North East Essex Clinical Commissioning Group
Constitution V3.3 Approved by Board 29th March 2016
CONTENTS Part Description Page Foreword 3 Definitions of key descriptions used in this constitution 4 1 Introduction, commencement and duration 7 2 Amendment and Variation & Locality 9 3 Mission, values and aims 9 4 Functions, general duties and engagement 12 5 Membership 23 6 Roles and Responsibilities 30 7 Decision making – The Governing Structure 37 8 Standards of business conduct and 43 managing conflicts 9 Disqualification of members of the board 50 10 Accountability and rules of engagement 51 11 Group as an employer 54 12 Notices 56 13 Transparency, ways of working and standing 57 orders
Appendix Description Page 1 List of member practices and signatures 58 2 Nolan Principles 60 3 Terms of reference 61 4 Standing Orders 70 5 Scheme of Reservation and delegation 85 6 Standing financial instructions 111 7 NHS Constitution 166 8 CCG Board lead roles 167 9 Memorandum of Agreement 170 10 CCG Governance structure 176 11 Prospectus for elected members 177 12 Specific Delegated powers 190
Schedule Description Page 1 Register of Interests Declaration Form 201 2 Lay members appointment process 203 3 Practice members appointment process 205 4 Proxy form 210 5 Dispute Resolution Procedures 213 6 Process for Appointment Chair 216 7 Procurement Strategy 218
FOREWORD
2 The North East Essex Clinical Commissioning Group (CCG) Constitution sets out how the CCG intends to do business as a statutory body through its Governance structure. The constitution is based upon the national template recommended by the National Commissioning Board.
As a CCG we take seriously our role on commissioning health care on behalf of our population. Fundamentally, this requires a governance arrangement that ensures we execute our statutory duties in a safe and considered manner.
This Constitution will be reviewed yearly.
The CCG’s Constitution sets out the arrangements made by the CCG to meet its responsibilities for commissioning care for the people for which it is responsible. It describes the governing principles, rules and procedures that the group will establish to ensure probity and accountability in the day to day running of the clinical commissioning group; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the group.
The Constitution meets with the requirements of the General Practitioners Committee as outlined in the GPC guidance: GPC Constitution Guidance.pdf.
The Constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment:
the group’s member practices; the group’s employees; individuals working on behalf of the group; anyone who is a member of the Clinical Commissioning Group Board anyone who is a member of any of the committee(s) or sub-committees established by the group or its Clinical Commissioning Group Board.
NHS North East Essex Clinical Commissioning Group would like to acknowledge and thank the Essex Local Medical Committee for their contribution in the production of this constitution. We would also like to thank the member practices, the staff and the Board for their contribution.
3 Definitions of key descriptions used in this constitution
Accountable An individual who is appointed by the NHS officer Commissioning Board and who may be a member or employee of the Clinical Commissioning Group or of anybody who is a member of the Clinical Commissioning Group and who duties and responsibilities are set out in paragraph 6.4 herein. Any Qualified The Any Qualified Provider principle to be applied by Provider (AQP) the Board when engaging in the commissioning of health care services Area The geographical area this group has responsibility for when providing healthcare services to patients not register with a practice Board The appointed and/or elected members of the Clinical Commissioning Group having the duties and responsibilities as set out in part 6 Budget The financial resources delegated to the Board for the purposes of commissioning and all relevant and related services and functions. Chair of the An individual who has been bee appointed in line with governing body the process as outlined in schedule 6 Chief Finance An individual who has been selected by member Officer practices and who may be a member or employee of the Clinical Commissioning Group or of anybody who is a member of the Clinical Commissioning Group and who duties and responsibilities are set out in paragraph 6.5 herein. Clinical Many roles described within the Constitution refer to the terms "Clinical" and "Health Professional". We regard these terms as interchangeable, and prefer to use this definition as it is the one referred to in Section14 of the National Health Service Act, in regard to the appointment to CCG Boards, as per the NHS Clinical Commissioning Group Regulations 2012. “health care professional” means an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002. Section 25(3) of the above Act list the following:- (a)the General Medical Council, (b)the General Dental Council, (c)the General Optical Council, (d)the General Osteopathic Council, (e)the General Chiropractic Council,
