required from time to time that it has considered and complied

with its obligations under this Agreement and the Law; and

For the avoidance of doubt, Schedule 3 (Financial and Decision-Making Limits) deals with the sign off

requirements for Primary Medical Services Contracts.

2. Enhanced Services a) The CCG must manage the design and commissioning of Enhanced Services, including re-commissioning

these services annually where appropriate.

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b) The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of

Enhanced Services.

c) When commissioning newly designed Enhanced Services, the CCG must:

Consider the needs of the local population in the Area;

Support Data Controllers in providing ‘fair processing’ information as required by the DPA;

Develop the necessary specifications and templates for the Enhanced Services, as required to meet the

needs of the local population in the Area;

When developing the necessary specifications and templates for the Enhanced Services, ensure that

value for money will be obtained;

Consult with Local Medical Committees, each relevant Health and Wellbeing Board and other

stakeholders in accordance with the duty of public involvement and consultation under section 14Z2 of

the NHS Act;

Obtain the appropriate read codes, to be maintained by the HSCIC;

Liaise with system providers and representative bodies to ensure that the system in relation to the

Enhanced Services will be functional and secure; and

Support GPs in entering into data processing agreements with data processors in the terms required by

the DPA.

3. Design of Local

Incentive Schemes

a) The CCG may design and offer Local Incentive Schemes for GP practices, sensitive to the needs of their

particular communities, in addition to or as an alternative to the national framework (including as an

alternative to QOF or directed Enhanced Services), provided that such schemes are voluntary and the CCG

continues to offer the national schemes.

b) There is no formal approvals process that the CCG must follow to develop a Local Incentive Scheme,

although any proposed new Local Incentive Scheme:

Is subject to consultation with the Local Medical Committee;

Must be able to demonstrate improved outcomes, reduced inequalities and value for money; and

Must reflect the changes agreed as part of the national PMS reviews.

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c) The ongoing assurance of any new Local Incentive Schemes will form part of the CCG’s assurance process

under the CCG Assurance Framework.

d) Any new Local Incentive Scheme must be implemented without prejudice to the right of GP practices

operating under a GMS Contract to obtain their entitlements which are negotiated and set nationally.

e) NHS England will continue to set national standing rules, to be reviewed annually, and the CCG must

comply with these rules which shall for the purposes of this Agreement be Guidance.

4. Making Decisions on

Discretionary Payments

a) The CCG must manage and make decisions in relation to the discretionary payments to be made to GP

practices in a consistent, open and transparent way.

b) The CCG must exercise its discretion to determine the level of payment to GP practices of discretionary

payments, in accordance with the Statement of Financial Entitlements Directions.

5. Making Decisions about

Commissioning Urgent

Care for Out of Area

Registered Patients

a) The CCG must manage the design and commissioning of urgent care services (including home visits as

required) for its patients registered out of area (including re-commissioning these services annually where

appropriate).


these services.

6. Planning the Provider

Landscape

a) The CCG must plan the primary medical services provider landscape in the Area, including considering and

taking decisions in relation to:

Establishing new GP practices in the Area;

Managing GP practices providing inadequate standards of patient care;

The procurement of new Primary Medical Services Contracts (in accordance with any procurement

protocol issued by NHS England from time to time);

Closure of practices and branch surgeries;

Dispersing the lists of GP practices;

Agreeing variations to the boundaries of GP practices; and

Coordinating and carrying out the process of list cleansing in relation to GP practices, according to any

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policy or Guidance issued by NHS England from time to time.

7. Approving GP Practice

Mergers and Closures

a) The CCG is responsible for approving GP practice mergers and GP practice closures in the Area.

b) The CCG must undertake all necessary consultation when taking any decision in relation to GP practice

mergers or GP practice closures in the Area, including those set out under section 14Z2 of the NHS Act

(duty for public involvement and consultation). The consultation undertaken must be appropriate and

proportionate in the circumstances and should include consulting with the Local Medical Committee.

c) Prior to making any decision, the CCG must be able to clearly demonstrate the grounds for such a decision

and must have fully considered any impact on the GP practice’s registered population and that of

surrounding practices. The CCG must be able to clearly demonstrate that it has considered other options

and has entered into dialogue with the GP contractor as to how any closure or merger will be managed.

d) In making any decisions, the CCG shall also take account of its obligations as set out at 1 j) above, where

applicable.

8. Information Sharing with

NHS England in relation

to the Delegated

Functions

a) The CCG must provide NHS England with:

Such information relating to individual GP practices in the Area as NHS England may reasonably

request, to ensure that NHS England is able to continue to gather national data regarding the

performances of GP practices;

Such data/data sets as required by NHS England to ensure population of the primary medical services

dashboard;

Any other data/data sets as required by NHS England; and

The CCG shall procure that providers accurately record and report information so as to allow NHS

England and other agencies to discharge their functions.

b) The CCG must use the NHS England approved primary medical services dashboard, as updated from time

to time, for the collection and dissemination of information relating to GP practices.

c) The CCG must (where appropriate) use the NHS England approved GP exception reporting service (as

notified to the CCGs by NHS England from time to time).

d) The CCG must provide any other information, and in any such form, as NHS England considers necessary

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and relevant.

e) NHS England reserves the right to set national standing rules (which may be considered Guidance for the

purpose of this Agreement), as needed, to be reviewed annually. NHS England will work with CCGs to

agree rules for, without limitation, areas such as the collection of data for national data sets and IT intra-

operability. Such national standing rules set from time to time shall be deemed to be part of this

Agreement.

9. Making Decisions in

relation to Management

of Poorly Performing GP

Practices

a) The CCG must make decisions in relation to the management of poorly performing GP practices and

including, without limitation, decisions and liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in relation to the performers list).

b) The CCG must:

Ensure regular and effective collaboration with the CQC to ensure that information on general practice

is shared and discussed in an appropriate and timely manner;

Ensure that any risks identified are managed and escalated where necessary;

Respond to CQC assessments of GP practices where improvement is required;

Where a GP practice is placed into special measures, lead a quality summit to ensure the development

and monitoring of an appropriate improvement plan (including a communications plan and actions to

manage primary care resilience in the locality); and

Take appropriate contractual action in response to CQC findings.

10. Premises Costs

Directions Functions

a) The CCG must comply with the Premises Costs Directions and will be responsible for making decisions in

relation to the Premises Costs Directions Functions.

b) In particular, the CCG shall make decisions concerning:

Applications for new payments under the Premises Costs Directions (whether such payments are to be

made by way of grants or in respect of recurring premises costs); and

Revisions to existing payments being made under the Premises Costs Directions.

c) The CCG must comply with any decision-making limits set out in Schedule 3 (Financial and Decision-

Making Limits) when taking decisions in relation to the Premises Costs Directions Functions.

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d) The CCG will comply with any guidance issued by the Secretary of State or NHS England in relation to the

Premises Costs Directions, including the Principles of Best Practice, and any other Guidance in relation to

the Premises Costs Directions.

e) The CCG must work cooperatively with other CCGs to manage premises and strategic estates planning.

f) The CCG must liaise where appropriate with NHS Property Services Limited and Community Health

Partnerships Limited in relation to the Premises Costs Directions Functions.

Part 2: General obligations regarding the carrying out of the delegated functions.

Delegated Function General Obligations

1. Planning and reviews a) The CCG is responsible for planning the commissioning of primary medical services. The role of the CCG

includes:

Carrying out primary medical health needs assessments (to be developed by the CCG) to help

determine the needs of the local population in the Area;

Recommending and implementing changes to meet any unmet primary medical service needs; and

Undertaking regular reviews of the primary medical health needs of the local population in the Area.

2. Procurement and new

contracts

a) The CCG will make procurement decisions relevant to the exercise of the Delegated Functions and in

accordance with the detailed arrangements regarding procurement set out in the procurement protocol

issued and updated by NHS England from time to time.

b) In discharging its responsibilities, the CCG must comply at all times with Law including its obligations set

out in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations

2013/500 and any other relevant statutory provisions. The CCG must have regard to any relevant

guidance, particularly Monitor’s guidance Substantive guidance on the Procurement, Patient Choice and

Competition Regulations

(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanc

eDec2013_0.pdf).

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c) Where the CCG wishes to develop and offer a locally designed contract, it must ensure that it has consulted

with its Local Medical Committee in relation to the proposal and that it can demonstrate that the scheme

will:

Improve outcomes;

Reduce inequalities; and

Provide value for money.

3. Integrated working a) The CCG must take an integrated approach to working and co-ordinating with stakeholders including NHS

England, Local Professional Networks, local authorities, Healthwatch, acute and community providers, the

Local Medical Committee, Public Health England and other stakeholders.

b) The CCG must work with NHS England and other CCGs to co-ordinate a common approach to the

commissioning of primary medical services generally.

c) The CCG and NHS England will work together to coordinate the exercise of their respective performance

management functions.

4. Resourcing a) NHS England may, at its discretion provide support or staff to the CCG. NHS England may, when

exercising such discretion, take into account, any relevant factors (including without limitation the size of the

CCG, the number of Primary Medical Services Contracts held and the need for the Local NHS England

Team to continue to deliver the Reserved Functions).

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Schedule 2 - Reserved Functions

This Schedule sets out further provision regarding the carrying out of the reserved functions. The CCG will work collaboratively with NHS

England and will support and assist NHS England to carry out the reserved functions.

Reserved function Further provisions

1. Management of the

national performers list

a) NHS England will continue to perform its primary medical care functions under the National Health Service

(Performers Lists) (England) Regulations 2013.

b) NHS England’s functions in relation to the management of the national performers list include:

Considering applications and decision-making in relation to inclusion on the national performers list,

inclusion with conditions and refusals;

Identifying, managing and supporting primary care performers where concerns arise; and

Managing suspension, imposition of conditions and removal from the national performers list.

c) NHS England may hold local Performance Advisory Group (“PAG”) meetings to consider all complaints or

concerns that are reported to NHS England in relation to a named performer and NHS England will

determine whether an initial investigation is to be carried out.

d) NHS England may notify the CCG of all relevant PAG meetings at least seven (7) days in advance of such

meetings. NHS England may require a representative of the CCG to attend such meetings to discuss any

performer concerns and/or quality issues that may impact on individual performer cases.

e) The CCG must develop a mechanism to ensure that all complaints regarding any named performer are

escalated to the Local NHS England Team for review. The CCG will comply with any Guidance issued by

NHS England in relation to the escalation of complaints about a named performer.


revalidation and

appraisal process

a) NHS England will continue to perform its functions under the Medical Profession (Responsible Officers)

Regulations 2010 (as amended by the Medical Profession (Responsible Officers) (Amendment)

Regulations 2013).

b) All functions in relation to GP appraisal and revalidation will remain the responsibility of NHS England,

including:

The funding of GP appraisers;

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Quality assurance of the GP appraisal process; and

The responsible officer network.

c) Funding to support the GP appraisal is incorporated within the global sum payment to GP practices.

d) The CCG must not remove or restrict the payments made to GP practices in respect of GP appraisal.

3. Administration of

payments and related

performers list

management activities

a) NHS England reserves its functions in relation to the administration of payments to individual performers

and related performers list management activities under the National Health Service (Performers Lists)

(England) Regulations 2013 and other relevant legislation.

b) NHS England may continue to pay GPs who are suspended from the national performers list under the

Secretary of State’s Determination: Payments to Medical Practitioners Suspended from the Medical

Performers List (1 April 2013).

c) For the avoidance of doubt, the CCG is responsible for any ad hoc or discretionary payments to GP

practices (including those under section 96 of the NHS Act), including where such payments may be

considered a consequence of actions taken under the National Health Service (Performers Lists) (England)

Regulations 2013.

4. Section 7A Functions a) NHS England retains the Section 7A Functions and will be responsible for taking decisions in relation to the

Section 7A Functions.

b) The CCG will provide certain management and/or administrative services to NHS England in relation to the


5. Capital Expenditure

Functions

c) NHS England retains the Capital Expenditure Functions and will be responsible for taking decisions in

relation to the Capital Expenditure Functions.

6. Functions in relation to

complaints management

a) NHS England retains its functions in relation to complaints management and will be responsible for taking

decisions in relation to the management of complaints. Such complaints include (but are not limited to):

Complaints about GP practices and individual named performers;

Controlled drugs; and

Whistleblowing in relation to a GP practice or individual performer.

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b) The CCG must immediately notify the Local NHS England Team of all complaints received by or notified to

the CCG and must send to the Local NHS England Team copies of any relevant correspondence.

c) The CCG must co-operate fully with NHS England in relation to any complaint and any response to such

complaint.

d) NHS England may ask the CCG to provide certain management and/or administrative services to NHS

England (from a date to be notified by NHS England to the CCG) in relation to the handling and

consideration of complaints.

7. Such other ancillary

activities that are

necessary in order to

exercise the Reserved

Functions

a) NHS England will carry out such other ancillary activities that are necessary in order for NHS England to

exercise the Reserved Functions.

b) NHS England will continue to comply with its obligations under the Controlled Drugs (Supervision of

Management and Use) Regulations 2013.

c) The CCG must assist NHS England’s controlled drug accountable officer (“CDAO”) to carry out its functions

under the Controlled Drugs (Supervision of Management and Use) Regulations 2013.

d) The CCG must nominate a relevant senior individual within the CCG (the “CCG CD Lead”) to liaise with and

assist NHS England to carry out its functions under the Controlled Drugs (Supervision of Management and

Use) Regulations 2013.

e) The CCG CD Lead must, in relation to the Delegated Functions:

On request provide NHS England’s CDAO with all reasonable assistance in any investigation involving

primary medical care services;

Report all complaints involving controlled drugs to NHS England’s CDAO;

Report all incidents or other concerns involving the safe use and management of controlled drugs to

NHS England’s CDAO;

Analyse the controlled drug prescribing data available; and

On request supply (or ensure organisations from whom the CCG commissions services involving the

regular use of controlled drugs supply) periodic self–declaration and/or self-assessments to NHS

England’s CDAO.

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Schedule 3 – Financial and Decision-Making Limits

The CCG has certain limitations placed on it in relation to its delegated functions, which need to be kept in mind when decisions are being

made. This Schedule sets out three specific categories where decisions can only be taken following the receipt of prior approval from NHS

England. The individuals that need to be involved in the decision-making process are also set out below.

Decision NHS England Approval CCG Approval

Taking any step or action in relation to the

settlement of a claim, where the value of the

settlement exceeds £100,000.

NHS England Head of Legal Services

and

Local NHS England Team Director or

Director of Finance

Accountable Officer or Chief Finance

Officer or Chair

Any matter in relation to the delegated functions

which is novel, contentious or repercussive.


Director of Finance

or

NHS England Regional Director or

Director of Finance

or

NHS England Chief Executive or Chief

Financial Officer


Officer or Chair

The entering into any Primary Medical Services

Contract, which has, or is capable of having, a term

which exceeds five years.


Director of Finance


Officer or Chair

Establishm

ent of NH

S N

ottingham and N

ottinghamshire C

CG

113 of 4399.00, M

icrosoft Team

s-08/04/20

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Appendix 5: 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 and Nottinghamshire Clinical Commissioning

Group (“the CCG”) so that it 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 CCG is established.

1.1.2. The Standing Orders, together with the CCG’s Scheme of Reservation

and Delegation (as contained within the CCG’s Governance Handbook)

and the CCG’s Standing Financial Instructions (see Appendix 6), provide

a procedural framework within which the CCG discharges its business.

They set out:

a) The arrangements for conducting the business of the CCG;

b) The appointment processes for the CCG’s Governing Body

Members;

c) The procedures to be followed at meetings of the CCG, the

Governing Body and any committees or sub-committees of the CCG

or the Governing Body;

d) The arrangements for managing the CCG’s financial affairs and the

delegated limits for financial commitments on behalf of the CCG.

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 appropriate2 of any relevant

guidance.

1.1.3. Employees, Members, Committee and Sub-Committee members of the


Committees, Joint Committees) and persons working on behalf of the

CCG should be aware of the existence of these documents and, where

necessary, be familiar with their detailed provisions.

1.1.4. Failure to comply with the Standing Orders, Scheme of Reservation and

Delegation and Standing Financial Instructions may be regarded as a

disciplinary matter that could result in dismissal.

2 Under some legislative provisions the CCG is obliged to have regard to particular guidance

but under other circumstances guidance is issued as best practice guidance.



73

1.2. Schedule of matters reserved to the Clinical Commissioning Group

and the scheme of reservation and delegation

1.2.1. The 2006 Act (as amended by the 2012 Act) provides the CCG with

powers to delegate the CCG’s functions and those of the Governing Body

to certain bodies (such as Committees) and certain persons. The CCG

has decided that certain decisions may only be exercised by the CCG in

formal session. These decisions and also those delegated are contained

in the CCG’s Scheme of Reservation and Delegation.

2. Composition of Membership, Key Roles and Appointment

Processes

2.1 Composition of membership

2.1.1 Chapter 3 of the CCG’s Constitution provides details of the CCG’s

Member Practices, including the role of Member Practice

Representatives. Member Practices are required to inform the CCG’s

governance lead of who their Member Practice Representative is.

2.1.2 Chapters 4 and 5 of the CCG’s Constitution provide details of the

governing structure used in the CCG’s decision-making processes.

2.2 Key Roles

2.2.1 Paragraph 5.5 of the CCG’s Constitution sets out the composition of the

CCG’s Governing Body. These Standing Orders set out how the CCG

appoints individuals to these key roles.

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 CCG’s

Governing Body. All Governing Body members are expected to be familiar

with the statutory exclusions and to comply with them at all times. Each

Governing Body member is responsible for informing the CCG’s

governance lead as soon as practicable if they become aware of any

actual or potential exclusion on the basis of the Regulations.

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



74

would be unable to make a full and proper contribution to the

Governing Body.

2.2.4 The Clinical Chair, as listed in paragraph 5.5.2 a) of the CCG’s

Constitution, is subject to the following appointment process:

a) Nominations and eligibility – Any GP who is performing primary

medical services for a Member Practice within the geographical Area

covered by the CCG may nominate themselves for this role when

advertised.

b) Appointment process – Appointments will be made as a result of:

i) A formal competency assessment and interview process; and

ii) Subsequent election by Member Practices if more than one

candidate is successful following interview.

The election will be on the basis of one vote per Member

Practice. The Nottinghamshire Local Medical Committee may

be requested to co-ordinate this process. The candidate who

receives a simple majority of votes cast will be considered

elected as Clinical Chair. If all candidates receive the same

number of votes, then the matter will be resolved by the

interview panel.

iii) If there is only one successful candidate following interview,

then that person will be automatically selected as the

successful candidate. The results will be communicated to

Member Practices.

c) Term of office – The normal term of office for this role is three years.

However, based on the CCG’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 2.2.4 a) and 2.2.4 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 individual

continues to have the support of the CCG’s Member Practices.



75

e) Grounds for removal from office –

i) Gross misconduct, to be determined by the Governing Body,

on the advice of the Remuneration and Terms of Service

Committee;

ii) Becoming disqualified from office (see standing order 2.2.2);

iii) Ceasing to fulfil the eligibility criteria for the role as set out at

standing order 2.2.4 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; or

vii) Where continuation in the role is not in the interests of either

the public or the CCG.

f) Notice period – The normal notice period for this role is three

months’ written notice to the Accountable Officer and the CCG’s lead

for governance. However, where any of the grounds for removal

from office apply, as set out at standing order 2.2.4 e) above, notice

shall be as considered appropriate in the circumstances.

2.2.5 The Accountable Officer as listed in paragraph 5.5.2 b) of the CCG’s


a) Nominations and eligibility – Any individual with the qualifications,

expertise and experience to ensure that the CCG 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 NHS England3.

c) Grounds for removal from office – Termination of employment in

accordance with the Accountable Officer’s contract of employment.

3 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



76

d) Notice period – As determined by the contract of employment.

2.2.6 The Chief Finance Officer as listed in paragraph 5.5.2 c) of the CCG’s


a) Nominations and eligibility – Any individual with the necessary

professional accountancy qualifications and the expertise or

experience to lead the financial management of the CCG may apply

for this role when advertised.

b) Appointment process –This appointment will be subject to national

NHS recruitment and selection policies and guidance.


accordance with the Chief Finance Officer’s contract of employment.


2.2.7 The Secondary Care Specialist as listed in paragraph 5.5.2 d) of the

CCG’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 CCG has responsibility.

b) Appointment process – This appointment will be made on the

basis of formal competency assessment and interview process.







77

d) Eligibility for reappointment – This appointment will be eligible for

reappointment at the end of each term of office, subject to

demonstration of continuing competence through a satisfactory

annual performance appraisal and agreement of this by the

Governing Body. No individual will have the right to be reappointed.

A person cannot be appointed to the role of Secondary Care

Specialist on the Governing Body for more than nine years in total,

which will include any years served in equivalent roles for the CCG’s

predecessor organisations.




Committee;




iv) Not attending Governing Body meetings for three consecutive


illness);

v) Failing to disclose a pecuniary interest regarding matters under





vi) Where continuation in the role is not in the interests of either


f) Notice period – The normal notice period for this role is two months’

written notice to the Clinical Chair and the CCG’s lead for

governance. However, where any of the grounds for removal from

office apply, as set out at standing order 2.2.7 e) above, notice shall

be as considered appropriate in the circumstances.

2.2.8 The Registered Nurse as listed in paragraph 5.5.2 e) of the CCG’s


a) Nominations and eligibility – Any individual who is a registered

nurse may 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 CCG has responsibility.



78

b) Appointment process –This appointment will be subject to national



accordance with the Registered Nurse’s contract of employment.


2.2.9 The Non-Executive Directors, as listed in paragraph 5.5.2 f) and 5.5.3 c),

d) and e) of the CCG’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 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 CCG Governing Bodies.

The Non-Executive Director role listed at paragraph 5.5.2 f) i) must

have qualifications, expertise or experience such as to enable the

person to express informed views about financial management and

audit matters.

The Non-Executive Director role listed at paragraph 5.5.2 f) ii) must

be a person who has knowledge about the area covered by the CCG,

such as to enable the person to express informed views about the

discharge of the CCG’s functions.

b) Appointment process – These appointments will be made on the


c) Term of office – The normal term of office for these roles is three

years. However, based on the CCG’s requirements at the time of


continuity is maintained between transitions

d) Eligibility for reappointment – These appointments will be eligible

for reappointment at the end of each term of office, subject to




A person cannot be appointed to the role of Non-Executive Director

on the Governing Body for more than nine years in total, which will

include any years served in equivalent roles for the CCG’s

predecessor organisations.




79



Committee;


iii) Ceasing to fulfil the eligibility criteria for the role of Non-

Executive Director on the Governing Body as set out at


iv) Not attending Governing Body meetings for three consecutive


illness);

v) Failing to disclose a pecuniary interest regarding matters under





vi) Where continuation in the role is not in the interests of either







2.2.10 The Lead GP for the Nottingham and Nottinghamshire Clinical Design

Authority as listed in paragraph 5.5.3 a) of the CCG’s Constitution, is

subject to the following appointment process:


medical services for a Member Practice within the geographical Area

covered by the CCG may apply for this role when advertised.

b) Appointment process – Appointments will be made as a result of a

formal competency assessment and interview process.





d) Eligibility for reappointment – This appointment will be eligible for

reappointment at the end of each term of office, subject to






80


whether consecutively or otherwise.




Committee;





practice;



illness);













2.2.11 The GPs drawn from Member Practices, as listed in paragraph 5.5.3 b) of

the CCG’s Constitution, are subject to the following appointment process:


medical services for a Member Practice within the relevant

geographical Place may nominate themselves for these roles when

advertised.

b) Appointment process – Appointments will be made as a result of:

i) A formal competency assessment and interview process; and

ii) Subsequent election by the Member Practices within the

relevant geographical Place if more than one candidate is

successful following interview.



81

The election will be on the basis of one vote per Member

Practice. The Nottinghamshire Local Medical Committee may

be requested to co-ordinate this process. The candidate who

receives a simple majority of votes cast will be considered

elected as GP Representative. If all candidates receive the

same number of votes, then the matter will be resolved by the

interview panel.

iii) If there is only one successful candidate following interview,

then that person will be automatically selected as the

successful candidate. The results will be communicated to

Member Practices within the relevant geographic Place.





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 2.2.11 a) and 2.2.11 b). The 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

the 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.


whether consecutively or otherwise, as long as the individuals

continue to have the support of the CCG’s Member Practices.




Committee;





practice;



illness);



82













2.2.12 The Chief Commissioning Officer as listed in paragraph 5.5.3 f) of the

CCG’s Constitution, is subject to the following appointment process:

a) Nominations and eligibility – Any individual with the necessary

qualifications, expertise and experience to lead the commissioning

function of the CCG may apply for this role when advertised.

b) Appointment process – This appointment will be subject to national



accordance with the Chief Commissioning Officer’s contract of

employment.


2.2.13 Where the CCG appoints an individual to a key role, in addition to those

set out above, to support the operation of a CCG or Governing Body

Committee or Sub-Committee, the following appointment process will be

followed:

a) Nominations and eligibility – Any individual with the expertise and

experience as required by the relevant role description can apply for

these roles when advertised.

b) Appointment process – These appointments will be made on the






d) Eligibility for reappointment – These appointments will be eligible

for reappointment at the end of each term of office, subject to




83






Committee;

ii) Ceasing to fulfil the eligibility criteria for the role;

iii) Not attending Committee or Sub-Committee meetings for three

consecutive months (except under extenuating circumstances,

such as illness);

iv) Failing to disclose a pecuniary interest regarding matters under



excluded from appointment to the Committee or Sub-

Committee in line with standing order 2.2.3; or

v) Where continuation in the role is not in the interests of either



written notice to the CCG’s lead for governance. However, where

any of the grounds for removal from office apply, as set out at

standing order 2.2.13 e) above, notice shall be as considered

appropriate in the circumstances.

3 Member Practice Meetings and Decision Making

3.1 Member Practice Meetings

3.1.1 Meetings of the CCG’s membership, either as a whole or on a

geographical Place basis (“Member Practice Meetings”) will be held on at

least an annual basis at such times and places as the CCG may

determine.

3.1.2 Every person who is employed or engaged as a healthcare professional

by a Member Practice as at the date of the relevant Member Practice

Meeting shall be entitled to attend and speak at a Member Practice

Meeting. However only Member Practice Representatives, or in their

absence their nominated deputies (subject to standing order 3.1.5), will be

entitled to vote at a Member Practice Meeting.

3.1.3 In normal circumstances, Member Practices will be given not less than

one months’ notice in writing of any Member Practice Meetings to be held.

However:



84

a) The CCG’s Clinical Chair may call a Member Practice Meeting at

any time by giving not less than 14 calendar days’ notice in writing.

b) The CCG’s membership may request the Clinical Chair to convene a

Member Practice Meeting by notice in writing to the Clinical 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 Clinical Chair refuses, or fails, to call a Member

Practice Meeting within seven calendar days of such a request being

presented, the Member Practice Representatives signing the

requisition may forthwith call a Member Practice Meeting by giving

not less than 14 calendar days’ notice in writing to all Member

Practices specifying the matters which the petitioners wish to be

considered at the meeting.

3.1.4 Before each Member Practice Meeting, the agenda and any supporting

papers will be circulated to all Member Practices, so as to be available to

Member Practices at least seven calendar days before the date of the

meeting taking place.

3.1.5 A Member Practice Representative who is unable to attend a Member

Practice Meeting is able to nominate a deputy to attend the meeting who

is authorised to cast a vote on behalf of the relevant Member Practice.

3.2 Decision making

3.2.1 The process for Member Practice decision making is set out below:

a) Eligibility: Member Practice Representatives (or their nominated

deputies) will be eligible to cast one vote each on behalf of their

Member Practice.

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 Clinical Chair will have a casting vote.

3.2.2 Decisions may be taken at Member Practice Meetings or conducted

virtually using an electronic voting process. The Nottinghamshire Local

Medical Committee may be requested to co-ordinate the electronic voting

process.

3.2.3 A record will be maintained of the outcome of all resolutions put to a vote.



85

4 Meetings of the Governing Body

4.1 Calling meetings

4.1.1 Ordinary meetings of the Governing Body shall be held at regular intervals

at such times and places as the Governing Body may determine.

4.1.2 In normal circumstances, each member of the Governing Body will be

given not less than one month’s notice in writing of any meeting of the

Governing Body to be held. However:

a) The Clinical Chair may call a meeting at any time by giving not less

than 14 calendar days’ notice in writing.

b) The members of the Governing Body may request the Clinical 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 which the petitioners wish to be

considered at the meeting. If the Clinical Chair refuses, or fails, to

call a meeting within seven calendar days of such a request being

presented, the Governing Body members signing the requisition may

forthwith call a meeting by giving not less than 14 calendar 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 Chair of a meeting

4.2.1 The Clinical Chair shall determine who will preside over meetings of the

Governing Body, with the expectation being that this responsibility will

ordinarily be shared between the Clinical Chair and the Non-Executive

Director who is Deputy Chair of the Governing Body.

4.2.2 If the Clinical Chair is absent, or is disqualified from participating by

reason of a declaration of a conflict of interest, the Deputy Chair of the

Governing Body will preside.

4.2.3 If the Deputy Chair of the Governing Body is absent, or is disqualified from

participating by reason of a declaration of a conflict of interest, and the

Clinical Chair does not decide to preside or is disqualified from doing so,

then a non-executive member of the Governing Body other than the Audit

and Governance Committee Chair shall be chosen by the members

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

4.2.4 The CCG’s Governance Handbook sets out expectations regarding the

chairing of meetings and the agreed delineation of responsibilities

between the Clinical Chair and Deputy Chair of the Governing Body.

4.3 Agenda, supporting papers and business to be transacted

4.3.1 The agenda for each meeting will be drawn up and agreed with the

person presiding over the meeting.



86

4.3.2 Supporting papers for all items need to be submitted at least seven

calendar days before the meeting takes place. The agenda and

supporting papers will be circulated to all members of the Governing Body

at least five calendar days before the date the meeting will take place.

4.3.3 Agendas and papers for meetings open to the public, including details

about meeting dates, times and venues, will be published on the CCG’s

website at [insert link on new CCG’s website].

4.4 Petitions

4.4.1 Where a petition has been received by the CCG, it shall be included as an

item for the agenda of the next meeting of the Governing Body.

4.5 Resolutions of the Governing Body

4.5.1 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 CCG’s lead for governance

at least 14 calendar 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.

4.5.2 Subject to the agreement of the person presiding over the meeting, 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 decision of the person

presiding over the meeting on whether to include the item will be final.

4.6 Chair's ruling

4.6.1 The decision of the person presiding over the meeting on questions of

order, relevancy and regularity and their interpretation of the Constitution,

Standing Orders, Scheme of Reservation and Delegation and Standing

Financial Instructions at the meeting, shall be final.

4.7 Nominated Deputies

4.7.1 With the permission of the person presiding over the meeting, the

Accountable Officer and Chief Finance Officer 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 The decision of person presiding over the meeting regarding authorisation

of nominated deputies is final.

4.8 Quorum

4.8.1 The quorum will be seven members, including:



87

a) Four clinical members (which includes the Clinical Chair, the Lead

GP for the Nottingham and Nottinghamshire Clinical Design

Authority, the GPs drawn from Member Practices, the Secondary

Care Specialist and the Registered Nurse);

b) Two Non-Executive Directors; and

c) Either the Accountable Officer or Chief Finance Officer (or their

deputies authorised in accordance with Standing Order 4.7).

4.8.2 For the sake of clarity:

a) No person can act in more than one capacity when determining the

quorum.

b) Any member of the Governing Body who has been disqualified from

participating in a discussion on any matter and/or from voting on any

motion by reason of a declaration of a conflict of interest, shall no

longer count towards the quorum.

4.8.3 For matters relating to instances where the quorum is not available by

reason of declared conflicts of interests, an alternative quorum of five non-

conflicted members shall apply. This alternative quorum must include at

least one clinical member, one Non-Executive Director and either the

Accountable Officer or Chief Finance Officer (or their deputies authorised

in accordance with Standing Order 4.7). Use of this alternative quorum will

be recorded in the minutes of the meeting.

4.8.4 For matters relating to Governing Body member remuneration, an

alternative quorum of five non-conflicted members shall apply. Use of this

alternative quorum will be recorded in the minutes of the meeting.

4.9 Decision making

4.9.1 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

members will be required, the process for which is set out below:

a) Eligibility – All members of the Governing Body as defined within

paragraphs 5.5.2 (or their deputies authorised in accordance with

Standing Order 4.7) and 5.5.3 of the CCG’s Constitution 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 additional attendees at the Governing

Body meetings (as detailed within paragraph 5.6.1 of the CCG’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.



88

c) Casting vote – If an equal number of votes are cast for and against

a resolution, then the Clinical Chair (or in their absence, the person

presiding over the meeting) will have a second and 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.

4.9.3 Where a decision of materiality is required (see paragraph 1.4.2 a) of the

CCG’s Constitution), the Accountable Officer will have the final deciding

power, subject to seeking advice from the Clinical Chair and the Non-

Executive Director who is Deputy Chair of the Governing Body and taking

this into account.

4.10 Urgent decisions

4.10.1 The powers of the CCG which are delegated to, or reserved by, the

Governing Body may for an urgent decision be exercised by the

Accountable Officer and the Clinical Chair having consulted at least one

Non-Executive Director.

4.10.2 The exercise of such powers by the Accountable Officer and the Clinical

Chair shall be reported to the next formal meeting of the Governing Body

for formal ratification.

4.11 Minutes

4.11.1 The names of all members of the Governing Body present shall be

recorded in the minutes of the Governing Body meetings.

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

submitted for agreement at the next meeting where they shall be signed

by the person presiding at it.

4.11.3 No discussion shall take place upon the minutes except upon their

accuracy or where the person presiding over the meeting considers

discussion appropriate.

4.11.4 Minutes shall be circulated in accordance with the reasonable

requirements of each member.

4.11.5 Where providing a record of a meeting held in public the minutes shall be

made available to the public as required by Code of Practice on

Openness in the NHS.

4.12 Admission of public and the press

4.12.1 Subject to Standing Order 4.12.2 below, meetings of the Governing Body

will be open to the public.

4.12.2 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



89

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.

4.12.3 In the event the public could be excluded from a meeting of the Governing

Body, the CCG shall consider whether the subject matter of the meeting

would in any event be subject to disclosure under the Freedom of

Information Act 2000, and if so, whether the public should be excluded in

such circumstances.

4.12.4 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.

4.12.5 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.

4.12.6 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.

4.12.7 Members of the Governing Body and employee or appointee of the CCG

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

or minutes marked as ‘confidential’ 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 Use of Seal and Authorisation of Documents

5.1 Clinical Commissioning Group’s seal

5.1.1 The CCG may have a seal for executing documents where necessary.

The following individuals or officers are authorised to authenticate its use

by their signature:

a) The Clinical Chair

b) The Accountable Officer

c) The Chief Finance Officer



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5.2 Execution of a document by signature

5.2.1 The following individuals are authorised to execute a document on behalf

of the CCG by their signature:

a) The Clinical Chair

b) The Accountable Officer

c) The Chief Finance Officer

6 Duty to Report Non-Compliance with Standing Orders

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.

6.2 All members of the CCG and staff have a duty to disclose any non-

compliance with these Standing Orders to the Accountable Officer as

soon as possible. If the Accountable Officer is responsible for the non-

compliance, then this should instead be reported to the CCG’s lead for

governance.

7 Suspension of Standing Orders

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

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

these Standing Orders may be suspended at any meeting, provided two-

thirds of CCG or Governing Body members are in agreement.

7.2 A decision to suspend Standing Orders together with the reasons for

doing so shall be recorded in the minutes of the meeting.

7.3 A separate record of matters discussed during the suspension shall be

kept. These records shall be made available to the Audit and Governance

Committee for review of the reasonableness of the decision to suspend

Standing Orders.



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Appendix 6: Standing Financial Instructions

1. Introduction

1.1 General

1.1.1 These Standing Financial Instructions are part of the CCG’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 (as contained within the CCG’s Governance Handbook).

1.1.2 These Standing Financial Instructions identify the financial responsibilities

which apply to the CCG’s employees, Members, Committee and Sub-

Committee members of the CCG and members of the Governing Body

(and its Committees, Sub-Committees, Joint Committees) and persons

working on behalf of the CCG. It is a duty of the Accountable Officer to

ensure that these individuals are notified of, and put in a position to

understand their responsibilities within these Standing Financial

Instructions.

1.1.3 Should any difficulties arise regarding the interpretation or application of

any of the Standing Financial Instructions then the advice of the Chief

Finance Officer, or an Operational Director of Finance, must be sought

before acting. The users of these Standing Financial Instructions should

also be familiar with and comply with the provisions of the CCG’s

Constitution, Standing Orders and Scheme of Reservation and

Delegation.

1.2 Contractors and their employees

1.2.1 Any contractor or employee of a contractor who is empowered by the

CCG to commit the CCG to expenditure or who is authorised to obtain

income shall be covered by these Standing Financial Instructions. It is the

responsibility of the Accountable Officer to ensure that such persons are

made aware of this.

1.3 Non-compliance with Standing Financial Instructions

1.3.1 Failure to comply with the Standing Financial Instructions, Standing

Orders or Scheme of Reservation and Delegation and may be regarded

as a disciplinary matter that could result in dismissal.



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1.3.2 If for any reason these Standing Financial Instructions 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 and Governance

Committee for referring action or ratification. All individuals as defined at

SFI 1.1.2 have a duty to disclose any non-compliance with these Standing

Financial Instructions to the Chief Finance Officer as soon as possible.

1.4 Amendment of Standing Financial Instructions

1.4.1 To ensure that these Standing Financial Instructions remain up-to-date

and relevant, the Chief Finance Officer will review them at least annually.

1.4.2 Following consultation with the Accountable Officer and scrutiny by the

Audit and Governance Committee, the Chief Finance Officer will

recommend amendments, as fitting, to the Governing Body for approval.

1.4.3 As these Standing Financial Instructions are an integral part of the CCG’s

Constitution, any amendment will not come into force until the CCG

applies to NHS England and that application is granted.

1.5 Responsibilities and delegation

1.5.1 The Governing Body exercises financial supervision and control by:

a) Formulating the financial strategy;

b) Requiring the submission and approval of budgets within approved

allocations/overall income;

c) Defining and approving essential features in respect of important

procedures and financial systems (including the need to obtain value

for money); and

d) Defining specific responsibilities placed on members of the

Governing Body and Accountable Officer and employees as

indicated in the Scheme of Reservation and Delegation document.

1.5.2 Within the Standing Financial Instructions, it is acknowledged that the

Accountable Officer is ultimately accountable to the Governing Body and

to the Secretary of State for ensuring that the Governing Body meets its

obligation to perform its functions within the available financial resources.

The Accountable Officer has overall executive responsibility for the CCG’s

activities; is responsible to the Chair and the Governing Body for ensuring

that its financial obligations and targets are met; and has overall

responsibility for the CCG’s system of internal control.

1.5.3 The Accountable Officer and Chief Finance Officer will, as far as possible,

delegate their detailed responsibilities, but they remain accountable for

financial control.

1.5.4 The Chief Finance Officer is responsible for:



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a) Implementing the CCG’s financial policies and for co-coordinating

any corrective action necessary to further these policies;

b) Maintaining an effective system of internal financial control including

ensuring that detailed financial procedures and systems

incorporating the principles of separation of duties and internal

checks are prepared, documented and maintained to supplement

these instructions;

c) Ensuring that sufficient records are maintained to show and explain

the CCG’s transactions, in order to disclose, with reasonable

accuracy, the financial position of the CCG at any time; and, without

prejudice to any other functions of the CCG, and employees of the

CCG, the duties of the Chief Finance Officer include:

i) The provision of financial advice to other members of the

Governing Body and Committees and employees;

ii) The design, implementation and supervision of systems of

internal financial control; and

iii) The preparation and maintenance of such accounts,

certificates, estimates, records and reports as the CCG may

require for the purpose of carrying out its statutory duties.

2 Internal Control and Audit

2.1 Internal Control

2.1.1 The Governing Body is required to establish an Audit and Governance

Committee with terms of reference agreed by the Governing Body (see

section 5.9 of the CCG’s Constitution for further information). An

independent Audit and Governance Committee is a central means by

which a Governing Body ensures effective internal control arrangements

are in place.

2.1.2 The Accountable Officer has overall responsibility for the CCG’s systems

of internal control.

2.1.3 The Chief Finance Officer will ensure that a proper procedure is in place

for regular checking of the adequacy and effectiveness of the internal

financial control environment.

2.2 Internal Audit

2.2.1 Internal Audit is an independent and objective appraisal service within an

organisation, which provides:



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a) An independent and objective opinion to the Accountable Officer, the

Governing Body, and the Audit and Governance Committee on the

degree to which risk management, control and governance, support

the achievement of the organisation’s agreed objectives; and

b) An independent and objective consultancy service specifically to

help line management improve the organisation’s risk management,

control and governance arrangements.

2.2.2 All internal audit services are provided under arrangements proposed by

the Chief Finance Officer and approved by the Audit and Governance

Committee, on behalf of the Governing Body.

2.2.3 Only the Chief Finance Officer may commission the procurement of

internal audit services (including services akin to internal audit services),

having sought the approval of the Audit and Governance Committee.

2.2.4 The Chief Finance Officer is responsible for ensuring that the Internal

Audit function meets the NHS mandatory audit standards and provides

sufficient independent and objective assurance to the Audit and

Governance Committee and the Accountable Officer.

2.2.5 Internal Audit will review, appraise and report upon policies, procedures

and operations in place to:

a) Establish and monitor the achievement of the organisation’s

objectives;

b) Identify, assess and manage the risks to achieving the organisation’s

objectives;

c) Ensure the economical, effective and efficient use of resources;

d) Ensure compliance with established policies (including behavioural

and ethical expectations), procedures, laws and regulations;

e) Safeguard the organisation’s assets and interests from losses of all

kinds, including those arising from fraud, irregularity or corruption;

f) Ensure the integrity and reliability of information, accounts and data,

including internal and external reporting and accountability

processes.

2.2.6 The Head of Internal Audit will provide to the Audit and Governance

Committee:

a) A risk-based plan of internal audit work, agreed with management

and approved by the Audit Committee, based upon the

management’s Assurance Framework that will enable the auditors to

collect sufficient evidence to give an opinion on the adequacy and

effective operation of the organisation;



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b) Regular updates on the progress against plan;

c) Reports of management’s progress on the implementation of action

agreed as a result of internal audit findings;

d) An annual opinion, based upon and limited to the work performed,

on the overall adequacy and effectiveness of the organisation’s risk

management, control and governance processes (i.e. the

organisation’s system of internal control). This opinion is used by the

Governing Body to inform the Annual Governance Statement and by

NHS England as part of its performance management role;

e) Additional reports as requested by the Audit and Governance

Committee.

2.2.7 Whenever any matter arises, which involves, or is thought to involve,

irregularities concerning cash, stores, or other property or any suspected

irregularity in the exercise of any function of a pecuniary nature, the Chief

Finance Officer must be notified immediately.

2.2.8 The Head of Internal Audit will normally attend Audit and Governance

Committee meetings and has a right of access to all Audit and

Governance Committee members, the Chair and Accountable Officer of

the CCG.

2.2.9 The Head of Internal Audit reports to the Audit and Governance

Committee and is accountable to the Chief Finance Officer. The reporting

system for Internal Audit shall be agreed between the Chief Finance

Officer, the Audit and Governance Committee and the Head of Internal

Audit. The agreement shall be in writing and shall comply with the

guidance on reporting contained in the NHS Internal Audit Standards. The

reporting system shall be reviewed at least every three years.

2.3 External Audit

2.3.1 The statutory responsibilities and powers of appointed auditors are set out

in the Local Audit and Accountability Act 2014. The main responsibility of

the CCG’s appointed auditors is to meet the requirements of the National

Audit Office’s Code of Audit Practice.

2.3.2 The External Auditors are required to provide an opinion on the CCG’s

financial statements. This confirms whether the Auditors believe the

financial statements give a true and fair view of the financial affairs of the

CCG and the income and expenditure recorded during the year.

2.3.3 The External Auditors are also required to:



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a) Form a view on the regularity of the CCG’s income and expenditure

i.e. that the expenditure and income included in the CCG’s financial

statements has been applied to the purposes intended by Parliament

and the financial transactions in the financial statements conform to

the authorities which govern them;

b) Report by exception if the CCG has not complied with the

requirements of NHS England in the preparation of its Governance

Statement; and

c) Examine and report on the consistency of the schedules or returns

prepared by the CCG for consolidation into the Whole of

Government Accounts.

2.3.4 The External Auditors will also conclude on the arrangements in place for

securing economy, efficiency and effectiveness (value for money) in the

CCG’s use of resources.

2.3.5 The Chief Finance Officer is responsible for ensuring that the CCG

procures external audit services in accordance with the Local Audit and

Accountability Act 2014 and the relevant national guidance.

2.3.6 The Audit and Governance Committee must ensure a cost-efficient

service. If there are any problems relating to the service provided by the

external auditor these should be raised with the external auditor and

referred to the Audit and Governance Committee if they cannot be

resolved.

2.3.7 The External Auditor will normally attend Audit and Governance

Committee meetings and has a right of access to all Audit and

Governance Committee members, the Chair and Accountable Officer of

the CCG.

3 Fraud, Bribery and Corruption (Economic Crime)

3.1 The Chief Finance Officer is responsible for overseeing and providing

strategic management and support for all counter fraud, bribery and

corruption work within the CCG. All counter fraud, bribery and corruption

services are provided by the Counter Fraud Specialist under

arrangements proposed by the Chief Finance Officer and approved by the

Audit and Governance Committee, on behalf of the Governing Body.

3.2 Only the Chief Finance Officer may commission the procurement of

counter fraud, bribery and corruption services (including services akin to

counter fraud, bribery and corruption services, e.g. post payment

verification), having sought the approval of the Audit and Governance

Committee.



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3.3 The Counter Fraud Specialist will produce an annual assessment of the

effectiveness of counter fraud, bribery and corruption arrangements for

the CCG, in accordance with standards set by NHS Counter Fraud

Authority. The outcome of these assessments will be reported to the Audit

and Governance Committee, including details of action plans to address

areas of weakness or non-compliance.

3.4 All the CCG’s members, employees, members of the Governing Body,

members of the Governing Body’s committees and any persons working

on behalf of the CCG, severally and collectively, are responsible for

ensuring CCG resources are appropriately protected from fraud, bribery

and corruption.

3.5 It will be the duty of any Officer having evidence of, or reason to suspect,

financial or other irregularities or impropriety in relation to these

instructions, (not involving evidence or suspicion of fraud, bribery or

corruption), to report these suspicions to the Chief Finance Officer.

3.6 It will be the duty of any Officer having evidence of, or reason to suspect,

fraud, bribery or corruption to report these suspicions to the CCG’s

nominated Counter Fraud Specialist or via the NHS Counter Fraud

Authority’s confidential fraud, bribery and corruption reporting line.

3.7 Under no circumstances should any Officer commence an investigation

into suspected or alleged crime, as this may compromise any further

investigation.

4 Security Management

4.1 In line with their responsibilities, the CCG’s Accountable Officer will

monitor and ensure compliance with Directions issued by the Secretary of

State for Health on NHS Security Management.

4.2 The CCG shall nominate a suitable person to carry out the duties of the

Local Security Management Specialist (LSMS) as specified by the

Secretary of State for Health guidance on NHS Security Management.

4.3 The Accountable Officer has overall responsibility for controlling and

coordinating security.

5 Resource Limits, Allocations, Planning, Budgets,

Budgetary Control

5.1 Financial Strategy

5.1.1 The Governing Body will approve the financial strategy of the CCG.

5.2 Resource Limits



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5.2.1 The CCG is required by statutory provisions to ensure that its expenditure

does not exceed its Resource Limits as notified by NHS England and any

other sums it has received and is legally allowed to spend. The

Accountable Officer has overall Executive responsibility for ensuring that

the CCG complies with its statutory obligations, including its financial and

accounting obligations, and that it exercise its functions effectively,

efficiently and economically and in a way which provides good value for

money.

5.2.2 The Chief Finance Officer will:

a) Provide reports in the form required by NHS England;

b) Provide regular financial reports in the form agreed by the Governing

Body;

c) Ensure money drawn from NHS England against cash forecasts is

required for approved expenditure only, and is drawn only at the time

of need, following best practice as set out in HMT Managing Public

Money; and

d) Be responsible for ensuring that an adequate system for monitoring

financial performance is in place to enable the CCG to fulfil its

statutory responsibility not to exceed its expenditure limits, as set by

the direction of NHS England.

5.3 Allocations

5.3.1 The Chief Finance Officer will:

a) Periodically review the basis and assumptions used by NHS

England for distributing allocations to the CCG and ensure that these

are reasonable and realistic and secure the CCG’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

c) Regularly update the Governing Body on significant changes to the

initial allocation and the uses of such funds.

5.4 Preparation and Approval of Plans and Budgets

5.4.1 The Accountable Officer will submit to the Governing Body a

Commissioning strategy which explains how it proposes to discharge its

financial duties. The CCG will support this with comprehensive medium

term financial plans and annual budgets, which take into account financial

targets and forecast limits of available resource. These documents will

include:



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a) A statement of the significant assumptions on which the plan is

based; and

b) Details of major changes in workload, delivery of service or

resources required to achieve the plan.

5.4.2 Prior to the start of the financial year the Chief Finance Officer will, on

behalf of the Accountable Officer, prepare and submit Budgets for

approval by the Governing Body. Such budgets will;

a) Be in accordance with the aims and objectives set out in the

Commissioning Strategy;

b) Accord with workload and workforce plans;

c) Be produced following discussion with appropriate Budget Holders;

d) Be prepared within the limits of available funds; and

e) Identify potential risks.

5.4.3 The Chief Finance Officer will monitor and review financial performance

against budget and plan and report to the CCG’s Governing Body. This

report should include explanations for significant variances.

5.4.4 All Budget Holders must provide information as required by the Chief

Finance Officer to enable budgets to be compiled.

5.4.5 All Budget Holders will be required to agree their allocated Budgets at the

commencement of each financial year.

5.4.6 The Chief Finance Officer has a responsibility to ensure that adequate

training is delivered on an on-going basis to Budget Holders to help them

manage their budget successfully.

5.5 Budgetary Delegation

5.5.1 The Governing Body will approve the level of non-pay expenditure on an

annual basis. The Accountable Officer may delegate the management of

a budget to permit the performance of a defined range of activities. This

delegation must be in writing and be accompanied by a clear definition of:

a) The amount of the budget;

b) The purpose(s) of each budget heading;

c) Individual and group responsibilities;

d) Achievement of planned levels of service;

e) The provision of regular reports;

f) The authority to exercise virement

5.5.2 All Budget Holders will agree their allocated Budgets at the

commencement of each financial year.



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5.5.3 Any budgeted funds not required for their designated purpose(s) revert to

the immediate control of the Accountable Officer, subject to any

authorised use of virement.

5.5.4 Non-recurring budgets should not be used to finance recurring

expenditure without the authorisation in writing of the Accountable Officer,

as advised by the Chief Finance Officer.

5.6 Budgetary Control and Reporting

5.6.1 The Chief Finance Officer will devise and maintain systems of budgetary

control. These will include:

a) Regular financial reports to the Governing Body in a form approved

by the Governing Body containing:

i) Income and expenditure to date showing the year to date and

forecast positions;

ii) Explanations of any material variances from budget; and

iii) Details of any corrective action where necessary and the

Accountable Officer's and/or Chief Finance Officer's view of

whether such actions are sufficient to correct the situation.

b) The issue of timely, accurate and comprehensible advice and

financial reports to each Budget Holder, covering the areas for which

they are responsible;

c) Investigation and reporting of variances from budgets;

d) Monitoring of management action to correct variances; and,

e) Arrangements for the authorisation of budget virements.

5.6.2 Each Budget Holder is responsible for ensuring that:

a) Any likely overspend or reduction of income which cannot be met by

virement is not incurred without the prior consent of the Chief

Finance Officer;

b) They review their budget holder pack on a monthly basis and report

any anomalies;

c) The amount provided in the approved Budget is not used in whole or

in part for any purpose other than that specifically authorised subject

to the rules of virement;

d) No permanent employees are appointed without adherence to the

relevant CCG guidance and policy; and



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e) No temporary employees are appointed that cost more than £600

per day (excluding VAT), are engaged for more than 6 months, or

that are in roles of significant influence, without the approval of the

Executive Management Team and NHS England.

5.6.3 The Accountable Officer is responsible for identifying and implementing

cost improvement and income generation initiatives in accordance with

the requirements of the Commissioning Strategy, the QIPP Plan and a

balanced budget.

5.7 Capital Expenditure

5.7.1 The general rules applying to delegation and reporting shall also apply to

capital expenditure.

5.8 Monitoring Returns

5.8.1 The Chief Finance Officer is responsible for ensuring that the appropriate

monitoring forms are submitted to NHS England.

6 Annual Report and Accounts

6.1 The Chief Finance Officer, on behalf of the Governing Body, will:

a) Ensure the preparation of financial returns in accordance with the

accounting policies and guidance given by the Department of Health

and Social Care and HM Treasury, NHS England’s accounting

policies and generally accepted accounting practice;

b) Ensure the preparation and submission of annual financial reports to

NHS England certified in accordance with current guidelines;

c) Ensure the submission of financial returns to NHS England for each

financial year in accordance with the timetable prescribed; and

d) Ensure the CCG considers the external auditor’s management letter

and fully addresses all issues within agreed timescales.

6.2 The CCG will produce an annual report and accounts in accordance with

relevant guidance, which will be audited.

6.3 The CCG’s audited annual report and accounts will be presented to a

public meeting and will be made available to the public, in accordance

with guidelines on local accountability.

7 Banking Arrangements

7.1 General



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7.1.1 The Chief Finance Officer is responsible for ensuring the effective

management of the CCG’s banking arrangements and for advising the

Governing Body on the provision of banking services and operation of

accounts, including the provision and use of procurement or other card

services. This advice will take into account guidance and/or directions

issued from time to time by the NHS England.

7.1.2 In line with Managing Public Money, the CCG should minimise the use of

commercial bank accounts (which require the consent of HM Treasury in

all instances) and consider using the Government Banking Service as its

supplier for all banking services.

7.1.3 The Chief Finance Officer will approve the banking arrangements. Any

new banking arrangements or changes to existing arrangements will be

reported to the next Governing Body meeting.

7.2 Commercial Bank and Government Banking Service Accounts


a) Commercial bank accounts and accounts operated through the

Government Banking Service;

b) Ensuring payments made from commercial banks or Government

Banking Service accounts do not exceed the amount credited to the

account except where arrangements have been made;

c) Reporting to the Governing Body all arrangements made with the

CCG’s bankers for accounts to be overdrawn; and

d) Monitoring of compliance with NHS England guidance on the level of

cleared funds.

7.3 Procurement and Other Card Services

7.3.1 The Chief Finance Officer is responsible for recommending to the

Governing Body, for approval:

a) Whether procurement or other card services should be allowed;

b) For each card service that is associated with a dedicated bank

account, the type of card services that should be allowed on each

account (debit, procurement, etc.); and

c) The types of transactions that should be permitted on each card.

7.3.2 Where the Governing Body has approved the use of card services, the

Chief Finance Officer is responsible for recommending to the Governing

Body for approval:

a) The posts who should be issued with a card, and the type of card;

b) The credit limit to be associated with each card; and



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c) The uses to which the card can be put.

7.3.3 The Chief Finance Officer will ensure that systems are accurately updated

with card transaction details by cardholders to monitor actual use against

authorised use in accordance with the approval given by the Governing

Body.

7.4 Cards Associated with Personal Health Budgets

7.4.1 Any proposal to use a card to pay a personal health budget, which is to be

funded by the CCG, should be raised with the Operational Director of

Finance in the first instance.

7.5 Banking Procedures

7.5.1 The Chief Finance Officer is responsible for ensuring that detailed

instructions on the operation of commercial bank and Government

Banking Service accounts are prepared, which must include:

a) The conditions under which each commercial bank and Government

Banking Service account is to be operated; and,

b) Those authorised to sign payable orders or other orders drawn on

the CCG’s accounts.

