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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
Jon Towler GB/20/074
7. Consolidated action log from the predecessor CCGs’ Governing Body meetings
Jon Towler GB/20/075
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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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
Fin
an
cia
l In
tere
st
No
n-f
ina
nc
ial
Pro
fes
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
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
-
Present This interest will be kept under review and specific
actions determined as required.
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
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
Action taken to mitigate risk
BRANSON, Lucy St George’s Medical Practice Registered Patient 01/11/2005 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.
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
actions determined as required.
CHALLENGER, Alison Nottingham City Council Employed as Director of Public Health 01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
CHALLENGER, Alison Nottingham University Hospitals NHS Trust Relative is Speciality General Manager of Emergency
Department
03/09/2018 Present This interest will be kept under review and specific
actions determined as required.
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
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.
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
actions determined as required.
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
actions determined as required.
DADGE, Lucy Pelham Homes Ltd – Housing provider
subsidiary of Nottinghamshire Community
Housing Association
Director 01/01/2008 Present This interest will be kept under review and specific
actions determined as required.
DADGE, Lucy 3Sixty Care Ltd – GP Federation,
Northamptonshire
Chair 01/01/2017 Present This interest will be kept under review and specific
actions determined as required.
DADGE, Lucy First for Wellbeing Community Interest
Company (Health and Wellbeing
Company)
Director 01/12/2016 Present This interest will be kept under review and specific
actions determined as required.
DADGE, Lucy Valley Road Surgery Registered Patient 19/06/1905 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.
DADGE, Lucy Nottingham Schools Trust Chair and Trustee 01/11/2017 Present This interest will be kept under review and specific
actions determined as required.
DE GILBERT, Eleri Middleton Lodge Surgery Husband registered patient
-Present This interest will be kept under review and specific
actions determined as required.
DE GILBERT, Eleri Middleton Lodge Surgery Registered Patient -
Present This interest will be kept under review and specific
actions determined as required.
DE GILBERT, Eleri Middleton Lodge Surgery Son registered patient
-18/10/2019 This interest will be kept under review and specific
actions determined as required.
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
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
Action taken to mitigate risk
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
actions determined as required.
DE GILBERT, Eleri Nottingham Bench Justice of the Peace
-Present This interest will be kept under review and specific
actions determined as required.
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
actions determined as required.
DE GILBERT, Eleri Major Oak Medical Practice, Edwinstowe Son, daughter in law and grandchild registered patient
-
Present This interest will be kept under review and specific
actions determined as required.
GRIBBIN, Jonathan Cornerstone Church Nottingham Director 01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
GRIBBIN, Jonathan Nottinghamshire County Council employed as Director of Public Health 01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
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
actions determined as required.
HOPKINSON, Dr James Calverton Practice GP Partner 01/04/2013 Present To be excluded from all commissioning decisions
(including procurement activities and contract
management arrangement) relating to services that are
currently, or could be, provided by GP Practices.
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
actions determined as required.
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
actions determined as required.
HOPKINSON, Dr James NEMS Healthcare Ltd Shareholder 01/04/2013 Present To be excluded from all commissioning decisions
(including procurement activities and contract
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
-
Present This interest will be kept under review and specific
actions determined as required.
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
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
Action taken to mitigate risk
LOVELOCK, Dr Hilary Brierley Park Medical Centre GP Partner
-
Present To be excluded from all commissioning decisions
(including procurement activities and contract
management arrangement) relating to services that are
currently, or could be, provided by GP Practices.
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
25/04/2016 Present This interest will be kept under review and specific
actions determined as required.
OKUBADEJO, Dr Adedeji Spire Independent private clinical anaesthetic practice undertaken in
private hospitals in the Birmingham area
17/12/2015 Present This interest will be kept under review and specific
actions determined as required.
OKUBADEJO, Dr Adedeji BMI Independent private clinical anaesthetic practice undertaken in
private hospitals in the Birmingham area
17/12/2015 Present This interest will be kept under review and specific
actions determined as required.
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
17/12/2015 Present This interest will be kept under review and specific
actions determined as required.
OKUBADEJO, Dr Adedeji Carwis Consulting Ltd – Healthcare
Management Consulting
Director 01/04/2018 Present This interest will be kept under review and specific
actions determined as required.
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
actions determined as required.
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
(including procurement activities and contract
management arrangement) relating to services that are
currently, or could be, provided by GP Practices.
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
(including procurement activities and contract
management arrangements) in relation to services
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
actions determined as required.
SHORTT, Dr Stephen Keyworth Medical Practice Spouse is GP partner 01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
SHORTT, Dr Stephen KMP Pharmacy Wife is Director 01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
SHORTT, Dr Stephen HS Primary Care Research Network Practice receives funding to host research studies and recruit
patients
01/04/2013 Present This interest will be kept under review and specific
actions determined as required.
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
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
Action taken to mitigate risk
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
(including procurement activities and contract
management arrangements) in relation to services
currently provided by Partners Health LLP; and Services
where it is believed that Partners Health LLP could be an
interested bidder.