4 (f)subject to section 26(5), the Royal Pharmaceutical Society of Great Britain, (g)subject to section 26(6), the Pharmaceutical Society of Northern Ireland, (h)until their abolition by virtue of section 60(3) of the 1999 Act— (i)the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and each of the National Boards for Nursing, Midwifery and Health Visiting, and (ii)the Council for Professions Supplementary to Medicine and each Board established by or by virtue of the Professions Supplementary to Medicine Act 1960 (c. 66), (i)any regulatory body (within the meaning of Schedule 3 to the 1999 Act) established by an Order in Council under section 60 of that Act as the successor to a body mentioned in paragraph (h), and (j)any other regulatory body (within that meaning) established by an Order in Council under that section. Please note in addition: The person should be registered at the time of appointment to the role for which this definition is relevant, and that registration should be then recognised as sufficient to meet the requirements of that role for the duration of the appointment, or for up to 3 years, whichever is the shorter period. For General Practitioners this requires the person to be on the “NHS Performers List” at the time of appointment. Also for the absence of doubt, Nurses should be registered at the time of appointment with the Nursing and Midwifery Council. Clinical NHS North East Essex Clinical Commissioning Group commissioning formed in accordance with and approved by the NHS group Commissioning Board Clinical leaders Individuals who have been elected and selected by member practices and who duties and responsibilities are set out in schedule 3 Commencement The date of commencement of this Constitution being Date 1st April 2013 Committee A committee or sub-committee created and appointed by: the membership of the group a committee / sub-committee created by the membership of the group a committee / sub-committee by the governing body Conflict of Interest Any conflict of interest as set out in paragraph 8.2 Constitution This Constitution as amended from time to time in accordance with its terms. Deputy chair of The individual who has been selected by the CCG chair the governing to act as deputy chair of the governing body
5 body Financial year Will run from 1 April to 31 March He / him / his These pronouns should be taken to refer to both genders Healthcare See ‘Clinical’ Professional Joint Joint commissioning is the term used to describe when Commissioning two or more commissioners come together to commission healthcare services. In this context it means NHS England working with clinical commissioning groups (CCGs) to commission primary care services.
Lay members The four members of the governing body that will be selected following a recruitment process and will have a lead role in overseeing key elements of governance and championing patient and public involvement. Locality The locality of North East Essex Local Medical means the Essex Local Medical Committee as Committee (LMC) recognised by the NHS Act 1977 and currently recognised by NHS North East Essex Clinical Commissioning Group Member / Those practices which constitute the group membership NHS The body corporate as identified in the Health and Commissioning Social Care Act 2012 known as NHS England Board (NHS England) Performers List Medical performers list prepared and published by NHS England Practice Member The practice, rather than the individual clinicians within a practice, which are members of the clinical commissioning group Register of A register of all interests held by the voting members of interests the governing body and sub-committees of the Board. The register records the interest of any related party as part of the disclosure of interests. Role and job titles These should always be read according to the most recent guidance from the NHS England.
6 1. INTRODUCTION, COMMENCEMENT AND DURATION
1.1 NAME
1.1.1 The name of this clinical commissioning group is the NHS North East Essex Clinical Commissioning Group
1.2 STATUTORY FRAMEWORK
1.2.1 Clinical Commissioning Groups were established under the Health and Social Care Act 2012 (“the 2012 Act”). They are NHS statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS Bodies for the purposes of the National Health Services Act 2006 (“the 2006 Act). The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.
1.2.2 NHS England is responsible for determining applications from prospective groups to be established as clinical commissioning groups and undertakes an annual assessment of each established group. It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.