7.5.2 For commercial banking arrangements, the Chief Finance Officer will

advise the CCG’s bankers in writing of the conditions under which each

account will be operated.

7.6 Tendering and Review

7.6.1 The Chief Finance Officer will review the commercial banking

arrangements of the CCG at intervals not exceeding five years, to ensure

they reflect best practice and represent best value for money. This will

include seeking competitive tenders for all the CCG’s commercial banking

business.

7.6.2 The results of the tendering exercise should be reported to the Governing

Body.

7.6.3 This review is not necessary for Government Banking Service accounts.

8 Fees and Charges, Payable orders and other Negotiable

Instruments

8.1 Income Systems

8.1.1 The CCG will seek to maximise its potential to raise additional income

only to the extent that it does not interfere with the performance of the

CCG or its functions.



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8.1.2 The Chief Finance Officer is responsible for ensuring systems are in place

for the proper recording, invoicing, and collection and coding of all monies

due.

8.1.3 The Chief Finance Officer is also responsible for ensuring systems are in

place for the secure handling and prompt banking of all payable orders

and negotiable instruments received.

8.1.4 The Chief Finance Officer will arrange to register with HM Revenue and

Customs if required under money laundering legislation.

8.2 Fees and Charges

8.2.1 The Chief Finance Officer is responsible for approving and regularly

reviewing the level of all fees and charges other than those determined by

NHS England or by statute. Independent professional advice on matters

of valuation should be taken as necessary.

8.2.2 Where sponsorship income (including items in kind such as subsidised

goods or loans of equipment) is considered, the guidance in the

Department of Health and Social Care’s Commercial Sponsorship –

Ethical Standards in the NHS should be followed.

8.2.3 All employees and other workers must inform the Finance team, in

accordance with notified procedures, promptly of money due arising from

transactions which they initiate/deal with, including all contracts, leases,

tenancy agreements and other transactions.

8.3 Debt Recovery


for the timely recovery of all outstanding debts.

8.3.2 Where it is necessary to use the services of a professional debt recovery

agency and/or the courts to recover an outstanding debt, the CCG will

seek to recover the associated costs from the debtor concerned.

8.3.3 Income not received should be dealt with in accordance with losses

procedures.

8.3.4 Overpayments should be detected (or preferably prevented) and recovery

initiated.

8.4 Security of Payable Orders, Petty Cash and Other Negotiable

Instruments


a) Approving the form of all receipt books, agreement forms, or other

means of officially acknowledging or recording monies received or

receivable;

b) Ordering and securely controlling any such stationery;



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c) The provision of adequate facilities and systems for employees

whose duties include collecting and holding cash, including the

provision of safes or lockable cash boxes and the procedures for

keys;

d) Prescribing systems and procedures for handling cash and

negotiable securities on behalf of the CCG.

8.4.2 Official money shall not, under any circumstances, be used for the

encashment of private cheques or IOUs.

8.4.3 All cheques, postal orders, cash etc., shall be banked intact.

Disbursements shall not be made from cash received, except under

arrangements approved by the Chief Finance Officer.

8.4.4 The holders of safe keys shall not accept unofficial funds for depositing in

their safes unless such deposits are in special sealed envelopes or locked

containers. It shall be made clear to the depositors that the CCG is not to

be held liable for any loss, and written indemnities must be obtained from

the organisation or individuals absolving the CCG from responsibility for

any loss.

9 Terms of Service, Allowances and Payment of Members,

Employees, Volunteers, Off Payroll Workers, Non-

Executive Directors and Non-Employed Officers

9.1 Remuneration and Terms of Service

9.1.1 The Governing Body is required to establish a Remuneration and Terms

of Service Committee with terms of reference agreed by the Governing

Body (see section 5.9 of the CCG’s Constitution for further information).

9.2 Funded Establishment

9.2.1 The workforce plan incorporated within the annual Budget will form the

funded establishment.

9.2.2 The funded establishment of any department may not be varied without

the approval of the Accountable Officer.

9.3 Staff Appointments

9.3.1 No officer or Member of the Sub-Committee, or Member of the CCG’s

Governing Body or employee may engage, re-engage, or re-grade

employees, either on a permanent or temporary nature, or hire agency

staff, or agree to changes in any aspect of remuneration:

a) Unless authorised to do so by the Accountable Officer; and

b) Within the limit of their approved budget and funded establishment.



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9.3.2 The Governing Body will approve procedures presented by the

Accountable Officer for the determination of commencing pay rates,

condition of service, etc., for employees

9.4 Contracts of Employment

9.4.1 The Governing Body shall delegate responsibility to an officer for:

a) Ensuring that all employees are issued with a contract of

employment in a form approved by the Governing Body and which

complies with employment legislation; and

b) Dealing with variations to, or termination of, contracts of

employment.

9.5 Processing Payroll


a) Specifying timetables for submission of properly authorised time

records (where applicable) and other notifications;

b) The final determination of pay and allowances;

c) Making payment on agreed dates;

d) Agreeing method of payment.

9.5.2 The Chief Finance Officer will issue instructions regarding:

a) Verification and documentation of data;

b) The timetable for receipt and preparation of payroll data and the

payment of employees and allowances;

c) Maintenance of subsidiary records for superannuation, income tax,

social security and other authorised deductions from pay;

d) Security and confidentiality of payroll information;

e) Checks to be applied to completed payroll before and after payment;

f) Authority to release payroll data under the provisions of the Data

Protection Act;

g) Methods of payment available to various categories of employee and

officers;

h) Procedures for payment by cheque, bank credit, or cash to

employees and officers;

i) Procedures for the recall of cheques and bank credits;

j) Pay advances and their recovery;

k) Maintenance of regular and independent reconciliation of pay control

accounts;



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l) Separation of duties of preparing records and handling cash;

m) A system to ensure the recovery from those leaving the employment

of the CCG of sums of money and property due by them to the CCG.

9.5.3 Appropriately nominated managers and Committee members have

delegated responsibility for:

a) Submitting time records (where applicable), and other notifications in

accordance with agreed timetables;

b) Completing time records and other notifications in accordance with

the Chief Finance Officer’s instructions and in the form prescribed by

the Chief Finance Officer;

c) Notifying the Human Resources department of any changes to

contracts using the Change of Circumstances form;

d) Notifying the Human Resources department of any new starters

using the New Starter form, and ensure other relevant actions are

completed;

e) Maintaining leave (carer’s, parental etc.) and sickness records for all

staff on the Electronic Staff Record (ESR);

f) Submitting termination forms in the prescribed form immediately

upon knowing the effective date of an employee's or officer’s

resignation, termination or retirement.

9.5.4 Where an employee fails to report for duty or to fulfil sub-committee

obligations in circumstances that suggest they have left without notice, the

Chief Finance Officer must be informed immediately.

9.5.5 Regardless of the arrangements for providing the payroll service, the

Chief Finance Officer will ensure that the chosen method is supported by

appropriate (contracted) terms and conditions, adequate internal controls

and audit review procedures, and that suitable arrangements are made for

the collection of payroll deductions and payment of these to appropriate

bodies.

10 Revenue Expenditure, Commercial, Procurement and

Payments

10.1 Undertaking revenue expenditure

10.1.1 All expenditure must be approved prior to the commitment being entered

into. The approval routes differ according to the value and type of

expenditure. The delegated financial limits are set out in these Standing

Financial Instructions at section 21 below.



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10.1.2 The Associate Director of Procurement and Commercial Development

will 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 into the

detailed CCG policies. Limits will be reviewed at least annually.

10.1.3 These requirements should be read in conjunction with the CCG

Procurement Policy and the Terms of Reference of the relevant approval

Committees or groups.

10.1.4 All officers must procure, commission and contract manage goods,

services and works in accordance with the CCG Procurement Policy and

ensure that expenditure complies with the principles and guidance stated

in HM Treasury Managing Public Money (2015). This requires all public-

sector organisations to demonstrate Value for Money, which includes both

financial and non-financial aspects, for their expenditure.

10.1.5 For all revenue expenditure, budget holders must ensure that:

a) They have approval to commit CCG resources before undertaking

procurement. Approval is either provided by an individual with the

appropriate authority approving the expenditure (for lower value

expenditure) or a business case which has been reviewed and

approved by the appropriate committee;

b) They seek quotes / tenders for the procurement of goods, services

or works in a legally compliant manner as set out in the Procurement

Policy that ensures the best value for the CCG;

c) Firms / individuals invited to tender (and where appropriate; quote)

are first selected from the approved lists and/or framework

agreements. Where no such list or agreement exists then the advice

of the Associate Director of Procurement and Commercial

Development should be sought ;

d) They adhere to the rule of aggregation, as detailed in the CCG

Procurement Policy, when identifying the total value of the contracts.

Budget holders must not split purchase orders and contracts to avoid

procurement thresholds. Suspected disaggregation will be

investigated and may lead to disciplinary action, as detailed in SFI

1.3.1; and

e) They set the length of the proposed contract following a rigorous

assessment of service need and value for money. Arbitrarily setting

the length of a contract to avoid control processes will be subject to

disciplinary action as set out in SFI 1.3.1.



https://www.gov.uk/government/publications/managing-public-money

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f) All business cases and contract awards should be based on the

whole life of the contract. This should include the cost of any

extension periods and irrecoverable VAT. They should exclude

recoverable VAT.

g) No commitment to expenditure, either verbal or written, should be

made without appropriate approvals. This includes variations and/or

extensions to contracts which must consider the whole life value of a

contract.

10.2 Planning a Procurement Project

10.2.1 All budget holders are required to:

a) Keep the Associate Director of Procurement and Commercial

Development apprised of future procurement activity;

b) Prepare all business cases in sufficient time to allow timely

approvals and procurement activity;

c) Plan well in advance of a contract ending;

d) Ensure the replacement procurement process is completed in

sufficient time; and

e) Ensure competition is undertaken on all relevant expenditure in line

with the Procurement policy.

10.2.2 Budget holders are accountable for any procurement activity in their area.

10.2.3 The Associate Director of Procurement and Commercial Development will

support budget holders and provide assurance to the budget holders over

compliance of procurement activity.

10.3 Contract Variations and Extensions

10.3.1 All extensions and variations to an existing contract must be reviewed to

confirm that they are legally possible they represent best value for money,

including financial and non-financial aspects, and they are not being

instigated solely to avoid or delay the requirement to conduct

procurement.

10.3.2 Extensions to existing contracts can only be approved where:

a) The terms and conditions of the contract make provision for an

extension;

b) Contract performance is satisfactory; and

c) All extensions and variations must be agreed, documented, signed

and countersigned by all parties or executed as a deed where

necessary.

10.4 Competition Waiver



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10.4.1 Competition Waivers should be avoided and only utilised in line with the

exemptions provided for in the CCG Procurement Policy.

10.4.2 The waiving of competitive tendering procedures should not be used to

deliberately avoid competition or for administrative convenience or to

award further work to a provider originally appointed through a competitive

procedure where this would breach the procurement regulations.

10.4.3 Approval of requests for Competition Waiver shall be in accordance with

the CCG Scheme of Reservation and Delegation.

10.4.4 All competition waivers are required to be reported retrospectively to the

Audit and Governance Committee.

10.5 Segregation of Duties

10.5.1 Officers must ensure that effective segregation of duties is maintained at

all times throughout the procurement process. This means that the same

officer cannot both requisition and approve the procurement of any goods,

services or works. This applies to transactions undertaken via purchase

orders or on a non-purchase order basis.

10.5.2 Any officer who requisitions and approves the same transaction will face

disciplinary action in accordance with SFI 1.3.1.

11 Capital Investment, Private Finance, Asset Register and

Security of Assets

11.1 Capital Investment


a) Ensuring 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) Ensuring that there are processes in place for the management of all

stages of capital schemes, that will ensure that schemes are

delivered on time and to cost; and

c) Ensuring that capital investment is not authorised without evidence

of availability of resources to finance all revenue consequences.

11.1.2 For every capital expenditure proposal the Chief Finance Officer is

responsible for ensuring there are processes in place to ensure that a

business case is produced setting out:

a) An option appraisal of potential benefits compared with known costs

to determine the option with the highest ratio of benefits to costs;

b) Appropriate project management and control arrangements.



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11.1.3 For every capital expenditure proposal the Chief Finance Officer shall

certify professionally to the costs and revenue consequences detailed,

involving appropriate CCG personnel and external agencies in the

process.

11.1.4 For a capital investment where the contract stipulates stage payments,

the Chief Finance Officer is responsible for ensuring there are processes

in place for their management.

11.1.5 The Chief Finance Officer is responsible for ensuring there are processes

in place for the issue of procedures for the regular reporting of

expenditure and commitment against authorised expenditure.

11.1.6 The approval of a capital programme does not constitute approval for

expenditure on any scheme included within that programme.

11.1.7 The Accountable Officer shall issue to the manager responsible for the

scheme:

a) Specific authority to commit expenditure;

b) Authority to proceed to tender; and

c) Approval to accept a successful tender.

11.1.8 The Chief Finance Officer shall issue procedures governing the financial

management, including variations to contract, of capital investment

projects and valuation for accounting purposes.

11.2 Private Finance

11.2.1 The CCG should test for PFI when considering capital procurement.

When the CCG proposes to use finance, which is to be provided other

than through its allocations, the following procedures will apply:

a) The Chief Finance Officer shall demonstrate that the use of private

finance represents value for money and genuinely transfers

significant risk to the private sector;

b) Where the sum involved exceeds delegated limits, the business

case must be referred to the Department of Health and Social Care

or in line with any current guidelines

c) Any PFI proposal must be specifically agreed by the Governing

Body.

11.3 Asset Registers

11.3.1 The Accountable Officer is responsible for the maintenance of the register

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 register to be

conducted periodically.



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in place to define the items of equipment which will be recorded on the

capital asset register.

11.3.3 Additions to the fixed asset register must be clearly identified to an

appropriate Budget Holder and be validated by reference to:

a) Properly authorised and approved agreements, architect's

certificates, supplier's invoices and other documentary evidence in

respect of purchases from third parties;

b) Stores, requisitions and wages records for own materials and labour

including appropriate overheads; or,

c) Lease agreements in respect of assets held under a finance lease

and capitalised.

11.3.4 Where capital assets are sold, scrapped, lost or otherwise disposed of,

their value must be removed from the accounting records and each

disposal must be validated by reference to authorisation documents and

invoices (where appropriate).

11.3.5 The Chief Finance Officer shall approve procedures for reconciling

balances on fixed asset and inventory accounts in ledgers against

balances on fixed asset registers.

11.3.6 Land and buildings will be held at values in accordance with the CCG’s

accounting policies which comply with the HM Treasury Financial

Reporting Manual.

11.3.7 The value of each asset will be depreciated using methods and rates as

specified in the CCG’s accounting policies which comply with the HM

Treasury Financial Reporting Manual. Estimated useful lives and

depreciation rates of assets will be reviewed on an annual basis.

11.3.8 Budget Holders will ensure that the respective assets for their areas are

physically checked annually.


in place to maintain an up to date register of properties owned or leased

by the CCG. This should include details of location, tenancy (where

appropriate), and custody of the deeds and lease documents.

11.4 Security of Assets

11.4.1 The overall control of fixed assets is the responsibility of the Accountable

Officer.

11.4.2 Asset control procedures (including fixed assets, cash, cheques and

negotiable instruments, inventories and donated assets) must be

approved by the Chief Finance Officer. These procedures should make

provision for:



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a) Recording managerial responsibility for each asset;

b) Identification of additions and disposals;

c) Identification of all repairs and maintenance expenses;

d) Physical security of assets;

e) Periodic verification of the existence of, condition of, and title to,

assets recorded;

f) Identification and reporting of all costs associated with the retention

of an asset; and

g) Reporting, recording and safekeeping of cash, payable orders, and

negotiable instruments.

11.4.3 All discrepancies revealed by verification of physical assets to fixed asset

or inventory registers should be notified to the Chief Finance Officer.

11.4.4 Whilst each employee and officer has a responsibility for the security of

property of the CCG, it is the responsibility of Governing Body, Committee

members and senior employees in all disciplines to apply such

appropriate routine security practices in relation to NHS property as may

be determined by the Governing Body. Any breach of agreed security

practices must be reported in accordance with agreed procedures.

11.4.5 Any damage to the CCG’s premises, vehicles and equipment or any loss

of equipment or supplies should be reported by Officers in accordance

with the agreed procedure for reporting losses.

11.4.6 Where practical, assets should be marked as CCG property.

11.5 Property Solutions

11.5.1 Unless the Chief Finance Officer very exceptionally agrees otherwise, all

CCG property requirements should be provided by/through NHS Property

Services Limited or Community Health Partnerships Limited or relevant

successor body.

11.5.2 Any perceived requirement for a new property contract should be

discussed with the Chief Finance Officer or an Officer nominated by him in

the first instance.

12 Payment of Accounts

12.1 System of Payment and Payment Verification


for the prompt payment of accounts and claims.



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12.1.2 Payment should normally be made by bank credit transfer. Payment by

other methods should only occur with the approval of Employees

nominated by the Chief Finance Officer.

12.1.3 Payment of contract invoices should be in accordance with contract terms.

All payments should comply with the Government's policy on prompt

payment.


for the design and maintenance of a system for the verification, recording

and payment of all accounts payable by the CCG. This system will

provide for:

a) A list of employees authorised to certify requisitions and invoices;

b) Certification that:

i) Goods have been duly received, examined, are in accordance

with specification and order, are satisfactory and that the prices

are correct;

ii) Work done or services rendered have been satisfactorily

carried out in accordance with the order, and, where applicable,

the materials used were of the requisite standard and that the

charges are correct;

iii) In the case of contracts based on the measurement of time,

materials or expenses, the time charged is in accordance with

the time sheets, that the rates of labour are in accordance with

appropriate rates, that the materials have been checked with

regard to quantity, quality and price and that the charges for the

use of vehicles, plant and machinery have been examined;

iv) Where appropriate, the expenditure is in accordance with

regulations and that all necessary authorisations have been

obtained;

v) The account is arithmetically correct; and

vi) The account is in order for payment.

c) A timetable and system for submission of accounts for payment,

including provision for early settlement of accounts subject to

settlement discount or otherwise requiring early settlement;

d) Instructions to Officers regarding the handling and payment of

accounts within the Finance Directorate.

12.1.5 Where an employee certifying accounts relies upon other employees to do

preliminary checking, the employee certifying accounts will ensure that

those who check delivery or execution of work, act independently of those

who have placed orders and negotiated prices and terms.



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12.2 Prepayments

12.2.1 Prepayments which fall outside of normal business practice (advance

payments) are only permitted in exceptional circumstances, and require

the approval of the Chief Finance Officer. In such instances:

a) The financial advantages must outweigh the disadvantages.

b) The appropriate budget holder must provide a case setting out all

relevant circumstances of the purchase. This must set out the

effects on the CCG if the supplier is, at some time during the course

of the advance payment agreement, unable to meet their

commitments.

c) The Chief Finance Officer will need to be satisfied with the proposed

arrangements before contractual arrangements proceed.

d) The Budget Holder is responsible for ensuring that all items due

under an advance payment contract are received and must

immediately inform the Chief Finance Officer if problems are

encountered.

13 Stores and Receipt of Goods

13.1 General Position

13.1.1 Stores (defined as stock or inventory), should be:

a) Kept to a minimum

b) Subjected to annual stock take; and

c) Valued at the lower of cost and net realisable value.

13.2 Control of Stores, Stocktaking, Condemnations and Disposal

13.2.1 Subject to the responsibility of the Chief Finance Officer for the systems of

control, overall responsibility for the control of stores shall be delegated to

an employee by the Chief Finance Officer. The day-to-day responsibility

may be delegated by him to departmental employees, subject to such

delegation being recorded in the relevant operating framework.

13.2.2 The responsibility for security arrangements and the custody of keys for

any stores and locations will be clearly defined in writing by the

designated employee. Wherever practicable, stocks should be marked as

health service property.

13.2.3 The Chief Finance Officer shall set out procedures and systems to

regulate stores including records for receipt of goods, issues, returns to

stores and losses.



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13.2.4 Stocktaking arrangements will be agreed with the Chief Finance Officer

and there will be a physical check covering all items in store at least once

a year.

13.2.5 Where a complete system of stores control is not justified, alternative

arrangements will require the approval of the Chief Finance Officer.

13.2.6 The designated employee will be responsible for a system, approved by

the Chief Finance Officer, for reviewing slow moving and obsolete items

and for condemnation, disposal, and replacement of all unserviceable

articles. The designated employee will report to the Chief Finance Officer

any evidence of significant overstocking and of any negligence or

malpractice. Procedures for the disposal of obsolete stock will follow the

procedures set out for disposal of all surplus and obsolete goods.

14 Disposals and Condemnations

14.1 Where the CCG has ownership of assets, the Chief Finance Officer must

prepare detailed procedures for any disposal or condemnation, and

ensure these are notified to managers.

14.2 When it is decided to dispose of a CCG asset, the Budget Holder or

authorised deputy will determine and advise the Chief Finance Officer of

the estimated market value of the item, taking account of professional

advice where appropriate.

14.3 All unserviceable articles should be:

a) Condemned or otherwise disposed of by an employee authorised for

that purpose by the Chief Finance Officer; and

b) Recorded by the condemning employee in a form approved by the

Chief Finance Officer which will indicate whether the articles are to

be converted, destroyed or otherwise disposed of. All entries should

be confirmed by the countersignature of a second employee

authorised for the purpose by the Chief Finance Officer.

14.4 The condemning employee should satisfy himself as to whether or not

there is evidence of negligence in use and should report any such

evidence to the Chief Finance Officer who will take appropriate action.

15 Losses and Special Payments

15.1 General



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15.1.1 Losses and Special payments are items that parliament would not have

contemplated when it agreed funds for NHS bodies or passed legislation.

By their nature, they are items that ideally should not arise. They are

therefore subject to special control procedures compared to the generality

of payments, and special notation in the accounts to bring them to the

attention of parliament.

15.1.2 The Chief Finance Officer must prepare procedural instructions on the

recording of and accounting for losses and special payments.

15.1.3 A loss, write off or special payment will always require HM Treasury

approval, irrespective of value, if it:

a) Involves important questions of principle;

b) Raises doubts about the effectiveness of existing systems;

c) Contains lessons which might be of wider interest;

d) Is novel or contentious;

e) Might create a precedent for other organisations in similar

circumstances; or

f) Arose because of obscure or ambiguous instructions issued

centrally.

15.1.4 All Losses and Special Payments should be reported to the Chief Finance

Officer.

15.2 Losses and Write-Offs

15.2.1 Within limits delegated by the Department of Health and Social Care, all

losses shall be approved by the Chief Finance Officer or nominated

deputy.

15.2.2 Managing Public Money defines losses as including, but not limited to:

a) Cash losses (physical loss of cash and its equivalents, e.g. credit

cards, electronic transfers);

b) Bookkeeping losses ( including missing items or inexplicable or

erroneous debit balances);

c) Exchange rate fluctuations;

d) Losses of pay, allowances and superannuation benefits paid to

Employees (including Overpayments due to miscalculation,

misinterpretation or missing information; unauthorised issue; and,

other causes);

e) Losses arising from overpayments;

f) Losses from failure to make adequate charges;



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g) Losses of accountable stores (through fraud, theft, arson, other

deliberate act or other cause);

h) Fruitless payments and constructive losses; and

i) Claims waived or abandoned (including bad debts).

15.2.3 Losses that are subject to insurance cover should be accounted for on a

net basis (i.e. after any insurance payout).

15.2.4 Fruitless payments include payments for rail fares and hotels that are not

required but could not be cancelled without a partial or full charge being

incurred.

15.2.5 Any employee or officer discovering or suspecting a loss of any kind must

either immediately inform their Director, who must immediately inform the

Accountable Officer and the Chief Finance Officer or inform an officer

charged with responsibility for responding to concerns involving loss. This

officer will then appropriately inform the Chief Finance Officer and/or

Accountable Officer. Where a criminal offence is suspected, the Chief

Finance Officer must immediately inform the police if theft or arson is

involved. In cases of fraud and corruption or of anomalies, which may

indicate fraud or corruption, the Chief Finance Officer must inform the

relevant Local Counter Fraud Specialists.

15.2.6 For losses apparently caused by theft, arson, neglect of duty or gross

carelessness, except if trivial, the Chief Finance Officer must immediately

notify the Governing Body and the External auditor.

15.2.7 The Chief Finance Officer is authorised to take any necessary steps to

safeguard the CCG’s interests in bankruptcies and company liquidations.

15.2.8 For any loss, the Chief Finance Officer should consider whether any

insurance claim could be made.

15.2.9 All write offs in accordance with the NHS Shared Business Services ISFE

contract do not require pre-approval if based on the debt management

policy.

15.2.10 All losses and write offs must be reported to the Audit and Governance

Committee.

15.3 Special Payments

15.3.1 Within limits delegated by the Department of Health and Social Care, all

special payments shall be approved by the Chief Finance Officer or

nominated deputy.

15.3.2 All special severance payments and retention payments require the

approval of the Remuneration and Terms of Service Committee.

15.3.3 Managing Public Money defines special payments as:



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a) Extra-contractual payments: payments which, though not legally due

under contract, appear to place an obligation on a public sector

organisation which the courts might uphold. Typically, these arise

from the organisation’s action or inaction in relation to a contract.

Payments may be extra-contractual even where there is some doubt

about the organisation’s liability to pay, e.g. where the contract

provides for arbitration but a settlement is reached without it. A

payment made as a result of an arbitration award is contractual.

b) Extra-statutory and extra-regulatory payments: are within the broad

intention of the statute or regulation, respectively, but go beyond a

strict interpretation of its terms.

c) Compensation payments: are made to provide redress for personal

injuries (except for payments under the Civil Service Injury Benefits

Scheme), traffic accidents, and damage to property etc. They

include other payments to those in the public service outside

statutory schemes or outside contracts.

d) Special severance payments: are paid to employees, contractors

and others outside of normal statutory or contractual requirements

when leaving employment in public service whether they resign, are

dismissed or reach an agreed termination of contract; and

e) Ex gratia payments: go beyond statutory cover, legal liability, or

administrative rules, including: payments made to meet hardship

caused by official failure or delay; out of court settlements to avoid

legal action on grounds of official inadequacy; and, payments to

contractors outside a binding contract, e.g. on grounds of hardship.

15.4 Losses and Special Payments Register

15.4.1 The Chief Finance Officer is responsible for ensuring that a losses and

special payments register is maintained in which write-off action is

recorded.

15.4.2 The losses and special payments register will take account of the

Parliamentary disclosure requirement to report on losses and special

payments over £300,000 in total.

15.4.3 All losses and special payments will be reported to the Audit and

Governance Committee.

16 Information Technology (IT)

16.1 Responsibilities of the Chief Finance Officer

16.1.1 The Chief Finance Officer, who is responsible for the accuracy and

security of the computerised financial data of the CCG, shall:



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a) Devise and implement any necessary procedures to ensure

adequate (reasonable) protection of the CCG’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 2018;

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.

16.1.2 The Chief Finance Officer shall need to 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.

16.2 Finance Systems

16.2.1 Where computer systems have an impact on corporate financial systems

the Chief Finance Officer shall need to be satisfied that:

a) Systems acquisition, development and maintenance are in line with

corporate policies such as an Information Technology Strategy;

b) Data produced for use with financial systems is adequate, accurate,

complete and timely, and that a management (audit) trail exists;

c) Chief Finance Officer staff have access to such data; and

d) Such computer audit reviews as are considered necessary are being

carried out.

16.2.2 The Chief Finance Officer will satisfy themselves that access to finance

systems is strictly controlled and delegated authorities within system

approved limits are appropriately assigned.

16.2.3 The Chief Finance Officer will ensure that appropriate financial limits are

allocated to users for journal postings to finance systems.



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16.2.4 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.

16.2.5 The Chief Finance Officer will ensure the CCG has suitable financial and

other software to enable the production of management and financial

accounts and to meet the consolidation requirements of NHS England.

17 Information Governance

17.1 The Chief Finance Officer is responsible for the CCG’s computerised

financial data and will devise and implement any necessary procedures to

ensure adequate protection of the CCG’s manual and computer data,

programs and hardware from accidental or intentional disclosure to

unauthorised persons, deletion or modification, theft or damage, having

due regard for the Data Protection Act and any defined NHS-wide security

requirements.

17.2 The Chief Finance Officer is responsible for the accuracy and security of

the computerised payroll data of the CCG in accordance with security

retention and data protection policies.

17.3 The Chief Finance Officer will ensure that adequate controls exist over

data entry, processing, storage, transmission and output to ensure

security, privacy, accuracy, completeness, and timeliness of all CCG

financial systems and data as well as the efficient and effective operation

of the system.

17.4 The Chief Finance Officer will ensure that contracts for computing

services for financial applications with other organisations 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.

17.5 Where another organisation provides a computer service for financial

applications, the Chief Finance Officer will periodically seek assurances

that adequate controls as outlined above are in operation.

17.6 The Chief Finance Officer will ensure that adequate controls exist to

maintain the security, privacy, accuracy and completeness of financial

data sent over transmission networks.

18 Funds Held on Trust, Including Charitable Funds

18.1 Corporate Trustee



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18.1.1 The discharge of the CCG’s corporate trustee responsibilities is distinct

from its responsibilities for exchequer funds and may not necessarily be

discharged in the same manner, but there must still be adherence to the

overriding general principles of financial regularity, prudence and

propriety. Trustee responsibilities cover both charitable and non-charitable

purposes.

18.1.2 The Chief Finance Officer will ensure that each fund which the CCG is

responsible for managing is managed appropriately with regard to its

purpose and to its requirements.

18.2 Accountability to Charity Commission and Secretary of State for

Health and Social Care

18.2.1 The trustee responsibilities must be discharged separately and full

recognition given to the CCG’s dual accountabilities to the Charity

Commission for charitable funds held on trust and to the Secretary of

State for Health and Social Care for all funds held on trust.

18.2.2 The Scheme of Reservation and Delegation makes clear where decisions

regarding the exercise of discretion regarding the disposal and use of the

funds are to be taken and by whom. All Governing Body and sub-

committee members and CCG Officers must take account of that

guidance before taking action.

18.3 Applicability of Standing Financial Instructions to Funds Held on

Trust

18.3.1 In so far as it is possible to do so, most of the sections of these Standing

Financial Instructions will apply to the management of funds held on trust.

19 Retention of Records

19.1 The Accountable Officer is responsible for ensuring systems are in place

to maintain archives for all documents required to be retained in

accordance with Department of Health and Social Care guidelines and

CCG policy.

19.2 Documents held in archives shall be capable of retrieval by authorised

persons.

20 Risk Management and Insurance

20.1 Programme of Risk Management



123

20.1.1 The Accountable Officer will ensure that the CCG has a programme of

risk management, in accordance with current Department of Health and

Social Care assurance framework requirements, which must be approved

by the Governing Body and monitored by the Audit and Governance

Committee.

20.1.2 The programme of risk management shall include;

a) A process for identifying and quantifying risks and potential liabilities;

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 including effective systems of internal

control, cost effective insurance cover, and decisions on the

acceptable level of retained risk;

d) Contingency plans to offset the impact of adverse events;

e) Audit arrangements including; internal audit, clinical audit, health and

safety review;

f) A clear indication of which risks shall be insured; and

g) Arrangements to review the risk management programme.

20.1.3 The existence, integration and evaluation of the above elements will assist

in providing a basis to complete the governance statement within the

annual report and accounts as required by the HM Treasury Financial

Reporting Manual.

20.2 Insurance: General

20.2.1 Insurance will be provided under arrangements proposed by the Chief

Finance Officer.

20.2.2 Only the Chief Finance Officer may commission the procurement of

insurance arrangements.

20.3 Insurance: Risk Pooling Schemes Administered by NHS Resolution

20.3.1 The Governing Body will decide if the CCG will insure through the risk

pooling schemes administered by NHS Resolution or self-insure for some

or all of the risks covered by the risk pooling schemes. If the Governing

Body decides not to use the risk pooling schemes for any of the risk areas

(clinical, property and employers/third party liability) covered by the

scheme this decision shall be reviewed annually.

20.3.2 Where it is possible to insure a risk via the risk pooling arrangements run

by NHS Resolution that will be the only acceptable form of insurance for

that risk. These arrangements do not need the approval of HM Treasury.

20.4 Insurance: Arrangements with Commercial Insurers



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20.4.1 There is a general prohibition on entering into insurance arrangements

with commercial insurers. There are, however, three exceptions when

CCGs may enter into insurance arrangements with commercial insurers.

The exceptions are:

a) Commercial arrangements for insuring motor vehicles owned or

leased by the CCG including insuring third party liability arising from

their use;

b) Where NHS England is involved with a consortium in a Private

Finance Initiative contract and the other consortium members

require that commercial insurance arrangements are entered into;

and

c) Where income generation activities take place these should normally

be insured against all risks using commercial insurance. If the

income generation activity is also an activity normally carried out by

the CCG for NHS purposes the activity may be covered in the risk

pool. Confirmation of coverage in the risk pool must be obtained

from NHS Resolution. In any case of doubt concerning the CCG’s

powers to enter into commercial insurance arrangements, the Chief

Finance Officer shall contact the Department of Health and Social

Care.

20.5 Arrangements to be followed by the Governing Body in Agreeing

Insurance Cover

20.5.1 Where the CCG uses the risk pooling schemes administered by NHS

Resolution, the Chief Finance Officer is responsible for ensuring that the

arrangements entered into are appropriate and complementary to the risk

management programme. The Chief Finance Officer shall ensure that

documented procedures cover these arrangements.

20.5.2 Where the Governing Body decides not to use the risk pooling schemes

administered by NHS Resolution for one or other of the risks covered by

the schemes, the Chief Finance Officer will ensure that the Governing

Body is informed of the nature and extent of the risks that are self-insured

because of this decision. The Chief Finance Officer will draw up formal

documented procedures for the management of any claims arising from

third parties and payments in respect of losses which will not be

reimbursed.

20.5.3 All Risk pooling schemes require scheme members to contribute to the

settlement of claims (the ‘deductible’). The Chief Finance Officer will

ensure documented procedures also cover the management of claims

and payments below the deductible in each case.



125

21 Delegated Financial Limits

Ref Matter delegated Delegated to

1 Management of budgets (responsible for keeping pay

and non-pay expenditure within approved budgets and

retaining income levels)

a) Approval of budgets a) Governing Body

b) Level of delegation to Budget Holders (Executive

Directors)

b) Accountable Officer (AO)

c) Level of delegation to Budget Managers c) Budget Holders (Executive Directors)

d) Responsibility for maintaining expenditure within

approved budgets:

d) As follows:

i) At individual budget level (pay and non-pay) i) Designated Budget Holder/Budget Manager

ii) For all other areas e.g. reserves ii) Chief Finance Officer (CFO)

e) Approval to spend e) Budget Holder/Manager is permitted to incur costs in accordance

with their budgets and authorisation limits (see Section 3 below)

f) Monitoring of financial performance f) CFO and Operational Directors of Finance

g) Virement limits g) Virements within a Budget Holder’s approved budget are permitted

in accordance with virement rules

h) Approval of overspends or reductions in income that

cannot be met by virement

h) CFO

i) Staff establishment changes i) AO

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2 Bank accounts

a) Opening of new (Government Banking Services)

bank accounts

a) Approved by the CFO and reported to the next Governing Body

meeting

b) Notification of changes to banking arrangements, with

the exception of changes in signatories

b) Approved by the CFO and reported to the next Governing Body

meeting

c) Banking procedures c) CFO

3a Revenue spend (corporate) / spend on goods and

services - Limits for requisition and invoice approvals,

includes procurement of professional services i.e. legal

advice, specialist advice, specific projects (all values are

inclusive of VAT irrespective of whether this is

reclaimable or not):

In line with budget management responsibilities (i.e. delegated budgets)

and subject to quoting and tendering as required (see Section 5 below):

a) to £1,000 a) Band 8a and above

b) to £10,000 b) Associate Directors (Band 8d and above)

c) to £50,000 c) Executive Directors

d) to £100,000 d) AO and CFO

e) £100,001 and above e) AO, following Governing Body approval

3b Revenue spend (commissioning and rebate approval)

This covers NHS and non-NHS spend, but excludes the

approval of Continuing Healthcare Packages (see 3c

below).

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Investments:

a) to £50,000 a) AO/CFO and retrospectively reported to the Strategic Commissioning

Committee

b) £50,001 to £500,000 b) Strategic Commissioning Committee

c) £500,001 and above c) Governing Body

Disinvestments:

d) to £500,000 d) Strategic Commissioning Committee

e) £500,001 and above e) Governing Body

3c Continuing healthcare (CHC) individual package

approval (weekly limits) and purchase of

consumables

a) CHC package approval - to £1,500 a) CHC Team (Band 7 and Band 8a)

b) CHC package approval - to £3,000 b) CHC Team (Band 8b)

c) CHC package approval - to £5,000 c) CHC Team (Band 8c)

d) CHC package approval - to £5,001 and above d) Deputy Chief Nurse or Chief Nurse

Patient consumables:

e) Purchase of patient consumables - up to £1,500 e) CAS Team Member (Band 7)

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3d Authorisation of invoices (in Oracle) - relating to

commissioning expenditure under service level

agreements, contracts or partnership agreements.

(this may include non-commissioning expenditure

included within NHS contracts - where this is the case,

ensure appropriate approval from the relevant Budget

Holder as well as the below)

In line with budget management responsibilities (i.e. delegated

budgets) and subject to quoting and tendering as required (see

Section 5 below):

a) to £50,000 a) Contract Manager

b) to £500,000 b) Associate Director

c) to £5,000,000 b) Budget Holder, Operational Director of Finance or Deputy CFO

d) to £20,000,000 c) AO or CFO

e) to £50,000,000 d) AO and CFO

e) £50,000,001 and above e) AO, following Governing Body approval

Continuing healthcare invoices:

f) to £25,000 f) CHC Team (Band 8a or 8b)

g) to £50,000 g) CHC Team (Band 8c)

h) £50,001 and above h) Deputy Chief Nurse or Chief Nurse

Primary care payments:

i) to £50,000 i) NHSE Primary Care Team (Band 8a)

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4 Capital schemes

a) Appointment of architects, quantity surveyors,

consultant engineers and other professional advisors

within EU regulations.

b) Associate Director and above, following consultation with the

Associate Director of Procurement and Commercial Development.

The delegated limits for spend associated with any such

arrangements are as detailed in Section 3a of these Detailed

Financial Limits.

a) Granting, terminating or extending leases with an

annual charge of:

c) The following:

i) to £100,000 i) Executive Director and CFO

ii) £100,001 and above ii) AO, following Governing Body approval

All arrangements are to be developed in conjunction with the Associate

Director of Estates and are subject to prior approval from NHS England/

NHS Property Services Limited (as required).

5a Quotation and tendering limits for non-healthcare

goods, services or works - Limits for quotes and

tenders (all values are inclusive of VAT irrespective of

whether this is reclaimable or not and apply to the total

contract duration):

a) to £25,000 a) Delegated budget holder responsibility

b) £25,001 to £100,000 b) Budget Holders, senior managers and assistant directors to obtain at

least three written competitive quotations

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c) £100,001 and above, but below the Public Contract

Regulation Threshold (see below)

c) Formal tendering process. Advice to be sought from the CCG

Associate Director of Procurement and Commercial Development (as

required).

d) Equal to or above the Public Contract Regulation

Threshold applicable at the time

(As at 1 January 2018, Supplies/Services Value =

£181,302 and Works =£4,551,413)

d) Compliance with the Public Contract Regulations 2015. Advice to be

sought from the CCG Associate Director of Procurement and

Commercial Development

5b Quotation and tendering limits for healthcare services

- Limits for quotes and tenders (all values are inclusive of

VAT irrespective of whether this is reclaimable or not and

apply to the total contract duration):

a) to £100,000 a) Delegated budget holder responsibility

b) £100,001 and above, but below the Public Contract

Regulation Threshold (see below)

b) Formal tendering process. Advice to be sought from the CCG

Associate Director of Procurement Commercial Development (as

required)

c) Equal to or above the Public Contract Regulation Light

Touch Regime Threshold applicable at the time

(As at 1 January 2018 - £615,278)

c) Compliance with the Public Contract Regulations 2015. Advice to be

sought from the CCG Associate Director of Procurement and

Commercial Development

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5c Contract awards

Where the CCG is a single or multi-participant in a contract

for services/works or the purchase of goods, either via

competition or direct award (i.e. waiver of

quotation/tender requirements) the following shall apply:

a) Total contract value/purchase price up to £250,000 a) Contract award approved by two Executive Directors, including either

the AO or CFO

b) Total contract value/purchase price £250,001 to

£1,000,000

b) Contract award approved by the Strategic Commissioning Committee

c) Total contract value/purchase price £1,000,001 and

above

c) Contract award approved by the Governing Body

5d Signing of contracts

Signing of service provision contracts including letters of

intent (the below is based on the lifetime value of the

contract). This includes NHS, independent care

placements, private sector and non-healthcare contracts

a) to £100,000 a) Budget Holders – Executive Directors

b) to £1,000,000 b) CFO

c) to £10,000,000 c) AO

d) £10,000,001 and above d) AO and CFO

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6 Setting of fees and charges

Fees and charges e.g. course fees, private use of NHS

equipment and facilities (photocopying, rooms)

CFO

7a Off-payroll/agency workers

Approval requirements to appointment off-payroll and

agency workers:

a) Less than £400 per day and less than three months

engagement

a) Senior Leadership Team

b) Less than £600 per day and less than six months

engagement

b) Executive Management Team (unless role of significant influence

see e) below)

c) Less than £600 per day and greater than six months

(including where initial arrangements were for less

than six months and have then been extended to

greater than 6 months)

c) Executive Management Team plus NHS England approval

d) More than £600 per day d) Executive Management Team plus NHS England approval

e) Role of significant influence (e.g. AO or Executive

Director)

e) Executive Management Team plus NHS England approval

f) Authority to appoint staff not on the formal

establishment

f) CFO and AO

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7b Personnel and pay: payroll forms

a) Authority to fill funded post within the budgeted

establishment with permanent staff

a) Senior Leadership Team after receipt of Vacancy Control form from

Budget Manager

b) Authority to complete standing data forms effecting

pay, new starters, variations and leavers

b) Budget Holders and Assistant Head of Finance within overall

financial budgets

c) Authority to authorise overtime, travel claims and

study leave and associated expenses

c) Line Managers (in line with policy)

d) Renewal of fixed term contract d) Senior Leadership Team after receipt of Vacancy Control form from

Budget Manager

7c Personnel and pay: other personnel and pay issues

a) Staff Retirement a) In line with Policy

b) Redundancy b) Remuneration and Terms of Service Committee oversight with

approval by Governing Body

c) Dismissal c) In line with Policy

d) Requests for upgrading/re-grading d) In line with procedure

e) Approval of Changes to Allowances paid to

Employees (i.e. Not included within and subject to

Agenda for Change)

e) Remuneration and Terms of Service Committee oversight with

approval by Governing Body

f) Removal Expenses, Excess Rent and House

Purchases

f) AO and CFO

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8 Consultancy expenditure

Approval requirements for consultancy spend:

a) to £49,999 a) Executive Management Team

b) £50,000 and above b) Executive Management Team plus NHS England approval as

necessary.

9 Agreements/Licenses

Headquarters:

a) Preparation and signature of tenancy

agreements/licenses

a) AO and CFO

b) Extensions to existing leases b) AO and CFO

c) Approval of rent calculation c) AO and CFO

Primary Care:

d) Extensions to existing leases – value up to £15,000 d) Associate Director of Estates and CFO

e) Extensions to existing leases – value £15,001 and above e) Primary Care Commissioning Committee

f) Approval of rent calculation – value up to £15,000 f) Associate Director of Estates and CFO

g) Approval of rent calculation – value £15,001 and

above

g) Primary Care Commissioning Committee

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10 Condemnations and disposals

Items obsolete, obsolescent, redundant, irreparable or

cannot be repaired cost effectively

a) With current purchase price up to £250 a) Budget Holder

b) With current purchase price £251 and abvoe b) Senior Manager (Band 8c and above)

c) Disposal of mechanical and engineering plant c) CFO and NHS England/ NHS Property Services

11 Losses, write-offs and compensation

Losses:

a) Losses and Cash (due to theft, fraud, overpayments

and others)

a) CFO or nominated deputy with oversight by the Audit and

Governance Committee

b) Fruitless Payments (including abandoned Capital

Schemes)

b) CFO or nominated deputy with oversight by the Audit and


c) Bad Debts and Claims Abandoned (Private Patients,

Overseas Visitors and Other)

c) CFO or nominated deputy with oversight by the Audit and


d) Damage to buildings, loss of equipment and property

(culpable causes and other causes)

d) CFO or nominated deputy with oversight by the Audit and


Special Payments:

e) Compensation payments made under legal

obligations

e) CFO or nominated deputy with oversight by the relevant Committee

f) Extra Contractual payments to contractors f) CFO or nominated deputy with oversight by the relevant Committee

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g) Ex-gratia payments:

To patients and staff for loss of personal effects

For clinical negligence (negotiated settlements

following legal advice) where the guidance relating to

such payments has been applied

For personal injury claims involving negligence where

legal advice obtained and relevant guidance has been

applied

Other clinical negligence cases and personal injury

claims

Other, except cases of maladministration where there

was no financial loss by the claimant

Maladministration where there was no financial loss by

claimant

g) CFO or nominated deputy with oversight by the relevant Committee

h) Extra statutory and extra regulatory payments

Necessary reporting to the NHS England for “novel,

contentious or repercussive” cases or general lessons

learnt in line with guidance.

h) CFO or nominated deputy with oversight by the relevant Committee

12 Reporting of incidents to the police

a) Where a criminal offence is suspected a) AO or nominated deputy

b) Where fraud is involved

b) In accordance with advice from the CCG’s Local Counter Fraud

Specialist

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13 Petty Cash

a) Petty cash disbursements up to £50 per item a) Designated Budget Holder

b) Petty cash float replenishment up to £500 per week b) Assistant Director of Finance or Assistant Head of Finance

15 Medicines Management

a) Delegated authority to the Nottinghamshire Area

Prescribing Committee (APC) for making £80,000

commissioning decisions on the use of medicines within

the CCG. Decisions will be reviewed through the APC

annual report.

a) APC

b) Approve policies, procedures and position statements

regarding medicines management issues and

pharmacy development

b) Medicines Optimisation Committee

c) Formulate and agree a stance or consensus on

health community wide prescribing and medicines

management issues

c) Medicines Optimisation Committee

16 Management of land, buildings and other assets owned

or leased by the CCG (in conjunction with NHS Property

Services or Community Health Partnerships)

a) Maintenance of Asset Register a) AO

b) Maintaining legal documents of Title (including

Leasehold)

b) AO

c) Inventory for items less than £5,000 c) Budget Managers

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17 Emergency response

The Department of Health and Social Care defines a

major incident as “an event or a situation which threatens

serious damage to human welfare in a place in the UK,

the environment of a place in the UK, or war or terrorism

which threatens serious damage to the security of the

UK.”

The On Call Manager and the Second On Call Manager have

delegated authority to make urgent financial decisions relating to the

CCG within the CCG unit of planning and other NHS organisations

within the health community as appropriate during a major incident.

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Delegation Agreement

1. Particulars

1.1. This Agreement records the particulars of the agreement made between

NHS England and the Clinical Commissioning Group named below.

Area NHS Midlands

Clinical Commissioning Group NHS Nottingham and Nottinghamshire

Clinical Commissioning Group

CCG Representative Amanda Sullivan, Accountable Officer

CCG Address for Notices Birch House, Ransom Wood Business

Park, Southwell Road West,

Rainworth, Mansfield,

Nottinghamshire, NG21 0HJ.

Date of Agreement 1 April 2020

Delegation means the delegation made by NHS

England to the CCG of certain

functions relating to primary medical

services under section 13Z of the NHS

Act and effective from 1 April 2015 (as

amended pursuant to the Delegation)

NHS England Representative Dale Bywater, Regional Director -

Midlands

Local NHS England Team Alison Tonge, Director of

Commissioning - Midlands

NHS England Address for Notices NHS England and Improvement,

Cardinal Square, 10 Nottingham Road,

Derby, DE1 3QT.



1.2. This Agreement comprises:

1.2.1. the Particulars (Clause 1);

1.2.2. the Terms and Conditions (Clauses 2 to 24 and Schedule 1 to

Schedule 6 and Schedule 8 to this Agreement); and

1.2.3. the Local Terms (Schedule 7).

Signed by

Dale Bywater

Regional Director – Midlands

For and on behalf of NHS England

Signed by

Amanda Sullivan

Accountable Officer

NHS Nottingham and Nottinghamshire Clinical

Commissioning Group



Terms and Conditions

A. Introduction

2. Interpretation

2.1. This Agreement is to be interpreted in accordance with Schedule 1

(Definitions and Interpretation).

2.2. If there is any conflict or inconsistency between the provisions of this

Agreement and the provisions of the Delegation, the provisions of the

Delegation will prevail.

2.3. If there is any conflict or inconsistency between the provisions of this

Agreement, that conflict or inconsistency must be resolved according to

the following order of priority:

2.3.1. the Particulars and Terms and Conditions (Clauses 1 to 24

and, in particular, clause 8.7);

2.3.2. Schedule 1 to Schedule 6 and Schedule 8 to this Agreement;

and

2.3.3. Schedule 7 (Local Terms).

2.4. This Agreement and any ancillary agreements it refers to constitute the

entire agreement and understanding between the Parties relating to the

Delegation and supersedes all previous agreements, promises and

understandings between them, whether written or oral, relating to its

subject matter.

3. Background

3.1. NHS England has delegated the Delegated Functions to the CCG under

section 13Z of the NHS Act and as set out in the Delegation.

3.2. Arrangements made under section 13Z of the NHS Act may be made on

such terms and conditions (including terms as to payment) as may be

agreed between NHS England and the CCG.



3.3. This Agreement sets out the arrangements that apply in relation to the

exercise of the Delegated Functions by the CCG.

3.4. For the avoidance of doubt, functions relating to the commissioning of

primary care pharmacy, dental and optical contracts are not delegated to

the CCG under the Delegation. The Delegation relates only to the

delegation and reservation of primary medical services commissioning

functions as set out in this Agreement.

4. Term

4.1. This Agreement has effect from the date set out in paragraph 10 of the

Delegation and will remain in force unless terminated in accordance with

clause 17 (Termination) below.

5. Principles

5.1. In performing their obligations under this Agreement, NHS England and

the CCG must:

5.1.1. at all times act in good faith towards each other;

5.1.2. at all times exercise functions effectively, efficiently and

economically;

5.1.3. act in a timely manner;

5.1.4. share information and best practice, and work collaboratively

to identify solutions, eliminate duplication of effort, mitigate risk

and reduce cost;

5.1.5. at all times observe relevant statutory powers, requirements

and best practice to ensure compliance with applicable laws

and standards including those governing procurement, and

Information Law; and

5.1.6. have regard to the needs and views of the other Party and as

far as is lawful and reasonably practicable, take such needs

and views into account.

B. Role of the CCG

6. Performance of the Delegated Functions



6.1. The role of the CCG will be to exercise the Delegated Functions in the

Area.

6.2. The Delegated Functions are the functions set out in paragraph 12 of the

Delegation and being:

6.2.1. decisions in relation to the commissioning, procurement and

management of Primary Medical Services Contracts, including

but not limited to the following activities:

6.2.1.1. decisions in relation to Enhanced Services;

6.2.1.2. decisions in relation to Local Incentive Schemes

(including the design of such schemes);

6.2.1.3. decisions in relation to the establishment of new

GP practices (including branch surgeries) and

closure of GP practices;

6.2.1.4. decisions about ‘discretionary’ payments;

6.2.1.5. decisions about commissioning urgent care

(including home visits as required) for out of area

registered patients;

6.2.2. the approval of practice mergers;

6.2.3. planning primary medical care services in the Area, including

carrying out needs assessments;

6.2.4. undertaking reviews of primary medical care services in the

Area;

6.2.5. decisions in relation to the management of poorly performing

GP practices and including, without limitation, decisions and

liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in

relation to the performers list);

6.2.6. management of the Delegated Funds in the Area;

6.2.7. Premises Costs Directions Functions;

6.2.8. co-ordinating a common approach to the commissioning of

primary care services with other commissioners in the Area

where appropriate; and

6.2.9. such other ancillary activities that are necessary in order to

exercise the Delegated Functions.



6.3. Schedule 2 (Delegated Functions) sets out further detail in relation to the

Delegated Functions and the exercise of such Delegated Functions.

6.4. The CCG agrees that it must perform the Delegated Functions in

accordance with:

6.4.1. the Delegation;

6.4.2. the terms of this Agreement;

6.4.3. all applicable Law;

6.4.4. the CCG’s constitution;

6.4.5. Statutory Guidance; and

6.4.6. Good Practice.

6.4.7. The Primary Medical Care Policy and Guidance Manual (PGM)

issued by NHS England)

6.4A The CCG must have due regard to Guidance and Contractual Notices.

6.5. Without prejudice to clause 6.4, the CCG agrees that it must perform the

Delegated Functions in such a manner as to ensure NHS England’s

compliance with NHS England’s statutory duties in respect of the

Delegated Functions and to enable NHS England to fulfil its Reserved

Functions.

6.6. When performing the Delegated Functions, the CCG will not do anything,

take any step or make any decision outside of its delegated authority as

set out in the Delegation.

6.7. Without prejudice to any other provision in this Agreement, the CCG must

comply with the NHS England central finance team’s operational process

(as such process is updated from time to time) for the reporting and

accounting of the Delegated Funds.

6.8. The decisions of the CCG in exercising the Delegated Functions will be

binding on the CCG and NHS England.



7. Committee

7.1. The CCG must establish a committee to exercise its Delegated

Functions.

7.2. The structure and operation of the committee must be constituted so as

to take into account Guidance issued by NHS England including the

updated Code of Conduct – statutory guidance for CCGs

https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-conflict-

of-interest-guidance-v7.pdf

C. Functions reserved to NHS England

8. Performance of the Reserved Functions

8.1. The role of NHS England will be to exercise the Reserved Functions.

8.2. Subject to clause 8.3, the Reserved Functions are all of NHS England’s

functions relating to primary medical services other than the Delegated

Functions and including those functions set out in paragraph 15 of the

Delegation and being:

8.2.1. management of the national performers list;

8.2.2. management of the revalidation and appraisal process;

8.2.3. administration of payments in circumstances where a

performer is suspended and related performers list

management activities;

8.2.4. Capital Expenditure Functions;

8.2.5. Section 7A Functions;

8.2.6. functions in relation to complaints management;

8.2.7. such other ancillary activities that are necessary in order to


8.3. For the avoidance of doubt, the Parties acknowledge that the Delegation

may be amended, and additional functions may be delegated to the CCG,

in which event consequential changes to this Agreement shall be agreed

with the CCG pursuant to clause 22 (Variations) of this Agreement.

8.4. Schedule 3 (Reserved Functions) sets out further detail in relation to the

Reserved Functions.



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https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-conflict-of-interest-guidance-v7.pdf

8.5. To support and assist NHS England in carrying out the Reserved

Functions, the CCG will share information with NHS England in

accordance with section E (Information) below.

8.6. NHS England will work collaboratively with the CCG when exercising the

Reserved Functions, including discussing with the CCG how it proposes

to address GP performance issues.

8.7. If there is any conflict or inconsistency between functions that are named

as Delegated Functions and functions that are named as Reserved

Functions, then such functions shall be interpreted as Reserved

Functions.

8.8. The Parties acknowledge that, as at the date of this Agreement, the CCG

shall provide administrative and management services to NHS England

in relation to certain Reserved Functions and that such administrative and

management services are as follows:

8.8.1. the administrative and management services in relation to the

Capital Expenditure Functions and the Capital Expenditure

Funds as more particularly set out in clauses 13.13 to 13.16;

and

8.8.2. the administrative and management services in relation to the

Section 7A Functions and Section 7A Funds as more

particularly set out in clauses 13.17 to 13.20.