SHORTT, Dr Stephen Principia Multi-specialty Community
Provider
Member 01/10/2015 Present To be excluded from all commissioning decisions
(including procurement activities and contract
management arrangements) in relation to services
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
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.
STRATTON, Dr Richard Belvoir Health Group GP Partner 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.
STRATTON, Dr Richard PartnersHealth LLP GP member To be excluded from all commissioning decisions
(including procurement activities and contract
management arrangements) in relation to services
currently provided by Partners Health LLP; and Services
where it is believed that Partners Health LLP could be an
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
actions determined as required.
SUNDERLAND, Sue NHS Bassetlaw CCG Governing Body Lay Member 16/12/2015 Present This interest will be kept under review and specific
actions determined as required.
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
actions determined as required.
THOMPSON, Gary Radcliffe on Trent Health Centre Registered Patient 01/01/2018 Present This interest will be kept under review and specific
actions determined as required.
THOMPSON, Gary Radcliffe on Trent Health Centre Spouse is a patient 01/01/2018 Present This interest will be kept under review and specific
actions determined as required.
TOWLER, Jon Sherwood Medical Practice. Registered Patient -
Present This interest will be kept under review and specific
actions determined as required.
TOWLER, Jon Major Oak Medical Practice, Edwinstowe Family members are registered patient
-Present This interest will be kept under review and specific
actions determined as required.
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
sio
na
l In
tere
sts
No
n-f
ina
nc
ial P
ers
on
al
Inte
res
ts
Ind
ire
ct
Inte
res
t
Da
te F
rom
:
Da
te T
o:
Action taken to mitigate risk
WADDINGHAM, Rosa No relevant interests declared Not applicable - - Not applicable
3.Declarations of interest for any item
on the agenda
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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
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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
NH
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ort
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CG
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
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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.
The Governing Bodies:
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.
In discussion the following points were raised:
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.
The Governing Bodies:
NOTED the Primary Care Commissioning Committees – Highlight Report.
Financial Stewardship
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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.
The Governing Bodies:
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.
The Governing Bodies:
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.
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The Governing Bodies:
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.
In discussion the following points were raised:
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.
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.
In discussion the following points were raised:
c) Members queried leadership at a senior level of the action plan and it was noted that
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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.
The Governing Bodies:
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.
The Governing Bodies:
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.
In discussion the following points were raised:
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
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would be brought to the June meeting of the new CCG’s Governing Body.
The Governing Bodies:
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.
The Governing Bodies:
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
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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).
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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
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 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
To be confirmed A verbal update will be
provided at the April 2020
meeting.
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MEETING
DATE
AGENDA
REFERENCE
AGENDA ITEM ACTION LEAD DATE TO BE
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
AGENDA ITEM ACTION LEAD DATE TO BE
COMPLETED
COMMENT
ACTIONS COMPLETE
No completed actions to report.
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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 ☐
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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.
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Establishment of NHS Nottingham and Nottinghamshire CCG
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.
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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.
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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.
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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
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NHS NOTTINGHAM AND
NOTTINGHAMSHIRE
CLINICAL COMMISSIONING GROUP
CONSTITUTION
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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
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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
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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
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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
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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).
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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
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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
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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
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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.
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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).
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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.
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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.
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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.
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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
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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”):
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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.
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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
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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.
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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
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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
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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;
b) The duties and responsibilities of the parties, and the legal basis for
such arrangements;
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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 the parties, including details around assets,
employees and equipment to be used under the joint working
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.
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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;
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, if applicable, payments towards a
pooled fund and management of that fund; and
e) Contributions from the parties, including details around assets,
employees and equipment to be used under the joint working
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.
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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.
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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.
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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
CCG and members of the Governing Body (and its Committees, Sub-
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.
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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.
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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.
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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
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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.
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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
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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
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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
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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
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Practice Name Address Place
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
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Practice Name Address Place
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
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Practice Name Address Place
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
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Practice Name Address Place
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
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Practice Name Address Place
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
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Practice Name Address Place
Selston Surgery 139 Nottingham Road,
Selston, NG16 6BT
Mid-Nottinghamshire
Sherrington Park Medical
Centre
402 Mansfield Road,
Sherwood, Nottingham, NG5
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,
Ilkeston Road, Radford,
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,
Ilkeston Road, Radford,
Nottingham, NG7 3GW
Nottingham City
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Practice Name Address Place
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
Boulevard, Hyson Green,
Nottingham, NG7 5HY
Nottingham City
The High Green Medical
Practice
Mary Potter Centre, Gregory
Boulevard, Hyson Green,
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
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Practice Name Address Place
Tudor House Medical
Practice
138 Edwards Lane,
Sherwood, Nottingham, NG5
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,
Sherwood, Nottingham, NG5
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
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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
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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.
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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.
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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
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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.
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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.
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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.
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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.