1.2.3 Clinical Commissioning Groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in their constitution.
1.3 STATUS OF THIS CONSTITUTION
1.3.1 This constitution is made between the practice members of NHS North East Essex Clinical Commissioning Group and in addition between the body of the membership and the governing body of NHS NEE Clinical Commissioning
7 Group. The constitution came into force on 23rd January 2013, when NHS England established the group and shall continue in force until 1st April 2016, with yearly reviews, unless otherwise terminated in accordance with the provisions of this constitution. The constitution is published on the group’s website at http://www.neessexccg.nhs.uk
1.3.2 This document will be made available upon request for inspection at the North East Essex Clinical Commissioning Group Headquarters as set out under 1.3.3
1.3.3 Copies will also be made available on application to;
NHS North East Essex Clinical Commissioning Group Aspen House Stephenson Road Severalls Business Park Colchester CO4 9QR
8 1.4 AMENDMENT AND VARIATION OF THIS CONSTITUTION
1.4.1 This constitution can only be varied in two circumstances:
1.1.a) where the group applies to NHS England, which is the only body with the authority to grant this application and that application is granted and that this is agreed with the member practices
1.1.b) where in the circumstances set out in legislation NHS England varies the group’s constitution other than on application by the group.
2. LOCALITY
2.1 The locality of the CGG shall be North East Essex and shall be made up of the member practices as set out in Part 5 of this Constitution.
2.2 The locality of the CCG is fully coterminous with Essex County Council.
2.3 The locality of the CCG is also fully coterminous with the Borough and District Councils of Colchester and Tendring.
3. MISSION, VALUES AND AIMS
3.1 MISSION
3.1.1 The mission of the NHS North East Clinical Commissioning Group is to:
‘Embrace Better Health for All’
3.1.2 In all of our activities the group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties.
3.2 VALUES
3.2.1 Good corporate governance arrangements are critical to achieving the clinical commissioning group’s objectives
3.2.2 The values that lie at the heart of all of the work of the clinical commissioning group align with those of the NHS Constitution:
9 Working together for patients
Respect and Dignity
Everyone counts
Commitment to quality of care
Compassion
Improving lives
3.3 AIMS
3.3.1 Through its governance arrangements, the clinical commissioning group aims are: To make a difference to individuals by encouraging people to feel valued and supported to make the right choices and use services appropriately
To improve the health and wellbeing of our population
To be accountable for the decision we take
As leaders within NEE we will be respected and trusted by our peers and the communities we serve by demonstrating compassion, care, dignity and respect towards all
To be ground breaking by focusing on innovation in quality, productivity and prevention
3.4 PRINCIPLES OF GOOD GOVERNANCE
3.4.1 In accordance with section 14L (2) (b) of the 2006 Act the group will at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:
a. the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the clinical commissioning group and the conduct of its business
b. the good governance standards for public services
10 c. the seven key principles of the NHS Constitution (appendix 7)
d. the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’ (appendix 2)
e. the Equality Act 2010
f. Managing Conflicts of Interest: Statutory Guidance for CCGs
3.5 ACCOUNTABILITY
The clinical commissioning group will demonstrate its accountability to its members, local people, stakeholders and the NHS Commissioning Board in a number of ways, including by:
3.5.1 publishing its constitution, standing orders and standing financial instructions
3.5.2 appointing independent lay members and non GP clinicians to its governing body
3.5.3 holding meetings of its governing body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting)
3.5.4 complying with local authority(ies) health overview and scrutiny committee requirements
3.5.5 publishing its annual report, annual accounts, annual commissioning plan and holding its annual general meeting in public
3.5.6 having a published and clear complaints process which complies with NHS Complaints Regulations
3.5.7 complying with the Freedom of Information Act 2000
3.5.8 providing information to the NHS Commissioning Board as required
3.5.9 publishing its principal commissioning and operational policies
11 3.5.10 The governing body of the group will throughout the year have an on-going role in reviewing the group’s governance arrangements to ensure that it continues to reflect the principles of good governance.
3.6 In addition to these statutory requirements, the group will demonstrate its accountability by:
1.1.a) Holding additional stakeholder events as part of its Communication and Engagement and Patient and Public Engagement (PPE) strategies.
3.7 The Clinical Commissioning Group governing body, will throughout each year have an on-going role in reviewing the group’s governance arrangements to ensure that the group continues to reflect the principles of good governance.
