NHS DERBY AND DERBYSHIRE CCG
GOVERNING BODY – MEETING IN PUBLIC
Date & Time: Thursday 11th April 2019 – 11.30am to 1.00pm
Venue: Conference Room, Toll Bar House, Ilkeston, Derbyshire DE7 5FH
Questions from members of the public should be emailed to [email protected] in which case a response will be provided on the day or will be sent within seven working days.
Item Subject Paper Presenter Time
GBP/1920/01 Welcome, Apologies & Quoracy Verbal Dr Avi 11.30 Bhatia Apologies received from: Ian Shaw, Jill Dentith, Dr Emma Pizzey, Dr Penny Blackwell, Dr Ruth Cooper, Deborah Hayman
GBP/1920/02 Questions from members of the public Verbal Dr Avi Bhatia
GBP/1920/03 Declarations of Interest Paper Dr Avi • Register of Interests Bhatia • Summary register for recording any conflicts of interests during meetings • Glossary
CHAIR AND CHIEF OFFICER REPORTS GBP/1920/04 Chair’s Report Paper Dr Avi 11.40 Bhatia
GBP/1920/05 Chief Executive Officers Report Paper Dr Chris Clayton
FOR DECISION GBP/1920/06 Constitution for new CCG and Paper Helen 12.00 Committee Terms of References Dillistone
Page 1 of 220 GBP/1920/07 19/20 Governing Body Assurance Paper Helen Framework Dillistone
MINUTES AND MATTERS ARISING FROM PREVIOUS MEETING GBP/1920/08 Minutes of the Derbyshire CCGs GB Paper Dr Avi 12.30 Meetings in Common held on 28th Bhatia March 2019
GBP/1920/09 Matters arising from the minutes not Paper Dr Avi elsewhere on agenda: Bhatia • Action Log
GBP/1920/10 Any Other Business Verbal ALL 12.45
Date and time of next meeting:
Thursday 2nd May 2019 at 11.30am at Tollbar House, Ilkeston, Derbyshire
Page 2 of 220 NHS DERBY AND DERBYSHIRE CCG GOVERNING BODY MEMBERS' REGISTER OF INTERESTS 2019/20
Name Job Title Committee Member Declared Interest (Including direct/ indirect Interest) Type of Interest Date of Interest Action taken to mitigate risk GP Partner at Moir Medical Centre 2000 Ongoing
GP Parter at Erewash Health Partnership April 2018 Ongoing Withdraw from all discussion and voting if Bhatia, Dr Avi Clinical Chair Governing Body Spouse works for Nottingham University Hospitals in Ongoing Ongoing organisation Is potential provider unless otherwise Gynaecology agreed by the meeting chair
Part landlord/owner of premises at College Street Medical Ongoing Ongoing Practice, Long Eaton, Nottingham
Director of Flourish Derbyshire Dales CIC, which aims to provide creative arts and activity projects and to support Feb 2019 Ongoing others in this activity for the Derbyshire Dales
GP partner at Hannage Brook Medical Centre, Wirksworth. Withdraw from all discussion and voting if Blackwell, Dr Penny Governing Body GP Governing Body Interests in Drug misuse Ongoing Ongoing organisation Is potential provider unless otherwise agreed by the meeting chair GP lead for Shared Care Pathology, Derbyshire Pathology 2011 Ongoing
Shareholder in BD Braithwaite Ltd, which provides clinical services to Ilkeston Community Hospital and provides private medical services in the East Midlands (including patients who Aug 2014 Ongoing Withdraw from all discussion and voting if are not eligible for NHS funded treatment according to CCG organisation Is potential provider unless otherwise guidelines) agreed by the meeting chair
Employed by Nottingham University Hospital NHS Trust which is commissioned by the CCG to provide services to NHS Aug 2000 Ongoing Declare interest in relevant patients. meetings
Founder Member, Shareholder and Director of Clinical Braithwaite, Bruce Secondary Care Specialist Governing Body Services for Alliance Surgical plc which is a company that bids July 2007 Ongoing Withdraw from all discussion and voting if for NHS contracts. organisation Is potential provider unless otherwise agreed by the meeting chair Fellow of the Royal College Of Surgeons of England and Member of the Vascular Society of Great Britain and Ireland. Aug 1992 Ongoing No action required Advisor to NICE on an occasional basis.
Honorary Associate Professor, University of Nottingham, involved in clinical research activity in the East Midlands. Aug 2009 Ongoing No action required
Clayton, Dr Chris Chief Executive Officer Governing Body Spouse is a Director at PWC 2001 Ongoing No action required
GP Partner at Staffa Health, Tibshelf 1992 Ongoing
Member of North East Derbyshire Federation 2016 Ongoing
Withdraw from all discussion and voting if Adult Safeguarding Lead, Staffa Health 2014 Ongoing Cooper, Dr Ruth Governing Body GP Governing Body organisation Is potential provider unless otherwise Senior Partner 2018 Ongoing agreed by the meeting chair
Frailty Integrated Care Lead/Community Support Bed Lead 2017 Ongoing
Self-employed through own management consultancy business trading as Jill Dentith Consulting 2012 Ongoing Declare interest at relevant meetings Dentith, Jill Lay Member for Governance Governing Body Providing part time consultancy service to Conexus (a GP Federation in Wakefield) 16 Jan 19 Ongoing No action required
Withdraw from all discussion and voting if Dhadda, Dr Bukhtawar S Governing Body GP Governing Body GP Partner at Swadlincote Surgery 2015 Ongoing organisation Is potential provider unless otherwise agreed by the meeting chair Executive Director of Corporate Strategy & Dillistone, Helen Governing Body Nil No action required Delivery Gibbard, Ian Lay Member for Audit Governing Body Nil No action required
Hayman, Deborah Chief Finance Officer Governing Body Nil No action required
Hogg, Sandy Executive Turnaround Director Governing Body Nil No action required Executive Director of Commissioning & Jones, Zara Governing Body Nil No action required Operations Lloyd, Dr Steven Medical Director Governing Body GP sessions x2 per week at St. Lawrence Road Surgery 2012 Ongoing Declare interest at relevant meetings Lay Vice Chair of East Riding of Yorkshire Clinical Jan 2017 Mar 2020 No action required Commissioning Group There is no overlap of direct commissioning responsibilities but as with most East Midlands Lay Member for Governance at South West Lincolnshire CCG June 2017 Mar 2020 CCGs there may be services commissioned for the Middleton, Andrew Lay Member for Finance Governing Body region through a lead CCG. In such cases this interest will be declared.
Lay Chair of Performers List Decision Panels for NHS England Will not sit on any case which has knowledge of the Central Midlands May 2013 Ongoing GP or their practice.
Lay Member for Patient and Public Will not take part in any decisions relating to Orwin, Gillian Governing Body Patient at Wingerworth Surgery Mar 2017 Ongoing Involvement Wingerworth Surgery Partner at Littlewick Medical Centre, with an interest in Pizzey, Dr Emma Governing Body GP Governing Body 2002 Ongoing Declare interest at relevant meetings diabetes (but not clinical lead) Shaw, Ian Lay Member for Primary Care Commissioning Governing Body Professor at the University of Nottingham 1992 Ongoing No action required
Stacey, Brigid Chief Nurse Officer Governing Body Nil No action required
Strachan, Dr Alexander Gregory Governing Body GP Governing Body Nil No action required Husband is Richard Faleiro - Anaesthetic and Chronic Pain Watkins, Dr Merryl Governing Body GP Governing Body 1992 Ongoing Declare interest at relevant meetings Consultant at Royal Derby Hospital Lay Member for Patient and Public Whittle, Martin Governing Body Nil No action required Involvement
Page 3 of 220 REGISTER FOR RECORDING ANY INTERESTS DURING MEETINGS
Name of Corporate Details of Date of person Meeting Chair (name) Secretary/CCG Agenda item interest Action taken Meeting declaring Meeting Lead declared interest
Page 4 of 220 Glossary
A&E Accident and Emergency
AfC Agenda for Change
AHP Allied Health Professional
AQP Any Qualified Provider
Arden & Arden & Greater East Midlands Commissioning Support Unit GEM CSU
ARP Ambulance Response Programme
ASD Autistic Spectrum Disorder
BAF Board Assurance Framework
BCCTH Better Care Closer to Home
BCF Better Care Fund
BME Black Minority Ethnic bn Billion
BPPC Better Payment Practice Code
BSL British Sign Language
CBT Cognitive Behaviour Therapy
CAMHS Child and Adolescent Mental Health Services
CCE Community Concern Erewash
CCG Clinical Commissioning Group
CDI Clostridium Difficile
C-DIFF Clostridium difficile
CETV Cash Equivalent Transfer Value
Page 5 of 220 Cfv Commissioning for Value
CHC Continuing Health Care
CHP Community Health Partnership
CMP Capacity Management Plan
CiC Committees in Common
CNO Chief Nursing Officer
COP Court of Protection
COPD Chronic Obstructive Pulmonary Disorder
CPD Continuing Professional Development
CPN Contract Performance Notice
CQC Care Quality Commission
CQN Contract Query Notice
CQUIN Commissioning for Quality and Innovation
CPN Contract Performance Notice
CPRG Clinical & Professional Reference Group
CRG Clinical Reference Group
CSE Child Sexual Exploitation
CSU Commissioning Support Unit
CRHFT Chesterfield Royal Hospital NHS Foundation Trust
CTR Care and Treatment Reviews
CVD Chronic Vascular Disorder
CYP Children and Young People
Page 6 of 220 D2AM Derbyshire Dis-charge to address and manage
DAAT Drug and Alcohol Action Teams DCC Derbyshire County Council
DCCPC Derbyshire Affiliated Clinical Commissioning Policies
DCHS Derbyshire Community Health Services
DCHSFT Derbyshire Community Healthcare Services NHS Foundation Trust
DCO Designated Clinical Officer
DHcFT Derbyshire Healthcare NHS Foundation Trust
DHU Derbyshire Health United
DNA Did not attend
DoH Department of Health
DoLS Deprivation of Liberty Safeguards
DRRT Dementia Rapid Response Service
DSN Diabetic Specialist Nurse
DTHFT Derby Teaching Hospitals NHS Foundation Trust
DTOC Delayed Transfers of Care – the number of days a patient deemed medically fit is still occupying a bed.
D2AM Discharge to Assess and Manage
ED Emergency Department
EDEN Effective Diabetes Education Now
EDS2 Equality Delivery System 2
EIHR Equality, Inclusion and Human Rights
EIP Early Intervention in Psychosis
EMAS East Midlands Ambulance Service
Page 7 of 220 EMAS Red 1 The number of Red 1 Incidents (conditions that may be immediately life threatening and the most time critical) which resulted in an emergency response arriving at the scene of the incident within 8 minutes of the call being presented to the control room telephone switch.
EMAS Red 2 The number of Red 2 Incidents (conditions which may be life threatening but less time critical than Red 1) which resulted in an emergency response arriving at the scene of the incident within 8 minutes from the earliest of; the chief complaint information being obtained; a vehicle being assigned; or 60 seconds after the call is presented to the control room telephone switch.
EMAS A19 The number of Category A incidents (conditions which may be immediately life threatening) which resulted in a fully equipped ambulance vehicle able to transport the patient in a clinically safe manner, arriving at the scene within 19 minutes of the request being made.
EMLA East Midlands Leadership Academy
ENT Ear Nose and Throat
EOL End of Life
EPRR Emergency Preparedness Resilience and Response
FFT Friends and Family Test
FGM Female Genital Mutilation
FIRST Falls Immediate Response Support Team
FRP Financial Recovery Plan
GAP Growth Abnormalities Protocol
GBAF Governing Body Assurance Framework
GP General Practitioner
GPSI GP with Specialist Interest
HCAI Healthcare Acquired Infections
HDU High Dependency Unit
HSJ Health Service Journal
GBAC Governing Body Assurance Committee
GBAF Governing Body Assurance Framework
Page 8 of 220
GDPR General Data Protection Regulation
GNBSI Gram Negative Bloodstream Infection
GPFV General Practice Forward View
GPWSI GPs with a special interest
GPSOC GP System of Choice
HCAI Healthcare Associated Infection
HLE Healthy Life Expectancy
HSJ Health Service Journal
HWB Health & Well-being Board
IAF Improvement and Assessment Framework
IAPT Improving Access to Psychological Therapies
ICM Institute of Credit Management
ICO Information Commissioner’s Office
ICS Integrated Care Service
ICU Intensive Care Unit
IGC Information Governance Committee
IGT Information Governance Toolkit
IP&C Infection Prevention & Control
IT Information Technology
IWL Improving Working Lives
JAPC Joint Area Prescribing Committee
JSAF Joint Safeguarding Assurance Framework
JSNA Joint Strategic Needs Assessment k Thousand
Page 9 of 220 KPI Key Performance Indicator
LA Local Authority
LAC Looked after Children
LCFS Local Counter Fraud Specialist
LD Learning Disabilities
LGB&T Lesbian, Gay, Bi-sexual and Trans-gender
LHRP Local Health Resilience Partnership
LMC Local Medical Council
LMS Local Maternity Service
LOC Local Optical Committee
LPC Local Pharmaceutical Council
LPF Lead Provider Framework
m Million
MAPPA Multi Agency Public Protection arrangements
MASH Multi Agency Safeguarding Hub
MCA Mental Capacity Act
MDT Multi-disciplinary Team
MH Mental Health
MHIS Mental Health Investment Standard
MIG Medical Interoperability Gateway
MIUs Minor Injury Units
MMT Medicines Management Team
MoM Map of Medicine
MoMO Mind of My Own
MRSA Methicillin-resistant Staphylococcus aureus
Page 10 of 220
MSK Musculoskeletal
MTD Month to Date
NDCCG NHS North Derbyshire Clinical Commissioning Group
NECS North of England Commissioning Services
NEPTS Non-emergency Patient Transport Services
NHAIS National Health Application and Infrastructure Services
NHSE NHS England
NHS e-RS NHS e-Referral Service
NICE National Institute for Health and Care Excellence
NOAC New oral anticoagulants
NUH Nottingham University Hospitals NHS Trust
OJEU Official Journal of the European Union
OOH Out of Hours
ORG Operational Resilience Group
PAD Personally Administered Drug
PALS Patient Advice and Liaison Service
PAS Patient Administration System
PCCC Primary Care Co-Commissioning Committee
PCD Patient Confidential Information
PCDG Primary Care Development Group
PEARS Primary Eye care Assessment Referral Service
PEC Patient Experience Committee
PHB’s Personal Health Budgets
PHSO Parliamentary and Health Service Ombudsman
Page 11 of 220 PIR Post-Infection Review
PLCV Procedures of Limited Clinical Value
POA Power of Attorney
POD Point of Delivery
PPG Patient Participation Groups
PPP Prescription Prescribing Division
PRIDE Personal Responsibility in Delivering Excellence
PSED Public Sector Equality Duty
PSO Paper Switch Off
PwC Price, Waterhouse, Cooper
QA Quality Assurance
QAG Quality Assurance Group
Q1 Quarter One reporting period: April – June
Q2 Quarter Two reporting period: July – September
Q3 Quarter Three reporting period: October – December
Q4 Quarter Four reporting period: January – March
QIPP Quality, Innovation, Productivity and Prevention
QUEST Quality Uninterrupted Education and Study Time
QOF Quality Outcome Framework
RAP Recovery Action Plan
RCA Root Cause Analysis
REMCOM Remuneration Committee
RTT Referral to Treatment
RTT Admitted The percentage of patients waiting 18 weeks or less for treatment of the patients on admitted pathways
Page 12 of 220 RTT Non-admitted The percentage if patients waiting 18 weeks or less for treatment of the patients on non-admitted pathways
RTT Incomplete The percentage of patients waiting 18 weeks or less of the patients on incomplete pathways at the end of the period
SAAF Safeguarding Adults Assurance Framework
SAR Service Auditor Reports
SAT Safeguarding Assurance Tool
SBS Shared Business Services
SDCCG Southern Derbyshire CCG
SDMP Sustainable Development Management Plan
SEND Special Educational Needs and Disabilities
SHFT Stockport NHS Foundation Trust
SFT Stockport Foundation Trust
SNF Strictly no Falling
SOC Strategic Outline Case
SPA Single Point of Access
SQI Supporting Quality Improvement
SRG Systems Resilience Group
SIRO Senior Information Risk Owner
SRT Self-Assessment Review Toolkit
STEIS Strategic Executive Information System
STHFT Sheffield Teaching Hospital Foundation Trust
STOMPLD Stop Over Medicating of Patients with Learning Disabilities
STP Sustainability and Transformation Plan
TCP Transforming Care Partnership
TDA Trust Development Authority
Page 13 of 220 T&O Trauma and Orthopaedics
TWG Transition Working Group
UEC Urgent and Emergency Care
YTD Year to Date
111 The out of hours service delivered by Derbyshire Health United: a call centre where patients, their relatives or carers can speak to trained staff, doctors and nurses who will assess their needs and either provide advice over the telephone, or make an appointment to attend one of our local clinics. For patients who are house-bound or so unwell that they are unable to travel, staff will arrange for a doctor or nurse to visit them at home
52WW 52 week wait
Page 14 of 220 15
Governing Body Meeting in Public
11th April 2019 Item No: 4 Report Title Chair’s Report Author(s) Dr Avi Bhatia Sponsor (Director) Dr Avi Bhatia
Paper for: Decision Assurance Discussion Information X Recommendations The Governing Body is requested to receive this report and to note the items as detailed.
Report Summary
This report provides a summary of the Chair’s vision and priorities
Firstly a warm welcome to the first Governing Body meeting of NHS Derby and Derbyshire CCG and to my first Governing Body Chair’s report. Welcome too to my new Governing Body colleagues and speaking on our collective behalf we share a view that visibility is important to us all.
We start the 2019/20 year as one of the early CCG areas to have successfully merged. The journey to this point has been challenging as we delivered the plan to proactively address our financial issues, to fulfil our commitment to the merger and to deliver an organisational restructure simultaneously.
The result is that we have emerged as a stronger organisation in an improving financial position now able to fully focus on delivering our ambitious plans as a lead system partner.
I thought it may be helpful to share my vision as Chair. My immediate aim is to capitalise on the opportunities and efficiencies that being one organisation brings and build upon the work of the four CCGs in the previous arrangements. These priorities include continuing to strengthen our financial position, to deliver our plans around the transformation of the health and care system in Derbyshire, the next phase in the development of ‘place’ and to ensure the continuing alignment with the NHS Long Term Plan.
Working effectively together as a system is critical to the future of health and care in Derbyshire and as the Governing Body we must ensure that our CCG has a proactive role in further developing the Joined Up Care Derbyshire (JUCD) partnership approach. The Governing Bodies and Boards of all JUCD partners have an important role to play in this and we will be working hard to ensure that we fulfil our part in this.
Involvement and transparency are also key elements of my vision. This applies across our activities and particularly with our public and patients. Recent developments include an engagement model which our patient representatives have helped to shape, an Engagement
Page 15 of 220 Committee with strong links to ‘place’ and ‘confirm and challenge’ sessions where public and patients are involved in helping to shape new services or service developments at the ideas stage. There are other developments underway and I am committed to ensuring that we maximise the opportunities for people to get involved and that our patient voice is both heard and listened to.
Looking forward we have some significant challenges but also some exciting developments ahead and I am looking forward to working closely with our system partners, stakeholders and our public and patients as we work to deliver these.
Are there any Resource Implications (including Financial, Staffing etc)?
No
Has Due Regard to the proactive duties of the Equality Act 2010 been taken into consideration in respect of the proposals within this report?
N/A
Have you involved patients, carers and the public in the preparation of the report?
N/A
Have any Quality and Compliance issues been identified/ actions taken
N/A
Have any Conflicts of Interest been identified/ actions taken?
N/A
Governing Body Assurance Framework
N/A
Identification of Key Risks
N/A
Page 16 of 220
Governing Body Meeting in Public
th 11 April 2019 Item No: 5 Report Title Chief Executive Officer’s Report Author(s) Dr Chris Clayton Sponsor (Director) Dr Chris Clayton
Paper for: Decision Assurance Discussion Information X Recommendations The Governing Body is requested to receive this report and to note the items as detailed.
1.0 Report Summary This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Chief Executive Officer’s efforts have been directed since the last meeting.
I am delighted to be opening this month with the news that following our successful authorisation to merge this is the first Chief Executive’s report for Derby and Derbyshire CCG. I would also like to welcome Dr Avi Bhatia as Chair of our CCG and Governing Body colleagues to our first meeting.
Becoming a single, statutory organisation with one Governing Body is an incredibly important development for us. We started to see the advantages in terms of efficiency and pace when we started working more closely together back in early 2017 and I have seen that progress further since I joined as CEO of the four CCGs in the Autumn of that year. I am already seeing a significant change in the way we deliver our business now and I am really looking forward to the coming months as we start to deliver some of the important developments which will improve the lives of our patients.
Most of my Chief Executive reports in recent months have referenced the financial challenge and the critical importance of achieving our £44m control total which would in turn release the Commissioner Sustainability Fund. I am pleased to say that this was achieved which means that we start the new CCG and the 2019/20 year in an improving financial position. I do not want to underestimate the scale of the challenge for this year and beyond but we start from a much stronger position than may have been the case.
I would like to take the opportunity to acknowledge the level of work and commitment of CCG colleagues in getting us to the point of merger and the strengthening financial position. I would also like to recognise the involvement of our system partners and our public and patients, all of whom continue to play a vital role in supporting the CCG to address the challenges we face as a system and to make some very difficult decisions. I look forward to strengthening these partnerships which will be critical as we work together to deliver the Joined Up Care Derbyshire vision.
The statutory and operational efficiency benefits of working as a single CCG must be
Page 17 of 220 underpinned by a one organisation approach. In my recent reports I have referenced the staff consultation and our collective work to facilitate our transition to “one team.”
The staff consultation and recruitment to unfilled positions is now very close to completion and at the point of transition to our new organisation I had the privilege of spending a morning with colleagues, partly to share our vision but mainly to listen to what matters most to people. There was a tangible “buzz” and energy amongst colleagues and whilst any transition of this nature presents challenges at an individual and organisational level I have been delighted, impressed and reassured by the commitment of our staff. We have a lot of feedback and suggestions which we are reflecting upon as we speak and this will be reflected in our ambitious organisational development plan.
These are exciting times for us. We have a lot of work to do and some significant challenges to address but I want to build upon our track record of delivery and my commitment is that we will do the very best to deliver services which best meet the needs and improve the lives of our patients within the resources available to us. Our partnerships with system colleagues, our public, patients and other partners and stakeholders are critical factors in our success and we will be working to ensure that we fulfil our roles in these partnerships.
2.0 Chief Executive meetings
Members may be interested to note the following meetings and events which the Chief Executive Officer has attended in recent weeks:
Date Meeting 01.02.19 CEO and FD provider meeting 04.02.19 Health Security Committee Meeting 06.02.19 Regional Financial Escalation Meeting 07.02.19 Extraordinary Governing Bodies Meeting in Common 08.02.19 PLACE meeting 08.02.19 CEO and FD provider meeting 15.02.19 Digital Strategy Meeting 25.02.19 Regional Financial Escalation meeting 25.02.19 Derby and Derbyshire safeguarding partnership team meeting 27.02.19 Finance Committee in Common 28.02.19 Derbyshire CCGs Governing Bodies in common meeting 01.03.19 CEO and FD provider meeting 06.03.19 STP leads development session 07.03.19 EMAS meeting 11.03.19 County Health Scrutiny Committee 13.03.19 GP provider leadership support meeting 14.03.19 Transition Working Group 15.03.19 EMAS contract discussion 15.03.19 Digital Strategy Meeting 15.03.19 CEO and FDs provider meeting 19.03.19 North and West Midlands Accountable Officers Workshop 21.03.19 Joined Up Care Derbyshire Board meeting 21.03.19 Health and Wellbeing Board meeting 22.03.19 CEO and FD provider meeting 27.03.19 Derbyshire Finance Committees in common meeting 28.03.19 Derbyshire CCGs Governing Bodies in common meeting 28.03.19 NHS England and NHS Improvement meeting 29.03.19 NHS Derby and Derbyshire CCG staff event
Page 18 of 220
3.0 Reports, studies, updates and news on health and care services
3.1 EU Exit Update Professor Keith Willett, Strategic Commander for EU Exit, has written to NHS organisations to advise that they should continue to prepare for EU Exit, working towards the current default exit date of 12 April. NHS England and Improvement have published updated information on planning for continuity of supply of medicines in the case of a ‘no deal’ exit, including supporting Q&As which may be helpful for healthcare professionals when having discussions with patients about their medicines and medical products. The nhs.uk website has also been updated with some patient-facing information on medicines supply.
3.2 NHS App All GP practices in England are being connected to the NHS App before 1 July 2019. Patients can already download the NHS App from app stores and use it to check their symptoms and get instant advice. Once their GP practice is connected, they will be able to book and manage appointments, order repeat prescriptions, securely view their GP medical record, and more. Guidance has been developed for practices and CCGs and information is available explaining how the NHS App will improve the patient experience of using digital services and bring benefits to practice staff. Practices in Derbyshire are due to go live w/c 20 May.
3.3 April is Bowel Cancer Awareness Month April is Bowel Cancer Awareness Month. Every 15 minutes in the UK someone is diagnosed with bowel cancer. It’s more common in the over 50s but can affect people of all ages.
3.4 Cervical screening awareness campaign In March 2019 Public Health England (PHE) launched a national campaign to help increase participation in the National Cervical Screening Programme. Cervical screening is estimated to save 5,000 lives a year and yet coverage is at a 20 year low. PHE has recently released an update blog on the campaign, including advice for women with symptoms and links to additional blogs for primary care.
3.5 Social prescribing As part of the NHS Long Term Plan’s commitment to personalised care, the NHS committed to funding 1,000 social prescribing link workers in primary care networks by April 2021. A summary guide to social prescribing describes what good looks like and there is more information on the role of the social prescribing link worker in a new case study and blog which was published to coincide with Social Prescribing Day on 14 March.
3.6 Conditions for which over the counter items should not routinely be prescribed in primary care – advice for implementing guidance for people living in care homes NHS England have recently produced a frequently asked questions resource, to facilitate the implementation of the recommendations of their publication detailing conditions for which over the counter medicines should not be routinely prescribed in primary care for people living in care homes.
Page 19 of 220 3.7 Staff and patients asked for their views on proposals to help the NHS deliver its Long Term Plan NHS England is currently seeking views on how targeted amendments to the law could help local and national health organisations work together more effectively to improve services for patients. People have until 25 April 2019 to give their views. More information is available here.
3.8 Delivering personalised care for the most severely injured service personnel NHS England and the Ministry of Defence have launched the Integrated Personal Commissioning for Veterans (IPC4V Framework), which is a new personalised care approach for the small number of Armed Forces personnel who have complex and enduring health conditions resulting from injury attributable to Service. IPC4V provides a framework for effectively planning and delivering Armed Forces aware care, underpinned by an improved discharge planning process. The framework brings together organisations at an earlier point in the care pathway to develop a personalised and integrated care plan with the individual, ensuring arrangements are in place as they transition to civilian life and beyond.
4.0 Local news updates for Derbyshire
Roadshows help tackle risk of diabetes
We’re working closely with local authority partners to host roadshows across Derby and Derbyshire to raise awareness of diabetes risk and help people protect themselves. Timed to coincide with Diabetes Prevention Week the roadshows help people avoid developing the condition and increase referrals of patients diagnosed as ‘pre-diabetic’ to the National Diabetes Prevention Programme. NHS Derby and Derbyshire Clinical Commissioning Group, together with Derby City Council, organised the events so people can talk to experts, find out their risk, get a blood pressure check and be referred into the support programme if appropriate. Across Derbyshire there have been more than 5,700 referrals between July 2016 and Jan this year. Almost half have gone on to have an initial assessment with the prevention programme, which is designed to stop or delay onset through a range of personalised lifestyle interventions. These include education on lifestyle choices, advice on how to reduce weight through healthier eating, and bespoke physical activity programmes. The NHS Long Term Plan announced that the programme which sees people at risk of developing Type 2 diabetes given help to lose weight, will double in size over the next few years to treat around 200,000 people a year. From July this year, online versions of the programme, which involve wearable technologies and apps to help those at risk of Type 2 Diabetes, will be provided for patients who find it difficult to attend sessions because of work or family commitments. Diabetes and its complications cost over £10 billion every year to treat and one in six patients in hospital has the condition.
For more information about ‘Healthier You’ Derbyshire’s National Diabetes Prevention Programme (NDPP) visit http://nhsstaywellderbyshire.co.uk/
Derbyshire patient, carer and citizen networking event planned An event to inform, inspire and activate public involvement in NHS and care services across Derby and Derbyshire is being held next month. Key healthcare organisations will share information about r services and how patients can get involved. Local patients and residents will be encouraged to share their involvement experience and the impact they are making. East Midlands Academic Health Science Network (EMAHSN) and the East Midlands Patient
Page 20 of 220 Public Involvement Senate are working in partnership with local healthcare organisations to host the event at The Derby Conference Centre Wednesday on Wednesday 15 May 2019 between 10am and 4pm. The NHS 10 Year Plan and local Sustainability Transformation Partnerships emphasise the need for more joined up care for patients and public and the importance of organisations involving patients, carers and citizens directly in decisions about health and care services. To encourage public involvement travel reimbursement is being offered.
For more information contact EMAHSN Patient Public Involvement Officer on 0115 8231431 or 07773610741, or email [email protected]
In the media
Derbyshire's health organisations merge as part of savings plan Derbyshire health chiefs have signed off on unprecedented multi-million-pound cutbacks, along with a landmark merger of the county’s main NHS organisations. At a meeting of the four Derbyshire Clinical Commissioning Groups (CCGs), the county’s NHS leadership approved plans to make £69.5 million in savings by next April. A decision was also sealed to merge the four CCGs (Erewash, Hardwick, North Derbyshire and Southern Derbyshire) into one organisation called NHS Derby and Derbyshire CCG. It is hoped forming the new organisation will make it easier to make large amounts of savings, make it more efficient and improve the consistency of quality and procedure across the county.
Are there any Resource Implications (including Financial, Staffing etc)?
No
Has Due Regard to the proactive duties of the Equality Act 2010 been taken into consideration in respect of the proposals within this report?
N/A
Have you involved patients, carers and the public in the preparation of the report?
N/A
Have any Quality and Compliance issues been identified/ actions taken
Page 21 of 220
N/A
Have any Conflicts of Interest been identified/ actions taken? N/A
Governing Body Assurance Framework N/A
Identification of Key Risks N/A
Page 22 of 220
Governing Body Meeting in Public
th 11 April 2019 Item No: 6 Report Title NHS Derby and Derbyshire CCG Constitution and Draft Committee Terms of References Author(s) Suzanne Pickering, Head of Governance Chrissy Tucker, Assistant Director of Corporate Strategy, Beverley Smith Director of Corporate Strategy and Development Sponsor (Director) Helen Dillistone, Executive Director of Corporate Strategy and Delivery
Paper for: Decision X Assurance X Discussion Information Recommendations Governing Body are asked to:
• NOTE the merger process for the creation of the new CCG
• APPROVE and FORMALLY ADOPT the NHS Derby and Derbyshire CCG Constitution
• APPROVE the draft Terms of Reference for the:
. Audit Committee . Remuneration Committee . Primary Care Commissioning Committee . Clinical and Lay Commissioning Committee . Finance Committee . Governance Committee . Quality and Performance Committee . Engagement Committee
Report Summary
Creation of the new CCG
An application to merge the CCGs was made to NHS England in August 2018 to create a single unified strategic commissioner co-terminous with both Derby and Derbyshire Local Authorities. (NB services in the Glossop area of Derbyshire are commissioned by Tameside and Glossop CCG). This application was fully supported by all partners of Derbyshire Joined Up Care. A single leadership structure, led by Dr Chris Clayton, was already in place and work commenced during 2018 and early 2019 to develop and implement a single staffing structure for the new organisation and to enhance joint decision-making through the creation
Page 23 of 220 of Committees in Common.
The new organisation was launched on 1st April , formed from the four former Derbyshire CCGs which are now legally dissolved, namely:
• NHS Erewash CCG • NHS Hardwick CCG • NHS North Derbyshire CCG • NHS Southern Derbyshire CCG
All assets, liabilities, staff and property were transferred from the dissolved CCGs to the new CCG on 1st April 2019.
A project group was established to lead and oversee the work, led by the Executive Director of Corporate Strategy & Delivery, with 360 Assurance providing support with our project management and governance processes. The project team worked closely with NHS England, including weekly assurance, to meet all the conditions required for the merger. We are pleased to report that formal approval was granted on 11th March 2019.
A key condition for the merger to be approved was the development of a new constitution for the new organisation.