The Governing Body has authorised the Committee to:
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
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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.
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 The Remuneration and Terms of Service Committee will be
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Decision-making
Arrangements
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 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 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
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 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
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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.
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 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
These terms of reference will be formally reviewed on an
annual basis, but may be amended at any time in order to
adapt to any national guidance as and when issued.
Any proposed amendments to the terms of reference will be
submitted to the Governing Body for approval.
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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.
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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
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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
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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.
In the event of the Chair being unable to attend all or part of
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
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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, 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.
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.
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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
Meetings of the Primary Care Commissioning Committee will
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
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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
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.
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
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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.
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.
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
These terms of reference will be formally reviewed on an
annual basis, but may be amended at any time in order to
adapt to any national guidance as and when issued.
Any proposed amendments to the terms of reference will be
submitted to the Governing Body for approval.
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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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Delegated Function Specific Obligations
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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Delegated Function Specific Obligations
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).
b) The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of
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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Delegated Function Specific Obligations
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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Delegated Function Specific Obligations
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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Delegated Function General Obligations
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.
2. Management of the
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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Reserved function Further provisions
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
Section 7A Functions.
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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Reserved function Further provisions
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.
Local NHS England Team Director or
Director of Finance
or
NHS England Regional Director or
Director of Finance
or
NHS England Chief Executive or Chief
Financial Officer
Accountable Officer or Chief Finance
Officer or Chair
The entering into any Primary Medical Services
Contract, which has, or is capable of having, a term
which exceeds five years.
Local NHS England Team Director or
Director of Finance
Accountable Officer or Chief Finance
Officer or Chair
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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
CCG and members of the Governing Body (and its Committees, Sub-
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.
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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
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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.
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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
Constitution, is subject to the following appointment process:
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
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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
Constitution, is subject to the following appointment process:
a) Nominations and eligibility – Any individual with the necessary
professional accountancy qualifications and the expertise or
experience to lead the financial management of the 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.
c) Grounds for removal from office – Termination of employment in
accordance with the Chief Finance Officer’s contract of employment.
d) Notice period – As determined by the 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.
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.
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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.
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 2.2.7 a) above;
iv) Not attending Governing Body meetings for three consecutive
months (except under extenuating circumstances, such as
illness);
v) Failing to disclose a pecuniary interest regarding matters under
discussion within the organisation or the introduction of a
conflict of interests that would warrant an individual being
excluded from appointment to the Governing Body in line with
standing order 2.2.3; or
vi) 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 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
Constitution, is subject to the following appointment process:
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.
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b) Appointment process –This appointment will be subject to national
NHS recruitment and selection policies and guidance.
c) Grounds for removal from office – Termination of employment in
accordance with the Registered Nurse’s contract of employment.
d) Notice period – As determined by the 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
basis of formal competency assessment and interview process.
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
appointment, normal terms of office may be varied to ensure that
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
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 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.
e) Grounds for removal from office –
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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 of Non-
Executive Director on the Governing Body as set out at
standing order 2.2.9 a) above;
iv) Not attending Governing Body meetings for three consecutive
months (except under extenuating circumstances, such as
illness);
v) Failing to disclose a pecuniary interest regarding matters under
discussion within the organisation or the introduction of a
conflict of interests that would warrant an individual being
excluded from appointment to the Governing Body in line with
standing order 2.2.3; or
vi) 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 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 2.2.9 e) above, notice shall
be as considered appropriate in the circumstances.
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:
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 apply for this role when advertised.
b) Appointment process – Appointments will be made as a result of a
formal competency assessment and interview process.
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 – 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.
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There is no limit to the number of terms of office that can be served,
whether consecutively or otherwise.
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 2.2.10 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 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 2.2.10 e) above, notice shall
be as considered appropriate in the circumstances.
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:
a) Nominations and eligibility – Any GP who is performing primary
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.
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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.
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
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,
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.
There is no limit to the number of terms of office that can be served,
whether consecutively or otherwise, as long as the individuals
continue to have the support of the CCG’s Member Practices.
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 2.2.11 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);
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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 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 2.2.11 e) above, notice shall
be as considered appropriate in the circumstances.
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
NHS recruitment and selection policies and guidance.
c) Grounds for removal from office – Termination of employment in
accordance with the Chief Commissioning Officer’s contract of
employment.
d) Notice period – As determined by the 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
basis of formal competency assessment and interview process.
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
appointment, normal terms of office may be varied to ensure that
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
demonstration of continuing competence through a satisfactory
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annual performance appraisal and agreement of this by the
Governing Body. No individual will have the right to be reappointed.
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) 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
discussion within the organisation or the introduction of a
conflict of interests that would warrant an individual being
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
the public or the CCG.
f) Notice period – The normal notice period for this role is two months’
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:
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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.
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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.
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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:
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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.