4. FUNCTIONS AND GENERAL DUTIES
4.1 FUNCTIONS
4.1.1 The functions that the group is responsible for exercising are set out in the 2006 Act, as amended by the 2012 Act. These are contained in the Department of Health’s Functions of clinical commissioning groups; a working document. In summary they are:
a commissioning certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of:
. all people registered with member practices and
. people who are resident in the area and are not registered with a member of any clinical commissioning group
b Commissioning emergency care for anyone present in the group’s area;
c determining the remuneration and travelling or other allowances of members of its governing body;
d paying its employees remuneration, fees and allowances in accordance with the determinations made by its governing body and
12 determining any other terms and conditions of service of the groups employees
4.1.2 In discharging its functions the group will:
a. When exercising its functions to commission health services, the group will act consistently with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service and with the objectives and requirements placed on NHS England through the mandate published by the Secretary of State.
Accountability remains with the Governing Body however delivery is delegated to all sub-committees via the governance structure. This is explicit in the Terms of Reference of the various sub-committees within the structure
b. meet the public sector equity duty, holding the board accountable and responsible for the delivery of this duty. This will be ensured via the terms of reference of the board and within the sub-committees
Under the Equality Act 2010, NHS North East Essex Clinical Commissioning Group will exercise their functions, and have due regard to the:
Need to eliminate unlawful discrimination harassment and victimisation and other conduct prohibited by the 2010 Act.
Advance equality of opportunity between people who share a protected characteristic and those who do not;
Foster good relations between people who share a protected characteristic and those who do not
NHS North East Essex Clinical Commissioning group will deliver this public sector duty by:
Publishing annually sufficient information to demonstrate compliance with this general duty across all their functions
By the end of April 2013, prepare and publish specific and measurable equality objectives, with a commitment to reviewing and publishing an annual review for the March Board.
13 c. work in partnership with our local authority to develop joint strategic needs assessments and joint health and wellbeing strategies by:
Active participation in informing the Health and Wellbeing Board and assisting with the completion of their county wide efforts.
In addition we will work in partnership to develop a NEE JSNA to inform our commissioning priorities.
This responsibility has been included in the Terms of Reference for the Operational Executive in conjunction with the Executive function of the Health and Wellbeing Board, as approved by the Governing Body.
4.2 Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions
4.2.1 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions.
4.2.2 The CCG may enter into arrangements with NHS England and, where applicable, other CCGs to:
Exercise such functions as specified by NHS England under delegated arrangements;
Jointly exercise such functions as specified with NHS England.
4.2.3 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question.
4.2.4 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.
4.2.5 For the purposes of the arrangements described at paragraph 4.2.2 above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.
4.2.6 Where the CCG enters into arrangements with NHS England as described at paragraph 4.2.2 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:
14 How the parties will work together to carry out their commissioning functions;
The duties and responsibilities of the parties;
How risk will be managed and apportioned between the parties;
Financial arrangements, including payments towards a pooled fund and management of that fund;
Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.
4.2.7 The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph 4.2.2.above.
4.2.8 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning.
4.2.9 Only arrangements that are safe and in the interests of patients registered with Practice Members will be approved by the Board.
4.2.10 The Board shall require, in all joint commissioning arrangements that the Chief Officer of the CCG make a quarterly written report to the Board and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.
4.2.11 Should a joint commissioning arrangement prove to be unsatisfactory the Board can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six month notice period.
4.3 GENERAL DUTIES
In discharging its functions NHS North East Essex Clinical Commissioning Group will:
4.3.1 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:
Working in partnership with patients and the local community to secure the best care for them
15 Investing resources in a local health forum, in line with our engagement strategy
Adapting engagement activities to meet the specific needs of the different patient groups and communities
Publishing information about health services on the group’s website and through other media
Encouraging and acting on feedback
Ensuring that there is a process for monitoring and reporting compliance against this statement of principles through the CCG Board.