NHS Derby and Derbyshire CCG Constitution
The CCG is a membership organisation, with 116 GP member practices throughout Derby and Derbyshire, which will make clinically driven decisions that will give patients and their carers a voice and put them at the heart of our work. The CCG has developed a Constitution which describes how it brings its GP member practices together to commission care for the residents of Derby and Derbyshire in the most effective way. Our Constitution sets out the powers that the member practices have decided to reserve to themselves as members of the CCG, and which powers they have decided to delegate to the Governing Body and its committees. It describes the governing principles, rules and procedures to ensure accountability and probity in the day to day running of the CCG and to ensure that it remains true to its vision.
The development and approach to the NHS Derby and Derbyshire CCG Constitution
The new NHS England model Constitution template was published in August 2018 and the new CGG has adopted this in developing and formulating the NHS Derby and Derbyshire CCG Constitution.
The draft Constitution development started in November 2018 and was developed by the CCG together with advice and recommendations being provided by the Transition Working Group (comprising of CCG Chairs, clinicians and governance representatives) on particular areas relating to the membership and composition of the Governing Body. Three drafts of the Constitution were submitted informally to NHS England for review and feedback. The support from NHS England has been invaluable in the development of the Constitution. The draft Constitution was approved by the former Derbyshire CCGs Governing Bodies Meeting in Common on the 24th January 2019 and this was formally submitted to NHS England on the 28th January 2019 for approval
The Constitution was approved by NHS England on the 19th February 2019
Page 24 of 220 Engagement and Consultation with the CCG Membership
As with all previous Constitutions, the CCGs are required to consult and engage with its membership and Governing Bodies in the development and approval of the Constitution. The December 2018 Governing Bodies Meeting in Common approved the commencement of the engagement with the CCG membership on the new draft NHS Derby and Derbyshire CCG Constitution. Engagement with the CCG membership took place over a three week period between the 16th December 2018 and the 9th January 2019.
Feedback and comments from the membership were considered fully and reflected in the final draft Constitution.
NHS Derby and Derbyshire CCG Committees
NHS Derby and Derbyshire CCG Governing Body has a total of eight formal Committees, including three statutory Committees. These are:
• Audit Committee • Remuneration Committee • Primary Care Commissioning Committee
There are five non-statutory Committees. These are:
• Clinical and Lay Commissioning Committee • Finance Committee • Governance Committee • Engagement Committee • Quality and Performance Committee
Draft NHS Derby and Derbyshire CCG Terms of References
As a starting point the Terms of References for the Committees have been drafted by drawing upon the existing ones from the Derbyshire CCGs Committees in Common. The Terms of References membership, roles and responsibilities, chairing and quoracy arrangements and reporting arrangements have been developed and reviewed through an engagement process with the responsible Committee, the Committee Chair and the lead Executive Director.
The Derbyshire CCGs Transitional Working Group have also been involved in the review and made further recommendations.
The Committees of NHS Derby and Derbyshire CCG will be established from 1st April 2019. A review period of 6 months has been set to enable the Committees to develop and become established and any changes to the terms of references made accordingly.
Are there any Resource Implications (including Financial, Staffing etc)?
Resource implications have been identified and managed through the merger process.
Has Due Regard to the proactive duties of the Equality Act 2010 been taken into consideration in respect of the proposals within this report?
Not required for this paper; however, an Equality Impact Assessment was undertaken as part of the steps to create a single CCG for Derbyshire. There were no adverse
Page 25 of 220 consequences or impacts identified in this regard. The Equality Act 2010 is a statutory responsibility of the CCG and will continue to be an integral statutory duty of NHS Derby and Derbyshire CCG.
Have you involved patients, carers and the public in the preparation of the report?
The public will be involved in any service changes or developments proposed through the delivery of the Commissioning Strategy.
Have any Quality and Compliance issues been identified/ actions taken
Not required for this paper. Notwithstanding this, where any issues/risks are identified from a Quality Impact Assessment and/or Data Protection Impact Assessment (DPIA) then appropriate actions will be taken to managed the associated risks.
Have any Conflicts of Interest been identified/ actions taken? None identified.
Governing Body Assurance Framework Any corporate risks relating to this agenda and recorded in the Risk Register are aligned to the Governing Body Assurance Framework.
Identification of Key Risks A project risk register has been in place throughout the process to record risks that may impact on the progress of the application.
Page 26 of 220
NHS DERBY AND DERBYSHIRE CLINICAL COMMISSIONING GROUP
CONSTITUTION
Page 27 of 220 NHS Derby and Derbyshire Clinical Commissioning Group Constitution
Version Effective Changes Date
V1 Aug 2018 Standard model
V2 15 October Draft NHS Derby and Derbyshire CCG Constitution 2018
V2.1 13 Updated Draft NHS Derby and Derbyshire CCG Constitution with November NHSE Feedback 2018
V2.2 28 Updated Draft NHS Derby and Derbyshire CCG Constitution with November NHSE Feedback
2018
V 2.3 11 December Updated Draft NHS Derby and Derbyshire CCG Constitution with 2018 NHS Feedback, E Polgar NHS England , Derbyshire CCG’s Lay Members and Engagement with the Derbyshire CCGs membership
V2.4 25 January Updated Draft NHS Derby and Derbyshire CCG Constitution 2019 following approval of the draft at the Derbyshire CCGs Governing Body Meetings in Common 24 January 2019
V3.0 31 January Updated Draft NHS Derby and Derbyshire CCG Constitution 2019 following formal feedback from NHS England received 31.1.19
V3.1 19 February Final Approved NHS Derby and Derbyshire CCG Constitution 2019
Page 28 of 220
Page 29 of 220 CONTENTS
1 Introduction ...... 6 1.1 Name ...... 6 1.2 Statutory Framework ...... 6 1.3 Status of this Constitution ...... 7 1.4 Amendment and Variation of this Constitution ...... 7 1.5 Related documents ...... 7 1.6 Accountability and transparency ...... 8 1.7 Liability and Indemnity ...... 11
2 Area Covered by the CCG ...... 13
3 Membership Matters ...... 23 3.1 Membership of the Clinical Commissioning Group ...... 23 3.2 Nature of Membership and Relationship with CCG ...... 30 3.3 Speaking, Writing or Acting in the Name of the CCG ...... 31 3.4 Members’ Rights ...... 31 3.5 Members’ Meetings ...... 31 3.6 Practice Representatives ...... 32
4 Arrangements for the Exercise of our Functions...... 33 4.1 Good Governance ...... 33 4.2 General ...... 33 4.3 Authority to Act: the CCG ...... 34 4.4 Authority to Act: the Governing Body ...... 34
5 Procedures for Making Decisions ...... 35 5.1 Scheme of Reservation and Delegation ...... 35 5.2 Standing Orders ...... 35 5.3 Standing Financial Instructions (SFIs) ...... 35 5.4 The Governing Body: Its Role and Functions ...... 35 5.5 Composition of the Governing Body ...... 37 5.6 Additional Attendees at the Governing Body Meetings ...... 38 5.7 Appointments to the Governing Body ...... 38 5.8 Committees and Sub-Committees ...... 39 5.9 Committees of the Governing Body ...... 39
Page 30 of 220 5.10 Collaborative Commissioning Arrangements ...... 40 5.11 Joint Commissioning Arrangements with Local Authority Partners ...... 41 5.12 Joint Commissioning Arrangements – Other CCGs ...... 43 5.13 Joint Commissioning Arrangements with NHS England ...... 45
6 Provisions for Conflict of Interest Management and Standards of Business Conduct ...... 47 6.1 Conflicts of Interest ...... 47 6.2 Declaring and Registering Interests ...... 47 6.3 Training in Relation to Conflicts of Interest ...... 48 6.4 Standards of Business Conduct ...... 48
Appendix 1: Definitions of Terms Used in This Constitution ...... 50
Appendix 2: Committee Terms of Reference ...... 53
Appendix 3: Standing Orders ...... 73
Appendix 4: Standing Financial Instructions – Financial Limits for Delegated Authority ...... 88
Page 31 of 220 1 Introduction
1.1 Name
The name of this clinical commissioning group is NHS Derby and Derbyshire Clinical Commissioning Group (“the 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) Equality, including the public-sector equality duty (under the Equality Act 2010); and f) Information law, (for instance under data protection laws, such as the EU General Data Protection Regulation 2016/679, and the Freedom of Information Act 2000). 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.
Page 32 of 220 1.2.5 CCGs are clinically-led membership organisations made up of general practices. The Members of the CCG 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 1st April 2019.
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 www.derbyandderbyshireccg.nhs.uk.
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 c) The Accountable Officer may periodically propose amendments to the constitution which shall be considered and approved by the Governing Body unless: • Changes are thought to have a material impact • Changes are proposed to the reserved powers of the members; • At least half (50%) of all the Governing Body Members formally request that the amendments be put before the membership 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 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 selection and appointment processes for the CCG’s Committees, and the CCG Governing Body (including Committees).
Page 33 of 220 b) Prime financial policies – which set out the arrangements for managing the CCG’s financial affairs. These are available in the Governance Handbook.
c) The CCG Governance Handbook – which includes:
• Standards of Business Conduct Policy – which includes the arrangements the CCG has made for the management of conflicts of interest; • The Scheme of Reservation and Delegation (SoRD); • Committee Terms of Reference • Prime Financial Policies • Standing Financial Instructions • Roles and Responsibilities • Corporate Governance Framework • General Duties 1.6 Accountability and transparency 1.6.1 The CCG will demonstrate its accountability to its members, 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 • CCG Governance Handbook;
b) appoint independent lay members and non-GP clinicians to our Governing Body;
c) manage actual or potential conflicts of interest in line with NHS England’s statutory guidance Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017 and expected standards of good practice (see also part 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 its duties under section 14Z2 of the 2006 Act, and as set out in more detail in the CCG’s Clinical
Page 34 of 220 Commissioning Strategy and Engagement Strategy. Further information can be found on the following website www.derbyandderbyshireccg.nhs.uk. h) When discharging its duties under section 14Z2, the CCG will ensure that it will make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements by:
i. delegating responsibility to its Governing Body and monitor its progress
ii. The Governing Body will delegate the responsibility for developing and delivering an Engagement Strategy which builds continuous and meaningful engagement with the public, patients and carers to influence the shaping of services and improve the health of people in Derbyshire including:
. working closely with seldom heard groups to ensure they have a voice
. using patient experience data and information to inform our work
. engaging all GP members, including practice managers, and CCG staff in the development and ongoing work of the CCG to ensure they are involved in the core business and related work streams
. support the development of relationships with key stakeholders to ensure partnership working and involvement
. develop core materials and mechanisms for ongoing two-way communications between the CCG and public to allow continual feedback in commissioning decisions 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;
Page 35 of 220 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
o) be an active member of the local Health and Wellbeing Board(s).
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 www.derbyandderbyshireccg.nhs.uk a) The CCG’s policies and procedures; b) Annual reports and Governance Statements; c) Minutes of public meetings of the Governing Body; d) Relevant equality and diversity documents and information and comply with the Public Sector Equality Duty; e) Relevant business resilience and emergency planning documents and information; f) Patient information documents, including notices of any public engagement event; g) Other communications issued by the CCG, including the clinical commissioning strategy, the financial plan and notices of procurement, public consultations, reports, Governing Body meetings dates, venues and papers, and; h) Details of the CCG’s key strategic priorities and plans; i) Expenditure over £25,000; j) Register of Interests; k) Register of Conflicts declared during meetings; l) Gifts and Hospitality Register; m) Register of Procurements decisions.
1.6.3 The Governing Body of the CCG will throughout the year have an on- going role in reviewing the CCG’s governance arrangements, to ensure that the CCG continues to reflect the principles of good governance. 1.6.4 The CCG may use other means of communication, including circulating information by post, electronic methods or making information available in venues or services accessible to the public. 1.6.5 The Statement of Principles of Derby and Derbyshire CCG in respect of public involvement are: i) We will work in partnership and involve local people, partners and staff at all stages in planning, shaping, designing and delivering services, and in setting priorities for Derby and Derbyshire. We will make the involvement of people central to everything we do and we aim to make
Page 36 of 220 it as easy as we can for people to be involved and to actively include them in ways that are meaningful and give real opportunities to influence. ii) We will also tell people how their involvement has influenced decisions. Prioritising local health needs may mean that on occasions we are not able to do what people want, if that happens we will explain why and be held to account for our decisions. iii) We aim to involve and engage local people through ongoing engagement and through project engagement, including through the following mechanisms: • Work in partnership with HealthWatch – the CCG will develop close working relationships with HealthWatch. A member of HealthWatch will also sit on the CCG Engagement Committee • Communications and engagement network – a map and contacts database for the CCG across Derby and Derbyshire that link to patients and the public to ensure a mechanism for two-way communication into and out from the CCG to existing groups • There will be 2 Governing Body Leads for Involvement – These roles will provide strategic leadership across the CCG for engagement and involvement and will chair the CCG Engagement Committee. • Patient Participation Groups (PPGs) – set up for each practice drawing in patients from local practice population. • Each of the 8 Places will look to develop lay participation in their local work
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 or former Member, nor any person who is at any time a proprietor, officer or employee of any Member or former Member, shall be liable (whether as a Member or as an individual) for the debts, liabilities, acts or omissions, howsoever caused by the CCG in discharging its statutory functions.
No Member or former Member, nor any person who is at any time a proprietor, officer or employee of any Member of former Member, shall be
Page 37 of 220 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 CCGs’ business, provided that the person indemnified shall not have acted recklessly or with gross negligence.
Page 38 of 220 2 Area Covered by the CCG 2.1.1 The geographical area covered by NHS Derby and Derbyshire Clinical Commissioning Group is approximately 2495 km2 within Derbyshire and Derby City.
2.1.2 As NHS Derby and Derbyshire CCG is not fully coterminous with the areas covered by Local Authorities, the area covered by the CCG is defined by the Lower Layer Super Output Areas (LSOAs) as listed below.
Page 39 of 220 The CCG has circa 40,000 patients in the geographical area of the Derby and Derbyshire CCG who are registered with Tameside and Glossop CCG.
2.1.3 The following are the District and Borough Councils and the Upper Tier Local Authority which the CCG covers.
• the County Council of Derbyshire • the City Council of Derby • the Borough of Chesterfield • the Borough of High Peak • the Borough of Amber Valley • the Borough of Erewash • the District of Bolsover • the District of North East Derbyshire • the District of Derbyshire Dales
2.1.4 In Derbyshire County Council Local Authority the CCG covers the following Lower Layer Super Output Areas (LSOAs):
LSOA Code LSOA Name LSOA Code LSOA Name E01019400 Amber Valley 001A E01019426 Amber Valley 016B E01019401 Amber Valley 001B E01019427 Amber Valley 016C E01019402 Amber Valley 001C E01019428 Amber Valley 007C E01019403 Amber Valley 003A E01019429 Amber Valley 006A E01019404 Amber Valley 001D E01019430 Amber Valley 007D E01019405 Amber Valley 007A E01019431 Amber Valley 012A E01019406 Amber Valley 002A E01019432 Amber Valley 008C E01019407 Amber Valley 010A E01019433 Amber Valley 012B E01019408 Amber Valley 009A E01019434 Amber Valley 013A E01019409 Amber Valley 009B E01019435 Amber Valley 013B E01019410 Amber Valley 011A E01019436 Amber Valley 013C E01019411 Amber Valley 011B E01019437 Amber Valley 017A E01019412 Amber Valley 009C E01019438 Amber Valley 012C E01019413 Amber Valley 009D E01019439 Amber Valley 013D E01019414 Amber Valley 007B E01019440 Amber Valley 013E E01019415 Amber Valley 010B E01019441 Amber Valley 017B E01019416 Amber Valley 009E E01019442 Amber Valley 005B E01019417 Amber Valley 010C E01019443 Amber Valley 004A E01019418 Amber Valley 011C E01019444 Amber Valley 003B E01019419 Amber Valley 010D E01019445 Amber Valley 005C E01019420 Amber Valley 005A E01019446 Amber Valley 015A
Page 40 of 220 E01019421 Amber Valley 008A E01019447 Amber Valley 011D E01019422 Amber Valley 008B E01019448 Amber Valley 015B E01019423 Amber Valley 002B E01019449 Amber Valley 011E E01019424 Amber Valley 002C E01019450 Amber Valley 015C E01019425 Amber Valley 016A E01019451 Amber Valley 012D
LSOA Code LSOA Name LSOA Code LSOA Name E01019452 Amber Valley 017C E01019497 Bolsover 003B E01019453 Amber Valley 017D E01019498 Bolsover 003C E01019454 Amber Valley 006B E01019499 Bolsover 010A E01019455 Amber Valley 005D E01019500 Bolsover 010B E01019456 Amber Valley 005E E01019501 Bolsover 010C E01019457 Amber Valley 005F E01019502 Bolsover 005E E01019458 Amber Valley 008D E01019503 Bolsover 007A E01019459 Amber Valley 008E E01019504 Bolsover 005F E01019460 Amber Valley 006C E01019505 Bolsover 007B E01019461 Amber Valley 006D E01019506 Bolsover 007C E01019462 Amber Valley 006E E01019507 Bolsover 007D E01019463 Amber Valley 008F E01019508 Bolsover 006A E01019464 Amber Valley 012E E01019509 Bolsover 006B E01019465 Amber Valley 015D E01019510 Bolsover 006C E01019467 Amber Valley 015E E01019511 Bolsover 007E E01019468 Amber Valley 003C E01019512 Bolsover 006D E01019469 Amber Valley 003D E01019513 Bolsover 010D E01019470 Amber Valley 004B E01019514 Bolsover 009B E01019471 Amber Valley 003E E01019515 Bolsover 009C E01019472 Amber Valley 016D E01019516 Bolsover 009D E01019473 Amber Valley 004C E01019517 Bolsover 010E E01019474 Amber Valley 004D E01019518 Bolsover 010F E01019475 Amber Valley 004E E01019519 Bolsover 009E E01019476 Amber Valley 004F E01019520 Bolsover 008C E01019477 Amber Valley 002D E01019521 Bolsover 008D E01019478 Bolsover 001A E01019522 Bolsover 008E E01019479 Bolsover 001B E01019523 Bolsover 003D E01019480 Bolsover 008A E01019524 Bolsover 002C E01019481 Bolsover 009A E01019525 Bolsover 002D E01019482 Bolsover 008B E01019526 Chesterfield 001A E01019483 Bolsover 004A E01019527 Chesterfield 003A E01019484 Bolsover 004B E01019528 Chesterfield 001B E01019485 Bolsover 004C E01019529 Chesterfield 003B E01019486 Bolsover 005A E01019530 Chesterfield 003C E01019487 Bolsover 005B E01019531 Chesterfield 003D E01019488 Bolsover 004D E01019532 Chesterfield 005A E01019489 Bolsover 005C E01019533 Chesterfield 005B
Page 41 of 220 E01019490 Bolsover 005D E01019534 Chesterfield 005C E01019491 Bolsover 001C E01019535 Chesterfield 005D E01019492 Bolsover 002A E01019536 Chesterfield 005E E01019493 Bolsover 001D E01019537 Chesterfield 007A E01019494 Bolsover 001E E01019538 Chesterfield 010A E01019495 Bolsover 002B E01019539 Chesterfield 009A E01019496 Bolsover 003A E01019540 Chesterfield 009B
LSOA Code LSOA Name LSOA Code LSOA Name E01019541 Chesterfield 004A E01019586 Chesterfield 011A E01019542 Chesterfield 004B E01019587 Chesterfield 011B E01019543 Chesterfield 004C E01019588 Chesterfield 011C E01019544 Chesterfield 004D E01019589 Chesterfield 011D E01019545 Chesterfield 012A E01019590 Chesterfield 009D E01019546 Chesterfield 012B E01019591 Chesterfield 009E E01019547 Chesterfield 012C E01019592 Chesterfield 011E E01019548 Chesterfield 012D E01019593 Chesterfield 011F E01019549 Chesterfield 006A E01019594 Derbyshire Dales 009A E01019550 Chesterfield 006B E01019595 Derbyshire Dales 008A E01019551 Chesterfield 006C E01019596 Derbyshire Dales 009B E01019552 Chesterfield 006D E01019597 Derbyshire Dales 009C E01019553 Chesterfield 003E E01019598 Derbyshire Dales 009D E01019554 Chesterfield 010B E01019599 Derbyshire Dales 003A E01019555 Chesterfield 009C E01019600 Derbyshire Dales 002A E01019556 Chesterfield 010C E01019601 Derbyshire Dales 003B E01019557 Chesterfield 008A E01019602 Derbyshire Dales 001A E01019558 Chesterfield 008B E01019603 Derbyshire Dales 010A E01019559 Chesterfield 008C E01019604 Derbyshire Dales 002B E01019560 Chesterfield 008D E01019605 Derbyshire Dales 008B E01019561 Chesterfield 008E E01019606 Derbyshire Dales 002C E01019562 Chesterfield 008F E01019607 Derbyshire Dales 010B E01019563 Chesterfield 002A E01019608 Derbyshire Dales 004A E01019564 Chesterfield 002B E01019609 Derbyshire Dales 005A E01019565 Chesterfield 002C E01019610 Derbyshire Dales 004B E01019566 Chesterfield 002D E01019611 Derbyshire Dales 008C E01019567 Chesterfield 006E E01019612 Derbyshire Dales 010C E01019568 Chesterfield 002E E01019613 Derbyshire Dales 003C E01019569 Chesterfield 007B E01019614 Derbyshire Dales 001B E01019570 Chesterfield 007C E01019615 Derbyshire Dales 001C E01019571 Chesterfield 004E E01019616 Derbyshire Dales 008D E01019572 Chesterfield 001C E01019617 Derbyshire Dales 003D E01019573 Chesterfield 001D E01019618 Derbyshire Dales 002D E01019574 Chesterfield 001E E01019619 Derbyshire Dales 006A E01019575 Chesterfield 013A E01019620 Derbyshire Dales 006B E01019576 Chesterfield 013B E01019621 Derbyshire Dales 005B
Page 42 of 220 E01019577 Chesterfield 013C E01019622 Derbyshire Dales 005C E01019578 Chesterfield 013D E01019623 Derbyshire Dales 006C E01019579 Chesterfield 010D E01019624 Derbyshire Dales 005D E01019580 Chesterfield 007D E01019625 Derbyshire Dales 006D E01019581 Chesterfield 007E E01019626 Derbyshire Dales 006E E01019582 Chesterfield 012E E01019627 Derbyshire Dales 005E E01019583 Chesterfield 012F E01019628 Derbyshire Dales 005F E01019585 Chesterfield 012G E01019629 Derbyshire Dales 010D
LSOA Code LSOA Name LSOA Code LSOA Name E01019630 Derbyshire Dales 004C E01019675 Erewash 012B E01019631 Derbyshire Dales 001D E01019676 Erewash 014A E01019632 Derbyshire Dales 006F E01019677 Erewash 014B E01019633 Derbyshire Dales 007A E01019678 Erewash 014C E01019634 Derbyshire Dales 007B E01019679 Erewash 012C E01019635 Derbyshire Dales 007C E01019680 Erewash 014D E01019636 Derbyshire Dales 007D E01019681 Erewash 014E E01019638 Erewash 016A E01019682 Erewash 012D E01019639 Erewash 016B E01019683 Erewash 009A E01019640 Erewash 016C E01019684 Erewash 009B E01019641 Erewash 011A E01019685 Erewash 009C E01019642 Erewash 013A E01019686 Erewash 009D E01019643 Erewash 013B E01019687 Erewash 009E E01019644 Erewash 001A E01019688 Erewash 006D E01019645 Erewash 016D E01019689 Erewash 006E E01019646 Erewash 001B E01019690 Erewash 003F E01019647 Erewash 012A E01019691 Erewash 008B E01019648 Erewash 010A E01019692 Erewash 008C E01019649 Erewash 010B E01019693 Erewash 008D E01019650 Erewash 010C E01019694 Erewash 008E E01019651 Erewash 010D E01019695 Erewash 010E E01019652 Erewash 011B E01019696 Erewash 008F E01019653 Erewash 011C E01019697 Erewash 015A E01019654 Erewash 013C E01019698 Erewash 014F E01019655 Erewash 013D E01019699 Erewash 015B E01019656 Erewash 008A E01019700 Erewash 015C E01019657 Erewash 003A E01019701 Erewash 004C E01019658 Erewash 006A E01019702 Erewash 005B E01019659 Erewash 006B E01019703 Erewash 005C E01019660 Erewash 003B E01019704 Erewash 005D E01019661 Erewash 003C E01019705 Erewash 015D E01019662 Erewash 003D E01019706 Erewash 015E E01019663 Erewash 001C E01019707 Erewash 011D E01019664 Erewash 001D E01019708 Erewash 011E E01019665 Erewash 001E E01019709 Erewash 015F
Page 43 of 220 E01019666 Erewash 007A E01019710 High Peak 010A E01019667 Erewash 007B E01019711 High Peak 006A E01019668 Erewash 007C E01019712 High Peak 008A E01019669 Erewash 007D E01019713 High Peak 008B E01019670 Erewash 004A E01019714 High Peak 012A E01019671 Erewash 004B E01019715 High Peak 010B E01019672 Erewash 003E E01019716 High Peak 011A E01019673 Erewash 005A E01019717 High Peak 010C E01019674 Erewash 006C E01019718 High Peak 013E
LSOA Code LSOA Name LSOA Code LSOA Name E01019719 High Peak 013F E01019784 North East Derbyshire 006B E01019720 High Peak 013G E01019785 North East Derbyshire 006C E01019721 High Peak 013H E01019786 North East Derbyshire 004D E01019722 High Peak 010D E01019787 North East Derbyshire 005B E01019723 High Peak 010E E01019788 North East Derbyshire 005C E01019724 High Peak 011B E01019790 North East Derbyshire 002C E01019725 High Peak 012B E01019791 North East Derbyshire 014A E01019726 High Peak 012C E01019792 North East Derbyshire 014B E01019734 High Peak 006B E01019793 North East Derbyshire 006D E01019735 High Peak 013A E01019794 North East Derbyshire 005D E01019736 High Peak 013B E01019795 North East Derbyshire 006E E01019737 High Peak 013C E01019796 North East Derbyshire 009A E01019741 High Peak 013I E01019797 North East Derbyshire 009B E01019742 High Peak 013D E01019798 North East Derbyshire 007A E01019743 High Peak 006C E01019799 North East Derbyshire 009C E01019744 High Peak 006D E01019800 North East Derbyshire 009D E01019745 High Peak 006E E01019801 North East Derbyshire 001A E01019746 High Peak 005A E01019802 North East Derbyshire 001B E01019747 High Peak 005B E01019803 North East Derbyshire 001C E01019748 High Peak 005C E01019804 North East Derbyshire 001D E01019755 High Peak 005D E01019805 North East Derbyshire 001E E01019759 High Peak 011C E01019806 North East Derbyshire 001F E01019760 High Peak 011D E01019807 North East Derbyshire 001G E01019761 High Peak 011E E01019808 North East Derbyshire 009E E01019762 High Peak 012D E01019809 North East Derbyshire 011A E01019764 High Peak 008C E01019810 North East Derbyshire 011B E01019765 High Peak 008D E01019811 North East Derbyshire 011C E01019766 High Peak 005E E01019812 North East Derbyshire 011D E01019767 High Peak 008E E01019813 North East Derbyshire 011E E01019769 North East Derbyshire 010A E01019814 North East Derbyshire 013A E01019770 North East Derbyshire 005A E01019815 North East Derbyshire 014C E01019771 North East Derbyshire 008A E01019816 North East Derbyshire 002D E01019772 North East Derbyshire 008B E01019817 North East Derbyshire 013B E01019773 North East Derbyshire 012A E01019818 North East Derbyshire 013C
Page 44 of 220 E01019774 North East Derbyshire 010B E01019819 North East Derbyshire 013D E01019775 North East Derbyshire 012B E01019820 North East Derbyshire 013E E01019776 North East Derbyshire 012C E01019821 North East Derbyshire 007B E01019777 North East Derbyshire 012D E01019822 North East Derbyshire 007C E01019778 North East Derbyshire 002A E01019823 North East Derbyshire 007D E01019779 North East Derbyshire 002B E01019824 North East Derbyshire 010C E01019780 North East Derbyshire 004A E01019825 North East Derbyshire 011F E01019781 North East Derbyshire 004B E01019826 North East Derbyshire 009F E01019782 North East Derbyshire 004C E01019827 North East Derbyshire 004E E01019783 North East Derbyshire 006A E01019828 North East Derbyshire 008C
LSOA Code LSOA Name LSOA Code LSOA Name E01019829 North East Derbyshire 008D E01019875 South Derbyshire 003C E01019830 North East Derbyshire 010D E01019876 South Derbyshire 009A E01019831 North East Derbyshire 010E E01019877 South Derbyshire 009B E01019832 South Derbyshire 004A E01019878 South Derbyshire 009C E01019833 South Derbyshire 004B E01019879 South Derbyshire 009D E01019834 South Derbyshire 004C E01019880 South Derbyshire 005D E01019835 South Derbyshire 004D E01019881 South Derbyshire 003D E01019837 South Derbyshire 012A E01019882 South Derbyshire 003E E01019838 South Derbyshire 012B E01019883 South Derbyshire 013B E01019839 South Derbyshire 001A E01019885 South Derbyshire 013C E01019840 South Derbyshire 002A E01032586 North East Derbyshire 014D E01019841 South Derbyshire 002B E01032613 Amber Valley 017E E01019842 South Derbyshire 013A E01032614 Erewash 016E E01019843 South Derbyshire 006A E01033387 Chesterfield 010F E01019844 South Derbyshire 007A E01033388 Chesterfield 010G E01019845 South Derbyshire 001B E01033531 South Derbyshire 012C E01019846 South Derbyshire 001C E01033532 South Derbyshire 002F E01019847 South Derbyshire 002C E01033533 South Derbyshire 002G E01019848 South Derbyshire 002D E01033534 South Derbyshire 002H E01019850 South Derbyshire 011A E01033535 South Derbyshire 013D E01019851 South Derbyshire 011B E01033536 South Derbyshire 012D E01019852 South Derbyshire 011C E01033537 South Derbyshire 012E E01019853 South Derbyshire 006B E01013453 Derby 013A E01019854 South Derbyshire 006C E01013454 Derby 013B E01019855 South Derbyshire 006D E01013455 Derby 017A E01019856 South Derbyshire 007B E01013456 Derby 013C E01019857 South Derbyshire 007C E01013457 Derby 013D E01019858 South Derbyshire 007D E01013458 Derby 017B E01019859 South Derbyshire 007E E01013459 Derby 020A E01019860 South Derbyshire 008A E01013460 Derby 013E E01019861 South Derbyshire 008B E01013461 Derby 001A E01019862 South Derbyshire 008C E01013462 Derby 001B E01019863 South Derbyshire 008D E01013463 Derby 001C
Page 45 of 220 E01019864 South Derbyshire 008E E01013464 Derby 001D E01019865 South Derbyshire 008F E01013465 Derby 002A E01019866 South Derbyshire 001D E01013466 Derby 002B E01019867 South Derbyshire 005A E01013467 Derby 002C E01019868 South Derbyshire 005B E01013468 Derby 002D E01019869 South Derbyshire 005C E01013469 Derby 002E E01019870 South Derbyshire 011D E01013470 Derby 024A E01019871 South Derbyshire 011E E01013471 Derby 025A E01019872 South Derbyshire 011F E01013472 Derby 026A E01019873 South Derbyshire 003A E01013473 Derby 025B E01019874 South Derbyshire 003B E01013474 Derby 024B
LSOA Code LSOA Name LSOA Code LSOA Name E01013475 Derby 025C E01013522 Derby 008A E01013476 Derby 024C E01013523 Derby 008B E01013477 Derby 025D E01013524 Derby 008C E01013479 Derby 013F E01013525 Derby 008D E01013480 Derby 016A E01013526 Derby 005A E01013481 Derby 018A E01013527 Derby 005B E01013483 Derby 016B E01013528 Derby 005C E01013484 Derby 018C E01013529 Derby 005D E01013485 Derby 016C E01013530 Derby 004A E01013486 Derby 018D E01013531 Derby 004B E01013487 Derby 018E E01013532 Derby 004C E01013488 Derby 022A E01013533 Derby 007A E01013489 Derby 022B E01013534 Derby 006D E01013490 Derby 022C E01013535 Derby 007B E01013491 Derby 022D E01013536 Derby 007C E01013492 Derby 027A E01013537 Derby 007D E01013493 Derby 027B E01013538 Derby 007E E01013494 Derby 027C E01013539 Derby 021A E01013495 Derby 027D E01013540 Derby 019A E01013496 Derby 028A E01013541 Derby 021B E01013497 Derby 026B E01013542 Derby 017C E01013498 Derby 028B E01013543 Derby 021C E01013499 Derby 028C E01013544 Derby 021D E01013500 Derby 028D E01013545 Derby 021E E01013501 Derby 028E E01013546 Derby 017D E01013502 Derby 025E E01013547 Derby 011A E01013503 Derby 025F E01013548 Derby 009A E01013504 Derby 026C E01013549 Derby 009B E01013505 Derby 006A E01013550 Derby 011B E01013506 Derby 006B E01013551 Derby 011C E01013507 Derby 012A E01013552 Derby 009C E01013508 Derby 012B E01013553 Derby 009D
Page 46 of 220 E01013509 Derby 012C E01013554 Derby 011D E01013510 Derby 012D E01013555 Derby 009E E01013511 Derby 012E E01013556 Derby 015A E01013512 Derby 012F E01013557 Derby 015B E01013513 Derby 006C E01013558 Derby 015C E01013514 Derby 031A E01013559 Derby 015D E01013515 Derby 031B E01013560 Derby 019B E01013517 Derby 030B E01013561 Derby 019C E01013518 Derby 030C E01013562 Derby 019D E01013519 Derby 031C E01013563 Derby 019E E01013520 Derby 031D E01013564 Derby 015E E01013521 Derby 030D E01013565 Derby 016D
LSOA Code LSOA Name E01013566 Derby 016E E01013567 Derby 020B E01013568 Derby 020C E01013569 Derby 020D E01013570 Derby 023A E01013571 Derby 023B E01013572 Derby 023C E01013573 Derby 023D E01013574 Derby 003A E01013575 Derby 003B E01013576 Derby 003C E01013577 Derby 003D E01013578 Derby 003E E01013579 Derby 003F E01013580 Derby 003G E01013581 Derby 004D E01013582 Derby 006E E01013583 Derby 026D E01013584 Derby 029A E01013585 Derby 029B E01013586 Derby 029C E01013587 Derby 029D E01013588 Derby 029E E01013589 Derby 029F E01013590 Derby 026E E01013591 Derby 026F E01013592 Derby 010A E01013593 Derby 014A E01013594 Derby 010B E01013595 Derby 014B E01013596 Derby 010C
Page 47 of 220 E01013597 Derby 014C E01013598 Derby 014D E01013599 Derby 010D E01033166 Derby 018F E01033167 Derby 018G E01033168 Derby 030E E01033169 Derby 030F E01033170 Derby 030G E01033171 Derby 024E E01033172 Derby 024F
Page 48 of 220 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 who 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 practices which make up the membership of the CCG are listed below.