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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
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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
7.2.1 The Chief Finance Officer is responsible for:
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
8.3.1 The Chief Finance Officer is responsible for ensuring systems are in place
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
8.4.1 The Chief Finance Officer is responsible for:
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
9.5.1 The Chief Finance Officer is responsible for:
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.
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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
11.1.1 The Chief Finance Officer is responsible for:
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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11.3.2 The Chief Finance Officer is responsible for ensuring there are processes
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.
11.3.9 The Chief Finance Officer is responsible for ensuring there are processes
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
12.1.1 The Chief Finance Officer is responsible for ensuring systems are in place
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.
12.1.4 The Chief Finance Officer is responsible for ensuring systems are in place
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
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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.
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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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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
Governance Committee
c) Bad Debts and Claims Abandoned (Private Patients,
Overseas Visitors and Other)
c) CFO or nominated deputy with oversight by the Audit and
Governance Committee
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
Governance Committee
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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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Ref Matter delegated Delegated to
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.
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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
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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.
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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
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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.
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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.
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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
exercise the Reserved Functions.
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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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.
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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.
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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.
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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.
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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;
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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.
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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:
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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
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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
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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
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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
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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
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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:
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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
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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).
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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
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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).
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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;
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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.
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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).
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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
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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
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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
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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.
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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.
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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
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• 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;
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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;
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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);
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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;
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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
Directions Functions
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;
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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
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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.
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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
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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
patient (if there is no contract sum).
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;
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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.
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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
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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:
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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.
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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
performances of GP practices;
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.
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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.
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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.
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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
Competition Regulations
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(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).
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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
determine whether an initial investigation is to be carried out.
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.
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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
Performers List (1 April 2013).
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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
(Performers Lists) (England) Regulations 2013.
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.
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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
Use) Regulations 2013.
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
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drugs supply) periodic self–declaration and/or self-assessments
to NHS England’s CDAO.
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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
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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.
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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.
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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
attached Personal Data Agreement.
8. Governance: Personnel
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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
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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
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accordance with written instructions from the originating Data
Controller in respect of its Relevant Information;
9.4.2. process the Personal Data (including Special Category
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;
9.4.3. process the Personal Data (including Special Category
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.
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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
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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
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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.
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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
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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
attached Personal Data Agreement.
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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:]
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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?:]
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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:]
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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:]
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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.
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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
NHS England Head of Legal Services
and
Local NHS England Team Director or
Director of Finance
Any matter in relation to the Delegated
Functions which is novel, contentious or
repercussive
CCG Accountable Officer or Chief
Finance Officer or Chair
Local NHS England Team Director or
Director of Finance or
NHS England Region Director or
Director of Finance or
NHS England Chief Executive or Chief
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
CCG Accountable Officer or Chief
Finance Officer or Chair
Local NHS England Team Director or
Director of Finance
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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])
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Schedule to Variation Agreement
[Insert details of variation]
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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.]
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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:
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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
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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.
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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
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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.
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NHS NOTTINGHAM AND
NOTTINGHAMSHIRE
CLINICAL COMMISSIONING GROUP
GOVERNANCE HANDBOOK
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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.
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Contents
[To be inserted]
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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.
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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.
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 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
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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
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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
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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
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
The Audit and Governance Committee will be quorate with a
minimum of two members present.
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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.
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
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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.
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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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.
The Governing Body has authorised the Committee to:
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
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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.
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 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
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.
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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 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 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.
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.
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
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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.
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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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
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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.
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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,
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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
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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
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
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
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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.
In the event of the Chair being unable to attend all or part of 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 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,
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.
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
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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
Meetings of the Primary Care Commissioning Committee will
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
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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
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.
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 are not sent to conflicted individuals.
At the beginning of each Committee meeting, members and
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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.
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.
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
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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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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Delegated Function Specific Obligations
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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Delegated Function Specific Obligations
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).
b) The CCG must ensure that it complies with any Guidance in relation to the design and commissioning of
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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Delegated Function Specific Obligations
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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Delegated Function Specific Obligations
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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Delegated Function General Obligations
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.
2. Management of the
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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Reserved function Further provisions
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
Section 7A Functions.
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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Reserved function Further provisions
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.
Local NHS England Team Director or
Director of Finance
or
NHS England Regional Director or
Director of Finance
or
NHS England Chief Executive or Chief
Financial Officer
Accountable Officer or Chief Finance
Officer or Chair
The entering into any Primary Medical Services
Contract, which has, or is capable of having, a term
which exceeds five years.
Local NHS England Team Director or
Director of Finance
Accountable Officer or Chief 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.
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j) Oversee the identification and management of risks relating to
the Committee’s remit.
4. Membership The Quality and Performance Committee will have 13 members,
comprised as follows:
Non-Executive Members
a) Three Non-Executive Directors
Clinical Members
b) Three GP Representatives
c) Chief Nurse
d) Deputy 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
Other officers may be invited to attend meetings when the
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.
In the event of the Chair being unable to attend all or part of the
meeting, a replacement from within the Committee’s non-executive
membership will be nominated to deputise for that meeting.