8.9. The Parties further acknowledge that NHS England may ask the CCG to

provide certain administrative and management services to NHS England

in relation to other Reserved Functions as more particularly set out in

clauses 13.21 to 13.23. Such administrative and management services

shall only be provided by the CCG following agreement by the CCG.

8.10. Notwithstanding any arrangement for or provision of administrative or

management services in respect of certain Reserved Functions, NHS

England shall retain and be accountable for the exercise of such

Reserved Functions.



D. Commissioning

9. Monitoring and Reporting – General Requirements

9.1. The CCG must comply with any reporting requirements under:

9.1.1. this Agreement (including, without limitation, as required by

clause 9 (Monitoring and Reporting – General Requirements),

clause 12 (Public Information and Access Targets), clause 13

(Financial Provisions and Liability), clause 14 (Claims and

Litigation) and Schedule 2 Part 1 paragraph 2 (Primary Medical

Services Contract Management) and paragraph 5 (Information

Sharing with NHS England));

9.1.2. the CCG Improvement and Assessment Framework; and

9.1.3. the CCG’s constitution.

9.2. NHS England shall monitor the exercise and carrying out of the

Delegated Functions by the CCG under the terms of this Agreement and

as part of the CCG Improvement and Assessment Framework.

9.3. The CCG will notify NHS England of all primary medical services

commissioning committee meetings at least seven (7) days in advance

of such meetings and NHS England will be entitled to attend such

meetings at its discretion.

9.4. The CCG must provide to NHS England:

9.4.1. all information in relation to the exercise of the Delegated

Functions (including in relation to the Delegation or this

Agreement), (and in such form) as requested by NHS England

from time to time; and

9.4.2. all such information (and in such form), that may be relevant to

NHS England in relation to the exercise by NHS England of its

other duties or functions including, without limitation, the

Reserved Functions.

9.5. Nothing in this Agreement shall affect NHS England’s power to require

information from the CCG under sections 14Z17, 14Z18, 14Z19 and

14Z20 of the NHS Act.



E. Information

10. Information Sharing and Information Governance

10.1. Schedule 4 (Further Information Sharing Provisions) makes further

provision about information sharing and information governance.

10.2. NHS England and the CCG will enter into a Personal Data Agreement

that will describe the processing of Relevant Information that identifies

individuals under this Agreement. A template Personal Data Agreement

is set out in Schedule 4 (Further Information Sharing Provisions).

10.3. Schedule 4 and the Personal Data Agreement:

10.3.1. sets out the relevant Information Law and best practice,

including the requirements of the NHS Digital Data Security

and Protection (DSP) IG Toolkit;

10.3.2. sets out how that law and best practice will be implemented,

including responsibilities of the Parties to co-operate properly

and fully with each other;

10.3.3. identifies the Relevant Information that may be processed,

including what may be shared, under this Agreement;

10.3.4. identifies the purposes for which the Relevant Information may

be so processed and states the legal basis for the processing

in each case;

10.3.5. states who is/are the data controller/s and, if appropriate, the

data processor/s of Personal Data;

10.3.6. sets out what will happen to the Personal Data on the

termination of this Agreement (with due regard to clause 17

(Termination) of the Agreement); and

10.3.7. sets out such other provisions as are necessary for the sharing

of Relevant Information to be fair, lawful and meet best

practice.

10.4. NHS England and the CCG will share all Non-Personal Data in

accordance with Information Law and their statutory powers as set out in

section 13Z3 (for NHS England) and section 14Z23 (for the CCG) of the

NHS Act.



10.5. The Parties agree that, in relation to information sharing and the

processing of Relevant Information under the Delegation and this

Agreement, they must comply with:

10.5.1. all relevant Information Law requirements including the

common law duty of confidence (unless disapplied by statute)

and other legal obligations in relation to information sharing

including those set out in the NHS Act and the Human Rights

Act 1998;

10.5.2. Good Practice; and

10.5.3. relevant guidance (including guidance given by the Information

Commissioner, the Caldicott Principles, the requirements of

the NHS DSP Toolkit to level 2, and guidance issued further to

sections 263 and 265 of the HSCA) and consistent with

guidance issued under section 13S of the NHS Act to

providers.

11. IT inter-operability

11.1. NHS England and the CCG will work together to ensure that all relevant

IT systems operated by NHS England and the CCG in respect of the

Delegated Functions and the Reserved Functions are inter-operable and

that data may be transferred between systems securely, easily and

efficiently.

11.2. The Parties will use their respective reasonable endeavours to help

develop initiatives to further this aim.

12. Public Information and Access Targets

12.1. The CCG must promptly make available to NHS England such

information as is required in respect of the Delegated Functions to ensure

NHS England’s discharge of its statutory duties.

12.2. The CCG must ensure that all new Primary Medical Services Contracts

contain appropriate provisions such that the CCG is able to discharge its

obligations in clause 12.1.



12.3. The CCG must ensure that any information provided under this

Agreement complies with all relevant national data sets issued by NHS

England and NHS Digital

F. General

13. Financial Provisions and Liability

Notification of the Delegated Funds and Adjustments to the Delegated Funds

13.1. NHS England will, in respect of each Financial Year, notify the CCG of

the proportion of the funds allocated to NHS England by the Secretary of

State pursuant to Chapter 6 of the NHS Act and which are to be paid to

the CCG for the purpose of meeting expenditure in respect of the

Delegated Functions for that Financial Year (the “Delegated Funds”).

13.2. Except in relation to pooled funds and subject to the terms of this clause

13 (Financial Provisions and Liability) and, in particular, clause 13.4, the

CCG must use the Delegated Funds to meet expenditure in respect of

the exercise of the Delegated Functions. Without prejudice to the

generality of the foregoing, the CCG must make:

13.2.1. all payments in relation to the Primary Medical Services

Contracts including payments in relation to QOF and

implementing financial adjustments or sanctions (including in

relation to breaches of provider obligations); and

13.2.2. all payments under the Premises Costs Directions.

13.3. NHS England may increase or reduce the Delegated Funds in any

Financial Year, by sending a notice to the CCG of such increase or

decrease:

13.3.1. in order to take into account any monthly adjustments or

corrections to the Delegated Funds that NHS England

considers appropriate (following discussions with the CCG),

including without limitation adjustments following any changes

to the Delegation or Delegated Functions (including changes

pursuant to paragraph 11 or paragraph 30 of the Delegation),

changes in allocations, changes in contracts or otherwise;



13.3.2. in order to comply with a change in the amount allocated to

NHS England by the Secretary of State pursuant to section

223B of the NHS Act;

13.3.3. to take into account any Losses arising under clause 13.35;

13.3.4. to take into account any Claim Losses;

13.3.5. to take into account any adjustments that NHS England

considers appropriate (including without limitation in order to

make corrections or otherwise to reflect notional budgets) to

reflect funds transferred (or that should have been transferred)

to the CCG in respect of the Delegated Funds and/or funds

transferred (or that should have been transferred) to the CCG

and in respect of which the CCG has management or

administrative responsibility under clauses 13.13 to 13.23 of

this Agreement; or

13.3.6. in order to ensure compliance by NHS England of its

obligations under the NHS Act (including without limitation,

Chapter 6 of the NHS Act) or the HSCA or any action taken or

direction made by the Secretary of State under the NHS Act or

the HSCA.

13.3A NHS England acknowledges that the intention of clause 13.3 is to reflect

genuine corrections and adjustments to the Delegated Funds and may

not be used to change the allocation of the Delegated Funds unless there

are significant or exceptional circumstances that would require such

corrections or adjustments (including but not limited to a change in the

mandate published by the Department of Health or other external

factors).

13.4. The CCG acknowledges that it must comply with its statutory financial

duties, including those under sections 223H and 223I of the NHS Act to

the extent that these sections apply in relation to the receipt of the

Delegated Funds.

13.5. The CCG acknowledges its duty under section 14S of the NHS Act to

assist and support NHS England in discharging its duty under section

13E so far as relating to securing continuous improvement in the quality

of primary medical services and agrees that it shall take this duty into

account in relation to the exercise of the Delegated Functions and the

use of the Delegated Funds.



13.6. The CCG must ensure that it uses the Delegated Funds in such a way as

to ensure that NHS England is able to fulfil its functions, including without

limitation the Reserved Functions, effectively and efficiently in

accordance with this Agreement.

13.7. NHS England may in respect of the Delegated Funds:

13.7.1. notify the CCG of the capital resource limit and revenue

resource limit that will apply in any Financial Year;

13.7.2. notify the CCG regarding the payment of sums by the CCG to

NHS England in respect of charges referable to the valuation

or disposal of assets and such conditions as to records,

certificates or otherwise;

13.7.3. by notice, require the CCG to take such action or step in

respect of the Delegated Funds, in order to ensure compliance

by NHS England of its duties or functions under the NHS Act

or the HSCA (including without limitation, Chapter 6 of the NHS

Act) or any action taken or direction made by the Secretary of

State under the NHS Act or the HSCA (including, without

limitation, Chapter 6 of the NHS Act).

13.8. Schedule 5 (Financial Provisions and Decision Making Limits) sets out

further financial provisions in respect of the exercise of the Delegated

Functions and, in particular, Table 1 in Schedule 5 (Financial Provisions

and Decision Making Limits) sets out certain financial limits and approvals

required in relation to the exercise of the Delegated Functions. NHS

England’s Standing Financial Instructions shall be updated accordingly.

Payment and Transfer

13.9. The CCG acknowledges that the Delegated Funds do not form part of

and are separate to the funds allocated annually under section 223G of

the NHS Act (the “Annual Allocation”).

13.10. NHS England will pay the Delegated Funds to the CCG monthly using

the same revenue transfer process as used for the Annual Allocation or

using such other process as notified to the CCG from time to time.

13.11. Without prejudice to any other obligation upon the CCG, the CCG agrees

that it must deal with the Delegated Funds in accordance with:



13.11.1. the terms and conditions of this Agreement;

13.11.2. the business rules as set out in NHS England’s planning

guidance or such other documents issued by NHS England

from time to time;

13.11.3. any Capital Investment Guidance or Primary Medical Care

Infrastructure Guidance;

13.11.4. any Guidance or Contractual Notice issued by NHS England

from time to time in relation to the Delegated Funds (including

in relation to the form or contents of any accounts in relation to

the Delegated Funds); and

13.11.5. the HM Treasury guidance Managing Public Money (dated July

2013 and found at

https://www.gov.uk/government/uploads/system/uploads/attac

hment_data/file/212123/Managing_Public_Money_AA_v2_-

_chapters_annex_web.pdf).

13.12. Without prejudice to any other obligation upon the CCG, the CCG agrees

that it must provide all information, assistance and support to NHS

England in relation to the audit and/or investigation (whether internal or

external and whether under Law or otherwise) in relation to the use of or

payment of the Delegated Funds and the discharge of the Delegated

Functions.

Administrative and/or Management Services and Funds in relation to the Capital

Expenditure Functions

13.13. The Parties acknowledge that the Capital Expenditure Functions are a

Reserved Function.

13.14. The Parties further acknowledge that:

13.14.1. accordingly, the Delegated Funds do not include any funds in

respect of amounts payable in relation to the Capital

Expenditure Functions (“Capital Expenditure Funds”); and

13.14.2. NHS England remains responsible and accountable for the

discharge of the Capital Expenditure Functions and nothing in

clauses 13.13 to 13.16 shall be construed as a divestment or

delegation of NHS England’s Capital Expenditure Functions.



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13.15. Without prejudice to clause 13.14 above, the CCG will comply with any

Guidance issued in relation to the Capital Expenditure Functions and

shall (on request from NHS England) provide the following administrative

services to NHS England in respect of the Capital Expenditure Funds:

13.15.1. the administration and payment of sums that NHS England has

approved as payable in relation to the Capital Expenditure

Functions;

13.15.2. if requested by NHS England and taking into account (i) any

other support or services provided to NHS England by NHS

Property Services Limited or otherwise and (ii) any Guidance

issued in respect of the Capital Expenditure Functions, the

provision of advice and/or recommendations to NHS England

in respect of expenditure to be made under the Capital

Expenditure Functions; and

13.15.3. such other support or administrative assistance to NHS

England that NHS England may reasonably request in order to

facilitate the discharge by NHS England of its responsibilities

under or in respect of the Capital Expenditure Functions.

13.16. NHS England may, at the same time as it transfers the Delegated Funds

to the CCG under clause 13.10, transfer to the CCG such amounts as

are necessary to enable the discharge of the CCG’s obligations under

this clause 13 (Financial Provisions and Liability) in respect of the Capital

Expenditure Functions.

Administrative and/or Management Services and Funds in relation to Section 7A

Functions

13.17. The Parties acknowledge that the Section 7A Functions are part of the

Reserved Functions.

13.18. The Parties further acknowledge that:

13.18.1. accordingly, the Delegated Funds do not include any funds in

respect of amounts payable in relation to the Section 7A

Functions (whether such arrangements are included in or

under Primary Medical Services Contracts or not) (“Section

7A Funds”); and



13.18.2. NHS England remains responsible and accountable for the

discharge of the Section 7A Functions and nothing in this

clause 13 (Financial Provisions and Liability) shall be

construed as a divestment or delegation of the Section 7A

Functions.

13.19. The CCG will provide the following services to NHS England in respect

of the Section 7A Funds:

13.19.1. the administration and payment of sums that NHS England has

approved as payable under or in respect of arrangements for

the Section 7A Functions; and

13.19.2. such other support or administrative assistance to NHS

England that NHS England may reasonably request in order to

facilitate the discharge by NHS England of its responsibilities

under or in respect of the Section 7A Funds.

13.20. NHS England shall, at the same time as it transfers the Delegated Funds

to the CCG under clause 13.10, transfer to the CCG such amounts as

are necessary to enable the discharge of the CCG’s obligations under

this clause 13 (Financial Provisions and Liability) in respect of the Section

7A Funds.

Administrative and/or Management Services and Funds in relation to other

Reserved Functions

13.21. NHS England may ask the CCG to provide certain management and/or

administrative services to NHS England (from a date to be notified by

NHS England to the CCG) in relation to:

13.21.1. the carrying out of any of the Reserved Functions; and/or

13.21.2. without prejudice to the generality of clause 13.21.1, the

handling and consideration of complaints.

13.22. If NHS England makes such a request to the CCG, then the CCG will, but

only if the CCG agrees to provide such services, from the date requested

by NHS England, comply with:

13.22.1. provisions equivalent to those set out above in relation to the

Capital Expenditure Functions (clauses 13.13 to 13.16) and the



Section 7A Functions (clauses 13.17 to 13.20) including in

relation to the administration of any funds for such functions

but only to the extent that such provisions are relevant to the

management or administrative services to be provided; and

13.22.2. such other provisions in respect of the carrying out of such

management and administrative services as agreed between

NHS England and the CCG.

13.23. If NHS England asks the CCG to provide certain management and

administrative services in relation to the handling and consideration of

complaints and if the CCG agrees to provide such management and

administrative services (with such agreement to be recorded as a

variation pursuant to clause 22 (Variations)) then:

13.23.1. NHS England may, in any Contractual Notice issued by NHS

England in respect of such service (and as referred to in clause

13.22.2), specify procedures and responsibilities of the CCG

and NHS England in relation to such complaints under the

Complaints Regulations and all other Law; and

13.23.2. such Contractual Notice may specify procedures in relation to

the provision of an annual report to the Chief Executive of NHS

England, procedures in relation to the approval of decisions in

relation to complaints and/or the appointment of a responsible

person by NHS England pursuant to the Complaints

Regulations;

13.23.3. such services shall be arrangements made under the

provisions of Regulation 3 of the Complaints Regulations; and

13.23.4. provided that any Contractual Notice issued pursuant to this

clause shall be discussed and agreed with the CCG prior to the

issue of the Contractual Notice by NHS England.

Pooled Funds

13.24. The CCG may, for the purposes of exercising the Delegated Functions

under this Agreement, establish and maintain a pooled fund in respect of

any part of the Delegated Funds with NHS England in accordance with

section 13V of the NHS Act except that the CCG may only do so if NHS

England (at its absolute discretion) consents in writing to the



establishment of the pooled fund (including any terms as to the

governance and payments out of such pooled fund).

13.25. At the date of this agreement, details of the pooled funds (including any

terms as to the governance and payments out of such pooled fund) of

NHS England and the CCG are set out in the Local Terms.

Business Plan, Commissioning Plan and Annual Report

13.26. Within two (2) months of the date of the Delegation and thereafter three

(3) months before the start of each Financial Year, the CCG must prepare

a plan setting out how it proposes to exercise the Delegated Functions in

that Financial Year and in each of the next two (2) Financial Years (or

over such longer period as NHS England may require).

13.27. The plan must, in particular, explain how the CCG proposes to ensure

NHS England’s compliance with its duties in relation to the Delegated

Functions under the NHS Act, including without limitation:

13.27.1. sections 223C (expenditure), 223D (controls on total resource

use) and 223E (additional controls on resource use) of the NHS

Act; and

13.27.2. sections 13E (duty as to improvement in quality of services),

13G (duty as to reducing inequalities) and 13Q (public

involvement and consultation) of the NHS Act.

13.28. The plan must include the following:

13.28.1. details of how the CCG proposes to exercise the Delegated

Functions in that Financial Year and in each of the next two (2)

Financial Years; and

13.28.2. details of how the CCG proposes to ensure NHS England’s

compliance with its duties to achieve any objectives and

requirements relating to the Delegated Functions which are

specified in the mandate published by the Department of

Health to NHS England for the first Financial Year to which the

plan relates; and

13.28.3. any other information or detail that NHS England considers

necessary to ensure NHS England’s compliance with its



obligations under section 13T of the NHS Act or any other

provision of the NHS Act or other Law.

13.29. The CCG must revise the plan at the request of NHS England and submit

a revised plan to NHS England before the date specified by NHS England

from time to time.

13.30. As soon as practicable after the end of each Financial Year (and in any

event within two (2) months of the end of each Financial Year or such

longer period as NHS England may specify), the CCG must provide to

NHS England a report on how the CCG has exercised the Delegated

Functions during the previous Financial Year.

13.31. The report referred to in clause 13.30 above must include sufficient detail

to ensure NHS England’s compliance with its statutory obligations under

section 13U of the NHS Act.

13.32. Following receipt of the report referred to in clause 13.30 above, NHS

England may (at its absolute discretion) require such further information

from the CCG as NHS England considers necessary to ensure NHS

England’s compliance with its obligations under section 13U of the NHS

Act.

13.33. The CCG shall comply with any Contractual Notices issued from time to

time by NHS England in relation to the inclusion of information in relation

to the Delegated Functions in any plan prepared by the CCG under

section 14Z11 of the NHS Act or in any report prepared under section

14Z15 of the NHS Act.

Risk sharing

13.34. In accordance with section 13Z(6) of the NHS Act, NHS England retains

liability in relation to the exercise of the Delegated Functions and nothing

in this Agreement affects the liability of NHS England in relation to the

Delegated Functions.

13.34A For the avoidance of doubt, NHS England retains liability in respect of

any Losses arising in respect of NHS England’s negligence, fraud,

recklessness or deliberate breach in respect of the Delegated Functions

and, if the CCG suffers any Losses in respect of such actions by NHS



England, NHS England shall make such adjustments to the Delegated

Funds (or other amounts payable to the CCG) in order to reflect any

Losses suffered by the CCG (except to the extent that the CCG is liable

for such Loss pursuant to clause 13.35).

13.35. The CCG is liable (and shall pay) to NHS England for any Losses suffered

by NHS England that result from or arise out of the CCG’s negligence,

fraud, recklessness or deliberate breach of the Delegation (including any

actions that are taken that exceed the authority conferred by the

Delegation) or this Agreement and, in respect of such Losses, NHS

England may, at its discretion and without prejudice to any other rights,

either require payment from the CCG or make such adjustments to the

Delegated Funds pursuant to clause 13.3. The CCG shall not be liable to

the extent that the Losses arose prior to the date of this Agreement.

13.36. Nothing in this clause 13 (Financial Provisions and Liability) or this

Agreement shall affect or prejudice NHS England’s right to exercise its

rights (whether arising under administrative law, common law or statute)

in relation to actions or steps of the CCG, including any actions or steps

that exceed the authority conferred by the Delegation or are a breach of

the terms and conditions of this Agreement.

14. Claims and Litigation

14.1. Schedule 2 (Delegated Functions) sets out further detail in relation to the

performance management of the Primary Medical Services Contracts.

14.2. Nothing in this clause 14 (Claims and Litigation) shall be interpreted as

affecting the reservation to NHS England of the Reserved Functions

(including the reservation to NHS England of all functions in relation to

the performers list activities).

14.3. Except in the circumstances set out in clause 14.7 and subject always to

compliance with this clause 14 (Claims and Litigation), the CCG shall be

responsible for and shall retain the conduct of any Claim.

14.4. The CCG must:



14.4.1. comply with any policy issued by NHS England from time to

time in relation to the conduct of or avoidance of Claims and/or

the pro-active management of Claims;

14.4.2. without prejudice to clause 14.4.1, in respect of legal advice or

assistance in relation to a Claim, comply with any requirements

of NHS England from time to time (whether set out in a policy

issued pursuant to clause 14.4.1 or otherwise) in relation to the

use of solicitors or barristers and, at the date of this Agreement,

NHS England’s requirement is that a CCG must obtain prior

approval from NHS England in respect of the firm of solicitors

instructed to provide legal advice or assistance in relation to a

Claim;

14.4.3. if it receives any correspondence, issue of proceedings, claim

document or other document concerning any Claim or potential

Claim, immediately notify NHS England and send to NHS

England all copies of such correspondence;

14.4.4. co-operate fully with NHS England in relation to such Claim and

the conduct of such Claim;

14.4.5. provide, at its own cost, to NHS England all documentation and

other correspondence that NHS England requires for the

purposes of considering and/or resisting such Claim; and/or

14.4.6. at the request of NHS England, take such action or step or

provide such assistance as may in NHS England’s discretion

be necessary or desirable having regard to the nature of the

Claim and the existence of any time limit in relation to avoiding,

disputing, defending, resisting, appealing, seeking a review or

compromising such Claim or to comply with the requirements

of the NHS Resolution or any insurer in relation to such Claim.

14.5. NHS England shall use its reasonable endeavours to keep the CCG

informed in respect of the conduct and/or outcome of the Claim except

that NHS England shall have no obligation to do so due to any

administrative or regulatory requirement, the requirement of any insurer

or the NHS Resolution or for any other reason that NHS England may

consider necessary or appropriate, at its absolute discretion, in relation

to the conduct of that Claim or related matter.

14.6. Subject to clause 14.4 and Schedule 5 (Financial Provisions and Decision

Making Limits) the CCG is entitled to conduct the Claim in the manner it



considers appropriate and is also entitled to pay or settle any Claim on

such terms as it thinks fit.

NHS England Stepping into Claims

14.7. NHS England may, at any time following discussion with the CCG, send

a notice to the CCG stating that NHS England will take over the conduct

of the Claim and the CCG must immediately take all steps necessary to

transfer the conduct of such Claim to NHS England. In such cases, NHS

England shall be entitled to conduct the Claim in the manner it considers

appropriate and is also entitled to pay or settle any Claim on such terms

as it thinks fit.

NHS England Stepping out of Claims

14.8. NHS England may, at any time after it has exercised its rights set out in

clause 14.7 above and following discussion with the CCG, send a notice

to the CCG stating that the CCG will be required to take over the conduct

of the Claim from NHS England and NHS England must immediately take

all steps necessary to transfer the conduct of such Claim to the CCG. In

such cases, the CCG shall be entitled to conduct the Claim in the manner

it considers appropriate in accordance with its obligations under this

clause 14 (Claims and Litigation) and subject to Schedule 4 (Further

Information Sharing Provisions) and Schedule 5 (Financial Provisions

and Decision Making Limits).

Claim Losses

14.9. The CCG and NHS England shall notify each other within a reasonable

time period of becoming aware of any Claim Losses.

14.10. If the CCG considers that, as a result of a Claim Loss, the Delegated

Funds will be insufficient to meet the Claim Loss as well as discharge the

Delegated Functions, then the CCG shall immediately notify NHS

England and the Parties shall meet to discuss and agree any adjustment

that may be needed pursuant to clause 13.3 (and taking into account any

funds, provisions or other resources retained by NHS England in respect

of such Claim Losses).



14.11. The CCG acknowledges that NHS England will pay to the CCG the funds

that are attributable to the Delegated Functions. Accordingly, the CCG

acknowledges that the Delegated Funds are required to be used to

discharge and/or pay any Claim Losses. NHS England may, in respect of

any Claim Losses, at its discretion and without prejudice to any other

rights, either require payment from the CCG for such Claim Losses or

pursuant to clause 13.3 make such adjustments to the Delegated Funds

to take into account the amount of any Claim Losses (other than any

Claim Losses in respect of which NHS England has retained any funds,

provisions or other resources to discharge such Claim Losses). For the

avoidance of doubt, in circumstances where NHS England suffers any

Claim Losses, then NHS England shall be entitled to recoup such Claim

Losses pursuant to clause 13.3. If and to the extent that NHS England

has retained any funds, provisions or other resources to discharge such

Claim Losses, then NHS England may either use such funds to discharge

the Claim Loss or make an upward adjustment to the amounts paid to the

CCG pursuant to clause 13.3.

15. Breach

15.1. If the CCG does not comply with the Delegation or the terms of this

Agreement, then NHS England may:

15.1.1. exercise its rights under this Agreement; and/or

15.1.2. take such steps as it considers appropriate under the CCG

Assurance Framework.

15.2. Without prejudice to clause 15.1, if the CCG does not comply with the

Delegation or the terms of this Agreement (including if the CCG exceeds

its delegated authority under the Delegation), NHS England may (at its

sole discretion):

15.2.1. waive such non-compliance in accordance with clause 15.3

and the Delegation;

15.2.2. ratify any decision in accordance with paragraph 29 of the

Delegation;

15.2.3. revoke the Delegation and terminate this Agreement in

accordance with clause 17 (Termination) below;

15.2.4. exercise the Escalation Rights in accordance with clause 16

(Escalation Rights); and/or



15.2.5. exercise its rights under common law.

15.3. NHS England may waive any non-compliance by the CCG with the terms

of this Agreement provided that the CCG provides a written report to NHS

England pursuant to clause 15.4 and, after considering the CCG’s written

report, NHS England is satisfied that the waiver is justified.

15.4. If:

15.4.1. the CCG does not comply (or the CCG considers that it may

not be able to comply) with this Agreement and/or the

Delegation; or

15.4.2. NHS England notifies the CCG that it considers the CCG has

not complied, or may not be able to comply with, this

Agreement and/or the Delegation,

then the CCG must provide a written report to NHS England within ten

(10) days of the non-compliance (or the date on which the CCG considers

that it may not be able to comply with this Agreement) or such notification

pursuant to clause 15.4.2 setting out:

15.4.3. details of and reasons for the non-compliance (or likely non-

compliance) with the Agreement and/or the Delegation; and

15.4.4. a plan for how the CCG proposes to remedy the non-

compliance.

16. Escalation Rights

16.1. If the CCG does not comply with this Agreement and/or the Delegation,

NHS England may exercise the following Escalation Rights:

16.1.1. NHS England may require a suitably senior representative of

the CCG to attend a review meeting within ten (10) days of

NHS England becoming aware of the non-compliance; and

16.1.2. NHS England may require the CCG to prepare an action plan

and report within twenty (20) days of the review meeting (to

include details of the non-compliance and a plan for how the

CCG proposes to remedy the non-compliance).



16.2. Nothing in clause 16 (Escalation Rights) will affect NHS England’s right

to revoke the Delegation and/or terminate this Agreement in accordance

with clause 17 (Termination) below.

17. Termination

17.1. The CCG may:

17.1.1. notify NHS England that it requires NHS England to revoke the

Delegation; and

17.1.2. terminate this Agreement

with effect from midnight on 31 March in any calendar year, provided that:

17.1.3. on or before 30 September of the previous calendar year, the

CCG sends written notice to NHS England of its requirement

that NHS England revoke the Delegation and intention to

terminate this Agreement; and

17.1.4. the CCG meets with NHS England within ten (10) Operational

Days of NHS England receiving the notice set out at clause

17.1.3 above to discuss arrangements for termination and

transition of the Delegated Functions to a successor

commissioner,

in which case NHS England shall revoke the Delegation and this

Agreement shall terminate with effect from midnight on 31 March in the

next calendar year.

17.2. NHS England may revoke the Delegation at midnight on 31 March in any

year, provided that it gives notice to the CCG of its intention to terminate

the Delegation on or before 30 September in the year prior to the year in

which the Delegation will terminate, and in which case clause 17.4 will

apply.

17.3. The Delegation may be revoked, and this Agreement may be terminated

by NHS England at any time, including in (but not limited to) the following

circumstances:

17.3.1. the CCG acts outside of the scope of its delegated authority;



17.3.2. the CCG fails to perform any material obligation of the CCG

owed to NHS England under the Delegation or this Agreement;

17.3.3. the CCG persistently commits non-material breaches of the

Delegation or this Agreement;

17.3.4. NHS England is satisfied that its intervention powers under

section 14Z21 of the NHS Act apply;

17.3.5. to give effect to legislative changes;

17.3.6. failure to agree to a National Variation in accordance with

clause 22 (Variations);

17.3.7. NHS England and the CCG agree in writing that the Delegation

shall be revoked and this Agreement shall terminate on such

date as is agreed; and/or

17.3.8. the CCG merges with another CCG or other body.

17.4. This Agreement will terminate immediately upon revocation or

termination of the Delegation (including revocation and termination in

accordance with this clause 17 (Termination)) except that the Survival

Clauses will continue in full force and effect. This Agreement shall not

terminate immediately if the Delegation is amended by a revocation and

re-issue of an amended Delegation.

17.5. Upon revocation or termination of the Delegation and this Agreement

(including revocation and termination in accordance with this clause 17

(Termination)), the Parties must:

17.5.1. agree a plan for the transition of the Delegated Functions from

the CCG to the successor commissioner, including details of

the transition, the Parties’ responsibilities in relation to the

transition, the Parties’ arrangements in respect of those staff

engaged in the Delegated Functions and the date on which the

successor commissioner will take responsibility for the

Delegated Functions;

17.5.2. implement and comply with their respective obligations under

the plan for transition agreed in accordance with clause 17.5.1

above; and

17.5.3. use all reasonable endeavours to minimise any inconvenience

or disruption to the commissioning of healthcare in the Area.



17.6. Without prejudice to clause 15.3 and for the avoidance of doubt, NHS

England may waive any right to terminate this Agreement under this

clause 17 (Termination).

18. Staffing

18.1. The Parties acknowledge and agree that the CCG may only engage staff

to undertake the Delegated Functions under one of the following three

staffing models:

18.1.1. “Model 1 – Assignment” under the terms of which the staff of

NHS England remain in their current roles and locations and

provide services to the CCG under a service level agreement;

18.1.2. “Model 2 – Secondment” under the terms of which certain staff

of NHS England are seconded to the CCG (and, for the

avoidance of doubt, such secondments will terminate on

revocation or termination of the Delegation); or

18.1.3. “Model 3 – Employment” under the terms of which the CCG

may create new posts within the CCG to undertake the

Delegated Functions provided that the CCG may only do so if

it first offers to existing staff of NHS England an opportunity to

apply for such posts and such staff must be appointed if they

are deemed appointable,

together, the “Staffing Models”.

18.2. The CCG and NHS England, must within six (6) months of the date of this

Agreement, agree which of the Staffing Models (set out at clauses 18.1.1

to 18.1.3 above) will be adopted by the CCG and the date on which such

Staffing Model shall take effect.

18.3. In the absence of any agreement under clause 18.2, and up until such

date as the CCG’s preferred Staffing Model shall take effect (as referred

to in clause 18.2 above), Model 1 described in clause 18.1.1 above will

apply. The terms on which Model 1 will apply are set out in Schedule 8

(Assignment of NHS England Staff to the CCG).



18.4. The CCG must comply with any Guidance issued by NHS England from

time to time in relation to the Staffing Models and such Guidance may

make changes to the Staffing Models from time to time.

18.5. For the avoidance of doubt, any breach by the CCG of the terms of this

clause 18 (Staffing), including any breach of the Guidance issued in

accordance with clause 18.4 above, will be a breach of the terms and

conditions of this Agreement for the purposes of clauses 13.3 and 13.35.

18.6. Without prejudice to clause 18.7, it is the understanding of the Parties

that the provisions of the Transfer Regulations will not operate to transfer

the employment of any staff of NHS England or any other party to the

CCG on the commencement of the Delegation and this Agreement.

18.7. The Parties acknowledge that if at any time before or after the revocation

or termination of the Delegation and this Agreement the Transfer

Regulations do apply, the Parties must co-operate and comply with their

obligations under the Transfer Regulations.

19. Disputes

19.1. This clause does not affect NHS England’s right to take action under the

CCG Assurance Framework.

19.2. If a dispute arises out of or in connection with this Agreement or the

Delegation (“Dispute”) then the Parties must follow the procedure set

out in this clause:

19.2.1. either Party must give to the other written notice of the Dispute,

setting out its nature and full particulars (“Dispute Notice”),

together with relevant supporting documents. On service of the

Dispute Notice, the Agreement Representatives must attempt

in good faith to resolve the Dispute;

19.2.2. if the Agreement Representatives are, for any reason, unable

to resolve the Dispute within twenty (20) days of service of the

Dispute Notice, the Dispute must be referred to the

Accountable Officer (or equivalent person) of the CCG and a

director of or other person nominated by NHS England (and



who has authority from NHS England to settle the Dispute) who

must attempt in good faith to resolve it; and

19.2.3. if the people referred to in clause 19.2.2 are for any reason

unable to resolve the Dispute within twenty (20) days of it being

referred to them, the Parties may attempt to settle it by

mediation in accordance with the CEDR model mediation

procedure. Unless otherwise agreed between the Parties, the

mediator must be nominated by CEDR Solve. To initiate the

mediation, a Party must serve notice in writing ( ‘Alternative

Dispute Resolution’ (ADR) notice) to the other Party to the

Dispute, requesting a mediation. A copy of the ADR notice

should be sent to CEDR Solve. The mediation will start not later

than ten (10) days after the date of the ADR notice.

19.3. If the Dispute is not resolved within thirty (30) days after service of the

ADR notice, or either Party fails to participate or to continue to participate

in the mediation before the expiration of the period of thirty (30) days, or

the mediation terminates before the expiration of the period of thirty (30)

days, the Dispute must be referred to the Secretary of State, who shall

resolve the matter and whose decision shall be binding upon the Parties.

20. Freedom of Information

20.1. Each Party acknowledges that the other is a public authority for the

purposes of the Freedom of Information Act 2000 (“FOIA”) and the

Environmental Information Regulations 2004 (“EIR”).

20.2. Each Party may be statutorily required to disclose further information

about the Agreement and the Relevant Information in response to a

specific request under FOIA or EIR, in which case:

20.2.1. each Party shall provide the other with all reasonable

assistance and co-operation to enable them to comply with

their obligations under FOIA or EIR;

20.2.2. each Party shall consult the other regarding the possible

application of exemptions in relation to the information

requested; and



20.2.3. subject only to clause 14 (Claims and Litigation), each Party

acknowledges that the final decision as to the form or content

of the response to any request is a matter for the Party to whom

the request is addressed.

20.3. NHS England may, from time to time, issue a FOIA or EIR protocol or

update a protocol previously issued relating to the dealing with and

responding to of FOIA or EIR requests in relation to the Delegated

Functions. The CCG shall comply with such FOIA or EIR protocols.

21. Conflicts of Interest

21.1. The CCG must comply with its statutory duties set out in:

21.1.1. Chapter A2 of the NHS Act (including those statutory duties

relating to the management of conflicts of interest as set out at

section 14O of the NHS Act);

21.1.2. the National Health Service (Procurement, Patient Choice and

Competition) (No. 2) Regulations 2013/500; and

21.1.3. Regulation 24 of the Public Contracts Regulations 2015/102,

and must perform its obligations under this Agreement in such a way as

to ensure NHS England’s compliance with its statutory duties in relat ion

to conflicts of interest.

21.2. The CCG must have regard to all relevant guidance published by NHS

England in relation to conflicts of interest in the co-commissioning

context.

22. Variations

22.1. The Parties acknowledge that, under paragraph 30 of the Delegation, the

Delegation may be reviewed and amended from time to time and that

such amendments may be effected by a revocation and re-issue of an

amended Delegation.

22.2. The Parties acknowledge that, under paragraph 11 of the Delegation,

certain additional functions may be delegated from time to time by NHS

England to the CCG on a date or dates to be notified to the CCG by NHS



England in accordance with clause 8.3. If NHS England amends the

Delegation and/or delegates additional functions to the CCG, then NHS

England and the CCG shall agree such consequential changes to this

Agreement pursuant to this clause 22 (Variations).

22.3. Subject to clauses 22.4 to 22.10 below, a variation of this Agreement will

only be effective if:

22.3.1. it is materially in the form of the template variation agreement

set out at Schedule 6 (Template Variation Agreement); and

22.3.2. it is signed by NHS England and the CCG (by their Agreement

Representatives or other duly authorised representatives).

22.4. The Parties may not vary any provision of this Agreement if the purported

variation would contradict or conflict with the Delegation.

22.5. NHS England may notify the CCG of any proposed National Variation by

issuing a National Variation Proposal by whatever means NHS England

may consider appropriate from time to time.

22.6. The CCG will be deemed to have received a National Variation Proposal

on the date that it is issued by NHS England.

22.7. The National Variation Proposal will set out the National Variation

proposed and the date on which NHS England requires the National

Variation to take effect.

22.8. The CCG must respond to a National Variation Proposal within thirty (30)

Operational Days following the date that it is issued by serving a written

notice on NHS England confirming either:

22.8.1. that it accepts the National Variation Proposal; or

22.8.2. that it refuses to accept the National Variation Proposal, and

setting out reasonable grounds for that refusal.

22.9. If the CCG accepts the National Variation Proposal in accordance with

clause 22.8.1, the CCG agrees (without delay) to take all necessary steps

(including executing a variation agreement) in order to give effect to any

National Variation by the date on which the proposed National Variation

takes effect as set out in the National Variation Proposal.



22.10. If the CCG refuses to accept the National Variation Proposal in

accordance with clause 22.8.2 or to take such steps as set out in clause

22.9, NHS England may terminate this Agreement and revoke the

Delegation in accordance with clause 17.3.6.

23. Counterparts

23.1. This Agreement may be executed in counterparts, each of which shall be

regarded as an original, but all of which together shall constitute one

agreement binding on both of the Parties.

24. Notices

24.1. Any notices given under this Agreement must be in writing, must be

marked for the appropriate department or person and must be served by

hand, post or email to the following address:

24.1.1. in the case of NHS England, to NHS England’s address for

notices set out in the Particulars; or

24.1.2. in the case of the CCG, to the CCG’s address for notices set

out in the Particulars.

24.2. Notices sent:

24.2.1. by hand will be effective upon delivery;

24.2.2. by post will be effective upon the earlier of actual receipt or five

(5) working days after mailing; or

24.2.3. by email will be effective when sent (subject to no automated

response being received).

24.3. NHS England may, at its discretion, issue Contractual Notices from time

to time relating to the manner in which the Delegated Functions should

be exercised by the CCG.

24.4. NHS England may, at its discretion, issue Guidance from time to time,

including any protocol, policy, guidance or manual relating to the exercise

of the Delegated Functions under this Agreement. NHS England

acknowledges that in considering the need and/or content of new

Guidance it will engage appropriately with CCGs.



Schedule 1

Definitions and Interpretation

In this Agreement, the following words and phrases will bear the following meanings:

Agreement means this agreement between NHS England and the

CCG comprising the Particulars, the Terms and

Conditions and the Schedules;

Agreement

Representatives

means the CCG Representative and the NHS England

Representative as set out in the Particulars;

APMS Contract means an agreement made in accordance with section

92 of the NHS Act;

Assigned Staff means those NHS England staff as agreed between

NHS England and the CCG from time to time;

Caldicott Principles means the patient confidentiality principles set out in

the report of the Caldicott Committee (December 1997

as amended by the 2013 Report, The Information

Governance Review – “To Share or Not to Share?”) and

now included in the NHS Confidentiality Code of

Practice, as may be amended from time to time;

Capital shall have the meaning set out in the Capital Investment

Guidance or such other replacement Guidance as

issued by NHS England from time to time;

Capital Expenditure

Functions

means those functions of NHS England in relation to

the use and expenditure of Capital funds (but excluding

the Premises Costs Directions Functions);

Capital Investment

Guidance

means any Guidance issued by NHS England from time

to time in relation to the development, assurance and

approvals process for proposals in relation to:

• the expenditure of Capital, or investment in

property, infrastructure or information and

technology; or



• the revenue consequences for commissioners or

third parties making such investment;

CCG Assurance

Framework

means the assurance framework that applies to CCGs

pursuant to the NHS Act;

Claims means, for or in relation to the Primary Medical Services

Contracts (a) any litigation or administrative, mediation,

arbitration or other proceedings, or any claims, actions

or hearings before any court, tribunal or any

governmental, regulatory or similar body, or any

department, board or agency or (b) any dispute with, or

any investigation, inquiry or enforcement proceedings

by, any governmental, regulatory or similar body or

agency;

Claim Losses means all Losses arising in relation to any Claim;

Complaints Regulations means the Local Authority Social Services and National

Health Service Complaints (England) Regulations

2009/309;

Contractual Notice means a contractual notice issued by NHS England to

the CCG or all CCGs (as the case may be) from time to

time and relating to the manner in which the Delegated

Functions should be exercised by the CCG, in

accordance with clause 24.3;

CQC means the Care Quality Commission;

Data Controller

Data Processor

shall have the same meaning as set out in the GDPR;

shall have the same meaning as set out in the GDPR;

Data Subject shall have the same meaning as set out in the GDPR;

Delegated Functions means the functions delegated by NHS England to the

CCG under the Delegation and as set out in detail in

this Agreement;

Delegated Funds shall have the meaning in clause 13.1;



Enhanced Services means the nationally defined enhanced services, as set

out in the Primary Medical Services (Directed

Enhanced Services) Directions 2014 or as amended

from time to time, and any other enhanced services

schemes locally developed by the CCG in the exercise

of its Delegated Functions (and excluding, for the

avoidance of doubt, any enhanced services arranged

or provided pursuant to the Section 7A Functions);

Escalation Rights means the escalation rights as defined in clause 16

(Escalation Rights);

Financial Year shall bear the same meaning as in section 275 of the

NHS Act;

GDPR means the General Data Protection Regulation

GMS Contract means a general medical services contract made under

section 84(1) of the NHS Act;

Good Practice means using standards, practices, methods and

procedures conforming to the law, reflecting up-to-date

published evidence and exercising that degree of skill

and care, diligence, prudence and foresight which

would reasonably and ordinarily be expected from a

skilled, efficient and experienced commissioner;

Guidance means any protocol, policy, guidance or manual (issued

by NHS England whether under this Agreement or

otherwise) and/or any policy or guidance relating to the

exercise of the Delegated Functions issued by NHS

England from time to time, in accordance with clause

24.4;

HSCA means the Health and Social Care Act 2012;



Information Law the GDPR, the Data Protection Act 2018, regulations

and guidance made under section 13S and section 251

of the NHS Act; guidance made or given under sections

263 and 265 of the HSCA; the Freedom of Information

Act 2000; the common law duty of confidentiality; the

Human Rights Act 1998 and all other applicable laws

and regulations relating to processing of Personal Data

and privacy;

Law means any applicable law, statute, bye-law, regulation,

direction, order, regulatory policy, guidance or code,

rule of court or directives or requirements of any

regulatory body, delegated or subordinate legislation or

notice of any regulatory body (including, for the

avoidance of doubt, the Premises Costs Directions, the

Statement of Financial Entitlements Directions and the

Primary Medical Services (Directed Enhanced

Services) Directions 2014 as amended from time to

time);

Local Incentive

Schemes

means an incentive scheme developed by the CCG in

the exercise of its Delegated Functions including

(without limitation) as an alternative to QOF;

Local Terms means the terms set out in Schedule 7 (Local Terms);

Losses means all damages, loss, liabilities, claims, actions,

costs, expenses (including the cost of legal and/or

professional services) proceedings, demands and

charges;

National Variation an addition, deletion or amendment to the provisions of

this Agreement mandated by NHS England (whether in

respect of the CCG or all or some of other Clinical

Commissioning Groups) including any addition,

deletion or amendment to reflect changes to the

Delegation, changes in Law, changes in policy and

notified to the CCG in accordance with clause 22

(Variations);



National Variation

Proposal

a written proposal for a National Variation, which

complies with the requirements of clause 22.7;

Need to Know has the meaning set out in paragraph 6.2 of Schedule

4 (Further Information Sharing Provisions);

NHS Act means the National Health Service Act 2006 (as

amended by the Health and Social Care Act 2012 or

other legislation from time to time);

NHS England means the National Health Service Commissioning

Board established by section 1H of the NHS Act, also

known as NHS England;

Non-Personal Data means data which is not Personal Data;

Operational Days a day other than a Saturday, Sunday or bank holiday in

England;

Particulars means the Particulars of this Agreement as set out in

clause 1 (Particulars);

Party/Parties means a party or both parties to this Agreement;

Personal Data shall have the same meaning as set out in the General

Data Protection Regulation and shall include

references to Special Category Personal Data where

appropriate;

Personal Data

Agreement

means the agreement governing Information Law

issues completed further to Schedule 4 (Further

Information Sharing Provisions);

Personnel means the Parties’ employees, officers, elected

members, directors, voluntary staff, consultants, and

other contractors and sub-contractors acting on behalf

of either Party (whether or not the arrangements with

such contractors and sub-contractors are subject to

legally binding contracts) and such contractors’ and

their sub-contractors’ personnel;



PMS Contract means an arrangement or contract for the provision of

primary medical services made under section 83(2) of

the NHS Act (including any arrangements which are

made in reliance on a combination of that section and

other powers to arrange for primary medical services);

Premises Agreements means tenancies, leases and other arrangements in

relation to the occupation of land for the delivery of

services under the Primary Medical Services Contracts;

Premises Costs

Directions

means the National Health Service (General Medical

Services Premises Costs) Directions 2013, as

amended;

Premises Costs


means NHS England’s functions in relation to the

Premises Costs Directions;

Primary Medical Care

Infrastructure Guidance

means any Guidance issued by NHS England from time

to time in relation to the procurement, development and

management of primary medical care infrastructure and

which may include principles of best practice;

Primary Medical

Services Contracts

means:

• PMS Contracts;

• GMS Contracts; and

• APMS Contracts,

in each case as amended or replaced from time to time

and including all ancillary or related agreements directly

relating to the subject matter of such agreements,

contracts or arrangements but excluding any Premises

Agreements;

Principles of Best

Practice

means the Guidance in relation to property and

investment which is to be published either before or

after the date of this Agreement;

QOF means the quality and outcomes framework;



Relevant Information means the Personal Data and Non-Personal Data

processed under the Delegation and this Agreement,

and includes, where appropriate, “confidential patient

information” (as defined under section 251 of the NHS

Act), and “patient confidential information” as defined in

the 2013 Report, The Information Governance Review

– “To Share or Not to Share?”);

Reserved Functions means the functions relating to the commissioning of

primary medical services which are reserved to NHS

England (and are therefore not delegated to the CCG

under the Delegation) and as set out in detail in clause

8.2 and Schedule 3 (Reserved Functions) of this

Agreement;

Secretary of State means the Secretary of State for Health from time to

time;

Section 7A Functions means those functions of NHS England exercised

pursuant to section 7A of the NHS Act relating to

primary medical services;

Section 7A Funds shall have the meaning in clause 13.18.1;

Special Category

Personal Data

shall have the same meaning as in GDPR;

Specified Purpose means the purpose for which the Relevant Information

is shared and processed, being to facilitate the exercise

of the CCG’s Delegated Functions and NHS England’s

Reserved Functions as specified in paragraph 2.1 of

Schedule 4 (Further Information Sharing Provisions) to

this Agreement;

Statement of Financial

Entitlements Directions

means the General Medical Services Statement of

Financial Entitlements Directions 2013, as amended or

updated from time to time;

Statutory Guidance means any applicable health and social care guidance,

guidelines, direction or determination, framework,

standard or requirement to which the CCG and/or NHS



England have a duty to have regard, to the extent that

the same are published and publicly available or the

existence or contents of them have been notified to the

CCG by NHS England from time to time;

Survival Clauses means clauses 10 (Information Sharing and Information

Governance), 13 (Financial Provisions and Liability), 14

(Claims and Litigation) 17 (Termination), 18 (Staffing),

19 (Disputes) and 20 (Freedom of Information),

together with such other provisions as are required to

interpret these clauses (including the Schedules to this

Agreement); and

Transfer Regulations means the Transfer of Undertakings (Protection of

Employment) Regulations 2006, as amended.



Schedule 2

Delegated Functions

Part 1: Delegated Functions: Specific Obligations

1. Introduction

1.1. This Part 1 of Schedule 2 (Delegated Functions) sets out further provision

regarding the carrying out of each of the Delegated Functions.

2. Primary Medical Services Contract Management

2.1. The CCG must:

2.1.1. manage the Primary Medical Services Contracts on behalf of

NHS England and perform all of NHS England’s obligations

under each of the Primary Medical Services Contracts in

accordance with the terms of the Primary Medical Services

Contracts as if it were named in the contract in place of NHS

England;

2.1.2. actively manage the performance of the counter-party to the

Primary Medical Services Contracts in order to secure the needs

of people who use the services, improve the quality of services

and improve efficiency in the provision of the services including

by taking timely action to enforce contractual breaches and

serve notice;

2.1.3. ensure that it obtains value for money under the Primary Medical

Services Contracts on behalf of NHS England and avoids

making any double payments under any Primary Medical

Services Contracts;

2.1.4. comply with all current and future relevant national Guidance

regarding PMS reviews and the management of practices

receiving Minimum Practice Income Guarantee (MPIG)

(including without limitation the Framework for Personal Medical

Services (PMS) Contracts Review guidance published by NHS

England in September 2014 (http://www.england.nhs.uk/wp-

content/uploads/2014/09/pms-review-guidance-sept14.pdf));

2.1.5. notify NHS England immediately (or in any event within two (2)

Operational Days) of any breach by the CCG of its obligations to





perform any of NHS England’s obligations under the Primary

Medical Services Contracts;

2.1.6. keep a record of all of the Primary Medical Services Contracts

that the CCG manages on behalf of NHS England setting out the

following details in relation to each Primary Medical Services

Contract:

2.1.6.1. name of counter-party;

2.1.6.2. location of provision of services; and

2.1.6.3. amounts payable under the contract (if a contract sum

is payable) or amount payable in respect of each


2.2. For the avoidance of doubt, all Primary Medical Services Contracts will

be in the name of NHS England.

2.3. The CCG must comply with any Guidance in relation to the issuing and

signing of Primary Medical Services Contracts in the name of NHS

England.

2.4. Without prejudice to clause 13 (Financial Provisions and Liability) or

paragraph 2.1 above, the CCG must actively manage each of the relevant

Primary Medical Services Contracts including by:

2.4.1. managing the relevant Primary Medical Services Contract,

including in respect of quality standards, incentives and the

QOF, observance of service specifications, and monitoring of

activity and finance;

2.4.2. assessing quality and outcomes (including clinical effectiveness,

patient experience and patient safety);

2.4.3. managing variations to the relevant Primary Medical Services

Contract or services in accordance with national policy, service

user needs and clinical developments;

2.4.4. agreeing information and reporting requirements and managing

information breaches (which will include use of the HSCIC IG

Toolkit SIRI system);

2.4.5. agreeing local prices, managing agreements or proposals for

local variations and local modifications;



2.4.6. conducting review meetings and undertaking contract

management including the issuing of contract queries and

agreeing any remedial action plan or related contract

management processes; and

2.4.7. complying with and implementing any relevant Guidance issued

from time to time.

Enhanced Services

2.5. The CCG must manage the design and commissioning of Enhanced

Services, including re-commissioning these services annually where

appropriate.

2.6. The CCG must ensure that it complies with any Guidance in relation to

the design and commissioning of Enhanced Services.

2.7. When commissioning newly designed Enhanced Services, the CCG

must:

2.7.1. consider the needs of the local population in the Area;

2.7.2. support Data Controllers in providing ‘fair processing’

information as required by the GDPR;

2.7.3. develop the necessary specifications and templates for the

Enhanced Services, as required to meet the needs of the local

population in the Area;

2.7.4. when developing the necessary specifications and templates for

the Enhanced Services, ensure that value for money will be

obtained;

2.7.5. consult with Local Medical Committees, each relevant Health

and Wellbeing Board and other stakeholders in accordance with

the duty of public involvement and consultation under section

14Z2 of the NHS Act;

2.7.6. obtain the appropriate read codes, to be maintained by the

HSCIC;

2.7.7. liaise with system providers and representative bodies to ensure

that the system in relation to the Enhanced Services will be

functional and secure; and

2.7.8. support GPs in entering into data processing agreements with

data processors in the terms required by the GDPR.



Design of Local Incentive Schemes

2.8. The CCG may design and offer Local Incentive Schemes for GP

practices, sensitive to the needs of their particular communities, in

addition to or as an alternative to the national framework (including as an

alternative to QOF or directed Enhanced Services), provided that such

schemes are voluntary, and the CCG continues to offer the national

schemes.

2.9. There is no formal approvals process that the CCG must follow to develop

a Local Incentive Scheme, although any proposed new Local Incentive

Scheme:

2.9.1. is subject to consultation with the Local Medical Committee;

2.9.2. must be able to demonstrate improved outcomes, reduced

inequalities and value for money; and

2.9.3. must reflect the changes agreed as part of the national PMS

reviews.

2.10. The ongoing assurance of any new Local Incentive Schemes will form

part of the CCG’s assurance process under the CCG Assurance

Framework.

2.11. Any new Local Incentive Scheme must be implemented without prejudice

to the right of GP practices operating under a GMS Contract to obtain

their entitlements which are negotiated and set nationally.

2.12. NHS England will continue to set national standing rules, to be reviewed

annually, and the CCG must comply with these rules which shall for the

purposes of this Agreement be Guidance.

Making Decisions on Discretionary Payments

2.13. The CCG must manage and make decisions in relation to the

discretionary payments to be made to GP practices in a consistent, open

and transparent way.

2.14. The CCG must exercise its discretion to determine the level of payment

to GP practices of discretionary payments, in accordance with the



Statement of Financial Entitlements Directions and Policy and Guidance

Manual.

Making Decisions about Commissioning Urgent Care for Out of Area

Registered Patients

2.15. The CCG must manage the design and commissioning of urgent care

services (including home visits as required) for its patients registered out

of area (including re-commissioning these services annually where

appropriate).

2.16. The CCG must ensure that it complies with any Guidance in relation to

the design and commissioning of these services. The includes guidance

in relation to disaggregation of practice lists when over 1,000 patients are

registered out-of-area in a single CCG.

3. Planning the Provider Landscape

3.1. The CCG must plan the primary medical services provider landscape in

the Area, including considering and taking decisions in relation to:

3.1.1. establishing new GP practices in the Area;

3.1.2. managing GP practices providing inadequate standards of

patient care;

3.1.3. the procurement of new Primary Medical Services Contracts (in

accordance with any procurement protocol issued by NHS

England from time to time);

3.1.4. closure of practices and branch surgeries;

3.1.5. dispersing the lists of GP practices;

3.1.6. agreeing variations to the boundaries of GP practices; and

3.1.7. coordinating and carrying out the process of list cleansing in

relation to GP practices, according to any policy or Guidance

issued by NHS England from time to time.