Practice Name Address Place Adam House 85-91 Derby Road, Sandiacre, Nottingham, Erewash Medical Centre NG10 5HZ The Aitune Midland Street, Long Eaton, Nottingham, NG10 Erewash Medical Practice 1RY Alvaston Medical 14 Boulton Lane, Alvaston, Derby, DE24 0GE Derby City Centre Appletree Medical 47A Town Street, Duffield, Derby, DE56 4GG Amber Practice Valley Arden House Sett Close, New Mills, SK22 4AQ High Peak Medical Practice Arthur Medical Main Street, Horsley Woodhouse, Derby, DE7 Amber Centre 6AX Valley Ashbourne Clifton Road, Ashbourne, Derby, DE6 1DR Derbyshire Medical Practice Dales Ashbourne Clifton Road, Ashbourne, Derby, DE6 1RR Derbyshire Surgery Dales
Ashover Medical Milken Lane, Ashover, Chesterfield, S45 0BA Derbyshire Centre Dales
Bakewell Medical Butts Quarry, Bakewell, De45 1ED Derbyshire Centre Dales Barlborough 7 Worksop Road, Barlborough, Chesterfield, Bolsover and Medical Practice S43 4TY North Eastern Derbyshire
Page 49 of 220 Baslow Health Church Lane, Baslow, Bakewell, DE45 1SP Derbyshire Centre Dales Blackwell Medical 6 Gloves Lane, Blackwell, Alfreton, DE55 5JJ Bolsover and Centre North Eastern Derbyshire Blue Dykes Eldon Street, Clay Cross, Chesterfield, S45 Bolsover and Surgery 9NR North Eastern Derbyshire Brailsford Medical The Green, Derby, DE6 3BX Derbyshire Centre Dales Brimington Church Street, Brimington, Chesterfield, S41 Chesterfield Surgery 1JG The Brook Medical 183 Kedleston Road, Derby, DE22 1FT Derby City Centre Brooklyn Medical 65 Mansfield Road, Derby, DE75 7AL Amber Practice Valley Buxton Medical Temple Road, Buxton, SK17 9BZ High Peak Practice Calow & Foljambe Road, Brimington, Chesterfield, S43 Chesterfield Brimington 1DD Practice Castle Street Castle Street, Bolsover, Chesterfield, S44 6PP Bolsover and Medical Centre North Eastern Derbyshire Chapel Street 10 Chapel Street, Spondon, Derby, DE21 7RJ Derby City Medical Centre Charnwood 5 Burton Road, Derby, DE1 1TH Derby City Surgery Chatsworth Road Chatsworth Road, Brampton, Chesterfield, S40 Chesterfield Medical Centre 3PY Chellaston & Rowallan Way, Chellaston, Derby, DE73 5GB Derby City Melbourne Medical Practice
Chesterfield Ashgate Manor, Ashgate Road, Chesterfield, Chesterfield
Page 50 of 220 Medical S40 4AA Partnership Clay Cross Bridge Street, Clay Cross, Chesterfield, S45 Bolsover and Medical Centre 9NG North Eastern Derbyshire College Street 86 College Street, Long Eaton, Nottingham, Erewash Medical Practice NG10 4NP Crags Health Care 174 Elmton Road, Creswell, Worksop, S80 4DY Bolsover and North Eastern Derbyshire Creswell & Welbeck Street, Creswell, Worksop, S80 4HA Bolsover and Langwith North Surgeries Eastern Derbyshire Crich Medical Oakwell Drive, Crich, Derby, DE4 5PB Amber Practice Valley Darley Dale Two Dales, Matlock, DE4 2SA Derbyshire Medical Centre Dales Derby Family 1 Hastings Street, DE23 6QQ Derby City Medical Centre Derwent Medical 26 North Street, Derby, DE1 3AZ Derby City Centre Derwent Valley 20 St Mark’s Road, DE61 6AT Derby City Medical Practice Dronfield Medical High Street, Dronfield, S18 1PY Bolsover and Practice North Eastern Derbyshire Eden Surgery Cavendish Road, Ilkeston, Derbyshire, DE7 Erewash 5AN Elmwood Medical Burlington Road, Buxton, SK17 9AY High Peak Centre Emmett Carr Abbey Place, Renishaw, S21 3TY Bolsover and Surgery North Eastern Derbyshire
Page 51 of 220 Evelyn Medical Marsh Avenue, Hope, S33 6RJ Derbyshire Centre Dales Eyam Surgery Church Street, Eyam, Hope Valley, S32 5QH Derbyshire Dales Family Friendly Welbeck Road, Bolsover, Chesterfield, S44 Bolsover and Surgery 6DE North Eastern Derbyshire Friar Gate Surgery Agard Street, Derby, DE1 1DZ Derby City Gladstone House Gladstone Street West, Ilkeston, Derbyshire, Erewash Surgery DE7 5QS The Golden Brook Midland Street, Long Eaton, Nottingham, NG10 Erewash Practice 1RY Goyt Valley Chapel Road, Whaley Bridge, SK23 7SR High Peak Medical Practice Gresleydale Glamorgan Way, Church Gresley, Swadlincote, Derby City Healthcare Centre DE11 9JT Hannage Brook Hannage Way, Wirksworth, Derbyshire, DE4 Derbyshire Medical Centre 4JG Dales Hartington Surgery Dig Street, Hartington, SK17 0AQ High Peak Haven Medical 690 Osmaston Road, Derby, DE24 8GT Derby City Centre Heartwood Civic Way, Swadlincote, Derby, DE11 0AE Derby City Medical Practice Hollybrook Medical Hollybrook Way, Heatherton, Derby, DE23 3TX Derby City Centre Imperial Road 8 Imperial Road, Matlock, DE4 3NL Derbyshire Surgery Dales Inspire Health 109 Saltergate, Chesterfield, S40 1LE Chesterfield Ivy Grove Surgery Steeple Drive, Ripley, Derbyshire, DE5 3TH Amber Valley Jessop Medical Greenhill Lane, Riddings, Alfreton, DE55 1LU Amber Practice Valley Kelvingrove 28 Hands Road, Heanor, Derbyshire, DE75 Amber Medical Centre 7HA Valley Killamarsh Medical 209 Sheffield Road, Killamarsh, Sheffield, S21 Bolsover and
Page 52 of 220 Practice 8DZ North Eastern Derbyshire Lime Grove Lime Grove Walk, Matlock, DE4 3FD Derbyshire Medical Centre Dales Limes Medical Limes Ave, Alfreton, DE55 7DW Bolsover and Centre North Eastern Derbyshire Lister House Fellow Lands Way, Derby, DE73 6SW Derby City Chellaston Surgery Lister House 207 St Thomas Road, Derby, DE23 8RJ Derby City Surgery Littlewick Medical 42 Nottingham Road, Ilkeston, Derbyshire, DE7 Erewash Centre 5PR Macklin Street 90 Macklin Street, Derby, DE1 1JX Derby City Surgery Mickleover Medical Vicarage Road, Mickleover, Derby, DE3 0HA Derby City Centre Mickleover Surgery 10 Cavendish Way, Mickleover, Derby, DE3 Derby City 9BJ The Moir Medical Regent Street, Long Eaton, Nottingham, NG10 Erewash Centre QQ Newbold Surgery 3 Windemere Road, Newbold, Chesterfield, S31 Chesterfield 8DU Newhall Surgery 46-48 High Street, Swadlincote, Derby, DE11 Derby City 0HU North Wingfield Chesterfield Road, North Wingfield, S42 5ND Bolsover and Medical Centre North Eastern Derbyshire Oakhill Medical Oakhill Road, Dronfield, S18 2EJ Bolsover and Practice North Eastern Derbyshire Oakwood Surgery 380 Bishops Drive, Oakwood, Derby, DE21 2DF Derby City Old Station Heanor Road, Ilkeston, Derbyshire, DE7 8ES Erewash
Page 53 of 220 Surgery The Osmaston 212 Osmaston Road, Derby, DE23 8JX Derby City Surgery Overdale Medical Breaston Surgery, 1 Bridgefield, Breaston, Derby City Practice DE72 3DS Overseal Surgery 1 Hallcroft Avenue, Overseal, Derby, DE12 6JF Derby City Park Farm Medical 3 Park Farm Centre, Allestree, Derby, DE22 Derby City Centre 2QN Parkfields Surgery 1217 London Road, Alvaston, Derby, DE24 8QJ Derby City Park Lane Surgery 2 Park Lane, Allestree, Derby, DE22 2DS Derby City Park Medical Maine Drive, Chaddesden, Derby, DE21 6LA Derby City Practice Park Surgery 60 Ilkeston Road, Heanor, Ilkeston, DE75 7DX Amber Valley Parkside Surgery Alfreton Primary Care Centre, Church Street, Amber Alfreton, DE55 7AH Valley Park View Medical Cranfleet Way, Long Eaton, Nottingham, NG10 Erewash Centre 3RJ Peartree Medical 159 Peartree Road, Derby, DE23 8NQ Derby City Centre Dr Purnell and Ilkeston Health Centre, South Street, Ilkeston, Erewash Partners DE7 5PZ Ripley Medical Derby Road, Ripley, Derbyshire, DE5 3HR Amber Centre Valley Riversdale 59 Bridge Street, Belper, Derbyshire, DE56 1AX Amber Valley Royal Primary Stubbing Road, Grangewood, Chesterfield, S40 Chesterfield Care 2HP St Lawrence Road 17-19 St Lawrence Road, North Wingfield, Bolsover and Surgery Chesterfield, S42 5LH North Eastern Derbyshire St Thomas Road 207 St Thomas Road, Derby, DE23 8RJ Derby City Surgery Sett Valley Medical Hyde Bank Road, New Mills, SK22 4BP High Peak
Page 54 of 220 Centre Shires Healthcare 18 Main Street, Shirebrook, Mansfield, NG20 Bolsover and 8DG North Eastern Derbyshire Somercotes 22 Nottingham Road, Somercotes, Derbyshire, Amber Medical Centre DE55 4JJ Valley The Springs Recreation Close, Clowne, Chesterfield, S43 Bolsover and Health Centre 3PL North Eastern Derbyshire Staffa Health 3 Waverley Street, Tibshelf, Alfreton, DE55 5PS Bolsover and North Eastern Derbyshire Stewart Medical Hartington Road, Buxton, SK17 6JP High Peak Centre Stubley Medical 7 Stubley Drive, Dronfield Woodhouse, Bolsover and Centre Dronfield, S18 8QU North Eastern Derbyshire The Surgery @ 30 Wheatbridge Road, Chesterfield, S40 1AB Chesterfield Wheatbridge Swadlincote Darklands Road, Swadlincote, Derbyshire, Derby City Surgery DE11 0PP Thornbrook Thornbrook Road, Chapel en Le Frith, SK23 High Peak Surgery 0RH Tideswell Surgery Parke Road, Tideswell, Buxton, SK17 8NS Derbyshire Dales The Valleys Gosber Road, Eckington, S21 4BZ Bolsover and Medical North Partnership Eastern Derbyshire Vernon Street 13 Vernon Street, Derby, DE1 1FW Derby City Medical Centre Village Surgery Village Community Medical Centre, Derby, Derby City DE23 8AL The Village The Hub, Shiners Way, South Normanton, Bolsover and
Page 55 of 220 Surgery DE55 2AA North Eastern Derbyshire Dr Webb & Ilkeston Health Centre, South Street, Ilkeston, Erewash Partners DE7 5PZ Welbeck Road 1b Welbeck Road, Bolsover, Chesterfield, S44 Bolsover and Surgery 6DF North Eastern Derbyshire Wellbrook Medical Welland Road, Derby, DE65 5GZ Derby City Centre Wellside Medical 3 Burton Road, Derby, DE22 4AU Derby City Centre West Hallam The Village, West Hallam, Ilkeston, DE7 6GR Amber Medical Centre Valley Whitemoor Medical Whitemoor Lane, Belper, Derbyshire, DE56 2JU Amber Centre Valley Whittington Moor Scarsdale Road, Whittington Moor, Chesterfield Surgery Chesterfield, S41 8NA Willington Surgery Kingfisher Lane, Willington, Derbyshire, DE65 Derby City 6YB Wilson Street 11 Wilson Street, Derby, DE1 1PG Derby City Surgery Wingerworth 3 Allendale Road, Wingerworth, Chesterfield, Bolsover and Medical Centre S42 6PX North Eastern Derbyshire Woodville Surgery Burton Road, Woodville, Swadlincote, DE11 Derby City 7JE
3.2 Nature of Membership and Relationship with CCG
3.2.1 The CCG’s Members are integral to the functioning of the CCG. Those exercising delegated functions on behalf of the Membership, including the Governing Body, remain accountable to the Membership.
Page 56 of 220 3.3 Speaking, Writing or Acting in the Name of the CCG
3.3.1 Members are not restricted from giving personal views on any matter. However, Members should make it clear that personal views are not necessarily the view of the CCG.
Nothing in or referred to in this constitution (including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the CCG, any member of its Governing Body, any member of any of its Committees or Sub- Committees or the Committees or Sub-Committees of its Governing Body, or any employee of the CCG or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.
3.4 Members’ Rights
3.4.1 A membership agreement shall describe the relationship between, and the respective responsibilities of Member practices, GPs and the CCG.
3.4.2 Member practices shall elect the GP Chair, who shall chair the Governing Body of, and take responsibility as the clinical leader of the CCG.
3.4.3 Member Practices shall elect six GPs to serve on the Governing Body, of the CCG.
3.4.4 Calling and attending a general meeting of the Members.
3.4.5 Submitting a proposal for amendment of the Constitution.
3.4.6 Putting themselves forward for the election to the Governing Body.
3.4.7 Removing the Chair (or other elected members) of the Governing Body.
3.4.8 Participating in the development of the CCG’s Corporate Governance documents, including the CCG Handbook.
3.5 Members’ Meetings
3.5.1 A Membership Forum, at which GPs and member practices will hold the Governing Body of the CCG to account at least three a year, shall be facilitated by the CCG; this Forum shall also meet on an ad hoc basis to consider matters of common interest and to procure dispute resolution.
Page 57 of 220
3.6 Practice Representatives
3.6.1 Each Member practice has a nominated lead healthcare professional who represents the practice in the dealings with the CCG.
3.6.2 Practice representatives of the Membership Forum represent their practice’s views and act on behalf of them, in matters relating to the CCG. The role of each Representative is to: a) Ensure the effective participation of each Member in the CCG, in order to develop and sustain high-quality commissioning arrangements and an understanding of local health needs; b) Feedback the views of their practice to the CCG; c) Act on behalf of their Practice in all aspects of the CCG’s activities; d) Feed back to the CCG the views of users, or potential users, of services in the area covered by the CCG, particularly in relation to any quality issues that might inform commissioning decisions; e) Feed back to their practice any relevant information or guidance produced by the CCG, which may require changes in the way in which the practice functions, in respect of the provision of healthcare in the local area covered by the CCG, as well as facilitating the dissemination of newsletters or other updates to practice staff or attendees at their practices; f) Establishing effective working arrangements with the clinical leaders of the CCG’s main providers, to achieve improved local health outcomes; g) Attend the regular Membership Forums and participate in an annual review of the CCG, the Governing Body and its Committees; and peer review as required; and h) Ensuring that key actions or information agreed by the CCG is noted and taken forward, as appropriate, by their own Member Practice.
Page 58 of 220 4 Arrangements for the Exercise of our Functions.
4.1 Good Governance
4.1.2 The CCG will, at all times, observe generally accepted principles of good governance. These include but are not limited to:
a) Use of the governance toolkit for CCGs www.ccggovernance.org; b) Undertaking regular governance reviews; c) Adoption of standards and procedures that facilitate speaking out and the raising of concerns including a freedom to speak up guardian if one is appointed; d) Adopting CCG values that include standards of propriety in relation to the stewardship of public funds, impartiality, integrity and objectivity; e) The Good Governance Standard for Public Services; f) The standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’; g) The seven key principles of the NHS Constitution; h) Relevant legislation including such as the Equality Act 2010; and i) 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’.
The CCG Handbook includes the NHS Derby and Derbyshire CCG Corporate Governance Framework which supports the above.
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)-(d) above, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant policies and procedures as appropriate.
Page 59 of 220
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 members or employees; b) its Governing Body; c) a Committee or Sub-Committee of the CCG.
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.
Page 60 of 220 5 Procedures for Making Decisions
5.1 Scheme of Reservation and Delegation
5.1.1 The CCG has agreed a scheme of reservation and delegation (SoRD) which is published in full in the CCG handbook which is available on the following link website www.derbyandderbyshireccg.nhs.uk.
5.1.2 The CCG’s SoRD sets out:
a) those decisions that are reserved for the membership as a whole; b) those decisions that have been delegated by the CCG, the Governing Body or other individuals.
5.1.3 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 Members 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 procedures for: • conducting the business of the CCG; • the appointments to key roles including Governing Body members; • the procedures to be followed during meetings; and • the process to delegate powers.
5.2.2 A full copy of the standing orders is included in appendix 3. The standing orders form part of this constitution.
5.3 Standing Financial Instructions (SFIs)
5.3.1 The CCG has agreed a set of SFIs which include the delegated limits of financial authority set out in the SoRD.
5.3.2 A copy if the SFIs is included at Appendix 4 and form part of this constitution.
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
Page 61 of 220 accordance with the CCG’s principles of good governance (its main function); and for
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) Approving any functions of the CCG that are specified in regulations; b) Ensuring delivery of the CCG’s statutory duties associated with its commissioning functions that have been delegated to the Governing Body as stated in section 5.9.6 below, including but not limited to; i. Assuring the quality of all commissioned services; ii. Safeguarding, and ensuring patient safety; iii. Promotion of a comprehensive health service and the mandate; iv. Delivery of statutory financial duties v. Meeting the public sector equality duty; vi. Working in partnership with the local authority(ies); vii. Promoting and securing the involvement of patients, carers, local people, clinicians, partners and other stakeholders; viii. Promoting awareness of the NHS Constitution; ix. Acting effectively, efficiently and economically; x. Securing continuous improvements in the quality of services, including primary medical services and specialised services, supporting the NHS Commissioning Board where required; xi. Reducing health inequalities; xii. Ensuring patient choice; xiii. Obtaining appropriate advice; xiv. Promoting innovation, research, education, training and integration; xv. Working with local partners to ensure the effective Emergency Planning and Resilience (EPRR) c) Approving all other matters delegated to it by the CCG, as detailed within the Scheme of Reservation and Delegation. The Governing Body will delegate decision making to other committees to act on its behalf; d) leading the development of vision and strategy of the CCG; e) overseeing and monitoring quality improvement; f) approving the CCG’s Commissioning Plans and its constitution arrangements; g) stimulating innovation and modernisation; h) overseeing and monitoring performance;
Page 62 of 220 i) overseeing risk assessment and securing assurance actions to mitigate identified strategic risks. j) promoting a culture of strong engagement with patients, their carers, Members, the public and other stakeholders about the activity and progress of the CCG; k) ensuring good governance and leading a culture of good governance throughout the CCG.
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 in the CCG Handbook. www.derbyandderbyshireccg.nhs.uk.
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 Clinical Chair
b) The Accountable Officer
c) The Chief Finance Officer
d) A Secondary Care Specialist
e) A Registered Nurse (Chief Nurse Officer)
f) Two lay members: • one who has qualifications expertise or experience to enable them to lead on finance and or audit matters; and another who • has knowledge about the CCG area enabling them to express an informed view about discharge of the CCG functions
5.5.3 The CCG has agreed the following additional Members:
a) A third lay member – one who shall be to be the Chair of the Primary Care Commissioning Committee
b) A fourth lay member who shall be a patient and public involvement lay member - who shall also be the Vice Chair and chair the Engagement Committee
c) A fifth lay member who shall lead on Finance
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d) A sixth lay member who shall lead on Governance.
(3 of the 6 Lay members will also represent the North, South and City areas)
e) 1 GP who shall be also be the Place Board Chair
f) 1 GP who shall be the General Practice lead and will also chair the Clinical and Lay Commissioning Committee
g) 1 GP who shall lead Quality and Performance who will also chair the Quality and Performance Committee
h) 1 GP who shall be the North lead and link with local Places and membership practices within that area
i) 1 GP who shall be the South lead and link with local Places and membership practices within that area
j) 1 GP who shall be the City lead and link with local Places and membership practices within that area
k) Medical Director
l) Turnaround Director
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.
5.6.2 The CCG Governing Body will regularly invite the following individuals to attend any or all of its meetings as attendees;
a) Executive Director of Commissioning b) Executive Director of Corporate Strategy and Delivery c) Two Public Health Consultants; one Consultant from Derby City Council and one consultant from Derbyshire County Council
5.7 Appointments to the Governing Body
Page 64 of 220 5.7.1 The process of appointing GPs to the Governing Body, the selection of the Chair, and the appointment procedures for other 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.
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 or 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 Committee, any Committee or Sub-Committee established in accordance with clause 5.8 may consist of or include persons other than members or employees of the CCG.
5.8.5 All members of the Remuneration Committee will be members of the CCG Governing Body.
5.8.6 The Governing Body has also established a number of other committees to assist it with the discharge of its functions. The terms of references for these committees are published in the CCG handbook.
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 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 and has the delegated authority for the approval of the Annual report and Accounts.
5.9.3 The Audit Committee will be chaired by a Lay Member who has qualifications, expertise or experience to enable them to lead on finance and audit matters and members of the Audit Committee may include
Page 65 of 220 people who are not Governing Body members.
5.9.4 Remuneration 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 Committee will be chaired by a lay member other than the audit chair and only members of the Governing Body may be members of the Remuneration 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 is accountable 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 member Chair and a lay Vice Chair.
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 2 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. These Committees are set out in the SoRD and further information about these Committees, including terms of reference, are published in the CCG Handbook which is available on the website www.derbyandderbyshireccg.nhs.uk .
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:
Page 66 of 220 a) reporting arrangements to the Governing Body, at appropriate intervals;
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;
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
Page 67 of 220 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 the Governing Body the ability to enter into arrangements with one or more relevant Local Authority in respect of:
a) Delegating specified commissioning functions to the Local Authority;
b) Exercising specified commissioning functions jointly with the Local Authority;
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, the Local Authority, or pool funds for the purpose of joint commissioning;
b) make the services of its employees or any other resources available to the Local Authority; and
c) receive the services of the employees or the resources from the Local Authority.
d) 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:
• how the parties will work together to carry out their commissioning functions;
• the duties and responsibilities of the parties, and the legal basis for such arrangements;
• how risk will be managed and apportioned between the parties;
• financial arrangements, including payments towards a pooled fund and management of that fund;
Page 68 of 220 • contributions from each party, including details of any assets, employees and equipment to be used under the joint working arrangements; and
• the liability of the CCG to carry out its functions, notwithstanding any joint arrangements entered into.
5.11.4 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
5.12.1 The CCG may work together with other CCGs in the exercise of its Commissioning Functions.
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; or
c) make the services of its employees or any other resources available to another CCG; or
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.
Page 69 of 220 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;
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 functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.12.1 above.
5.12.9 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.12.1 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.
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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 months’ 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 functions or in relation to NHS England’s functions.
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.
5.13.3 In terms of either the CCG’s functions or NHS England’s 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 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;
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c) how risk will be managed and apportioned between the parties;
d) financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund;
e) contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.
5.13.8 Where any joint arrangements entered into relate to the CCG’s 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 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.
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 make;
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.
Page 72 of 220 6 Provisions for Conflict 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.
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 policy on conflicts of interest. 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 Standards of Business Conduct Policy.
6.1.4 The CCG has appointed the Audit Chair 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 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.
Page 73 of 220 6.2.2 The CCG will, as a minimum, publish the registers of conflicts of interest, gifts and hospitality of decision making staff and the procurement register of decisions and investments at least annually on the CCG 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 reasonable 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.
6.2.6 Activities funded in whole or in part by 3rd parties who may have an interest in CCG business such as sponsored events, posts and research will be managed in accordance with the CCG policy 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;
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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 Policy, including the requirements set out in the policy for managing conflicts of interest which is available on the CCG’s website at www.derbyandderbyshireccg.nhs.uk 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 Standards of Business Conduct policy.
Page 75 of 220 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 (AO) of the 2006 Act, appointed by NHS England, with responsibility for ensuring the CCG: complies with its obligations under: sections 14Q and 14R of the 2006 Act, sections 223H to 223J of the 2006 Act, paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006, and any other provision of the 2006 Act specified in a document published by the Board for that purpose; exercises its functions in a way which provides good value for money.
Area The geographical area that the CCG has responsibility for, as defined in part 2 of this constitution
Chair of the CCG The individual appointed by the CCG to act as chair of the Governing Body Governing Body and who is usually either a GP member or a lay member of the Governing Body.
Chief Finance A qualified accountant employed by the CCG with Officer (CFO) responsibility for financial strategy, financial management and financial governance and who is a member of the Governing Body.
Clinical A body corporate established by NHS England in Commissioning accordance with Chapter A2 of Part 2 of the 2006 Act. Groups (CCG)
Committee A Committee created and appointed by the membership of the CCG or the Governing Body.
Sub-Committee A Committee created by and reporting to a Committee.
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
Page 76 of 220 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 Any individual appointed to the Governing Body of the CCG Member
Healthcare A Member of a profession that is regulated by one of the Professional following bodies: the General Medical Council (GMC) the General Dental Council (GDC) the General Optical Council; the General Osteopathic Council the General Chiropractic Council the General Pharmaceutical Council the Pharmaceutical Society of Northern Ireland the Nursing and Midwifery Council the Health and Care Professions Council any other regulatory body established by an Order in Council under Section 60 of the Health Act 1999
Lay Member A lay Member of the CCG Governing Body, appointed by the CCG. A lay Member is an individual who is not a Member of the CCG or a healthcare professional (as defined above) or as otherwise defined in law.
Place An alliance of commissioners, community services providers local authority, (City, County, District & Boroughs), primary care, voluntary sector and other community stakeholders working together and utilising their collective resources most effectively to meet the needs of their local population
Primary Care A Committee required by the terms of the delegation from Commissioning NHS England in relation to primary care commissioning Committee functions. The Primary Care Commissioning Committee reports to NHS England and the Governing Body
Professional An independent body accountable to the UK Parliament Standards Authority which help Parliament monitor and improve the protection of
Page 77 of 220 the public. Published Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England in 2013
Member/ Member A provider of primary medical services to a registered patient Practice list, who is a Member of this CCG.
Member practice Member practices appoint a healthcare professional to act as representative 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.
NHS England The operational name for the National Health Service Commissioning Board.
Registers of Registers of the CCG is required to maintain and make interests publicly available under section 14O of the 2006 Act and the statutory guidance issues by NHS England, of the interests of: the Members of the CCG; the Members of its CCG Governing Body; the Members of its Committees or Sub-Committees and Committees or Sub-Committees of its CCG Governing Body; and Its employees.
STP Sustainability and Transformation Partnerships – the framework within which the NHS and local authorities have come together to plan to improve health and social care over the next few years. STP can also refer to the formal proposals agreed between the NHS and local councils – a “Sustainability and Transformation Plan”.
Joint Committee Committees from two or more organisations that work together with delegated authority from both organisations to enable joint decision-making
Page 78 of 220 Appendix 2: Committee Terms of Reference
DRAFT
Audit Committee Draft Terms of Reference
1. PURPOSE
1.1. The Governing Body of Derby and Derbyshire CCG (the “CCG”) has established a committee of the Governing Body to be known as the Audit Committee (the “Committee”). The Committee has no executive powers, other than those specifically delegated in these terms of reference.
1.2. The Committee is established in accordance with the CCG’s constitution and Schedule 1A of the National Health Service Act 2006 (as amended) (the “NHS Act”). These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the constitution.
2. ROLES AND RESPONSIBILITIES 2.1. The Committee will incorporate the following duties: 2.1.1. Integrated governance, risk management and internal control
The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities that support the achievement of the CCG’s objectives. Its work will dovetail with that of the Quality and Performance Committee which the CCG has established to seek assurance that robust clinical quality is in place. In particular, the Committee will review the adequacy and effectiveness of:
• All risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the CCG;
• The underlying assurance processes that indicate the degree of achievement of the CCG's objectives, the effectiveness of the
Page 79 of 220 management of principal risks and the appropriateness of the above disclosure statements;
• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification; and • The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud and Security Management Service. In carrying out this work the Committee will agree an annual audit plan and 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, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Committee’s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it.
2.1.2. Internal Audit The Committee shall ensure that there is an effective internal audit function that meets mandatory Public Sector Internal Audit Standards and provides appropriate independent assurance to the Committee, Accountable Officer and CCG. This will be achieved by:
• Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal;
• Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework;
• Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the Internal and External Auditors to optimise audit resources;
• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG;
• An annual review of the effectiveness of internal audit.
2.1.3. External Audit
The Committee shall review the work and findings of the External Auditors and consider the implications and responses by officers of the CCG to their work. This will be achieved by:
Page 80 of 220 • Consideration of the performance of the External Auditors, as far as the rules governing the appointment permit;
• Discussion and agreement with the External Auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring coordination, as appropriate, with other external auditors in the local health economy;
• Discussion with the External Auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee;
• Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the CCG and any work undertaken outside the annual audit plan, together with the appropriateness of management responses. 2.1.4. Other assurance functions The Committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the CCG. These will include, but will not be limited to any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Resolution) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).
2.1.5. Counter fraud The Committee shall satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.
2.1.6. Management The Committee shall request and review reports and positive assurances from directors and officers of the CCG on the overall arrangements for governance, risk management and internal control. The Committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements.
2.1.7. Financial reporting The Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance. The Committee shall ensure that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG.
Page 81 of 220 The Committee shall review and approve the annual report and financial statements on behalf of the Governing Body and the CCG, focusing particularly on: • The wording in the governance statement and other disclosures relevant to the terms of reference of the Committee; • Changes in, and compliance with, accounting policies, practices and estimation techniques; • Unadjusted mis-statements in the financial statements; • Significant judgements in preparing of the financial statements; • Significant adjustments resulting from the audit; • Letter of representation; and • Qualitative aspects of financial reporting. 2.1.8. Whistleblowing The Committee shall review the effectiveness of arrangements in place for allow staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently. 2.1.9. Conflicts of Interest The Committee shall receive reports in respect of any Conflicts of Interest breaches. The Committee shall review the impact and actions taken.
3. CHAIR ARRANGEMENTS
3.1. The CCG Governing Body shall appoint the Chair of the Committee from its Lay or Independent members. The Chair shall have the lead independent role in overseeing audit and remuneration in the CCG. In the event that the Chair is unavailable to attend, a member of the Committee will deputise and Chair the meeting.