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.
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,
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.
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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
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.
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 Quality and Performance
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 Quality and
Performance 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 Quality and Performance
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.
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
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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 Quality and Performance Committee will report to the
Governing Body through regular submission of minutes from its
meetings. Any items of specific concern, or which require
Governing Body approval, will be the subject of a separate report.
The Committee will provide an annual report to the Governing Body
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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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
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) 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
the Committee’s remit.
4. Membership The Finance and Turnaround Committee will have 13 members,
comprised as follows:
Non-Executive Members
a) Three Non-Executive Directors
Clinical Members
b) Joint Clinical Leaders
Managerial Members
c) Accountable Officer
d) Chief Finance Officer
e) Director of Special Projects
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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
Other officers may be invited to attend meetings when the
Committee is discussing matters that fall within their areas of
responsibility.
5. Chair and
Deputy
The Finance and Turnaround Committee will be chaired by a Non-Executive Director.
In the event of the Chair being unable to attend all or part of the
meeting, a replacement from within the Committee’s non-executive
membership will be nominated to deputise for that meeting.
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.
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,
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
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.
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 Finance and Turnaround
Committee to ensure the day to day work of the Committee is
proceeding satisfactorily.
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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 Finance and
Turnaround 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 Finance and Turnaround
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.
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 Finance and Turnaround 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
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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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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
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) 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
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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
the Committee’s remit.
4. Membership The Prioritisation and Investment Committee will have 13 members,
comprised as follows:
Non-Executive Members
a) Three Non-Executive Directors
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
Other officers may be invited to attend meetings when the
Committee is discussing matters that fall within their areas of
responsibility.
5. Chair and
Deputy
The Prioritisation and Investment Committee will be chaired by a Non-Executive Director.
In the event of the Chair being unable to attend all or part of the
meeting, a replacement from within the Committee’s non-executive
membership will be nominated to deputise for that meeting.
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.
To ensure that the quorum can be maintained, Committee members
are able nominate a suitable deputy to attend a meeting of the
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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,
by reason of a declaration of a conflict of interest, then that
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.
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.
7. Decision-making Arrangements
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.
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 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.
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.
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
Committee is proceeding satisfactorily.
Agendas and supporting papers will be circulated no later than five
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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.
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 Prioritisation and
Investment 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 Prioritisation and Investment
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.
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.
12. Reporting
Responsibilities
and Review of
Committee
Effectiveness
The Prioritisation and Investment 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
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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
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.
Issue Date:
April 2020
Status:
FINAL
Version:
1.0
Review Date:
March 2021
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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
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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.
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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
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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.
The Chair of the Committee will determine how declared interests
should be managed, which is likely to involve one the following
actions:
d) 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.
e) Allowing the individual to participate in the discussion, but not
the decision-making process.
f) 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
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
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
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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
Approve arrangements
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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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
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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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
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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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
meeting the public
sector equality duty.
Regulation and
Control
Approve arrangements
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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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
Strategy and
Planning
Approval of the CCG’s
commissioning
strategies and plans.
Strategy and
Planning
Approval of the CCG’s
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
Approval of the CCG’s
annual report and
annual accounts.
Human
Resources
Approval of the
arrangements for
discharging the CCG’s
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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
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
Approval of the CCG’s
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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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
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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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
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
Approve arrangements
for the management of
GMS, PMS and APMS
contracts (including the
design of PMS and
APMS contracts,
monitoring of contracts,
taking contractual action
such as issuing
branch/remedial
notices, and removing a
contract)
Primary Care
Commissioning
Approve all newly
designed enhanced
services (“Local
Enhanced Services”
and “Directed Enhanced
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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
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
Approve arrangements
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]
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Operational Division of Roles and Responsibilities between Non-
Executive Directors
[To be inserted]
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Operational Division of Roles and Responsibilities between the
Joint Clinical Leaders
[To be inserted]
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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
Review date by 31 March 2023
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
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Policy Ref Policy Title Review date by 31 March 2021
Review date by 31 March 2022
Review date by 31 March 2023
Awaiting endorsement and approval via Health & Safety Steering Group and Audit and Governance Committee.
H&S-002 Fire Safety Policy
Awaiting endorsement and approval via Health & Safety Steering Group and Audit and Governance Committee.
P
H&S-003 Display Screen Equipment Use Policy
Awaiting endorsement and approval via Health & Safety Steering Group and Audit and Governance Committee.
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
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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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Meeting Title: Governing Body (Open Session) Date: 08 April 2020
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.
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 ☐
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):
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• 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.
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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.
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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
Key Progress between 18th March and 3rd April
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
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- 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
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- 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
Key Progress between 18th March and 3rd April
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.
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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
Key Progress between 18th March and 3rd April
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
Key Progress between 18th March and 3rd April
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.
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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
Key Progress between 18th March and 3rd April
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
Key Progress between 18th March and 3rd April
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.