3.2. In relation to any new Primary Medical Services Contract to be entered

into, the CCG must, without prejudice to any obligation in Schedule 2,

Part 2, paragraph 3 (Procurement and New Contracts) and Schedule 2,

Part 1, paragraph 2.3:



3.2.1. consider and use the form of Primary Medical Services Contract

that will ensure compliance with NHS England’s obligations

under Law including the Public Contracts Regulations 2015/102

and the National Health Service (Procurement, Patient Choice

and Competition) (No. 2) Regulations 2013/500 taking into

account the persons to whom such Primary Medical Services

Contracts may be awarded;

3.2.2. provide to NHS England confirmation as required from time to

time that it has considered and complied with its obligations

under this Agreement and the Law; and

3.2.3. for the avoidance of doubt, Schedule 5 (Financial Provisions and

Decision Making Limits) deals with the sign off requirements for

Primary Medical Services Contracts.

4. Approving GP Practice Mergers and Closures

4.1. The CCG is responsible for approving GP practice mergers and GP

practice closures in the Area.

4.2. The CCG must undertake all necessary consultation when taking any

decision in relation to GP practice mergers or GP practice closures in the

Area, including those set out under section 14Z2 of the NHS Act (duty for

public involvement and consultation). The consultation undertaken must

be appropriate and proportionate in the circumstances and should include

consulting with the Local Medical Committee.

4.3. Prior to making any decision in accordance with this paragraph 4

(Approving GP Practice Mergers and Closures), the CCG must be able

to clearly demonstrate the grounds for such a decision and must have

fully considered any impact on the GP practice’s registered population

and that of surrounding practices. The CCG must be able to clearly

demonstrate that it has considered other options and has entered into

dialogue with the GP contractor as to how any closure or merger will be

managed.

4.4. In making any decisions pursuant to paragraph 4 (Approving GP Practice

Mergers and Closures), the CCG shall also take account of its obligations

as set out in Schedule 2, part 2, paragraph 3 (Procurement and New

Contracts), where applicable.



5. Information Sharing with NHS England in relation to the Delegated

Functions

5.1. This paragraph 5 (Information Sharing with NHS England) is without

prejudice to clause 9.4 or any other provision in this Agreement. The CCG

must provide NHS England with:

5.1.1. such information relating to individual GP practices in the Area

as NHS England may reasonably request, to ensure that NHS

England is able to continue to gather national data regarding the


5.1.2. such data/data sets as required by NHS England to ensure

population of the primary medical services dashboard;

5.1.3. any other data/data sets as required by NHS England; and

5.1.4. the CCG shall procure that providers accurately record and

report information so as to allow NHS England and other

agencies to discharge their functions.

5.2. The CCG must use the NHS England approved primary medical services

dashboard, as updated from time to time, for the collection and

dissemination of information relating to GP practices.

5.3. The CCG must (where appropriate) use the NHS England approved GP

exception reporting service (as notified to the CCGs by NHS England

from time to time).

5.4. The CCG must provide any other information, and in any such form, as

NHS England considers necessary and relevant.

5.5. NHS England reserves the right to set national standing rules (which may

be considered Guidance for the purpose of this Agreement) , as needed,

to be reviewed annually. NHS England will work with CCGs to agree

rules for, without limitation, areas such as the collection of data for

national data sets and IT intra-operability. Such national standing rules

set from time to time shall be deemed to be part of this Agreement.



6. Making Decisions in relation to Management of Poorly Performing GP

Practices

6.1. The CCG must make decisions in relation to the management of poorly

performing GP practices and including, without limitation, decisions and

liaison with the CQC where the CQC has reported non-compliance with

standards (but excluding any decisions in relation to the performers list).

6.2. In accordance with paragraph 6.1 above, the CCG must:

6.2.1. ensure regular and effective collaboration with the CQC to

ensure that information on general practice is shared and

discussed in an appropriate and timely manner;

6.2.2. ensure that any risks identified are managed and escalated

where necessary;

6.2.3. respond to CQC assessments of GP practices where

improvement is required;

6.2.4. where a GP practice is placed into special measures, lead a

quality summit to ensure the development and monitoring of an

appropriate improvement plan (including a communications plan

and actions to manage primary care resilience in the locality);

and

6.2.5. take appropriate contractual action in response to CQC findings.

7. Premises Costs Directions Functions

7.1. The CCG must comply with the Premises Costs Directions and will be

responsible for making decisions in relation to the Premises Costs

Directions Functions.

7.2. In particular, but without limiting the generality of paragraph 7.1, the CCG

shall make decisions concerning:

7.2.1. applications for new payments under the Premises Costs

Directions (whether such payments are to be made by way of

grants or in respect of recurring premises costs); and

7.2.2. revisions to existing payments being made under the Premises

Costs Directions.



7.3. The CCG must comply with any decision-making limits set out in

Schedule 5 (Financial Provisions and Decision Making Limits) when

taking decisions in relation to the Premises Costs Directions Functions.

7.4. The CCG will comply with any guidance issued by the Secretary of State

or NHS England in relation to the Premises Costs Directions, including

the Principles of Best Practice, and any other Guidance in relation to the

Premises Costs Directions.

7.5. The CCG must work cooperatively with other CCGs to manage premises

and strategic estates planning.

7.6. The CCG must liaise where appropriate with NHS Property Services

Limited and Community Health Partnerships Limited in relation to the

Premises Costs Directions Functions.



Schedule 2

Part 2 – Delegated Functions: General Obligations

1. Introduction

1.1. This Part 2 of Schedule 2 (Delegated Functions) sets out general

provisions regarding the carrying out of the Delegated Functions.

2. Planning and reviews

2.1. The CCG is responsible for planning the commissioning of primary medical

services.

2.2. The role of the CCG includes:

2.2.1. carrying out primary medical health needs assessments (to be

developed by the CCG) to help determine the needs of the local

population in the Area;

2.2.2. recommending and implementing changes to meet any unmet

primary medical services needs; and

2.2.3. undertaking regular reviews of the primary medical health needs

of the local population in the Area.

3. Procurement and New Contracts

3.1. The CCG will make procurement decisions relevant to the exercise of the

Delegated Functions and in accordance with the detailed arrangements

regarding procurement set out in the procurement protocol issued and

updated by NHS England from time to time.

3.2. In discharging its responsibilities set out in clause 6 (Performance of the

Delegated Functions) of this Agreement and paragraph 1 of this Schedule

2 (Delegated Functions), the CCG must comply at all times with Law

including its obligations set out in the National Health Service

(Procurement, Patient Choice and Competition) (No. 2) Regulations

2013/500 and any other relevant statutory provisions. The CCG must have

regard to any relevant guidance, particularly Monitor’s guidance

Substantive guidance on the Procurement, Patient Choice and




(https://www.gov.uk/government/uploads/system/uploads/attachment_dat

a/file/283505/SubstantiveGuidanceDec2013_0.pdf).

3.3. Where the CCG wishes to develop and offer a locally designed contract, it

must ensure that it has consulted with its Local Medical Committee in

relation to the proposal and that it can demonstrate that the scheme will:

3.3.1. improve outcomes;

3.3.2. reduce inequalities; and

3.3.3. provide value for money.

4. Integrated working

4.1. The CCG must take an integrated approach to working and co-ordinating

with stakeholders including NHS England, Local Professional Networks,

local authorities, Healthwatch, acute and community providers, the Local

Medical Committee, Public Health England and other stakeholders.

4.2. The CCG must work with NHS England and other CCGs to co-ordinate a

common approach to the commissioning of primary medical services

generally.

4.3. The CCG and NHS England will work together to coordinate the exercise

of their respective performance management functions.

5. Resourcing

5.1. NHS England may, at its discretion provide support or staff to the CCG.

NHS England may, when exercising such discretion, take into account, any

relevant factors (including without limitation the size of the CCG, the

number of Primary Medical Services Contracts held and the need for the

Local NHS England Team to continue to deliver the Reserved Functions).





Schedule 3

Reserved Functions

1. Introduction

1.1. This Schedule 3 (Reserved Functions) sets out further provision regarding

the carrying out of the Reserved Functions.

1.2. The CCG will work collaboratively with NHS England and will support and

assist NHS England to carry out the Reserved Functions.

2. Management of the national performers list

2.1. NHS England will continue to perform its primary medical care functions

under the National Health Service (Performers Lists) (England)

Regulations 2013.

2.2. NHS England’s functions in relation to the management of the national

performers list include:

2.2.1. considering applications and decision-making in relation to

inclusion on the national performers list, inclusion with conditions

and refusals;

2.2.2. identifying, managing and supporting primary care performers

where concerns arise; and

2.2.3. managing suspension, imposition of conditions and removal

from the national performers list.

2.3. NHS England may hold local Performance Advisory Group (“PAG”)

meetings to consider all complaints or concerns that are reported to NHS

England in relation to a named performer and NHS England will


2.4. NHS England may notify the CCG of all relevant PAG meetings at least

seven (7) days in advance of such meetings. NHS England may require

a representative of the CCG to attend such meetings to discuss any

performer concerns and/or quality issues that may impact on individual

performer cases.



2.5. The CCG must develop a mechanism to ensure that all complaints

regarding any named performer are escalated to the Local NHS England

Team for review. The CCG will comply with any Guidance issued by NHS

England in relation to the escalation of complaints about a named

performer.

3. Management of the revalidation and appraisal process

3.1. NHS England will continue to perform its functions under the Medical

Profession (Responsible Officers) Regulations 2010 (as amended by the

Medical Profession (Responsible Officers) (Amendment) Regulations

2013).

3.2. All functions in relation to GP appraisal and revalidation will remain the

responsibility of NHS England, including:

3.2.1. the funding of GP appraisers;

3.2.2. quality assurance of the GP appraisal process; and

3.2.3. the responsible officer network.

3.3. Funding to support the GP appraisal is incorporated within the global sum

payment to GP practices.

3.4. The CCG must not remove or restrict the payments made to GP practices

in respect of GP appraisal.

4. Administration of payments and related performers list management

activities

4.1. NHS England reserves its functions in relation to the administration of

payments to individual performers and related performers list

management activities under the National Health Service (Performers

Lists) (England) Regulations 2013 and other relevant legislation.

4.2. NHS England may continue to pay GPs who are suspended from the

national performers list under the Secretary of State’s Determination:

Payments to Medical Practitioners Suspended from the Medical




4.3. For the avoidance of doubt, the CCG is responsible for any ad hoc or

discretionary payments to GP practices (including those under section 96

of the NHS Act) in accordance with clause 6.2.1.4 and Schedule 2

(Delegated Functions) Part 1 paragraphs 2.13 and 2.14 of this

Agreement, including where such payments may be considered a

consequence of actions taken under the National Health Service


5. Section 7A Functions

5.1. In accordance with clauses 13.17 to 13.20, NHS England retains the

Section 7A Functions and will be responsible for taking decisions in

relation to the Section 7A Functions.

5.2. In accordance with clauses 13.17 to 13.20, the CCG will provide certain

management and/or administrative services to NHS England in relation

to the Section 7A Functions.

6. Capital Expenditure Functions

6.1. In accordance with clauses 13.13 to 13.16, NHS England retains the

Capital Expenditure Functions and will be responsible for taking decisions

in relation to the Capital Expenditure Functions.

7. Functions in relation to complaints management

7.1. NHS England retains its functions in relation to complaints management

and will be responsible for taking decisions in relation to the management

of complaints. Such complaints include (but are not limited to):

7.1.1. complaints about GP practices and individual named

performers;

7.1.2. controlled drugs; and

7.1.3. whistleblowing in relation to a GP practice or individual

performer.

7.2. The CCG must immediately notify the Local NHS England Team of all

complaints received by or notified to the CCG and must send to the Local

NHS England Team copies of any relevant correspondence.



7.3. The CCG must co-operate fully with NHS England in relation to any

complaint and any response to such complaint.

7.4. In accordance with clauses 13.21 to 13.23, NHS England may ask the

CCG to provide certain management and/or administrative services to

NHS England (from a date to be notified by NHS England to the CCG) in

relation to the handling and consideration of complaints.

8. Such other ancillary activities that are necessary in order to exercise the

Reserved Functions

8.1. NHS England will carry out such other ancillary activities that are

necessary in order for NHS England to exercise the Reserved Functions.

8.2. NHS England will continue to comply with its obligations under the

Controlled Drugs (Supervision of Management and Use) Regulations

2013.

8.3. The CCG must assist NHS England’s controlled drug accountable officer

(“CDAO”) to carry out its functions under the Controlled Drugs

(Supervision of Management and Use) Regulations 2013.

8.4. The CCG must nominate a relevant senior individual within the CCG (the

“CCG CD Lead”) to liaise with and assist NHS England to carry out its

functions under the Controlled Drugs (Supervision of Management and


8.5. The CCG CD Lead must, in relation to the Delegated Functions:

8.5.1. on request provide NHS England’s CDAO with all reasonable

assistance in any investigation involving primary medical care

services;

8.5.2. report all complaints involving controlled drugs to NHS

England’s CDAO;

8.5.3. report all incidents or other concerns involving the safe use and

management of controlled drugs to NHS England’s CDAO;

8.5.4. analyse the controlled drug prescribing data available; and

8.5.5. on request supply (or ensure organisations from whom the CCG

commissions services involving the regular use of controlled



drugs supply) periodic self–declaration and/or self-assessments

to NHS England’s CDAO.



Schedule 4

Further Information Sharing Provisions

1. Introduction

1.1. The purpose of this Schedule 4 (Further Information Sharing Provisions)

and the associated Personal Data Agreement is to set out the scope for

the secure and confidential sharing of information between the Parties

on a Need To Know basis between individual Personnel in order to

enable the Parties to exercise their primary medical care commissioning

functions in accordance with the law. This Schedule and the associated

Personal Data Agreement is designed to:

1.1.1. inform about the reasons why Relevant Information may need

to be shared and how this will be managed and controlled by

the organisations involved;

1.1.2. describe the purposes for which the Parties have agreed to

share Relevant Information;

1.1.3. set out the lawful basis for the sharing of information between

the Parties, and the principles that underpin the exchange of

Relevant Information;

1.1.4. describe roles and structures to support the exchange of

Relevant Information between the Parties;

1.1.5. apply to the sharing of Relevant Information relating to GPs

where necessary;

1.1.6. apply to the sharing of Relevant Information whatever the

medium in which it is held and however it is transmitted;

1.1.7. ensure that Data Subjects are, where appropriate, informed

of the reasons why Personal Data about them may need to

be shared and how this sharing will be managed;

1.1.8. apply to the activities of the Parties’ Personnel; and

1.1.9. describe how complaints relating to Personal Data sharing

between the Parties will be investigated and resolved, and

how the information sharing will be monitored and reviewed.

2. Purpose



2.1. The Specified Purpose(s) of the data sharing initiative is to facilitate the

exercise of the CCG’s Delegated Functions and NHS England’s

Reserved Functions:

2.1.1. the management of the primary medical service performers’

list in accordance with section 91 of the NHS Act;

2.1.2. management of GP revalidation and appraisal;

2.1.3. administration of payments and related performers list

management activities;

2.1.4. planning and delivering the provision of appropriate care

services;

2.1.5. improving the health of the local population;

2.1.6. performance management of GP providers;

2.1.7. investigating and responding to incidents and complaints;

and

2.1.8. reducing risk to individuals, service providers and the public

as a whole.

2.2. Specific and detailed purposes are set out in the Personal Data

Agreement appended to this Schedule.

3. Benefits of information sharing

3.1. The benefits of sharing information are the achievement of the Specified

Purposes set out above, with benefits for service users and other

stakeholders in terms of the improved local delivery of primary

healthcare services.

4. Legal basis for Sharing

4.1. Each Party shall comply with all relevant Information Law requirements

and good practice in relation to the processing of Relevant Information

shared further to this Agreement.

4.2. The Parties shall identify the lawful basis for sharing Relevant

Information for each purpose and data flow, and document these in the

attached Personal Data Agreement.



5. Relevant Information to be shared

5.1. The Relevant Information to be shared is set out in the attached

Personal Data Agreement.

6. Restrictions on use of the Shared Information

6.1. Each Party shall only process the Relevant Information as is necessary

to achieve the Specified Purpose, and, in particular, shall not use or

process Relevant Information for any other purpose unless agreed in

writing by the Data Controller that released the information to the other.

There shall be no other use or onward transmission of the Relevant

Information to any third party without a lawful basis first being

determined, and the originating Data Controller being notified.

6.2. Access to, and processing of, the Relevant Information provided by a

Party must be the minimum necessary to achieve the Specified

Purpose. Information and Special Category Personal Data will be

handled at all times on a restricted basis, in compliance with Information

Law requirements, and Personnel should only have access to Personal

Data on a justifiable Need to Know basis for the purpose of performing

their duties in connection with the services they are there to deliver. The

Need to Know requirement means that the Data Controllers’ Personnel

will only have access to Personal Data or Sensitive Personal Data if it

is lawful for such Personnel to have access to such data for the

Specified Purpose and the function they are required to fulfil at that

particular time, in relation to the Specified Purpose, cannot be achieved

without access to the Personal Data or Special Category Personal Data

specified.

6.3. Having this Agreement in place does not give licence for unrestricted

access to data that the other Data Controller may hold. It lays the

parameters for the safe and secure sharing and processing of

information for a justifiable Need to Know purpose.

6.4. Neither Party shall subcontract any processing of the Relevant

Information without the prior written consent of the other Party. Where

a Party subcontracts its obligations, it shall do so only by way of a written

agreement with the sub-contractor which imposes the same obligations

as are imposed on the Data Controllers under this Agreement.



6.5. Neither Party shall cause or allow Data to be transferred to any territory

outside the European Economic Area without the prior written

permission of the responsible Data Controller.

6.6. Any particular restrictions on use of certain Relevant Information are

included in the attached Personal Data Agreement.

7. Ensuring fairness to the Data Subject

7.1. In addition to having a lawful basis for sharing information, the GDPR

generally requires that the sharing must be fair. In order to achieve

fairness to the Data Subjects, the Parties will put in place the following

arrangements:

7.1.1. amendment of internal guidance to improve awareness and

understanding among Personnel;

7.1.2. amendment of respective privacy notices and policies to

reflect the processing of data carried out further to this

agreement, including covering the requirements of articles 13

and 14 GDPR and providing these (or making them available

to) Data Subjects; and

7.1.3. consideration given to further activities to promote public

understanding where appropriate.

7.2. Each Party shall procure that its notification to the Information

Commissioner’s Office and record of processing maintained for the

purposes of Article 30 GDPR reflects the flows of information under this

Agreement.

7.3. Each Party shall reasonably cooperate with the other in undertaking any

Data Protection Impact Assessment associated with the processing of

data further to this Agreement.

7.4. Further provision in relation to specific data flows is included in the


8. Governance: Personnel



8.1. Each Party must take reasonable steps to ensure the suitability,

reliability, training and competence, of any Personnel who have access

to the Personal Data (and Special Category Personal Data) including

reasonable background checks and evidence of completeness should

be available on request by each Party.

8.2. The Parties agree to treat all Relevant Information as confidential and

imparted in confidence and must safeguard it accordingly. Where the

Personnel are not healthcare professionals (for the purposes of the

Data Protection Act 2018) the employing Parties must procure that its

Personnel operate under a duty of confidentiality which is equivalent to

that which would arise if that person were a health professional.

8.3. Each Party shall ensure that all Personnel required to access the

Personal Data (including Special Category Personal Data) are informed

of the confidential nature of the Personal Data and each Party shall

include appropriate confidentiality clauses in employment/service

contracts of all Personnel that have any access whatsoever to the

Relevant Information, including details of sanctions against any

employee acting in a deliberate or reckless manner that may breach the

confidentiality or the non-disclosure provisions of Information Law

requirements, or causes damage to or loss of the Relevant Information.

8.4. Each Party shall provide evidence (further to any reasonable request)

that all Personnel that have any access to the Relevant Information

whatsoever are adequately and appropriately trained to comply with

their responsibilities under Information Law and this Agreement.

8.5. Each Party shall ensure that:

8.5.1. only those employees involved in delivery of the Agreement

use or have access to the Relevant Information; and

8.5.2. that such access is granted on a strict Need to Know basis

and shall implement appropriate access controls to ensure

this requirement is satisfied and audited. Evidence of audit

should be made freely available on request by the originating

Data Controller. These access controls are set out in the

attached Personal Data Agreement; and



8.5.3. specific limitations on the Personnel who may have access to

the Information are set out in the attached Personal Data

Agreement.

9. Governance: Protection of Personal Data

9.1. At all times, the Parties shall have regard to the requirements of

Information Law and the rights of Data Subjects.

9.2. Wherever possible (in descending order of preference), only

anonymised information, or strongly or weakly pseudonymised

information will be shared and processed by Parties, without the need

to share easily identifiable Personal Data. The Parties shall cooperate

in exploring alternative strategies to avoid the use of Personal Data in

order to achieve the Specified Purpose. However, it is accepted that

some Relevant Information shared further to this Agreement may be

Personal Data/Special Category Personal Data.

9.3. Processing of any Personal Data or Special Category Personal Data

shall be to the minimum extent necessary to achieve the Specified

Purpose, and on a Need to Know basis. If either Party:

9.3.1. becomes aware of any unauthorised or unlawful processing

of any Relevant Information or that any Relevant Information

is lost or destroyed or has become damaged, corrupted or

unusable; or

9.3.2. becomes aware of any security vulnerability or breach,

in respect of the Relevant Information it shall promptly (and within 48

hours) notify the other Party. The Parties shall fully cooperate with one

another to remedy the issue as soon as reasonably practicable, and in

making information about the incident available to the Information

Commissioner and Data Subjects where required by Information Law.

9.4. In processing any Relevant Information further to this Agreement, each

Party shall:

9.4.1. process the Personal Data (including Special Category

Personal Data) only in accordance with the terms of this

Agreement and otherwise (to the extent that it acts as a Data

Processor for the purposes of Article 27-28 GDPR) only in



accordance with written instructions from the originating Data

Controller in respect of its Relevant Information;


Personal Data) only to the extent as is necessary for the

provision of the Specified Purpose or as is required by law or

any regulatory body;


Personal Data) only in accordance with Information Law

requirements and shall not perform its obligations under this

Agreement in such a way as to cause any other Data

Controller to breach any of their applicable obligations under

Information Law; and

9.4.4. process the Personal Data in accordance with the

requirements of Information Law and in particular the

principles set out in Article 5(1) and accountability

requirements set out in Article 5(2) GDPR.

9.5. Each Party shall act generally in accordance with Information Law

requirements, and in particular shall implement, maintain and keep

under review appropriate technical and organisational measures to

ensure and to be able to demonstrate that the processing of Personal

Data is undertaken in accordance with Information Law, and in

particular to protect the Personal Data (and Special Category Personal

Data) against unauthorised or unlawful processing and against

accidental loss, destruction, damage, alteration or disclosure. These

measures shall:

9.5.1. Take account of the nature, scope, context and purposes of

processing as well as the risks of varying likelihood and severity for the

rights and freedoms of Data Subjects; and

9.5.2. Be appropriate to the harm which might result from any

unauthorised or unlawful processing, accidental loss, destruction or

damage to the Personal Data (and Special Category Personal Data)

and having regard to the nature of the Personal Data (and Special

Category Personal Data) which is to be protected.



9.6. In particular, each Party shall:

9.6.1. ensure that only Personnel authorised under this Agreement

have access to the Personal Data (and Special Category

Personal Data);

9.6.2. ensure that the Relevant Information is kept secure and in an

encrypted form, and shall use all reasonable security

practices and systems applicable to the use of the Relevant

Information to prevent and to take prompt and proper

remedial action against, unauthorised access, copying,

modification, storage, reproduction, display or distribution, of

the Relevant Information;

9.6.3. obtain prior written consent from the originating Party in order

to transfer the Relevant Information to any third party;

9.6.4. permit the other Party or their representatives (subject to

reasonable and appropriate confidentiality undertakings), to

inspect and audit the data processing activities carried out

further to this Agreement (and/or those of its agents,

successors or assigns) and comply with all reasonable

requests or directions to enable each Party to verify and/or

procure that the other is in full compliance with its obligations

under this Agreement; and

9.6.5. if requested, provide a written description of the technical and

organisational methods and security measures employed in

processing Personal Data.

9.7. Specific requirements as to information security set out in the Personal

Data Agreement(s).

9.8. Each Party shall use best endeavours to achieve and adhere to the

requirements of the NHS Information Governance Toolkit, particularly in

relation to Confidentiality and Data Protection Assurance, Information

Security Assurance and Clinical Information Assurance.

9.9. The Parties’ Single Points of Contact (“SPoC”) set out in paragraph 14

(Governance: Single Points of Contact) below will be the persons who, in

the first instance, will have oversight of third party security measures.

10. Governance: Transmission of Information between the Parties



10.1. This paragraph supplements paragraph 9 (Governance: Protection of

Personal Data) of this Schedule.

10.2. Transfer of Personal Data between the Parties shall be done through

secure mechanisms including use of the N3 network, encryption, and

approved secure (NHS.net / gcsx) email.

10.3. Faxes shall only be used to transmit Personal Data in an emergency.

10.4. Wherever possible, Personal Data should be transmitted (and held) in

pseudonymised form, with only reference to the NHS number in 'clear'

transmissions. Where there are significant consequences for the care

of the patient, then additional data items, such as the postcode, date of

birth and/or other identifiers should also be transmitted, in accordance

with good information governance and clinical safety practice, so as to

ensure that the correct patient record / data is identified.

10.5. Any other special measures relating to security of transfer are specified

in the attached Personal Data Agreement.

10.6. Each Party shall keep an audit log of Relevant Information transmitted

and received in the course of this Agreement.

10.7. The Parties’ Single Point of Contact notified pursuant to paragraph 14

(Governance: Single Points of Contact) will be the persons who, in the

first instance, will have oversight of the transmission of information

between the Parties.

11. Governance: Quality of Information

11.1. The Parties will take steps to ensure the quality of the Relevant

Information and to comply with the principles set out in Article 5(1)(c)

and (d) GDPR.

11.2. Special measures relating to ensuring quality are set out in the attached

Personal Data Agreement.

12. Governance: Retention and Disposal of Shared Information



12.1. The non-originating Party shall securely destroy or return the Relevant

Information once the need to use it has passed or, if later, upon the

termination of this Agreement, howsoever determined. Where Relevant

Information is held electronically the Relevant Information will be

deleted and formal notice of the deletion sent to the Party that shared

the Relevant Information. Once paper information is no longer required,

paper records will be securely destroyed or securely returned to the

Party they came from.

12.2. Each Party shall provide an explanation of the processes used to

securely destroy or return the information, or verify such destruction or

return, if requested by the other Party and shall comply with any request

of the Data Controllers to dispose of data in accordance with specified

standards or criteria.

12.3. If either Party is required by any law, regulation, or government or

regulatory body to retain any documents or materials that it would

otherwise be required to return or destroy under this paragraph 12

(Governance: Retention and Disposal of Shared Information) , it shall

notify the other Party in writing of that retention, giving details of the

documents or materials that it must retain.

12.4. Retention of any data shall comply with the requirements of Article

5(1)(e) GDPR and with all good practice including the Records

Management NHS Code of Practice, as updated or amended from time

to time.

12.5. Any special retention periods are set out in attached Personal Data

Agreement.

12.6. Each Party shall ensure that Relevant Information held in paper form is

held in secure files, and, when it is no-longer needed, destroyed using

a cross cut shredder or subcontracted to a confidential waste company

that complies with European Standard EN15713.

12.7. Each Party shall ensure that, when no longer required, electronic

storage media used to hold or process Personal Data are destroyed or

overwritten to current policy requirements.



12.8. Electronic records will be considered for deletion once the relevant

retention period has ended.

12.9. In the event of any bad or unusable sectors of electronic storage media

that cannot be overwritten, the Party shall ensure complete and

irretrievable destruction of the media itself in accordance with policy

requirements.

13. Governance: Complaints and Access to Personal Data

13.1. Each Party shall assist the other in responding to any request made

under Information Law made by persons who wish to access copies of

information held about them (“Subject Access Requests”), as well as

any other purported exercise of a Data Subject’s righ ts under

Information Law or complaint to or investigation undertaken by the

Information Commissioner.

13.2. Complaints about information sharing shall be routed through each

Party’s own complaints procedure but reported to the Single Points of

Contact set out in paragraph 14 (Governance: Single Points of Contact)

below.

13.3. The Parties shall use all reasonable endeavours to work together to

resolve any dispute or complaint arising under this Agreement or any

data processing carried out further to it.

13.4. Basic details of the Agreement shall be included in the appropriate log

under each Party’s Publication Scheme.

14. Governance: Single Points of Contact

14.1. The Parties each shall appoint a single point of contact to whom all

queries relating to the particular information sharing should be directed

in the first instance. Details of the single points of contact shall be set

out in the attached Personal Data Agreement.

15. Monitoring and review



15.1. The Parties shall monitor and review on an ongoing basis the sharing

of Relevant Information to ensure compliance with Information Law and

best practice. Specific monitoring requirements are set out in the




Template Personal Data Agreement

Data flow subject matter: [Description]

Data flow duration: The duration of the delegation arrangement [OR Insert

alternative period]

Nature and purpose of processing: Described in the Delegation Agreement at

Schedule 4 paragraph 2.1 above

Description of information flow and single points of contact for parties

involved

Originating Data

Controller

[Insert:]

Contact details

for single point

of contact for

Originating Data

Controller

Name of

point of

contact

Title Contact

(email)

Contact

(phone)

Recipient Data

Controller

[Insert:]

Contact details

for single point

of contact of

Recipient Data

Controller

Name of

point of

contact

Title Contact

(email)

Contact

(phone)

Description of information to be shared

Comprehensive

description of

Relevant

Information to be

shared –

including the

type(s) of

personal data to

be shared and

[Insert:]



categories of

personal data

Anonymised / not

information

about individual

persons

Yes / No

Strongly

pseudonymised

Yes / No

Weakly

pseudonymised

Yes / No

Person -

identifiable data

Yes / No

Justification for

the level of

identifiability

required

[Insert or N/A:]

Legal basis for disclosure and use

GDPR Article 6

Legitimising

Condition/s

[Insert or N/A:]

GDPR Article 9

Legitimising

Conditions

[Insert or N/A:]

Confidentiality Explicit consent Yes / No

[If yes, how documented?:]

Implied Consent Yes / No

[If yes, how have you implied

consent?:]



Statutory

required/permitted

disclosure

[Insert statutory basis:]

Public interest disclosure [Insert how the public interest

favours use/disclosure of the

information:]

Other legal basis [Insert:]

s. 13Z3 / 14Z23

NHS Act 2006

justification

S. 13Z3 condition(s) to

permit disclosure

[Insert:]

S. 14Z23 condition(s) to

permit disclosure

[Insert:]

Other specific

legal

considerations

Restrictions on use of information

[Insert:]

Governance arrangements

Specific measures to

ensure fairness to the

Data Subject, including

privacy impact

assessments undertaken

[Insert:]

Access controls on use

of information

[Insert:]

Specific limitations on

Personnel who may

access information

[Insert:]



Other specific security

requirements

(transmission)

[Insert:]

Other specific security

requirements (general)

[Insert:]

Specific requirements as

to ensuring quality of

information

[Insert:]

Specific requirements for

retention and destruction

of information

[Insert:]

Specific monitoring and

review arrangements

[Insert:]



Schedule 5

Financial Provisions and Decision Making Limits

Financial Limits and Approvals

1. The CCG shall ensure that any decisions in respect of the Delegated Functions

and which exceed the financial limits set out below are only taken:

1.1. by the following persons and/or individuals set out in column 2 of Table 1

below; and

1.2. following the approval of NHS England (if any) as set out in column 3 of

the Table 1 below.

2. NHS England may, from time to time, update Table 1 by sending a notice to the

CCG of amendments to Table 1.



Table 1 – Financial Limits

Decision Person/Individual NHS England Approval

General

Taking any step or action in relation to

the settlement of a Claim, where the

value of the settlement exceeds

£100,000

CCG Accountable Officer or Chief

Finance Officer or Chair


and


Director of Finance

Any matter in relation to the Delegated

Functions which is novel, contentious or

repercussive




Director of Finance or

NHS England Region Director or

Director of Finance or


Financial Officer

Revenue Contracts

The entering into of any Primary

Medical Services Contract which has or

is capable of having a term which

exceeds five (5) years




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Capital

Note: As at the date of this Agreement, the CCG will not have delegated or directed responsibility for decisions in relation

to Capital expenditure (and these decisions are retained by NHS England) but the CCG may be required to carry out

certain administrative services in relation to Capital expenditure under clause 13 (Financial Provisions and Liability).

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Schedule 6

Template Variation Agreement

Variation Reference: [insert reference] Proposed by: [insert party] [Note – only NHS England may

propose National Variations] Date of Proposal: [insert date] Date of Variation Agreement: [insert date] Capitalised words and phrases in this Variation Agreement have the meanings given to them in the Agreement referred to above. 1. The Parties have agreed the [National] Variation summarised below:

2. The [National] Variation is reflected in the attached Schedule and the Parties

agree that the Agreement is varied accordingly. 3. The Variation takes effect on [insert date].

IN WITNESS OF WHICH the Parties have signed this Variation Agreement on the date(s) shown below

Signed by

NHS England

[Insert name of Authorised Signatory] [for and on

behalf of] [ ]

Signed by

[insert name of Authorised Signatory] Clinical

Commissioning Group

[insert name] (for and on behalf of [insert])



Schedule to Variation Agreement

[Insert details of variation]



Schedule 7

Local Terms

[Note – Local terms may only be agreed between the CCG and NHS England on an

exceptional basis and must not derogate from the terms and conditions of this

Agreement. Please note that Local Terms may include:

• details of any pooled funds of NHS England and the CCG;

• resourcing arrangements between NHS England and the CCG; and

• details of any particular services that the Assigned Staff will provide to the CCG

under Schedule 8.

If there are no Local Terms, state “There are no Local Terms” in this Schedule 7.]



Schedule 8

Assignment of NHS England Staff to the CCG

1. Introduction

1.1. The purpose of this Schedule 8 (Assignment of NHS England Staff to the

CCG) is to give clarity to the CCG and NHS England, in circumstances

where NHS England staff are assigned to the CCG under Model 1 of the

Staffing Models.

1.2. In accordance with clause 18 of this Agreement, the Parties have agreed

that the CCG may only engage staff to undertake the Delegated

Functions under one of the three Staffing Models referred to in that

clause.

1.3. The Parties agree and acknowledge that until such time as the CCG’s

preferred Staffing Model takes effect, the engagement of staff to

undertake the Delegated Functions shall be in accordance with the terms

of this Schedule 8 (Assignment of NHS England Staff to the CCG) (the

“Arrangements”).

2. Duration

2.1. The Arrangements shall commence on the date of this Agreement and

shall continue until the date on which the Parties agree which of the

Staffing Models (set out at clauses 18.1.1 to 18.1.3) will be adopted by

the CCG and the date on which such Staffing Model shall take effect.

3. Services

3.1. NHS England agrees to make available the Assigned Staff to the CCG to

perform administrative and management support services together with

such other services specified in Schedule 7 (Local Terms) (the

“Services”) so as to facilitate the CCG in undertaking the Delegated

Functions pursuant to the terms of this Agreement.

3.2. NHS England shall take all reasonable steps to ensure that the Assigned

Staff shall:



3.2.1. faithfully and diligently perform duties and exercise such

powers as may from time to time be reasonably assigned to or

vested in them; and

3.2.2. perform all duties assigned to them pursuant to this Schedule

8 (Assignment of NHS England Staff to the CCG).

3.3. The CCG shall notify NHS England if the CCG becomes aware of any act

or omission by any Assigned Staff which may have a material adverse

impact on the provision of the Services or constitute a material breach of

the terms and conditions of employment of the Assigned Staff.

3.4. NHS England shall be released from its obligations to make the Assigned

Staff available for the purposes of this Schedule 8 (Assignment of NHS

England Staff to the CCG) whilst the Assigned Staff are absent:

3.4.1. by reason of industrial action taken in contemplation of a trade

dispute;

3.4.2. as a result of the suspension or exclusion of employment or

secondment of any Assigned Staff by NHS England;

3.4.3. in accordance with the Assigned Staff’s respective terms and

conditions of employment and policies, including, but not

limited to, by reason of training, holidays, sickness, injury, trade

union duties, paternity leave or maternity or where absence is

permitted by Law;

3.4.4. if making the Assigned Staff available would breach or

contravene any Law;

3.4.5. as a result of the cessation of employment of any individual

Assigned Staff; and/or

3.4.6. at such other times as may be agreed between NHS England

and the CCG.

4. Employment of the Assigned Staff

4.1. NHS England shall employ the Assigned Staff and shall be responsible

for the employment of the Assigned Staff at all times on whatever terms

and conditions as NHS England and the Assigned Staff may agree from

time to time.

4.2. NHS England shall pay the Assigned Staff their salaries and benefits and

make any deductions for income tax liability and national insurance or



similar contributions it is required to make from the Assigned Staff’s

salaries and other payments.

4.3. The Assigned Staff shall carry out the Services from NHS England’s

places of work and may be required to attend the offices of the CCG from

time to time in the course of carrying out the Services. Nothing in this

Schedule 8 (Assignment of NHS England Staff to the CCG) shall be

construed or have effect as constituting any relationship of employer and

employee between the CCG and the Assigned Staff.

4.4. NHS England shall not, and shall procure that the Assigned Staff shall

not, hold themselves out as employees of the CCG.

5. Management

5.1. NHS England shall have day-to-day control of the activities of the

Assigned Staff and deal with any management issues concerning the

Assigned Staff including, without limitation, performance appraisal,

discipline and leave requests.

5.2. The CCG agrees to provide all such assistance and co-operation that

NHS England may reasonably request from time to time to resolve

grievances raised by Assigned Staff and to deal with any disciplinary

allegations made against Assigned Staff arising out of or in connection

with the provision of the Services which shall include, without limitation,

supplying NHS England with all information and the provision of access

to all documentation and personnel as NHS England requires for the

purposes of considering and dealing with such issues and participating

promptly in any action which may be necessary.

6. Conduct of Claims

6.1. If the CCG becomes aware of any matter that may give rise to a claim by

or against a member of Assigned Staff, notice of that fact shall be given

as soon as possible to NHS England. NHS England and the CCG shall

co-operate in relation to the investigation and resolution of any such

claims or potential claims.

6.2. No admission of liability shall be made by or on behalf of the CCG and

any such claim shall not be compromised, disposed of or settled without

the consent of NHS England.



7. Confidential Information and Property

7.1. For the avoidance of doubt, this paragraph 8 (Confidential Information

and Property) is without prejudice to any other provision of this

Agreement in relation to confidential information.

7.2. It is acknowledged that to enable the Assigned Staff to provide the

Services, the Parties may share information of a highly confidential nature

being information or material which is the property of NHS England or the

CCG or which NHS England or the CCG are obliged to hold confidential

including, without limitation, all official secrets, information relating to the

working of any project carried on or used by the relevant Party, research

projects, strategy documents, tenders, financial information, reports,

ideas and know-how, employee confidential information and patient

confidential information and any proprietary party information (any and all

of the foregoing being “Confidential Information”).

7.3. The Parties agree to adopt all such procedures as the other party may

reasonably require and to keep confidential all Confidential Information

and that the Parties shall not (save as required by law) disclose the

Confidential Information in whole or in part to anyone and agree not to

disclose the Confidential Information other than in connection with the

provision of the Services.

7.4. The obligations under this Agreement apply to all and any Confidential

Information whether the Confidential Information was in or comes into the

possession of the relevant person prior to or following this Agreement and

such obligations shall continue at all times following the termination of the

Arrangements but shall cease to apply to information which may come

into the public domain otherwise than through unauthorised disclosure by

NHS England or the CCG, as the case may be.

8. Intellectual Property

8.1. All Intellectual Property (meaning any invention, idea, improvement,

discovery, development, innovation, patent, writing, concept design

made, process information discovered, copyright work, trademark, trade



name and/or domain name) made, written, designed, discovered or

originated by the Assigned Staff shall be the property of NHS England to

the fullest extent permitted by law and NHS England shall be the absolute

beneficial owner of the copyright in any such Intellectual Property.



NHS NOTTINGHAM AND

NOTTINGHAMSHIRE

CLINICAL COMMISSIONING GROUP

GOVERNANCE HANDBOOK



NHS Nottingham and Nottinghamshire Clinical Commissioning Group Governance Handbook

Version Effective

Date

Changes

0.1 1 April 2020 First version Governance Handbook on establishment of the

CCG.



Contents

[To be inserted]



1

Introduction

This Governance Handbook, which sits alongside the CCG’s Constitution (see below),

contains the following key documents:

Terms of Reference – for all of the CCG’s Committees, Sub-Committees and Joint

Committees, and the terms of reference for all of the Governing Body’s Committees,

Sub-Committees and Joint Committees; and

Scheme of Reservation and Delegation – which sets out those decisions that are

reserved for the membership as a whole and those decisions that are the responsibilities

of the CCG’s Governing Body (and its Committees, Sub-Committees and Joint

Committees) and employees.

The CCG’s Constitution sets out the statutory framework that the CCG operates within and

its arrangements for demonstrating accountability and transparency. It also provides details

relating to the CCG’s Membership and sets out the arrangements for exercising the CCG’s

functions and procedures for making decisions. Provisions for conflict of interest

management and required standards of business conduct are also included.

There are two further documents that provide details on how the CCG operates. These

documents form part of the CCG’s Constitution and they are the CCG’s:

Standing Orders – which set out the arrangements for the CCG’s Governing Body

meetings and the appointment processes for Governing Body members.

Standing Financial Instructions – which set out the arrangements for managing the

CCG’s financial affairs and the delegated limits for financial commitments on behalf of

the CCG.



2

NHS Nottingham and Nottinghamshire CCG - Governance Framework

ICS

Partnership

Board

Governing Body (GB)

Member Practices

Primary Care Commissioning

Committee

(PCCC)

Audit and

Governance

Committee

(A&G)

Remuneration

and Terms of

Service

Committee

(RATS)

Finance and Turnaround Committee

(F&T)

Quality and Performance Committee

(Q&P)

Patient and Public

Engagement Committee

(PPEC)

Prioritisation and Investment

Committee

(PIC)

Statutory Committees Non-Statutory Committees Advisory

Enabling and Delivery Groups: Outputs feed into the GB and its committees to provide advice and support to decision-making, scrutiny and assurance arrangements

Executive Management

Team (EMT)

Senior Leadership

Team (SLT)

Clinical Design

Authority

(CDA)

Financial Recovery

Group (FRG)

Performance Delivery

Group (PDG)

Staff Engagement

Group (SEG)

Primary Care Quality Groups

(PCQG)

Medicines Management Optimisation

Group (MMOG)

Information Governance

Steering

Group (IGSG)

Health and Safety

Steering

Group (HSSG)

Research and Evidence Strategy

Group (RESG)

Health and

Wellbeing

Boards

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Audit and Governance Committee – Terms of Reference

1. Purpose The Audit and Governance Committee exists to:

a) Provide the Governing Body with an independent and objective

view of the CCG’s financial systems, financial information and

compliance with the laws, regulations and directions governing

the CCG in as far as they relate to finance.

b) Review the establishment and maintenance of an effective

system of integrated governance, risk management and internal

control, across the whole of the CCG’s activities that supports

the achievement of the organisation’s objectives.

c) Scrutinise every instance of non-compliance with the CCG’s

Standing Orders, Scheme of Reservation and Delegation and

Standing Financial Instructions and monitoring compliance with

the CCG’s Conflicts of Interest Policy and Gifts, Hospitality and

Sponsorship Policy.

d) Approve the CCG’s Annual Report and Accounts.

2. Status The Audit and Governance Committee is established in accordance

with the National Health Service Act 2006 (as amended) and the

CCG’s Constitution. It is a statutory committee of, and accountable

to, the Governing Body.


a) Investigate any activity within its terms of reference.

b) Seek any information it requires from any employee and all

employees are directed to co-operate with any request made by

the Committee.

c) Obtain outside legal or other independent advice and to secure

the attendance of individuals with relevant experience and

expertise if it considers this necessary.

d) Create task and finish sub-groups in order to take forward

specific programmes of work as considered necessary by the

Committee’s membership. The Committee shall determine the

membership and terms of reference of any such task and finish

sub-groups.

3. Duties Integrated governance, risk management and internal control

a) The Committee will review the establishment and maintenance

of an effective system of integrated governance, risk

management and internal control across the whole of the

CCG’s activities, which supports the achievement of its

objectives. In particular the Committee will:

i) Review the adequacy and effectiveness of the CCG’s risk

management arrangements and all risk and control related

disclosure statements (in particular the annual governance

statement) together with any accompanying head of internal



4

audit opinion, external audit opinion or other appropriate

independent assurances.

ii) Review the adequacy and effectiveness of the underlying

assurance processes that indicate the degree of

achievement of the CCG’s objectives, the effectiveness of

the management of principal risks and the appropriateness

of the above disclosure statements.

iii) Scrutinise all instances on non-compliance with Standing

Orders, Scheme of Reservation and Delegation and

Standing Financial Instructions.

iv) Approve and monitor compliance with standards of business

conduct policies and any related reporting and self-

certifications.

v) Approve and monitor arrangements in place for allowing

staff to raise concerns (in confidence) about possible

improprieties, ensuring that any such concerns are

investigated proportionately and independently.

vi) Approve and monitor the policies and procedures for all

work related to counter fraud, bribery and corruption as

required by the NHS Counter Fraud Authority.

vii) Scrutinise compliance with legislative and regulatory

requirements relating to information governance and the

extent to which associated systems and processes are

effective and embedded within the CCGs. This will include

approval of associated policies.

viii) Monitor progress against the CCG’s overarching Policy

Work Programme.

b) In carrying out this work the Committee will primarily utilise the

work of internal audit, 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.

c) 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.

Internal audit

d) The Committee will ensure that there is an effective internal

audit function established by management that meets the

Public Sector Internal Audit Standards 2017 and provides

appropriate independent assurance to the Committee,

Accountable Officer and Governing Body. This will be achieved

by:

i) Considering the provision of the internal audit service and

the costs involved.

ii) Reviewing and approving of the annual internal audit plan



5

and more detailed programme of work, ensuring that this is

consistent with the audit needs of the CCG (as identified in

the Governing Body Assurance Framework).

iii) Considering the major findings of internal audit work (and

management’s response), and ensuring co-ordination

between the internal and external auditors to optimise the

use of audit resources.

iv) Ensuring that the internal audit function is adequately

resourced and has appropriate standing within the

organisation.

v) Monitoring the effectiveness of internal audit and completing

an annual review.

External audit

e) The Committee will 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:

i) Considering the appointment and performance of the

external auditors, as far as the rules governing the

appointment permits (and make recommendations to the

Governing Body when appropriate).

ii) Discussing and agreeing with the external auditors, before

the audit commences, the nature and scope of the audit as

set out in the annual plan.

iii) Discussing with the external auditors their local evaluation

of audit risks and assessment of the organisation and the

impact on the audit fee.

iv) Review of all external audit reports, including the report to

those charged with governance and any work undertaken

outside of the audit plan, together with the appropriateness

of management responses.

v) Ensuring that there is in place a clear protocol for the

engagement of external auditors to supply non-audit

services.

Counter fraud

f) The Committee will satisfy itself that the organisation has

adequate arrangements in place for counter fraud, bribery and

corruption that meet NHS Counter Fraud Authority’s standards

and will review the outcomes of work in these areas. This will

include approving the counter fraud work programme.

g) The Committee will refer any suspicions of fraud, bribery and

corruption to the NHS Counter Fraud Authority.

Financial reporting

h) The Committee will monitor the integrity of the financial

statements of the CCG and any formal announcements relating



6

to the organisation’s financial performance.

i) The Committee will ensure that the systems for financial

reporting to the Governing Body, including those of budgetary

control, are subject to review as to completeness and accuracy

of the information provided.

j) The Committee will review and approve the annual report and

accounts, focusing particularly on:

i) The wording in the annual governance statement and other

disclosures.

ii) Changes in, and compliance with, accounting policies,

practices and estimation techniques.

iii) Unadjusted mis-statements in the financial statements.

iv) Significant judgements in preparation of the financial

statements.

v) Significant adjustments resulting from the audit.

vi) Letters of representation.

vii) Explanations for significant variances.

4. Membership The Audit and Governance Committee’s membership will be

comprised of three Non-Executive Directors of the Governing Body.

Attendees

The following will be routine attendees at Audit and Governance

Committee meetings:

a) Chief Finance Officer

b) Associate Director of Governance

c) Internal Audit

d) External Audit


Committee is discussing areas of risk or operation that fall within

their areas of responsibility. This will include:

e) The Accountable Officer being invited to attend, at least

annually, to discuss with the Committee the process for

assurance that supports the annual governance statement.

f) The Local Counter Fraud Specialist being invited to attend at

least twice per year.

5. Chair and

Deputy

The Audit and Governance Committee will be chaired by a Non-

Executive Director who has qualifications, expertise or experience

to enable them to lead on finance and audit matters.

In the event of the Chair being unable to attend all or part of the

meeting, a replacement from within the Committee’s membership

will be nominated to deputise for that meeting.

6. Quorum and

Decision-making

The Audit and Governance Committee will be quorate with a

minimum of two members present.



7

Arrangements If any Committee member has been disqualified from participating

in the discussion and/or decision-making for an item on the

agenda, by reason of a declaration of a conflict of interest, then that

individual shall no longer count towards the quorum.

If the quorum has not been reached, then the meeting may proceed

if those attending agree, but no decisions may be taken.

For the sake of clarity, no person can act in more than one capacity

when determining the quorum.

Committee members will seek to reach decisions by consensus

where possible. If a consensus agreement cannot be reached, then

the item will be escalated to the Governing Body for a decision.

7. Frequency of

Meetings

The Audit and Governance Committee will meet no less than six

times per year at appropriate times in the reporting and audit cycle.

The Head of Internal Audit and representatives from external audit

have a right of direct access to the Chair of the Committee and may

request a meeting if they consider that one is necessary. The

Committee will meet privately with the internal and external auditors

at least once during the year.

Meetings of the Committee, other than those regularly scheduled

above, shall be summoned by the secretary to the Committee at

the request of the Chair.

8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Audit and Governance

Committee to ensure the day to day work of the Committee is

proceeding satisfactorily.

Agendas and supporting papers will be circulated no later than five

calendar days in advance of meetings and will be distributed by the

secretary to the Committee.




agenda may be added on receipt of permission from the Chair.

The Committee agenda will be agreed with the Chair prior to the

meeting.

9. Minutes of

Meetings

Minutes will be taken at all meetings and presented according the

corporate style.

The minutes will be ratified by agreement of the Audit and

Governance Committee at the following meeting.

The Chair of the Committee will agree minutes if they are to be

submitted to the Governing Body prior to formal ratification.

10. Conflicts of

Interest

Management

In advance of any meeting of the Audit and Governance

Committee, consideration will be given as to whether conflicts of

interest are likely to arise in relation to any agenda item and how

they should be managed. This may include steps to be taken prior

to the meeting, such as ensuring that supporting papers for a



8

particular agenda item are not sent to conflicted individuals.




existence of an interest becomes apparent during a meeting, then

this must be declared at the point at which it arises. Any such

declarations will be formally recorded in the minutes for the

meeting.

The Chair of the Committee will determine how declared interests

should be managed, which is likely to involve one the following

actions:

a) Requiring the individual to withdraw from the meeting for that

part of the discussion if the conflict could be seen as

detrimental to the Committee’s decision-making arrangements.

b) Allowing the individual to participate in the discussion, but not

the decision-making process.

c) Allowing full participation in discussion and the decision-making

process, as the potential conflict is not perceived to be material

or detrimental to the Committee’s decision-making

arrangements.

11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Audit and Governance 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

to provide assurance that it is effectively discharging its delegated

responsibilities, as set out in these terms of reference. The

Committee will conduct an annual review of its effectiveness to

inform this report.

12. 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.



Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



9

Remuneration and Terms of Service Committee – Terms of

Reference

1. Purpose The Remuneration and Terms of Service Committee exists to make

recommendations to the Governing Body in relation to:

a) The remuneration, fees and allowances payable to employees

of the CCG and to other persons providing services to it; and

b) Any determinations about allowances payable under pension

schemes established by the CCG.

In addition, the Governing Body has delegated a number of

functions to the Committee relating to the Governing Body’s duty to

ensure that the CCG has appropriate arrangements in place to

exercise its functions effectively, efficiently and economically and in

accordance with the principles of good governance (as set out in

section 3 below).

2. Status The Remuneration and Terms of Service Committee is established

in accordance with the National Health Service Act 2006 (as

amended) and the CCG’s constitution. It is a statutory committee of,

and accountable to, the Governing Body.


a) Seek such independent information as may be necessary to

inform their recommendations.

b) Create task and finish sub-groups in order to take forward

specific programmes of work as considered necessary by the

Committee’s membership. The Committee shall determine the

membership and terms of reference of any such task and finish

sub-groups.

3. Duties a) Make recommendations to the Governing Body about

appropriate remuneration, fees and allowances for Governing

Body members (who are employees) and all senior managers

on Very Senior Managers pay. This will include all aspects of

salary (including any performance-related elements and other

benefits, such as lease cars). Recommendations will be guided

by national NHS policy and best practice and 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.

b) Make recommendations to the Governing Body about

allowances payable under pension schemes established by the

CCG.

c) Make recommendations to the Governing Body about

termination payments (including redundancy and severance

payments) and any special payments following scrutiny of their



10

proper calculation and taking account of such national guidance

as appropriate.

d) Make recommendations to the Governing Body about

contractual terms and conditions for senior managers on Very

Senior Managers pay.

e) Determine the allowances to be paid to:

i) Governing Body GPs who are not employees (i.e. the

Clinical Chair, the Lead GP for the Nottingham and

Nottinghamshire Clinical Design Authority and the GPs

drawn from Member Practices);

ii) Other Governing Body members who are not employees

(excluding Non-Executive Directors); and

iii) Other clinical roles who are not employees.

NOTE: Non-Executive Director allowances are determined by

the Governing Body (non-conflicted members) in line with the

Scheme of Reservation and Delegation and Standing Orders.

f) Approve all human resources policies for CCG employees.

g) Oversee compliance with the requirements set out in the

Equality Act 2010 (Specific Duties and Public Authorities)

Regulations 2017, as necessary.

h) Oversee the identification and management of risks relating to

the Committee’s remit.

4. Membership The Remuneration and Terms of Service Committee’s membership will be comprised of four Non-Executive Directors of the Governing Body.

Senior Managers may be invited to attend for all or part of the

meeting (providing their own remuneration is not being discussed).

5. Chair and

Deputy

The Remuneration and Terms of Service Committee will be chaired

by a Non-Executive Director other than the Audit and Governance

Committee Chair.


meeting, a replacement from within the Committee’s membership

will be nominated to deputise for that meeting.

6. Quorum and

Decision-making

Arrangements

The Remuneration and Terms of Service Committee will be quorate

with a minimum of three members present.

If any Committee member has been disqualified from participating

in the discussion and/or decision-making for an item on the agenda,

by reason of a declaration of a conflict of interest, then that








11




7. Frequency of

Meetings

The Remuneration and Terms of Service Committee will meet as

required, with a minimum of one meeting per year.

8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Remuneration and Terms

of Service Committee to ensure the day to day work of the







meeting. Items which miss the deadline for inclusion on the agenda

may be added on receipt of permission from the Chair.


meeting.

9. Minutes of

Meetings


corporate style.

The minutes will be ratified by agreement of the Remuneration and

Terms of Service Committee at the following meeting.

10. Conflicts of

Interest

Management

In advance of any meeting of the Remuneration and Terms of

Service Committee, consideration will be given as to whether

conflicts of interest are likely to arise in relation to any agenda item

and how they should be managed. This may include steps to be

taken prior to the meeting, such as ensuring that supporting papers

for a particular agenda item are not sent to conflicted individuals.



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 declarations will

be formally recorded in the minutes for the meeting.



actions:


part of the discussion if the conflict could be seen as detrimental

to the Committee’s decision-making arrangements.








12

arrangements.

11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Remuneration and Terms of Service Committee will submit

reports to the Governing Body following each of its meetings.

These will include any items of specific concern, or which require

Governing Body approval.





inform this report.