4. MEMBERSHIP
4.1. Members of the Committee shall be appointed by the CCG Governing Body. Good practice recommends at least three Lay Members. 4.2. Membership will comprise:
• Governing Body Lay Member with responsibility for Audit;
• Governing Body Lay Member with responsibility for Finance;
Page 82 of 220 • Governing Body Lay Member with responsibility for Governance;
• Secondary Care Doctor The Chair of the Governing Body, the Accountable Officer and the Chief Finance Officer shall not be members of the Audit Committee and will be invited to attend.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS 5.1. The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs1 or any successor document will apply at all times. 5.2. Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible. 5.3. The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Deputy Chair will act as Chair for the relevant part of the meeting. 5.4. Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes. 5.5. Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee. 5.6. All members of the Committee shall comply with, and are bound by, the requirements in the Derby and Derbyshire CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
1 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance- jul-17.pdf
Page 83 of 220 6. QUORACY 6.1. The quorum necessary for the transaction of business shall be two Members.
7. DECISION MAKING AND VOTING 7.1. The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Deputy) may call a vote. 7.2. Only members of the Committee set out in section 4 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote. 7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook
8. ACCOUNTABILITY 8.1. The Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to cooperate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or other independent professional advice and secure the attendance of external personnel with relevant experience and expertise if it considers this necessary.
9. REPORTING ARRANGEMENTS 9.1. The Committee shall report to the Governing Body on how it discharges its responsibilities. The minutes of the Committee’s meetings shall be formally recorded by the secretary and submitted to the Governing Body. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the full Governing Body, or that require executive action. 9.2. The Committee will report to the Governing Body at least annually on its work in support of the annual governance statement, specifically commenting on the: • Fitness for purpose of the assurance framework; • Completeness and ‘embeddedness’ of risk management in the organisation; • Integration of governance arrangements;
Page 84 of 220 • Appropriateness of the evidence that shows the organisation is fulfilling regulatory requirements relating to its existence as a functioning business; • Robustness of the processes behind the quality accounts. 9.3. The annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee has considered in relation to the financial statements and how they were addressed.
10. ATTENDANCE AT MEETINGS 10.1. The Chief Finance Officer and appropriate Internal and External Audit representatives shall normally attend meetings but shall not have voting rights. In addition, the following good practice will be followed:
• At least once a year the Audit Committee should meet privately with the External and Internal Auditors; • Representatives from NHS Counter Fraud Authority may be invited to attend meetings and will normally attend at least one meeting each year; • Regardless of attendance, external audit, internal audit, local counter fraud and security management (NHS Counter Fraud Authority) providers will have full and unrestricted rights of access to the Committee; • The Accountable Officer will be invited to attend and discuss, at least annually with the Audit Committee, the process for assurance that supports the annual governance statement. He or she would also normally attend when the Audit Committee considers the draft internal audit plan and the annual accounts; • Any other officers of the CCG who have responsibility for specific areas (or similar) may be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director; and • The chair of the Governing Body may also be invited to attend one meeting each year in order to form a view on, and understanding of, the Audit Committee’s operations.
11. FREQUENCY AND NOTICE OF MEETINGS 11.1. The Audit Committee must consider the frequency and timing of meetings needed to allow it to discharge all of its responsibilities. Meetings of the Committee shall be held at regular intervals, at such times and places that the CCG may determine, but not less than four times per year. The External Auditors or Head of Internal Audit may request a meeting if they consider that one is necessary. The Committee will agree an annual programme of
Page 85 of 220 meetings in advance to link with key business to be transacted. Papers will be issued at least five working days in advance of the meetings wherever possible. 11.2. The Chair of the Committee, Governing Body or Accountable Officer may call additional meetings as required, giving not less than 14 days’ notice.
12. SUB-COMMITTEES 12.1. Committee may delegate responsibility for specific aspects of its duties to sub committees or working groups. The Terms of Reference of each such sub- committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority. 12.2. Any sub-committees or working groups will report via their respective Chair’s following each meeting or at an appropriate frequency as determined by the Committee.
13. ADMINISTRATIVE SUPPORT 13.1. The CCG’s governance lead shall be secretary to the Committee and shall attend to provide appropriate support to the Chair and Audit Committee members. The secretary will be responsible for supporting the Chair in the management of the Audit Committee’s business and for drawing the Audit Committee’s attention to best practice, national guidance and other relevant documents, as appropriate. The secretary will either take minutes or make arrangements for minutes to be taken.
14. REVIEW OF TERMS OF REFERENCE 14.1. These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any changes to the terms of reference to the Governing Body and will be approved by the Governing Body. Reviewed by Audit Committee: [Date] Approved by Governing Body: [Date] Review Date: October 2019
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DRAFT
Remuneration Committee Terms of Reference
1. PURPOSE 1.1. The Remuneration Committee (the “Committee”) is established by Derby and Derbyshire CCG (the “CCG”). In accordance with section 14M and 14L(3) of the NHS Act. 1.2 Subject to any restrictions set out in the relevant legislation, the Remuneration Committee has the function of making recommendations to the governing body about the exercise of its functions under section 14L(3)(a) and (b), i.e. its functions in relation to:
• determining the remuneration, fees and allowances payable to employees of the CCG and to other persons providing services to it; and • determining allowances payable under pension schemes established by the CCG.
1.3. The purpose of the Committee is to make recommendations to Governing Body on the appropriate remuneration and terms of service for the Accountable Officer, Directors, other Very Senior Managers, Clinicians and Lay Members. The Committee will have delegated powers to act on behalf of the CCG within the approved Terms of Reference. 1.4. The Committee shall adhere to all relevant laws, regulations and policies in all respects including (but not limited to) determining levels of remuneration that are sufficient to attract, retain and motivate executive directors and senior staff whilst remaining cost effective.
2. ROLES AND RESPONSIBILITIES 2.1. The Committee will incorporate the following duties: 2.1.1. With regard to the Accountable Officer, Directors and other Very Senior Managers, make recommendations to Governing Body all aspects of salary (including any performance-related elements, bonuses);
2.1.2. Make recommendations to Governing Body contractual arrangements for clinicians engaged to support the CCG Governing Body;
Page 87 of 220 2.1.3. Make recommendations on provisions for other benefits, including pensions and cars for all staff; 2.1.4. Make recommendations for arrangements for termination of employment and other contractual terms for all staff (decisions requiring dismissal shall be referred to the Governing Body); 2.1.5. Ensure that officers are fairly rewarded for their individual contribution to the organisation – having proper regard to the organisation’s circumstances and performance and to the provisions of any national arrangements for such staff; 2.1.6. Ensure proper calculation and scrutiny of termination payments taking account of such national guidance as is appropriate, advising on and overseeing appropriate contractual arrangements for such staff. This will apply to all CCG staff; 2.1.7. Ensure proper calculation and scrutiny of any special payments.
3. CHAIR ARRANGEMENTS 3.1. The CCG Governing Body shall appoint the Chair of the Committee, who shall be the Lay Member for Audit. In the event that the Chair is unavailable to attend, the Lay Member for Governance or Lay Member for Patient and Public Involvement will deputise and Chair the meeting.
4. MEMBERSHIP
4.1. Members of the Committee must be appointed from the CCG Governing Body. 4.2. To maintain the independence of members, the committee will comprise of four Lay members;
• Lay Member Audit • Lay Member Finance • Lay Member Governance • Lay Member Patient and Public Involvement
4.3. Only members of the Committee have the right to attend meetings, however, individuals such as the Accountable Officer, Chief Finance Officer, HR Advisor and external advisors may be invited to attend for all or part of a meeting as and when appropriate but shall not have voting rights. No member or attendee shall be party to discussions about their own remuneration or terms of service.
Page 88 of 220 5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS 5.1. The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs2 or any successor document will apply at all times. 5.2. Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible. 5.3. The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Deputy Chair will act as Chair for the relevant part of the meeting. 5.4. Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes. 5.5. Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee. 5.6. All members of the Committee shall comply with, and are bound by, the requirements in the Derby and Derbyshire CCG’s Constitution, Standards for Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY 6.1. The quorum necessary for the transaction of business shall be two Lay Members.
6.2. A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
2 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance- jul-17.pdf
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7. DECISION MAKING AND VOTING 7.1. The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Deputy) may call a vote. 7.2. Only members of the Committee set out in section 4 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote. 7.3. If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook at Section 5.4.
8. ACCOUNTABILITY 8.1. For the avoidance of doubt, in the event of any conflict the Standing Orders, the Standing Financial Instructions and the Scheme of Reservation and Delegation of the CCG will prevail over these Terms of Reference.
8.2. Review Role 8.2.1. The Committee may investigate, monitor and review activity within its terms of reference. It is authorised to seek any information it requires from any committee, group, clinician or employee (including interim and temporary members of staff), contractor, sub-contractor or agent, who are directed to co-operate with any request made by it. 8.2.2. The Committee will apply best practice in the decision making process. For example, when considering individual remuneration the Committee will:
• Comply with current disclosure requirements for remuneration;
• On occasion, and where appropriate, seek independent advice about remuneration for individuals; and
• Ensure that decisions are based on clear and transparent criteria and be able to withstand public scrutiny and audit. 8.2.3. The Committee will have authority to commission reports or surveys it deems necessary to help fulfil its obligations.
Page 90 of 220 9. REPORTING ARRANGEMENTS 9.1. The Committee will provide a written report or the minutes of the meeting to the CCG Governing Body following each meeting, confirming all recommendations of decisions made.
10. FREQUENCY AND NOTICE OF MEETINGS 10.1. Meetings will be held at least four times a year and when required and may be called at any other such time as the Committee Chair may require.
11. ADMINISTRATIVE SUPPORT 11.1. The CCG’s governance lead shall be secretary to the Committee and shall attend to provide appropriate support to the Chair and Remuneration Committee members. The secretary will be responsible for supporting the Chair in the management of the Committee’s business and for drawing the Remuneration Committee’s attention to best practice, national guidance and other relevant documents, as appropriate. The secretary will either take minutes or make arrangements for minutes to be taken.
12. REVIEW OF TERMS OF REFERENCE 12.1. These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any changes to the terms of reference to the Governing Body and will be approved by the Governing Body.
Reviewed by Remuneration Committee: [Date] Approved by Governing Body: [Date] Review Date: October 2019
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DRAFT
Primary Care Commissioning Committee
Terms of Reference
1. INTRODUCTION
1.1 In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended); NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Derby and Derbyshire CCG. Schedule 1 and 2 are specified in the NHS Derby and Derbyshire CCG Delegated Agreement.
1.2 The CCG has established the Primary Care Commissioning Committee. The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.
1.3 It is a committee comprising representatives of the following organisations: • NHS Derby and Derbyshire CCG
2. STATUTORY FRAMEWORK
2.1. NHS England has delegated to NHS Derby and Derbyshire CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the National Health Service Act 2006 (as amended).
2.2. 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.
2.3. 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:
Page 92 of 220 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).
2.4. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:
• Duty to have regard to impact on services in certain areas (section 13O); • Duty as respects variation in provision of health services (section 13P).
2.5. The Committee is established as a committee of the Governing Body in accordance with Schedule 1A of the National Health Service Act 2006 (NHS Act).
2.6. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.
3. ROLE OF THE COMMITTEE
3.1. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in the CCG, under delegated authority from NHS England.
3.2. 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 Derby and Derbyshire CCG, which will sit alongside the delegation and terms of reference.
Page 93 of 220 3.3. 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.
3.4. 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.
3.4.1. This includes the following:
• decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities: • decisions in relation to Enhanced Services; • decisions in relation to Local Incentive Schemes (including the design of such schemes); • decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices; • decisions about ‘discretionary’ payments; • decisions about commissioning urgent care (including home visits as required) for out of area registered patients; • the approval of practice mergers; • planning primary medical care services in the Area, including carrying out needs assessments; • undertaking reviews of primary medical care services in the Area; • 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); • management of the Delegated Funds in the Area; • Premises Costs Directions Functions; • co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and • such other ancillary activities that are necessary in order to exercise the Delegated Functions.
3.5. The CCG will also carry out the following activities:
a) To plan, including needs assessment, primary medical care services in the CCG’s geographical area;
b) To undertake reviews of primary medical care services in the CCG’s geographical area;
c) To co-ordinate a common approach to the commissioning of primary care services generally;
d) To manage the budget for commissioning of primary medical care services in the CCG’s geographical area
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4. GEOGRAPHICAL COVERAGE
4.1. The Committee will comprise NHS Derby and Derbyshire CCG’s geographical area.
5. MEMBERSHIP
5.1. The membership of the Committee is as follows:
• 3 x Governing Body Lay Members • Accountable Officer or nominated Deputy • Chief Finance Officer or nominated Deputy • Chief Nurse Officer or nominated Deputy • Medical Director or nominated Deputy • Turnaround Director or nominated Deputy
Representatives shall attend the Committee as regular attendees as follows:
• NHS England Primary Care Representative • Local Medical Committee Representative • 2 x GP Representative (Non Partner) • Health and Wellbeing Board (County) • Health and Wellbeing Board (City) • Senior Healthwatch Representatives
5.2. Officers of the CCG shall attend or nominate deputies appropriate to the items for discussion on the agenda. The Committee may also request attendance by appropriate individuals to present relevant reports and/ or advise the Committee.
5.3. The Chair of the Committee shall be the Governing Body Primary Care Commissioning Lay Member.
5.4. The Deputy Chair of the Committee shall be a Patient and Public Involvement Lay Member.
5.5 GP members of the Governing Body shall be invited to attend meetings to participate in strategic discussions on primary care issues, subject to adherence with the CCG’s conflicts of interest requirements and the appropriate management of conflicts of interest. They will be required, for example, to withdraw from the meeting during the deliberations leading up to decisions and from the decision where there is an actual or potential conflict of interest.
6. MEETINGS AND VOTING
6.1. The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of the
Page 95 of 220 meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.
6.2. 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.
6.3. If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the Derby and Derbyshire Corporate Governance Framework at Section 5.4.
6.4. Members are required to declare any interest relating to any matter to be considered at each meeting, in accordance with the CCG’s constitution and the CCG Standards for Business Conduct and Managing Conflicts of Interest Policy. Members who have declared an interest will be required to leave the meeting at the point at which a decision on such matter is being made. At the discretion of the Chair, they may be allowed to participate in the preceding discussion.
7. QUORUM
7.1. A quorum shall be four voting members, at least two of whom shall be Lay Members, to include the Chair or Deputy Chair. Deputies are invited to attend in the place of the regular members as required.
7.2. A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook
8. FREQUENCY AND NOTICE OF MEETINGS
8.1. The meetings held in public session will take place quarterly. The meetings to discuss items of a confidential nature will be held monthly and cancelled if necessary. On the dates of the meetings held in public session the meetings
Page 96 of 220 will be divided into two sections; Public and Confidential. The Public session will commence at the start of the meeting.
8.2. Meetings of the Committee:
a) Shall be held in public;
b) May resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.
8.3. 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.
8.4. 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.
8.5. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.
8.6. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Standing Orders.
8.7. The Committee will present its minutes to NHS England Midlands and the Governing Body of the CCG each quarter for information.
8.8. The CCG will also comply with any reporting requirements set out in its constitution.
8.9. It is envisaged that these Terms of Reference will be reviewed from time to time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.
9. ACCOUNTABILITY OF COMMITTEE
9.1. The Committee will operate within the delegation detailed within the CCG Standing Orders, Schemes of Reservation and Delegation and Prime Financial Policies.
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10. PROCUREMENT OF AGREED SERVICES
10.1. The detailed arrangements regarding procurement are set out in the delegation agreement3
11. DECISIONS
11.1. The Committee will make decisions within the bounds of its remit.
11.2. The decisions of the Committee shall be binding on NHS England and the CCG.
11.3 The Committee will produce an executive summary report which will be presented to the NHS England Midlands and the Governing Body of the CCG each month for information.
12. REVIEW OF TERMS OF REFERENCE 12.1. These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any changes to the terms of reference to the Governing Body and will be approved by the Governing Body.
Reviewed by Primary Care Commissioning Committee: [Date]
Approved by: [Date]
Review Date: October 2019
3 NHS England Next Steps in primary care co-commissioning guidance https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2014/11/nxt-steps-pc-cocomms.pdf
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Appendix 3: Standing Orders
DRAFT 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 Derby and Derbyshire Clinical Commissioning Group so that group can fulfil its obligations, as set out largely in the NHS Act 2006, 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 and the CCG’s standing financial instructions, provide a procedural framework within which the CCG discharges its business. They set out: a) the arrangements for conducting the business of the CCG; b) the appointment of member practice representatives; c) the procedure to be followed at meetings of the CCG, the Governing Body and any committees or sub-committees of the CCG or the Governing Body; d) the process to delegate powers, e) the declaration of interests and standards of conduct.
These arrangements must comply, and be consistent where applicable, with requirements set out in the NHS Act 2006 (as amended by the 2012 Act) and related regulations and take account as appropriate of any relevant guidance.
1.1.3. The standing orders, scheme of reservation and delegation and prime financial policies have effect as if incorporated into the CCG’s Constitution. Group members, employees, members of the Governing Body, members of the Governing Body’s committees and sub- committees, and persons working on behalf of the CCG should be aware
Page 99 of 220 of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.
1.2. Schedule of matters reserved to the Clinical Commissioning Group and the scheme of reservation and delegation
1.2.1. The NHS Act 2006 (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 (Please see CCG Governance Handbook)
2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS
2.1. Composition of Membership
2.1.1. Section 3 of the CCG’s Constitution provides details of the membership of the CCG .
2.1.2 Section 5 of the CCG’s Constitution provides details of the governing structure used in the CCG’s decision-making processes, whilst section 5.5 of the Constitution outlines certain key roles and responsibilities within the CCG and it’s Governing Body, including the role of practice representatives (section 3.6 of the Constitution).
2.2. Key Roles
2.2.1. Section 5.5 of the CCG’s Constitution sets out the composition of the CCG’s Governing Body whilst CCG Governance Handbook identifies certain key roles and responsibilities within the CCG and it’s Governing Body. These standing orders set out how the CCG appoints individuals to these key roles.
2.2.2. The Accountable Officer, is subject to the following appointment process: a) Nominations – n/a b) Eligibility – Appointment to be from individuals who meet the core competencies identified for the Accountable Officer role. Appointment to be proposed by the CCG and appointed to by NHS England. c) Appointment process – Advert, assessment process and interview. d) Term of office – substantive appointment e) Eligibility for reappointment – n/a f) Grounds for removal from office – • Gross misconduct. The process is to be overseen by NHSE and Lay Member for Audit.
Page 100 of 220 g) Notice period – 6 months. Notice to be given in writing to the Chair of the CCG.
2.2.3. The Clinical Chair/ Clinical Leader of the Governing Body, is subject to the following appointment process: a) Nominations – Membership of NHS Derby and Derbyshire CCG. b) Eligibility – Must meet the core competencies identified for the role of Chair and subject to performance appraisal. Must be a GP within NHS Derby and Derbyshire CCG. c) Appointment process – Election by Partner and salaried GP’s and long-term locums within NHS Derby and Derbyshire CCG. Expression of Interest/ application/ meeting a pre-determined criteria and interview process supported by the Local Medical Committee. The Governing Body will appoint the Clinical Chair. d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Clinical Chair is able to serve 3 months’ notice. e) Eligibility for reappointment – There is no limit to the number of terms served whether consecutively or not as long as the person wishes to continue and has the support of the local membership GPs f) Grounds for removal from office – • You become bankrupt or make any composition with your creditors or you are convicted of an arrestable offence (other than a road traffic offence for which a non-custodial penalty is imposed) • You are unable to properly provide the Services by reason of ill- health, accident or any other reason for a period or periods of [60] working days or more (whether or not consecutive) in any 12 month period • You do not provide the Services efficiently and diligently or are guilty of any serious or (after warning) repeated breach of your obligations under this Agreement • You are guilty of serious misconduct or any other conduct (whether in the performance of the Services or otherwise) which adversely affects or is likely to adversely affect our interests • You are guilty of gross misconduct • You cease to be a clinician in a member practice • You are deselected by the Membership through a vote as contained in the CCG Constitution • Your Practice ceases to be eligible for Membership • You become disqualified from being a member of the CCG in accordance with the CCG Regulations • Your actions constitute a material breach. g) Notice period – 6 months. Notice to be given in writing to the Accountable Officer of the CCG.
2.2.4. The Chief Finance Officer is subject to the following appointment process: a) Nominations – n/a b) Eligibility – Initial appointment from a pool of people that have passed National Assessment Centre to assess capability to meet the
Page 101 of 220 core competencies identified for the CFO role. Subsequent appointments to be via open advert. c) Appointment process – Advert, assessment process and interview. d) Term of office – substantive appointment e) Eligibility for reappointment – n/a f) Grounds for removal from office – • Removal of professional registration • Gross misconduct Process overseen by Lay Member for Audit. g) Notice period – 6 months. Notice to be given in writing to the Accountable Officer.
2.2.5. The Lay Member for Audit is subject to the following appointment process: a) Nominations – n/a b) Eligibility –Interview against person specification and job description for the role. c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – Yes f) Grounds for removal from office –
• Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer.
2.2.6. The 2 Public and Patient Engagement Lay Members are subject to the following appointment process: a) Nominations – n/a b) Eligibility –interview against person specification and job description for the role. c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – Yes f) Grounds for removal from office – • Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer
2.2.7. The Governance Lay Member is subject to the following appointment process: a) Nominations – n/a b) Eligibility –interview against person specification and job description for the role. c) Appointment process – Advert and interview
Page 102 of 220 d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – Yes f) Grounds for removal from office – • Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer
2.2.8. The Finance Lay Member is subject to the following appointment process: a) Nominations – n/a b) Eligibility –interview against person specification and job description for the role. c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – Yes f) Grounds for removal from office – • Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer
2.2.9. The Primary Care Commissioning Lay Member is subject to the following appointment process: a) Nominations – n/a b) Eligibility –interview against person specification and job description for the role. c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – Yes f) Grounds for removal from office – • Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer
2.2.10. The Chief Nurse Officer is subject to the following appointment process: a) Nominations – n/a b) Eligibility –Professional Registration. No conflicts of interest as defined by national guidance on NHS England website. Appraisal at interview against person specification and job description for the role. c) Appointment process – Advert and interview d) Term of office – substantive post e) Eligibility for reappointment – n/a f) Grounds for removal from office – • Removal of professional registration • Gross misconduct
Page 103 of 220 Process overseen by Lay Member for audit. g) Notice period – 6 months. Notice to be given in writing to the Accountable Officer.
2.2.11. The Secondary Care Doctor is subject to the following appointment process: a) Nominations – n/a b) Eligibility – Current registered doctor. Current or recent secondary care experience as defined by national guidance on NHCCB website. No conflicts of interest as defined by national guidance on NHSCB website; c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – yes f) Grounds for removal from office – • Removal of professional registration. • Can be deselected by the Membership through a vote or removed by the Clinical Chair. • Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer.
2.2.12. The GP Representatives are subject to the following appointment process: a) Expressions of Interest – Elected by the membership and appointed by the Governing Body b) Eligibility – GP member of NHS Derby and Derbyshire CCG. c) Appointment process – Advert and interview d) Term of office – 3 years (annually reviewable). If the term of office is not to be continued at annual review, the Accountable Officer is able to serve 3 months’ notice. e) Eligibility for reappointment – yes f) Grounds for removal from office – • Removal of professional registration.
• Gross misconduct including breach of Nolan principles. g) Notice period – 3 months. Notice to be given in writing to the Accountable Officer.
2.2.13. The roles and responsibilities of each of these key roles are set out in the CCG Governance Handbook.
3. MEETINGS OF THE CLINICAL COMMISSIONING GROUP
3.1. Calling meetings
3.1.1. The Governing Body of the CCG will meet at least twelve times per year with at least half of these meetings held in public session. The agenda
Page 104 of 220 and supporting papers will be sent to all members five working days before the meeting either manually or electronically, whichever is appropriate at the time.
3.2. Agenda, supporting papers and business to be transacted
3.2.1. Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair of the meeting at least six working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least six working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting five working days before the date the meeting will take place.
3.2.2. Agendas and certain papers for the CCG’s Governing Body – including details about meeting dates, times and venues - will be published on the CCG’s website at www.DerbyandDerbyshireccg.nhs.uk and will be made available for inspection at the CCG’s Headquarters.
3.2.3. The documents will be made available upon application either by:- a) post – NHS Derby and Derbyshire CCG, First Floor Cardinal Square, Nottingham Road Derby, Derby and Derbyshire DE1 3QT email – via the website – [email protected]
3.3. Petitions
3.3.1. Where a petition has been received by the CCG, the Chair of the Governing Body shall receive the petition at the start of the meeting in public session.
3.4. Chair of a meeting
3.4.1. At any meeting of the CCG or its Governing Body or of a committee the Chair of the CCG, if any and if present, shall preside. If the Chair is absent from the meeting, the Deputy Chair, if any and if present, shall preside.
3.4.2. If the Chair is absent temporarily on the grounds of a declared conflict of interest the Deputy Chair, if present, shall preside. If both the Chair and Deputy Chair are absent, or are disqualified from participating, or there is neither a Chair or Deputy a member of the CCG, Governing Body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.
Page 105 of 220 3.5. Chair's ruling
3.5.1. The decision of the Chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.
3.6. Quorum
The quorum necessary for the transaction of Governing Body business must include:
• Clinical Chair or Vice Chair (PPI Lay Member) • 1 x CCG Officer (Accountable Officer, or Chief Finance Officer or Chief Nurse Officer) • 2 x Lay Members • 4 x Voting Clinicians (to include GP Members and or Secondary Care Clinician)
3.6.1. Voting Officers may nominate a deputy to attend on their behalf. The nomination must be approved by the Chair. Where a nominated deputy attends, the nominated individual will have delegated responsibility for representation at meetings including voting, actions as required and any decisions made.
3.6.2. For all other of the CCG’s committees and sub-committees, including the Governing Body’s committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference.
3.7. Decision making
3.7.1. Section 5 of the CCG’s Constitution, together with the scheme of reservation and delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at the CCG’s / 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 – Governing Body Members b) Majority necessary to confirm a decision - Majority c) Casting vote – The Chair
3.7.2. Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting.
3.7.3. For all other of the CCG’s committees and sub-committees, including the Governing Body’s committees and sub-committee, the details of the
Page 106 of 220 process for holding a vote are set out in the appropriate terms of reference.
3.8. Emergency powers and urgent decisions
3.8.1. Emergency meetings of the Governing Body, Audit Committee, or Remuneration Committee and any other committees can be called at the request of the respective chair of the meetings, the Accountable Officer, the Chief Finance Officer or Lay Member with the responsibility for governance.
3.8.2. The need for an urgent decision exceeding individual’s delegated authority can be agreed by the Accountable Officer or Deputy (Chief Finance Officer or Assistant Chief Officer and Corporate Director) and the Chair. Such decisions must be reported to the next Governing Body Meeting. In such cases where the CCG is responding to an Emergency Planning Resilience and Response (EPRR) issue or when there is a need to implement the Business Continuity Plan then the Senior Officer with responsibility for decision making at the time will have the authority to make emergency decisions. Any decisions made must be reported upon as soon as possible following any incident to the Accountable Officer or Chief Finance Officer and Executive Director of Corporate Strategy and Delivery and the Chair and must be reported to the next Governing Body Meeting.
3.8.3. Where an urgent decision or approval needs to be made before the next scheduled meeting of the Governing Body a “virtual” decision can be made by contacting all voting members, usually by electronic means, including all the relevant information for them to make an informed decision. There must be a majority response to the proposals which must be quorate in line with the Terms of Reference. Any decision must be reported to the next meeting of the Governing Body.
3.9. Suspension of Standing Orders
3.9.1. Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or NHS England, any part of these standing orders may be suspended at any meeting, provided the majority of group members are in agreement.
3.9.2. A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting.
3.9.3. A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Governing Body’s Audit Committee for review of the reasonableness of the decision to suspend standing orders.
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3.10. Record of Attendance
3.10.1. The names of all members of the meeting present at the meeting shall be recorded in the minutes of the CCG’s meetings. The names of all members of the Governing Body present shall be recorded in the minutes of the Governing Body meetings. The names of all members of the Governing Body’s committees present shall be recorded in the minutes of the respective Governing Body committee meetings.
3.11. Minutes
3.11.1. The names and designation of all members of the Governing Body, the Governing Body’s committees present shall be recorded in the minutes of the respective Governing Body, Governing Body’s committee meetings. The minutes of the Governing Body, Governing Body’s committee meetings will be formally signed off by the respective Governing Body, Governing Body’s committee at their next meeting and be made available on the CCG’s website. Minutes of a confidential nature will not be made available on the CCG’s website or by application to the CCG Headquarters. All meetings will ask for declarations of Conflicts of Interest at the commencement of the meeting and record any declared or which become apparent during the meeting in line with the CCG’s Conflicts of Interest policy which may be amended from time to time.
3.12. Admission of public and the press
3.12.1. Meetings of the Governing Body will be held in public, other than for business deemed to be confidential. Arrangements will accord with the Public Bodies (Admission to Meetings) Act 1960, the Freedom of Information Act 2000 and the General Data Protection Regulation (GDPR) 2018.
3.12.2. The public meetings of the Governing Body will be announced for the period ahead via the Clinical Commissioning Group’s website. The agenda papers of upcoming meetings and previous meetings (including minutes as approved) will be available on the Clinical Commissioning Group’s website.
3.12.3. Rooms used for Governing Body meetings will allow for the presence of as many members of the public as have attended previously. Those who attend have no right to speak other than by invitation from the Chair. Members of the Public are requested to submit any questions they wish to pose to the Clinical Commissioning Group’s Headquarters three working days in advance of the meeting.
3.12.4. The Governing Body must pass the following resolution to exclude the public on the grounds of confidentiality:
Page 108 of 220 “That representatives of the press and other members of the public be excluded from the remainder of this meeting due to the confidential nature of the business to be transacted - publicity on which would be prejudicial to the public interest”
3.12.5. Where exclusion is anticipated, due to the nature of the business scheduled for a meeting, the public agenda will identify what the topic is for such an exclusion to be considered.
3.12.6. The meeting can consider an emergency resolution to exclude the public/press, or to adjourn to a private place, if any of those present are disrupting its business and will not leave on request.
3.12.7. When the public/press are excluded, group members, employees, and committee members will be required not to disclose the contents of papers or discussions without the express permission of the Clinical Commissioning Group’s Chair. The discussion can identify a future point at which the contents are no longer confidential and the minutes shall record this.
3.12.8. The Annual General Meeting of the CCG will be held in public for presentation of the Annual Report and Annual Accounts with members of the Governing Body present. A substantial proportion of this meeting time will be given over to hearing and responding to the views and questions of the public.
3.13. Meetings of the members of the Clinical Commissioning Group
3.13.1 Calling meetings
The Membership of the CCG will meet as a Membership Forum, at which GPs and member practices will hold the Governing Body of the CCG to account at least three times a year. The Membership Forum shall be facilitated by the CCG. The Membership Forum shall also meet on an ad hoc basis to consider matters of common interest and to procure dispute resolution.
3.13.2 Agenda, supporting papers and business to be transacted
Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair of the Membership Forum at least six working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least six working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting five working days before the date the meeting will take place.
Page 109 of 220 3.13.3 Selection of the Chair
The selection of the Membership Forum Chair shall be by nomination and or expression of interest from the membership of NHS Derby and Derbyshire CCG. The Chair must be a GP. Engagement of the nominations and or expressions of interest will take place with the membership. The Chair will be elected by the membership of NHS Derby and Derbyshire CCG.
3.13.4 Chair's ruling
The decision of the Chair of the Membership Forum on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.
3.13.5 Quorum
The quorum necessary for the transaction of the Membership Forum business shall be at least half or more of the GPs and member practices of NHS Derby and Derbyshire CCG.
The members may nominate a deputy to attend on their behalf. The nomination must be approved by the Chair. Where a nominated deputy attends, the nominated individual will have delegated responsibility for representation at the Membership Forum including voting, actions as required and any decisions made.
3.13.6 Decision making
Section 5 of the CCG’s Constitution, together with the scheme of reservation and delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at the Membership Forum meeting 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: • Eligibility – GPs and Member Practice Members • Majority necessary to confirm a decision - Majority • Casting vote – The Chair of the membership Forum
Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting.
Page 110 of 220 3.13.7 Emergency powers and urgent decisions
Where an urgent decision or approval needs to be made before the next scheduled meeting of the Membership Forum a “virtual” decision can be made by contacting all voting members, usually by electronic means, including all the relevant information for them to make an informed decision. There must be a majority response to the proposals which must be quorate in line with the Terms of Reference. Any decision must be reported to the next meeting of the CCG Governing Body.