Ensuring that there are processes in place to monitor and act on patient feedback
4.3.2 Promote awareness of, and act with regard to the NHS Constitution by:
ensuring that the principles upheld in the NHS Constitution are reflected in the group’s values, its commissioning and operational plans
actively promoting the NHS Constitution via its website and in its engagement with our staff, patients, the public, providers of services and other key stakeholders
reflecting the NHS Constitution in its commissioning plans
publishing a comprehensive Integrated plan which will include the steps that the group will take to embed the NHS Constitution in its work
This will be monitored by the Board and scrutinised by the Audit committee. This is also included in the Terms of reference for each committee within the governance structure
4.3.3 Act effectively, efficiently and economically by::
Ensuring effective governance arrangements
Joint commissioning primary care services in collaboration with neighbouring clinical commissioning groups to drive better outcomes for patients, achieve greater value for money
Robust and comprehensive arrangements with the Commissioning Support Unit
16 Ensuring that the added value of clinical commissioning is always considered
Ensure quality, value for money and evidence base is always considered
This will be monitored by the Board and scrutinised by the Finance and Performance Committee.
Joint commissioning duties will be monitored by the Board and scrutinised by the Joint Commissioning Committee
This is also included in the Terms of reference for each committee within the governance structure
4.3.4 Act with a view to securing continuous improvement to the quality of services by:
Being driven by our Joint Strategic Needs Assessment and Joint Health and Well Being Strategy
Adding clinical value
Benchmarking local services, both regionally and nationally
Using patient and public feedback and experience to inform commissioning decisions
Using patient and public feedback and experience to identify and improve quality and safety of services
Peer review of services
Embedding a culture of continuous improvement through robust contract monitoring and use of data and information
Engaging with primary care and patient groups to evaluate services
Integration of services across both health and social care
Learn from serious untoward incidents and never events
This will be monitored by the Quality Committee providing the assurance to the Board.
4.3.5 Assist and support NHS England in relation to the Board’s duty to improve the quality of primary medical services and specialised care by:
17 Joint commissioning with NHS England and, where applicable, other CCGs to commission primary care services that deliver local priorities
Engaging primary care in the overall development of priorities
Defining the role of primary care in the health system
Defining what good quality primary care looks like
Reducing unwarranted variation
Aligning incentives and rewards to the needs of the patients
Peer review and support to improve quality
Resourcing and supporting practice forums
Actively encouraging practices to embed a culture of listening to their patients
The Board will take overall responsibility for this with delivery through the quality committee, strategic planning forum and the practice forums.
Joint commissioning duties will be monitored by the Board and scrutinised by the Joint Commissioning Committee
4.3.6 Have regard to the need to reduce inequalities by:
Listening to our patients and communities
Making sure that we are well informed of where and what our inequalities are, through the JSNA.
Supporting innovation to reach out to our patient groups
Staff engagement
Actively seek the views of our whole population, especially the hard to reach groups
Implement interventions that effectively target deprived and hard to reach groups
Provide additional resources where required to overcome barriers faced by hard to reach groups in accessing healthcare
18 Work with public health colleagues to identify key determinants of health inequalities and develop innovative interventions to address these
The Board will take responsibility for this with the Transformation and Delivery Committee providing the assurance. 4.3.7 Promote the involvement of patients, carers’, and representatives in decisions about their healthcare by:
Ensuring that the patient is at the centre of all we do through our vision and values
Resourcing and supporting patient representation throughout the organisation
Encouraging practices to use their patient participation groups to feed through to the practice forums
The Board will take overall lead responsibility to deliver this area. This is reflected in the terms of reference.
4.3.8 Act with a view to enabling patients to make choices by:
Embedding our vision for ‘helping yourself and your NHS’ within the local community
Making it easy for patients to influence direction and decision making
This will be reflected within the terms of reference for the Transformation and Delivery Committee and the relevant delivery groups.
4.3.9 Obtain appropriate advice from persons who, taken together, have a broad range of professional expertise in healthcare and public health by:
Having regular clinician to clinician meetings with the secondary and community care specialists
Supporting and resourcing regular practice forums, ensuring engagement with all GPs, Nurses, Practice managers and AHPs
Regular visits to member practices and local providers to gather local intelligence
Running a programme of development that includes our practices, other clinical specialities and newly qualified GPs
19 Supporting and resourcing clinical Forums including the nursing forums
A Public Health Consultant will be a member of our Operational Executive Committee.
The terms of reference for each committee within the governance structure reflects this responsibility.