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2.8 Capacity
Key Progress between 18th March and 3rd April
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
Key Progress between 18th March and 3rd April
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
Key Progress between 18th March and 3rd April
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.
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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
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Meeting Title: Governing Body (Open Session) Date: 08 April 2020
Paper Title: Governance Arrangements during the
Emergency Response Period Paper Reference: GB 20 078
Sponsor:
Presenter:
Amanda Sullivan, Accountable Officer Attachments/ Appendices:
-
Lucy Branson, Associate Director of Governance
Purpose: Approve ☒ Endorse ☐ Review
☐ Receive/Note for:
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.
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 ☐
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
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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):
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.
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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
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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
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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
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‘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
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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
4.1 The Governing Body is requested to:
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
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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)
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.
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
Normal meeting arrangements to be suspended until further
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.
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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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Ref Matter Delegated Delegated to
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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Ref Matter Delegated Delegated to
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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Meeting Title: Governing Body (Open Session) Date: 08 April 2020
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
Purpose: Approve ☐ Endorse ☐ Review
☐ Receive/Note for:
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.
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 ☐
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):
There are no risks identified
Confidentiality:
☒No
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Recommendation(s):
1. The Governing Body is asked to NOTE the annual BCF assurance report.
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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:
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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
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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.
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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
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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+).
Nottinghamshire County HWB
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.
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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.
Nottinghamshire County HWB
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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).
Nottinghamshire County HWB
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
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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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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
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Meeting Title: Governing Body (Open Session) Date: 08 April 2020
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
☐ Receive/Note for:
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
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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.
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Meeting Title: Governing Body (Open Session) Date: 08 April 2020
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.
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 ☐
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 Yes ☐ No ☐ N/A ☒
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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
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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
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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)
Circle - Nations Healthcare - ISTC 18.59 17.12 1.47 18.59 17.12 1.47
NUH - Treatment Centre 31.60 29.86 1.75 27.64 26.13 1.51
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)
Sherwood Forest Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
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
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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
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APPENDIX 1b – Operating Cost Statement (Mid Nottinghamshire CCGs)
FORECAST YEAR TO DATE
Annual Plan
£'Mil
Forecast Outturn
£'Mil
Forecast
Variance
£'Mil
Plan
£'Mil
Actual
£'Mil
Variance
£'Mil
Acute Services
Sherwood Forest Hospitals 196.41 200.21 (3.81) 179.27 182.77 (3.50)
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 31.60 31.60 (0.00) 28.85 28.86 (0.00)
Nottingham University Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
East Midlands Ambulance Service 12.87 12.89 (0.02) 11.79 11.84 (0.05)
Acute - NHS - United Lincs 4.54 4.67 (0.13) 4.16 4.28 (0.12)
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 1.73 1.66 0.07 1.58 1.56 0.03
Acute - NHS - Univ Leicester 0.31 0.32 (0.01) 0.28 0.29 (0.01)
Acute - NHS - Chesterfield 1.12 1.14 (0.02) 1.03 1.05 (0.03)
Acute - NHS - Sheff Teaching 0.88 0.72 0.15 0.80 0.66 0.14
Acute - NHS - Sheff Childrens 0.17 0.10 0.07 0.15 0.09 0.06
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)
Circle - Nations Healthcare - ISTC 1.03 0.96 0.08 1.03 0.96 0.08