3.13.8 Record of Attendance
The names of all members of the meeting present at the meeting shall be recorded in the minutes of the Membership Forum.
3.13.9 Minutes
The names and designation of all members of the Membership Forum present shall be recorded in the minutes of the respective Membership Forum meetings. All meetings will ask for declarations of Conflicts of Interest at the commencement of the meeting and record any declared or which become apparent during the meeting in line with the CCG’s Conflicts of Interest policy which may be amended from time to time.
3.13.10 Annual General Meeting
The Annual General Meeting of the CCG will be held in public for presentation of the Annual Report and Annual Accounts with members of the Governing Body present. A substantial proportion of this meeting time will be given over to hearing and responding to the views and questions of the public.
4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES
4.1. Appointment of committees and sub-committees
4.1.1. The CCG may appoint committees and sub-committees of the CCG, subject to any regulations made by the Secretary of State, and make provision for the appointment of committees and sub-committees of its Governing Body. Where such committees and sub-committees of the CCG, or committees and sub-committees of its Governing Body, are appointed they are included in section 5.8 of the CCG’s Constitution.
4.1.2. Other than where there are statutory requirements, such as in relation to the Governing Body’s Audit Committee, Remuneration Committee or Primary Care Commissioning Committee, the CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG.
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4.1.3. The provisions of these standing orders shall apply where relevant to the operation of the Governing Body, the Governing Body’s committees and sub-committee and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.
4.2. Terms of Reference
4.2.1. Terms of reference shall have effect as if incorporated into the Constitution Appendices and in the CCG Governance Handbook.. Terms of References are published on the CCG’s website at www.DerbyandDerbyshireccg.nhs.uk/ specific link page of the Handbook/ Terms of References.
4.3. Delegation of Powers by Committees to Sub-committees
4.3.1. Where committees are authorised to establish sub-committees they may not delegate executive powers to the sub-committee unless expressly authorised by the CCG.
4.4. Approval of Appointments to Committees and Sub-Committees
4.4.1. The CCG shall approve the appointments to the Governing Body which it has formally constituted. The CCG shall agree such travelling or other allowances as it considers appropriate.
5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES
5.1. If for any reason these standing orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the CCG and staff have a duty to disclose any non- compliance with these standing orders to the Accountable Officer as soon as possible.
6. USE OF SEAL AND AUTHORISATION OF DOCUMENTS
6.1. Clinical Commissioning Group’s seal
6.1.1. The CCG may have a seal for executing documents where necessary. The following individuals or officers are authorised to authenticate its use by their signature: a) The Accountable Officer; b) The Chief Finance Officer; c) The Corporate Secretary.
Page 112 of 220 6.2. Execution of a document by signature
6.2.1. The following individuals are authorised to execute a document on behalf of the CCG by their signature. a) The Accountable Officer; b) The Chief Finance Officer; c) The Corporate Secretary.
7. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS
7.1. Policy statements: general principles
7.1.1 The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS Derby and Derbyshire Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate group minute and will be deemed where appropriate to be an integral part of the CCG’s standing orders.
Page 113 of 220 Appendix 4: Standing Financial Instructions – Financial Limits for Delegated Authority
Page 114 of 220 Annex 1: Decisions, Authorities and Duties Delegated to Officers of the CCG Governing Body
1.1. The arrangements made by the CCG as set out in the Overarching Scheme of Reservation and Delegation of decisions shall have effect as if incorporated in the CCG’s Constitution.
1.2. The CCG remains accountable for all of its functions, including those that it has delegated.
1.3. The Overarching Scheme of Reservation & Delegation (Schedule of Matters Reserved to the CCG and Scheme of Delegation) and details the arrangements made by the CCG for discharging its functions.
1.4. The Schedule below details the Operational Scheme of Delegation (and financial authority limits). These should be read in conjunction with the Prime Financial Policies (See CCG Governance Handbook).
1.5. This is prepared by the Accountable Officer and sets out those key operational decisions delegated to individual employees of the CCG
1.6. The approval of the CCG’s Operational Scheme of Delegation that underpins the CCG’s “Overarching Scheme of Reservation and Delegation”, is reserved to the Governing Body.
Page 115 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 1. Capital Projects and Assets 1.1 Approval of capital business cases This includes cases that may receive including leases external funding. These powers may not be further delegated. In the All PFI schemes and other schemes Governing Body absence of the appropriate officer greater than £250,000 authorisation must be obtained from the level above. Clinical and Lay Commissioning Up to £250,000 Committee In urgent cases- joint approval by the Finance Committee Accountable Officer and Chief Finance Officer required ( up to limits of approval by the Clinical Executive Committee)
Approval would be required for granting, terminating or extending leases.
Page 116 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 1.2 Capital expenditure variations In urgent cases- joint approval by the Variation over the original business case Accountable Officer and Chief Finance figure: Officer required ( up to limits of approval by the Clinical Executive Greater than £100,000 Governing Body Committee)
Greater than £25,000 and less than Clinical & Lay Commissioning £100,000 or greater than 5% of the Committee original business case whichever is the Finance Committee lower
Less than £25,000 or less than 5% of the original business case whichever is the Chief Finance Officer lower 1.3 Maintenance of the capital asset register Chief Finance Officer Head of Finance
Page 117 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 1.4 Approval of asset disposals:
Land and buildings Governing Body
Other Assets, where asset has a residual Head of Finance must always be value: informed to enable the asset
register to be updated. Greater than £100,000 Governing Body
Disposals include those items that are £50,000 and up to £100,000 Accountable Officer obsolete, obsolescent, redundant,
irreparable or cannot be repaired cost £10,000 but less than £50,000 Chief Finance Officer effectively.
Less than £10,000 Executive Directors
Other – where the asset has no residual Deputy Director of Finance value 2 Contracts 2.1 Financial appraisal of companies Chief Finance Officer Delegated to Chief Finance Officer identified as potential tenders
Page 118 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 2.2 Authorisation of less than the requisite The requisite number of tenders / number of tenders / quotes: For all quotes: contracts of £250,000 and above a) Up to £20,000, at least 3 written For all contracts less than £250,000 competitive quotations for goods / Including Capital projects / Works Accountable Officer services obtained Goods and Services b) From £20,000 to £50,000, at least 5 Chief Finance Officer written competitive quotations for goods / services obtained c) Above £50,000, a full tender is to be carried out.
2.3 Authorisation of single tender / single quote Where a single tender / single quote is action: sought or received, the CCG shall as Accountable Officer far as practical, determine that the For all contracts of £250,000 and above price to be paid is fair and reasonable (Illegal under EU Regulations) and that details of the investigation are recorded. For all contracts less than £250,000 but Chief Finance Officer above £4,000 (illegal under EU Where a single tender / single quote is Regulations if above EU Threshold) authorised, this will be reported at the including next audit committee. Capital projects / Works Goods and services
Page 119 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 2.4 Single tender / single quote action for maintenance or other support contracts Delegated to Head of Finance, who will for Chief Finance Officer maintain a register of such contracts existing goods or assets where the CCG approved. is contractually tied to specific companies.
2.5 Monitoring of the use of single tender / Audit Committee on behalf of Appropriate records to be maintained single Governing Body by the Chief Finance Officer as the quote action. basis for reporting, delegated to Head A CCG Waiver must be completed and of Finance. forward to the Head of Finance.
2.6 Advertising of contracts/awards: Accountable Officer Delegated to the CCG Procurement - Must be advertised, lead - The CCG Procurement Manager will co-ordinate this via the appropriate web portal
2.7 Opening of tenders (will be automatic Any two from “List of CCG officers once web portal is being used for authorised to open tenders” where advertising of all tenders) tender is over £50,000. Any one from list where tender is below £50,000. 2.8 Permission to consider late tenders Accountable Officer
Page 120 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 2.9 Tender ratification and award, including authorisation of any actions resulting from post tender negotiations:
All types of tenders (on the lifetime value of the contract):
a) Up to £50,000 Budget Holder – Exec Director
b) Above £50,000
i. Non-clinical spend Accountable Officer ii. Clinical spend up to £1,500,000 Clinical Commissioning Lay Committee iii. Clinical spend above £1,500,000 Governing Body
Page 121 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 2.10 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
Greater than £10 million Accountable Officer AND Chief All Works contracts of £500,000 Finance Officer and above should be sealed; Greater than £1 million and up to £10 Accountable Officer other contracts should be sealed million if in the interests of the CCG.
Greater than £100,000 and up to £1 Chief Finance Officer million
Less than £100,000 Budget Holders – Exec Directors
2.11 Approval of variations or extensions to In all contracts the CCG should contracts: endeavour to obtain best value for
money. See 2.10 above
2.12 Sealing of documents Subsidiary pages of Works contracts to Chair (or Vice-Chair in the absence of be signed in accordance with Power of the Chair) and one Executive Director Appointment procedure
Page 122 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION Income Generation and Research and 3 Development Contracts 3.1 Approval of income generation contracts
and
variations or extensions to income
generation These powers may not be further contracts: delegated; in the absence of the
Governing Body appropriate officer authorisation must Greater than £500,000 be obtained from the level above
Accountable Officer £250,000 and up to £500,000
Chief Finance Officer Less than £250,000
Page 123 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 3.2 Approval of research and development These powers may not be further contracts delegated.
(including variations or extensions) In the absence of the appropriate Governing Body Greater than £500,000 officer
authorisation must be obtained Accountable Officer £250,000 and up to £500,000 from the level above
Chief Finance Officer Up to £250,000
4 Purchasing and Payments (excl. Payroll)
Page 124 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 4.1 Non Pay Expenditure for healthcare contracts that have been signed and ratified by the governing body
Greater than £50 million Accountable Officer following Governing Body approval
Greater than £ 1 million up to £50 million Budget Holder – Exec Director, or In line with budget management Accountable Officer / Chief Finance responsibilities (i.e. delegated Officer budgets) and subject to quoting & Greater than £50,000 to £1 million Budget Manager – Functional tendering as required (see Section 2 Director above)
Up to £50,000 Senior Manager – Band 8a or above
Exceptional: CHC under £10,000 Band 7 or above
Exceptional: NCAs under £1,000 Band 7 or above
Page 125 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 4.2 All Other Non Pay ( Limits include VAT) Authorisation of internal requisitions and invoices: Greater than £50 million
Greater than £ 1 million up to £50 million
Accountable Officer following Greater than £50,000 to £1million Governing Body approval
These limits are the maximum limits for
each delegated group and at any time,
as deemed necessary, the Chief Up to £50,000 Budget Holder – Exec Director, or Finance Officer can impose lower limits Accountable Officer / Chief Finance for each delegated group. Officer
For further information please refer to Exceptional: CHC under £10,000 Budget Manager – Functional the Authorised Signatory Policy Director Exceptional: NCAs under £1,000
Procurement of Professional Services Senior Manager – Band 8a or above (additional controls are required due to the nature of expenditure): - Legal advice Band 7 or above - Specialist advice - Specific projects Band 7 or above
Accountable Officer, Deputy Accountable Officer or CFO.
Page 126 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 4.3 Authorised list “List of CCG officers Authorisation of official orders permitted to authorise official orders” (maintained by Chief Finance Officer) 4.4 Authorisation for re-imbursement in Authorisation of petty cash payments line with procedures as outlined in the Authorised Signatory Policy
Disbursements up to £50 Budget Holder – Exec Director
5 Payroll Expenditure 5.1 Remuneration Committee Pay including substantive/agency (excluding timesheets) within Accountable Officer and Chief establishment Finance Officer Prior to incurring pay expenditure Substantive staff on VSM contracts Accountable Officer and Chief which includes agency, interim and Finance Officer and NHS England. temporary staff, the CCG’s All Off-payroll / Agency staff where: Establishment Vacancy Control - Cost is less than £600/day (excl. VAT) Process must be followed as well as - Engaged for less than 6 months the Temporary Staffing Policy - And not in roles of significant incorporating escalation policies for influence. Budget Holders - Executive Directors rates outside either framework or Where any of the above are not met NHSE caps. Once approved by the Establishment Control process the following delegated limits apply.
All other pay expenditure up to VSM rates Accountable Officer and Chief Finance Officer
Page 127 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION Engagement of Staff not within Governing Body Establishment
Authority to appoint staff Accountable Officer and Chief Finance Officer
Authority to permanently amend the formal establishment Accountable Officer and Chief All Off-payroll / Agency staff where: Finance Officer and NHS England. - Cost is less than £600/day (excl. VAT) - Engaged for less than 6 months Accountable Officer and Chief - And not in roles of significant Finance Officer (in conjunction with influence. the CCG’s Lead for Governance) Where any of the above are not met Chief Finance Officer and Budget Holder – Exec Director (within financial budget) Engagement of CCG’s solicitors
Booking of bank staff from approved lists
Page 128 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 5.2 Authorisation of travel claims ( Mileage) Line Managers with Delegated Signatory as outlined in the Any expenses claimed by Authorised Signatory List the Chair shall be authorised by the Accountable Officer and any expenses claimed by the Accountable Maximum value of any single monthly Authorisation for claims older than 3 Officer shall be authorised by the Chair claim is restricted to £2,500 with no months can be delegated to the of Chief Finance Officer. claims being older than 3 months unless Deputy Chief Finance Officer approved by either the Chief Finance Officer or Accountable Officer. 5.3 Authorisation of other travel and other allowances outside the CCGs Expenses Accountable Officer See Travel & Expenses Policy for Policy details of other allowable expenses. Authorisation of other travel and other allowances as per the CCGs Expenses Any study leave and associated Policy expenses should be agreed by the CFO and Budget Holder – Exec Over £300 Director in advance. Accountable Officer or Chief Finance Up to £300 Officer
Up to £100 Budget Holder – Exec Director
Budget Manager – Functional Director No claims being older than 3 months Can be delegated to the Deputy Chief unless approved by either the Finance Finance Officer Director or Accountable Officer.
Page 129 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 5.4 Authorisation of payroll timesheets
Maximum value of any single monthly Delegated Line Managers. See Authorised Signatory Policy claim is restricted to £2,500 with no claims being older than 3 months unless Authorisation for claims older than 3 approved by either the Finance Director months can be delegated to the or Accountable Officer. Deputy Chief Finance Officer
6 Income/debt write-off 6.1 Authorisation of credit notes
Greater than £500,000 Governing Body
£250,000 and up to £500,000 Accountable Officer or Chief Finance Officer Greater than £5,000 but less than Budget Holder – Exec Director £250,000 Budget Managers
Up to £5,000 6.2 Authorisation to refer debts to debt Chief Finance Officer Delegated to Head of Financial collection Accounts/Deputy Chief Finance Officer agency
Page 130 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 6.3 Authorisation of debt write-off: Individual debts All write offs to be reportedto the Audit Committee Greater than £10,000 Governing Body
Greater than £5,000 and up to £10,000 Accountable Officer
Up to £5,000 Chief Finance Officer 7 Losses and special payments 7.1 Authorisation of losses and special payments, All losses greater than £100,000 must including ex-gratia payments: be approved by Treasury. See losses Governing Body procedure contained in the General Greater than £50,000 Financial Procedures. Accountable Officer After advice taken by lawyers. £10,000 and up to £50,000 Executive Director of Corporate The Chief Finance Officer will report Up to £30,000 (Staff Compromise Strategy and Development any cases they consider to be “novel, agreements only) contentious or repercussive” to the Audit Committee or in an emergency Chair of the Audit Committee as soon Up to £10,000 Chief Finance Officer or Deputy Chief as they become aware of the case. Finance Officer And should be reported to NHS England in line with guidance. 7.2 Authorisation of clinical negligence payments Chief Finance Officer - Up to the CNST excess Governing Body - Above the CNST excess
Page 131 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 7.3 Monitoring of losses and special Audit Committee Liaison with the CCG’s Local Counter payments Fraud Specialist & Police as required and in line with the CCG’s Fraud, Corruption and Bribery Policy. 7.4 Authorisation of early retirement, redundancy and other termination payments to staff: Governing Body and Remuneration Greater than £100,000 Committee
£50,000 and up to £100,000 Accountable Officer
Up to £50,000 Chief Finance Officer
8 Budgetary Control
8.1 Approval of budgets and resources Governing Body The approval of budgets and resources will usually take place Delegation of budgets Accountable Officer and Chief during the March Governing Body Finance Officer meeting.
Approval to spend Budget Holder / Manager is permitted to incur costs in accordance with their budgets & authorisation limits
Page 132 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 8.2 Approval of budget virements Virements within a budget holders If Virement is the result of an approved budget are permitted in authorised contract variation accordance with virement rules. Greater than £100,000 Accountable Officer, Chief Finance Officer, Deputy Chief Finance Officer
Associate Directors /Deputy/ Greater than £25,000 up to £100,000 Assistant Directors, Medical Director, Head of Complex Cases
Greater than £500 up to £25,000 Budget Holder
£500 and below Budget Manager
For other virements
Greater than £10,000 Clinical and Lay Commissioning Committee Up to £10,000 A Business Case is required. Budget Holder 8.3 Approval of transfers from reserves Chief Finance Officer
Page 133 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 8.4. Approval of Revenue Business Cases (not Capital) In urgent cases- joint approval by the Accountable Officer and Chief Greater than £500,000 Governing Body Finance Officer required ( up to limits of approval by the Clinical Executive Up to £500,000 Clinical and Lay Commissioning Committee) Committee 9 Stores 9.1 Management and control of stores:
General Executive Director of Corporate Delegated to CCG Procurement Strategy and Delivery Manager
Pharmacy Medical Director 10 Bank accounts and payment methods 10.1 Opening of bank accounts or changes to Chief Finance Officer Governing Banking Services only. banking arrangements. Should be reported to the next Governing Body meeting. 10.2 Signing of cheques for cash, signing of See authorised signatory list Lists to be maintained by the Chief other cheques, and authorisation of Finance Officer electronic payments ,cheque and BACs payment schedules 11 Fees and charges 11.1 Approval of fees and charges Chief Finance Officer Examples are course fees, mobile phone use, private use of NHS equipment and facilities (such as photocopiers and rooms).
Page 134 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 12 Standards of business conduct 12.1 Maintenance of the CCG Register of Chief Finance Officer Interests Maintained by CCG Secretary
12.2 Maintenance of CCG Gifts and Hospitality register Chief Finance Officer Maintained by CCG Secretary
13 Insurance 13.1 Decision of level of and claims against Chief Finance Officer The risk should be managed by the Non Clinical Insurance Accountable Officer, in conjunction with the CCG’s Lead for Governance. 13.2 Decision of level of and claims against Chief Finance Officer The risk should be managed by the Clinical Insurance Accountable Officer, in conjunction with the CCG’s Lead for Governance. 14.0 Fraud and Irregularity 14.1 Counter fraud and corruption work in Chief Finance Officer In liaison with Local Counter Fraud accordance with Secretary of State’s Specialist, Counter Fraud Operational Directions Service and Police as appropriate
14.2 Investigation of suspected cases of Chief Finance Officer irregularity not related to fraud or corruption 15 Investments 15.1 Approval of Investment Policy Governing Body 15.2 Investment decisions Chief Finance Officer 16 Borrowing
Page 135 of 220 RESPONSIBILITY DELEGATION ARRANGEMENTS FURTHER INFORMATION 16.1 Approval of loans:
All Loans Governing Body
Page 136 of 220 Annex 2: Conflicts of Interest Management
On 16 June 2017, NHS England published revised statutory guidance on managing conflicts of interest for CCGs. This replaces the 2016 version of the guidance.
The guidance has been updated to ensure it is fully aligned with the recently published cross system conflicts of interest guidance – Managing conflicts of interest in the NHS: Guidance for staff and organisations. A small number of changes have been made including:
• Registers of interest: We have updated the CCG guidance to require that CCGs have systems in place to satisfy themselves as a minimum on an annual basis that their registers of interest are accurate and up-to-date, and to require that only decision-making staff are included on the published register. • Gifts from suppliers or contractors: In line with the NHS-wide guidance, gifts of low value (up to £6), such as promotional items, can now be accepted. • Gifts from other sources: We have amended the thresholds so that gifts of under £50 (rather than £10) can be accepted from non-suppliers and non- contractors, and do not need to be declared. Gifts with a value of over £50 can now be accepted on behalf of an organisation, but not in a personal capacity. • Hospitality – meals and refreshments: We have amended the thresholds so that hospitality under £25 does not need to be declared. Hospitality between £25 and £75 can be accepted, but must be declared, and hospitality over £75 should be refused unless senior approval is given. • New care models: We have included a new annex to provide further advice on identifying, declaring and managing conflicts of interest in the commissioning of new care models: Annex K: Conflicts of interest and New Models of Care.
Page 137 of 220
NHS Derby and Derbyshire Clinical Commissioning Group
Committee Terms of References
Page 138 of 220 CONTENTS
Page
Audit Committee ...... 3
Remuneration Committee ...... 11
Primary Care Commissioning Committee ...... 16
Clinical and Lay Commissioning Committee ...... 23
Finance Committee ...... 28
Governance Committee ...... 33
Engagement Committee ...... 38
Quality & Performance Committee ...... 45
Page 139 of 220
Audit Committee
Draft Terms of Reference
1. PURPOSE
1.1 The Governing Body of Derby and Derbyshire CCG (the “CCG”) has established a committee of the Governing Body to be known as the Audit Committee (the “Committee”). The Committee has no executive powers, other than those specifically delegated in these terms of reference.
1.2 The Committee is established in accordance with the CCG’s constitution and Schedule 1A of the National Health Service Act 2006 (as amended) (the “NHS Act”). These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the constitution.
2. ROLES AND RESPONSIBILITIES
2.1 The Committee will incorporate the following duties:
2.1.1. Integrated governance, risk management and internal control
The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities that support the achievement of the CCG’s objectives. Its work will dovetail with that of the Quality and Performance Committee which the CCG has established to seek assurance that robust clinical quality is in place.
In particular, the Committee will review the adequacy and effectiveness of:
• all risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the CCG;
• 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;
Page 140 of 220 • the policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification; and
• the policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud and Security Management Service.
In carrying out this work the Committee will agree an annual audit plan and 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, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Committee’s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it.
2.1.2 Internal Audit
The Committee shall ensure that there is an effective internal audit function that meets mandatory Public Sector Internal Audit Standards and provides appropriate independent assurance to the Committee, Accountable Officer and CCG. This will be achieved by:
• consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal;
• review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework;
• considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the Internal and External Auditors to optimise audit resources;
• ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG;
• an annual review of the effectiveness of internal audit.
2.1.3 External Audit
The Committee shall review the work and findings of the External Auditors and consider the implications and responses by officers of the CCG to their work. This will be achieved by:
• consideration of the performance of the External Auditors, as far as the rules governing the appointment permit;
• discussion and agreement with the External Auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring coordination, as appropriate, with other external auditors in the local health economy;
Page 141 of 220 • discussion with the External Auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee;
• review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the CCG and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.
2.1.4. Other assurance functions
The Committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the CCG. These will include, but will not be limited to any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Resolution) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).
2.1.5. Counter fraud
The Committee shall satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.
2.1.6. Management
The Committee shall request and review reports and positive assurances from directors and officers of the CCG on the overall arrangements for governance, risk management and internal control.
The Committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements.
2.1.7. Financial reporting
The Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.
The Committee shall ensure that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG.
The Committee shall review and approve the annual report and financial statements on behalf of the Governing Body and the CCG, focusing particularly on:
• the wording in the governance statement and other disclosures relevant to the terms of reference of the Committee;
• changes in, and compliance with, accounting policies, practices and estimation techniques;
• unadjusted mis-statements in the financial statements;
Page 142 of 220 • significant judgements in preparing of the financial statements;
• significant adjustments resulting from the audit;
• letter of representation; and
• qualitative aspects of financial reporting.
2.1.8. Whistleblowing
The Committee shall review the effectiveness of arrangements in place for allow staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.
2.1.9. Conflicts of Interest
The Committee shall receive reports in respect of any Conflicts of Interest breaches. The Committee shall review the impact and actions taken.
3. CHAIR ARRANGEMENTS
The CCG Governing Body shall appoint the Chair of the Committee from its Lay or Independent members. The Chair shall have the lead independent role in overseeing audit and remuneration in the CCG. In the event that the Chair is unavailable to attend, a member of the Committee will deputise and Chair the meeting.
4. MEMBERSHIP
4.1 Members of the Committee shall be appointed by the CCG Governing Body. Good practice recommends at least three Lay Members.
4.2 Membership will comprise:
• Governing Body Lay Member with responsibility for Audit;
• Governing Body Lay Member with responsibility for Finance;
• Governing Body Lay Member with responsibility for Governance;
• Secondary Care Doctor.
The Chair of the Governing Body, the Accountable Officer and the Chief Finance Officer shall not be members of the Audit Committee and will be invited to attend.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs1 or any successor document will apply at all times.
1 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 143 of 220 5.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Deputy Chair will act as Chair for the relevant part of the meeting.
5.4 Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
The quorum necessary for the transaction of business shall be two Members.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Deputy) may call a vote.
7.2 Only members of the Committee set out in section 4 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook
8. ACCOUNTABILITY
The Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any
Page 144 of 220 employee and all employees are directed to cooperate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or other independent professional advice and secure the attendance of external personnel with relevant experience and expertise if it considers this necessary.
9. REPORTING ARRANGEMENTS
9.1 The Committee shall report to the Governing Body on how it discharges its responsibilities. The minutes of the Committee’s meetings shall be formally recorded by the secretary and submitted to the Governing Body. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the full Governing Body, or that require executive action.
9.2 The Committee will report to the Governing Body at least annually on its work in support of the annual governance statement, specifically commenting on the:
• fitness for purpose of the assurance framework;
• completeness and ‘embeddedness’ of risk management in the organisation;
• integration of governance arrangements;
• appropriateness of the evidence that shows the organisation is fulfilling regulatory requirements relating to its existence as a functioning business;
• robustness of the processes behind the quality accounts.
9.3 The annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee has considered in relation to the financial statements and how they were addressed.
10. ATTENDANCE AT MEETINGS
The Chief Finance Officer and appropriate Internal and External Audit representatives shall normally attend meetings but shall not have voting rights. In addition, the following good practice will be followed:
10.1 at least once a year the Audit Committee should meet privately with the External and Internal Auditors;
10.2 representatives from NHS Counter Fraud Authority may be invited to attend meetings and will normally attend at least one meeting each year;
10.3 regardless of attendance, external audit, internal audit, local counter fraud and security management (NHS Counter Fraud Authority) providers will have full and unrestricted rights of access to the Committee;
10.4 the Accountable Officer will be invited to attend and discuss, at least annually with the Audit Committee, the process for assurance that supports the annual governance statement. He or she would also normally attend when the Audit Committee considers the draft internal audit plan and the annual accounts;
Page 145 of 220 10.5 any other officers of the CCG who have responsibility for specific areas (or similar) may be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that director; and
10.6 the chair of the Governing Body may also be invited to attend one meeting each year in order to form a view on, and understanding of, the Audit Committee’s operations.
11. FREQUENCY AND NOTICE OF MEETINGS
11.1 The Audit Committee must consider the frequency and timing of meetings needed to allow it to discharge all of its responsibilities. Meetings of the Committee shall be held at regular intervals, at such times and places that the CCG may determine, but not less than four times per year. The External Auditors or Head of Internal Audit may request a meeting if they consider that one is necessary. The Committee will agree an annual programme of meetings in advance to link with key business to be transacted. Papers will be issued at least five working days in advance of the meetings wherever possible.
11.2 The Chair of the Committee, Governing Body or Accountable Officer may call additional meetings as required, giving not less than 14 days’ notice.
12. SUB-COMMITTEES
12.1 Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of each such sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority.
12.2 Any sub-committees or working groups will report via their respective Chair’s following each meeting or at an appropriate frequency as determined by the Committee.
13. ADMINISTRATIVE SUPPORT
The CCG’s governance lead shall be secretary to the Committee and shall attend to provide appropriate support to the Chair and Audit Committee members. The secretary will be responsible for supporting the Chair in the management of the Audit Committee’s business and for drawing the Audit Committee’s attention to best practice, national guidance and other relevant documents, as appropriate. The secretary will either take minutes or make arrangements for minutes to be taken.
14. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any changes to the terms of reference to the Governing Body and will be approved by the Governing Body.
Page 146 of 220
Reviewed by Audit Committee: [Date]
Approved by Governing Body: [Date]
Review Date: October 2019
Page 147 of 220
Remuneration Committee
Draft Terms of Reference
1. PURPOSE
1.1 The Remuneration Committee (the “Committee”) is established by NHS Derby and Derbyshire Clinical Commissioning Group (the “CCG”). In accordance with section 14M and 14L(3) of the NHS Act.
1.2 Subject to any restrictions set out in the relevant legislation, the Remuneration Committee has the function of making recommendations to the governing body about the exercise of its functions under section 14L(3)(a) and (b), i.e. its functions in relation to:
• determining the remuneration, fees and allowances payable to employees of the CCG and to other persons providing services to it; and
• determining allowances payable under pension schemes established by the CCG.
1.3 The purpose of the Committee is to make recommendations to Governing Body on the appropriate remuneration and terms of service for the Accountable Officer, Directors, other Very Senior Managers, Clinicians and Lay Members. The Committee will have delegated powers to act on behalf of the CCG within the approved Terms of Reference.
1.4 The Committee shall adhere to all relevant laws, regulations and policies in all respects including (but not limited to) determining levels of remuneration that are sufficient to attract, retain and motivate executive directors and senior staff whilst remaining cost effective.
2. ROLES AND RESPONSIBILITIES
The Committee will incorporate the following duties:
2.1 with regard to the Accountable Officer, Directors and other Very Senior Managers, make recommendations to Governing Body all aspects of salary (including any performance-related elements, bonuses);
2.2 make recommendations to Governing Body contractual arrangements for clinicians engaged to support the CCG Governing Body;
Page 148 of 220 2.3 make recommendations on provisions for other benefits, including pensions and cars for all staff;
2.4 make recommendations for arrangements for termination of employment and other contractual terms for all staff (decisions requiring dismissal shall be referred to the Governing Body);
2.5 ensure that officers are fairly rewarded for their individual contribution to the organisation – having proper regard to the organisation’s circumstances and performance and to the provisions of any national arrangements for such staff;
2.6 ensure proper calculation and scrutiny of termination payments taking account of such national guidance as is appropriate, advising on and overseeing appropriate contractual arrangements for such staff. This will apply to all CCG staff;
2.7 ensure proper calculation and scrutiny of any special payments.
3. CHAIR ARRANGEMENTS
The CCG Governing Body shall appoint the Chair of the Committee, who shall be the Lay Member for Audit. . In the event that the Chair is unavailable to attend, the Lay Member for Governance or Lay Member for Patient and Public Involvement will deputise and Chair the meeting.
4. MEMBERSHIP
4.1 Members of the Committee must be appointed from the CCG Governing Body.
4.2 To maintain the independence of members, the committee will comprise of four Lay members:
• Lay Member Audit;
• Lay Member Finance;
• Lay Member Governance;
• Lay Member Patient and Public Involvement.
4.3 Only members of the Committee have the right to attend meetings, however, individuals such as the Accountable Officer, Chief Finance Officer, HR Advisor and external advisors may be invited to attend for all or part of a meeting as and when appropriate but shall not have voting rights. No member or attendee shall be party to discussions about their own remuneration or terms of service.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs2 or any successor document will apply at all times.
2 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 149 of 220 5.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Deputy Chair will act as Chair for the relevant part of the meeting.
5.4 Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum necessary for the transaction of business shall be two Lay Members.
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Deputy) may call a vote.
7.2 Only members of the Committee set out in section 4 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook.
Page 150 of 220 8. ACCOUNTABILITY
8.1 For the avoidance of doubt, in the event of any conflict the Standing Orders, the Standing Financial Instructions and the Scheme of Reservation and Delegation of the CCG will prevail over these Terms of Reference.
8.2 Review Role
8.2.1 The Committee may investigate, monitor and review activity within its terms of reference. It is authorised to seek any information it requires from any committee, group, clinician or employee (including interim and temporary members of staff), contractor, sub-contractor or agent, who are directed to co- operate with any request made by it.
8.2.2. The Committee will apply best practice in the decision making process. For example, when considering individual remuneration the Committee will:
• comply with current disclosure requirements for remuneration;
• on occasion, and where appropriate, seek independent advice about remuneration for individuals; and
• ensure that decisions are based on clear and transparent criteria and be able to withstand public scrutiny and audit.
8.2.3. The Committee will have authority to commission reports or surveys it deems necessary to help fulfil its obligations.
9. REPORTING ARRANGEMENTS
The Committee will provide a written report or the minutes of the meeting to the CCG Governing Body following each meeting, confirming all recommendations of decisions made.
10. FREQUENCY AND NOTICE OF MEETINGS
Meetings will be held at least four times a year and when required and may be called at any other such time as the Committee Chair may require.