12. Review of Terms

of Reference






Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



13

Schedule 1 - Protocol for Decision-Making on Remuneration

1. Introduction

NHS Nottingham and Nottinghamshire CCG’s Remuneration and Terms of Service

Committee has been established in accordance with the National Health Service Act 2006

(as amended) and the CCG’s Constitution. In line with national guidance, the Committee

exist to make recommendations to the CCG’s Governing Body, in relation to:

a) The remuneration, fees and allowances payable to employees of the CCG (excluding

Non-Executive Directors) and to other persons providing services to them; and

b) Any determinations about allowances payable under pension schemes established by

the CCG.

The purpose of this document is to outline the principles and process that will be adopted for

the decision-making process; ensuring that robust, transparent and timely decision-making is

achieved whilst avoiding any unnecessary duplication.

This document only applies to decisions relating to points a) and b) as shown above. Other

duties as detailed within the Committee’s Terms of Reference have been fully delegated to

the Committee.

2. Principles and Process

The following principles and process will be adopted to ensure robust decision-making with

regard to remuneration:

a) The Committee will receive the appropriate level of information to inform its

recommendation(s). This will include national guidance on remuneration and (where

appropriate) detailed benchmarking of comparative organisations/roles. Clear

recommendations from the CCG’s senior human resource professionals will be stated

within the Committee’s papers, along with any necessary input from the CCG’s

Executive Directors (where not conflicted).

b) Papers will be sent to the Committee within the timeframe stated within the Terms

of Reference. The Committee should be able to demonstrate that they have had

sufficient time to inform their recommendation(s) and to request any further information

needed in advance of the meeting.

c) The Governing Body will be assured that the appropriate scrutiny has been carried

out. The Governing Body should not need to receive the level of information reviewed

by the Committee but will be advised as to the basis on which the Committee made its

recommendation(s). This will be demonstrated through the presentation of a formal

paper to the Governing Body which clearly describes the information received by the

Committee and the factors that led to the Committee’s recommendation(s). The paper

will be prepared by the Committee’s secretary (in conjunction with HR colleagues) and

approved by the Committee’s Chair. As all members of the Committee are also members

of the Governing Body, they will be present at meetings to provide any further verbal

assurances required by other Governing Body members.

The minutes of the Committee’s meetings will be submitted to the Governing Body (once

formally ratified) for information; however, this will be to provide assurance in relation to



14

its wider role. To avoid unnecessary duplication of discussion on matters relating to

remuneration, these aspects of the minutes will be redacted.

d) Decisions on remuneration should fit within the agreed cycle of business. To

ensure the timeliness of decision-making, meetings of the Committee should be

convened to enable the Governing Body to receive the recommendations at the following

meeting of the Governing Body. This means allowing the appropriate time for the paper

to be:

Drafted by the Committee’s secretary;

Agreed by the Committee’s Chair; and

Submitted to the Governing Body in line with the required timeframe for receiving

papers.

e) The Committee’s paper will be presented in the confidential session of the

Governing Body meeting. An assessment of any conflicts of interest relating to

Governing Body members will be undertaken prior to the meeting and any appropriate

management actions put in place. This may require the exclusion of Executive Directors

from the item, in which case the quoracy requirements defined in the CCG’s Standing

Orders will be adhered to.

f) Decisions on remuneration are only taken by the Governing Body. Whilst unlikely,

there may be instances where the Governing Body:

Does not feel fully assured on the robustness of the Committee’s recommendations;

and/or

Does not agree with the Committee’s recommendation(s).

Where this may be the case, the Governing Body can:

Seek further verbal information/assurance from the Committee members present; or

Request that the Committee holds an extraordinary meeting to review the items

again. If this option is selected, the Governing Body will clearly set out their

comments/concerns about the initial recommendations and direct the Committee with

regard to any specific/additional factors they would like the Committee to consider.

g) Decisions on remuneration should not be delayed due to process. If the Governing

Body requests that a recommendation is re-visited, but a deadline is in place, then:

The Committee has the ability to review and discuss the item(s) again ‘virtually’ if

unable to meet again within the required timeframe; and/or

The Emergency Powers (defined in the CCG’s Constitution) can be utilised to

consider the outcome of the Committee’s review and to make a final decision. This

will be the final decision and will be reported back to the following meeting of the

Governing Body.

NB. ‘Virtual’ decisions still require evidence of scrutiny and the consideration of factors

pertinent to the outcome.

h) The principles of this approach will be reviewed on an ongoing basis. Feedback

from the Committee and the Governing Body on the fitness for purpose of this protocol

will inform the process going forwards.



15

Primary Care Commissioning Committee – Terms of Reference

1. Introduction /

Statutory

Framework

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

National Health Service Act 2006 (as amended), NHS England has

delegated the exercise of the primary care commissioning functions

specified in Schedule 1 to these Terms of Reference to NHS

Nottingham and Nottinghamshire CCG. More detailed information

on the specific and general obligations relating to the delegated

functions are also set out in Schedule 1. Details of those functions

reserved to NHS England are set out at Schedule 2.

Arrangements made under section 13Z may be on such terms and

conditions (including terms as to payment) as may be agreed

between NHS England and the CCG.

Arrangements made under section 13Z do not affect the liability of

NHS England for the exercise of any of its functions. However, the

CCG acknowledges that in exercising its functions (including those

delegated to it), it must comply with the statutory duties set out in

Chapter A2 of the NHS Act and including:

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

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

c) Duty to exercise its functions effectively, efficiently and

economically (section 14Q);

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

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

14S);

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

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

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

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

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

The CCG will also need to specifically, in respect of the delegated

functions from NHS England, exercise those in accordance with the

relevant provisions of section 13 of the NHS Act.

The Committee is subject to any directions made by NHS England

or by the Secretary of State.

The Primary Care Commissioning Committee has been established

in accordance with the CCG’s Constitution. The Committee will

function as a corporate decision-making body for the management

of the delegated functions and the exercise of the delegated

powers.

The Committee may delegate tasks to such individuals, sub-

committees or individual members as it shall see fit, provided that

any such delegations are consistent with the parties’ relevant

governance arrangements, are recorded in a scheme of delegation,



16

are governed by terms of reference as appropriate and reflect

appropriate arrangements for the management of conflicts of

interest.

For the avoidance of doubt, in the event of any conflict between the

terms of the Delegation Agreement in place between NHS England

and NHS Nottingham and Nottinghamshire CCG, these terms of

reference for the Primary Care Commissioning Committee and the

CCG’s Standing Orders or Standing Financial Instructions, then the

Delegation Agreement will prevail.

2. Duties The Committee has been established in accordance with the above

statutory provisions to enable the Committee to make collective

decisions on the review, planning and procurement of primary care

services in Nottingham and Nottinghamshire, under delegated

authority from NHS England.

In performing its role the Committee will exercise its management of

the functions in accordance with the agreement entered into

between NHS England and NHS Nottingham and Nottinghamshire

CCG, which will sit alongside the delegation and the Terms of

Reference.

The functions of the Committee are undertaken in the context of a

desire to promote increased co-commissioning to increase quality,

efficiency, productivity and value for money and to remove

administrative barriers.

The role of the Committee shall be to carry out the functions relating

to the commissioning of primary medical services under section 83

of the NHS Act.

This includes the following:

a) Decisions in relation to the commissioning, procurement and

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), including but not limited to the

following activities:

i) Decisions in relation to Enhanced Services;

ii) Decisions in relation to Local Incentive Schemes (including

the design of such schemes);

iii) Decisions in relation to the establishment of new GP

practices (including branch surgeries) and closure of GP

practices;

iv) Decisions about ‘discretionary’ payments;

v) Decisions about commissioning urgent care (including home

visits as required) for out of area registered patients;

a) The approval of practice mergers;

b) Planning primary medical care services in Nottingham and



17

Nottinghamshire, including carrying out needs assessments;

c) Undertaking reviews of primary medical care services in

Nottingham and Nottinghamshire;

d) Decisions in relation to the management of poorly performing

GP practices and including, without limitation, decisions and

liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in

relation to the performers list);

e) Management of the delegated funds for primary care medical

services;

f) Making decisions on premises costs directions functions; and

g) Co-ordinating a common approach to the commissioning of

primary care services generally.

The Committee will also:

h) Oversee delivery of the General Practice Forward View;

i) Review and approve policies specific to the Committee’s remit;

and

j) Oversee the identification and management of risks relating to


3. Membership The Primary Care Commissioning Committee will have ten

members, comprised as follows:



Clinical Members

b) GP Representative

c) An Independent GP Advisor


Managerial Members

e) Chief Commissioning Officer

f) Associate Director of Primary Care

g) Associate Director of Primary Care Development

h) Operational Director of Finance

There will be a standing invitation to the following to offer

representation in a non-voting capacity on the Committee:

a) Locality Directors for Mid-Nottinghamshire, Nottingham City and

South Nottinghamshire

b) Nottinghamshire Local Medical Committee

c) Healthwatch Nottingham and Nottinghamshire

d) Nottingham City Health and Wellbeing Board

e) Nottinghamshire County Health and Wellbeing Board



18

Other CCG officers may be invited to attend meetings when the

Committee is discussing items that fall within their areas of

expertise and/or responsibility.

4. Chair and

Deputy

The Primary Care Commissioning Committee will be chaired by a

Non-Executive Director other than the Audit and Governance

Committee Chair.


meeting, a replacement from within the Committee’s non-executive

membership will be nominated to deputise for that meeting. In such

circumstances, care will be taken to ensure that the Audit and

Governance Committee Chair’s role of Conflicts of Interest

Guardian is not compromised.

5. Quorum The Primary Care Commissioning Committee will be quorate with a

minimum of five members, to include:

a) Two Non-Executive Directors;

b) Either the Independent GP Advisor or the Deputy Chief Nurse;

and

c) Either the Chief Commissioning Officer or the Associate Director

of Primary Care.

To ensure that the quorum can be maintained, Committee members

are able nominate a suitable deputy to attend a meeting of the

Committee that they are unable to attend to speak and vote on their

behalf. Committee members are responsible for fully briefing their

nominated deputies and for informing the secretariat so that the

quorum can be maintained.

If any Committee member has been disqualified from participating in

the discussion and/or decision-making for an item on the agenda,








Each member of the Committee shall have one vote. The

Committee shall reach decisions by a simple majority of members

present, but with the Chair having a second and deciding vote, if

necessary. However, the aim of the Committee will be to achieve

consensus decision-making wherever possible.

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

The decisions of the Committee shall be binding on NHS England

and NHS Nottingham and Nottinghamshire CCG.


decisions. An urgent decision is one where the requirement for the

decision to be made arises between the scheduled monthly



19

meetings of the Committee 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 Committee members by the secretary to the

Committee.

The Committee members may meet either in person, via telephone

conference or communicate by email to take an urgent decision.

The quorum, as described in section 5, must be adhered to for

urgent decisions.

A minute of the discussion (including those performed virtually) and

decision will be taken by the secretary to the Committee and will be

reported to the next meeting of the Committee for formal ratification.

7. Frequency of

Meetings

Meetings of the Primary Care Commissioning Committee will be

scheduled on a monthly basis and the Committee will meet, as a

minimum, on a bi-monthly basis.

Meetings of the Primary Care Commissioning Committee, other

than those regularly scheduled above, shall be summoned by the

secretary to the Committee at the request of the Chair. When the

Chair of the Committee deems it necessary in light of urgent

circumstances to call a meeting at short notice, the notice period

shall be such as s/he shall specify.

8. Admission of public and the press


normally be open to the public.

However, the Committee 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.

In the event the public could be excluded from a meeting of the

Committee, the CCG shall consider whether the subject matter of

the meeting would in any event be subject to disclosure under the

Freedom of Information Act 2000, and if so, whether the public

should be excluded in such circumstances.

The Committee 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.

The Chair (or Deputy Chair) as 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



20

and representatives of the press such as to ensure that the

Committee’s business shall be conducted without interruption and

disruption.

Matters to be dealt with by the Committee following the exclusion of

representatives of the press, and other members of the public shall

be confidential to the members of the Committee.

Members of the Committee and any member or employee of the

CCG 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 Committee, without the express

permission of the Committee. This will apply equally to the content

of any discussion during the Committee meeting which may take

place on such reports or papers.

9. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Primary Care

Commissioning Committee to ensure the day to day work of the










meeting.

Members of the Committee have a collective responsibility for the

operation of the Committee. They will participate in discussion,

review evidence and provide objective expert input to the best of

their knowledge and ability, and endeavour to reach a collective

view.

10. Minutes of

Meetings


corporate style.

The minutes will be ratified by agreement of the Primary Care

Commissioning Committee at the following meeting.



11. Conflicts of

Interest

Management

In advance of any meeting of the Primary Care Commissioning









21








actions:









arrangements.

12. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Primary Care Commissioning Committee will report to the

Governing Body through regular submission of minutes from its

meetings (and those of any sub-committees to which responsibilities

have been delegated), accompanied by executive summary reports.

Any items of specific concern, or which require Governing Body

approval, will be the subject of a separate report.

The Committee will provide minutes and reports to NHS England for

information, at a frequency determined by the NHS England Local

Team.





inform this report.

13. Review of Terms

of Reference






Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



22

Schedule 1 - Delegated Functions

Part 1: Specific obligations regarding the carrying out of each of the delegated functions.


1. Primary Medical

Services Contract

Management

The CCG must:

a) Manage the Primary Medical Services Contracts on behalf of NHS England and perform all of NHS

England’s obligations under each of the Primary Medical Services Contracts in accordance with the terms

of the Primary Medical Services Contracts as if it were named in the contract in place of NHS England;

b) Actively manage the performance of the counter-party to the Primary Medical Services Contracts in order to

secure the needs of people who use the services, improve the quality of services and improve efficiency in

the provision of the services including by taking timely action to enforce contractual breaches and serve

notice;

c) Ensure that it obtains value for money under the Primary Medical Services Contracts on behalf of NHS

England and avoids making any double payments under any Primary Medical Services Contracts;

d) Comply with all current and future relevant national Guidance regarding PMS reviews and the management

of practices receiving Minimum Practice Income Guarantee (MPIG) (including without limitation the

Framework for Personal Medical Services (PMS) Contracts Review guidance published by NHS England in

September 2014 (http://www.england.nhs.uk/wp-content/uploads/2014/09/pms-review-guidance-

sept14.pdf));

e) Notify NHS England immediately (or in any event within two (2) Operational Days) of any breach by the

CCG of its obligations to perform any of NHS England’s obligations under the Primary Medical Services

Contracts;

f) Keep a record of all of the Primary Medical Services Contracts that the CCG manages on behalf of NHS

England setting out the following details in relation to each Primary Medical Services Contract:

Name of counter-party;

Location of provision of services; and

Amounts payable under the contract (if a contract sum is payable) or amount payable in respect of each


Establishm

ent of NH

S N

ottingham and N

ottinghamshire C

CG

289 of 4399.00, M

icrosoft Team

s-08/04/20



23


g) For the avoidance of doubt, all Primary Medical Services Contracts will be in the name of NHS England.

h) The CCG must comply with any Guidance in relation to the issuing and signing of Primary Medical Services

Contracts in the name of NHS England.

i) The CCG must actively manage each of the relevant Primary Medical Services Contracts including by:

Managing the relevant Primary Medical Services Contract, including in respect of quality standards,

incentives and the QOF, observance of service specifications, and monitoring of activity and finance;

Assessing quality and outcomes (including clinical effectiveness, patient experience and patient safety);

Managing variations to the relevant Primary Medical Services Contract or services in accordance with

national policy, service user needs and clinical developments;

Agreeing information and reporting requirements and managing information breaches (which will

include use of the HSCIC IG Toolkit SIRI system);

Agreeing local prices, managing agreements or proposals for local variations and local modifications;

Conducting review meetings and undertaking contract management including the issuing of contract

queries and agreeing any remedial action plan or related contract management processes; and

Complying with and implementing any relevant Guidance issued from time to time.

j) In relation to any new Primary Medical Services Contract to be entered into, the CCG must:

Consider and use the form of Primary Medical Services Contract that will ensure compliance with NHS

England’s obligations under Law including the Public Contracts Regulations 2015/102 and the National

Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013/500 taking into

account the persons to whom such Primary Medical Services Contracts may be awarded;

Provide to NHS England confirmation as required from time to time that it has considered and complied

with its obligations under this Agreement and the Law; and

For the avoidance of doubt, Schedule 3 (Financial and Decision-Making Limits) deals with the sign off

requirements for Primary Medical Services Contracts.

2. Enhanced Services a) The CCG must manage the design and commissioning of Enhanced Services, including re-commissioning

these services annually where appropriate.

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Enhanced Services.

c) When commissioning newly designed Enhanced Services, the CCG must:

Consider the needs of the local population in the Area;

Support Data Controllers in providing ‘fair processing’ information as required by the DPA;

Develop the necessary specifications and templates for the Enhanced Services, as required to meet the

needs of the local population in the Area;

When developing the necessary specifications and templates for the Enhanced Services, ensure that

value for money will be obtained;

Consult with Local Medical Committees, each relevant Health and Wellbeing Board and other

stakeholders in accordance with the duty of public involvement and consultation under section 14Z2 of

the NHS Act;

Obtain the appropriate read codes, to be maintained by the HSCIC;

Liaise with system providers and representative bodies to ensure that the system in relation to the

Enhanced Services will be functional and secure; and

Support GPs in entering into data processing agreements with data processors in the terms required by

the DPA.

3. Design of Local

Incentive Schemes

a) The CCG may design and offer Local Incentive Schemes for GP practices, sensitive to the needs of their

particular communities, in addition to or as an alternative to the national framework (including as an

alternative to QOF or directed Enhanced Services), provided that such schemes are voluntary and the CCG

continues to offer the national schemes.

b) There is no formal approvals process that the CCG must follow to develop a Local Incentive Scheme,

although any proposed new Local Incentive Scheme:

Is subject to consultation with the Local Medical Committee;

Must be able to demonstrate improved outcomes, reduced inequalities and value for money; and

Must reflect the changes agreed as part of the national PMS reviews.

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c) The ongoing assurance of any new Local Incentive Schemes will form part of the CCG’s assurance process

under the CCG Assurance Framework.

d) Any new Local Incentive Scheme must be implemented without prejudice to the right of GP practices

operating under a GMS Contract to obtain their entitlements which are negotiated and set nationally.

e) NHS England will continue to set national standing rules, to be reviewed annually, and the CCG must

comply with these rules which shall for the purposes of this Agreement be Guidance.

4. Making Decisions on

Discretionary Payments

a) The CCG must manage and make decisions in relation to the discretionary payments to be made to GP

practices in a consistent, open and transparent way.

b) The CCG must exercise its discretion to determine the level of payment to GP practices of discretionary

payments, in accordance with the Statement of Financial Entitlements Directions.

5. Making Decisions about

Commissioning Urgent

Care for Out of Area

Registered Patients

a) The CCG must manage the design and commissioning of urgent care services (including home visits as

required) for its patients registered out of area (including re-commissioning these services annually where

appropriate).


these services.

6. Planning the Provider

Landscape

a) The CCG must plan the primary medical services provider landscape in the Area, including considering and

taking decisions in relation to:

Establishing new GP practices in the Area;

Managing GP practices providing inadequate standards of patient care;

The procurement of new Primary Medical Services Contracts (in accordance with any procurement

protocol issued by NHS England from time to time);

Closure of practices and branch surgeries;

Dispersing the lists of GP practices;

Agreeing variations to the boundaries of GP practices; and

Coordinating and carrying out the process of list cleansing in relation to GP practices, according to any

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policy or Guidance issued by NHS England from time to time.

7. Approving GP Practice

Mergers and Closures

a) The CCG is responsible for approving GP practice mergers and GP practice closures in the Area.

b) The CCG must undertake all necessary consultation when taking any decision in relation to GP practice

mergers or GP practice closures in the Area, including those set out under section 14Z2 of the NHS Act

(duty for public involvement and consultation). The consultation undertaken must be appropriate and

proportionate in the circumstances and should include consulting with the Local Medical Committee.

c) Prior to making any decision, the CCG must be able to clearly demonstrate the grounds for such a decision

and must have fully considered any impact on the GP practice’s registered population and that of

surrounding practices. The CCG must be able to clearly demonstrate that it has considered other options

and has entered into dialogue with the GP contractor as to how any closure or merger will be managed.

d) In making any decisions, the CCG shall also take account of its obligations as set out at 1 j) above, where

applicable.

8. Information Sharing with

NHS England in relation

to the Delegated

Functions

a) The CCG must provide NHS England with:

Such information relating to individual GP practices in the Area as NHS England may reasonably

request, to ensure that NHS England is able to continue to gather national data regarding the


Such data/data sets as required by NHS England to ensure population of the primary medical services

dashboard;

Any other data/data sets as required by NHS England; and

The CCG shall procure that providers accurately record and report information so as to allow NHS

England and other agencies to discharge their functions.

b) The CCG must use the NHS England approved primary medical services dashboard, as updated from time

to time, for the collection and dissemination of information relating to GP practices.

c) The CCG must (where appropriate) use the NHS England approved GP exception reporting service (as

notified to the CCGs by NHS England from time to time).

d) The CCG must provide any other information, and in any such form, as NHS England considers necessary

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and relevant.

e) NHS England reserves the right to set national standing rules (which may be considered Guidance for the

purpose of this Agreement), as needed, to be reviewed annually. NHS England will work with CCGs to

agree rules for, without limitation, areas such as the collection of data for national data sets and IT intra-

operability. Such national standing rules set from time to time shall be deemed to be part of this

Agreement.

9. Making Decisions in

relation to Management

of Poorly Performing GP

Practices

a) The CCG must make decisions in relation to the management of poorly performing GP practices and

including, without limitation, decisions and liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in relation to the performers list).

b) The CCG must:

Ensure regular and effective collaboration with the CQC to ensure that information on general practice

is shared and discussed in an appropriate and timely manner;

Ensure that any risks identified are managed and escalated where necessary;

Respond to CQC assessments of GP practices where improvement is required;

Where a GP practice is placed into special measures, lead a quality summit to ensure the development

and monitoring of an appropriate improvement plan (including a communications plan and actions to

manage primary care resilience in the locality); and

Take appropriate contractual action in response to CQC findings.

10. Premises Costs


a) The CCG must comply with the Premises Costs Directions and will be responsible for making decisions in

relation to the Premises Costs Directions Functions.

b) In particular, the CCG shall make decisions concerning:

Applications for new payments under the Premises Costs Directions (whether such payments are to be

made by way of grants or in respect of recurring premises costs); and

Revisions to existing payments being made under the Premises Costs Directions.

c) The CCG must comply with any decision-making limits set out in Schedule 3 (Financial and Decision-

Making Limits) when taking decisions in relation to the Premises Costs Directions Functions.

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d) The CCG will comply with any guidance issued by the Secretary of State or NHS England in relation to the

Premises Costs Directions, including the Principles of Best Practice, and any other Guidance in relation to

the Premises Costs Directions.

e) The CCG must work cooperatively with other CCGs to manage premises and strategic estates planning.

f) The CCG must liaise where appropriate with NHS Property Services Limited and Community Health

Partnerships Limited in relation to the Premises Costs Directions Functions.

Part 2: General obligations regarding the carrying out of the delegated functions.


1. Planning and reviews a) The CCG is responsible for planning the commissioning of primary medical services. The role of the CCG

includes:

Carrying out primary medical health needs assessments (to be developed by the CCG) to help

determine the needs of the local population in the Area;

Recommending and implementing changes to meet any unmet primary medical service needs; and

Undertaking regular reviews of the primary medical health needs of the local population in the Area.

2. Procurement and new

contracts

a) The CCG will make procurement decisions relevant to the exercise of the Delegated Functions and in

accordance with the detailed arrangements regarding procurement set out in the procurement protocol

issued and updated by NHS England from time to time.

b) In discharging its responsibilities, the CCG must comply at all times with Law including its obligations set

out in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations

2013/500 and any other relevant statutory provisions. The CCG must have regard to any relevant

guidance, particularly Monitor’s guidance Substantive guidance on the Procurement, Patient Choice and


(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanc

eDec2013_0.pdf).

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c) Where the CCG wishes to develop and offer a locally designed contract, it must ensure that it has consulted

with its Local Medical Committee in relation to the proposal and that it can demonstrate that the scheme

will:

Improve outcomes;

Reduce inequalities; and

Provide value for money.

3. Integrated working a) The CCG must take an integrated approach to working and co-ordinating with stakeholders including NHS

England, Local Professional Networks, local authorities, Healthwatch, acute and community providers, the

Local Medical Committee, Public Health England and other stakeholders.

b) The CCG must work with NHS England and other CCGs to co-ordinate a common approach to the

commissioning of primary medical services generally.

c) The CCG and NHS England will work together to coordinate the exercise of their respective performance

management functions.

4. Resourcing a) NHS England may, at its discretion provide support or staff to the CCG. NHS England may, when

exercising such discretion, take into account, any relevant factors (including without limitation the size of the

CCG, the number of Primary Medical Services Contracts held and the need for the Local NHS England

Team to continue to deliver the Reserved Functions).

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Schedule 2 - Reserved Functions

This Schedule sets out further provision regarding the carrying out of the reserved functions. The CCG will work collaboratively with NHS

England and will support and assist NHS England to carry out the reserved functions.



national performers list

a) NHS England will continue to perform its primary medical care functions under the National Health Service


b) NHS England’s functions in relation to the management of the national performers list include:

Considering applications and decision-making in relation to inclusion on the national performers list,

inclusion with conditions and refusals;

Identifying, managing and supporting primary care performers where concerns arise; and

Managing suspension, imposition of conditions and removal from the national performers list.

c) NHS England may hold local Performance Advisory Group (“PAG”) meetings to consider all complaints or

concerns that are reported to NHS England in relation to a named performer and NHS England will


d) NHS England may notify the CCG of all relevant PAG meetings at least seven (7) days in advance of such

meetings. NHS England may require a representative of the CCG to attend such meetings to discuss any

performer concerns and/or quality issues that may impact on individual performer cases.

e) The CCG must develop a mechanism to ensure that all complaints regarding any named performer are

escalated to the Local NHS England Team for review. The CCG will comply with any Guidance issued by

NHS England in relation to the escalation of complaints about a named performer.


revalidation and

appraisal process

a) NHS England will continue to perform its functions under the Medical Profession (Responsible Officers)

Regulations 2010 (as amended by the Medical Profession (Responsible Officers) (Amendment)

Regulations 2013).

b) All functions in relation to GP appraisal and revalidation will remain the responsibility of NHS England,

including:

The funding of GP appraisers;

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Quality assurance of the GP appraisal process; and

The responsible officer network.

c) Funding to support the GP appraisal is incorporated within the global sum payment to GP practices.

d) The CCG must not remove or restrict the payments made to GP practices in respect of GP appraisal.

3. Administration of

payments and related

performers list

management activities

a) NHS England reserves its functions in relation to the administration of payments to individual performers

and related performers list management activities under the National Health Service (Performers Lists)

(England) Regulations 2013 and other relevant legislation.

b) NHS England may continue to pay GPs who are suspended from the national performers list under the

Secretary of State’s Determination: Payments to Medical Practitioners Suspended from the Medical


c) For the avoidance of doubt, the CCG is responsible for any ad hoc or discretionary payments to GP

practices (including those under section 96 of the NHS Act), including where such payments may be

considered a consequence of actions taken under the National Health Service (Performers Lists) (England)

Regulations 2013.

4. Section 7A Functions a) NHS England retains the Section 7A Functions and will be responsible for taking decisions in relation to the


b) The CCG will provide certain management and/or administrative services to NHS England in relation to the


5. Capital Expenditure

Functions

c) NHS England retains the Capital Expenditure Functions and will be responsible for taking decisions in

relation to the Capital Expenditure Functions.

6. Functions in relation to

complaints management

a) NHS England retains its functions in relation to complaints management and will be responsible for taking

decisions in relation to the management of complaints. Such complaints include (but are not limited to):

Complaints about GP practices and individual named performers;

Controlled drugs; and

Whistleblowing in relation to a GP practice or individual performer.

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b) The CCG must immediately notify the Local NHS England Team of all complaints received by or notified to

the CCG and must send to the Local NHS England Team copies of any relevant correspondence.

c) The CCG must co-operate fully with NHS England in relation to any complaint and any response to such

complaint.

d) NHS England may ask the CCG to provide certain management and/or administrative services to NHS

England (from a date to be notified by NHS England to the CCG) in relation to the handling and

consideration of complaints.

7. Such other ancillary

activities that are

necessary in order to

exercise the Reserved

Functions

a) NHS England will carry out such other ancillary activities that are necessary in order for NHS England to


b) NHS England will continue to comply with its obligations under the Controlled Drugs (Supervision of

Management and Use) Regulations 2013.

c) The CCG must assist NHS England’s controlled drug accountable officer (“CDAO”) to carry out its functions

under the Controlled Drugs (Supervision of Management and Use) Regulations 2013.

d) The CCG must nominate a relevant senior individual within the CCG (the “CCG CD Lead”) to liaise with and

assist NHS England to carry out its functions under the Controlled Drugs (Supervision of Management and


e) The CCG CD Lead must, in relation to the Delegated Functions:

On request provide NHS England’s CDAO with all reasonable assistance in any investigation involving

primary medical care services;

Report all complaints involving controlled drugs to NHS England’s CDAO;

Report all incidents or other concerns involving the safe use and management of controlled drugs to

NHS England’s CDAO;

Analyse the controlled drug prescribing data available; and

On request supply (or ensure organisations from whom the CCG commissions services involving the

regular use of controlled drugs supply) periodic self–declaration and/or self-assessments to NHS

England’s CDAO.

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Schedule 3 – Financial and Decision-Making Limits

The CCG has certain limitations placed on it in relation to its delegated functions, which need to be kept in mind when decisions are being

made. This Schedule sets out three specific categories where decisions can only be taken following the receipt of prior approval from NHS

England. The individuals that need to be involved in the decision-making process are also set out below.

Decision NHS England Approval CCG Approval

Taking any step or action in relation to the

settlement of a claim, where the value of the

settlement exceeds £100,000.


and


Director of Finance


Officer or Chair

Any matter in relation to the delegated functions

which is novel, contentious or repercussive.


Director of Finance

or

NHS England Regional Director or

Director of Finance

or


Financial Officer


Officer or Chair

The entering into any Primary Medical Services

Contract, which has, or is capable of having, a term

which exceeds five years.


Director of Finance


Officer or Chair

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Quality and Performance Committee – Terms of Reference

1. Purpose The Quality and Performance Committee exists to scrutinise

arrangements for ensuring the quality of CCG commissioned

services, scrutinise the robustness of safeguarding arrangements,

and to oversee the development, implementation and monitoring of

performance management arrangements.

The Committee also monitors equality performance in relation to

health outcomes, patient access and experience, and promotes a

culture of continuous quality improvement.

2. Status The Quality and Performance Committee is established in

accordance with the CCG’s Constitution. It is a committee of, and

accountable to, the Governing Body.

The Governing Body has authorised the Committee to create task

and finish sub-groups in order to take forward specific programmes

of work as considered necessary by the Committee’s membership.

The Committee shall determine the membership and terms of

reference of any such task and finish sub-groups.

3. Duties a) Scrutinise arrangements for monitoring the quality of

commissioned services.

b) Seek assurance that quality outcomes and benefits in

commissioned services are being achieved through a range of

processes, highlighting good practice and areas of concern and

recommend changes in practice through the commissioning

process.

c) Review the annual Quality Accounts prepared by the CCG’s

main providers prior to final sign off.

d) Scrutinise arrangements for safeguarding vulnerable adults and

children in line with the CCG’s statutory requirements.

e) Scrutinise arrangements for ensuring that patient feedback and

engagement are embedded in the commissioning cycle and

meeting legal duties.

f) Monitor delivery of the CCG’s 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)

g) Oversee the performance management framework, including

scrutiny of identified action plans to address shortfalls in

performance against national and local health targets and

performance standards.

h) Scrutinise the effectiveness of interventions where deteriorating

provider performance could compromise health outcomes or

quality of service.

i) Review and approve policies specific to the Committee’s remit.



35

j) Oversee the identification and management of risks relating to


4. Membership The Quality and Performance Committee will have 13 members,

comprised as follows:



Clinical Members

b) Three GP Representatives

c) Chief Nurse


e) Associate Director of Nursing and Outcomes

f) Chief Pharmacist

Managerial Members

g) Chief Finance Officer

h) Associate Director of Joint Commissioning and Planned Care

i) Associate Director of Performance and Information


Committee is discussing matters that fall within their areas of

responsibility.

5. Chair and

Deputy

The Quality and Performance Committee will be chaired by a Non-Executive Director.




6. Quorum and

Decision-making

Arrangements

The Quality and Performance Committee will be quorate with a

minimum of six members, to include two non-executive members,

three clinical members (of which one must be the Chief Nurse or

Deputy Chief Nurse) and one managerial member.

















36




7. Frequency of

Meetings

Meetings of the Quality and Performance Committee will be

scheduled on a monthly basis and the Committee will meet no less

than ten times per year.


above, shall be summoned by the secretary to the Committee at the

request of the Chair.

8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Quality and Performance











meeting.

9. Minutes of

Meetings


corporate style.

The minutes will be ratified by agreement of the Quality and

Performance Committee at the following meeting.



10. Conflicts of

Interest

Management

In advance of any meeting of the Quality and Performance














actions:





37







arrangements.

11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Quality and Performance Committee will report to the


meetings. Any items of specific concern, or which require

Governing Body approval, will be the subject of a separate report.





inform this report.

12. Review of Terms

of Reference






Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



38

Finance and Turnaround Committee – Terms of Reference

1. Purpose The Finance and Turnaround Committee exists to scrutinise

arrangements for ensuring the delivery of the CCG’s statutory

financial duties, including the achievement of the CCG’s Financial

Recovery Plan and QIPP targets.

The Committee will review the monthly financial performance and

identify key issues and risks requiring discussion or decision by the

Governing Body.

2. Status The Finance and Turnaround Committee is established in








3. Duties a) Oversee the development of the CCGs’ finance strategies and

annual financial plans (prior to approval by the Governing Body).

b) Monitor progress against financial plans and approved budgets,

scrutinising the adequacy of proposed remedial action plans

where plan delivery is off target.

c) Scrutinise the reported position on finance, triangulating finance,

QIPP and contract activity information.

d) Scrutinise major shifts in spending, demand pressures and

triangulation with financial recovery/turnaround plans.

e) Oversee arrangements for data quality to ensure confidence in

the contract activity and finance information being used for

monitoring and reporting purposes.

f) Review and approve policies specific to the Committee’s remit.

g) Oversee the identification and management of risks relating to


4. Membership The Finance and Turnaround Committee will have 13 members,




Clinical Members

b) Joint Clinical Leaders

Managerial Members

c) Accountable Officer

d) Chief Finance Officer

e) Director of Special Projects



39

f) Operational Director of Finance

g) Associate Director of Commissioning – Acute Contracts

h) Associate Director of Commissioning, Contracting and

Performance - Mental Health and Community

i) Associate Director of Performance and Information

j) Associate Director of Joint Commissioning and Planned Care



responsibility.

5. Chair and

Deputy

The Finance and Turnaround Committee will be chaired by a Non-Executive Director.




6. Quorum and

Decision-making

Arrangements

The Finance and Turnaround Committee will be quorate with a

minimum of six members, to include two non-executive members

and one clinical member.


















7. Frequency of

Meetings

Meetings of the Finance and Turnaround Committee will be

scheduled on a monthly basis and the Committee will meet no less

than ten times per year.




8. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Finance and Turnaround





40









meeting.

9. Minutes of

Meetings


corporate style.

The minutes will be ratified by agreement of the Finance and

Turnaround Committee at the following meeting.



10. Conflicts of

Interest

Management

In advance of any meeting of the Finance and Turnaround














actions:









arrangements.

11. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Finance and Turnaround Committee will report to the







41




inform this report.

12. Review of Terms

of Reference






Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



42

Prioritisation and Investment Committee – Terms of Reference

1. Purpose The Prioritisation and Investment Committee exists to evaluate,

scrutinise and quality assure the clinical and cost effectiveness of

business case proposals for new investments, recurrent funding

allocations and decommissioning and disinvestment of services.

This will include assessment of any associated equality and quality

impacts arising from proposals and feedback from patient and

public engagement/consultation activities where necessary.

The Committee will also ensure that the CCG’s procurement

responsibilities are appropriately discharged, including oversight of

annual procurement plans.

2. Status The Prioritisation and Investment Committee is established in








3. Duties a) Oversee the development and ongoing review of the CCG’s

ethical decision-making framework, established to promote

fairness and consistency in decision making and ensure that the

reasons behind commissioning decisions are clear and

comprehensive. The ethical decision-making framework will be

Governing Body approved following recommendation by the

Committee.

b) Make commissioning decisions in line with the financial limits

delegated by the Governing Body (as set out within the Standing

Financial Instructions), or make recommendations to the

Governing Body for decisions that exceed the delegated

financial limits, or where proposals are considered to set

precedent, are novel, contentious or repercussive.

When making decisions, the Committee will ensure that:

i) Appropriate evidence is available to demonstrate clinical and

cost effectiveness, including consideration of benchmarking

information where available.

ii) Appropriate Quality, Equality and Data Protection Impact

Assessments are completed and their findings considered.

This will include consideration of the collective impact of

previous decisions and current and future proposals.

iii) Appropriate stakeholder engagement and consultation takes

place and is considered.

iv) Appropriate information on wider commissioning decisions

and services across the health and social care system is



43

considered.

c) Periodically review decisions taken to ensure the consistency of

decision making and to consider potential improvements to the

prioritisation process.

d) Evaluate the return on investment of funded healthcare services

in terms of reduced health inequalities and improved health

outcomes.

e) Review and approve annual procurement plans and monitor

their implementation, making decisions on procurement

approach and contract awards, in line with the financial limits

delegated by the Governing Body (as set out within the Standing

Financial Instructions).

f) Review and approve policies specific to the Committee’s remit.

g) Oversee the identification and management of risks relating to


4. Membership The Prioritisation and Investment Committee will have 13 members,




Clinical Members

b) Joint Clinical Leaders

c) Two GP Representatives

d) Chief Nurse

Managerial Members

e) Accountable Officer

f) Chief Finance Officer

g) Chief Commissioning Officer

h) Director of Special Projects

i) Associate Director of Procurement and Commercial

Development



responsibility.

5. Chair and

Deputy

The Prioritisation and Investment Committee will be chaired by a Non-Executive Director.




6. Quorum The Prioritisation and Investment Committee will be quorate with a

minimum of six members, to include two non-executive members,

two clinical members and two managerial members.





44








individual shall no longer count towards the quorum. For agenda

items where all GP members are not permitted to take part in the

Committee’s discussions/decision-making, then the Committee will

be quorate with one clinical member (or their nominated deputy)

present.










decisions. An urgent decision is one where the requirement for the

decision to be made arises between the scheduled meetings of the

Committee 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 Committee members by the secretary to the

Committee.

The Committee members may meet either in person, via telephone

conference or communicate by email to take an urgent decision.

The quorum, as described in section 6, must be adhered to for

urgent decisions.

A minute of the discussion (including those performed virtually) and

decision will be taken by the secretary to the Committee and will be

reported to the next meeting of the Committee for formal ratification.

8. Frequency of

Meetings

Meetings of the Prioritisation and Investment Committee will be

scheduled on a monthly basis and the Committee will meet, as a

minimum, on a bi-monthly basis.




9. Secretariat and

Conduct of

Business

Secretariat support will be provided to the Prioritisation and

Investment Committee to ensure the day to day work of the





45








meeting.

10. Minutes of

Meetings


corporate style.

The minutes will be ratified by agreement of the Prioritisation and

Investment Committee at the following meeting.



11. Conflicts of

Interest

Management

In advance of any meeting of the Prioritisation and Investment














actions:









arrangements.

12. Reporting

Responsibilities

and Review of

Committee

Effectiveness

The Prioritisation and Investment Committee will report to the








46



inform this report.

13. Review of Terms

of Reference






Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



47

Patient and Public Engagement Committee – Terms of Reference

1. Purpose The Patient and Public Engagement Committee (PPEC) has been

established as a strategic advisory group to ensure that the patient

voice informs the decision making of the CCG.

Acting in an advisory capacity, the PPEC will align its work

programme to that of the CCG’s commissioning intentions and

priorities and will ensure that patient and public involvement is

embedded across the work of the CCGs. In addition, the PPEC will

provide assurance to the Governing Body that the organisation is

meeting its statutory requirements to involve the public in its

commissioning activities.

2. Status The PPEC is established in accordance with the CCG’s

Constitution. It is a committee of, and accountable to, the CCG’s

Governing Body.

3. Duties a) To take an active role in supporting and assuring the CCG in

regard to meeting its statutory duties for patient and public

involvement.

b) To provide an interface between communities and networks

across Nottingham and Nottinghamshire and the Governing

Bodies, for the purposes of providing the patient and public

perspective in the planning and commissioning of health and

care services for the area.

c) To provide advice and guidance on the CCG’s’ approaches to

patient and public involvement to inform commissioning

decisions, drawing on the PPEC’s knowledge and expertise as

representatives of communities; networks and health interests.

d) To use the interface between communities and networks as a

mechanism to communicate outputs/outcomes of engagement

and involvement.

e) To review the outputs from any engagement work, including how

any recommendations have informed the commissioning of

services.

f) To provide oversight of the CCG’s submission to NHS England

under the Integrated Assurance Framework.

4. Membership The membership of the Committee will comprise:

a) Non-Executive Director for Patient and Public Involvement

b) Associate Non-Executive Director for Patient and Public

Involvement

c) A lay member and voluntary and community sector

representative from each of the three ‘Places’ in Nottingham and

Nottinghamshire as defined by Integrated Care Partnerships -

Mid Nottinghamshire, South Nottinghamshire and Nottingham

City



48

d) Representatives from communities and networks across

Nottingham and Nottinghamshire who reflect the CCG’s priorities

aligned to its commissioning intentions.

e) Up to eight representatives from groups with protected

characteristics from the voluntary and community sector

including self-help groups, and health interest groups or patient

leaders:

Carers

BAME* communities and faith groups

Older people

Younger people/students

People who identify as LGBT

Disability

Other populations or communities experiencing poor health

outcomes or barriers to accessing health services*

*focusing on key communities e.g. Gypsy Roma Traveller

community.

f) Local Authority officer representation from Nottinghamshire

County Council and Nottingham City Council

g) Representative from Healthwatch Nottinghamshire.

h) CCG Executive Director

i) Engagement Team representative

5. Requirements of

Members

Members of the PPEC will have a collective responsibility for the

operation of the group. They will participate in discussion, review

evidence and provide objective expert input to the best of their

knowledge and ability, and endeavour to reach a collective view.

PPEC members will be expected to:

a) Represent the views of their communities and networks they

represent.

b) Consider issues from across the Nottingham and

Nottinghamshire area and be well informed about the health

issues affecting the population.

c) Undertake preparation for meetings.

d) Share learning experiences and feedback from PPEC meetings

to the groups/networks they represent.

e) Participate in training and development opportunities.

f) Be a role model and ambassador with a positive, collegiate

approach.

g) Bring challenge to the CCG in the role of ‘critical friend’.

h) Contribute to a work plan to ensure that the PPEC has clear

aims and objectives to support the work of the CCG and its

priorities.



49

i) Adhere to the confidentiality requirements of the CCG. Any

information shared in confidence or any information believed to

be of a confidential nature should not be disclosed. It is the

responsibility of the author or speaker to be explicit around the

status of information shared.

j) conduct themselves in an exemplary manner working to the

Nolan seven principles of public life.

Members must not claim to represent the CCG without prior

consent.

If any member is not in a position to attend a meeting then

apologies must be sent in order that they can be noted and

recorded within the minutes of the meeting.

PPEC members will be required to attend no less than 80% of

meetings during the course of a year. If a PPEC member does not

attend the minimum number of meetings required, the Chair may

request that the PPEC member resign from their position. Special

consideration will always be given when there are extenuating

circumstances.

Members not able to attend a meeting should submit any feedback

requested prior to the meeting.

6. Chair and Vice

Chair

The Non-Executive Director for Patient and Public Involvement will

Chair the PPEC, with the Associate Non-Executive Director

deputising in the event of absence.

7. Quorum and

Decision-making

Arrangements

As the PPEC is not a decision making body, quoracy does not

impact on its business. The Chair will determine if a meeting should

be reconvened in the event of a high number of apologies.

8. Frequency of

Meetings

The PPEC will meet monthly and meetings will take place at

accessible venues across Nottingham and Nottinghamshire.

To support access, virtual working through email links and

telephone conference calls will be used where appropriate.

Extraordinary meetings will be arranged as required. The PPEC

Members will also be expected to attend quarterly Development

Sessions to enhance their skills, knowledge and expertise.

9. Secretariat and

Conduct of

Meetings

An agenda and supporting papers will be distributed at least 5 days

before meetings. The agenda will be agreed with the Chair prior to

the meeting.

Administrative support will be provided by the CCG’s Engagement

Team.

10. Conflicts of

Interest

Management

In advance of any meeting of the meeting, consideration will be

given as to whether conflicts of interest are likely to arise in relation

to any agenda item and how they should be managed. This may

include steps to be taken prior to the meeting, such as ensuring that

supporting papers for a particular agenda item are not sent to



https://www.gov.uk/government/publications/the-7-principles-of-public-life

50

conflicted individuals.









actions:

d) Requiring the individual to withdraw from the meeting for that



e) Allowing the individual to participate in the discussion, but not


f) Allowing full participation in discussion and the decision-making



arrangements.

11. Reporting

Responsibilities

The PPEC will report items for consideration to the Governing Body

through submission of minutes and integrated reports. In addition,

PPEC members will report back to their respective groups and

networks.

The PPEC will provide an annual report to the Governing Body

setting out progress made and future developments in line with the

work plan produced by the members. This report will then be

published on the CCGs’ websites and shared with PPEC members’

groups and networks.

12. Review of Terms

of Reference




Issue Date:

April 2020

Status:

FINAL

Version:

1.0

Review Date:

March 2021



51

Scheme of Reservation and Delegation

Policy Area Decision Reserved to

the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Practice

Member

Representatives

and Members of

the Governing

Body

Approve the

arrangements for

electing/appointing the

CCG’s Chair and

Clinical Leader.

Practice

Member

Representatives

and Members of

the Governing

Body

Approve arrangements

for securing effective

participation by each

Member of the CCG in

exercising its functions

Practice

Member

Representatives

and Members of

the Governing

Body


for identifying the

CCG’s proposed

Accountable Officer.

Practice

Member

Representatives

and Members of

the Governing

Approve the process for

recruiting non-elected

members to the

Governing Body

(subject to any

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Body regulatory

requirements) and

succession planning.

Regulation and

Control

Ensuring that the CCG

has appropriate

arrangements in place

to exercise its functions

effectively, efficiently

and economically and in

accordance with the

CCG’s principles of

good governance

Regulation and

Control

Approval of proposed

amendments to the

CCG’s Constitution

(including its Standing

Orders and Standing

Financial Instructions).

1

2

Regulation and Approval of proposed 3

4

1 When proposed amendments are thought to have a material impact, or relate to the reserved powers of the Membership, or if at least half of all Governing

Body Members request that the proposed amendments are put before the Membership for approval. 2 For all other proposed amendments.

3 When proposed amendments relate to the reserved powers of the Membership or if at least half of all Governing Body Members request that the proposed

amendments are put before the Membership for approval.

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Control amendment to the

Scheme of Reservation

and Delegation.

Regulation and

Control

Approval of the

establishment of

Committees, Sub-

Committees and Joint

Committees of the

Governing Body

(including agreement of

associated terms of

reference)

Regulation and

Control

Approval of the

arrangements for

discharging the CCG’s

commissioning

functions and the

statutory duties

associated with its

commissioning

functions.

Regulation and

Control

Approval of

arrangements for

4 For all other proposed amendments.

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

meeting the public

sector equality duty.

Regulation and

Control


for ratification of the

CCG’s internal policies

and procedures.

Regulation and

Control

Exercise or delegation

of those functions of the

CCG which have not

been retained as

reserved by the

Membership, delegated

to the Governing Body,

delegated to a

Committee, Sub-

Committee or Joint

Committee, or to one of

its Members or

employees.

Strategy and

Planning

Agreeing the vision,

values and strategic

objectives of the CCG.

Strategy and

Planning

Approval of the CCG’s

staffing structure.

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Strategy and

Planning


commissioning

strategies and plans.

Strategy and

Planning


finance strategy and

annual financial budgets

to meet its statutory

financial duties.

Strategy and

Planning

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 CCG’s ability to

achieve its agreed

strategic objectives.

Annual Reports

and Accounts


annual report and

annual accounts.

Human

Resources

Approval of the

arrangements for

discharging the CCG’s

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

statutory duties as an

employer.

Human

Resources

Determining the

remuneration, fees and

other allowances

payable to employees

or other persons

providing services to the

CCG and the

allowances payable

under any pension

scheme established.

Operational and

Risk

Management


risk management

arrangements.

Operational and

Risk

Management

Approve the CCG’s

internal audit plan.

Operational and

Risk

Management

Approve the CCG’s

counter fraud and

security management

plans.

Operational and Approve proposals for

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Risk

Management

action on litigation

against or on behalf of

the CCG.

Operational and

Risk

Management

Approve the CCG’s

arrangements for

business continuity and

for supporting

emergency planning.

Partnership

Working

Approval of decisions

that individual

members, employees or

appointees of the CCG

can make when

participating in joint

arrangements on behalf

of the CCG.

Partnership

Working

Approval of decisions

delegated to Joint

Committees established

under sections 14Z3

and 75 of the NHS 2006

Act (as amended).

Partnership

Working

Approval of

arrangements for

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

financial risk sharing

and/or risk pooling with

other organisations (for

example arrangements

for pooled funds with

other CCGs or pooled

budget arrangements

under section 75 of the

NHS Act 2006).

Primary Care

Commissioning


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)

Primary Care

Commissioning

Approve all newly

designed enhanced

services (“Local

Enhanced Services”

and “Directed Enhanced

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the

Membership

Delegated to /

Reserved by

Governing

Body

Chair /

Clinical

Leader

Accountable

Officer

Audit and

Governance

Committee

Remuneration

and Terms of

Service

committee

Primary Care

Commissioning

Committee

Services”)

Primary Care

Commissioning

Approve the design of

local incentive schemes

as an alternative to the

Quality Outcomes

Framework (QOF)

Primary Care

Commissioning

Approve the

establishment of new

GP practices in the

area.

Primary Care

Commissioning

Approve GP practice

mergers and/or

closures.

Primary Care

Commissioning


for the authorisation of

‘discretionary’ payments

(e.g. returner/retainer

schemes).

Primary Care

Commissioning

Making decisions on

premises costs

directions functions

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Operational Arrangements for Chairing Governing Body Meetings

[To be inserted]



61

Operational Division of Roles and Responsibilities between Non-

Executive Directors

[To be inserted]



62

Operational Division of Roles and Responsibilities between the

Joint Clinical Leaders

[To be inserted]



Appendix G: Organisational Policies to be adopted by NHS Nottingham and Nottinghamshire CCG

Policy Ref Policy Title Review date by 31 March 2021

Review date by 31 March 2022


GOV-001 Risk Management Policy P

GOV-002 Managing Conflicts of Interest Policy P

GOV-003 Gifts, Hospitality and Sponsorship Policy P

GOV-004 Raising Concerns (Whistleblowing) Policy

P

GOV-005 Policy for the Development and Management of Policy Documents

P

GOV-006 Emergency Preparedness, Resilience and Response (EPRR) Policy

P

GOV-007 Fraud, Bribery and Corruption Policy P

GOV-008 CCG Incident Reporting (and Near-misses) Policy

Awaiting endorsement and approval via Health & Safety Steering Group and Audit and Governance Committee.

P

QUAL-001 Safeguarding Policy (including PREVENT, Training and Supervision Strategy)

P

QUAL-002 Safeguarding Children and Adults: Managing Allegations and Concerns Policy

P

QUAL-003 Mental Capacity Act 2005 Policy P

QUAL-004 Complaints, Concerns and Enquiries Policy

Awaiting approval at an upcoming meeting of the Quality and Performance Committee.

P

QUAL-005 Equality, Diversity and Inclusion Policy

Awaiting approval at an upcoming meeting of the Quality and Performance Committee.

P

COMM-001 Service Benefit Review Policy P

COMM-002 Procurement Policy P

COMM-003 Continuing Healthcare Children and Young People’s Continuing Care (and Joint Packages of Health and Social Care Services) Commissioning Policy

P

COMM-004 Service Restriction Policy P

H&S-001 Health, Safety and Security Policy P



Policy Ref Policy Title Review date by 31 March 2021




H&S-002 Fire Safety Policy


P

H&S-003 Display Screen Equipment Use Policy


P

IG-001 Information Governance Management Framework

P

IG-002 Confidentiality and Data Protection Policy

P P

IG-003 Information Security Policy P P

IG-004 Internet and Email Policy P

IG-005 Data Quality Policy P

IG-006 Records Management Policy

Awaiting endorsement and approval via Information Governance Steering Group and Audit and Governance Committee.

P

IG-007 Freedom of Information (FOI) and Environmental Information Regulations (EIR) Policy

P

HR-001 Sickness Absence Policy P

HR-002 Capability Policy P

HR-003 Change Management Policy P

HR-004 Disciplinary Policy P

HR-005 Family Leave Policy P

HR-006 Grievance Policy P

HR-007 Leave Policy P

HR-008 Staff Appraisal Policy P

HR-009 Acceptable Behaviours Policy P

HR-010 Long Service and Retirement Policy P

HR-011 Flexible Working Policy P

HR-012 Travel and Expenses Policy P

HR-013 Agency Workers Policy P

HR-014 Professional Registration Policy P

HR-015 Employment Breaks Policy P



Our 6 Core ValuesWe have six values which we share across the NHS.

Our own staff have shaped these further to help guide our day-to-day decisions

and the way we behave.

Working Together for

Patients

Commitment to Quality of Care

Respect and

Dignity

Compassion

EveryoneCounts

ImprovingLives

NHS Nottingham and Nottinghamshire Clinical Commissioning

Group

1 We put citizens at the heart of everything we do

We believe in a truly person-centred NHS. Understanding the individual needs of citizens is central to the exciting new models of care we are commissioning, such as social prescribing.

We listen to our patients, families and carers and share their feedback to improve the services we commission. We work collaboratively and build new, trusting relationships across health and social care.

2 We value every person

Trust is the foundation upon which everything else is built. Our decision making is open, honest and transparent and we make decisions based on our values.

We treat each other and our citizens with dignity and respect, and we have an expectation that the providers we commission treat patients and their staff with dignity and respect.

3 We care about quality

Quality is at the heart of our organisation and we work collectively to commission high quality services.

As a membership organisation we are clinically led which supports us to commission services which are safe, effective, provide good patient experience and continuously improve.

4 We care for each other

We are one team; one voice. We are good listeners, support one another and act with kindness and empathy. We are ambassadors for our organisation.

We value each person as an individual, respect their commitments in life, and support flexible working.

5 We strive to be healthier and happier

We believe that the health and wellbeing of each other is important and we all champion the benefits of good health and wellbeing.

We will innovate, try new things, cherish excellence and embrace new technology. We will grasp opportunities for learning, development and to try something new.

6 Everyone counts

We are all committed to good financial stewardship and firmly committed to spending the NHS pound to deliver the best value and outcomes for the population we serve.

We will challenge waste, inequalities and variation in the services we commission to make sure that everyone has the opportunity for positive outcomes.