NUH - Treatment Centre 1.69 1.48 0.20 1.48 1.32 0.16
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)
Ramsay Woodthorpe 1.17 2.42 (1.25) 1.07 2.22 (1.15)
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)
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 (0.41) 0.00 (0.41) (0.38) 0.00 (0.38)
Total Acute Services 252.91 271.60 (18.69) 231.39 248.15 (16.76)
Community Services
Nottinghamshire Healthcare - General Health 25.87 26.05 (0.17) 23.70 23.86 (0.16)
Nottinghamshire Healthcare - QIPP 0.00 0.00 0.00 0.00 0.00 0.00
Nottingham Citycare 0.00 0.00 0.00 0.00 0.00 0.00
Nottingham Citycare - QIPP 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)
Sherwood Forest Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
Other NHS - Community 2.24 2.34 (0.10) 2.05 2.14 (0.08)
Other Non NHS - Community 0.34 0.23 0.11 0.32 0.22 0.10
Other Non NHS - QIPP 0.00 0.00 0.00 0.00 0.00 0.00
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 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 41.24 40.90 0.34 37.80 37.49 0.32
Mental Health Services
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
Other Non NHS - Mental Health 5.90 5.54 0.35 5.42 5.12 0.30
S117 Placements 11.18 10.22 0.96 10.25 11.03 (0.79)
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 1.72 2.65 (0.93) 1.04 0.00 1.04
Total Mental Health Services 55.61 55.12 0.49 50.41 49.76 0.65
Primary Care Services
Primary Care Contracting 46.09 45.35 0.75 40.72 39.87 0.85
Prescribing 51.11 53.26 (2.14) 46.71 48.77 (2.06)
Prescribing - QIPP 0.00 0.00 0.00 0.00 0.00 0.00
Medicine Management - Clinical 1.30 1.04 0.26 1.19 0.96 0.23
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)
Practice Transformation fund 0.00 0.00 0.00 0.00 0.00 0.00
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
Primary Care - Other 0.28 0.00 0.28 0.26 0.00 0.26
Total Primary Care Services 108.66 109.54 (0.88) 97.92 98.72 (0.80)
Continuing Healthcare
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)
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Other Contracts
Other Non-NHS Services 3.71 3.61 0.10 3.38 3.25 0.12
Patient Transport 2.49 2.61 (0.12) 2.31 2.28 0.03
Other Non-NHS Services - 111 1.21 1.49 (0.28) 1.11 1.36 (0.25)
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 Non-Running Costs
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 - Chief Commissioning Officer 1.01 0.82 0.19 1.04 0.89 0.15
Corporate Costs - Chief Finance Officer 0.67 0.38 0.29 0.61 0.30 0.31
Corporate Costs - ICS (0.08) (0.08) (0.00) (0.07) (0.07) (0.00)
Corporate Costs - Chief Nurse 0.89 0.72 0.18 0.82 0.65 0.17
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
Risk Reserves (inc. running cost headroom) 2.66 0.00 2.66 2.44 0.00 2.44
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 PROGRAMME NON- HEALTHCARE COSTS 41.47 21.29 20.19 35.56 19.27 16.30
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 - Special Projects 0.17 0.19 (0.02) 0.16 0.17 (0.01)
Running Costs - ICS 0.23 0.23 0.00 0.21 0.20 0.01
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)
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APPENDIX 1c – Operating Cost Statement (Greater Nottinghamshire CCGs)
FORECAST YEAR TO DATE
Annual Plan
£'Mil
Forecast Outturn
£'Mil
Forecast
Variance
£'Mil
Plan
£'Mil
Actual
£'Mil
Variance
£'Mil
Acute Services
Sherwood Forest Hospitals 10.40 10.95 (0.55) 9.49 10.02 (0.53)
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
Sherwood Forest Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
Nottingham University Hospitals 405.09 405.84 (0.75) 369.68 370.26 (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 26.33 26.34 (0.01) 24.14 24.14 (0.01)
Acute - NHS - United Lincs 0.67 0.68 (0.01) 0.61 0.62 (0.01)
Acute - NHS - United Lincs - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
Acute - NHS - Doncaster & Bassetlaw 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 - Univ Leicester 1.29 1.68 (0.39) 1.18 1.50 (0.32)
Acute - NHS - Chesterfield 0.10 0.12 (0.02) 0.09 0.11 (0.01)
Acute - NHS - Sheff Teaching 0.51 0.44 0.07 0.47 0.40 0.07
Acute - NHS - Sheff Childrens 0.04 0.02 0.02 0.04 0.02 0.01
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)
Circle - Nations Healthcare - ISTC 17.55 16.16 1.39 17.55 16.16 1.39
NUH - Treatment Centre 29.92 28.37 1.54 26.16 24.81 1.35
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)
Ramsay Woodthorpe 7.06 9.41 (2.35) 6.45 8.76 (2.31)
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)
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 (0.95) 0.00 (0.95) (0.87) 0.00 (0.87)
Total Acute Services 509.31 527.10 (17.79) 465.78 481.60 (15.82)
Community Services
Nottinghamshire Healthcare - General Health 39.36 39.29 0.08 36.05 35.97 0.07
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 1.88 1.88 0.00 1.73 1.72 0.00
Sherwood Forest Hospitals - Activity Reserve / QIPP / FRP 0.00 0.00 0.00 0.00 0.00 0.00
Other NHS - Community 3.50 2.72 0.78 3.20 2.37 0.83
Other Non NHS - Community 14.22 12.75 1.46 13.10 11.35 1.75
Other Non NHS - QIPP 0.00 0.00 0.00 0.00 0.00 0.00
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 Investment QIPP 0.00 0.00 0.00 0.00 0.00 0.00
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)
Mental Health Services
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)
Other Non NHS - Mental Health 9.83 8.62 1.21 9.06 7.75 1.30
S117 Placements 15.33 16.22 (0.89) 14.05 13.14 0.91
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 1.25 (2.10) 3.36 1.04 0.00 1.04
Total Mental Health Services 108.42 106.13 2.28 99.04 97.11 1.93
Primary Care Services
Primary Care Contracting 100.35 95.03 5.32 91.33 86.72 4.62
Prescribing 93.58 96.11 (2.53) 85.67 87.90 (2.23)
Prescribing - QIPP 0.00 0.00 0.00 0.00 0.00 0.00
Medicine Management - Clinical 2.71 2.22 0.49 2.49 2.01 0.48
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
Practice Transformation fund 0.00 0.00 0.00 0.00 0.00 0.00
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)
Primary Care - Other 0.00 0.00 0.00 0.00 0.00 0.00
Total Primary Care Services 218.35 214.68 3.67 199.24 196.04 3.21
Continuing Healthcare
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
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Other Contracts
Other Non-NHS Services 0.00 0.00 0.00 0.00 0.00 0.00
Patient Transport 5.05 4.86 0.19 4.66 4.40 0.26
Other Non-NHS Services - 111 3.09 3.18 (0.09) 2.83 2.91 (0.08)
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 Non-Running Costs
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 - Chief Commissioning Officer 2.45 1.57 0.89 2.25 1.36 0.89
Corporate Costs - Chief Finance Officer 0.00 0.00 0.00 0.00 0.00 0.00
Corporate Costs - ICS 2.19 2.19 (0.00) 0.22 0.22 0.00