4.3.10 Promote partnership working, in particular with local authority(ies) and Health and Wellbeing Board(s) by:
Identifying with partners joint commissioning opportunities for commissioning integrated services across health, mental health and social services
Actively participating in forums and projects which bring together public sector partners across local government, the NHS, the emergency services and various national government agencies to redesign services around the needs of local communities and citizens.
The terms of reference for both the Transformation and Delivery Committee and the Operational Executive, include this responsibility in conjunction with the Executive function of the Health and Wellbeing Board, as approved by the Governing Body.
4.3.11 Promote innovation by:
Utilising the practice forums as a vehicle for developing innovative ideas from patient groups through practices
Exploring examples of good practice across the NHS nationally, external to the NHS and internationally.
Using technologies to achieve innovation
Providing opportunities to listen to stakeholders to achieve innovation
Commissioning outcomes rather than process
Ensuring all opportunities for joint co-commissioning have been explored
This is included in all terms of reference for committees within the governance structure
The co-commissioning duties will be monitored by the Board and scrutinised by the Joint Commissioning Committee
20 4.3.12 Promote research and the use of research by:
Develop as a learning organisation
Sharing our learning at regional and national events
Commissioning cycle will be evidence based
Encourage staff to engage in research
Work with Commissioning Support to develop and embed a research culture
The Board will take overall lead responsibility to deliver this area, this is reflected in the terms of reference
4.3.13 Have regard to the need to promote education and training for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health services in England so as to assist the Secretary of State for Health in the discharge of this related duty by:
By specifying in contracts the need for continuous education and training of staff
Through personal development plans for our employed staff
By continually updating and developing our Organisational Development Plan
This responsibility is reflected in the terms of reference of the CCG Board, with delivery through the Quality Committee for Providers and through the Operational Executive Committee
4.3.14 Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the group considers that this would improve the quality of services or reduce inequalities by:
Actively encouraging integration through the delivery structure to ensure that all opportunities are maximised
Ensuring that all planning and delivery involves social care colleagues ensuring that our Strategic Planning Forum has broad membership to ensure that all opportunities for integration are seized.
Look for all opportunities to share resources and align outcomes through commissioning plans and delivery
21 Ensuring all opportunities for joint co-commissioning have been explored
These responsibilities in the terms of reference of the Strategic Commissioning Committee
The co-commissioning duties will be monitored by the Board and scrutinised by the Joint Commissioning Committee.
4.4 GENERAL FINANCIAL DUTIES
NHS North East Essex Clinical Commissioning Group will perform its functions so as to:
Ensure its expenditure does not exceed the aggregate of its allocations for the financial year:
1. Through both the Operational Executive Committee and Finance and Performance Committee as outlined in the terms of reference.
Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS Commissioning Board for the financial year:
2. Through both the Operational Executive Committee and Finance and Performance Committee as outlined in the terms of reference.
4.4.1 Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the group do not exceed an amount specified by NHS England :
Through both the Operational Executive Committee and Finance and Performance Committee as outlined in the terms of reference
4.4.2 Publish an explanation of how the group spent any money received as a result of the Quality Premium payment made by NHS England: Through both the Operational Executive Committee and Finance and Performance Committee as outlined in the terms of reference
4.5 OTHER RELEVANT REGULATIONS, DIRECTIONS AND GUIDANCE
4.5.1 The group will
22 a. Comply with all relevant regulations