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Our

beh

avio

urs

1 Working together for patients• We promote health and wellbeing

and work/life balance• We are involved in decision-making• We place patients at the heart of our

work

2 Respect and dignity• We listen to each other and work in

collaboration• We mean what we say and follow

through on our commitments• We welcome the giving and

receiving of feedback• We are open and honest about

future change• We have open diaries and easy

ways to communicate with each other

3 Commitment to quality of care• We have clear roles and goals• We have appraisals and

opportunities for personal development

• We are offered training and opportunities for promotion where suitable

• We welcome different ways of working – shadowing opportunities and peer support

4 Compassion• We show kindness to others• We welcome a coaching style of

management• We have time for reflection and

development• We are welcoming and friendly

5 Improving lives• We can ask questions without being

judged• We acknowledge good work• We can work flexibly and remotely

where appropriate• We welcome consistent messages• We have a consistent approach

across teams• We recognise and are supported

when mistakes are made and that we can all learn from them

• We are encouraged to try new things

6 Everyone counts• We are a team working together• We share good practice• We celebrate our achievements

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Page 1 of 10


Paper Title: COVID-19 Incident Response

Arrangements Paper Reference: GB 20 077

Sponsor:

Presenter:

Sarah Carter – Executive Incident Director

Nottingham & Nottinghamshire CCG

Attachments/ Appendices:

-

Sarah Carter – Executive Incident Director

Nottingham & Nottinghamshire CCG

Purpose: Approve ☐ Endorse ☐ Review

☐ Receive/Note for:

Assurance

Information

☒

Executive Summary

The Governing Body has been updated regarding the establishment of the Incident Control approach for the CCG previously.

The purpose of this paper is to update the Governing Body on progress of the CCG’s incident management of the COVID 19 pandemic. The Governing Body is asked to review and support the on-going COVID 19 incident management approach.



☐

Financial Management ☐ Cultural and/or Organisational Development

☐












Risk(s):

COVID-19 Incident Response Arrangements


Page 2 of 10

• Increased pressure primary care services, alongside potential shortfall in primary care capacity (due to self-isolation/sickness), may result in adverse patient outcomes/experience;

• Increased activity within the Acute sector (urgent and emergency care), due to higher levels of attendances/admissions, alongside shortages in Critical Care capacity, may result in poor patient and clinical outcomes;

• Increased pressure on community services, which may hinder ability to promptly discharge and care for patients/service users within the community setting;

• Delays in elective activity due to planned operations having to be cancelled (to accommodate above), which may adversely impact patient safety and experience;

• Increased pressure in Home care, and Care home services, alongside potential shortfall in capacity (due to self-isolation/sickness), may result in adverse patient outcomes/experience and/or failures to provide optimal care;

• Limited, or no, supply of Personal Protective Equipment (PPE) across primary and secondary care providers, including Care Homes and Home Care providers, presents a significant risk to the Covid-19 response;

• Reduced capacity within the CCGs to support the incident response and deliver business critical functions (e.g. delivery of annual accounts, agreement of contracts, delivery of statutory functions, for example) or support system response (especially if multiple key members of staff unwell);

• Increase in home, and virtual, working increases the dependence on IT capacity to deliver, increasing the risks associated with IT failure/cyber risk during this time.

Confidentiality:

☒No

Recommendation(s):

1. To NOTE the contents of the report.



Page 3 of 10

COVID 19 Incident Update to Governing Body

1. Introduction

Significant progress has been made since the last Governing Body update in ensuring the Nottingham

and Nottinghamshire health response to the COVID 19 pandemic has effective coordination and plans.

At a pan Nottingham and Nottinghamshire level we have seen over recent weeks;

- a significant reduction in the number of patients who are attending the Emergency Departments

- a lowering of the numbers of patients attending Primary Care, with most consultations now being

undertaken via telephone

- the majority of planned operations deferred & outpatient consultations where need, delivered by

telephone

- the conversion of many wards and theatres into critical care space

- an escalation in the number of hospital discharges taking place (with dedicated Discharge Team

support)

- an expansion/stretch of the numbers of critical care beds available in Nottingham &

Nottinghamshire

- The establishment of the EPRR Nottingham & Nottinghamshire infrastructure in support of

coordination & management of the approach

- Partnership working & mutual aid between Universities, Colleges, Industry, Local Authorities, the

Private Sector & Health & Care sectors

- Primary Care/ PCNs enhancing mutual aid approaches through the development of a Clinical

Management Centres approach

- A reorganisation of our coordinating workforce into cells supporting the response to COVID 19.

Some of the more significant challenges we are working collectively to address include;

- an increase in workforce numbers (over 10%) across all providers being off work either self-

isolating or experiencing symptoms of COVID 19

- access to appropriate levels of personal protective equipment (PPE) for community facing

services & the changes to national guidance

- planning across a changing environment to ensure an effective capacity response at the right

levels of care

- ensuring our workforce are resilient and supported.

Our teams are working at great speed and focus, to ensure we get what needs to be done completed at

the earliest opportunity. What we have achieved so far across Nottingham and Nottinghamshire CCG

has been the result of a collaborative effort which will continue throughout the incident response. Whilst

we are facing challenging times, our teams continue to provide the same dedication and commitment as

always to the response.

In the paper below I have outlined in summary the progress that has been made across each of the cells

and priority areas, and will provide a further verbal update at Governing Body.



Page 4 of 10

2. Key Cells & Coordination Functions

2.1 Incident Control Centre

Key Progress between 18th March and 3rd April

Incident Control Call Handling & Management of the ICC

Calls and emails remain at the volume of 150-170 per day at present. A rota for the ICC lead is being

drafted taking into account feedback from a number of individuals and focussing on a core group which

can be supported in times of deficit by a number of other individuals. ICC staff who have been self

isolating are gradually returning which is lightening the administrative burden. Standard operating

procedures are being implemented and the ICC continues to operate a staffed model every day 8am to

8pm.

Themes of calls/enquiries are:

PPE supply

PPE advice

National/Regional Returns

Primary care

Care Homes – COVID related or anticipatory medicines

2.2 Business Continuity


This cell provides additional support to other cells, alongside the core work updated below, for example

the Estates Team is providing significant support to the development of the Clinical Management

Centres at present.

Human Resources

- Completed a number of initial staff surveys to determine how the workforce would be affected by

school closures, caring responsibilities, pre-cautionary self-isolation

- Established a database recording the allocation of all key CCG staff to the ICC, Specialist Cells,

Business Critical Functions or Unallocated. This is being updated to include new starters and

clinical resources.

- Communicated to all staff in relation to their allocation and welcoming them to their new team

(where relevant)

- Established and mandated completion of daily staff reporting of working status using Google

Forms which produces a daily dashboard

- Daily HR Sub Group in place to review the availability of staff to effectively respond to the Covid-

19 incident and deliver business critical functions, respond to gaps resulting from absence, re-

deployment of clinicians to the frontline, dynamically control the deployment of staff between the

ICC, Specialist Cells and Business Critical Functions in order to ensure that we continue to

deliver against these priorities, provide an internal ‘Staff Agency’ function within the CCG,

managing requests for staffing and matching to available resource (both within the CCG and from

the resources database), oversee an accelerated approvals and HR process to secure additional

external support into the CCG, update the database on a daily basis and share with the ICC,

Specialist Cells and Business Critical Function Leads once a week



Page 5 of 10

- Developed and communicated HR guidance regularly through the daily Staff Updates including

key messages such as ‘Stay at Home’ and guidance to support remote working

- Actively promoted ‘Stay at Home’ practice by targeting support to staff identified as still working in

the office.

Resources

- Established and maintaining a database of support offers received by the ICC. These are logged

and shared as appropriate within the CCG and where appropriate the wider system.

- A standard operational procedure is being finalised which will seek to match requirements

emerging in the CCG / wider system to the support offers on the database. Initially this is through

Business Continuity Cell members aligning with each of the Specialist Cells to make this link.

- Strengthening links between the CCG resources database and the wider system (e.g. British Red

Cross, NHS National Volunteers)

- Developed PCN Link Worker business continuity process to redeploy Link Workers to support GP

practices with high risk patients, in agreement with existing Link Worker providers

- Supporting other Specialist Cells (e.g. joining QSCS and Care Homes and Homecare Cell.

- Liaising with national and local partners to collate potential car parking opportunities for staff

working in the ICC at Standard Court. Developed and communicated key information – e.g. local

parking information through the daily Staff Updates

- Developed a standard operational procedure and decision process to manage the deployment of

CCG registered clinicians to the frontline, working in tandem with the HR Sub Group in order to

ensure business critical roles are backfilled.

Cell Operations

- Established daily call for the Business Continuity Cell core team and weekly calls for the

Business Continuity cell wider team

- Established and maintained a rota of ‘first contacts’ for the Business Continuity Cell operating 8 –

8 and 7 days per week including a buddying arrangement as part the induction of new team

members into the process

- Agreed Leads and key responsibilities of each area of work within the Business Continuity Cell

- Established standardised operational procedure to interface with the original paper based ICC

operations

- Equipped and manned a physical Business Continuity Room before moving to remote working in

line with electronic ICC operations

- Re-designed operational procedures to interface with the new electronic ICC operations

- Established and updated communication standards for all Specialist Cells (e.g. standardised out

of office messages)

- Produced surge plan for the Cell with triggers/thresholds relating to staff availability to work and

what the CCG response would be as thresholds were met

IM&T

- Secured input/expertise from NHIS to the ICC, the Business Continuity Cell and Primary Care

Cell (others supported as necessary)

- Completed a number of initial staff surveys to determine organisational capability for remote

working (e.g. laptops, VPNs, mobile phones etc)

- Established MS Teams for all users, providing an interim solution while the national solution was

being resolved

- Established process for IM&T issues to be escalated via the ICC and ensured these were

responded through CCG and NHIS colleagues



Page 6 of 10

- Provided guidance to facilitate remote working e.g. allowing staff to take desktops home

- Established prioritisation criteria for resolution of VPN issues and deployment of laptops ensuring

clinical services were prioritised

- Provided clear IMT communications updates through the daily Staff Updates and Teamnet

Estates

- Facilitated establishment of the ICC and Specialist Cells in Standard Court

- Facilitated safe working through enhanced cleaning schedules and securing additional cleaning

materials for CCG staff (e.g. alcohol wipes)

- Advised and responded to estates issues to facilitate greater home working (e.g. diverting

reception phones, handling of post etc)

- Developing proposals for CCG offices during the incident, including consolidating access to a

smaller number of buildings

Business Critical Functions

- Led an organisational review of the Business Continuity Plan to confirm the Business Critical and

Non-Essential functions and identify the business as usual and minimal resource levels required

to deliver these

- Develop prioritised list of functions that could be ‘paused’ should we need to re-deploy staff as

part of the daily dynamic management.

Finance

- Ensured resilience in the Business Critical function to ensure payments are made, annual

accounts are finalised and closed, and budget setting for 2020/21 is complete

- Established a process and tool to capture all additional costs relating to Covid-19 and managed

submissions to the regulator assessing the scale of potential costs.

Communications

- Proactively used the daily Staff Updates to promote compliance with new Business Continuity

processes (e.g. daily staff situation report) and share key guidance and support tools.

2.3 Primary Care


Surge Planning

Surge Planning is in progress and ensuring vital areas for each site is reviewed and a plan in place

including PPE.

Clinical Management Centres

A significant amount of progress has been made in the development of the plan for Clinical Management

Centres (CMCs) following guidance from the Department of Health and Social Care about how to cope

with the surge in cases. . The CMC plans will create a system of resilience and mutual support for

neighbouring practices should the need arise, offering a specific location to assess suspected

Coronavirus cases, separate from face-to-face contact required for other illnesses or conditions. The

CMCs will operate within an existing general practice location.



Page 7 of 10

The plan that has evolved for Nottingham and Nottinghamshire could have 21 or more CMCs based in

existing GP locations. Plans are in place to mobilise all of these at short notice if required but for now we

are only activating four of these proposed CMCs. The plan developed is that the model will be activated

at different stages and times in different areas of Nottingham and Nottinghamshire. This has been a

significant piece of work for the Primary Care Cell over recent days.

Opel System

The Primary Care Cell has also developed & implemented a robust approach to the identification of

triggers and escalations as part of a wider sitrep approach. Daily practice based reporting is now

undertaken and this is aggregated into a PCN and Place based OPEL system for Primary Care.

Modelling

Impact modelling on Primary Care is in place & the team has received a discreet modelling package

which outlines anticipated projections in activity from a primary and community care perspective. This

has informed the span of development of the CMCs, and further surge approaches.

2.4 Care Homes/Home Care Services


Support & Guidance

Care Homes & Home Care Services (HCS) Cell has been developing guidance for Care Homes & Home

Care Services in the areas of clinical management, infection prevention and control, & PPE. Main areas

of enquiry relate to PPE, anticipatory meds, COVID outbreak advice, and discharges to homes.

Workforce Support

The cell has also distributed its core workforce out into practice, working within care homes and

supporting/advising complex home based packages of care.

2.5 Service Change


Reviewing service change

The cell has established a system and approach for the assessment review and impact analysis of

service changes happening as a result of COVID 19 management. The cell has reviewed a number of

service changes, which are all communicated through the ICC, and is responsible for ensuring that the

impact of any change does not have an unanticipated negative impact, and communicated to other parts

of the system the change that has happened.

Decision Making

The cell has developed a decision-making criteria to be applied to each proposal – including decision

tree and high level impact and equality assessment & the approach to communicating the outcome of

the evaluation of each proposal to affected parties.



Page 8 of 10

Governance

The cell has developed a process to ensure that all agreed service change is appropriately documented

and transacted & that all agreed service change is clearly identified according required duration e.g.

• emergency response only (short term);

• emergency response and recovery action (medium term)

• new or expansion of existing system transformation (longer term)

This cell will merge with the Capacity Cell as we move to a more escalated position.

2.6 Clinical Quality & Safety


Advice & Guidance

The cell primarily has been focussed on the establishment of a pathway for the process of translating

national to local guidance, pathway and algorithm development, and liaison with clinical leads re: quality

& safety issues.

Over recent weeks the cell has been driving a coordinated response to national guidance, developing

the Nottingham & Nottinghamshire position statement for immediate circulation.

Subject Matter Expert

The team in the cell have supported & acted as expert advisors to other cells, including over recent

weeks in relation to the application of swabbing/testing approaches, delivering the CMC model, and

ensuing quality remains at the heart of any change or development commissioned as part of the COVID

19 response.

2.7 Urgent Care


Daily escalations

The cell now administers the daily COVID 19 Chief Executive call (Gold Command), supporting the

escalations approach, and any decision making escalation.

Surge Planning

The cell has been involved in the surge planning process and facilitated discussion regarding the types

of capacity required as the system escalates, working in concert with the system discharge cell to

develop a seamless approach to flow management between the hospital and community.



Page 9 of 10

2.8 Capacity


The Capacity Cell has been established in order to develop a whole system capacity plan & approach.

Actions taken to date include;

Reviewing

Reviewed the demand model that has been agreed for use across the LRF and commence the

development of a plan matching modelled demand with system capacity requirements.

Mapping

Commenced mapping this against the operational assumptions of the providers, health and care, in

terms of what / type of capacity can be stepped up should it be required.

Producing

Commenced the development of a system capacity and demand model that enables us to take capacity

change and increase action as required.

2.9 System Discharge


Cell Purpose

This a system wide cell which has been newly established to develop a proactive approach to the

management of flow out of hospital in response to COVID 19. The management of discharge flow from

Acute hospitals is business critical in ensuring that people get the correct levels of care and intervention

when needed. As the numbers of people requiring hospital admission due to COVID 19 related

symptoms, the system will require an escalated response to create this capacity.

At present the cell is managing all discharges with support need from both acute hospitals and

developing escalation plans for efficient and effective appropriate discharge.

2.10 Modelling


A Data Cell has been established and activity projections, particularly in relation to oxygen, oxygen +

and ventilated beds has been undertaken. Further work is in progress regarding the extrapolation of

demand into primary and community care services, this in support of the Capacity & Primary Care Cell

requirements.



Page 10 of 10

3. Conclusion

The forthcoming two weeks will see a further escalation of the demands made on our system. The cells

will continue to respond to this challenge and are reviewing their work programmes accordingly,

prioritising those areas for rapid response. In managing some of the challenges identified at the

beginning of the paper we are pursuing the following actions over next week;

- Accelerating and coordinating staff testing/swabbing in order to support returns to work

- Further development of the logistics PPE approach, and the establishment of a just in time

emergency distribution approach

- Continuous review of the modelling based upon emerging intelligence from London and other

areas, and what we are seeing in actual demand throughout Nottingham and Nottinghamshire

- Implementation of further staff support and enhanced access to emotional health & wellbeing

services.

Appendix 1.

Nottingham & Nottinghamshire System Meeting Structure & Cells



1


Paper Title: Governance Arrangements during the

Emergency Response Period Paper Reference: GB 20 078

Sponsor:

Presenter:

Amanda Sullivan, Accountable Officer Attachments/ Appendices:

-


Purpose: Approve ☒ Endorse ☐ Review


Assurance

Information

☐

Executive Summary

This paper sets out in detail the governance arrangements that will apply during the period of emergency response to the Covid-19 pandemic. It builds on the outline proposals that were informally discussed and agreed by Governing Body members during a teleconference on 20 March 2020. This paper is now presented for formal approval.

The Governing Body is asked to note that the CCG’s approach is consistent with the guidance issued by NHS England and NHS Improvement in their letter of 28 March 2020: Reducing burden and releasing capacity at NHS providers and commissioners to manage the COVID-19 pandemic.



☐


☐









Governance Arrangements during the Emergency Response Period


https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0113-28-March-2020-Reducing-burden-and-releasing-capacity-at-NHS-providers-and-commissioners-to-manage-the-CO.pdf


2




Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

a) APPROVE: The proposed governance arrangements during the emergency response period for inclusion within the CCG’s Governance Handbook.

b) ENDORSE: The proposal to review these temporary governance arrangements in line with official NHS and Government guidance regarding the Covid-19 pandemic to ensure a transition to ‘business as usual’ governance within an appropriate timeframe.



1

Governance Arrangements during the Covid-19 Emergency Response Period

1. Introduction

1.1 This paper sets out in detail the governance arrangements that will apply during the

period of emergency response to the Covid-19 pandemic.

1.2 This paper builds on the outline proposals that were informally discussed and agreed

by Governing Body members during a teleconference on 20 March 2020. This paper is

now presented for formal approval.

1.3 The Governing Body is asked to note that the CCG’s approach is consistent with the

guidance issued by NHS England and NHS Improvement in their letter of 28 March

2020: Reducing burden and releasing capacity at NHS providers and commissioners

to manage the COVID-19 pandemic.

2. Context

2.1 In order to ensure that the CCG can operate efficiently and effectively throughout the

period of emergency response, a review has been carried out of the current

governance arrangements, including those specifically designed to apply to

emergency decision-making. This culminated in the informal proposals that were

discussed in late March and which are summarised in table form at Appendix 1.

2.2 Further work has also been completed to review invoice approval limits and payroll

signatories to ensure resilience during the period of emergency response.

2.3 It is important to recognise that the duration of the emergency response period is not

currently known. Accordingly, the arrangements set out below will be kept under

review and may need to evolve further. Review and scrutiny of emergency decision-

making has been built-in and this has already led to arrangements being adapted and

strengthened to reflect feedback provided.

2.4 Any further proposals for revised arrangements will be brought to the Governing Body

for consideration and approval and the CCG’s overall approach will be reviewed in line

with official NHS and Government guidance regarding the Covid-19 outbreak. At this

stage, the Government is expected to formally review the ‘lockdown’ arrangements

after Easter and the CCG will continue to monitor the position so as to ensure that it

reviews its own arrangements accordingly.

2.5 As there is currently no set duration for the emergency period, the CCG will also need

to agree in time appropriate exit arrangements and a return to ‘business as usual’

governance. This will be considered and developed as appropriate, once a clearer

timeframe is known.

3. Emergency and business-critical decision-making during the emergency

response period





2

3.1 There are two main areas of focus for the CCG’s decision-making during the

emergency response period, as follows:

a) To enable rapid, robust decision-making on urgent issues directly relating to the

Covid-19 outbreak and its management. All such urgent decisions will be taken

in line with the following principles:

Saving and protecting human life.

Containing the emergency – limiting its escalation or spread, and mitigating

its impacts.

Providing the public with proportionate advice and information, in line with

national advice and guidance.

Ensuring plans are in place to maintain normal services at an appropriate

level should the situation escalate.

Reducing harm.

Protecting the health and safety of all staff.

These principles are aligned to the Nottingham and Nottinghamshire Local

Resilience Forum’s Strategic Co-ordination Group’s Covid-19 Strategy.

b) Ensuring that business-critical decisions not directly relating to the Covid-19

outbreak can continue to be made. This latter category includes, for example,

decisions on required extensions of contractual arrangements in light of the

Covid-19 outbreak, but where the extension is not directly related to the provision

of Covid-19 related services.

3.2 The revised governance arrangements that will apply during the emergency response

period are, as follows:

a) All Governing Body and committees are authorised to meet on a virtual basis.

b) The Governing Body will continue to meet on a bi-monthly basis (as scheduled),

with additional extra-ordinary meetings convened if required. This is consistent

with the guidance provided by NHS England and NHS Improvement, where

CCGs are asked to “continue to hold board meetings but streamline papers,

focus agendas and hold virtual not face-to-face meetings”.

c) Should a decision be needed urgently outside of the scheduled Governing Body

meetings, then the existing emergency decision-making powers, as set out in the

Standing Orders, will be utilised.

d) Weekly briefing sessions will be held with Governing Body members (on a virtual

basis) to ensure that the Governing Body is kept up-to-date on the CCG’s

management of the Covid-19 outbreak.

e) The Governing Body’s virtual meetings and weekly briefing sessions will focus

on key items including: finance; transformation; quality and statutory compliance;

workforce; key risks and mitigation; and communications.

f) The difficulty of complying with the CCG’s obligations around transparency

during this period is recognised. In order to continue to ensure some degree of

transparency around decision-making, the CCG will continue to publish



3

forthcoming meeting dates for its Governing Body and members of the public will

be invited to submit questions in advance for the Governing Body to consider

(with responses collated and published on the CCG’s website). Other updates

around the CCG’s decision-making during this period will be published as

considered appropriate and relevant to the public. As with all the arrangements

agreed for this period, the ways in which transparency and openness can be met

will be kept under review.

g) All non-business critical decision-making will be suspended until further notice,

with a monthly review of requirements and business critical items. All committees

will retain the ability to meet (on a virtual basis) to consider business-critical

matters. In the event that a decision-making committee is not able to be

convened, then the matter will be decided upon utilising the urgent decision-

making arrangements as set out within the relevant committee’s terms of

reference.

h) Normal minuting requirements continue to apply to all virtual meetings and

urgent decisions made.

i) An Incident Co-ordination Centre has been established, supported by a number

of specialist ‘Cells’ covering primary care, urgent care, clinical quality and safety

(including care homes, home care and medicines optimisation), logistics

(currently focussing on PPE), capacity planning, business continuity and service

change. The Service Change Cell has been established with a formal terms of

reference and standard operating procedures to enable decision-making on

service change proposals to support the emergency response. Decisions will be

made by the Chief Commissioning Officer (or suitable nominated deputy)

following consultation with the membership of the Service Change Cell and the

Clinical Quality and Safety Cell. Dependent on consideration of potential risk and

patient harm, the Chief Commissioning Officer may escalate decisions to the

daily Executive Management Team meetings. These decision-making

arrangements are summarised in a Covid-19 specific Scheme of Reservation

and Delegation (SoRD), which is attached at Appendix 2 for approval.

j) A decision-log will be maintained of all urgent decisions taken in relation to

Covid-19 matters, which will include a record of the duration of each service

change to ensure appropriate review.

k) Weekly Non-Executive Director oversight and scrutiny sessions have been

established to retrospectively review urgent decisions and to provide a forum for

matters that would normally fall within the remit of the Quality and Performance

and Finance and Turnaround Committees to be discussed.

l) The delegated financial limits for the purpose of invoice approvals have been

reviewed and amended to ensure the CCG has sufficient resilience to make

payments to its suppliers. It is important to note that the proposed changes

mainly relate to invoice approvals associated with commissioning expenditure

under SLAs, contracts and agreements. In these instances invoice approval is

more of a payment mechanism, as the spend has already been committed at the

point the contract was agreed. In addition, as part of the national emergency

response arrangements, organisations will be moving to block contract payments



4

‘on account’ for all NHS trusts and foundation trusts for an initial period of 1 April

to 31 July 2020, with suspension of the usual PBR national tariff payment

architecture and associated administrative/ transactional processes. Invoices are

therefore expected to be raised on this basis and will need to be processed and

paid in an efficient manner.

m) Costs incurred in responding to the Covid-19 outbreak are covered by existing

delegated financial limits, as set out in the CCG’s Standing Financial

Instructions. However, due to the scale and complexity of the required response

to the Covid-19 incident, it is proposed that the delegation to the On Call

Manager and the Second On Call Manager be extended to the Incident Co-

ordination Centre and Cell Leads. A clear audit-trail of financial decision-making

will be maintained in line with national guidance and reported to the Governing

Body.

n) In order to respond effectively to the Covid-19 outbreak, the CCG has been

required to purchase goods and services from suppliers who will only provide

these goods and services with immediate payment. As a result, and in line with

the CCG’s Standing Financial Instructions, the Chief Finance Officer has set up a

Procurement Card Account subsequent to discussing these proposals with the

Audit and Governance Committee.

o) The proposed changes to the CCG’s delegated financial limits are attached at

Appendix 3 for approval. Changes are highlighted in red for ease of reference.

p) The authorised signatories for payroll transactions have been reviewed and

amended to ensure the CCG has sufficient resilience to make accurate and

timely payments to its staff. It is proposed that the payroll Authorised Signatures

list is extended to include all Associate Directors for the following processes:

Payroll forms where changes are in line with Agenda for Change and carry a

cost to the organisation (i.e. increased hours, regarding, extension of fixed

term contracts)

Payroll forms unsigned by employee or where not in line with Agenda for

Change (includes salary justification forms)

Salary advances

Overpayment recovery plans

3.3 Except as expressly provided in the revised governance arrangements, the CCG’s

normal governance framework continues to apply. This includes the Standing Orders,

Standing Financial Instructions, SoRD and committee terms of reference. As is

recognised in the guidance issued by NHS England and NHS Improvement, it is

possible that the CCG may have difficulties complying with some of the technical

requirements contained within the Standing Orders and committee terms of reference.

The example given in the guidance is around “technical quorum breaches (e.g.

because of self-isolation)”. In such cases, the guidance states that there will be no

sanction for such a breach. Our understanding is that this is referring to situations

where a meeting is held, but not all of those required for quoracy can attend, even

virtually. However, in addition to this being as a result of illness/self-isolation, we have

understood this to also apply to clinical staff, as the guidance notes that Governing

Body GPs, for instance, should focus on provision of care and so may not be able to



5

attend meetings (even virtually) as usual. In instances where the standard quoracy

requirements cannot be met, the person presiding over the relevant meeting will take a

view as to whether it is able to continue to make a decision or whether the matter

needs to be escalated or deferred as appropriate. In all cases, a balance will need to

be struck between robust and lawful decision-making, while recognising a degree of

pragmatism around the circumstances within which the CCG is operating. The

rationale and approach taken will be noted in the meeting minutes.

3.4 All those involved in decision-making are reminded of the need to ensure that they

comply with relevant policies and procedures, including those relating to conflicts of

interest. Any concerns about compliance or difficulties of complying in the

circumstances should be raised in the first instance with the Associate Director of

Governance.

3.5 The revised governance arrangements will be appended to the CCG’s Governance

Handbook and updated as necessary during the course of the emergency response

period.

4. Recommendations


c) APPROVE: The proposed governance arrangements during the emergency response

period for inclusion within the CCG’s Governance Handbook.

d) ENDORSE: The proposal to review these temporary governance arrangements in line

with official NHS and Government guidance regarding the Covid-19 pandemic to ensure

a transition to ‘business as usual’ governance within an appropriate timeframe.

Lucy Branson

Associate Director of Governance

April 2020



6

Appendix 1: Summary of Emergency Governance Arrangements

Meeting Summary Arrangements

Governing Body All meetings to continue to be held in line with the annual

business cycle, but with focussed agendas and streamlined

papers.

All meetings to be held virtually until further notice.

Informal weekly briefings to be held to update on key Covid-19

developments and the CCG’s response.

Emergency powers to be utilised for urgent decisions, as

needed and in line with the CCG’s Standing Orders.

Audit and Governance

Committee

Meetings will continue to be held, with a key focus on the

review and approval of the predecessor CCGs’ annual reports

and accounts. Meeting dates will be reviewed and amended in

line with the deferred national submission timetable.

All meetings to be held virtually until further notice.

Remuneration and Terms

of Service Committee

Normal meeting arrangements to be suspended until further

notice, with a monthly review of requirements.

Virtual meetings to be held, as required, to consider business

critical matters.

Primary Care

Commissioning Committee

and

Prioritisation and

Investment Committee

(formerly referred to as

Strategic Commissioning

Committee)


notice, with a monthly review of requirements.

Virtual meetings to be held, as required, to consider business

critical matters.

Emergency powers to be utilised for urgent decisions, as

needed and in line with the committee’s terms of reference.

Finance and Turnaround

Committee

and

Quality and Performance

Committee


notice, with a monthly review of requirements and virtual

meetings to be held, as required.

Weekly Non-Executive Director oversight and scrutiny

arrangements established – to consider business critical

matters.

Service Change

Cell/Executive

Management Team (EMT)

The Service Change Cell has been established as part of the

CCG’s emergency response arrangements to support urgent

decisions relating to the Covid-19 outbreak and its

management. Decisions can be escalated to the daily meetings

of the EMT, as required.

Weekly Non-Executive Director oversight and scrutiny

arrangements established – to retrospectively review all

decisions made by the Service Change Cell/EMT.



7

Appendix 2: Covid-19 Emergency Scheme of Reservation and Delegation

Policy Area Decision Service Change

Cell

Chief Commissioning

Officer (or nominated

deputy1)

Executive Management

Team

Non-Executive Directors

Other

Service changes Review and evaluation of emergency service change proposals.

Service changes Agree decision-making criteria to be applied to emergency service change proposals.

Service changes Whether to proceed with proposed emergency service change proposals.

2

3

Emergency decision making

Scrutiny of emergency decision-making. 4

Quality monitoring Deploy appropriate clinical resource, support and deliver on the CCG’s safeguarding functions and provide support to address all ongoing quality requirements.

Clinical Quality and Safety Cell, with overall quality monitoring and statutory compliance reporting at the weekly Governing Body briefings

1 Nominated deputy will be the relevant Cell Lead or Deputy

2 After consultation with the Service Change Cell and Quality, Safety and Clinical Cell.

3 Decisions may be escalated to the Executive Management Team if considered high risk.

4 With scrutiny feedback provided to the CCG’s Accountable Officer, Chief Commissioning Officer, Chief Financial Officer, Chief Nurse and other senior leaders as appropriate

for actioning.

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Appendix 3: Covid-19 Emergency Delegated Financial Limits

Ref Matter Delegated Delegated to

3a Revenue spend (corporate) / spend on goods and

services - Limits for requisition and invoice approvals,

includes procurement of professional services i.e. legal

advice, specialist advice, specific projects (all values are

inclusive of VAT irrespective of whether this is

reclaimable or not):

In line with budget management responsibilities (i.e. delegated budgets) and subject to

quoting and tendering as required (see Section 5 below):

a) to £1,000 a) Band 8a and above

b) to £10,000 b) Associate Directors (Band 8d and above)

c) to £50,000 c) Executive Directors or Deputy CFO

d) to £100,000 d) AO, and CFO or Operational Director of Finance

e) £100,001 and above e) AO or CFO, following Governing Body approval

3c Continuing healthcare (CHC) individual package

approval (weekly limits) and purchase of

consumables

Patient consumables:

e) Purchase of patient consumables - up to £1,500 e) CAS Team Member (Band 7 6 and above)

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3d Authorisation of invoices (in Oracle) - relating to

commissioning expenditure under service level

agreements, contracts or partnership agreements.

(this may include non-commissioning expenditure

included within NHS contracts - where this is the case,

ensure appropriate approval from the relevant Budget

Holder as well as the below)

In line with budget management responsibilities (i.e. delegated budgets) and subject to

quoting and tendering as required (see Section 5 below):

a) to £50,000 a) Contract Manager

b) to £500,000 b) Senior Manager (Band 8a and above) Associate Director

c) to £5,000,000 c) Associate Director Budget Holder, Operational Director of Finance or Deputy CFO

d) to £20,000,000 d) Budget Holder, Operational Director of Finance or Deputy CFO AO or CFO

e) to £50,000,000 e) AO and or CFO

f) £50,000,001 and above f) AO or CFO, following Governing Body approval

17 Emergency response

The Department of Health and Social Care defines a

major incident as “an event or a situation which

threatens serious damage to human welfare in a place in

the UK, the environment of a place in the UK, or war or

terrorism which threatens serious damage to the security

of the UK.”

The On Call Manager and the Second On Call Manager have delegated authority to

make urgent financial decisions relating to the CCG within the CCG unit of planning and

other NHS organisations within the health community as appropriate during a major

incident.

During the period of emergency response to the Covid-19 pandemic, this delegation

applies to the Incident Co-ordination Centre and Cell Leads. All Covid-19 related

expenditure will be reviewed and verified by finance staff assigned to each Cell and

subsequently reported to the Governing Body.

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18 Procurement cards

Four procurement cards, with a £10,000 monthly credit

limit, have been issued to named individuals to purchase

goods and services (needed to respond to the Covid-19

incident) from one-off suppliers who will only provide

these goods and services with immediate payment.

There are no limitations to the use of the cards due to

the nature of the emergency incident.

There is no facility for cash withdrawals.

Stuart Poynor, Chief Finance Officer

Sarah Carter, Executive Director Lead (Covid-19 Incident)

Jonathan Rycroft, Business Continuity Lead (Covid-19 Incident)

Neil Moore, Associate Director of Procurement and Commercial Development

Procurement card usage will be monitored and reviewed on a monthly basis by finance

staff and subsequently reported to the Governing Body.

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Paper Title: BCF 2019/20 annual assurance report Paper Reference: GB 20 080

Sponsor:

Presenter:

Lucy Dadge, Director of Commissioning Attachments/ Appendices:

Sarah Fleming, Head of Joint Commissioning



Assurance

Information

☒

Executive Summary

The purpose of the paper is to provide an assurance update on the Better Care Fund 2019/20 with regard to:

1. Delivery against the BCF objectives/indicators during 2019/20

2. Plans for the development of the BCF in 2020/21.



☐


☐











Yes ☐ No ☐ N/A ☐ Not applicable to this item

Risk(s):

There are no risks identified

Confidentiality:

☒No

Better Care Fund


Page 2 of 2

Recommendation(s):

1. The Governing Body is asked to NOTE the annual BCF assurance report.

Better Care Fund


1

BCF 2019/20 annual assurance report

Purpose of report

The purpose of the report is to provide the Governing Body with an update on:

∑ Delivery against the BCF objectives/indicators during 2019/20∑ Plans for the development of the BCF in 2020/21.

Background

The Better Care Fund (BCF) was announced in June 2013 as part of the Government’s Spending Review. It was described as creating a national £3.8 billion pool of NHS and Local Authority monies intended to:

∑ Support an increase in the scale and pace of integration∑ Promote joint planning for the sustainability of local health and care economies.

It is important to note that the funds that had to be put into the pooled arrangements were not a new / additional source of funding. This was money that was already funding frontline services in health, social care and local government. The CCG did, however, receive an additional recurrent allocation for the ‘pass through’ elements of Protecting Social Services and Care Act funding. The national requirement was to put a “minimum” amount per CCG into the BCF.

Additional sources of funding have been included within the BCF since it commenced. The six elements of funding are shown below.

Type of funding Purpose of funding Payment mechanismCCG funding Out of hospital care (primary, mental

health, community or social care)Directly received by CCG as part of baseline allocation

Protecting social care and Care Act funding

To help adult social care manage demand and fund services for people with social care needs.

Received by CCG as a pass through to be paid automatically to Nottingham City and Nottinghamshire County Council

Disabled Facilities Grants

Capital funding for Housing Authorities to provide adaptations to homes and discretionary schemes that meet the aims of the BCF

Directly received by unitary authority and District and Borough Councils

Improved BCF (iBCF)

To meet adult social care needs, reduce pressure on the NHS (including hospital discharge), and stabilise the social care provider market.

Directly received by City and County Council

Winter Pressures Grant

Originally provided in Winter 18/19 to Adult Social Care to support increased demand over the winter. Made recurrent from April 2019.

Directly received by City and County Council

Table 1: BCF funding elements There are 4 national conditions that must be in place to receive the funds:

Better Care Fund


2

1. An agreed plan at the Health and Wellbeing Board level: local plans must align with the BCF national conditions and demonstrate measurable progress in respect of key outcomes.

2. Investment to maintain provision of social care services.3. A specific proportion of the funding must be invested in NHS commissioned out-of-

hospital services.4. There must be a plan in place to manage transfers of care out of hospital, based on the

“High Impact Change Model”.

Plans must support delivery against four national targets:

BCF 1: Emergency/unplanned admissions to hospital per 100,000 population.BCF 2: Rate of admissions to residential and nursing homes for older adults (aged 65+).BCF 3: Effectiveness of reablement services (proportion of older people discharged from

hospital who receive reablement services and are still at home, 91 days after discharge).

BCF 4: Delayed transfers of care: number of days of delay in hospital experienced by people after they were well enough to be discharged.

BCF plans are agreed at a Health and Wellbeing Board (HWB) level, and therefore there are two CCG BCF plans based on the City and County local authority footprints.

Current delivery against these metrics is shown in Appendix 1.

Within the County plan, schemes are based on the units of planning for South Notts, Mid Notts and Bassetlaw. The income and expenditure for the pooled fund is shown in Appendix 2.

Review of schemes badged against BCF

Due to BCF planning being based on historical units of planning, there is variation across the CCG as to the specific schemes badged against the BCF.

A review was undertaken in January 2020 to identify all the schemes currently badged against the BCF to ensure that there is a process for reviewing the scheme and to consider alignment with the aims of the BCF.

The outcome of the review was presented to the CCG’s Financial Recovery Group on 24th February 2020. This demonstrated that the schemes badged against the BCF are subject to regular review, including Service Benefit Review and on-going contract monitoring. Schemes across the units of planning vary considerably, with little consistency as to what is badged as a BCF scheme.

There has been a continued focus throughout 2019/20 from CCG finance teams to ensure the minimum allocation has been met, and to ensure the section 75 agreements are in place and updated.

BCF plans for 2020/21

Better Care Fund


3

Discussions with the NHSE BCF regional lead have indicated that the BCF plan for 2020/21 will be a rollover of the current plan with an expectation that the partnership will review existing plans for impact. We have also been asked to consider the level of ambition in the four national targets. A publication date for the national BCF planning guidance is yet to be confirmed.

Following Director level discussions, it has been agreed to refocus the schemes within the BCF to focus on work that supports avoided admissions and reducing delayed discharges. This will be aligned across the CCG wherever possible.

We are working with local authority partners to consider how to jointly review schemes to ensure there is benefit across the system and no duplication.

The financial minimum contributions for 2020/21 have been issued at an overall CCG / Local Authority Level as follows:

HWB CCG minimum contribution

% uplift

Nottingham City £24,733,970 5.42%Nottinghamshire County (including Bassetlaw)

£58,225,790 5.37%

The planning guidance suggests that the pass through element must be uplifted by the CCG overall allocation increase, which is c 4.4%. We are trying to ascertain whether the 4.4% is applied or whether the 5.42% and 5.37% uplifts noted above will need to be applied.

We are working with partners to consider how to jointly review schemes to ensure there is benefit across the system and no duplication.

Recommendation

The Governing Body is asked to NOTE the annual BCF assurance report.

Better Care Fund


4

Appendix 1 – BCF metrics performance

Performance is monitored at the level of the Health and Wellbeing Board for the purpose of the BCF. Therefore for Nottinghamshire County, performance information includes Bassetlaw CCG.

The data presented are the most up to date at the time of writing the report. This corresponds to Month 8 for Nottingham City and Month 9 for Nottinghamshire County. There are currently different processes in place for reporting BCF performance due to historical arrangements. This will be aligned by the CCG’s Joint Commissioning team for 2020/21.

It has been recognised that governance arrangements for managing delivery of the BCF are not necessarily those that have overall accountability for delivery of the BCF metrics. Therefore, whilst performance against the metrics is reported at BCF meetings, the detailed discussion and operational management is undertaken elsewhere e.g. A&E Delivery Boards.

BCF 1: Emergency/unplanned admissions to hospital per 100,000 population

Nottingham City HWB

There were 2,857 non-elective admissions in October 2019. This is 18.0% below the monthly planned figure of 3,483.

Analysis shows that monthly 0-day length of stay admissions are -29.8% against plan (391 admissions) in October 2019. Meanwhile, 1+ day length of stay admissions are -10.8% against plan (235 admissions) in October 2019. The under-performance issue is being driven by 0-day length of stay admissions. During construction of the CCG operating plan, NUH declared some significant coding and counting changes which resulted in the Trust adding in 15,000 additional 0-day length of stay non-elective spells. These substantial increases in activity have not been seen in Q1 and have formed part of a formal query to the trust within the contractual process.

2000

2200

2400

2600

2800

3000

3200

3400

3600

Monthly NEL Admissions - Nottingham UA

Better Care Fund


5

Nottinghamshire County HWB

A deep dive into non-elective admissions has occurred and findings have been fed into the local demand avoidance (South Nottinghamshire) and drivers of demand (Mid Nottinghamshire) groups.

The analysis indicated that there is no single reason for the increasing demand, but that several factors may be contributing to the rising demand with key areas identified as:

∑ Community Services Review∑ GP Demand and Impact of Drivers of Demand∑ IRRS Model Development∑ Review of DOS and link to 111∑ Streaming to PC24 and NEMS Capacity Confirmation∑ GP Cover and the amalgamation of the GP Duty Cover into Newark Hospital and

potential to explore the opportunity to replicate in Sherwood Forest Hospital∑ Intervention for Drugs and Alcohol related conditions ∑ East Midlands Ambulance Service Conveyance Rates∑ Care Homes

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BCF 2: Rate of admissions to residential and nursing homes for older adults (aged 65+)

Nottingham City HWB

The number permanent admissions to residential and nursing care homes in Nottingham in October 2019 was 9 admissions. This corresponds to 22.9 admissions per 100,000 people (aged 65+).


34% of admissions are to Nursing Care, 66% to Residential Care. Admissions for 19/20 are now over target (741 against a year-to-date target of 720). In 2018/19 there was a total of 979 admissions, potentially this year admissions could exceed 1,000. The admissions are highest in Bassetlaw, lowest in Ashfield and Mansfield.

Better Care Fund


7

BCF3: Effectiveness of reablement services (proportion of older people discharged from hospital who receive reablement services and are still at home, 91 days after discharge)

Nottingham City HWB

The proportion of older people aged 65 and over still at home 91 days after discharge from hospital into reablement was 90.3% in October 2019. At present, there is no target for this indicator.


Better Care Fund


8

National reporting shows that Nottinghamshire benchmarks as having a higher than average number of people not completing their re-ablement due to being re-admitted to hospital very soon after discharge. Partners are working to understand the reasons for this.

BCF4: Delayed transfers of care: number of days of delay in hospital experienced by people after they were well enough to be discharged

Nottingham City HWB

Key reasons given for delays in September were awaiting care package in own home (responsible for 35.2% of days delayed), awaiting further non-acute care (30.4% of days delayed), and patient or family choice (24.4% of days delayed).


0

200

400

600

800

1000

1200

1400

1600

1800

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Jul-1

8

Aug-

18

Sep-

18

Oct

-18

Nov

-18

Dec-

18

Jan-

19

Feb-

19

Mar

-19

Apr-

19

May

-19

Jun-

19

Jul-1

9

Aug-

19

Sep-

19

DTOC (Delayed Days) - All Sources - Nottingham UA

Better Care Fund


9

Nottingham DToC rates are beginning to decrease from a high of 3.81% in June 19 to 2.84% in September 2019. This equates to 1,217 delayed bed days in September 2019, a decrease of 311 from August 2019. 86.1% of all bed day delays are attributed to NHS, 9% to Social Care with the remaining being joint (4.9%).

Issues contributing to the change in DToC rates and delayed bed days include: ∑ Inclusion of patients that are in community beds.∑ Increase in complexity and dependency of patients: for example, bariatric patients

who require two or more carers or specialist equipment.∑ Increase in housing and homelessness discharge issues, particularly relating to

complex needs such as wheelchair access or patients’ eligibility to public resource.

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10

Appendix 2: Month 10 2019/20 Income and Expenditure

Nottingham City BCF Income and Expenditure

Nottinghamshire County BCF Income and Expenditure

Scheme Provider CommissionerS75 Annual

Budget (Plan)

Annual Forecast (Pd10)

Forecast Variance (Pd10 to Budget)

Access & Navigation CityCare Partnership CCG 877,783 877,783 0Access & Navigation NCC & External Provision NCC 1,018,443 1,018,443 0Integrated Care CityCare Partnership CCG 5,781,292 5,781,292 0Integrated Care NCC & External Provision NCC 9,686,008 9,686,008 0Facilitating Discharge NCC NCC 2,392,571 2,392,571 0Primary Care GP's CCG 2,422,372 2,422,372 0Assistive Technology Nottingham City Homes NCC (Joint Service) 467,300 467,300 0Carers External Provision NCC (Joint Service) 714,040 714,040 0Capital Grants External Provision NCC 2,439,908 2,439,908 0Programme Costs CCG CCG 25,244 25,244 0Housing Health - Housing Related Schemes

External Provision CCG 77,000 77,000 0

Sub-Total 25,901,961 25,901,961 0

Improved Better Care Fund NCC & External Provision NCC 14,564,610 14,564,610 0Sub-Total 14,564,610 14,564,610 0

TOTAL 40,466,571 40,466,571 0

Contributing partnerNHS Mansfield and Ashfield

NHS Newark and Sherwood

NHS Nottingham North and East

NHS Nottingham West NHS Rushcliffe

Nottinghamshire County Council

£'sPayments made into pooled budget £10,387,584 £6,633,045 £7,493,534 £5,006,886 £5,788,215 £29,459,118

Payments received from pooled budget £6,462,640 £4,243,533 £4,519,664 £2,785,285 £3,562,520 £45,548,130A - Seven day working £231,285 £152,520 £178,789B - Delayed transfers of care £1,939,101 £831,612 £1,530,364C - Reducing non-elective admissions £2,128,246 £1,661,183 £1,683,584D - Support to social care £88,587 £54,276 £62,342E - Enabling £132,445 £85,694 £107,441F - Proactive care £6,285,767 £4,161,375G - Patient and carer support £122,123 £71,164H - Better together implementation support £54,750 £10,994O - Support for carers £1,001,112P - Protecting social care £13,461,400Q - Disabled Facilities Grant £6,950,696R - Enabling Care Act statutory responsibilities and meeting demand implications £1,626,501S - Improved Better Care Fund £19,863,119T- Winter Pressure £2,645,303Total spend to period 9 £6,462,640 £4,243,533 £4,519,664 £2,785,285 £3,562,520 £45,548,130Under/(over) spend to period 9 £0 (£0) £0 (£0) £0 £0

Better Care Fund


Page 1 of 2


Paper Title: Highlight report from the (virtual)

meeting in Common of the

Predecessor CCGs’ Primary Care

Commissioning Committees

Paper Reference: GB 20 081

Chair of the

meeting in

common

Eleri de Gilbert - Lay Member, Quality

and Performance

Attachments/

Appendices:

-

Summary

Purpose:

Approve ☐ Endorse ☐ Review


Assurance

Information

☒

Summary of the Meeting

The Primary Care Commissioning Committees (PCCCs) of the six predecessor Clinical Commissioning

Groups (CCGs) met in common on the 25 March 2020. Due to the current Coronavirus (COVID-19)

situation, the meeting was held virtually.

At this meeting, the Nottingham City Primary Care Commissioning Committee:

APPROVED the extension of the temporary boundary reduction for Leen View Surgery, which was due

to expire in June, until 30 September 2020. This will allow extra time for agreement of services to two

care homes affected by the boundary changes and to align it with the new service specification in the

Primary Care Network Direct Enhanced Service for care homes.

DISCUSSED the application from Deer Park Family Medical Practice to close their list to new patients

for a period of twelve months. The Committee noted that the practice had previously submitted an

application back in June 2016. The practice had requested a further list closure due to their growing list

size. The practice had stated in the application that the list closure could be mitigated if a number of

premises issues were resolved. These issues had been ongoing since the previous list closure

application. The Committee was concerned that neighbouring practices had not responded to the

consultation about the proposed closure and was reluctant to make a decision without their input; and

noted the pressure on the Practice was primarily a premises issue. The broader issue of practice

resilience and sustainability during the response to COVID-19 was also taken into account and the

possible impact a list closure may have on other practices. It was agreed that in principle under the

current circumstances that list closures would not be encouraged at this time; but that every effort

should be made to work with practices to ensure sustainability throughout the COVID-19 response

period.

Key Messages for the Governing Bodies

Predecessor CCGs’ Primary Care Commissioning Committees – Highlight Report 25 March 2020


Page 2 of 2

Approval of the extension of a temporary boundary reduction for Leen View Surgery

Rejection of the application by Deer Park Family Medical Practice to close their list to new patients

The ratified minutes of the meeting will be received by the Governing Body on the 6 May 2020.

Predecessor CCGs’ Primary Care Commissioning Committees – Highlight Report 25 March 2020


Page 1 of 2


Paper Title: Finance Report Paper Reference: GB 20 082

Sponsor:

Presenter:

Stuart Poynor – Chief Finance Officer Attachments/ Appendices:

Andrew Morton – Operational Director of Finance

Purpose: Approve ☐ Endorse ☐ Review ☐ Receive/Note for:

∑ Assurance∑ Information

☒

Executive Summary

To present the Year to Date and Forecast Financial Position of the 6 Nottingham and Nottinghamshire CCGs.

The forecast position is to deliver the planned £11.9 million cumulative surplus, but there remains risk to this position. The risk of not achieving the planned surplus is £6.5 million. There are currently mitigations to the value of £4.6m identified to offset this risk. The previously assumed mitigation relating to receipt of additional national funding to offset the prescribing Cat M risk has been confirmed by NHSE/I as being not available. This leaves the CCG with a further £1.9 million of mitigations to identify in order to deliver the forecast position. The CCG is having on-going conversations with regulators regarding the financial position.

Year to date, the combined CCG position is £1.5 million adverse to plan.


Compliance with Statutory Duties ☐ Wider system architecture development (e.g. ICP, PCN development)

☐


☐










Equality / Quality Impact Yes ☐ No ☐ N/A ☒

Finance Report


Page 2 of 2

Assessment (EQIA)

Risk(s):

No risks identified

Confidentiality:

☒No

Recommendation(s):

1. NOTE the financial position of the Nottingham and Nottinghamshire CCGs for the reporting period and the significant risks to the delivery of the Planned Surplus

2. NOTE the QIPP position of the CCGs for the period

Finance Report


FINANCE REPORT TO FINANCE & TURNAROUND COMMITTEE

Month 11 2020

Finance report for the period ending 29th February 2020 Nottingham & Nottinghamshire CCGs Finance Report

Consolidated Finance Report for NHS Mansfield & Ashfield, NHS Newark & Sherwood, NHS Nottingham City, NHS Nottingham North and

East, NHS Nottingham West and NHS Rushcliffe.

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1) Summary Financial Performance

The tables below summarise the financial plan that has been approved by the statutory organisations. The financial

position compared to plan is reflected in the attribution of the red, amber green ratings.

Key Financial Duties (figures = targets) Section Total M&A N&S Nottm City NNE NW Rushcliffe

Remain within the Revenue Resource Limit 4 £1,617.19m £317.68m £217.25m £533.09m £212.42m £157.58m £179.18m

Achieve in Year Planned Surplus £2.34m surplus £0.87m surplus £0.30m surplus £1.17m surplus £b/even £b/even £b/even

Remain within Running Cost Allowance 12 £22.39m £4.06m £2.79m £7.36m £3.42m £2.02m £2.74m

Remain within the Cash Balance Limit 12 £1.534m £0.302m £0.214m £0.425m £0.194m £0.150m £0.250m

Better Payments Practice Code > 95% > 95% > 95% > 95% > 95% > 95% > 95%

Key Internal Financial Indicators Section Total M&A N&S Nottm City NNE NW Rushcliffe

QIPP – Achievement of Annual Plan 8 £78.20m £15.00m £10.20m £22.20m £13.80m £5.60m £11.40m

Achievement of Planned Underlying Position 11 £4.14m deficit £3.40m deficit £1.52m deficit £0.52m surplus £0.11m surplus £0.07m surplus £0.08m surplus

Co-commissioning – spend remains within budget App 1 £146.44m £27.54m £18.55m £50.72m £18.56m £14.59m £16.49m

Acute services – spend remains within budget App 1 £760.65m £149.04m £103.87m £243.34m £103.24m £77.85m £84.88m

Continuing healthcare – spend remains within budget App 1 £111.71m £22.35 £14.07m £33.80m £15.28m £10.87m £15.34m

Prescribing – spend remains within budget App 1 £144.33m £30.36m £20.68m £41.89m £20.08m £15.12m £16.20m

NHSE - CCG Improvement & Assessment Framework Section Total M&A N&S Nottm City NNE NW Rushcliffe

Forecast v plan for the year: Red - below plan G G G G G G

YTD financial position: Amber 0.1% to 2%; Red > 2% over plan A A G G G G

Net risk: Amber 1% to 2%; Red > 2% of planned spend G G G G G G

YTD QIPP: Amber < 80% plan G G G G G G

FOT QIPP: Amber < 90% plan A A G A G A

MHIS achievement: Amber unachieved A G G A G G

I&A OVERALL RATING: Red - any red; Amber - any amber A A G A G A

Note

- Figures in Table are the Plan Figures - Achievement of this Plan is shown by RAG Rating. - The Key Internal Financial Indicators table shows Amber for an adverse variance to plan of up to 1% - The Planned Underlying position relates to underlying position at planning stage rather than reflecting

movements of underlying position in year.

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2) Summary of Financial Position & Risk

MN GN Total

£m £m £m

Resource Position

Surplus / (Deficit) brought forward (A) (9.78) 19.35 9.57

In Year Allocation 2019/20 544.70 1,062.93 1,607.63

Available Resources 2019/20 4 534.92 1,082.28 1,617.20

Expenditure Position

Budgeted Gross Expenditure Budget 568.69 1,114.75 1,683.44

Planned QIPP 8 (25.15) (53.00) (78.15)

Net Expenditure Budget (as per OCS) (C) 5 543.54 1,061.75 1,605.29

Planned Surplus / (Deficit) c/f (B) (8.62) 20.53 11.91

Planned Improvement in cumulative Surplus / (Deficit) [(B)-(A)] 1.17 1.18 2.35

Forecast Outturn Expenditure plus Risk (pre QIPP) 565.07 1,113.13 1,678.20

Actual - FOT QIPP Delivery 8 (20.70) (45.70) (66.40)

Net Forecast Expenditure plus Risks (D) 544.37 1,067.43 1,611.80

Variance to Budget (including Risk) [(D) - (C)] 9 (0.83) (5.68) (6.51)

Recovery Plan 9

New QIPP 0.00 0.00 0.00

Inter CCG risk transfer 0.00 0.00 0.00

Solutions to be developed 0.29 1.59 1.88

Financial Management/ Flexibilities 0.54 4.09 4.63

Total Recovery Plan 0.83 5.68 6.51

Forecast Outturn against Plan 0.00 0.00 0.00

Nottingham & Nottinghamshire CCGs Section

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3) Summary Narrative - Month 11 Position

The consolidated year to date (YTD) position is reporting an adverse variance of £1.5m (0.1%) against plan. There remains a risk

associated with the delivery of the forecast outturn position, assessed at £6.5m (0.4%) which is a slight deterioration from last

month of £0.4m. This is primarily relates to pressures on Acute spend on non-NHS providers. The CCGs remain in dialogue with

regulators regarding the current position.

The CCGs continue to work up additional mitigations to offset the £6.5m risk. At this stage, £4.6m of potential solutions have

been identified for delivery by year end. The residual £1.9m requires further solutions to be identified. As noted in the month 10

finance report, the residual risk was assumed to be covered by national funding to offset nationally recognised Category M

prescribing pressures. However, NHSE/I have notified the CCG that this funding will not be available.