11. ADMINISTRATIVE SUPPORT
The CCG’s governance lead shall be secretary to the Committee and shall attend to provide appropriate support to the Chair and Remuneration Committee members. The secretary will be responsible for supporting the Chair in the management of the Committee’s business and for drawing the Remuneration Committee’s attention to best practice, national guidance and other relevant documents, as appropriate. The secretary will either take minutes or make arrangements for minutes to be taken.
Page 151 of 220 12. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any changes to the terms of reference to the Governing Body and will be approved by the Governing Body.
Reviewed by Remuneration Committee: [Date]
Approved by Governing Body: [Date]
Review Date: October 2019
Page 152 of 220
Primary Care Commissioning Committee
Draft Terms of Reference
1. INTRODUCTION
1.1 In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended); NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Derby and Derbyshire CCG. Schedule 1 and 2 are specified in the NHS Derby and Derbyshire CCG Delegated Agreement.
1.2 The CCG has established the Primary Care Commissioning Committee. The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.
1.3 It is a committee comprising representatives of the following organisations:
• NHS Derby and Derbyshire CCG (the “CCG”)
2. STATUTORY FRAMEWORK
2.1 NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the National Health Service Act 2006 (as amended).
2.2 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.
2.3 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:
2.3.1 management of conflicts of interest (section 14O);
2.3.2 duty to promote the NHS Constitution (section 14P);
2.3.3 duty to exercise its functions effectively, efficiently and economically (section 14Q);
2.3.4 duty as to improvement in quality of services (section 14R);
Page 153 of 220 2.3.5 duty in relation to quality of primary medical services (section 14S);
2.3.6 duties as to reducing inequalities (section 14T);
2.3.7 duty to promote the involvement of each patient (section 14U);
2.3.8 duty as to patient choice (section 14V);
2.3.9 duty as to promoting integration (section 14Z1);
2.3.10 public involvement and consultation (section 14Z2).
2.4 The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below:
• duty to have regard to impact on services in certain areas (section 13O);
• duty as respects variation in provision of health services (section 13P).
2.5 The Committee is established as a committee of the Governing Body in accordance with Schedule 1A of the National Health Service Act 2006 (NHS Act).
2.6 The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.
3. ROLE OF THE COMMITTEE
3.1 The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in the CCG, under delegated authority from NHS England.
3.2 In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and the CCG, which will sit alongside the delegation and terms of reference.
3.3 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.
3.4 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 decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to the following activities:
3.4.1 decisions in relation to Enhanced Services;
3.4.2 decisions in relation to Local Incentive Schemes (including the design of such schemes);
3.4.3 decisions in relation to the establishment of new GP practices (including branch surgeries) and closure of GP practices;
Page 154 of 220 3.4.4 decisions about ‘discretionary’ payments;
3.4.5 decisions about commissioning urgent care (including home visits as required) for out of area registered patients;
3.4.6 the approval of practice mergers;
3.4.7 planning primary medical care services in the Area, including carrying out needs assessments;
3.4.8 undertaking reviews of primary medical care services in the Area;
3.4.9 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);
3.4.10 management of the Delegated Funds in the Area;
3.4.11 Premises Costs Directions Functions;
3.4.12 co-ordinating a common approach to the commissioning of primary care services with other commissioners in the Area where appropriate; and
3.4.13 such other ancillary activities that are necessary in order to exercise the Delegated Functions.
3.5 The CCG will also carry out the following activities to:
3.5.1 plan, including needs assessment, primary medical care services in the CCG’s geographical area;
3.5.2 undertake reviews of primary medical care services in the CCG’s geographical area;
3.5.3 co-ordinate a common approach to the commissioning of primary care services generally;
3.5.4 manage the budget for commissioning of primary medical care services in the CCG’s geographical area.
4. GEOGRAPHICAL COVERAGE
The Committee will comprise NHS Derby and Derbyshire CCG’s geographical area.
5. MEMBERSHIP
5.1 The membership of the Committee is as follows:
• 3 x Governing Body Lay Members; • Accountable Officer or nominated Deputy (who shall be the Medical Director); • Chief Finance Officer or nominated Deputy; • Chief Nurse Officer or nominated Deputy;
Page 155 of 220 • Medical Director or nominated Deputy; • Turnaround Director or nominated Deputy.
Representatives shall attend the Committee as regular attendees as follows:
• NHS England Primary Care Representative; • Local Medical Committee Representative; • 2 x GP Representative (Non Partner); • Health and Wellbeing Board (County); • Health and Wellbeing Board (City); • Senior Healthwatch Representatives.
5.2 Officers of the CCG shall attend or nominate deputies appropriate to the items for discussion on the agenda. The Committee may also request attendance by appropriate individuals to present relevant reports and/ or advise the Committee.
5.3 The Chair of the Committee shall be the Governing Body Primary Care Commissioning Lay Member.
5.4 The Deputy Chair of the Committee shall be a Patient and Public Involvement Lay Member.
5.5 GP members of the Governing Body shall be invited to attend meetings to participate in strategic discussions on primary care issues, subject to adherence with the CCG’s conflicts of interest requirements and the appropriate management of conflicts of interest. They will be required, for example, to withdraw from the meeting during the deliberations leading up to decisions and from the decision where there is an actual or potential conflict of interest.
6. MEETINGS AND VOTING
6.1 The Committee will operate in accordance with the CCG’s Standing Orders. The Secretary to the Committee will be responsible for giving notice of the meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than five working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.
6.2 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.
6.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the Derby and Derbyshire Corporate Governance Framework at Section 5.4.
Page 156 of 220 6.4 Members are required to declare any interest relating to any matter to be considered at each meeting, in accordance with the CCG’s constitution and the CCG Standards for Business Conduct and Managing Conflicts of Interest Policy. Members who have declared an interest will be required to leave the meeting at the point at which a decision on such matter is being made. At the discretion of the Chair, they may be allowed to participate in the preceding discussion.
7. QUORUM
7.1 A quorum shall be four voting members, at least two of whom shall be Lay Members, to include the Chair or Deputy Chair. Deputies are invited to attend in the place of the regular members as required.
7.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with relevant sections of the Derby and Derbyshire CCG Governance Handbook.
8. FREQUENCY AND NOTICE OF MEETINGS
8.1 The meetings held in public session will take place quarterly. The meetings to discuss items of a confidential nature will be held monthly and cancelled if necessary. On the dates of the meetings held in public session the meetings will be divided into two sections; Public and Confidential. The Public session will commence at the start of the meeting.
8.2 Meetings of the Committee:
8.2.1 shall be held in public;
8.2.2 may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.
8.3 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.
Page 157 of 220 8.4 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.
8.5 The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.
8.6 Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Standing Orders.
8.7 The Committee will present its minutes to NHS England Midlands and the Governing Body of the CCG each quarter for information.
8.8 The CCG will also comply with any reporting requirements set out in its constitution.
8.9 It is envisaged that these Terms of Reference will be reviewed from time to time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.
9. ACCOUNTABILITY OF COMMITTEE
The Committee will operate within the delegation detailed within the CCG Standing Orders, Schemes of Reservation and Delegation and Prime Financial Policies.
10. PROCUREMENT OF AGREED SERVICES
The detailed arrangements regarding procurement are set out in the delegation agreement3.
11. DECISIONS
11.1 The Committee will make decisions within the bounds of its remit.
11.2 The decisions of the Committee shall be binding on NHS England and the CCG.
11.3 The Committee will produce an executive summary report which will be presented to the NHS England Midlands and the Governing Body of the CCG each month for information.
12. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required. The Committee will recommend any
3 NHS England Next Steps in primary care co-commissioning guidance https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/11/nxt-steps-pc- cocomms.pdf
Page 158 of 220 changes to the terms of reference to the Governing Body and will be approved by the Governing Body.
Reviewed by Primary Care Commissioning Committee: [Date]
Approved by: [Date]
Review Date: October 2019
Page 159 of 220
Clinical and Lay Commissioning Committee
Draft Terms of Reference
1. PURPOSE
The purpose of the Clinical and Lay Commissioning Committee (the “Committee”) is to:
1.1 provide a clinical and lay forum within which discussions can take place to develop and implement the commissioning strategy and policy of NHS Derby and Derbyshire Clinical Commissioning Group (the "CCG") and to help secure the continuous improvement of the quality of services;
1.2 retain a focus on health inequalities, improved outcomes and quality and ensure that the delivery of the CCG's strategic and operational plans are achieved within financial allocations;
1.3 have delegated authority to make decisions within the limits as set out in the CCG's Schemes of Reservation and Delegation.
2. ROLES AND RESPONSIBILITIES
The Committee will incorporate the following duties:
2.1 support and advise on the development of the strategic commissioning plan;
2.2 develop and agree commissioning policy for the CCG, within the agreed financial envelope, (for example, the CCG’s approach to access to services, treatment thresholds, interpretation of national policy etc.);
2.3 have clinical oversight of the QIPP programme and the responsibility for the approval of new QIPP Schemes;
2.4 act as the gateway of invest to save QIPP schemes to Governing Body;
2.5 consider full business cases for schemes detailed in the CCG’s Financial Recovery Plan. The Committee will provide a clinical opinion and decision on schemes already contained within the annual Financial Plan. For schemes out with the Financial Plan, the Committee will provide a clinical opinion with the decision to be escalated to the Governing Body;
2.6 oversee, as part of the development of the Commissioning Plan, a prioritisation process for both investment and savings that supports the CCG in formulating the Savings Plan for the next financial year;
Page 160 of 220 2.7 oversee the development of the Savings Plans and services as detailed in the CCG’s Operational Plan, approving the appropriate business cases and mobilisation plans, subject to appropriate evidence being provided (with particular reference to statutory equality and engagement duties) to support the decisions made;
2.8 prioritise service investments/disinvestments arising from the Financial Recovery Group’s strategic and operational plans, underpinned by value based decisions and against available resources;
2.9 support the development of the CCG’s annual commissioning intentions which identify to providers the service changes that the CCG wishes to negotiate in the forthcoming year;
2.10 ensure appropriate evaluation is in place for new and existing investments;
2.11 ensure all procurements are undertaken in accordance with national policy and legal requirements;
2.12 ensure the CCG appropriately identifies and addresses inequalities;
2.13 ensure commissioning decisions are underpinned and informed by communications and engagement with the membership and local population as appropriate;
2.14 review the risk register for its area of remit, considering the adequacy of the submissions and whether new risks need to be added or whether any risks require immediate escalation to the Governing Body.
3. CHAIR ARRANGEMENTS
The Chair shall be a Governing Body GP nominated by the Committee from the membership of the Committee and endorsed by the CCG Chair. In the event that the Chair is unavailable to attend, the Vice Chair who shall be a Governing Body GP will deputise and Chair the meeting.
4. MEMBERSHIP
4.1 Members of the Committee may be appointed from the Governing Body of the CCG, officers of the CCG or other external bodies as required to enable the Committee to fulfil its purpose.
4.2 The membership of the Committee will comprise of:
• 6 x GPs (Governing Body members providing appropriate geographical coverage and the GB Chair); • 2 x Clinical representatives taken from clinical lead roles • 1 x Secondary Care Doctor; • 2 x Lay Members (Patient and Public Involvement); • 1 x Lay Member (Audit or Governance); • 1 x Chief Nurse Officer; • 1 x Medical Director; • 1x Chief Finance Officer;
Page 161 of 220 • 1 x Public Health Representative; • 1 x Turnaround Director • 1 x Executive Director of Commissioning Operations.
4.3 CCG Officer subject experts will be attendees at each meeting.
4.4 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Committee. All deputies should be fully briefed and the Committee secretariat informed of any agreement to deputise so that quoracy can be maintained.
4.5 The Committee may also request attendance by appropriate individuals to present relevant reports and/or advise the Committee.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs4 or any successor document will apply at all times.
5.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.4 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interest they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.5 Any declarations of interest, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.6 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.7 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and
4 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 162 of 220 Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum necessary for the transaction of business shall be six members, to include four Clinicians (can include the Chair), one Lay Member and one Executive Lead.
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Vice Chair) may call a vote. Any member where there is a conflict of interest will be excluded from voting for the proposal where there is a conflict.
7.2 Only members of the Committee set out at paragraph 4.2 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the CCG’s Corporate Governance Framework at Section 5.4.
8. ACCOUNTABILITY
The Committee is accountable to the CCG’s Governing Body.
9. FREQUENCY AND NOTICE OF MEETINGS
Meetings will be held monthly, but may be called at any other such time as the Committee Chair may require. The agenda and supporting papers will be sent to all members at least five working days before the meeting either manually or electronically, whichever is appropriate at the time.
10. REPORTING ARRANGEMENTS
The Committee will report to the CCG’s Governing Body following each meeting, confirming all decisions made. The report will include recommendations that are
Page 163 of 220 outside the delegated limits of the Committee and which require escalation to, and approval from the Governing Body, if not already approved by them.
11. SUB-COMMITTEES
11.1 The Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of such sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority.
11.2 Any sub-committees or working groups will report via their respective Chairs following each meeting or at an appropriate frequency as determined by the Committee.
12. ADMINISTRATIVE SUPPORT
12.1 The CCG will provide appropriate administration resource to ensure meetings are fully supported and business is conducted efficiently and effectively.
12.2 The meetings will be clearly minuted with particular attention paid to noting the declaration and management of any potential or actual conflicts of interest.
13. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required.
Reviewed by Clinical and Lay Commissioning Committee: [Date]
Approved by Governing Body: [Date]
Review Date: October 2019
Page 164 of 220
Finance Committee
Draft Terms of Reference
1. PURPOSE
The purpose of the Finance Committee is to:
1.1 oversee delivery of the financial recovery plan including the financial performance of the NHS Derby and Derbyshire Clinical Commissioning Group (the “CCG”) against financial targets, financial control targets and the annual commissioning plan, identifying where remedial action is needed, ensuring that action plans are put in place and delivery is monitored;
1.2 consider full business cases for schemes detailed in the CCG’s Financial Recovery Plan;
1.3 receive reports from the Financial Recovery Group and escalate risks to the Derbyshire Strategic Risk Register;
1.4 review Quality, Innovation, Productivity and Prevention (QIPP) programmes managed by the Financial Recovery Group;
1.5 oversee achievement and receive assurance of delivery against the Financial Recovery Plan. The Committee can recommend to the Governing Body that the financial recovery plan continues; changes or stops; and
1.6 provide a framework which proactively manages the CCG’s Financial and Improving Value (i.e. QIPP) and Cost Out Schemes agenda and provides assurance in the delivery of all these areas to the CCG’s Governing Body.
2. ROLES AND RESPONSIBILITIES
The Committee will incorporate the following duties:
2.1 oversee and recommend to the Governing Body the annual financial plan that reflects the prioritised commissioning plan for the CCG;
2.2 oversee and gain assurance on the delivery of the Financial Recovery Plan ensuring that it provides the desired strategic outcomes for the CCG in accordance with the short and long term recovery plans approved by NHS England;
Page 165 of 220 2.3 review, monitor and have oversight of finance in relation to the following areas:
• 'In year' financial position – receiving a detailed report of the financial position, variances and progress towards meeting the targets within the CCG’s financial plan, statutory financial targets and financial control targets; and • implementation of the CCG’s Operational Plans;
2.4 to review exception reports on any material breaches of the delivery of agreed QIPP Schemes including the adequacy of proposed remedial action plans;
2.5 to review exception reports on any material in-year overspends against delegated budgets, including the adequacy of proposed remedial action plans;
2.6 to have responsibility to the Governing Body for oversight and advice on the current risk exposures with regard to the short and long term financial recovery plans and the associated recovery strategies;
2.7 identify resource allocation in relation to mitigation plans and risks identified within programmes as appropriate;
2.8 identify and allocate resources where appropriate to improve performance of identified schemes or ad-hoc finance and performance related issues that may arise;
2.9 review the risk register for its area of remit, considering the adequacy of the submissions and whether new risks need to be added or whether any risks require immediate escalation to the Governing Body;
2.10 scrutinise progress of the relevant Improvement Plan workstreams by:
• seeking assurance from Executive Leads on delivery and impact of actions; • approving completion of requirements; • validating evidence of embeddedness; and • providing assurance to Governing Body on Improvement Plan progress; and
2.11 review the work plan for the Committee to ensure preparatory work to meet national planning timelines are appropriately scheduled.
3. CHAIR ARRANGEMENTS
The Chair of the Committee shall be the Finance Lay Member (not the Audit Chair), nominated by the Accountable Officer and endorsed by the CCG Chair. In the event that the Chair is unavailable to attend, the Vice Chair, who shall be a Lay Member will deputise and Chair the meeting.
4. MEMBERSHIP
4.1 Members of the Committee may be appointed from the CCG’s Governing Body, officers of the CCG or other external bodies as required to enable the Committee to fulfil its purpose.
Page 166 of 220 4.2 The membership of the Committee will comprise:
• 3 x Governing Body GPs;
• 3 x Governing Body Lay Members (including Finance, Governance and Patient and Public Involvement);
• Chief Finance Officer
• Turnaround Director; and
• 1 x Clinical Representative (Chief Nurse Officer/Medical Director).
4.3 CCG Officer subject experts will be attendees at each meeting (i.e. Governance Lead).
4.4 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Committee. All deputies should be fully briefed and the Committee secretariat informed of any agreement to deputise so that quoracy can be maintained.
4.5 The Committee may also request attendance by appropriate individuals to present relevant reports and/or advise the Committee.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs5 or any successor document will apply at all times.
5.2 Where a member of the Committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.4 Any declarations of interest, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 167 of 220 5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum shall be five members, to include at least one Executive Lead (Chief Finance Officer or Turnaround Director), at least one Clinical Representative and at least two Governing Body Lay Members.
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Vice Chair) may call a vote. Any member where there is a conflict of interest will be excluded from voting for the proposal where there is a conflict.
7.2 Only members of the Committee set out at paragraph 4.2 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the CCG’s Corporate Governance Framework at Section 5.4.
8. ACCOUNTABILITY
The Committee is accountable to the CCG’s Governing Body.
9. REPORTING ARRANGEMENTS
The Committee will report to the CCG’s Governing Body following each meeting, confirming all decisions made. The report will include recommendations that are outside the delegated limits of the Committee and which require escalation to, and approval from the CCG’s Governing Body, if not already approved by them.
Page 168 of 220 10. FREQUENCY AND NOTICE OF MEETINGS
Meetings will be held monthly. Agenda items and papers must be circulated five working days before the meeting date.
11. SUB-COMMITTEES
The Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of each sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority. The Financial Recovery Group is an Executive Working Group which is accountable to the Finance Committee.
12. ADMINISTRATIVE SUPPORT
12.1 The CCG will provide appropriate administration resource to ensure meetings are fully supported and business is conducted efficiently and effectively.
12.2 The meetings will be clearly minuted with particular attention paid to noting the declaration and management of any potential or actual conflicts of interest.
13. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required.
Reviewed by Finance Committee: [Date]
Approved by Governing Body: [Date]
Review Date: October 2019
Page 169 of 220
Governance Committee
Draft Terms of Reference
1. PURPOSE
1.1 The purpose of the Committee is to ensure that NHS Derby and Derbyshire Clinical Commissioning Group (the “CCG”) complies with the principles of good governance whilst effectively delivering the statutory functions of the CCG.
1.2 The Committee has delegated authority to make decisions as set out in the CCG’s Prime Financial Policies and the Scheme of Reservation and Delegation.
2. ROLES AND RESPONSIBILITIES
2.1 The Committee will discharge the CCG’s responsibilities in respect of the following functions:
• Business Continuity; • Corporate Governance; • Emergency Preparedness Resilience and Response; • Equality, Human Rights and Inclusion; • Estates; • Health, Safety, Fire and Security; • Human Resources; • Information Governance; • Organisational Development; • Procurement; • Research Governance; • Risk Management – oversight of the development and implementation of the risk management framework.
2.2 In order to discharges these duties, the Committee will:
• produce an annual work programme; • ensure that suitable policies and procedures are in place to comply with relevant regulatory, legal and code of conduct requirements; • ensure that arrangements are in place to monitor compliance with statutory responsibilities; • promote good risk management and ensure robust controls are in place in accordance with the CCG’s Risk Management Framework;
Page 170 of 220 • establish and approve the terms of reference of such reporting sub-groups or task and finish groups as the Committee believes are necessary to fulfil its terms of reference; • review the risk register for its area of remit, considering the adequacy of the submissions and whether new risks need to be added or whether any risks require immediate escalation to the CCG’s Governing Body; • scrutinise progress of the relevant Improvement Plan workstreams: seek assurance from Executive Leads on delivery and impact of actions; approve completion of requirements; validate evidence of embeddedness; provide assurance to the CCG’s Governing Body on Improvement Plan progress.
3. CHAIR ARRANGEMENTS
The Chair of the Committee shall be the Lay Member for Governance, nominated by the Accountable Officer and endorsed by the CCG Chair. In the event that the Chair is unavailable to attend, the Vice Chair, who shall be a Lay Member will deputise and Chair the meeting.
4. MEMBERSHIP
4.1 Members of the Committee may be appointed from the CCG’s Governing Body, Officers of the CCG or other external bodies as required to enable the Committee to fulfil its purpose.
4.2 The membership of the Committee will comprise of:
• 3 x Governing Body Lay Members; • 2 x GP Governing Body Members; • Executive Director (Corporate) or Deputy;
4.3 CCG Officer subject experts will be attendees at each meeting.
4.4 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Committee. All deputies should be fully briefed and the Committee secretariat informed of any agreement to deputise so that quoracy can be maintained.
4.5 The Committee may also request attendance by appropriate individuals to present relevant reports and/or advise the Committee.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs6 or any successor document will apply at all times.
5.2 Where a member of the Committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they
6 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 171 of 220 will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.4 Any declarations of interest, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum necessary for the transaction of business shall be four members, to include two Governing Body Lay Members, one Clinician and the Executive Lead (or deputy).
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Vice Chair) may call a vote. Any member where there is a conflict of interest will be excluded from voting for the proposal where there is a conflict.
7.2 Only voting members of the Committee set out at paragraph 4.2 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and
Page 172 of 220 virtual meetings in accordance with the CCG’s Corporate Governance Framework at Section 5.4.
8. ACCOUNTABILITY
The Committee is accountable to the CCG’s Governing Body.
9. REPORTING ARRANGEMENTS
The Committee will report to the CCG’s Governing Body following each meeting, confirming all decisions made. The report will include recommendations that are outside the delegated limits of the Committee and which require escalation to, and approval from the CCG’s Governing Body, if not already approved by them.
The Committee will provide an annual report to the CCG’s Governing Body on the effectiveness of the Committee to discharge its duties.
10. FREQUENCY AND NOTICE OF MEETINGS
Meetings will be held bi-monthly, but may be called at any other such time as the Committee Chair may require.
11. SUB-COMMITTEES
11.1 The Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of each such sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority.
11.2 Any sub-committees or working groups will report via their respective Chairs following each meeting or at an appropriate frequency as determined by the Committee.
12. ADMINISTRATIVE SUPPORT
The CCG will provide appropriate administration resource to ensure meetings are fully supported and business is conducted efficiently and effectively. The meetings will be clearly minuted with particular attention paid to noting the declaration and management of any potential or actual conflicts of interest.
13. REVIEW OF TERMS OF REFERENCE
These terms of reference and the effectiveness of the Committee will be reviewed at least annually or sooner if required.
Page 173 of 220 Reviewed by Governance Committee: [Date]
Approved by Governing Body: [Date]
Review Date: October 2019
Page 174 of 220
Engagement Committee
Terms of Reference
1. PURPOSE
The purpose of the NHS Derby and Derbyshire Clinical Commissioning Group (the “CCG”) Engagement Committee (the “Committee”) is to:
1.1 ensure any service changes and plans are developed and delivered through effective engagement with those affected by change and that patients, carers and the public are at the centre of shaping the future of health and care in Derbyshire;
1.2 provide a lay forum within which discussions can take place to assess levels of assurance and risk in relation to the delivery of statutory duties in public and patient involvement and consultation, as defined within the Health & Social Care Act 2012;
1.3 retain a focus on the need for engagement in strategic priorities and programmes, to ensure the local health system is developing robust processes in the discharging of duties relating to involvement and consultation;
1.4 promote innovation and improvement in public and patient engagement;
1.5 provide update reports to the CCG’s Governing Body on assurance and risk; and on the delivery of duties and activities relating to patient and public engagement and involvement;
1.6 champion Patient and Public Involvement in all processes relating to CCG decisions;
1.7 seek assurance on the delivery of Equality & Diversity objectives and that the CCG is following defined processes to take due regard when considering and implementing service changes, as defined by the Equality Act 2010.
2. ROLES AND RESPONSIBILITIES
The Committee is asked by the Governing Body to:
2.1 champion patient and public engagement across the Derbyshire health and care system, providing a watchful eye in scrutinising service developments;
2.2 seek assurance, through reports, reviews and presentations that patients and the public are an integral part of designing, commissioning, transforming and monitoring services;
Page 175 of 220 2.3 seek assurance that the CCG are meeting statutory duties relating to Patient and Public Engagement, as laid out in the Health & Social Care Act 2012, including those relating to Local Authority Scrutiny;
2.4 seek assurance that the CCG has robust mechanisms for training relevant staff on statutory duties relating to Patient and Public Engagement, as laid out in the Health & Social Care Act 2012;
2.5 oversee the development, implementation and monitoring of a robust engagement infrastructure across the Derbyshire health and care system;
2.6 ensure due process and appropriate methodologies have been followed in terms of involving patients and the public in CCG projects, including providing constructive advice and challenge on proposed methods;
2.7 sign off the approach to all formal consultation programmes, either with delegated authority from the CCG’s Governing Body or prior to their final sign off at those meetings;
2.8 seek assurance that the CCG have processes to ensure that adherence to the Equality Act duties of due regard is informing engagement programmes accordingly;
2.9 report to the CCG’s Governing Body with regard to key risk areas and monitoring actions;
2.10 make recommendations for improvements and innovations in the way the CCG works with patients and the public;
2.11 oversee the development, completion and action planning of any internal or external audits relating to patient and public engagement;
2.12 respond to external reviews and National Lessons Learnt reviews and bulletins especially with regards to the way patients and the public are engaged;
2.13 ensure that all voices are heard at committee meetings and that all groups are given appropriate opportunity to shape local services;
2.14 act as an advocate for the engagement work being carried out for the future of health and social care in Derbyshire through appropriate networks.
Page 176 of 220 Meeting Part Two
To reflect the joint approach to resourcing of Communications & Engagement being taken across the CCG and Joined Up Care Derbyshire, the Engagement Committee will have a ‘Part 2’ meeting. All other elements of the Terms of Reference are the same, with the exception of the addition of the Derbyshire Sustainability and Transformation Partnership Director to the non-voting membership of the group. This ‘Part 2’ will not represent a formal sub-committee of the CCG, but will instead report to the Joined Up Care Derbyshire Board. This ‘Part 2’ meeting will take the place of the previously established Joined Up Care Derbyshire Patient Engagement Forum and will discharge the following objectives relating to the work of Joined Up Care Derbyshire:
2.15 ensure any service changes and plans are developed and delivered through effective engagement with those affected by change and that patients, carers and the public are at the centre of shaping the future of health and care in Derbyshire;
2.16 provide a lay forum within which discussions can take place to assess levels of assurance and risk in relation to public and patient involvement and consultation;
2.17 retain a focus on the need for engagement in strategic priorities and programmes, to ensure the local health system is developing robust processes in the discharging of duties relating to involvement and consultation;
2.18 promote innovation and improvement in public and patient engagement;
2.19 provide update reports on assurance and risk to the Joined Up Care Derbyshire Board on the delivery of duties and activities relating to patient and public engagement and involvement;
2.20 champion Patient and Public Involvement in all processes relating to CCG and Joined Up Care Derbyshire decisions; and
2.21 oversee the development and delivery of a robust infrastructure of engagement mechanisms including, but not limited to, place-level engagement, reference groups to provide insight on emerging issues, a citizen’s panel from which can be drawn individuals across a matrix of geography/conditions/protected characteristics, project-specific lay representation and other mechanisms as required.
3. CHAIR ARRANGEMENTS
The Chair of the Committee shall be one of the Lay Members for Patient and Public Involvement (PPI), nominated by the Accountable Officer and endorsed by the CCG Chair. In the event that the Chair is unavailable to attend, the second Lay Member for PPI shall be the Vice Chair.
Page 177 of 220 4. MEMBERSHIP
4.1 The membership of the Committee will comprise of the following voting and non-voting members:
Voting Members
• Governing Body Lay Member - PPI lead (Chair) • Governing Body Lay Member - PPI lead (Vice-Chair) • Governing Body Lay Member - Primary Care Commissioning • Foundation Trust Governor – Secondary Care • Foundation Trust Governor – Community • Foundation Trust Governor – Mental Health • Derbyshire County Council representative • Derby City Council representative • Clinical representative – TBC • 8 x Place Engagement structure (TBC) representatives • Education Sector independent representative – e.g. Derby University representative • Executive Director of Corporate Strategy and Delivery or Deputy • Business Sector Independent representative
Non-voting Members
• Healthwatch Derby Representative • Healthwatch Derbyshire Representative • Voluntary Sector City and County representation – nominated infrastructure lead officer • CCG/Joined Up Care Derbyshire, Assistant Director Communications and Engagement (or deputy) • Joined Up Care Derbyshire Head of Engagement
4.2 CCG officer subject experts will be attendees at each meeting as required.
5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs7 or any successor document will apply at all times.
5.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the
7 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 178 of 220 meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.4 Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum necessary for the transaction of business shall be 5 members:
6.1.1 2 x PPI Lay Members including either the Chair or Vice Chair is present; and
6.1.2 2 x Place Engagement Representatives
6.1.3 1 x Executive Director or Deputy.
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Vice Chair) may call a vote. Any member where there is a conflict of interest will be excluded from voting for the proposal where there is a conflict.
7.2 Only voting members of the Committee set out at paragraph 4.1 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the CCG’s Corporate Governance Framework at Section 5.4.
Page 179 of 220 8. ACCOUNTABILITY
8.1 The Committee is accountable to the CCG’s Governing Body.
8.2 The Engagement Committee is authorised by the Governing Body to provide the Governing Body with appropriate assurances in respect of ensuring the voice of patients and the public is heard throughout the CCG processes in the planning, commissioning, transformation and monitoring of services and to provide advice and support in the delivery of appropriate and effective PPI methodologies.
9. REPORTING ARRANGEMENTS
9.1 The committee will report items for consideration by the CCG’s Governing Body through submission of minutes, papers and reports to relevant meetings.
9.2 The Chair and/or Vice Chair of the committee will have a seat at the CCG Governing Body to ensure feedback from the committee is heard.
10. FREQUENCY AND NOTICE OF MEETINGS
Meetings will be held monthly, but may be called at any other such time as the Committee Chair may require.
11. SUB-COMMITTEES
11.1 The Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of each such sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority.
11.2 Any sub-committees or working groups will report via their respective Chair’s following each meeting or at an appropriate frequency as determined by the Committee.
12. ADMINSTRATIVE SUPPORT
12.1 The Personal Assistant to the CCG’s Executive Director Corporate Strategy and Delivery shall provide the administrative support.
12.2 Agenda and supporting papers will be circulated to members at least five working days prior to any meeting.
12.3 Minutes shall be prepared and distributed in draft within 14 working days of the meeting.
13. REVIEW
The terms of reference and the effectiveness of the Committee shall be reviewed at least annually or sooner if required.
Page 180 of 220
Reviewed by Engagement Committee: [Date]
Approved by Governing Body [Date]
Review Date: October 2019
Page 181 of 220
Quality & Performance Committee
Draft Terms of Reference
1. PURPOSE
1.1 The prime function of the Quality & Performance Committee (the “Committee”) is to provide assurance to the NHS Derby and Derbyshire Clinical Commissioning Group (the “CCG”) Governing Body in relation to the quality, performance, safety, experience and outcomes of services commissioned by the CCG.
1.2 It shall ensure that the CCG discharges the statutory duties in relation to the achievement of continuous quality improvement and safeguarding of vulnerable children and adults.
1.3 It shall pro-actively challenge and review delivery against the performance expectations for the CCG against the Constitution, NHS Mandate, Public Health Outcomes Framework and associated NHS performance regimes, agreeing any action plans or recommendations as appropriate.
1.4 Monitor progress in the delivery against the Improvement and Assessment Framework (IAF), challenge variances from plan and ensuring actions are put in place to rectify adverse trends.
1.5 It shall receive and scrutinise performance delivery information against key performance trajectories ensuring delivery and where necessary corrective actions are followed up.
1.6 It shall review the performance of the main services commissioned by the CCG. It will provide members with greater clarity and detailed information about the underlying performance on key services commissioned by the CCG and on delivery of the annual commissioning programme set out in the CCG’s Operational Plan.