b. Comply with directions issued by the Secretary of State for Health or NHS England
c. Have regard to guidance issued by NHS England
d. Develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant group policies and procedures
23 5. MEMBERSHIP
5.1 MEMBERSHIP OF THE CLINICAL COMMISSIONING GROUP
5.1.1 The following practices comprise the members of the NHS North East Essex Clinical Commissioning Group:
Practice Address Abbey Field Medical Centre Ypres Road (formerly Mersea Road) Colchester CO2 7UW Ambrose Avenue Group Practice 76 Ambrose Avenue Colchester CO3 4LN Ardleigh Surgery The Surgery Dedham Road Ardleigh CO7 7LD Bluebell Surgery Jack Andrews Drive Highwoods Colchester CO4 9YN Caradoc (Station Approach Station Approach Surgery) Frinton on Sea CO13 9JT Colchester Medical Practice Castle Gardens Surgery 78 East Hill Colchester CO1 2QS (incorporating Castle Gardens Medical Shrub End Surgery Centre, Shrub End & Wimpole Road 122 Shrub End Rd Surgeries) Colchester CO3 4RY Wimpole Road Surgery 52 Wimpole Road Colchester CO1 2DL Colne Medical Centre 40 Station Road Brightlingsea CO7 0DT Creffield Medical Centre 15 Cavalry Road Colchester CO2 7GH Crusader Surgery 7-8 Crusader Business Park Stephenson Road West Clacton-on-Sea CO15 4TN
24 East Hill Surgery 78 East Hill Colchester CO1 2RW East Lynne Medical Centre 3 - 5 Wellesley Road Clacton-on-Sea CO15 3PP Epping Close Surgery Kennedy Way Clacton on Sea CO15 4AB Frinton Road Medical Centre 68 Frinton Road Holland on Sea Clacton-on-Sea CO15 5UW Fronks Road Surgery 77 Fronks Road Dovercourt Harwich CO12 3RS Great Bentley Surgery The Hollies, The Green Great Bentley Colchester CO7 8PJ Great Clacton Medical Practice 17 North Road (North Road) Great Clacton Clacton-on-Sea CO15 4DA Green Elms Surgery 32 Crossways Jaywick Clacton-on-Sea CO15 2NB Harewood Surgery Harwich Road Great Oakley Harwich CO12 5AD Hawthorn Surgery St Edmunds Centre Tamerisk Way Colchester CO4 3GW Highwoods Surgery Highwoods Square Colchester CO4 9SR Lawford Surgery 2 Edgefield Avenue Lawford Manningtree CO11 2HD Layer Road Surgery Layer Road Colchester CO2 9LA Mayflower Medical Centre 419 Main Road Dovercourt Harwich CO12 4EX
25 Mersea Island Medical Practice 32 Kingsland Road West Mersea Colchester CO5 8RA Mill Road Surgery 47 Mill Road Mile End Colchester CO4 5LE North Colchester Healthcare Centre Primary Care Centre Turner Road Colchester CO4 5JR North Hill Medical Group 18 North Hill Colchester CO1 1DZ Old Road Medical Practice 145-149 Old Road Clacton-on-Sea CO15 3AU Parsons Heath Medical Practice 35a Parsons Heath Colchester CO4 3HS Portland Medical Practice Ypres Road Colchester CO2 7UW Ranworth Surgery 103 Pier Avenue Clacton-on-Sea CO15 1NJ Riverside Health Centre Station Road Mannigtree CO11 1AA Rowhedge & University of Essex 7 Rectory Road Medical Practice Rowhedge Colchester CO5 7HP St James Surgery 89 Wash Lane Clacton-on-Sea CO15 1DA Thorpe-le-Soken Surgery The Surgery High Street Thorpe-le-Soken CO16 0EA Tiptree Medical Centre Church Road Tiptree Colchester CO5 0HB Tollgate Medical Centre 145 London Road Stanway Colchester CO3 8NZ Walton Medical Centre The Surgery Vicarage Lane Walton-on-the-Naze CO14 8PA
26 Winstree Medical Practice 84 Winstree Road Colchester CO3 5QF Wivenhoe Surgery 71 The Avenue Wivenhoe Colchester CO7 9PP
5.1.2 Appendix 1 of this constitution contains a list of Practice Members, together with the signatures of the Practice Representatives confirming their agreement to this constitution.
5.2 ELIGIBILITY
5.2.1 Any Practice within the geographical area of NHS North East Essex Clinical Commissioning Group, holding a contract for the provision of primary medical services with NHS England, and whose practice population is in the majority resident in North East Essex, will be eligible for membership of the group.
5.3 VARIATION TO THE CCG MEMBERSHIP
5.3.1 The membership of the group can only be changed:
a. where the group formally applies to NHS England, which is the only body with the authority to grant this application
b. where NHS England, under its authority, varies the group’s constitution
5.3.2 Variations to the membership of the group only come into force when granted by NHS England.
5.4 MEMBERS OF THE GOVERNING BODY (BOARD) OF THE CCG
The Board shall consist of a maximum of 15 voting members in addition to the Chair, voting membership will always ensure a Non-executive majority and may be adjusted accordingly. Total number of voting members should not exceed 15 plus Chair.