QIPP delivery is forecast to deliver £66.4m (84.9%) against the £78.2m plan. This represents an adverse variance of £11.8m

shortfall. Of the £66.4m delivery, £12.3m is non recurrent. This leaves a recurrent shortfall of £24.1m which is a key factor in the

deterioration of the underlying position (see below).

Whilst the Cat M pressure is driving an adverse variance on the prescribing budget (£4.7m forecast overspend), the key pressure

to the CCGs remains acute spend and QIPP performance. This translates to overspend within high cost drugs, non-elective

activity, continuing healthcare, independent sector and prescribing. Total adverse variance across the CCGs on acute budgets is

£32.6m (4.7%) year to date and £36.5m (4.8%) forecast outturn. Community services are forecast to be off plan by £2.2m

(1.7%), mainly due to non-delivery of community QIPP targets.

The underlying position remains as per the position last month, following the detailed m9 review at £30.8 million deficit (£26.7

million off plan). This brings forward an opening deficit for the 2020/21 Financial Plan to recover.

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4) Revenue Resource Limit

The combined Nottingham and Nottinghamshire CCGs Revenue Resource Limit (RRL) for 2019/20 is £1,617.20m per

below:-

Recurrent

£m

Non Recurrent

£m

Total

£m

19/20 Agreed Allocations at Mth 10 1,586.72 29.54 1,616.26

Breakdown of Allocation issued at Mth 11

Adoption Fund applications 0.15 0.15Clinical Network - IAPT Wellbeing 0.02 0.02

CYP Green Paper Waiting Time Initiatives 0.04 0.04

Digital Transformation - Digital First Primary care 0.32 0.32

GPFV Online Consultation Funding 0.00 0.00

GPN Innovation Fund 0.00 0.00

Intra Nottingham & Nottinghamshire CCG System Risk Share 0.00 0.00

MH Suicide Prevention Postvention bereavement 0.02 0.02

Pharmacy Integration MOCH - Q4 - £30,338 0.03 0.03

Share of GPFV Online Consultation Funding 0.00 0.00

Share of GPFV PCN Funding 0.00 0.00

UEC - Frailty collaboratives 0.15 0.15

Winter Pressures - Tranche2 - Nottingham University Hospitals NHS Trust - Elective -

Orthopaedics 0.22 0.22

0.00 0.00

Total RRL to be carried Forward to Mth 12 1,586.72 30.48 1,617.20

Memo : Composition of total RRL

Mid Notts 523.36 11.56 534.92

Greater Notts 1,063.35 18.92 1,082.27

Annual Resource Limit

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5) Revenue Expenditure Position

YTD Plan YTD Actual YTD Variance Annual Plan Forecast Outturn Forecast Variance

£m £m £m £m £m £m

Programme Healthcare Costs

Acute Care 697.17 729.75 (32.58) 762.22 798.70 (36.48)

Community Care 118.36 119.66 (1.30) 128.68 130.91 (2.23)

Mental Health Care 149.45 146.87 2.58 164.02 161.25 2.78

Primary Care 164.78 158.09 6.70 182.32 174.86 7.46

Prescribing 132.38 136.67 (4.29) 144.69 149.37 (4.67)

Continuing Care 102.33 101.78 0.55 111.71 111.51 0.19

Total Programme Healthcare Costs 1,364.47 1,392.79 (28.32) 1,493.65 1,526.59 (32.94)

Programme Non Healthcare Costs

Other Contracts 44.68 44.73 (0.04) 48.66 49.01 (0.35)

Corporate Costs (excl. admin/ running costs) 2.97 5.65 (2.68) 6.17 9.30 (3.13)

Programme Reserves 29.76 0.00 29.76 35.40 (1.16) 36.56

Total Programme Non Healthcare Costs 77.41 50.37 27.04 90.23 57.15 33.08

Total Net Operating Expenditure - Programme 1,441.88 1,443.16 (1.28) 1,583.87 1,583.74 0.14

Planned Historic Surplus / (Deficit) 10.92 0.00 10.92 11.92 0.00 11.92

Total Available Resource - Programme 1,452.80 1,443.16 9.64 1,595.79 1,583.74 12.05

Total Available Resource - Admin 19.76 19.97 (0.21) 21.42 21.55 (0.14)

Total Available Resource 1,472.56 1,463.13 9.44 1,617.21 1,605.29 11.91

Position excluding Planned Surplus 1,461.64 1,463.13 (1.48) 1,605.29 1,605.29 (0.00)

Nottingham & Nottinghamshire CCGs

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6) Key Areas

The key areas of Acute, Prescribing and Continuing Healthcare are detailed within Section 7 – Deep Dive. In addition key areas include:

AREAS Responsible

DirectorKey Officer(s) YTD Variance Commentary

Mental Health Lucy Dadge Maxine Bunn £2.58m Underspend

Mid Notts

- £1.2m underspend on S117 placements offset within the CHC position and reflecting a different patient mix compared to plan

- £0.3m underspend on locked rehab placements.

- £1m MHIS and transformation funding slippage

Greater Notts

- Locked Rehab is showing a YTD underspend of £0.45m due to activity levels.

- S117 is showing a £0.8m overspend on placements based on QA

- £1m YTD MHIS funding slippage

- NCAs are £0.87m overspent across all CCG's within Greater Notts. due to high observations and out of area PICU.

Risk share adjustments have been made within mental health to even out the differential variances in CHC/S117 and enable all

CCGs to meet the MHIS.

Primary Care Lucy Dadge Sharon Pickett

Mid Notts

- YTD underspend due to slippage on investment costs to deliver transformation

Greater Notts

- The underspend here relates to Local Enhanced Services where costs are no longer expected following an updated review of

claims from the submission of Qtr 3 activity across a number of the services that are offered.

Delegated Co-

CommissioningLucy Dadge Sharon Pickett

Mid Notts

There has been a change in methodology of accruals in relation to QOF and other Enhanced Services across the CCGs.

Greater Notts

There has been prior year fallout of accruals in relation to both Premises and Locums as well as there being Business Rates Rebate

due to a national exercise being done by NHSE and this has led to a further benefit.

£1.66m underspend relates to the rephasing of the Reserves so this is now phased across the year in order for all processes to be

aligned across the 6 CCGs.

There has also been a change to the methodology of accruals in relation to QOF and other Enhanced Services across the CCGs.

£5.99m Underspend

(excluding

Prescribing)

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AREASResponsible

DirectorKey Officer(s) YTD Variance Commentary

Community Health Services Lucy Dadge Maxine Bunn £1.30m Overspend

Mid Notts

- £0.2m benefit NHT feedback website funding not required until 20/21.

- £0.2m benefit Short breaks disinvested from NHT.

Greater Notts

- Community Services savings requirement is under achieving giving an overspend of £2.7m.

- £0.8m benefit relating to stock in issue work in progress

- £0.3m benefit Short breaks disinvested from NHT.

Admin (Running Costs) /

CorporateSarah Carter

All Executive

Directors

£0.21m Overspend

(Running Costs) /

£1.18m overspend

(Programme)

The pay budgets have been aligned across Greater & Mid Notts according to Running Costs / Programme definitions and this has

been taken place. This has moved various pay costs from Running Costs to Programme.

Recharges have also been applied across the six organisations so that each CCG has the correct costs allocated for each team.

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7) Key Areas – Deep Dive

Acute Services

Month 11 Position

Total Acute services are overspent at month 1 by £32.6m and forecast to overspend by £36.5m at month 12

Sherwood Forest Hospitals – Forecast Outturn –£4.4m

These are principally in the areas of non-elective admissions (£2.0), A&E attendances (£0.3m), high cost drugs (£1.7m), Day Cases (£0.5m) and GP direct

access (£0.3m), offset by an underspend on Elective care services £0.6m and critical care £0.1m. Under the SFH Aligned Incentive Contract for 2019/20

there is, however, a forecast saving compared to a PbR contract of £6.5m. This includes £1.9m of savings from the outpatient transformational scheme.

MN & GN NHS Clinical Commissioning Groups YEAR TO DATE

Acute Services Plan

£'Mil

Actual

£'Mil

Variance

£'Mil

Annual

Plan

£'Mil

Forecast

Outturn

£'Mil

Forecast

Variance

£'Mil

Sherwood Forest Hospitals 189.82 193.90 -4.08 207.94 212.36 -4.42

Nottingham University Hospitals 398.54 399.12 -0.58 436.69 437.44 -0.76

NUH - Treatment Centre 27.64 26.13 1.51 31.60 29.86 1.75

Circle - Nations Healthcare - ISTC 18.59 17.12 1.47 18.59 17.12 1.47

BMI Healthcare 3.98 5.80 -1.82 4.35 6.36 -2.01

Barlborough 0.95 1.08 -0.13 1.04 1.19 -0.15

Ramsay Woodthorpe 7.52 10.98 -3.46 8.23 11.83 -3.59

Acute - NHS 62.62 64.36 -1.74 68.42 70.32 -1.91

Other Non NHS - Acute 9.01 11.35 -2.34 9.71 12.33 -2.62

Acute Riskshare -0.00 -0.02 0.02 -0.00 -0.04 0.04

Acute Activity Reserve / QIPP / FRP -20.23 -0.06 -20.17 -22.98 -0.06 -22.92

Activity - Other -1.26 0.00 -1.26 -1.36 0.00 -1.36

Total Acute Services 697.17 729.75 -32.58 762.22 798.70 -36.48

FORECAST

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Acute Services cont..

Nottingham University Hospitals – Forecast Outturn -£0.76m

The year end agreement between Greater Notts and the Trust represents a £0.1m underspend to plan. This takes account of the full -£3.6m impact for z-

codes, and an agreed forecast for drugs and devices. A further cost of £0.8m relating to NUH Patient Streaming has been agreed with NUH and forms

part of this position. Mid Notts contract is a full block and therefore will deliver to plan.

Other Independent Sector – Forecast Outturn -£5.2m

Ramsay Woodthorpe (£3.6m) is forecast over plan from a combination of over-performance on Trauma and Orthopaedic (T&O) and Spinal surgery

activity and under-accrued prior year charges. T&O activity is also forecast above plan at Spire (£3.0m), BMI, The Park (£2.0m) and Barlborough

Treatment Centre (£0.2m).

Risks and Mitigations

Significant risks have been identified to delivery of the reported acute position. Also mitigations include demand management schemes which may

reduce activity, making the final position more difficult to forecast accurately.

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Continuing Health Care (CHC)

Overview CHC, FNC and Section 117 packages are managed collectively through the same assessment process and panel. The QIPP plan covers both CHC and Section 117

(rather than there being separate targets), with a focus on achieving overall cost containment

Month 11 Position Mid Notts.

The year to date activity is above planned levels in CHC placements and below planned levels in S117 placements. Some of this shift may be due to the

Transforming Care Partnership (TCP) discharges to date being from locked rehabilitation. As these are not necessarily sectioned patients they have therefore

transferred into CHC rather than S117. There has been an increase in the number of high cost Learning Disability packages in CHC. Within the 19/20 financial plan

a higher level of growth for accelerated discharge was applied to the S117 budget.

Fast track activity and costs grew throughout 18/19 and this trend is continuing in the 19/20 year to date position. A new agreement has been implemented with

the Carer’s Trust and suitability of referrals to fast track services are being reviewed; both of which are expected to improve the position. The Fast Track forecast

outturn has improved since M10.

Nottinghamshire Summary £mYTD

Budget

YTD

Spend

YTD

Variance

Activity

Variance

Price

Variance

Annual

BudgetFOT Spend

FOT

Variance

Mental Health - S117 24.29 24.17 0.12 (0.47) 0.60 26.51 26.43 0.07

CHC & FNC 99.28 101.98 (2.69) (1.08) (1.61) 108.40 110.67 (2.26)

Prior Year Accrual / Risk Share 0.00 (3.13) 3.13 0.00 3.13 0.00 (3.13) 3.13

Bassetlaw 18/19 0.25 0.25 0.00 0.00 0.00 0.25 0.25 0.00

Retrospective claims provision 0.00 0.76 (0.76)

CHC & FNC (A) 99.53 99.10 0.43 (1.08) 1.51 108.65 108.55 0.10

Total (CHC (excl Assessment Service) + S117) 123.82 123.27 0.55 (1.55) 2.11 135.16 134.98 0.17

CHC Assessment Service (B) 2.80 2.68 0.12 0.00 0.12 3.06 2.95 0.11

Total CHC Costs per OCS (A+B) 102.33 101.78 0.55 (1.08) 1.63 111.71 111.50 0.21

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There has also been a marked growth in the number packages relating to physical disabilities throughout 19/20.

The forecast outturn position in Mid Notts has improved slightly since M10 with the main driver being the reduction in forecast fast track expenditure.

Continuing Health Care cont..

Month 11 Position Greater Notts.

The year to date position shows growth above planned levels in CHC placements and also in S117 placements; mainly due to increased high cost LD packages in

Nottingham City. Within the 19/20 financial plan a higher level of growth for accelerated discharge was applied to the S117 budget to take into account TCP

discharges however actual growth is above planned levels.

Physicial Disability and Learning Disability within the Adult Fully Funded service line is currently showing the greatest year to date overspend compared to

budget, the overspend is a combination of both increasing activity and increasing cost of packages with a number of high cost patients and provider tariff uplifts.

Children’s Continuing Care expenditure is below plan as is Fast Track where the Carer’s Trust service has been in place for some time.

The forecast outturn position has deteriorated slightly in City since M10 with the main driver being increased fully funded CHC package expenditure. The position

has improved in South Notts meaning the overall Greater Notts forecast outturn position has improved since M10.

The savings target within the QIPP plan is a combined target for CHC and Section 117 and is based on achieving overall cost containment. Overall growth in the

budget is 5% (which is net of the stretch target). This includes the impact of accelerated discharge resulting from the Transforming Care Programme (TCP).

Eligibility criteria for CHC are set nationally and S117 is a mandatory offer for people coming off a mental health section, so the QIPP is focussed on cost not

activity. QIPP delivery (including the stretch plan) is currently forecast at 61%. CHC is being reviewed at Oversight / Assurance & Financial Recovery Meetings and

a plan to deliver savings is being implemented. The CHC team are reviewing a number of options to recover the position:

• Review of fast track referrals, refresh and re-issue of the policy, undertaking further work with hospitals & GPs to ensure fast track referrals adhere to

the policy.

Spend per calendar day - £m Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

2018/19 0.33 0.34 0.35 0.35 0.35 0.36 0.37 0.36 0.36 0.36 0.36 0.37

2019/20 YTD 0.37 0.38 0.38 0.38 0.38 0.38 0.39 0.39 0.38 0.38 0.38 -

QIPP in position2019/20

BudgetFOT

FOT

Variance

YTD

Budget

YTD

Spend

YTD

Variance

Original Plan (5.49) (4.30) 1.20 (5.03) (3.81) 1.22

Stretch Plan (1.51) 0.00 1.51 (1.37) 0.00 1.37

Total (7.00) (4.30) 2.70 (6.40) (3.81) 2.59

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• Review of PHB and costs versus standard packages.

• Choice policy and options to implement a price cap.

• Review of one to one costs.

Prescribing

Overview

The prescribing budget for 2019/20 is based upon the 2018/19 outturn that has been uplifted for inflation and growth

with the full year effect of the 2018/19 QIPP delivery removed.

In addition to this there are a number of 2019/20 QIPP schemes that have further reduced the Prescribing budget by

£5.21m, including Medicines Optimisation, Prescribing IT, Self Care, Prescribing Processes, and Clinical Prescribing

Review.

Month 11 Position

The Prescribing position at Month 11 is shown in the table below:

The year to date spend is based upon months 1 to 9 PMD data that has been received and accruals for Months 10 and

11 based upon the updated PPA % budget profile. There are 2018/19 accruals that have not materialised, amounting to

£562k, that form part of this position.

There is a combined pressure of £6.0m across Nottinghamshire in relation to price increases due to Category M drugs

and this has been factored into the position as both YTD and FOT. Cat M drugs are those drugs where prices and margins

to suppliers are set by the DH according to market conditions affecting both demand and supply.

YTD Budget YTD Spend YTD Variance Annual Budget FOT Spend FOT Variance

£m £m £m £m £m £m

Greater Notts 85.67 87.90 (2.23) 93.58 96.11 (2.53)

Mid Notts 46.71 48.77 (2.06) 51.11 53.26 (2.14)

Total 132.38 136.67 (4.29) 144.69 149.37 (4.67)

Nottinghamshire

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Prescribing cont..

QIPP Delivery

Mid Notts Prescribing QIPP M11 YTD Target M11 YTD Actual M11 YTD Variance Annual Target M11 FOT FOT Variance

£'m £'m £'m £'m £'m £'m

Self Care (Prescribing) 0.30 0.10 (0.21) 0.35 0.12 0.23

Prescription Processes 0.17 0.22 0.05 0.20 0.22 (0.02)

Medicines Optimisation 0.48 0.24 (0.24) 0.54 0.30 0.24

Clinical Prescribing Review 0.40 0.08 (0.32) 0.45 0.09 0.36

Prescribing FYE 0.14 1.34 1.20 0.14 1.47 (1.33)

Total 1.49 1.97 0.48 1.68 2.20 (0.52)

Greater Notts Prescribing QIPP M11 YTD Target M11 YTD Actual M11 YTD Variance Annual Target M11 FOT FOT Variance

£'m £'m £'m £'m £'m £'m

Medicines Value and Optimisation 1.13 2.07 0.94 1.23 2.25 (1.02)

Prescribing IT 0.69 0.53 (0.16) 0.75 0.58 0.18

Self Care 0.29 0.33 0.05 0.31 0.36 (0.05)

Gluten Free 0.11 0.12 0.01 0.11 0.12 (0.01)

Community Based prescribing schemes 0.14 0.15 0.01 0.15 0.16 (0.01)

Repeat Prescribing 0.58 0.20 (0.38) 0.63 0.22 0.41

Prescribing stretch target 0.92 (0.92) 1.00 1.00

Drugs of Limited Clinical Value 0.15 0.93 0.78 0.16 1.02 (0.85)

Total 4.00 4.33 0.33 4.35 4.71 (0.36)

Greater & Mid Notts Total 5.49 6.30 0.81 6.03 6.91 (0.88)

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8) QIPP – Month 11

The QIPP position for the CCGs will be covered within the PMO report under separate agenda item

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9) Risks & Mitigations The risks and mitigations at month 11 are as per the table below, together with movements from prior month.

The gross risk position has increased by £0.43m to £6.51m, maily due to Acute pressures in Non-Contract Activty (NCAs) and independent

sector activity

To offset the £6.51m, potential solutions of £4.62m have been identified. These mitigations are being firmed up and will be transacted in

month 12 reporting once confirmed. After this £4.62m, a risk of £1.88m remains. The previously assumed national funding to cover this risk

(linked to Cat M funding) is now not available. Work is remains on-going to identify mitigations to cover this remaining risk.

GN MN Total GN MN Total GN MN Total GN MN Total

Risks:

Activity/Price Pressures

Acute Activity 1.92 -13.70 -11.78 -0.72 -0.26 -0.98 0.00 1.20 -13.96 -12.76

Non NHS Acute Activity 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

General activity risk 0.00 0.00 0.00 -0.33 0.03 -0.30 0.00 -0.33 0.03 -0.30

Other Risks 3.80 1.30 5.10 -10.95 11.80 0.85 0.00 -7.15 13.10 5.95

Prescribing

CAT M drugs pressure 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Prescribing FOT risk 0.60 0.00 0.60 0.00 0.00 0.60 0.00 0.60

CHC Volume

CHC FOT Risk 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Total Risks 6.32 -12.40 -6.08 -12.00 11.57 -0.43 0.00 0.00 0.00 -5.68 -0.83 -6.51

Mitigations

Other/Financial management/Flex

Impl. Financial Measures (GN Supp) -9.43 9.43 0.00 9.43 -9.43 0.00 0.00 0.00 0.00 0.00

Financial Measures 3.11 1.05 4.16 0.51 -0.51 0.00 0.47 0.47 4.09 0.53 4.62

Mitigations Reliant on National Support

Cat M funding (m9) / Unidentified Solutions (m10+) 0.00 1.92 1.92 0.00 -0.04 -0.04 1.59 0.29 1.88

Total Mitigations -6.32 12.40 6.08 9.94 -9.94 0.00 0.43 0.00 0.43 5.68 0.82 6.51

Net Risk 0.00 0.00 0.00 -2.06 1.63 -0.43 0.43 0.00 0.43 0.00 0.00 0.00

M11 Movements - in to OCSM11 Movements - after

reviewMonth 11Month 10

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10) Financial Recovery

As with the QIPP report, the Financial Recovery report for the CCGs will be covered within the PMO report under separate agenda item

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11) Forecast Outturn and Underlying Position

Forecast Outturn. The forecast outturn position across the 6 CCGs continues to show delivery against plan. However, as previously noted there are risks to this position amounting to £6.5m.

Underlying Position. The underlying position was comprehensively reviewed in the previous reporting period and remains at the same level. This is an overall £30.8 million deficit, £26.7 million adverse to the planned deficit.

Underlying Position as at m11£000's

Recurrent Variance M11 Comments

Acute Services £33,889 contract overspends; untransacted QIPP non-delivery

Community Services £6,281 QIPP non-delivery

Mental Health Services -£631 release of MHIS reserve

Primary Care Contracting £0

Prescribing £5,040 Category M Pricing pressure

Other Primary Care £12

Continuing Care & Free Nursing Care £3,988 CHC packages volume

Other Programme £3,825 Non delivery of corporate QIPP plus establishment of CCG revised structure

Programme Reserves -£25,704 Reserves, Contingency

Running Costs £0

Total Recurrent Variance £26,700

Planned UDL - Deficit / (Surplus) £4,137

Exit Underlying Deficit / (Surplus) £30,837

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12) Other Key Areas

Running costs (RC) Allowance

The CCG running costs are within the RC allowances up to Reporting Period Mth 11.

The exercise to populate all six CCG ledgers with the revised establishment has now concluded. Both

budget and actuals have been input, back-dated to the beginning of the financial year.

Mental Health Investment Standard – see section 12B

Statement of Financial Position and Cash

The Statement of Financial Position can be found in Appendix 2.

The Cash Management regime expects CCGs to have a cash balance at the end of the month, that is

no more than 1.25% of the months drawdown. (This equates to c.£1.53m). The target that was

achieved in Mth 11 was a balance of £0.44m (0.35%), under target by £1.1m.

Better Care Fund (BCF)

BCF spend remains on plan.

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Aged Debtors

Non NHS

Mid Notts

o £2k Salary Overpayments in relation to 1 ex-employee

o Nottinghamshire County Council - £255k CHC, £30k Medicines Management , £34k Mental Health

o £54k - Balderton Contract

o Central Nottinghamshire Clinical Services £30k Prescribing

Greater Notts

o £815K – NEMS – Programme Projects

o £73k – CHC Recharges with 10 Care Homes

o £46k – Macmillan Cancer Support – Cancer Transformation Funding

NHS

Mid Notts

o £913K Inter CCG recharges - Mental Health Services

o £90k - NHS Derby & Derbyshire CCGs Out of Hours Services

o £21k - Nottingham University Hospitals - Medicines Management

o £271k - NHS England - Prescribing

o £5,845k Nottinghamshire CCGs - Inter CCG recharging - Corporate

Greater Notts

o £77k – Inter CCG recharges re Acute

o £28k – Nottingham University Hospitals – Programme Projects

o £510k - NHS England – Prescribing

o £5,083k Nottinghamshire CCGs - Inter CCG recharging - Corporate

Volume Value Volume Value Volume Value Volume Value Volume Value Volume Value Volume Value Volume Value

Mid Notts. 4 37,109 15 234,727 1 4,620 4 119,773 21 672,659 68 7,589,586 1 1,950 3 90,912

Gtr Notts. 8 34,346 5 21,218 3 4,876 21 942,009 7 511,360 51 5,180,073 1 457 2 28,180

Mid & Gtr

Notts Total12 71,455 20 255,945 4 9,496 25 1,061,782 28 1,184,019 119 12,769,659 2 2,407 5 119,092

Non NHS NHS

Not Yet Due Overdue 1 - 30 Days Overdue 31 - 60 days Overdue 60 days + Not Yet Due Overdue 1 - 30 Days Overdue 31 Days+ Overdue 60 days +

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Cash Flow Forecast

CCGs forecast to remain within the cash holding allowances at year end. During month 12 the

CCG will monitor cash requirements on a daily basis. With the merger of the CCGs to one CCG

for 2020/21 the CCGs are looking to hold minimal working capital (debtor and creditor)

balances as at 31 March 2020. This is likely to entail lower closing creditor balances than the

opening 2019/20 balances and therefore an increased cash requirement. The CCG is utilising

the cash drawdown availability from NHS England during March to facilitate this.

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12B) MHIS Update

• The Mental Health Investment Standard requires a 6.5% increase in mental health expenditure compared to 2018/19

outturn

• Risk share adjustments have been made within mental health to even out the differential variances in CHC/S117 and

enable all CCGs to meet the MHIS.

• The recent audit of the 2018/19 standard required an adjustment to the methodology used to estimate mental health

expenditure within prescribing. This has now been updated in the 2019/20 reporting and had the effect of reducing the

value of prescribing for mental health in the MHIS reported position

• There has been slippage in 19/20 investments and S117/CHC MH expenditure remains lower than planned. All other

expenditure areas have been reviewed to ensure all mental health spend is captured and this along with a CCG risk share

has led to an improvement in the position.

CCG18/19

£'000

19/20

FOT

£'000

Growth

in MH

Spend %

MHIS

Achieved

City CCG 60,637 64,403 6.2% Y

Mansfield and Ashfield CCG 29,556 31,453 6.4% Y

Newark & Sherwood CCG 19,014 20,254 6.5% Y

Nottingham North & East CCG 18,702 20,036 7.1% Y

Nottingham West CCG 12,690 13,479 6.2% Y

Rushcliffe CCG 14,603 15,542 6.4% Y

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12C) Risk Share

Following approval by NHS England the risk share transfer described in the month 10 Financial Report has

been enacted via a series of Inter Authority Transfers (IATS) as follows:

Mansfield & Ashfield £9.050 million (receiving)

Newark & Sherwood £8.861 million (receiving)

Nottingham City £15.351 million (awarding)

Nottingham North & East £1.257 million (receiving)

Nottingham West £5.031 million (awarding)

Rushcliffe £1.214 million (receiving)

The above requirement reflected a combination of risks and overspends in the respective CCGs, but also

that Nottingham City CCG has been the recipient of key allocations and reserves that are Notts-wide, and

therefore reflcted in the distribution required.

Assuming an overall achievement of the CCGs’ combined position, any final risk share required in month 12

will be enacted via inter-CCG invoices in order to ensure each CCG meets its respective Control Total.

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13) Key Messages

The YTD position is a deficit of £1.5 million. Whilst the forecast position is to deliver the planned surplus as

required by NHS England, there remains significant risk (£6.5 million) to the delivery of this position.

Potential solutions of £4.6 million have been identified to offset this risk with the residual risk of £1.9

million requiring further mitigating solutions to be developed. NHS England/Improvement are aware of the

risk

Of the £78.2 million QIPP target, a delivery of £66.4 million is forecast, of which £12.3 million is non recurrent. The shortfall of £11.8 million is a key driver of the challenging financial position and the recurrent under delivery of £24.1 million is impacting the underlying position.

The underlying position remains at £26.7million adverse to the deficit plan of £4.1 million. The CCGs are

therefore carrying forward an opening deficit position of £30.8 million in to the 2020/21 financial year and financial plan.

14) Recommendations

The Governing Body is recommended to:

NOTE the financial position of the Nottingham and Nottinghamshire CCGs for the reporting period and the

continued risk to the delivery of its planned surplus.

NOTE the QIPP position of the CCGs for the reporting period.

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APPENDIX 1a – Operating Cost Statement (Nottingham & Nottinghamshire CCGs

Finance Report


FORECAST YEAR TO DATE

Annual Plan

£'Mil

Forecast

Outturn

£'Mil

Forecast

Variance

£'Mil

Plan

£'Mil

Actual

£'Mil

Variance

£'Mil

Acute Services

Sherwood Forest Hospitals 206.81 211.17 (4.36) 188.76 192.78 (4.03)

Sherwood Forest Hospitals - Non Core 1.13 1.26 (0.13) 1.06 1.18 (0.12)

Sherwood Forest Hospitals - Prior Year 0.00 (0.06) 0.06 0.00 (0.06) 0.06

Sherwood Forest Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00

Nottingham University Hospitals 436.69 437.44 (0.76) 398.54 399.12 (0.58)

Nottingham University Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00

East Midlands Ambulance Service 39.20 39.22 (0.02) 35.93 35.98 (0.05)

Acute - NHS - United Lincs 5.21 5.35 (0.14) 4.76 4.90 (0.14)

Acute - NHS - United Lincs - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00

Acute - NHS - Doncaster & Bassetlaw 3.40 3.26 0.14 3.10 3.00 0.10

Acute - NHS - Derby & Burton 6.35 6.61 (0.25) 5.81 6.10 (0.29)

Acute - NHS - Univ Leicester 1.60 2.00 (0.40) 1.46 1.79 (0.33)

Acute - NHS - Chesterfield 1.23 1.26 (0.04) 1.12 1.16 (0.04)

Acute - NHS - Sheff Teaching 1.39 1.17 0.23 1.27 1.06 0.21

Acute - NHS - Sheff Childrens 0.21 0.13 0.08 0.19 0.12 0.07

Acute - NHS (0.01) (0.04) 0.03 (0.01) (0.43) 0.43

Other NHS - NCA's 9.84 11.37 (1.53) 8.98 10.67 (1.69)



BMI Healthcare 4.35 6.36 (2.01) 3.98 5.80 (1.82)

Barlborough 1.04 1.19 (0.15) 0.95 1.08 (0.13)

Ramsay Woodthorpe 8.23 11.83 (3.59) 7.52 10.98 (3.46)

Other Non NHS - Acute 9.71 12.33 (2.62) 9.01 11.35 (2.34)

Acute Riskshare (0.00) (0.04) 0.04 (0.00) (0.02) 0.02

Acute Activity Reserve / QIPP / FRP (22.98) (0.06) (22.92) (20.23) (0.06) (20.17)

Acute Investment QIPP 0.00 0.00 0.00 0.00 0.00 0.00

NHS 111 0.00 0.00 0.00 0.00 0.00 0.00

Activity - Other (1.36) 0.00 (1.36) (1.26) 0.00 (1.26)

Total Acute Services 762.22 798.70 (36.48) 697.17 729.75 (32.58)

Community Services

Nottinghamshire Healthcare - General Health 65.24 65.33 (0.10) 59.74 59.83 (0.09)

Nottinghamshire Healthcare - QIPP 0.00 0.00 0.00 0.00 0.00 0.00

Nottingham Citycare 32.66 32.89 (0.23) 30.01 30.25 (0.24)

Nottingham Citycare - QIPP 0.00 0.00 0.00 0.00 0.00 0.00

Sherwood Forest Hospitals 10.02 10.01 0.00 9.18 9.19 (0.01)


Other NHS - Community 5.74 5.06 0.68 5.25 4.51 0.74

Other Non NHS - Community 14.56 12.98 1.58 13.42 11.56 1.85

Other Non NHS - QIPP 0.00 0.00 0.00 0.00 0.00 0.00

End of Life 4.62 4.63 (0.01) 4.29 4.30 (0.01)

Community QIPP not transacted (4.49) 0.00 (4.49) (3.85) 0.01 (3.87)

Community Investment QIPP 0.00 0.00 0.00 0.00 0.00 0.00

Community - Other 0.33 0.00 0.33 0.31 0.00 0.31

Total Community Services 128.68 130.91 (2.23) 118.36 119.66 (1.30)

Mental Health Services

Nottinghamshire Healthcare - Mental Health 109.24 108.84 0.40 99.81 99.42 0.39

Other NHS - Mental Health 9.57 11.26 (1.69) 8.79 10.40 (1.61)

Other Non NHS - Mental Health 15.73 14.16 1.57 14.48 12.87 1.61

S117 Placements 26.51 26.43 0.07 24.29 24.17 0.12

Mental Health QIPP not transacted 0.00 0.00 0.00 0.00 0.00 0.00

Mental Health Investment QIPP 0.00 0.00 0.00 0.00 0.00 0.00

Mental Health - Other 2.98 0.55 2.43 2.08 0.00 2.08

Total Mental Health Services 164.02 161.25 2.78 149.45 146.87 2.58

Primary Care Services

Primary Care Contracting 146.44 140.38 6.07 132.05 126.59 5.46

Prescribing 144.69 149.37 (4.67) 132.38 136.67 (4.29)

Prescribing - QIPP 0.00 0.00 0.00 0.00 0.00 0.00

Medicine Management - Clinical 4.01 3.27 0.75 3.68 2.97 0.71

CCG Pathways 0.05 (0.11) 0.16 0.05 (0.11) 0.15

Primary Care General 0.06 0.04 0.02 0.04 0.02 0.02

GP Forward View 8.60 8.60 0.00 7.88 7.88 (0.00)

Enhanced Services 7.36 6.76 0.60 6.64 6.12 0.52

Practice Transformation fund 0.00 0.00 0.00 0.00 0.00 0.00

GPIT 5.05 5.12 (0.07) 4.60 4.70 (0.11)

Out of Hours 10.45 10.79 (0.34) 9.58 9.90 (0.32)

Primary Care - Other 0.28 0.00 0.28 0.26 0.00 0.26

Total Primary Care Services 327.01 324.22 2.79 297.17 294.76 2.41

Continuing Healthcare

Continuing Care & Free Nursing Care 108.65 108.55 0.10 99.53 99.10 0.43

CHC Assessment 3.06 2.95 0.11 2.80 2.68 0.13

Total Continuing Healthcare Costs 111.71 111.51 0.20 102.33 101.78 0.55

TOTAL PROGRAMME HEALTHCARE COSTS 1,493.65 1,526.59 (32.94) 1,364.47 1,392.80 (28.33)

MN & GN NHS Clinical Commissioning Groups

Finance Report


Other Contracts

Other Non-NHS Services 3.71 3.61 0.10 3.38 3.25 0.12

Patient Transport 7.54 7.48 0.06 6.97 6.68 0.29

Other Non-NHS Services - 111 4.31 4.67 (0.37) 3.94 4.27 (0.33)

Other NHS Services 0.53 0.68 (0.15) 0.53 0.66 (0.13)

Social Care 32.58 32.58 0.00 29.86 29.86 (0.00)

Total Other Contracts 48.66 49.01 (0.35) 44.68 44.73 (0.04)

Corporate Non-Running Costs

Corporate - Estates 10.64 10.69 (0.05) 9.76 9.79 (0.03)

Corporate Costs - Chief Officer (2.86) 1.73 (4.59) (2.66) 1.37 (4.03)

Corporate Costs - Chief Commissioning Officer 3.46 2.38 1.08 3.29 2.25 1.04

Corporate Costs - Chief Finance Officer 0.67 0.38 0.29 0.61 0.30 0.31

Corporate Costs - ICS 2.11 2.11 (0.00) 0.15 0.15 (0.00)

Corporate Costs - Chief Nurse 4.04 3.24 0.80 3.71 3.02 0.69

Depreciation, provisions & technical adjustments (11.89) (11.22) (0.66) (11.89) (11.23) (0.65)

Total Corporate Non-Running Costs 6.17 9.30 (3.13) 2.97 5.65 (2.68)

Programme Reserves

Risk Reserves (inc. running cost headroom) 7.47 0.00 7.47 6.84 0.00 6.84

PCCC (1.80) 0.00 (1.80) (1.65) 0.00 (1.65)

QIPP (2.00) 0.00 (2.00) (1.44) 0.00 (1.44)

Other 31.74 (1.16) 32.90 26.00 0.00 26.00

Total Programme Reserves 35.40 (1.16) 36.56 29.76 0.00 29.76

TOTAL PROGRAMME NON- HEALTHCARE COSTS 90.23 57.15 33.08 77.41 50.37 27.04

TOTAL NET OPERATING EXPENDITURE - PROGRAMME 1,583.87 1,583.74 0.14 1,441.88 1,443.17 (1.29)

Planned Surplus 11.92 0.00 11.92 10.92 0.00 10.92

TOTAL AVAILABLE RESOURCE - PROGRAMME 1,595.79 1,583.74 12.05 1,452.80 1,443.17 9.63

Running Costs

Running Costs 0.00 0.00 0.00 0.00 0.00 0.00

Running Costs - Chief Officer 3.74 3.66 0.09 3.50 3.38 0.12

Running Costs - Chief Finance Officer 5.63 5.96 (0.33) 5.22 5.58 (0.35)

Running Costs - Chief Commissioniong Officer 7.53 6.85 0.68 6.91 6.31 0.60

Running Costs - Chief Nurse 1.09 1.39 (0.30) 1.00 1.30 (0.30)

Running Costs - Special Projects 0.52 0.68 (0.16) 0.48 0.63 (0.15)

Running Costs - ICS 0.68 0.62 0.06 0.62 0.55 0.07

Running Costs - Estates 2.37 2.40 (0.03) 2.17 2.21 (0.04)

Running Costs - Other (0.14) 0.00 (0.14) (0.15) 0.00 (0.15)

TOTAL AVAILABLE RESOURCE - ADMIN 21.42 21.55 (0.14) 19.76 19.97 (0.21)

TOTAL 1,617.21 1,605.29 11.91 1,472.56 1,463.14 9.42

Finance Report


APPENDIX 1b – Operating Cost Statement (Mid Nottinghamshire CCGs)


Annual Plan

£'Mil

Forecast Outturn

£'Mil

Forecast

Variance

£'Mil

Plan

£'Mil

Actual

£'Mil

Variance

£'Mil

Acute Services


Sherwood Forest Hospitals - Non Core 1.13 1.26 (0.13) 1.06 1.18 (0.12)

Sherwood Forest Hospitals - Prior Year 0.00 (0.06) 0.06 0.00 (0.06) 0.06








Acute - NHS - Derby & Burton 1.73 1.66 0.07 1.58 1.56 0.03





Acute - NHS (0.01) (0.04) 0.03 (0.01) (0.04) 0.03

Other NHS - NCA's 3.25 4.05 (0.80) 2.96 3.66 (0.70)



BMI Healthcare 2.94 3.90 (0.96) 2.68 3.54 (0.85)

Barlborough 0.99 1.11 (0.12) 0.90 1.01 (0.10)


Other Non NHS - Acute 0.00 0.00 0.00 0.00 0.00 0.00

Acute Riskshare (0.00) (0.04) 0.04 (0.00) (0.02) 0.02

Acute Activity Reserve / QIPP / FRP (11.89) 0.00 (11.89) (10.42) 0.00 (10.42)


NHS 111 0.00 0.00 0.00 0.00 0.00 0.00

Activity - Other (0.41) 0.00 (0.41) (0.38) 0.00 (0.38)


Community Services

Nottinghamshire Healthcare - General Health 25.87 26.05 (0.17) 23.70 23.86 (0.16)


Nottingham Citycare 0.00 0.00 0.00 0.00 0.00 0.00


Sherwood Forest Hospitals 8.13 8.13 0.00 7.46 7.47 (0.01)


Other NHS - Community 2.24 2.34 (0.10) 2.05 2.14 (0.08)



End of Life 4.14 4.15 (0.01) 3.81 3.81 (0.00)

Community QIPP not transacted 0.17 0.00 0.17 0.16 0.00 0.16


Community - Other 0.33 0.00 0.33 0.31 0.00 0.31

Total Community Services 41.24 40.90 0.34 37.80 37.49 0.32


Nottinghamshire Healthcare - Mental Health 35.11 35.13 (0.01) 32.15 32.18 (0.03)

Other NHS - Mental Health 1.69 1.57 0.12 1.55 1.43 0.12


S117 Placements 11.18 10.22 0.96 10.25 11.03 (0.79)



Mental Health - Other 1.72 2.65 (0.93) 1.04 0.00 1.04




Prescribing 51.11 53.26 (2.14) 46.71 48.77 (2.06)



CCG Pathways 0.00 0.00 0.00 0.00 0.00 0.00

Primary Care General 0.11 0.18 (0.07) 0.10 0.16 (0.06)

GP Forward View 2.22 2.22 0.00 2.03 2.03 (0.00)

Enhanced Services 2.41 2.45 (0.04) 2.20 2.26 (0.05)


GPIT 1.17 1.13 0.04 1.07 1.07 (0.00)

Out of Hours 3.96 3.91 0.05 3.63 3.59 0.04


Total Primary Care Services 108.66 109.54 (0.88) 97.92 98.72 (0.80)


Continuing Care & Free Nursing Care 35.87 37.85 (1.97) 32.87 34.57 (1.70)

CHC Assessment 0.54 0.44 0.10 0.50 0.38 0.12

Total Continuing Healthcare Costs 36.41 38.29 (1.87) 33.37 34.94 (1.58)

TOTAL PROGRAMME HEALTHCARE COSTS 494.83 515.44 (20.61) 450.90 469.06 (18.16)

MN NHS Clinical Commissioning Groups

Finance Report


Other Contracts


Patient Transport 2.49 2.61 (0.12) 2.31 2.28 0.03


Other NHS Services 0.53 0.68 (0.15) 0.53 0.66 (0.13)

Social Care 8.42 8.42 0.00 7.72 7.72 0.00

Total Other Contracts 16.36 16.81 (0.45) 15.04 15.27 (0.23)


Corporate - Estates 2.33 2.33 0.00 2.14 2.14 0.00

Corporate Costs - Chief Officer 0.42 0.11 0.31 0.38 0.07 0.31



Corporate Costs - ICS (0.08) (0.08) (0.00) (0.07) (0.07) (0.00)


Depreciation, provisions & technical adjustments 0.03 0.03 0.00 0.03 0.03 0.00

Total Corporate Non-Running Costs 5.26 4.30 0.96 4.94 4.00 0.95

Programme Reserves


PCCC (1.80) 0.00 (1.80) (1.65) 0.00 (1.65)

QIPP (1.67) 0.00 (1.67) (1.44) 0.00 (1.44)

Other 20.66 0.17 20.48 16.23 0.00 16.23

Total Programme Reserves 19.85 0.17 19.68 15.58 0.00 15.58


TOTAL NET OPERATING EXPENDITURE - PROGRAMME 536.30 536.73 (0.42) 486.46 488.33 (1.87)

(8.61) 0.00 (8.61) (7.90) 0.00 (7.90)

TOTAL AVAILABLE RESOURCE - PROGRAMME 527.69 536.73 (9.04) 478.57 488.33 (9.76)

Running Costs

Running Costs 0.00 0.00 0.00 0.00 0.00 0.00

Running Costs - Chief Officer 0.53 0.74 (0.21) 0.49 0.69 (0.20)

Running Costs - Chief Finance Officer 2.12 2.64 (0.51) 1.98 2.44 (0.47)

Running Costs - Chief Commissioniong Officer 3.48 2.29 1.19 3.19 2.09 1.10

Running Costs - Chief Nurse 0.33 0.24 0.10 0.30 0.24 0.06



Running Costs - Estates 0.52 0.50 0.02 0.47 0.46 0.02

Running Costs - Other (0.14) 0.00 (0.14) (0.15) 0.00 (0.15)

TOTAL AVAILABLE RESOURCE - ADMIN 7.24 6.82 0.42 6.66 6.29 0.37

TOTAL 534.93 543.54 (8.61) 485.22 494.62 (9.40)

Finance Report


APPENDIX 1c – Operating Cost Statement (Greater Nottinghamshire CCGs)


Annual Plan

£'Mil

Forecast Outturn

£'Mil

Forecast

Variance

£'Mil

Plan

£'Mil

Actual

£'Mil

Variance

£'Mil

Acute Services


Sherwood Forest Hospitals - Non Core 0.00 0.00 0.00 0.00 0.00 0.00

Sherwood Forest Hospitals - Prior Year 0.00 0.00 0.00 0.00 0.00 0.00








Acute - NHS - Derby & Burton 4.62 4.95 (0.32) 4.22 4.55 (0.32)





Acute - NHS 0.00 0.00 0.00 0.00 (0.39) 0.39

Other NHS - NCA's 6.60 7.32 (0.72) 6.02 7.02 (1.00)



BMI Healthcare 1.42 2.47 (1.05) 1.29 2.26 (0.97)

Barlborough 0.05 0.08 (0.03) 0.05 0.07 (0.03)


Other Non NHS - Acute 9.71 12.33 (2.62) 9.01 11.35 (2.34)

Acute Riskshare 0.00 0.00 0.00 0.00 0.00 0.00

Acute Activity Reserve / QIPP / FRP (11.09) (0.06) (11.03) (9.81) (0.06) (9.74)


NHS 111 0.00 0.00 0.00 0.00 0.00 0.00

Activity - Other (0.95) 0.00 (0.95) (0.87) 0.00 (0.87)


Community Services

Nottinghamshire Healthcare - General Health 39.36 39.29 0.08 36.05 35.97 0.07


Nottingham Citycare 32.66 32.89 (0.23) 30.01 30.25 (0.24)


Sherwood Forest Hospitals 1.88 1.88 0.00 1.73 1.72 0.00


Other NHS - Community 3.50 2.72 0.78 3.20 2.37 0.83



End of Life 0.48 0.48 0.00 0.48 0.49 (0.01)

Community QIPP not transacted (4.67) 0.00 (4.67) (4.01) 0.01 (4.02)


Community - Other 0.00 0.00 0.00 0.00 0.00 0.00

Total Community Services 87.44 90.02 (2.57) 80.55 82.17 (1.61)


Nottinghamshire Healthcare - Mental Health 74.13 73.71 0.42 67.65 67.24 0.41

Other NHS - Mental Health 7.87 9.69 (1.81) 7.24 8.97 (1.74)


S117 Placements 15.33 16.22 (0.89) 14.05 13.14 0.91



Mental Health - Other 1.25 (2.10) 3.36 1.04 0.00 1.04




Prescribing 93.58 96.11 (2.53) 85.67 87.90 (2.23)



CCG Pathways 0.05 (0.11) 0.16 0.05 (0.11) 0.15

Primary Care General (0.05) (0.13) 0.09 (0.06) (0.14) 0.08

GP Forward View 6.38 6.38 0.00 5.85 5.85 (0.00)

Enhanced Services 4.96 4.31 0.64 4.43 3.87 0.57


GPIT 3.88 3.99 (0.11) 3.53 3.63 (0.10)

Out of Hours 6.49 6.88 (0.39) 5.95 6.31 (0.36)


Total Primary Care Services 218.35 214.68 3.67 199.24 196.04 3.21


Continuing Care & Free Nursing Care 72.78 70.71 2.07 66.66 64.53 2.12

CHC Assessment 2.52 2.51 0.01 2.31 2.30 0.01

Total Continuing Healthcare Costs 75.29 73.22 2.08 68.96 66.83 2.13

TOTAL PROGRAMME HEALTHCARE COSTS 998.82 1,011.15 (12.34) 913.57 923.74 (10.17)

GN NHS Clinical Commissioning Groups

Finance Report


Other Contracts


Patient Transport 5.05 4.86 0.19 4.66 4.40 0.26


Other NHS Services 0.00 0.00 0.00 0.00 0.00 0.00

Social Care 24.16 24.16 0.00 22.14 22.14 (0.00)

Total Other Contracts 32.30 32.20 0.10 29.64 29.46 0.18


Corporate - Estates 8.31 8.35 (0.05) 7.61 7.65 (0.03)

Corporate Costs - Chief Officer (3.28) 1.62 (4.89) (3.04) 1.30 (4.34)



Corporate Costs - ICS 2.19 2.19 (0.00) 0.22 0.22 0.00


Depreciation, provisions & technical adjustments (11.91) (11.25) (0.66) (11.91) (11.26) (0.65)

Total Corporate Non-Running Costs 0.90 4.99 (4.09) (1.97) 1.65 (3.62)

Programme Reserves


PCCC 0.00 0.00 0.00 0.00 0.00 0.00

QIPP (0.34) 0.00 (0.34) 0.00 0.00 0.00

Other 11.08 (1.34) 12.42 9.78 0.00 9.78

Total Programme Reserves 15.55 (1.34) 16.89 14.18 0.00 14.18


TOTAL NET OPERATING EXPENDITURE - PROGRAMME 1,047.57 1,047.01 0.56 955.42 954.85 0.57

20.53 0.00 20.53 18.82 0.00 18.82

TOTAL AVAILABLE RESOURCE - PROGRAMME 1,068.10 1,047.01 21.09 974.24 954.85 19.39

Running Costs

Running Costs 0.00 0.00 0.00 0.00 0.00 0.00

Running Costs - Chief Officer 3.21 2.92 0.30 3.02 2.70 0.32

Running Costs - Chief Finance Officer 3.51 3.33 0.18 3.24 3.13 0.11

Running Costs - Chief Commissioniong Officer 4.05 4.56 (0.51) 3.72 4.22 (0.50)

Running Costs - Chief Nurse 0.76 1.15 (0.39) 0.70 1.07 (0.37)



Running Costs - Estates 1.85 1.90 (0.05) 1.70 1.75 (0.05)

Running Costs - Other 0.00 0.00 0.00 0.00 0.00 0.00

TOTAL AVAILABLE RESOURCE - ADMIN 14.18 14.74 (0.56) 13.10 13.67 (0.57)

TOTAL 1,082.28 1,061.75 20.53 987.34 968.52 18.82

Finance Report


APPENDIX 2 – Balance Sheet – Nottingham & Nottinghamshire CCGs

STATEMENT OF FINANCIAL POSITION

As at 29th February 2020

Audited Closing Net

Open Bal at Balance Change

Apr-19 for period

£m £m £m

Non-current assets

Property, plant and equipment 0.04 0.02 (0.03)

Intangible assets 0.00 0.00 0.00

Investment Property 0.00 0.00 0.00

Trade & Other Receivables 0.00 0.00 0.00

Other Financial Assets 0.00 0.00 0.00

Total non-current assets 0.04 0.02 (0.03)

Current assets

Inventories 0.00 0.00 0.00

Trade and other receivables 22.69 63.61 40.92


Other Current Assets 0.00 0.00 0.00

Cash and cash equivalents (2.04) (3.09) (1.05)

Total Current Assets 20.65 60.52 39.87

Non Current Assets classified as "Held for Sale"

Total assets 20.70 60.54 39.84

Current Liabilities

Trade and other payables (100.22) (119.23) (19.00)

Other Financial Liabilities 0.00 0.00 0.00

Other Liabilities 0.00 0.00 0.00

Borrowings 0.00 0.00 0.00

Provisions (1.86) (1.84) 0.02

Total current liabilities (102.08) (121.06) (18.98)

Total assets less current liabilities (81.39) (60.52) 20.86

Non-current liabilities

Trade and other payables 0.00 0.00 0.00




Provisions 0.00 0.00 0.00

Total assets employed (81.39) (60.52) 20.86

Financed By Taxpayers' equity

General Fund (81.39) (60.52) 20.86

Revaluation reserve 0.00 0.00 0.00

Donation reserve 0.00 0.00 0.00

Charitable Reserve 0.00 0.00 0.00

Total taxpayer's equity (81.39) (60.52) 20.86

Finance Report


APPENDIX 2 – Balance Sheet – Mid Nottinghamshire CCGs



Audited Closing Net


Apr-19 for period

£m £m £m

Non-current assets

Property, plant and equipment 0.04 0.02 (0.03)





Total non-current assets 0.04 0.02 (0.03)

Current assets





Cash and cash equivalents 0.16 0.20 0.04



Total assets 9.16 15.12 5.96

Current Liabilities





Provisions (0.28) (0.28) 0.00











General Fund (24.18) (23.05) 1.12





Finance Report


APPENDIX 2 – Balance Sheet – Greater Nottinghamshire CCGs



Audited Closing Net


Apr-19 for period

£m £m £m

Non-current assets

Property, plant and equipment 0.00 0.00 0.00





Total non-current assets 0.00 0.00 0.00

Current assets





Cash and cash equivalents (2.19) (3.29) (1.09)



Total assets 11.53 45.42 33.89

Current Liabilities





Provisions (1.57) (1.55) 0.02











General Fund (57.21) (37.48) 19.74





Finance Report


Page 1 of 2


Paper Title: Highlight report from the (virtual)

meeting in Common of the predecessor

CCGs’ Audit and Governance

Committees 27 March 2020

Paper Reference: GB 20 083

Chair of the

meeting in

common

Sue Sunderland, Lay Member for Audit

and Governance

Attachments/

Appendices:

-

Summary

Purpose:

Approve ☐ Endorse ☐ Review


Assurance

Information

☒

Summary of the Meeting

Due to the current Coronavirus (COVID-19) situation, the Audit and Governance Committees’ meeting on

27 March 2020 was held virtually. At this meeting the Committees:

APPROVED the 2020/21 Internal Audit and Counter Fraud Plan. It was noted that under current circumstances the ability to deliver this Plan may be significantly affected by the impact of the COVID-19 pandemic. As such, the Committees asked that the Plan be kept under constant review to ensure it continued to be focused on the CCG’s principal risks and priorities.

APPROVED a proposal to allow the CCG to acquire procurement cards to purchase goods and

services from suppliers who would only provide these goods and services with immediate payment, in

order to respond to suppliers in a timely manner during the COVID-19 outbreak.

RECEIVED an update from the CCG’s Internal Auditors on the progress of the Internal Audit Plan. The

Committees noted there had been delays in finalising the remaining assignments with CCG officers

due to the need to prioritise the COVID-19 response. However assurance was given that all the draft

reports had clear audit opinions except for the workforce report, where it was deemed inappropriate to

provide an opinion at this time due to continued work and development in this area. It was anticipated

that all outstanding reports would be signed off before the end of the financial year.

RECEIVED the Draft Head of Internal Audit Opinion, which provided an opinion of ‘significant

assurance’ that there was a generally sound framework of governance, risk management and control

designed to meet the organisation’s objectives, and that controls were generally being applied

consistently.

RECEIVED an assurance report for the CCGs’ Counter Fraud Specialist, which noted actions put in

place to mitigate the rise in phishing emails following the COVID-19 outbreak.

Predecessor CCGs’ Audit and Governance Committees – Highlight Report 27 March 2020


Page 2 of 2

RECEIVED assurance that work to scrutinise and consolidate off payroll arrangements was

progressing.

NOTED that NHS England was currently changing the timetable for the submission of 2019/20

accounts due to the need to prioritise the response to the COVID-19 outbreak. Further work would be

undertaken to discuss the implications for the completion timetable of the annual reports for the six

CCGs.

Key Messages for the Governing Bodies

Approval of the Internal Audit Plan 2020/21, on proviso that the Plan was reviewed on a regular basis.

Approval for credit cards to be purchased in order to respond to suppliers in a timely manner during the COVID-19 outbreak.

The ratified minutes of the meeting in common will be received by the Governing Body on the 6 May

2020.

Predecessor CCGs’ Audit and Governance Committees – Highlight Report 27 March 2020


1


Paper Title: Corporate Risk Report Paper Reference: GB 20 084

Sponsor:

Presenter:

N/A Attachments/ Appendices:

-




Assurance

Information

☒

Executive Summary

The purpose of this paper is to present the Governing Body with the major (red) operational risks from the CCG’s joint Corporate Risk Register. This paper is a standing agenda item, presented to each meeting to ensure that the Governing Body kept informed of the key risks facing the CCG and assured that robust management actions are in place to manage and mitigate them.



☒


☒

Performance Management ☒ Procurement and/or Contract Management ☒

Strategic Planning ☒









Yes ☐ No ☐ N/A ☒ Not applicable to this report

Risk(s):

The paper details the current major (red) risks in the Corporate Risk Register.

Corporate Risk Report


2

Confidentiality:

☒No

Recommendation(s):

1. COMMENT on the major (red) risks shown within this paper and at Appendix A; and

2. HIGHLIGHT any risks identified during the course of the meeting for inclusion within the Corporate Risk Register



3


1. Introduction

The purpose of this paper is to present the Governing Body with the major (red) operational

risks from the CCG’s Corporate Risk Register in order to provide assurance that robust

management actions are being taken to mitigate them.