Corporate Costs - Chief Nurse 3.15 2.52 0.62 2.89 2.38 0.52
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
Risk Reserves (inc. running cost headroom) 4.81 0.00 4.81 4.41 0.00 4.41
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 PROGRAMME NON- HEALTHCARE COSTS 48.75 35.86 12.90 41.85 31.11 10.74
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 - Special Projects 0.35 0.49 (0.14) 0.32 0.46 (0.14)
Running Costs - ICS 0.44 0.39 0.06 0.41 0.35 0.05
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
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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 Financial Assets 0.00 0.00 0.00
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
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 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
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APPENDIX 2 – Balance Sheet – Mid 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 8.96 14.90 5.94
Other Financial Assets 0.00 0.00 0.00
Other Current Assets 0.00 0.00 0.00
Cash and cash equivalents 0.16 0.20 0.04
Total Current Assets 9.12 15.10 5.98
Non Current Assets classified as "Held for Sale"
Total assets 9.16 15.12 5.96
Current Liabilities
Trade and other payables (33.05) (37.89) (4.84)
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 (0.28) (0.28) 0.00
Total current liabilities (33.34) (38.17) (4.84)
Total assets less current liabilities (24.18) (23.05) 1.12
Non-current liabilities
Trade and other payables 0.00 0.00 0.00
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 0.00 0.00 0.00
Total assets employed (24.18) (23.05) 1.12
Financed By Taxpayers' equity
General Fund (24.18) (23.05) 1.12
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 (24.18) (23.05) 1.12
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APPENDIX 2 – Balance Sheet – Greater 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 0.00 0.00 0.00
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 0.00 0.00 0.00
Current assets
Inventories 0.00 0.00 0.00
Trade and other receivables 13.73 48.71 34.98
Other Financial Assets 0.00 0.00 0.00
Other Current Assets 0.00 0.00 0.00
Cash and cash equivalents (2.19) (3.29) (1.09)
Total Current Assets 11.53 45.42 33.89
Non Current Assets classified as "Held for Sale"
Total assets 11.53 45.42 33.89
Current Liabilities
Trade and other payables (67.17) (81.34) (14.17)
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 (1.57) (1.55) 0.02
Total current liabilities (68.74) (82.89) (14.14)
Total assets less current liabilities (57.21) (37.47) 19.74
Non-current liabilities
Trade and other payables 0.00 0.00 0.00
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 0.00 0.00 0.00
Total assets employed (57.21) (37.47) 19.74
Financed By Taxpayers' equity
General Fund (57.21) (37.48) 19.74
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 (57.21) (37.48) 19.74
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Page 1 of 2
Meeting Title: Governing Body (Open Session) Date: 08 April 2020
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
☐ Receive/Note for:
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.
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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.
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1
Meeting Title: Governing Body (Open Session) Date: 08 April 2020
Paper Title: Corporate Risk Report Paper Reference: GB 20 084
Sponsor:
Presenter:
N/A Attachments/ Appendices:
-
Lucy Branson, Associate Director of Governance
Purpose: Approve ☐ Endorse ☐ Review
☐ Receive/Note for:
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.
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 ☒
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 report
Risk(s):
The paper details the current major (red) risks in the Corporate Risk Register.
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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
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Corporate Risk Report
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
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Risk
Reference Risk Narrative
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)
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Risk
Reference Risk Narrative
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
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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
5.1 The Governing Body is requested to:
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
Organisation
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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 ¸ ¸ ¸ ¸ ¸ ¸
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Cumulative Record of Members Attendance (2019/20)1
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.
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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
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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.
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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
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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:
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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.
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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
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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 ¸ ¸ ¸ ¸
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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)
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Jo Simmonds Head of Corporate Governance ¸ ¸ ¸ ¸ ¸ ¸
Dr Arun Tangri GP Representative ¸
Kerrie Woods Primary Care Lead (GP Contracts), NHS England/Improvement
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Michael Wright Chief Executive, Local Medical Committee (LMC)
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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 ¸ ¸ ¸ ¸ ¸ ¸
Cumulative Record of Members Attendance (2019/20)1
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
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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
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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
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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
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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)
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