2. ROLES AND RESPONSIBILITIES
2.1 Quality
2.1.1 Ensure that processes are in place to provide assurance that CCG commissioned services are high quality, safe, effective, and provide patients and carers with positive experiences of care.
2.1.2 Ensure that quality assurance data is used to inform commissioning decisions and drive improvements in quality.
Page 182 of 220 2.1.3 Have oversight of the process and compliance issues concerning serious incidents requiring investigation (SIRIs); being informed of all Never Events and informing the governing body of any escalation or sensitive issues in good time. To seek assurance on the performance of NHS organisations in terms of the Care Quality Commission (CQC) and any other relevant regulatory bodies.
2.1.4 Continually develop the approach to quality improvement.
2.1.5 Ensure processes are in place to interpret and implement local, regional and national policy (e.g. Quality Accounts, Safeguarding etc.) and provide assurance that policy requirements are embedded in commissioned services.
2.1.6 Take responsibility for the development, implementation and monitoring of quality schedules and any quality improvement schemes for commissioned services.
2.1.7 Receive reports from provider Quality Assurance Groups and ensure that a clearly defined escalation process is in place.
2.1.8 Take action where required to investigate any quality, safety or patient experience concerns and to ensure that a clearly defined escalation process is in place, taking action to ensure that improvements in quality are implemented where necessary.
2.1.9 Ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern.
2.1.10 Ensure considerations relating to safeguarding children and adults are integral to commissioning services and robust processes are in place to deliver statutory functions, including Safeguarding Children, Looked After Children, Deprivation of Liberty Safeguarding (including Adult Safeguarding) and the Duty to Consult.
2.1.11 Commission any reports, surveys or reviews of services it deems necessary to help it fulfil its obligations.
2.1.12 Receive and scrutinise independent investigation reports relating to patient safety issues and agree any further actions.
2.1.13 Support the role of CCG Medicines Safety and Medical Devices Safety Officer to monitor, and to respond to, national and local requirements.
2.1.14 Provide a view on the quality aspects of the Sustainability and Transformation Partnership plans.
2.2 Performance
2.2.1 Monitor contract and operational performance across all commissioned services from key partners on an exception basis, assessing potential shortfalls and risk and to identify recommended actions. Review, challenge and scrutinise exception reports against delivery of targets or improved performance in accordance with agreed Recovery Action Plans (RAPs).
Page 183 of 220 2.2.2 Monitor Key Performance Indicators (KPIs) relating to CCG performance, for example outlined in the CCG’s Assurance Framework and the Public Health Outcomes Framework.
2.2.3 Review monthly reports detailing performance of commissioned services against contract standards, national and local targets and the CCG’s Strategic Plans.
2.2.4 Review the risk register for its area of remit, considering the adequacy of the submissions and whether new risks need to be added or whether any risks require immediate escalation to the Governing Bodies.
3. CHAIR ARRANGEMENTS
The Chair of the Committee shall be a GP, nominated by the Accountable Officer and endorsed by the CCG Chair. In the event that the Chair is unavailable to attend, a Patient and Public Lay Member of the Committee will act as the Vice Chair and Chair the meeting, unless there is a conflict of interest.
4. MEMBERSHIP
4.1 Members of the Committee may be appointed from the CCG’s Governing Body, Officers of the CCG or other external bodies as required to enable the Committee to fulfil its purpose.
4.2 The membership of the Committee will comprise:
• 4 x GP Governing Body Members;
• 3 x Lay Members;
• 1 x Chief Nurse Officer or Deputy;
• 1 x Medical Director;
• 1 x Secondary Care Doctor
• 1 x Executive Director of Commissioning and Operations;
• 2 x Senior Healthwatch Representative (Derby City and Derbyshire County).
4.3 Patient representation (to be determined following review of patient engagement across Derbyshire).
4.4 CCG Officer subject experts will be attendees at each meeting.
4.5 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Committee. All deputies should be fully briefed and the Committee secretariat informed of any agreement to deputise so that quoracy can be maintained.
4.6 The Committee may also request attendance by appropriate individuals to present relevant reports and/or advise the Committee.
Page 184 of 220 5. DECLARATIONS OF INTEREST, CONFLICTS AND POTENTIAL CONFLICTS
5.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs8 or any successor document will apply at all times.
5.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
5.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interest they will bring it to the attention of the Committee, and the Vice Chair will act as Chair for the relevant part of the meeting (or another non-conflicted member of the meeting if the Vice Chair is also conflicted).
5.4 Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
5.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Managing Conflicts of Interest: Revised Statutory Guidance and may result in suspension from the Committee.
5.6 All members of the Committee shall comply with, and are bound by, the requirements in the CCG’s Constitution, Standards of Business Conduct and Conflicts of Interest Policy, the Standards of Business Conduct for NHS staff (where applicable) and NHS Code of Conduct.
6. QUORACY
6.1 The quorum shall be five members, to include two Clinicians, two Lay Members and one Executive Lead (Chief Nurse Officer, Executive Director of Commissioning and Operations or Deputy). Nominated deputies are invited to attend in place of the regular member as required.
6.2 A duly convened meeting of the Committee at which quorum is present at the meeting, or are contactable by telephone conference call, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
7. DECISION MAKING AND VOTING
7.1 The Committee will use its best endeavours to make decisions by consensus. Exceptionally, where this is not possible the Chair (or Vice Chair) may call a vote. Any member where there is a conflict of interest will be excluded from voting for the proposal where there is a conflict.
8 https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf
Page 185 of 220 7.2 Only members of the Committee set out at paragraph 4.2 have voting rights. Each voting member is allowed one vote and a majority will be conclusive on any matter. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
7.3 If a decision is needed which cannot wait for the next scheduled meeting or it is not considered necessary to call a full meeting, the Committee may choose to convene a telephone conference or conduct its business on a ‘virtual’ basis through the use of email communication. Minutes will be recorded for telephone conference and virtual meetings in accordance with the CCG’s Corporate Governance Framework at Section 5.4.
8. ACCOUNTABILITY
8.1 The Committee is accountable to the CCG’s Governing Body.
8.2 It shall maintain an annual work programme, ensuring that all matters for which it is responsible are addressed in a planned manner, with appropriate frequency across the year.
8.3 The Committee may investigate, monitor and review any activity within its terms of reference. It is authorised to seek any information it requires from any committee, group, clinician or employee (including interim and temporary members of staff), who are directed to co-operate with any request made by it.
9. REPORTING ARRANGEMENTS
The Committee shall report to the CCG’s Governing Body following each meeting. The report shall highlight any recommendations and matters which require escalation.
10. FREQUENCY AND NOTICE OF MEETINGS
10.1 Meetings will be held monthly, but may be called at any other such time as the Committee Chair may require.
10.2 Agendas and papers will be circulated five working days before the meeting date.
11. SUB-COMMITTEES
11.1 The Committee may delegate responsibility for specific aspects of its duties to sub-committees or working groups. The Terms of Reference of each such sub-committee or working group shall be approved by the Committee and shall set out specific details of the areas of responsibility and authority.
11.2 Any sub-committees or working groups will report via their respective Chair’s following each meeting or at an appropriate frequency as determined by the Committee.
Page 186 of 220 12. ADMINSTRATIVE SUPPORT
12.1 The CCG will provide appropriate administration resource to ensure meetings are fully supported and business is conducted efficiently and effectively.
12.2 The meetings will be clearly minuted with particular attention paid to noting the declaration and management of any potential or actual conflicts of interest.
13. REVIEW
The terms of reference and the effectiveness of the Committee shall be reviewed at least annually or sooner if required.
Reviewed by Quality and Performance Committee: [Date]
Approved by Governing Body [Date]
Review Date: October 2019
Page 187 of 220
Governing Body Meeting in Public
11th April 2019
Paper: 7
Report Title Draft Governing Body Assurance Framework 2019-20 Author(s) Rosalie Whitehead – Risk Management & Legal Assurance Manager Sponsor Helen Dillistone – Executive Director Corporate Strategy & Delivery
Paper for: Decision X Corporate Discussion Information Assurance Recommendations The Governing Body is asked to: • APPROVE the draft opening 2019-20 Derbyshire Governing Body Assurance Framework. (Appendix 1).
Report Summary The Governing Body Assurance Framework (GBAF) provides a structure and process that enables the organisation to focus on the strategic/ principal risks that might compromise the CCG in achieving its corporate objectives. It also maps out both the key controls that should be in place to manage those objectives and associated strategic risks, and confirms that the Governing Body has sufficient assurance about the effectiveness of the controls.
The closing 2018-19 GBAF is the opening draft 2019-20 GBAF and identifies the 9 principal/ strategic risks that were associated to the agreed Derbyshire Objectives for 2018-19.
The 2018-19 Strategic Objectives of the Derbyshire CCGs were:
• To reduce health inequalities by improving the physical and mental health for the people of Derbyshire. • To continue to reduce the variation in the quality of care across Derbyshire. • To take the lead in planning and commissioning care for the population of Derbyshire. • To make best use of available resources that must include achieving our statutory financial duties. • To deliver improvements in communications and engagement with our patients and stakeholders.
The 2018-19 strategic risks are detailed within the assurance framework in Appendix 1. This is presented as an individual risk extract that illustrates the management of each strategic/principal risk; the key controls to mitigate the threats and the gaps in control /assurance and the corrective actions taken to address the gaps.
Page 188 of 220
The strategic risks have been assigned to the relevant Executive Director and responsible committee who worked with their teams to populate the attached framework. This reflects the position as at the end of March 2019. In summary the risk scores assigned to these risks for the closing position of 2018-19 are:
Low risk M ode rate risk High risk Very high risk (scored 1 -3) (scored 4-6) (8 – 12) (15 – 25) - 1 7 1
The four Derbyshire CCGs ceased to exist at the end of March 2019. From 1st April the merged organisation Derby and Derbyshire CCG commenced.
Governing Body are now asked to discuss the carried forward strategic risks from 2018-19 and further develop in May at a Governing Body Development session / Board Assurance Framework Workshop, for the new organisation for 2019-20. This will identify the key strategic risks for the CCG and develop the 2019-20 GBAF to enable it to be approved at the June 2019 Governing Body meeting.
Are there any Resource Implications (including Financial, Staffing etc)?
The Derby and Derbyshire CCG attaches great importance to the effective management of risks that may be faced by patients, members of the public, member practices and their partners and staff, CCG managers and staff, partners and other stakeholders, and by the CCG itself. Has Due Regard to the proactive duties of the Equality Act 2010 been taken into consideration in respect of the proposals within this report?
Due Regard is not found applicable to this update on the basis that the GBAF is not a decision making tool; however, addressing risks will impact positively across the organisation as a whole. Have you involved patients, carers and the public in the preparation of the report?
Not applicable to this update.
Have any Quality and Compliance issues been identified/ actions taken
Not required for this paper. Notwithstanding this, where any issues/risks that have been identified from a Quality Impact Assessment and Data Protection Impact Assessment (DPIA) appropriate actions will be taken to managed the associated risks. Have any Conflicts of Interest been identified/ actions taken? Not applicable to this report.
Governing Body Assurance Framework The paper provides the Governing Body the draft Derbyshire GBAF representing the strategic /principal risks identified against the agreed Objectives that were set for 2018-19. Identification of Key Risks The GBAF identifies the strategic/ principal risks which are linked to the corporate/ operational risks identified in the Corporate Risks Register.
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Paper
Appendix 1
Derby and Derbyshire CCG: Summary of the Governing Body Assurance Framework 2019/20 – April 2019
Introduction The Governing Body Assurance Framework (GBAF) aims to identify the strategic/principal risks to the delivery of the Derby and Derbyshire CGGs strategic objectives. It sets out the controls that are in place to manage the risks and the assurances that show if the controls are having the desired impact. It identifies the gaps in control and hence the key mitigating actions required to reduce the risks towards the target or appetite risk score. It also identifies any gaps in assurance and what actions can be taken to increase assurance to the Derby and Derbyshire CCG. The table below sets out the Derby and Derbyshire CCG strategic objectives; lists the strategic/principal risks that relate to them, and highlights where gaps in control or assurance have been identified. Further details can be found on the extract pages for each of the strategic/ principal Risks.
The Strategic Objectives of Derby and Derbyshire CCG are:
• To reduce health inequalities by improving the physical and mental health for the people of Derbyshire. • To continue to reduce the variation in the quality of care across Derbyshire. • To take the lead in planning and commissioning care for the population of Derbyshire. • To make best use of available resources that must include achieving our statutory financial duties. • To deliver improvements in communications and engagement with our patients and stakeholders.
Current Rating Monthly Change Strategic Risk(s) (Jan –Feb) The CCG resource allocation impacts on effective commissioning decisions which prevents the Derby and Derbyshire CCG improving health and reducing 1 12 health inequalities
2 Lack of capacity and capability to deliver the objectives of the CCG. This will impact on delivery of transformation to support and improve health outcomes and 12 health inequalities.
3 There is a risk that Commissioners (Place) and providers deliver poor quality care and patient safety which do not meet constitutional standards resulting in 15 reduced health outcomes and experience of the Derbyshire population.
12 4 Poor planning of resources (staff and money) has an adverse impact on the planning and commissioning of care for all the population of Derbyshire
5 The Derbyshire health economy may not be sustainable unless there is a delivery of transformational change through the Derbyshire Sustainability and 12 Transformation Partnerships (STP)
6 Failure to effectively manage demand, activity and cost pressures across the health system may impact on delivery of the CCGs financial plan 10
7 Inability to invest in service transformation which may impact on patient outcomes 4
8 Failure to engage with patients and stakeholders could risk poor decision making that do not meet the needs of the recipients of services. 12
9 Failure to engage with patients and stakeholders could risk a challenge to process, and reputational damage with local relationships 12
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Executive Lead: Brigid Stacey Strategic Objective 1 GBAF RISK 1 Assigned to Committee: Quality and Performance
What would success look like? Principal threat(s) to delivery of the strategic objective
To reduce health inequalities by improving the physical and mental health for The CCG resource allocation impacts on effective commissioning decisions which prevents the Derby and Derbyshire CCG the people of Derbyshire improving health and reducing health inequalities.
Risk rating Likelihood Consequence Total Date reviewed March 2019 GBAF Risk 1 GBAF Risk 1 Rating Rationale for risk rating (and any change in score): 14 • The QIPP process requires substantial reduction in Initial 4 3 12 12 10 resource allocation. 8 • STP strategic planning is still in development. 6 • Joint funding with the Local Authorities is under review 4 e.g. Section 75. 2 Current 4 3 12 0
July May June April March August January October February December November Link to Derby and Derbyshire Risk Register Level Category Target Score September
Risk Appetite Closing 18/19 Risk 005 and Risk 007 2 3 6 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • QIPP and SBR challenge process • NHSE and NHSI assurance arrangements • Quality & Performance Committee • Quality Surveillance Group • Prioritisation tool. • CQC inspections and associated commissioner • Risk management controls and exception reports • Recovery Action Plans • Clinical & Lay Commissioning Committee and provider action plans on clinical risks to Quality & Performance • Commissioning Boards providing clinical oversight of commissioning and • Programme Boards Committee • Health and Well-being Boards decommissioning decisions. • STP Oversight • Performance reporting framework in place • Legal advice where appropriate • Robust QIA process for commissioning/ • Lay representation within Governing Bodies and • NHSE Assurance Letters decommissioning schemes committee in common structures. • Clinical Quality Review Group (CQRG) measures built into all contracts GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Not applicable • Not applicable • Not applicable • Not applicable
ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe
NHSE assurance meetings to provide assurance. • 2019 - 20 • Meetings with Local Authority to identify joint funding opportunities. • 2019-20 • STP 2019-20 planning is being developed.
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Executive Lead: Brigid Stacey Strategic Objective 1 GBAF RISK 2 Assigned to Committee: Quality and Performance
What would success look like? Principal threat(s) to delivery of the strategic objective To reduce health inequalities by improving the physical and mental health for Lack of capacity and capability to deliver the objectives of the CCG. This will impact on the delivery of transformation to the people of Derbyshire support and improve health outcomes and health inequalities.
Risk rating Likelihood Consequence Total Date reviewed March 2019 GBAF Risk 2 GBAF Risk 2 Rating Rationale for risk rating (and any change in score): 14 • Reduced consultant and inpatient staffing vacancies Initial 3 4 12 12 10 resulted in increased waiting times. 8 • Reduced offer to the voluntary sector 6 • Expectations to deliver the control total against a high 4 2 quality service Current 3 4 12 0
July May June April March August January October February December
November Link to Derby and Derbyshire Risk Register Level Category Target Score September
Risk Appetite Closing 18/19 Risk 004, Risk 007 and Risk 013
3 3 9 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • Clinical & Lay Commissioning Committee • NHSE assurance arrangements • Quality & Performance Committee • Collaboration with Healthwatch providing clinical oversight of commissioning and • Provider Governance arrangements are clear and • Risk management controls and exception reports • Health and Well-being Boards decommissioning decisions include any subcontracting responsibilities. on clinical risk to Quality & Performance • 360 Assurance audits • Robust QIA process for commissioning/ • CQC inspections and associated commissioner • Performance reporting framework • NHSE/I assurance meetings decommissioning schemes and provider action plans • Lay and Council representation within Governing • CQC Inspections and action plans • Clinical Quality Review Group (CQRG) measures • NHSI assurance arrangements Bodies and committees in common structure. • Quality Surveillance Group built into all contracts • STP Oversight • Clinical committee established at Place, • Financial Recovery Group (FRG) oversight. • Quality assurance visits • Contract Management Board (CMB) oversight • Quality & Performance Committee GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Not applicable • Not applicable • Not applicable • Not applicable
ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe • NHSE assurance meetings to provide assurance. • STP planning in development. • Ongoing 2019-2020 • Ongoing 2018-19
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Executive Lead: Zara Jones Strategic Objective 2 GBAF RISK 3 Assigned to Committee: Quality and Performance
What would success look like? Risk description to delivery of the strategic objective
To continue to reduce the variation in the quality of care across Derbyshire There is a risk that Commissioners (Place) and providers deliver poor quality care and patient safety which do not meet constitutional standards resulting in reduced health outcomes and experience of the Derbyshire population March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 3 GBAF Risk 3… Rationale for risk rating (and any change in score):
20 Commissioning processes include mechanisms to ensure quality Initial 3 5 15 15 provision is required and the impact assessed and constitutional 10 standards required of providers No responsibilities have transferred under the developing Place 5 Based working. The risk rating remains high due to the fact that Current 3 5 15 0 the consequence/impact is high even where the likelihood is rated
July as ‘possible’. May June April March
August Closing… January October Level Category Target Score February Link to Derby and Derbyshire Risk Register December November Risk Appetite September Risk 002, 006, 009, 015 3 3 9 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External
• Quality leads assigned to contracts and included • NHSE assurance arrangements • Clinical & Lay Commissioning Committee • NHSE assurance processes in commissioning reviews and decisions • Derbyshire and Derby Healthwatch reviews and minutes • Local Council scrutiny • Clinical & Lay Commissioning Committee engagement. • QIA panel outputs • Patient and public engagement providing clinical oversight of commissioning and • Provider Governance arrangements are clear and • Quality & Assurance Committee minutes • Adult care board decommissioning decisions. include any subcontracting responsibilities. • Performance reporting framework • Peoples commissioning board • Robust QIA process for commissioning schemes • CQC inspections and associated commissioner • Health and Well-being Boards • Robust Quality and Performance governance and provider action plans embedded within the CCG
GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • None identified • None identified • None identified • None identified
ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe
• None identified. • None identified. • None identified.
Page 193 of 220 • None identified.
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Executive Lead: Zara Jones Strategic Objective 3 GBAF RISK 4 Assigned to Committee: Clinical and Lay Commissioning Committee
What would success look like? Risk description to delivery of the strategic objective
To take the lead in planning and commissioning care for the population of Poor planning of resources (staff and money) has an adverse impact on the planning and commissioning of care for all the Derbyshire population of Derbyshire
March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 4 GBAF Risk 4 Rating Rationale for risk rating (and any change in score): 14 Initial 4 4 16 12 10 The likelihood rating remains ‘possible’ from ‘likely’ to reflect 8 the processes now in place for resource management control 6 4 and the improved planning mechanisms undertaken as part of 2 the CCGs’ merger application / developing commissioning Current 3 4 12 0 plans for 2019/20 and national guidance. Consequence rating remains the same. July May June April March August Closing…
January October Link to Derby and Derbyshire Risk Register Level Category Target Score February
December November Risk Appetite September Risk 006 and Risk 020 3 3 9 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External
• Commissioning Strategy developed • NHSE assurance meetings • Clinical and Lay Commissioning Committee • NHSE assurance packs • Executive Director for Commissioning Operations minutes • Merger application in post • Governing Body minutes • Framework for strategy development • Transition working Group GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Lack of stability within CCG teams-restructure • Initial planning guidance received – further detail • None identified • None identified underway. needed and need to work through ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe • Restructure almost complete (timeframe reflects fact that external recruitment • End of March 2018 • • will be necessary to fully populate structure)
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Executive Lead: Zara Jones Strategic Objective 3 GBAF RISK 5 Assigned to Committee: Clinical & Lay Commissioning
What would success look like? Risk description to delivery of the strategic objective
To take the lead in planning and commissioning care for the population of Derbyshire The STP partners across health and social care are not able to jointly provide the i.e. To meet the health and well-being needs of the population of Derbyshire within the agreed financial envelope necessary transformational change required to deliver the triple aim of better health, better care, better value. March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 5 GBAF Risk 5… Rationale for risk rating (and any change in 14 score): Initial 4 4 16 12 10 The likelihood rating was previsouly reduced to 8 reflect the fact that National Guidance introduced 6 single system wide operational planning process 4 2 and collective responsibilities for delivery. The risk Current 3 4 12 0 level has not been further reduced as the contract round is proving challenging to system wide July May June April relationships. March
August January October February Link to Derby and Derbyshire Risk Register December Level Category Target Score November Risk Appetite September Risk 003 Closing 18/19 2 3 6 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • Senior members of staff are fully involved in STP • Governance structure becoming embedded • Clinical & Lay Commissioning Committee • JUCD Board workstreams • Good CEO/DoF system engagement meetings • CEO/DoF meetings • Link with STP and PMO • JUCD Board now fully functioning as a group of system leaders • Governing Body • CPRG meetings • Strong CEO lead and influence on STP • Strong STP Director with good national links • PMO • NHSE/I reviews • Good clinical engagement i.e. Medical Director a key player in CPRG GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Not able to influence decisions • National directives • • • Capacity to contribute to all meetings • ‘Club v’s country’ i.e. organisational sovereignty over system
ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe
• Establish coherent QIPP transformational plans to meet both system and internal • End of March 2019 • Work with system partners to develop transformational QIPP • End of March 19 requirements plans – gaining ownership
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Executive Lead: Deborah Hayman Strategic Objective 4 GBAF RISK 6 Assigned to Committee: Finance Committee
What would success look like? Risk description to delivery of the strategic objective
To make the best use of available resources that must include achieving our Failure to effectively manage demand, activity and cost pressures across the health system may impact on delivery of the statutory financial duties CCGs financial plan. March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 6 GBAF Risk 6 Rating Rationale for risk rating (and any change in score): 12 At month 9 the CCGs reported position was on plan with a Initial 4 4 16 10 8 forecast to achieve the required control total in 2018/19. Acute 6 contract expenditure at month 9 is 0 over plan (£5.4m) with a 4 FOT position of 1% over plan (£8.4m). The overall financial 2 position is being managed through budget flexibilities and use 0 Current 2 5 10 of the contingency. July
May Risk reduced to reflect the CCG remains on track to deliver its June April March August control total. January October February December November Level Category Target Score September Link to Derby and Derbyshire Risk Register
Risk Appetite Closing 18/19 Risk 001, Risk 008, Risk 010, Risk 014, Risk 023, Risk 025 3 2 6 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • Contracting timetable; including validation of • Standardised contract governance in line with • Contract position reported monthly to Finance • Internal audit review of Contract Management contract information, coding and counting national best practice. Committee. challenges etc. in place • Internal management processes – monthly confirm and challenge overseen by Director of Contracting and Performance. GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Clinical input/oversight of contract over • • • performance ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe
• April 2019 (TBC) • •
Page 197 of 220 • Alignment of clinical leadership to main provider contracts
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Executive Lead: Zara Jones Strategic Objective 4 GBAF RISK 7 Assigned to Committee: Quality & Performance Committee
What would success look like? Risk description to delivery of the strategic objective
To make the best use of available resources that must include achieving our Inability to invest in service transformation which may impact on patient outcomes statutory financial duties March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 7 GBAF Risk 7 Rating Rationale for risk rating (and any change in score): 5 Consequence – 2 Initial 4 4 16 4 The consequence of being unable to invest in service transformation 3 may impact on patient outcomes. The CCGs must have the ability to 2 invest in service transformation to enable a return to a financially sustainable position. 1 Likelihood – 2 Current 2 2 4 0 The CCGs 2018/19 plan does not provide investment funding for service transformation due to the current financial position. July May June April March August
January Link to Derby and Derbyshire Risk Register Level Category Target Score October February December Risk Appetite November Risk 001, Risk 019, Risk 022 2 2 4 September Closing 18/19
KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • Budgetary control and escalation policy in place, • NHSE monthly reporting of financial position • Monthly reporting of financial position to Finance • Internal audit reporting budgetary control and key approved by the Finance Committee Committee and Governing Body. financial systems 2017/18 • 2018/19 financial plan and QIPP programme • Governing Body (meetings in common) only approve • External audit of year end accounts approved by Governing Bodies. business cases requiring investment. These are • Financial position overseen by Financial Recovery scrutinised by Clinical & Lay Commissioning Committee prior to its recommendation to the GB. Group (FRG) This ensures that only robust business case proposals • Control Total Action plan in place 2018/19 are recommended. • NHSE Finance and Governance self-assessment GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Budget Holder Manual • • • • Formal Budget Holder training • Approved Medium Term Financial Plan ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe • Budget Holder Manual • March 2019 • Formal Budget Holder training • March 2019 • • • NHSE Finance and Governance self-assessment presentation to audit • November 2018
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Executive Lead: Helen Dillistone Strategic Objective 5 GBAF RISK 8 Assigned to Committee: Governance Committee
What would success look like? Risk description to delivery of the strategic objective To deliver improvements in communications and engagement with our Failure to engage with patients and stakeholders could risk poor decisions making that do not meet the needs of the recipients of patients and stakeholders services. March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 8 GBAF Risk 8 Rating Rationale for risk rating (and any change in score): 14 Likelihood reflects the current position that during 2018-19 the Initial 3 4 12 12 10 CCG did not fully engage with all schemes. Processes are being 8 6 put into place to address gaps as outlined in the mitigations; 4 2 however, these are not yet fully embedded. 0 Current 3 4 12
July May June April March August January October February Link to Derby and Derbyshire Risk Register December Level Category Target Score November Risk Appetite September Risks 012, Risk 022, Risk 024 3 2 6 Closing 18/19
KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE Internal External Internal External • Engagement function with clearly defined roles • Alignment of JUCD and CCG communications and • Confirm and challenge and outputs for Lay/Patient • Membership (and other stakeholder) feedback via annual and agreed priorities engagement agendas where necessary to provide Reference Group providing assurance to GBs 360 survey • Meeting of Patient/Lay Reference Group to streamlined and coherent approach • Governing Body assurance • Approval of engagement and consultation processes from provide challenge and internal scrutiny • Clarity of offer and process to engagement mechanisms for Overview and Scrutiny Committees • Alignment of CCG and JUCD communications Place • NHS England CCG Assurance and engagement agendas where necessary to • Relationship development with local parliamentary and • Internal Audit Report provide streamlined and coherent approach council politicians • Early involvement of communications and • Structured approach to broader stakeholder engagement engagement team in planning process • Proactive formal and informal Engagement with Overview & • Clearly defined offer and ownership of Scrutiny Committees, with clear business plan communications channels to support • Co-production approach to planning utilising existing local consistency of approach and clarity of message experts by experience • Improved coordination of membership • Joined Up Care Derbyshire Comms and Engagement engagement mechanisms, linked to planning collaboration and planning • Legal/Consultation Institute advice on wicked issues GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Agreement on roles, priorities and processes • Lack of provider engagement in JUCD communications and • Resistance to change for existing lay reference • None identified engagement work. Lack of clarity in place development. groups leading to loss of expertise ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe • Clear work programme being developed for • Programme agreed in stages between October 18 • Reviewing engagement processes to retain existing expertise, linked to place • 31.3.19 CCG communications and engagement offer (channels/offer development) and March 19 (CCG • 360 Assurance completed review of comms and engagement processes in • 31.3.19 and team project delivery projects) QIPP delivery, action plan being drafted to deliver recommendations • Ongoing
Page 200 of 220 • Tracking of 19/20 QIPP programme • Ongoing from 1/11/18 to project delivery • JUCD & CCG agendas aligning
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Executive Lead: Helen Dillistone Strategic Objective 5 GBAF RISK 9 Assigned to Committee: Governance Committee
What would success look like? Risk description to delivery of the strategic objective
To deliver improvements in communication and engagement with our patients Failure to engage with patients and stakeholders could risk a challenge to process, and reputational damage with local and stakeholders relationships March Risk rating Likelihood Consequence Total Date reviewed 2019 GBAF Risk 9 GBAF Risk 9 Rating Rationale for risk rating (and any change in score):
14 Likelihood reflects the current position that during 2018-19 the Initial 4 3 12 12 10 CCG did not fully engage with all schemes. Processes are 8 being put into place to address gaps as outlined in the 6 4 mitigations; however, these are not yet fully embedded. 2 0 Current 4 3 12
July May June April March August January October February Link to Derby and Derbyshire Risk Register December Level Category Target Score November Risk Appetite September Risk 020 and Risk 024 Closing 18/19 3 3 9 KEY CONTROLS TO MITIGATE RISK SOURCES OF ASSURANCE
Internal External Internal External • Settled Comms and Engagement function with clearly • Alignment of JUCD and CCG communications and engagement • Confirm and challenge and outputs for • Membership (and other stakeholder) feedback via defined roles and agreed priorities agendas where necessary to provide streamlined and coherent Lay/Patient Reference Group providing annual 360 survey • Meeting of Patient/Lay Reference Group to provide approach assurance to GBs • Approval of engagement and consultation processes challenge and internal scrutiny • Clarity of offer and process to engagement mechanisms for Place • Governing Body assurance from Overview and Scrutiny Committees • Alignment of CCG and JUCD communications and • Relationship development with local parliamentary and council • NHS England CCG Assurance engagement agendas where necessary to provide politicians • Internal Audit Report streamlined and coherent approach • Structured approach to broader stakeholder engagement • Early involvement of communications and engagement • Proactive formal and informal Engagement with Overview & team in planning process Scrutiny Committees, with clear business plan • Clearly defined offer and ownership of communications • Co-production approach to planning utilising existing local experts channels to support consistency of approach and by experience clarity of message • Joined Up Care Derbyshire Comms and Engagement collaboration • Improved coordination of membership engagement and planning mechanisms, linked to planning • Legal/Consultation Institute advice on wicked issues GAPS IN CONTROL GAPS IN ASSURANCE Internal External Internal External • Agreement on roles, priorities and processes • Lack of provider engagement in JUCD communications and • Resistance to change for existing lay • engagement work reference groups leading to loss of • Lack of clarity in place development expertise ACTIONS BEING TAKEN TO ADDRESS GAPS IN CONTROL/ASSURANCE (INCLUDE TIMESCALES) Internal Timeframe External Timeframe • Clear work programme being developed for CCG • Programme agreed in stages between October • Reviewing engagement processes to retain existing expertise, linked to • 31.3.19 communications and engagement offer and team 18 (channels/offer development) and March 19 place • 31.3.19 project delivery (CCG projects) • 360 Assurance completed review of comms and engagement processes • Tracking of 19/20 QIPP programme • Ongoing from 1/11/18 to project delivery in QIPP delivery, action plan being drafted to deliver recommendations • Ongoing • JUCD & CCG agendas aligning
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Page 203 of 220 Erewash Clinical Commissioning Group Hardwick Clinical Commissioning Group North Derbyshire Clinical Commissioning Group Southern Derbyshire Clinical Commissioning Group
DERBYSHIRE CCGs GOVERNING BODIES MEETING IN COMMON – Meeting in Public Held on Thursday 28th March 2019
UNCONFIRMED Present:
Derbyshire-wide Executives Dr Steve Lloyd SL Medical Director (part meeting) Helen Dillistone HD Executive Director Corporate Strategy & Delivery Sandy Hogg SH Turnaround Director Craig Cook CCo Director of Commissioning Operations Brigid Stacey BS Chief Nursing Officer Deborah Hayman DH Interim Chief Finance Officer
ECCG Dr Avi Bhatia AB CCG Chair (meeting Chair) Pamela Watson PWa Lay Member Ian Shaw ISh Lay Member Margaret Amos MA Lay Member
HCCG Jill Dentith JD Lay Member Gillian Orwin GO Lay Member Julie Vollor JV Derbyshire County Council Representative
NDCCG Dr Ben Milton BM NDCCG Chair Dr Anne-Marie Spooner AMS Governing Body GP Dr Debbie Austin DA Governing Body GP Ian Gibbard IG Lay Member Isabella Stone ISt Lay Member Gary Apsley GA Lay Member Jill Dentith JD Lay Member
SDCCG Dr Paul Wood PW SDCCG Chair Dr Nick Bishop NB Governing Body GP Dr Andy Mott AM Governing Body GP Dr Buk Dhadda BD Governing Body GP Dr Richard Crowson RCr Governing Body GP Dr Merryl Watkins MWa Governing Body GP Martin Whittle MWh Lay Member Margaret Amos MA Lay Member
Page 204 of 220 In attendance: Suzanne Pickering SP Head of Governance Dawn Litchfield DL Executive Assistant / Minute Taker
Item No. Item Action GBIC/1819/ Apologies, welcome and quoracy 116 The Chair welcomed members to the meeting and introductions were made for the benefit of the public in attendance.