The paper also sets out how it is proposed that operational risks will be managed during the

Covid-19 emergency response period.

2. Major Operational Risks

The CCG currently has four major (red) operational risks in its Corporate Risk Register. The

tables below show the profile of the current risk scores, along with a summary of the risk

narratives and mitigating actions.

2.1 Major/Red Operational Risks:

Risk

Reference Risk Narrative

Current Risk

Score

RR 030

Following a period of ongoing change, staff may become disengaged

which could result in low morale and reduced productivity.

Mitigating action(s) include: Daily staff communications being

published as part of the CCG’s response to Covid-19. Staff health and

well-being is a core focus of the Business Continuity Cell.

Staff are being supported to work from home in the current environment.

Daily workforce 'situation reports' are collated to understand where staff

are working, whether they are self-isolating, etc. IT solutions are being

rolled out to ensure that staff remain 'connected' (e.g. .MS Teams, VPN

solutions).

Overall Score

16:

Red (I4 x L4)

Risk Matrix

Imp

act

5 - Very High

1

4 – High 2 1

3 – Medium

2 – Low

1- Very low

1 -

Rare

2 -

unlik

ely

3 -

Po

ssib

le

4 -

Lik

ely

5 -

Alm

ost

Cert

ain

Likelihood



4

Risk


Current Risk

Score

RR 032

Reducing workforce capacity within General Practice may impact the

sustainability of some GP Practices. In responding to these challenges,

Practices should consider adapting their workforce models to enable the

sustained delivery of core services, whilst also ensuring sufficient

capacity to deliver/contribute to system and transformation

requirements.

Lack of pace of change (e.g. adaption of workforce models) may

present a risk that the CCGs' population access needs are not met,

adversely impacting patient experience and/or outcomes.

Mitigating action(s) include: GP workforce capacity is being monitored

daily via the Primary Care Cell (which has been established as part of

the incident response structure). A daily Primary Care OPEL report has

been established to monitor primary care workforce and service

pressure. In addition, each Primary Care Network (PCN) has identified a

business continuity plan to respond to workforce pressures. Joint

working through local 'hub' arrangements are also taking place / being

developed as part of the Covid-19 response. This will build more

capacity and resilience to delivering core General Practice services.

Overall Score

16:

Red (I4 x L4)

RR 116

Lack of assurance regarding the culture and leadership at

Nottinghamshire Healthcare NHS Foundation Trust, as identified by

recent Care Quality Commission (CQC) reports, alongside non-

achievement of required performance targets, raises concerns regarding

the quality of services provided by the Trust.

This, in turn, may present a risk of poor patient experience, adverse

clinical outcomes and/or patient safety issues for members of the CCGs'

population.

Mitigating action(s) include: A full risk scoping paper was presented to

the January 2020 meetings in common of the predecessor CCGs’

Quality, Safeguarding and Performance Committees. This document

triangulated all the areas of concern raised with the Trust (e.g. by the

CCGs, CQC, Regulators, etc.), action(s) taken and any residual risk

areas (or 'next steps' required).

Monitoring and support continues in a proportionate way through the

Covid-19 emergency response period. The Lucy Wade Unit has re-

opened with support from CQC.

Overall Score

20:

Red (I4 x L5)



5

Risk


Current Risk

Score

RR 122

The Covid-19 pandemic may present significant quality, reputational and

financial risks to the CCG. This includes, but is not limited to, the

following:

Increased pressure primary care services, alongside potential

shortfall in primary care capacity (due to self-isolation/sickness),

may result in adverse patient outcomes/experience;

Increased activity within the Acute sector (urgent and emergency

care), due to higher levels of attendances/admissions, alongside

shortages in Critical Care capacity, may result in poor patient and

clinical outcomes;

Increased pressure on community services, which may hinder ability

to promptly discharge and care for patients/service users within the

community setting;

Delays in elective activity due to planned operations having to be

cancelled (to accommodate above), which may adversely impact

patient safety and experience;

Increased pressure in Home care, and Care home services,

alongside potential shortfall in capacity (due to self-

isolation/sickness), may result in adverse patient

outcomes/experience and/or failures to provide optimal care;

Disruption to supply of Personal Protective Equipment (PPE) across

primary and secondary care providers, including Care Homes and

Home Care providers, presents a significant risk to the Covid-19

response;

Reduced capacity within the CCGs to support the incident response

and deliver business critical functions (e.g. delivery of annual

accounts, agreement of contracts, delivery of statutory functions, for

example) or support system response (especially if multiple key

members of staff unwell);

Increase in home, and virtual, working increases the dependence on

IT capacity to deliver, increasing the risks associated with IT

failure/cyber risk during this time.

All of the above may present financial risks to the CCGs as a result of

additional costs being incurred or transformation/QIPP schemes not

being delivered.

Mitigating action(s) include: Establishment of CCG’s major incident

response infrastructure; including Incident Coordination Centre, a

number of key ‘cells’, daily Incident Management Team and Executive

Team meetings. This has included the redeployment of CCG staff from

non-essential functions.

Overall Score

20:

Red (I5 x L4)

2.2 Following discussions with the Chief Nurse, the likelihood score of risk RR 026 (patient

experience within NUH A&E) has been reduced, resulting in the overall risk score

being below the threshold for reporting to the Governing Body.



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2.3 Financial risk areas for 2020/21 are also being considered by the CCG’s finance team.

3. Risk Management during the Covid-19 Emergency Response Period

3.1 Risk management is identified as a ‘critical function’ within the CCG’s Business

Continuity Plan. As such, it is important that ‘business as usual’ risk management

processes continue, however, these should be paired down to ensure they do not

hinder incident response priorities/activities.

3.2 Given the significant nature of the CCG’s response to Covid-19, it is proposed that

risks are managed as set out below. It is important to note that this approach is ‘time

bound’ and will be reviewed on an ongoing basis to ensure that risk management

processes return to normal as soon as practicable.

a) The Head of Corporate Assurance will continue to manage the content of the

CCG’s Corporate Risk Register; minimising impact on the CCG’s senior leaders

as much as possible. The Head of Corporate Assurance is a member of the

Incident Management Team (daily meetings) and will utilise discussions at this

meet to reflect updates to risks where relevant/appropriate.

b) In line with the requirements outlined within the CCG’s Risk Management Policy

(section 12.6), amber and amber/red risks will only be updated quarterly and bi-

monthly respectively. Routine Corporate Risk Reports will not be provided to

Committee meetings during the incident response period, however, major (red)

risks will continue to be updated monthly and reported to the Governing Body.

c) The Head of Corporate Assurance will establish a Covid-19 Risk/Issues Log,

which reflects those potential risks, and issues currently being managed,

specifically relating to the Covid-19 incident response. The log will be populated

through identification of risks/issues from individual Cell Leads, as well as

through discussions as the Health Economy Tactical Coordination Group

(system level) and CCG’s daily Incident Management Team meetings. A single

major/red risk has been articulated for inclusion within the Corporate Risk

Register, as highlighted in Section 4 above (RR 122). This will be updated

monthly and reported to the Governing Body.

4. Next Steps for 2020/21

4.1 Key areas of focus for risk management during the first quarter of 2020/21 will include:

a) Full review of the Risk Management Policy to ensure it is ‘fit for purpose’ and

reflective of the requirements of the new CCG. The Policy will clearly distinguish

between the CCG’s strategic and operational risk management arrangements

and provide further guidance on local risk logs (e.g. team/directorate/project).

This will also include review of the CCG’s risk appetite statement and supporting

processes.

b) A full refresh of the Governing Body Assurance Framework (GBAF) in line with

the development and agreement of the new CCG’s strategic objectives and

associated strategic risks. There will be clear alignment between the strategic

risks and the CCG’s key statutory duties, which will strengthen assurance



7

reporting to the Governing Body and ensure the CCG’s risk management

arrangements align with year-end annual reporting requirements.

In the interim, Governing Body members are asked to agree that the closing

position of the GBAF (presented to the March 2020 meetings in common of the

predecessor CCGs’ Governing Bodies) is ‘approved’ as the opening position for

2020/21.

5. Recommendations


a) NOTE: the major risks shown at Section 2 and comment on whether sufficient

controls and actions are in place, or whether any additional risks required

adding.

b) ENDORSE: the risk management processes proposed during the Covid-19

emergency response period.

c) NOTE: the next steps identified for 2020/21, recognising these will be

progressed as appropriate during the Covid-19 incident response period.

d) APPROVE: the opening position of the 2020/21 Governing Body Assurance

Framework to be in line with the closing position for 2019/20, subject to further

review ahead of the June 2020 meeting.

Siân Gascoigne

Head of Corporate Assurance

April 2020



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NHS Mansfield and Ashfield CCG Audit and Governance CommitteeNHS Newark and Sherwood CCG Audit and Governance Committee

NHS Nottingham City CCG Audit and Governance CommitteeNHS Nottingham North and East CCG Audit and Governance Committee

NHS Nottingham West CCG Audit and Governance CommitteeNHS Rushcliffe CCG Audit and Governance Committee

Ratified minutes of the meetings held in common on16 January 2020 9.30-12.30

Rooms 3, Birch House, Ransom Wood Business Park, Mansfield, NG21 0HJ

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Members present:

Sue Sunderland Lay Member, Audit and Governance(Chair)

¸ ¸ ¸ ¸ ¸ ¸

Eleri de Gilbert Lay Member, Quality and Performance ¸ ¸ ¸ ¸ ¸ ¸

In attendance:Lucy Branson Associate Director of Governance ¸ ¸ ¸ ¸ ¸ ¸Lisa Cannon Interim Financial Projects and

Development Lead (item AG 20 008)¸ ¸ ¸ ¸ ¸ ¸

Sarah Carter Director of Transition (item AG 20 014) ¸ ¸ ¸ ¸ ¸ ¸Tiffany Hey Assistant Client Manager, 360

Assurance¸ ¸ ¸ ¸ ¸ ¸

Neil Moore Director of Procurement and Market Development (item AG 20 007)

¸ ¸ ¸ ¸ ¸ ¸

Andrew Morton Operational Director of Finance ¸ ¸ ¸ ¸ ¸ ¸Claire Page Client Manager, 360 Assurance ¸ ¸ ¸ ¸ ¸ ¸Richard Walton Senior Manager, KPMG ¸ ¸ ¸ ¸ ¸ ¸Sue Wass Corporate Governance Officer

(minutes)¸ ¸ ¸ ¸ ¸ ¸

Apologies:Jon Towler Lay Chair of Governing Body ¸ ¸ ¸ ¸ ¸ ¸

Ratified Minutes of Governing Body Committees


Page 2 of 10


Name Possible Actual Name Possible ActualDavid Heathcote2 3 3 Sue Sunderland 5 5Eleri de Gilbert 5 5 Jon Towler3 2 11 From commencement of new aligned governance arrangements2 Membership ceased 31 October 20193 Membership commenced 1 November 2019

ITEMIntroductory Items

AG 20 001 Welcome and Apologies for AbsenceSue Sunderland welcomed everyone to the meeting in common of the Audit and Governance Committees of NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham City CCG, NHS Nottingham North and East CCG, NHS Nottingham West CCG and NHS Rushcliffe CCG (hereafter referred to collectively as “the Committees” unless the item being discussed pertains to an individual CCG (or CCGs)).

Apologies for absence were noted as above.

AG 20 002 Confirmation of Quoracy The meetings were confirmed as quorate for all CCGs.

AG 20 003 Declaration of interest for any item on the shared agendaNo interests were declared in relation to any item on the shared agenda. Sue Sunderland reminded members of their responsibility to highlight any interests should they transpire as a result of discussions during the meeting.

AG 20 004 Management of any real or perceived conflicts of interestAs no conflicts of interest had been identified, this item was not necessary for the meetings.

AG 20 005 Shared minutes from the extraordinary meeting in common held on 29 November 2019It was agreed that the minutes were an accurate record of the meeting.

AG 20 006 Action log and matters arising from meeting in common held on 29 November 2019The following action was noted as an ongoing action: AG 19054: regarding a further report to be brought to the Committees on the Mental Health Investment Standard; it was noted this would be brought to the next meeting.

All other actions were noted as completed and agreed for closing. There were no further matters arising.

Merger Due Diligence

AG 20 007a Merger Due DiligenceLucy Branson and Neil Moore were in attendance to present this item. The following key points were highlighted:a) The report detailed the work completed to meet the due diligence requirements

of the merger in order to provide assurance to the Committees that action was being undertaken to ensure a smooth transfer to the new organisation on 1 April 2020. The report highlighted any areas of risk that had been identified following a detailed review of the CCGs’ staff, assets and liabilities.



Page 3 of 10

ITEMb) It was noted that elements of this paper were confidential.c) There was also a need to ensure organisational memory in this process. As the

organisations had been working together since July, the process was well established and the CCGs’ IT and technical infrastructure would be aligned to preserve the organisational memory.

d) The approach to the due diligence work was detailed and the outcome of the review was discussed. Any significant findings or areas where further work was required were highlighted:∑ Constitutional and Structural Information: No issues of non-compliance with

any of the CCGs’ governing documents had been found and all governing documents had been aligned or were being aligned as part of business as usual processes. This work would be completed by the end of March2020. It was noted that Section 75 agreements would transfer to the new CCG; however, they would require review, with legal support as necessary, to ensure appropriate agreements are in place for the new organisation. There was a need to ensure appropriate arrangements were in place for the new organisation in regard to the East Midlands Affiliated Commissioning Committee; however a review of the viability of thiscommittee was currently underway. Delegation agreements relating toexcess treatment costs would also transfer to the new CCG; however, they would require review and consolidation. The delegation agreement for primary care commissioning would not transfer and NHS England would issue a revised agreement prior to 1 April.

∑ Compliance, Litigation and Insurance: As at January 2020, the six CCGs were not in receipt of any claims nor aware of any pending claims or incidents or complaints that may become claims. All CCGs were members of NHS Resolution and were registered with the Information Commissioner’s Office. Aligned information governance systems were in place. Two risks were noted: Newark and Sherwood CCG was currently in the mediation phase of a challenge made by one of its former providers with regard to the notice period given on cessation of the contract. However provision had been made to cover any costs. Rushcliffe CCG was subject to legal challenge over the procurement of the Nottingham Treatment Centre. Costs were being built into the new financial year.

∑ Contracts and Commercial Agreements: Neil Moore noted that work to develop a contracts database for all healthcare contracts had been completed and a list of all healthcare contracts was provided at Appendix A to the paper. For all non-healthcare spend an exercise was nearing completion to review all payments during 2018/19 and 2019/20 to date to ascertain whether there were any ongoing financial liabilities. An update would be given at the next meeting. The CCGs were not currently aware of any issues with regard to existing contracts that will, or may, result in a negative impact on the new CCG. All bidders as part of ongoing procurement exercises were aware they would be bidding into a new organisation.

∑ Property and Business Assets: a review of all properties where the CCGs held an ‘interest’ had been undertaken and the outcome was provided at Appendix B to the paper. No freehold properties were held. NHS Rushcliffe CCG was noted as having leaseholder arrangements in place for two premises, as part of ‘historical’ arrangements. These arrangements were not at a financial cost to the CCG. Each landlord or service provider had been asked to highlight any environmental matters in relation to the listed properties and there were no issues to report. Regarding IT arrangements, a programme of work was currently ongoing to migrate the



Page 4 of 10

ITEMCCGs’ systems to Windows 10, which was due to complete by the end of the financial year. The annual data-mapping process was also due to be completed by the end of March 2020 and would be reported to the next meeting. There was a risk for Nottingham City CCG with regard to the intellectual property arrangements for the e-Healthscope system. Work to enter into a formal assignment was currently ongoing.

∑ Employees and Employee Benefits: A list of all employed staff had been compiled and provided at Appendix C to the report. There were a number of posts currently out to advert, these posts would commence on 1 April2020. Appropriate contracts were in place for all staff and all would transfer under their existing terms and conditions. There were two members of staff currently on external secondments that did not currently have substantive posts to return to within the CCG. This presented a potential risk of redundancy for these individuals. A recruitment process was currently ongoing to appoint to the five GP Governing Body roles for the new CCG from 1 April 2020. A further exercise was ongoing to determine the lay and independent member appointments for the new CCG. Both exercises would be concluded ahead of 29 February 2020. Nottingham City CCG had one ongoing employment tribunal claim that was listed to be heard in October 2020. There were no other outstanding issues.

∑ Clinical Governance: the review confirmed that the CCGs had not been involved in any inquests.

The following points were made in discussion:e) Richard Walton noted that the external auditors would need to have a clear

understanding of the ongoing positions of each CCG prior to their audit and would need to see the legal advice regarding the merger.

f) The contracting database and financial exercise were noted as good practice and a helpful baseline as the CCGs moved to a new organisation.

g) Members queried the potential risk around any challenge to the proposed future use of the e-Healthscope system, and it was noted as low.

h) Members queried the historical leasehold arrangements in Rushcliffe and whether there were any risks going forward. It was agreed that more information would be sought on the arrangements.

i) Richard Walton noted the potential impact of IFRS 16 on the treatment of leases in the CCGs’ accounts. Lisa Cannon noted that the Finance Team wasaware and had estimated the impact.

j) Members considered the review to have been robust and comprehensive and thanked staff for their hard work to ensure the CCGs were well prepared for transfer to the new organisation.

The Committees:∑ REVIEWED the output from the CCGs’ due diligence review and confirmed the

Committees’ satisfaction regarding the robustness of the process followed;∑ NOTED the liabilities and risks identified by the review; and∑ ENDORSED the areas identified as requiring further work.

ACTION: ∑ Lucy Branson to bring further information to the Committees on the

historical leasehold properties in Rushcliffe.

At this point, Neil Moore left the meeting.



Page 5 of 10

ITEMFinancial Management

AG 20 008 Finance Merger Workstream ReportLisa Cannon was in attendance to provide a verbal update in relation to this item. The following key points were highlighted:a) The report gave an overview of the management of the finance workstream

within the CCGs’ merger programme. A summary of progress to date wasprovided.

b) All elements of the workstream were on track and there were no concerns as to deliverability. However, as the bulk of the work was back-loaded, progress would be closely monitored.

c) There was one strategic risk identified, relating to the possible detrimental impact of failure to deliver against current financial targets. Other risks were not CCG-specific and related to the Shared Business Service (SBS) and the CCG/SBS Board had oversight of these risks.

The following points were made in discussion:d) Members received assurance that there was sufficient resource and capacity to

manage the workload.e) Members discussed the potential risk relating to the impact of any failure to

meet the financial targets. It was noted that a failure to meet the financial targets was not a risk to the merger process, however it would have a negative impact on next year’s resources.

f) Members were assured of the management and controls that were in place to deliver the workstream and thanked staff for their hard work.

The Committees:∑ NOTED the arrangements in place to deliver the Finance workstream of the

CCG Merger Programme.

AG 20 009 Off Payroll ArrangementsAndrew Morton was in attendance to present this item. The following key points were highlighted:a) During quarter three, nineteen off-payroll engagements had been in place, of

which eight remained current. b) The CCGs continued to comply with governance requirements and the

assessment of business need when agreeing these posts.

The following points were made in discussion:c) Members were assured that the CCGs continued to employ robust processes

for the employment of individuals on off-payroll arrangements.

The Committees:∑ CONSIDERED the off-payroll arrangements in place during quarter three,

October to December 2019.

Internal Audit

AG 20 010 Internal Audit Progress Report Claire Page was in attendance to present this item. The following key points were highlighted:a) The report provided an update on progress made regarding the provision by

Internal Audit of planned assurances for 2019/20.b) A review of the planned assurances for 2019/20 had been completed and a

refreshed plan was presented to the Committees as a separate agenda item for



Page 6 of 10

ITEMconsideration and approval.

c) Since the last meeting two audit reports had been issued, which were presented as separate items on the agenda.

d) It was anticipated that all other outstanding reports would be completed to enable them to be brought to the next meeting.

e) The number of actions implemented at the time of first follow up currently stood at 97%.

f) It was proposed that no further work would be carried out in relation to Integrated Care System (ICS)/Integrated Care Partnership (ICP) partnership working, but that the need for assurance in this area was considered as part of 2020/21 internal audit planning.

The Committees:∑ RECIEVED the progress report and noted the key messages and progress

being made with the delivery of planned assurances for 2019/20.∑ AGREED the proposal to undertake no further work at this point in relation to

ICS/ICP partnership working.

AG 20 011 2019/20 Internal Audit Plan RefreshClaire Page was in attendance to present this item. The following key points were highlighted:a) Following the request at the previous meeting and subsequent discussions with

Lucy Branson and Andrew Morton the plan had been changed to reflect discussions; and the proposals were detailed in the report.

b) The main changes were noted as no new or additional risk-based or consultancy reviews to be undertaken; the commissioning, contract management and engagement reviews no longer to be undertaken; and a reduction in days allocated to the change management review.

c) The proposed changes resulted in a reduction of 183 days; however with the commissioning of 75 days for the post payment verification (PPV) review, the net reduction amounted to 108 days.

d) This provided sufficient coverage for a balanced Head of Internal Audit Opinion at year end.

e) It was noted that no specific reviews had been undertaken on ‘quality’ but aspects had been considered as part of other reviews, such as the QIPP review.

The following points were made in discussion:f) Members were satisfied that a number of the planned reviews would now be

undertaken in the next financial year, given the pressures of the merger on CCG staff workload.

g) Eleri de Gilbert emphasised the need for next year’s plan to consider quality audits early in the year.

The Committees:∑ APPROVED the 2019/20 Internal Audit Plan refresh. ∑ CONFIRMED agreement for 75 days of PPV work to be commissioned by the

CCGs.

AG 20 012 Internal Audit Assignment Reports∑ Head of Internal Audit Opinion – Stage 2 Memo∑ Data Security and Protection ToolkitTiffany Hey and Claire Page were in attendance to present this item. The following key points were highlighted:



Page 7 of 10

ITEMa) In accordance with the Internal Auditor’s programme of work for the Head of

Internal Audit Opinion, Stage Two had been completed for 2019/20. As this was an interim report an audit opinion was not provided at this stage; however it was confirmed that the strategic risk management arrangements identified in Stage One had been put in place by the CCGs and continued to develop.

b) Regarding the interim Data Security and Protection Toolkit Review, it was noted that for this year there had been a two stage approach. The first review in December 2019 had examined governance arrangements. Although no opinion was given at this time, assurance had been received that sound arrangements were in place. A follow up in February 2020 would assess whether the CCGs were on track to meet the requirements of the Toolkit.

The following points were made in discussion:c) Lucy Branson noted that the two stage approach to the review had been

helpful.

The Committees:∑ RECEIVED and NOTED the Stage 2 Memo.∑ RECEIVED and NOTED the interim report and the timetable to compete further

work during 2019/20 on the Data Security and Protection Toolkit.

External Audit

AG 20 013 External Audit PlanRichard Walton was in attendance to present this item. The following key points were highlighted:a) The plans for each CCG set out the planned approach, any significant risks and

the nature and timing of the planned work by the external auditors. b) The main change noted from previous years was the requirement for the impact

of IFRS 16 to be understood for each CCG, to be quantified and then reported within the 2019/20 financial statements.

c) The six reports were broadly similar in approach and content; and the content of the audit plans was detailed.

d) The plans included detail on the IFRS 16 process, which was noted as a significant issue to finance teams and was reflected in audit costs.

The Committees:∑ APPROVED the content of the External Audit Plans for each CCG.

Corporate Assurance and Risk Management

AG 20 014 Targeted Risk and Assurance Reports∑ Special Projects∑ Transition, Human Resources and Operational DevelopmentLucy Branson noted that Gary Thompson had given apologies for the meeting and she would present his assurance report on Special Projects. Sarah Carter was in attendance to present the report on Transition, Human Resources and Operational Development. The following key points were highlighted:a) The purpose of the report was to present the Committees with a focussed

review of the strategic risks in relation to the Commissioning Directorate, as identified within the CCGs’ 2019/20 Joint Governing Body Assurance Framework. This was the third report and focused on the risks relating to the Transition, Human Resources and Operational Development and Special Projects Directorates.



Page 8 of 10

ITEMb) Sarah Carter gave an overview of the two strategic risks that related to

transition and operations and detailed actions to address the identified gaps in assurance for the two risks.

c) Regarding strategic risk two, relating to arrangements for engagement with the CCGs’ membership, a Member Practice Engagement Strategy was being developed by the CCGs’ Engagement Team in conjunction with the CCGs’ Primary Care and Locality Teams.

d) Regarding strategic risk thirteen, relating to the risk of the CCGs’ operating model and clinical leadership model not meeting the future requirement of the organisation, work to finalise the alignment of the six CCGs’ HR policies would be completed by the end of the financial year; the appointment to statutory roles was underway and would be completed by the end of the financial year; and the clinical leadership model had been agreed. A programme to develop the CCGs’ strategic commissioning capability was being developed.

e) Lucy Branson gave an overview of the one risk that sat under the responsibility of the Special Projects Directorate, which related to the risk that the CCGs may not meet their statutory Emergency Preparedness, Resilience and Response (EPRR) responsibilities.

f) There were two gaps in assurance for this strategic risk. Work was underway to test business continuity plans and the outcome would be reported to the Information Governance Steering Group. The second gap in assurance related to the need to participate in a partner-led system emergency response test; and this was noted as being completed during 2020.

The following points were made in discussion:g) Regarding strategic risk two, members queried whether there would be an

equivalent body to replace the Membership Forum. It was noted that the approach would be flexible to discover the most effective method of communication, but there would be a minimum requirement for the entire membership to meet once a year. This could be on an ICP footprint.

h) On this point members queried whether there were plans to review the effectiveness of membership engagement, and it was noted this would be built into the Engagement Strategy.

i) In relation to emergency preparedness, Sue Sunderland noted that she had had conversations with the Special Projects Team regarding any particular issues for emergency planning relating to the merger. No risks had been flagged but it had been agreed to review this again in April 2020.

The Committees:∑ SCRUTINISED and COMMENTED on the Joint Governing Body Assurance

Framework current position for the Transition Operations Directorate; ∑ SCRUTINISED and COMMENTED on the Joint Governing Body Assurance

Framework current position for the Special Projects Directorate; and∑ NOTED the work in place to remedy any identified gaps in controls and

assurances.

AG 20 015 2019/20 Annual Governance Statement (Month 9 Submission)Lucy Branson was in attendance to present this verbal update. The following key points were highlighted:a) The month nine submission had been signed by the Accountable Officer and

would be circulated to the Committees for noting.b) As at month nine all six CCGs were recognising the risk to their financial

positions, but had reported they still expected to meet their control totals.c) Three performance issues had been highlighted: All six CCGs had highlighted

Accident and Emergency waiting time standards; the 52 week referral to



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ITEMtreatment (RTT) standard had been highlighted for Mansfield and Ashfield, Newark and Sherwood and Nottingham North and East CCGs); and 62 day cancer treatment RTT had been highlighted for all six CCGs.

The Committees:∑ RECEIVED and NOTED the verbal update for information and assurance.

ACTION: ∑ Lucy Branson to circulate the CCGs’ month nine Annual Governance

Statement.

AG 20 016 2019/20 Annual Report and Accounts TimetableLucy Branson was in attendance to present this item. The following key points were highlighted:a) The Audit and Governance Committees were currently responsible for

approving the annual reports and accounts of their respective organisations; however, this would be superseded by the establishment of the new CCG on 1 April 2020 and the new Audit and Governance Committee would take over this responsibility.

b) Members were asked to note the high level timetable for the 2019/20 annual reporting process.

The following points were made in discussion:c) Members sought assurance that there was sufficient time between the 26 May

meeting and the submission of the final accounts on 28 May. It was noted that time had been set aside in the Accountable Officer’s diary for final scrutiny and signing and the Accountable Officer would be in attendance at the Audit and Governance Committee meeting.

The Committees:∑ NOTED the timetable for the 2019/20 Annual Reports and Accounts process.

AG 20 017 Committee Effectiveness ReviewLucy Branson was in attendance to present this item. The following key points were highlighted:a) A review of the CCGs’ governance arrangements was underway to inform the

development of the committee structure for the new CCG in April 2020. As part of this review, the CCGs’ committees were being requested to consider and feedback on the suitability of the current arrangements and the scope and remit of the Committees in line with the requirements of the new organisation.

b) The Audit and Governance Committees were slightly different to other committees, as their remit is more prescribed.

c) Due to the changes to the Committees during the year and the impending merger, it was proposed not to complete the recommended Audit Committee Effectiveness Self-Assessment for 2019/20, but to complete it early in the next financial year.

The following points were made in discussion:d) Claire Page noted that their own in-house Audit Committee Maturity Matrix

could also be used, which was supported by Sue Sunderland. It was noted that 360 Assurance was also developing a similar checklist for quality committees.

e) It was noted that the Committees’ new remit of oversight of InformationGovernance was a welcome addition and the targeted risk reports had given the Committees additional assurance of the CCGs’ management of risk.



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ITEMf) The robust and constructive challenge that the Committee members brought

was welcomed.

The Committees:∑ PROVIDED FEEDBACK on the current arrangements for the Audit and

Governance Committees in the context of the new CCG.

Closing Items

AG 20 018 Any other businessThere was no other business.

AG 20 019 Key messages to the Governing Bodies(a) Assurance on preparations for merger and recognition of the hard work that

has been undertaken to ensure the CCGs are well prepared(b) Approval of the refreshed Internal Audit Plan(c) Approval of the External Audit Plans(d) Assurance from the targeted risk reports

AG 20 020 Date of next meeting27/03/2020Chappell Room, Civic Centre, Arnot Hill Park, Arnold, NG5 6LU



Page 1 of 15

Meetings in common of theNHS Mansfield and Ashfield CCG Primary Care Commissioning CommitteeNHS Newark and Sherwood CCG Primary Care Commissioning Committee

NHS Nottingham City CCG Primary Care Commissioning CommitteeNHS Nottingham North and East CCG Primary Care Commissioning Committee

NHS Nottingham West CCG Primary Care Commissioning CommitteeNHS Rushcliffe CCG Primary Care Commissioning Committee

Public SessionRatified minutes of the meetings held in common on

19/02/2020, 09:00 – 10:50Boardroom, Standard Court, 1 Park Row, Nottingham, NG1 6GN

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Members present:

Eleri de Gilbert Lay Member, Quality and Performance (Chair)

¸ ¸ ¸ ¸ ¸ ¸

Shaun Beebe Lay Member, Financial Management ¸ ¸ ¸ ¸ ¸ ¸Lucy Dadge Chief Commissioning Officer ¸ ¸ ¸ ¸ ¸ ¸Ian Livsey Deputy Chief Finance Officer

(deputising for Mick Cawley and Andrew Morton)

¸ ¸ ¸ ¸ ¸ ¸

Dr Nigel Marshall

Independent GP Advisor ¸ ¸ ¸ ¸ ¸ ¸

Sue Sunderland Lay Member – Audit and Governance

¸ ¸ ¸ ¸ ¸ ¸

Dr Ian Trimble Independent GP Advisor ¸ ¸ ¸ ¸



Page 2 of 15

Rosa Waddingham

Interim Chief Nurse ¸ ¸ ¸ ¸ ¸ ¸

In attendance:David Ainsworth Locality Director ¸ ¸Fiona Daws Corporate Governance Officer

(minute taker)¸ ¸ ¸ ¸ ¸ ¸

Fiona Callaghan

Locality Director ¸ ¸ ¸

Dr Ian Campbell GP Representative ¸Lynette Daws Head of Primary Care ¸ ¸ ¸ ¸ ¸ ¸Esther Gaskill Head of Quality Intelligence ¸ ¸ ¸ ¸ ¸ ¸Joe Lunn Head of Primary Care, NHS

England/Improvement¸ ¸ ¸ ¸ ¸ ¸

Kate McCandlish

Deputy Locality Director (deputising for Michelle Tilling)

¸

Jacki Moss Senior Service Transformation Manager – South Nottinghamshire Locality (item PCC 20/023)

¸ ¸ ¸

Jo Simmonds Head of Corporate Governance ¸ ¸ ¸ ¸ ¸ ¸

Dr Arun Tangri GP Representative ¸

Kerrie Woods Primary Care Lead (GP Contracts), NHS England/Improvement

¸ ¸ ¸ ¸ ¸ ¸

Michael Wright Chief Executive, Local Medical Committee (LMC)

¸ ¸ ¸ ¸ ¸ ¸

Apologies:Michael Cawley Operational Director of Finance ¸ ¸Andrew Morton Operational Director of Finance ¸ ¸ ¸ ¸Sharon Pickett Associate Director of Primary Care

Commissioning¸ ¸ ¸ ¸ ¸ ¸

Amanda Sullivan

Accountable Officer ¸ ¸ ¸ ¸ ¸ ¸


Name Possible Actual Name Possible Actual

Eleri de Gilbert 9 8 Michael Cawley 9 8

Shaun Beebe 9 7 Lucy Dadge 9 9

David Heathcote2 6 6 Andrew Morton 9 5

Dr Nigel Marshall 9 8 Sharon Pickett 9 2

Dr Ian Trimble 9 7 Amanda Sullivan 9 1

Rosa Waddingham 9 6 Sue Sunderland3 4 41 From commencement of new aligned governance arrangements2 Membership ceased October 20193 Membership commenced November 2019



Page 3 of 15

ITEMIntroductory Items

PCC 20/015 Welcome and Apologies for Absence

Eleri de Gilbert welcomed everyone to the public meeting in common of the Primary Care Commissioning Committees of NHS Nottingham City CCG, NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG, NHS Nottingham West CCG, NHS Rushcliffe CCG and NHS Nottingham North and East CCG (hereafter referred to collectively as “the Committees” unless the item being discussed pertains to an individual CCG (or CCGs)).

Apologies were noted as above and it was confirmed that Ian Livsey was deputising for Michael Cawley and Andrew Morton.

The Chair welcomed the Locality Directors to the meeting.

PCC 20/016 Confirmation of Quoracy

It was confirmed that each Committee was quorate for the meeting.

PCC 20/017 Declaration of interest for any item on the shared agenda

Potential conflicts of interest had been highlighted in advance of the meeting:

∑ PCC 20/024 (Contract Management Update Report) – GP attendees at the meeting are practising General Practitioners in Nottingham and Nottinghamshire and may be conflicted in relation to this item.

∑ PCC 20/032 (Park House Medical Centre and The Jubilee Practice Merger)

Dr Campbell is the Senior Partner at Park House Medical Centre.

David Ainsworth highlighted that his interests needs to be updated, which will be highlighted to the Governance Team.

PCC 20/018 Management of any real or perceived conflicts of interest

The following management actions were agreed:

∑ PCC 20/024 – as the Contract Management Report is provided for information only and no decision is required, the GP representatives should stay in the meeting and participate in the discussion.

∑ PCC 20/032 – Dr Campbell will remain in the meeting (as in public session) however, will not participate in the discussion.

PCC 20/019 Questions from the Public

There were no questions from the public.



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ITEMPCC 20/020 Shared Minutes from previous meetings in common held on 15 January 2020

It was agreed that the minutes were an accurate record of the meeting.

PCC 20/021 Action log and matters arising from the meetings in common held on 15 January 2020

Members discussed the actions that were in progress and highlighted the following key points:

∑ PCC 19/048 - to develop a set of objective criteria for the Committees to use when considering patient list closure applications.

The objective criteria has been developed and work to test this is underway and will be presented to the March 2020 meeting for approval.

PCC 19/075 Eleri de Gilbert to meet with Lucy Dadge, Helen Griffiths and Lucy Branson to seek clarity on the governance and oversight arrangements for PCNs and the way that the PCCCs interface with the PCNs.

A meeting took place in January 2020 which provided clarity on future oversight arrangements for PCN delivery which will be incorporated within the PCCCs Terms of Reference and reflected in the annual work programme 2020/21. Further meetings will take place in February and March to finalise arrangements. It was agreed that this action can be closed as issues have been addressed with a balanced approach.

∑ PCC 19/115 To bring an outline plan, with proposed timescales (supported by the affected practices) to the January 2020 meeting to demonstrate that work was in progress to alleviate pressure on neighbouring practices caused by recent practice closures.

Kate McCandlish provided a brief update on progress of the plan and confirmed that this would be presented at the next meeting.

PCC 20/022 Actions arising from the Governing Bodies

At the Governing Bodies’ meeting on 4 December 2019, Lucy Dadge was asked to consider the timing of a discussion paper on how to better manage demand in primary care. Jacki Moss is in attendance to present a paper on General Practice Demand Management to the Committees (agenda item PCC 20/023).

Items for Discussion/Assurance

PCC 20/023 Demand Management in General Practice

Jacki Moss was in attendance to present this item and highlighted the following key points:

(a) The paper is in response to the Governing Bodies request that the Committees’ review how demand is managed within general practice.

(b) Contracts are underpinned by Regulatory Legislation with GP practices who agree



Page 5 of 15

ITEMto provide primary medical services to patients in that area. These are unique to each practice but do not determine appointment flow or demand management.

(c) Practices determine their own approach to managing demand, taking into account external and internal factors. A range of examples were given regarding how demand is managed; these range from telephone triage to closing patient lists in extreme circumstances.

(d) The GP forward view offers initiatives to support demand management; such as the GP resilience programme, active signposting, productive work flows and team development and alternatives to seeing a GP, such as utilising social prescribing. These mechanisms have been formalised within the new GP contract.

(e) New types of patient consultations, for example, digital solutions including an NHS App, phone and email options, also help to reduce clinical time and improve continuity.

The following points were made in discussion:(f) Members were keen to know the background context and numbers around ‘Did

Not Attend’ (DNA) appointments, given that the number of available appointments has increased. It was explained that there are measures in place to reduce this as far as possible, for example, text appointment reminders. However, there are varying reasons why patients do not arrive for their appointment and it is not unique to general practice. It was recognised however that numbers were still too high and had an impact on availability of appointments.

(g) Members considered whether more could be done with Patient Participation Groups to educate and inform patients, not only around DNAs but around other demand management issues including self-care and accessing local pharmacies. It was suggested that work could be done with the CCGs Communications and Engagement team to explore this further.

(h) Members discussed an ‘Operational Pressures Escalation Levels’ (OPEL) type warning system for Primary Care, however, measures would need to be in place to deal with any alert.

(i) Members noted that more could be done to share best practice to pragmatically improve both short and long term issues. Good relationships exist between practices, federations and the CCGs with support provided by the CCGs regarding individual issues.

(j) Regarding 111 referrals, the new pharmacy contract allows direct referrals. A provider meeting will provide the opportunity to discuss further improvements in this area. It was noted that urgent care and 111 assessment services aim to redirect activity away from urgent to primary care via a direct booking system, however, care must be taken to not overload primary care.

(k) The appointment data set is being reviewed as part of the national access review process.

(l) Members acknowledged the achievements of general practice and suggested that these be more widely recognised and shared via case studies and patient stories.

(m) Consideration was given to exploring the system leadership exampled by Burton on Trent CCG.

(n) Demand is still increasing in the system and across Primary Care Networks (PCNs). The work around the access improvement programme will be taken



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ITEMforward by the primary care team, in conjunction with PCNs, although more information is required regarding the access review. Whilst practices cannot be compelled to collaborate to look at ways to better manage demand and contact, it was anticipated that localities/PCNs would be addressing this as part of how they better manage supply and demand. The benefits of working at scale was recognised. It was agreed that a further discussion on progress will take place at the April meeting.

The Committees:∑ NOTED the information within the paper.

Action:A paper regarding the progress to date on the access improvement programme, including addressing some of the issues raised by members will be presented to the Committee at its meeting in April 2020 by Lucy Dadge.

Jacki Moss left the meeting at this point.

PCC 20/024 Contract Management Update Report

GP representatives at the meeting are practising General Practitioners in Nottingham and Nottinghamshire and are conflicted in relation to this item. As no decision is required it was agreed that they could participate in the discussion.

Kerrie Woods was in attendance to present this item. The following key points were highlighted:

(a) The Contract Management Update provides a quarterly overview of agreed contractual changes undertaken by practices in Nottingham and Nottinghamshire area.

(b) There were five patient list closures in the quarter up to 31 December 2019.(c) Four practice mergers were outlined, in addition to one potential merger which did

not take place as contract notice was served and the merger no longer proposed. (d) A summary was provided of those Personal Medical Services (PMS) practices that

are due to return to General Medical Services (GMS) contracts. (e) Partnership contract variations included twelve partners either resigning or retiring

in some form.

The following points were made in discussion:(f) There have been a number of practices returning to the GMS contract. A review of

PMS contracts took place and included the reduction of premiums over a seven-year period, which ends in 2020/21, hence the incentive to change.

(g) Members enquired as to whether the partners that have left the contracts are due to a timeline issue and what are the barriers into entering a partnership. It was explained that the national trend is a steady decline in GP partners. There is a programme of work to encourage partnership take up and funding is available through the PCN for associated education of what partnership entails. The Local



Page 7 of 15

ITEMMedical Committee (LMC) are also hosting informative events. Premises issues via NHS Property Services are contributing towards a lack of uptake. Given the net loss of GP partners this quarter and continuing partnership recruitment difficulties it was agreed further work should take place to understand the barriers further and explore what if any local action was needed.

(h) Members suggested exploring alternative models in General Practices, for example, the Advanced Practice Nurse (APN) led practice in London, which has been extremely successful.

(i) It was agreed that premises issues were having an impact on recruitment and retention and it would be helpful to understand the wider workforce and estate pressures.

The Committees:∑ RECEIVED and NOTED the update for information and assurance.

Actions:It was agreed that a joint piece of work detailing the local recruitment of GP Partners and issues around the GP estate be brought to the Committees for discussion at a future meeting.

PCC 20/025 Primary Care Quality Update Report

Esther Gaskill was in attendance to present this agenda item. The following key points were highlighted:

(a) The report is a quarterly update which includes the primary care quality dashboard, an update from primary care quality groups / quality team, a summary of Care Quality Commission (CQC) ratings and actions, and an overview of any practices currently receiving enhanced support.

(b) The Quality team continue to work with Mid-Nottinghamshire practices on their Dashboard submission and have visited approximately 30 of the 40 practices, receiving positive responses, which will be included within the next report submission to the Committees.

(c) Six practices across Nottingham and Nottinghamshire did not achieve 85% or less within the 2018/19 Quality Outcomes Framework indicators overall. The overall results have been shared with practices and PCNs with the CQC speaking to those practices that have exceptions above 6-7%.

(d) Of the CQC inspections as at 1 February 2020, two practices are deemed inadequate across the total of 130:∑ Queen’s Bower Surgery – support to this practice is being arranged.∑ Hounsfield Surgery - a focused inspection took place in January 2020 as a

result of an inspection notice. The practice are working hard to make improvement.

(e) RHR Medical Centre, which “requires improvement”, have met the requirements of the warning notices and will therefore revert to the regular programme of inspections.

(f) St Peter’s Surgery are taking steps to ensure that they are providing a safe and



Page 8 of 15

ITEMeffective service with work taking place behind the scenes.

The following points were made in discussion:(g) Members were assured that Queens Bower Surgery and Hounsfield Surgery, were

being supported to implement actions to improve their “inadequate” ratings. (h) Members raised concerns that intelligence regarding struggling practices needs to

be identified so that they can be supported and potential issues prevented. It was suggested that an illustration of lessons learned via a case study could illustrate the process to the Committees and provide assurance.

(i) The provision of a combined contract and quality issues log will be introduced at the next meeting to ensure that the Committees are able to keep track and receive timely updates on ongoing issues.

(j)The Committees:∑ NOTED the Primary Care Quality Exception Report as at February 2020

Actions:

∑ The Committees will routinely receive a log of ongoing contractual and quality issues from the next meeting.

PCC 20/026 Primary Care Quality Group’s Terms of Reference and Quality Reporting

Esther Gaskill presented this item. The following key points were highlighted:

(a) The draft terms of reference for the Primary Care Quality Groups were presented for endorsement.

(b) The Groups are established, with one for each locality/place. Membership will includes a GP representative from the yet to be formed Clinical Design Authority.

(c) Quality monitoring arrangements have been incorporated within the Quality Assurance Framework, already embedded across Nottingham and Nottinghamshire CCGs.

(d) The quarterly assurance report includes updates relating to the dashboard, CQC, enhanced support to practices and particular complaints or safety incidents.

The following points were made in discussion:(e) Members were interest to know how ‘lessons learnt’ had helped to inform the

CCGs’ systems and processes and requested a retrospective report to demonstrate how this had been performed.

The Committees:∑ ENDORSED the Primary Care quality reporting arrangements and Primary Care

Quality Groups’ Terms of Reference∑ FEDBACK on any further actions required or recommendations made in relation to

the Terms of Reference

Action:A report to be produced detailing how ‘lessons learnt’ have informed the CCGs' quality



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ITEMmonitoring systems and processes.

PCC 20/027 General Practice Forward View (GPFV) Update

Lynette Daws presented this item. The following key points were highlighted:

(a) The report summarises the progress of the Integrated Care System (ICS) work programmes funded by the General Practice Forward View (GPFV).

(b) Allocation of funding within the 2019 guidance is on an (ICS) basis along with the delivery of programme areas.

(c) Practice resilience is being provided in the form of roving practice manager support, managed by the LMC. To date, eleven practices have accessed support. An evaluation of this initiative is currently underway.

(d) Practice manager training is focusing on deputies stepping up into the role. Feedback received so far is positive and evaluation is in progress.

(e) A best practice event in the Spring is planned as part of the practice resilience group consultation process.

(f) Care navigation and active signposting training has been delivered to 122 reception and clerical practice staff, the evaluation of which is positive. Additional events are planned for March 2020.

(g) Online consultation forms part of the wider strategic public facing digital services and access is a key requirement within the new GP contract. A single point of access and technical availability is on track for 31 March 2020.

The following points were made in discussion:(h) Members were encouraged by the amount of Practice Manager training available.

It was highlighted that this training is also available to practice partners and serves as both a refresher and induction.

(i) Members enquired as to the next steps required before March 2020 prior to Online Consultation being available. It was explained that GP leads will be working with the practices and the first pilots go live in Mansfield next week with “fast followers” rolled out shortly afterwards.

(j) Future reporting of the GPFV and development fund money is being discussed next week and an update will be provided to the Committees at a future meeting, as necessary.

The Committees:∑ RECEIVED and NOTED the paper for information and assurance and considered

the content of future updates.

PCC 20/028 Local Enhanced Services (LES) Update

Lynette Daws presented this item. The following key points were highlighted:

(a) The paper outlines and provides assurance on the engagement and communications that have taken place whilst undertaking the LES review and since approving the new service specifications for sharing with GP practices.

(b) A summary of the formal communications and meetings was provided, noting that significant engagement and communication has taken place in other meetings, in



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ITEMresponse to queries and concerns raised by practices.

The Committees:∑ NOTED the communication and engagement that has taken place in relation to the

primary care Enhanced Services review.

PCC 20/029 Network Contract Direct Enhanced Services (DES) Update

Lucy Dadge presented this item. The following key points were highlighted:

(a) The paper outlines the summary feedback from NHS England/Improvement further to the Network DES consultation on the draft Primary Care Network service specifications which closed on 15 January 2020.

(b) Feedback received is informing negotiations on the final GP contract package. (c) Service-specific messages for clarification were received in relation to:

∑ Structured mediation reviews∑ Enhanced health in care homes∑ Anticipatory care∑ Personalised care∑ Early cancer diagnosis

(d) NHS England/Improvement have reflected on the response and provided additional feedback.

(e) Three specifications are due to be implemented during 2020/21, the other specifications have been delayed by one year.

The following points were made in discussion:(f) Members noted that the new GP contracts continues to be discussed locally and

would be considered further at a conference hosted during March 2020.

The Committees:∑ NOTED the national feedback to the PCN draft specification consultation.

Contract Management Update and Applications

PCC 20/030 Barnby Gate: List Closure Update

Kerrie Woods presented this item to NHS Newark and Sherwood CCG’s Primary Care Commissioning Committee. The following key points were highlighted:

(a) Following the agreed list closure which has now been in place for a period of seven months, the paper provides a summary of the progress the practice has made in relation to recruitment and workload pressures.

(b) During this time, the practice has seen a reduction in list growth and have benefitted from the breathing space this arrangement has allowed.

(c) The practice has successfully recruited to various posts and stabilised its workforce.

(d) The list is due to re-open in April 2020.



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ITEMThe following points were made in discussion:(e) Members recognised the positive progress made and were assured that the

activities undertaken were sufficient for the practice to re-open its list on 1 April 2020 after a total of a nine month closure. The Chair highlighted that whilst the Committees were always reluctant to close lists and only did so as a last resort, it was encouraging in this instance to see how a practice had maximized the opportunity of a 9 month breathing space and been able to put in place a sustainable solution.

NHS Newark and Sherwood CCG’s Primary Care Commissioning Committee:∑ NOTED that the practice list will re-open in April 2020 following progress made

during the period of the list closure.

PCC 20/031 Giltbrook Surgery: List Closure Extension Request

Kerrie Woods presented this item to NHS Nottingham West CCG’s Primary Care Commissioning Committee. The following key points were highlighted:

(a) Following the agreed list closure on 18 September 2019 for a period of six months,a further request has been received to continue the list closure for a further six months, extending it to 20 September 2020.

(b) Caveats to the approval of a further six month extension are proposed as the practice undertaking a patient list cleansing exercise; submitting an application to reduce its boundary and undertaking proactive engagement with the PCN.

(c) Patient registry has stemmed, however, a reduction has not been seen. (d) Premises and its development is a long term issue. The practice has commenced

some initial work, including elements of list cleansing but further work is required to continue to reduce the patient list.

The following points were made in discussion:(e) Additional capacity arrangements, including the Portacabin costs, were discussed.(f) Members suggested a definitive action plan was required for the practice should

the extension be agreed and that learning from other practices in a similar situation be shared. This was felt important as the practice had not maximised the opportunity afforded to it of a list closure

(g) There was little evidence of engagement with the PCN to address ongoing sustainability concerns

(h) An explanation was provided regarding a potential premises solution however, this is not in line with the list closure timelines.

NHS Nottingham West CCG’s Primary Care Commissioning Committee:∑ NOTED the information contained within the paper and;∑ APPROVED the request for an extension for a period of six months with the

following caveats:

ÿ Practice carries out a robust cleansing of the patient list;

ÿ Practice submits an application to reduce the practice boundary;

ÿ Practice undertakes more proactive engagement with the PCN to explore



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ITEMavailable space and medium term solutions.

ÿ A definitive and robust action plan is developed and worked to.

PCC 20/032 Park House Medical Centre and Jubilee Practice merger: patient engagement outcomeDr Ian Campbell is conflicted in relation to this item as he is the Senior GP Partner at Park House Medical Centre. It was agreed that he should not participate in the discussion.

Kerrie Woods presented this item to NHS Nottingham North and East CCG’s Primary Care Commissioning Committee. The following key points were highlighted:

(a) The Jubilee Practice and Park House Medical Centre submitted a joint application in December 2019 to undertake a contractual merger and this was approved by the Primary Care Commissioning Committee on 18 December 2019 subject to patient engagement.

(b) Patient engagement has been undertaken, the outcome of which is detailed within the paper.

The following points were raised in discussion:(c) Having reviewed the feedback, the Committee agreed that there had been a good

response from the stakeholder engagement activities and were satisfied that concerns raised during that exercise had been responded to.

NHS Nottingham North and East CCG’s Primary Care Commissioning Committee:∑ APPROVED the full contractual merger of The Jubilee Practice and Park House

Medical Centre following the completion of their patient and stakeholder engagement.

PCC 20/033 Welbeck Surgery – List closure extension

Kerrie Woods presented this item to NHS Nottingham City Clinical Commissioning Group’s Primary Care Commissioning Committee. The following key points were highlighted:

(a) Further to the approval for the surgery to close their patient list in October 2019 for a period of three months; a submission to extend their list closure for a further three-month period has been received which would mean the list closure would come to an end on 1 June 2020.

(b) A successful recruitment campaign has been completed and the list closure will be lifted ahead of new staff coming into post, following an induction period.

(c) The practice is aware that the list closure extension request falls outside the required notice period of a minimum eight weeks.

The following points were raised in discussion:(d) Members highlighted that other factors should be considered such as the impact of

a further extension on neighboring practices. It was explained that consultation



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ITEMwith neighbouring practices has worked well and that contractual discussion with the practice’s business partners have been supportive. The suggestion of a locality plan developed in conjunction with contracting colleagues and including case studies and lessons learned is to be presented to the Committee in March 2020 to provide further information and assurance.

(e) Members felt the application was difficult to decline based on a technicality regarding the request timescale not being met, particularly as the practice have made good progress and that the extension request has been positively pitched for the list to re-open following further work, in three months’ time.

(f) It was acknowledged that the practice has worked hard over the past three months to resolve issues and have recruited to fill vacancies.

The NHS Nottingham City Clinical Commissioning Group’s Primary Care Commissioning Committee:∑ APPROVED the list closure of Welbeck Surgery for a further three months (total six

months).

Financial Management

PCC 20/034 Finance Report

Ian Livsey presented this item and highlighted the following key points:

(a) The consolidated position of the delegated primary care budget for the six Nottingham and Nottinghamshire CCGs year to date is showing a forecasteddelivery of planned surplus, of £5.26 million with a number of drivers to the underspend which includes residual primary care contingency reserves.

(b) The forecast consolidated position at £5.71 million is a favourable variance. This forecast underspend is a key component in the overall financial position.

(c) The overall CCGs’ financial position is challenging with an adverse year to date position of £3.5 million overspend, with significant risks remaining to deliver the full year planned surplus.

(d) Primary care month ten position has almost remained static. (e) Slippage on Primary Care Network (PCN) staffing monies has been discussed with

locality directors.(f) The premises underspend is largely around small business rate reviews taking

place nationally, from which the CCGs have benefited. These were noted as non-recurrent.

(g) The CCGs are receiving scrutiny regarding PCN Directed Enhanced Services slippage, although this is addressed within 2020/21 financial plans.

The following points were made in discussion:(h) Members enquired as to the impact of the new GP contact. It was explained that

detailed work on budget lines is still required and an initial uplift in the GMS contact, anticipated growth and ICS assumptions provides a potential 6% uplift on the CCGs’ allocation. Members requested a further update at the next Committees’



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ITEMmeeting, however it was explained that information will not be known until early inthe new financial year therefore an update could be provided then.

(i) Budget allocation will be for the one CCG next year and some modelling will be taking place.

The Committees:

∑ NOTED the financial position of the Delegated Primary Care Budget for month ten.

Risk Management

PCC 20/035 Risk Report

Jo Simmonds was in attendance to present this item. The following key points were highlighted and discussed:

(a) There are five risks within the Committee’s remit; including one red (major) risk relating to workforce capacity (RR 032).

(b) The risk narrative for RR 032 has been revised following discussions at the last meeting of the Committees and is presented for approval.

(c) The Committees’ attention was drawn to the risks contained with the Appendix and associated actions.

The following points were raised in discussion:(d) Members queried whether a risk has been captured regarding primary care estate

debt which was confirmed as being referred to on the register as non-reimbursable costs to practices – RR 023.

The Committees:

∑ COMMENTED on the risks shown within this paper (including the high/red risk) and those at Appendix A.

∑ AGREED to the proposed change of narrative for risk RR 032.

Information Items

PCC 20/036 Forward Work Programme

This item was presented for information only.

Closing Items

PCC 20/037 Any other businessNo other business was raised.

PCC 20/038 Key messages to escalate to the Governing Bodies



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ITEM∑ Practice workforce and workload concerns continue with practice list closures and

GP retirements and resignations. Workforce plans and risks continue to be monitored.

∑ Demand in general practice remains a key area of focus for the Committees due to the continuing impact on workload, capacity and workforce retention. - The Committees have started to consider the issue of demand in general

∑ Barnby Gate Practice in Newark will reopen its list to new patients on 1 April 2020 after a nine month list closure. The practice has evidenced various benefits from this breathing space, in particular successful recruitment, workforce stabilization and list reduction.

PCC 20/039 Date of next meeting18/03/2020 - Rooms 2-3, Birch House, Ransom Wood Business Mark, Mansfield, NG21 0HJ

Confidential Motion

The Primary Care Commissioning Committees will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