Apologies for absence were received from Dr Bruce Braithwaite, Dr Andrew Maronge, Dr Duncan Gooch, Perveez Sadiq, Shokat Lal, Dr Kath Bagshaw, Dr Arvind Mistry, Dean Wallace, Dr Chris Clayton, Dr Ruth Cooper, Zara Jones
The Chair recognised that Hardwick CCG were not fully quorate; the members of Hardwick CCG present at the meeting will agree in principle to any decisions made, where appropriate, with a caveat that ratification will be sought from Dr Ruth Cooper post meeting.
Post meeting note: Dr Ruth Cooper confirmed that she as in agreement with all decisions made.
GBIC/1819/ Questions from members of the public 117 Dr Bhatia stated that 4 questions have been received:
1. In 2013, without consultation, Babington Hospital was transferred into the ownership of NHS Properties which has since then effectively acted as landlord. As landlord what steps has NHS Properties taken to maintain its upkeep, what estimates have been made of the costs needed for improvement and refurbishment and where are such estimates open and available to public scrutiny?
Response: This question cannot be answered in detail by the CCG. While the CCG worked closely with NHS Property Services in establishing the opportunities for future use of the Babington Hospital site and other options as we sought to solve the issue of the long term future of Babington prior to last year’s engagement, we do not have regular liaison with NHS Property Services about the ongoing maintenance of their asset list.
Colleagues at Derbyshire Community Health Services NHS Foundation Trust (DCHS) have indicated that there has been ongoing maintenance work performed under the instruction of NHS Property Services. This has included work to the fire detection & alarm system, the passenger lift, fitting of new windows, replacing the slate roof to the buildings previously occupied by the Physiotherapy Department and replaced part of the roof coverings at Belper Clinic. There has been some asbestos removal work to make safe, although the majority of the asbestos at the site remains.
Neither the CCG nor DCHS are aware of the costs involved as these have not been shared by NHSPS. In terms of the availability of detailed maintenance records relating to the Babington Hospital and
Page 205 of 220 Belper Clinic site, we would suggest contacting NHS Property Services directly with your enquiry.
2. Instead of transferring a public asset into private ownership, has consideration been given to developing Babington Hospital as a community hub including the use of its facilities for a wide range of community groups and enterprises?
Response: The CCG can confirm that it has not considered this option. The building is owned by NHS Property Services and will have the responsibility, once the site is declared surplus by the local NHS, to dispose of the site and secure the best return they can which is the put back into capital assets for the Secretary of State for Health and Social Care to re-circulate into the NHS to fund major capital schemes in England. The CCG would suggest contacting NHS Property Services with your suggestion.
3. How will the CCG ensure that the reorganisation and cuts, currently being planned to its Learning Disability Service by Derbyshire Healthcare FT, will not lead to further increases in waiting times, a loss of specialist skills and experience and the failing of a vulnerable client group and their carers? Will you commit to reporting regularly on this issue at public meetings?
Response: Your question relates to the Learning Disability Community Services Review that also links to Learning Disability therapies. This is a process which Derbyshire Healthcare NHS Foundation Trust (DHcFT) have instigated internally to meet the demands and new specifications commissioners have issued in line with other national service specifications included in Building The Right Support.
Because this is an internal review of DHcFT’s organisation structure, it is about potential improvements in performance and efficiency and not about “cuts” that could impact upon waiting times or other areas of the service.
DHcFT have assured the CCG “that day to day performance and associated risks will be managed internally as this is a routine organisational change process.”
On that basis the CCG are not included in the ongoing staff consultation process. However the CCG will work with DHcFT to ensure that all KPIs continue to be monitored and that waiting times are reviewed frequently. Commissioners will require information on dysphasia assessments especially as this has been an area of specific investment to reduce expressed wait times.
As this is primarily a question for our provider I cannot guarantee that we will specifically report regularly on this at public meetings but we will be ensuring that we do report in line with our responsibilities to inform, as we do with any service that we commission.
4. I attach a detailed account of cutbacks recently stated by one of the Health. Ministers in Conversation with MP Ruth George. May I ask the CCG the question "How does the CCG plan to manage these cuts?
Page 206 of 220 Could you give specific details?"
Thank you for your question and we will endeavour to respond to your request in as much detail as possible although we are not able to address every specific element described within the attachment provided.
Firstly, patient needs and expectations, new technologies, national requirements and other aspects of health and care provision change constantly. The fundamental role of the CCG is to ensure that we respond to these changing scenarios at a local Derbyshire level and to manage the NHS resources allocated to the Derbyshire health system in the most effective and efficient way. This means that the way the commissioning budget is allocated must change in response to this.
It is therefore important to recognise that to describe changes as “cuts” in isolation does not reflect the wider commissioning context. For example, a reduction in funding for a particular service may be in response to changing patient needs and priorities, it may be due to new technologies, it may be part of a provider or contractual change, or for other clearly defined reasons. Some changes in funding may indicate a reduction or the end of funding for a particular service but they are often set in the context of new investments and re- investments in other service lines. It is also important to note the recent announcement from NHS England about the uplift in funding over the next five years and to set this in the context of our commissioning responsibilities.
Whilst the CCG is in a strengthening financial position it must be recognised that we must continue to review every service line on a regular basis as part of our statutory responsibility to achieve best value of the Derbyshire NHS pound for our citizens. We must ensure that each service meets strict criteria in terms of outcomes and priorities for our patients and it is inevitable that this will sometimes result in difficult decisions being made. In terms of reassurance with regard to the way the CCG manages resources on behalf of the public, patients and the wider health system in Derbyshire, it is important to recognise the rigorous clinical input and system of governance that sits behind any decision we make. This includes increasing patient and public involvement at an earlier stage for every potential change the CCG makes. As a further assurance regarding the way we manage our resources any funding decision whether it is to reduce, end or increase will be subject to the approval of our Governing Body which includes clinicians and lay members.
Our Governing Body papers for 28 March can be found here and may be helpful in terms of detailed information about our plans and also our processes.
I hope that this helps to explain our approach to managing NHS resources.
Written responses will be provided to the individuals directly and noted in the minutes of the meeting.
Page 207 of 220 From 1st April the new CCG will rationalise how it takes questions to make it easier for members of the public to submit them and receive answers.
GBIC/1819/ Declarations of Interest 118 Dr Bhatia reminded committee members of their obligation to declare any interests they may have on any issues arising from meetings which might conflict with the business of the governing bodies. Any declarations made by the members of the governing bodies are listed in the individual CCG’s Register of Interests. No changes were requested to the Register of Interest today and no further declarations of interest were reported.
GBIC/1819/ Chair’s Report 119 The outgoing CCG Chairs made reflections on their term in office. They shared examples of initiatives and developments that their individual CCG had been part of and the challenges they have faced.
It is important to take the best elements forward and develop them. It is important that the finances are kept in check and the CCG is cognisant of this at all times. The new CCG will need to be innovative to meet the challenges it will face. It will need to keep its membership on side. Clear and honest communication channels are required with the public in order that they understand the next stage of the journey.
Dr Bhatia thanked everyone who has worked on the governing bodies: those who are moving on to new things and those who are staying on. He also thanked GP members across the whole area for maintaining engagement, and gave thanks to the members of public for sticking with the CCGs over this period of reorganisation. Dr Bhatia personally thanked the Chairs, stating that it had been a pleasure to work with them over the years.
GBIC/1819/ 2019/20 QIPP Programme 120 SH presented the QIPP programme for 2019/20; although this is a savings plan, it is also about maintaining and improving quality of care, innovation, prevention and productivity. The Executive Team were clear that this information should be discussed at a meeting in public. The CCGs’ Finance Committees in common, chaired by Dr Milton, met yesterday to go through it in detail. The Clinical and Lay Commissioning Committee (CLCC), chaired by Dr Austin, has governed the approval of the 2019/20 QIPP schemes and a meeting was held this morning to discuss it further.
The paper set out:
• The approach to delivering savings in 2018/19 and how the CCGs built on this approach for 2019/20. • The rationale for the QIPP programme for 2019/20 • The savings programme requirements to support the CCG’s 2019/20 Financial Plan and the £29m deficit control total agreed with NHS England. • The proposed QIPP position for 2019/20, the nature of the programme and how the CCG will work with its partners to deliver it. • The approach to ensure that QIPP is appropriately reflected in CCG budgets and Provider contract agreements where relevant.
Page 208 of 220 • The position in relation to the management of risk and mitigations to ensure the delivery of the QIPP programme in 2019/20 • The CCG’s approach to developing further QIPP schemes during 2019/20 through a ‘Pipeline Process’.
There are 2 types of QIPP schemes: transactional - where the CCG is able to make savings itself based on evidence or by reviewing pricing arrangements, and transformational - where the CCG must work with its Providers and system partners to find efficiencies.
A summary of the 2018/19 QIPP programme between transactional and transformational schemes and by value and number of schemes was provided for information.
A summary of the 2019/20 QIPP programme by value and number of schemes was provided for information. It illustrated the full year effect of the 2018/19 savings schemes and 15 new QIPP schemes over £1m in value, which account for £53.4m in total, which is 77% of QIPP delivery; the remaining 23% will be delivered through 48 new savings schemes of less than £1m in value. There is therefore a need to find larger schemes, as a lot of energy is being expended for small values. 54% of the 2019/20 QIPP Plan is transactional and 46% is transformational. This represents a significant change in the nature of the savings that the CCG plan to deliver, as in 2018/19 the savings were mainly transactional.
The level of savings required in 2019/20 means that the CCG is no longer able to afford to commission all of its current services at the same level; it needs to ensure that there is enough money to maintain the essential health care services that its population requires. The clinical strategy of the new CCG will support ambitious clinical transformation programmes. The key transformation priorities for urgent care, primary care, planned care, continuing health care, mental health, medicines management, service benefit reviews, long term conditions/disease management, Place, organisational efficiency and community services were summarised. It is important that colleagues know what is set out in these programmes, as enacting them will help the CCG to manage its resources.
A summary of the current Rightcare benchmarked opportunities for NHS Derby and Derbyshire CCG was provided for information; it demonstrated local variation and opportunities to address outcomes for patients and best value commissioning and provision. Each Derbyshire CCG has its own nationally determined benchmark based on demographics; this has now been aggregated Derbyshire wide to demonstrate potential opportunities to agree pathways and gain value for money. The STP and Providers are working together to find a way to deliver efficiencies using Rightcare.
The CCGs started working on the QIPP programme last September; a huge amount of work has been needed to do this whilst also going through a restructuring exercise.
The QIPP target was agreed by governing bodies in January/February 2019. The CCG will be aiming for £83m to achieve the £69.5m QIPP target which is good practice. Confirmed schemes have been assured through the CLCC and Finance Committee. Additional schemes, totalling £4.9m, due for consideration by the CLCC this morning, have now been approved. There are a further £2.9m of schemes still to be worked up. The CCG is in a strong
Page 209 of 220 position of having nearly £60m of confirmed schemes for 2019/20 at this point in the year. The governing body will be presented with additional schemes for consideration early in the new year.
A summary of the QIPP profiling based on the current assessment of approved and in-development schemes was provided as requested. Concern was expressed around the values set out for the 2nd half of the year. SH confirmed that work continues to mobilise the Provider facing schemes.
The CCGs have completed a full risk assessment of the current QIPP planning position and will continue to monitor and address any identified risks.
The QIPP programme governance arrangements were provided for information; it is important to note the accountability to the governing body, which cannot be delegated. It will be ensured that the Joined Up Care Derbyshire system governance arrangements include formal reporting to NHS Derby and Derbyshire CCG’s governing body.
The CCG’s Chief Executive is in discussion with system partners about the formal agreement of financial risk sharing arrangements. It is hoped that there will be a move away from the transactional approach to a more transformational integrated system approach.
The CCG is implementing a QIPP pipeline process to ensure the ongoing development of QIPP schemes and delivery of the 2019/20 QIPP targets.
Continued work will be undertaken with members of the public to ensure that engagement is undertaken on any projects that represent a potential service change.
DA, Chair of the CLCC, confirmed that the CLCC has extended the length of its meetings to consider the PIDs and that an extra meeting was held this morning to gateway further PIDs; from an assurance point of view all PIDs have been considered by the Committee. DA thanked the Committee members for all their hard work and the CCG staff who produced the papers.
BM, Chair of the Finance Committee, stated that although the meeting was not quorate, the Committee supported the recommendations made. Significant consideration has been given to the 2019/20 savings plan. Some changes have been made in the last week but there was a clear view that this was supportable by the Committee who received assurance from the amount of detail provided. The remaining risks, that still need to be worked up, were highlighted; going forward the governing body needs to be sighted on these.
The governing bodies:
• Noted the approach to developing the 2019/20 QIPP programme. • Noted the 2019/20 CCG QIPP governance and accountability framework. • Approved the 2019/20 CCG QIPP Plan for the new NHS Derby and Derbyshire CCG. • Noted that the Executive Financial Recovery Group will continue to develop the QIPP Programme, and in particular ensure additional pipeline schemes are established to meet the £83m stretch target, that as much of the QIPP Programme is mobilised for delivery in the first half of the financial year, and that CCG resource is focused on
Page 210 of 220 delivering Schemes of largest value and lowest complexity, to mitigate risk to delivery of the CCG Financial Control total agreed with NHS England for 2019/20. • Noted ongoing work with system partners to develop a single system plan, incorporating the CCG’s QIPP Plan.
Although Hardwick CCG was not quorate at the meeting, those members present approved and noted the recommendations in principle. Ratification of the decisions will be sought from Dr Ruth Cooper outside of this meeting.
GBIC/1819/ Annual Budget 2019/20 121 DH informed the governing bodies of the Financial Plan and budgets that will be set for 2019/20, confirming that the Finance Committee considered them in detail yesterday. The pooling together of 4 budgets into 1 has not been without its challenges.
Due to a revised national offer being received, adjustments have been made to the information previously provided; a revised budget was tabled for approval.
The CCGs are forecasting an underlying deficit of £60.8m. Table 4.1 demonstrated the impact of allocation growth on the underlying position and QIPP savings for 2019/20. Table 4.2 showed the application of the allocation and primary care co-commissioning growth based on the 2018/19 month 11 forecast outturn position. As a result of receiving less growth than the national average the CCG has identified a cost pressure of £37.5m. The CCG has received additional allocations of £82.7m however when the Operational Plan was developed it confirmed that the CCG is committed to additional growth of £120.2m; the recurrent impact of having to fund £37.5m more growth in contracts within the CCG’s plan than the level funded contributes towards a QIPP requirement of £69.5m in 2019/20. A breakdown of the total resources available to the CCG in 2019/20 was provided. It has 3 income sources: programme monies, running costs and primary care co-commissioning; the total allocation will be £1.651b.
A level of assurance was provided from the processes undertaken before the Plan was bought to the governing bodies for approval. The expenditure budgets set will be based on the contracts agreed with Providers. All budgets have been agreed and signed off in conjunction with the CCG budget holder, subject to governing bodies’ approval.
BM provided a response on behalf of the Finance Committee in relation to the budget plan and budget setting principles. The governing bodies should take assurance from this process. It is important that going forward the ongoing size and shape of the plan is well understood.
IG supported the way in which the paper had been put together but asked what the approval process would be should the outcome from the contract discussions vary from those anticipated in the current plans. DH confirmed that some changes may be required; if this should be the case it will come back to governing bodies to make them aware.
BD commented that the paper was well laid out and easy to read. He requested that this paper and the savings paper form the basis of the papers going to the new governing body to enable them to grasp what the CCG is
Page 211 of 220 trying to do, as these discussions are pivotal to the new organisation.
GA advised that the process started in September with vigour; the challenges faced were dealt with sensitivity and a robustness of information was provided. DH/SH have provided a much clearer understanding of the task and difficulties facing the new CCG than the governing bodies had a year ago. The robustness and resilience are now more prevalent; this is a strong position to be in for the new members and will help to bring them up to speed. This is due in no small part to SH and DH.
The Governing Bodies:
• Noted that a more detailed version of this paper was received by the Finance Committee on 27th March 2019 and was scrutinised in detail. • Noted the update on CCG Allocations for 2019/2020 (section 2) • Noted the approach taken to Planning and Contracting (section 3, 4 & 5) • Noted the QIPP savings approach (section 6) • Noted the CCG Financial Duties (section 7) • Approved the updated financial plan and the opening budgets for 2019/2020 (sections 9 & Appendix I • Approved the Operational Plan that the budgets are based upon for submission on 4th April 2019
Although Hardwick CCG was not quorate at the meeting, those members present approved and noted the recommendations in principle. Ratification of the decisions will be sought from Dr Ruth Cooper outside of this meeting.
GBIC/1819/ Creating the new CCG 122 The governing bodies received an overview of the organisational developments required to create a single CCG for Derbyshire at the meeting held on 28th February 2019. HD provided an update on 3 key areas for completeness:
• Recruitment to Governing Body roles – The names and roles of the newly appointed governing body members were provided for information.
• Approval to merge – The governing bodies have been kept up to date on this monthly; they have played an active part in reaching this point. A number of key documents have now been received from NHSE to formally approve the merger (copies were provided for information). NHSE set out certain conditions on the CCGs prior to the merger; confirmation was provided that all of these conditions were now met.
• Next steps – There are a number of close down elements to be undertaken during Quarter 1, including finalising the final accounts of the 4 CCGs for 2018/19, and the annual reports.
• A letter has been received from Simon Stevens stating that Dr Clayton has been confirmed as the CEO for the new CCG.
• The new corporate committees have now been established. The Terms of Reference of these committees will be formally adopted at
Page 212 of 220 the first meeting of the new governing body on 11th April.
The governance team and the members of the Transition Working Group were thanked for all their hard work in pulling this all together.
The governing bodies noted the report.
GBIC/1819/ 2019/20 Contract 123 CCo provided an update on the status of the contract negotiations with Providers. He confirmed that DCHSFT and DHcFT have signed their contracts. Negotiations are still being held with the Acute Trusts; the main issues to resolve are the efficiencies in the contracts and how to take this forward in the system space. There have been movements in the QIPP acceptance position this week. Difficult conversations are being held with EMAS relating to financial issues. A further update will be provided at the next meeting.
GBIC/1819/ Voluntary sector update 124 CCo provided an update on the position relating to the review of VCS arrangements.
Infrastructure organisations – The CCGs have met regularly with the infrastructure organisations to develop interim arrangements for the delivery of VCS infrastructure support across Derby and Derbyshire. This collaborative work has resulted in a framework specification and an agreed activity/outcome matrix.
Voluntary Single Point of Access (vSPA) – The work on the vSPA identified the usefulness of simple signposting in addition to facilitated signposting. Half of the current funding for the service will be reinvested into the infrastructure organisations to provide a signposting service. This work will be reviewed alongside the infrastructure work to consider future needs.
Discretionary schemes retained – The CCGs have been working with each discretionary scheme that the governing bodies agreed to continue funding for 2019/20 in order to set up contract arrangements. A summary of the progress made was provided for information.
Discretionary schemes (CCG funded ceased from 1.4.2019) – As a result of the governing bodies raising concerns on the unintended consequences of ceasing to fund these schemes, a review programme was developed through the QIA process. The VCS organisations and Place Alliance Groups will alert the CCG of any unintended consequences.
Transport policy – A framework document setting out the proposed policy for the commissioning of transport services, underpinned by the Derbyshire CCGs’ NEPTS guidance, was agreed by the CLCC on 14.2.2019.
It was requested that timescales be included on the action plan. CCo confirmed that there is a more detailed plan which governing body members are welcome to have sight of that included timescales. It was asked which committee will oversee the delivery of this programme of work. CCo advised that it will continue to be followed up by the CLCC. Comment was made that it was good to see the review process through and reassuring to note that it will
Page 213 of 220 continue to be monitored.
The governing bodies agreed to sign off the following arrangements:
• The VCS infrastructure services transitional arrangements (including signposting) for implementation from 1st April 2019. • The contractual arrangements for the discretionary schemes continuing to receive funding in 2019/20. • The process of how the CCG will monitor unintended consequences of the discretionary schemes that will cease receiving funding in 2019/20. • A final copy of the CCG’s transport policy.
Although Hardwick CCG was not quorate at the meeting, those members present approved and noted the recommendations in principle. Ratification of the decisions will be sought from Dr Ruth Cooper outside of this meeting.
GBIC/1819/ Finance and QIPP Assurance Report for Month 11 125 It was noted that the CCGs are 3 days away from the end of the year and having to compile 4 sets of accounts.
DH drew the governing bodies’ attention to Table 1 which summarised performance against the CCG’s key financial duties. The delivery of the savings target is forecast to be missed.
At month 11 the CCGs are continuing to report delivery of the Financial Plan year to date and forecast delivery of the agreed £44m deficit control total by the end of the year. The way in which the Commissioner Sustainability Funding works is that CCGs are paid in quarters; they have already received £28.6m and upon reaching the £44m total they will be eligible for £15.4m which will allow them to end the year as breakeven.
Each CCG is achieving the Better Payment Practice Code (BPPD) paying invoices individually and cumulatively within 30 days.
Table 3 provided a summary of the operating costs for the combined Derbyshire CCGs. It is hoped that any risks that materialise in the coming weeks will be managed within the deficit control total.
NB noted a variation in the language being used with contracts; some are ‘over performing’ whilst others are ‘over spent’ or have ‘an increase in spend’. There is a need to be clear and consistent. DH agreed to address this.
ISh queried how the finances will support the CCG’s strategic aims and how the financial strategy `be aligned with the strategic objectives; going forward this will need to be addressed. DH confirmed that finance is one of the CCG’s strategic aims and this is something worth considering. HD confirmed that as part of the merger evidence an early commissioning strategy was required; this included a financial plan which set out the shape of finances and the direction of travel.
SH provided an update on the QIPP position for 2018/19. The full year forecast is £45.3m with a total savings risk of £5.4m. The risk of non-delivery is now incorporated in the forecast outturn position for month 11. It was noted that £7.6m of the forecast outturn is non-recurrent in nature and there will be
Page 214 of 220 a full year effect of £8.8m in 2019/20. In 2018/19, 80% of QIPP was non- recurrent. A process of assurance has been undertaken through the Finance Committee.
RCr commented on the Burton hospital position and the over performance in many areas. He was under the impression that the purpose of the merger was to provide financial stability however an increase in expenditure does not bode well for contract negotiations. CCo confirmed that this has been flagged up with UHDBFT.
The governing bodies:
• Noted the Month 11 overall financial performance • Noted the Month 11+ savings performance • Noted the level of risk on the 2018/19 Savings Programme at Month 11 (using month 11+ information) • Noted the use of contingencies and budget flexibilities to manage savings under-delivery and other cost pressures
GBIC/1819/ Audit Committee Assurance Report 126 IG introduced a summary of the items of business transacted at the Audit Committee meeting on 21st March 2019, stating that it was a busy but positive meeting. IG thanked the team for all their hard work on this Committee.
In relation to the limited assurance provided by the communication and engagement report and management follow up in 2018, that improvements made have been recognised; this will be revisited in due course.
With reference to the STP governance report, initiated by MA, the committee formally agreed to share the report with the STP team and wider to the other STP partners.
The Head of Internal Audit Opinion report is currently rated as moderate assurance. Once the new organisation is embedded it will recognise change.
The governing Bodies noted the contents of this report.
GBIC/1819/ Finance Committee Assurance Report 127 BM has already provided feedback from the meeting held yesterday during the course of the meeting. He further highlighted the Audit Committee reflective on what is going on in the STP from a CCG perspective.
Following the earlier discussions on the 2018/19 position, BM confirmed that the Committee had reviewed the savings plan and financial position and drew assurance from them. It was noted that there are mitigations in place to cover any risks in the plan as the organisations head to year end. BM thanked SH and DH for getting the organisations to year end.
In relation to the outstanding action on activity and the costs associated with waiting lists at the Acute, BM was content with the financial picture that no unexpected risks were associated with it, however he asked, from a quality point of view, if the Quality and Performance Committee had an associated action to monitor this. BD stated that the first mention of this was in the performance report in March however he was aware of this within the NHS;
Page 215 of 220 the Quality and Performance Committee will keep a close eye on it.
ISh posed a question in relation to activity levels and the income and tax contributions of consultants; he asked if consultants are stopping taking on additional work in order to avoid this and how this will affect waiting times. CCo responded that this has been recognised and a solution is being looked at by Trust.
The governing bodies noted the verbal update.
GBIC/1819/ Governance Committee Assurance Report 128 JD confirmed that a number of subjects were discussed at the meeting held in March. Concern was previously expressed at the level of data security information being received from NECS however the CCGs are now receiving adequate data to allow them to fulfil their reporting requirements. The CCGs are required to attain a 95% compliance on data security mandatory training; this is being worked towards.
The governing bodies noted the contents of this report.
GBIC/1819/ Quality and Performance Committee Assurance Report 129 BD highlighted the key points from the Quality and Performance Committee meeting held on 7th March 2019:
• A&E – Standards remains challenging as they are not being met at either UHDBFT or CRHFT; the CCGs are keeping an eye on this but it is a national issue. • 18 week RTT incomplete pathways – This continues to be non- compliant at UHDBFT at 90.6%, however CRHFT did achieve the 92% target. Both Trusts are however on target to reduce the total waiting lists back to the March 2018 activity levels. The trajectory is on plan and the CCGs are keeping an eye on it. • Cancer 62 day screening – Both UHDBFT and CRHFT failed to meet the 90% standard at 71.9% and 89.7% respectively. The CCG is inviting UHDBFT to a Quality and Performance meeting to discuss the reasoning behind the non-compliance further. • CQC inspection – Between September and November 2018 the CQC undertook an unannounced visit at CRHFT; this covered the directorates of medicine, surgery, children and young people, CAMHS and end of life care. The final report was published in January 2019 and the CQC rated the Trust good overall. • CHC – The performance against the CHC target was met. • Risk register – Item 028 – ND/HCCG short breaks – it was considered that, due to the distress this may cause to both carers and individuals and the risks to the CCG’s reputation, this risk should be rated high.
BD thanked members of the Quality and Performance Committee for their dedication over the past 12 months which has helped to ensure high quality health care across Derbyshire.
The governing bodies noted the key performance and quality highlights and the actions being taken to mitigate any risks.
Page 216 of 220 GBIC/1819/ Clinical and Lay Commissioning Committee Assurance Report 130 DA presented the decisions made by the CLCC which the governing bodies were asked to ratify. DA is leaving the role of CLCC Chair at the end of March and thanked its members for all the hard work they have put in, particularly looking through the PIDs. DA wished Dr Ruth Cooper well in taking over the role of CLCC Chair in future.
The governing bodies ratified the decisions made by the Clinical and Lay Commissioning Committees held on 14th March 2019.
GBIC/1819/ Governing Body Assurance Framework – March 2019 131 HD presented the quarterly update on the Governing Body Assurance Framework (GBAF) which identifies 9 principle/strategic risks that are associated with the agreed strategic objectives for 2018-19. The movements since the January report were highlighted. These include:
Risk 6 – Failure to effectively manage demand, activity and cost pressures across the system may impact on delivery of the CCGs Financial Plan – A recommendation was made by the Executive Team that this should be reduced based on the fact that the CCG is on track to deliver its control total.
Risk 7 – Inability to invest in service transformation which may impact on patient outcomes – This has been reduced from 16 to 4 due to work undertaken throughout the year to meet the control total.
HD advised that a process of agreeing the 2019/20 GBAF will be undertaken with the new governing body in April and May, in conjunction with 360 Assurance by the end of Quarter 1. Work will be undertaken with new members to bring them up to speed in this area.
The governing bodies received and noted the report.
GBIC/1819/ Risk Register Exception Report – March 2019 / 132 HD presented this report highlighting the areas of organisational risk that are recorded in the Derbyshire Corporate Risk Register as at March 2019. This monthly report describes any high risks and the movement to those risks during the month. The following risks were highlighted:
Risk 14 relates to a national shortage of psychiatric intensive care unit beds which have resulted in delayed transfers (12 hour trolley breaches) in the emergency departments of both UHDBFT and CRHFT which is unacceptable. This risk has been increased from 12 to 20. The MHMIS work will be used to support development of this area and hopefully be instrumental in reducing this risk.
The governing bodies received and noted the exception risk register report, and received and noted a summary of the very high risks facing the organisation as at March 2019.
Risk year-end close down report
Suzanne Pickering, Head of Governance, has undertaken a process over the last month or so to close down the risks on the risk register. Each corporate
Page 217 of 220 committee was assigned risks which they are required to review at their monthly meetings. Each committee was requested to provide a year-end position on its risks. It has been possible for the committees to close down many of the risks however there are a number of risks that need to be carried forward to the new organisation.
The governing bodies received and noted the risk year-end close down report and the recommendations made.
GBIC/1819/ Committees in common minutes – for information 133 The minutes of the Quality and Performance Committee meeting held on 7th February 2019 were provided for information and the contents noted.
The minutes of the Audit Committees in common meeting held on 17th January 2019 were provided for information and the contents noted.
The minutes of the Governance Committees in common meeting held on 10th January 2019 were provided for information and the contents noted.
GBIC/1819/ Minutes of the governing bodies meeting in common 134 The minutes of the meeting held on 28th February 2019 were approved as a true and accurate record with the requested amendments.
GBIC/1819/ Action Log and Matters arising 135 A process has been undertaken to close down any outstanding actions; however there is a need to carry some forward to April into the new organisation.
GBIC/1819/ Any Other Business 136 Dr Bhatia thanked the governing body members and staff of all 4 organisations.
DATE AND TIME OF NEXT MEETING
Thursday 11th April 2019 from 11.30 to 1.30pm at Tollbar House, Ilkeston, Derby DE7 5FH
Signed by: …………………………………………………. Dated: ………………… (Chair)
Page 218 of 220 GOVERNING BODY MEETING IN PUBLIC ACTION SHEET – MARCH 2019 GBIC meeting
Item / Action Proposed Lead Action Required Action still to be taken Due Date Minute No. 2018 Actions GBIC/1819/78 Creating the new Helen There is a need to work Update for the February GB meeting: April 2019 GBIC/1819/105 CCG Dillistone through the quoracy numbers The TORs for the new Committees will be around a clinical / lay vice discussed at the Transition Working Group on chair once governing body 14th March with a recommendation to the new members have been governing body. These will then need appointed; the vice chair agreement by the new GB at the April meeting. appointment will be at the discretion of the Chair. Update from the February meeting: Associated to this is a piece of work on the new committees; the Terms of Reference are currently being finalised, together with the required attendance of each group. Further details will be presented to the new governing body in April.
Chris Further thought needs to be Update for the February GB meeting: April 2019 Clayton given to the staggering of the Upon completion of the creation of the GB, length of the terms of office suggest the newly formed GB review Terms of for all governing body Office and consider how it creates continuity. appointments in order to prevent destabilisation of the committee.
Chris The recently published long Update for the February GB meeting: April 2019 Clayton term plan clearly discusses There is a clearer understanding of Derby’s population sizes of 30 to 50K Model of Care including both PLACE and which do not necessary map Primary Care Networks and how this model will to the Place alliances evolve. currently identified in Derbyshire. There is a need Page 219 of 220 to be mindful of the emerging geography in primary care networks and ensure that general practice is supported to ensure the networks interact as efficiently as possible with Place alliances. CC to give this further thought.
GBIC/1819/98 Chief Executive’s Chris Weblinks to be included in To be included going forward Item Report Clayton the items on engagement to Complete allow people to access items directly.
GBIC/1819/101 Framework for Sandy Hogg Update to be provided at the Agenda items included for both meetings Item 2019/20 QIPP 19th March governing bodies Complete Programme confidential session, with details of the contract negotiations, and at the 28th March meeting for formal approval.
Chris The STP workforce forum will Clayton be invited to attend a April 2019 governing body meeting in due course to provide an update on the challenges being faced and what is being done about them.
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