Voting Members Chair (Casting vote only) Accountable Officer Chief Operating Officer Chief Financial Officer Director of Quality / Executive Nurse Director of Integration Elected Member (minimum 2; Maximum 4) (Non-Executive)* Lay Member (Minimum 2;Maximum 4) (Non-
27 Executive)** Secondary Care Consultant (Non-Executive) Director of Integrated Commissioning from ECC Non-voting Members Elected Patient Representative NHS England Representative EEC Councillor (Speaker / Observer)
*of whom one will be the Clinical Deputy Chair and one will be Chair of the Transformation and Delivery Committee **of whom one will be Board Vice-Chair and one will be Audit Committee Chair
5.5 All members of the Board will share responsibility in ensuring that the CCG exercises its functions effectively, efficiently and with good governance and in accordance with the terms of the CCG constitution as agreed by its members.
5.6 Individual Members will bring their unique perspective, informed by their expertise and experience. This will underpin decisions made by the Board and will help ensure that as far as reasonably practicable:
The values and principles of the NHS Constitution are actively promoted The interests of patients and the community remain at the heart of discussions and decisions The Board and the wider CCG acts in the best interests of the local population at all times The CCG commissions the highest quality services and best possible outcomes for their patients within their resource allocation Good governance remains central at all times Ensure that the board adopts an approach that supports candour, honesty and transparency
5.7 People who are ineligible for appointment to the CCG Board include anyone who: is not eligible to work in the UK has received a prison sentence or suspended sentence of 3 months or more in the last 5 years is the subject of a bankruptcy order or interim order has been dismissed (except by redundancy) by any NHS body is subject to a disqualification order set out under the Company Directors Disqualification Act 1986 has been removed from acting as a trustee of a charity
5.8 THE CHAIRMAN AND VICE CHAIRMAN
28 5.7.1 The Chairman and Vice Chairman shall serve on the Board for a period 3 years after which the positions shall be subject to re-appointment. In agreement with the member practices this may be extended for a maximum of 2 years.
5.7.2 The appointment of these roles is detailed in standing orders. If the Chairman is one of the member practice elected members they will not be included in any election of members if this occurs within their 3 year tenure.
5.7.3 Where the Chairman is a Health Professional, the Vice Chairman shall be a lay member (who is not the Audit Committee Chair). The Vice Chair will deputise for the Chair at Board meetings in their absence,
5.7.4 Where the Chairman is a Health Professional the Deputy Clinical Chairman will be selected by the Chair from the elected membership who will deputise for the chair when necessary but this role does not include Chairmanship of the Governing Board meetings. The Deputy Clinical Chair shall be the Vice Chair should the Chair not be a Health Professional.
5.7.5. The roles of Chairman and Accountable Officer shall not be held by the same individual.
5.7.6 Member practices will be asked to signal their support to the recommendation for appointment of the Chair from the interview panel.
5.7.7 The appointment of the Chair will subject to the satisfactory outcome of a relevant assessment process.
5.9 THE ACCOUNTABLE OFFICER
5.8.1 The Board will nominate an Accountable Officer and appoint following an open appointment process which will include a relevant and appropriate assessment. If the Accountable Officer is one of the member practice elected members on appointment, they will then cease to be an elected member.
5.8.2 The Accountable Officer will be an ex-officio member of the Board.
5.8.3 The Accountable Officer will have specific responsibilities for ensuring that the CCG complies with its financial duties, promotes quality improvements and demonstrates value for money.
5.8.4 The Accountable Officer must be either
a GP who is a member of the CCG;
29 an employee of the CCG or any member of the CCG; or
In the case of a joint appointment, an employee of any member of any of the groups in question or any member of those groups.
5.10 GP MEMBERS
5.9.1 The selection and election process for the GP members of the Board will be assisted by an independent body in accordance with the process and principles set out in schedule 3 of this Constitution.
5.11 LAY MEMBERS
5.10.1 The Board will appoint a minimum of 2 and a maximum of 4 lay members who must either be residents of the area covered by the CCG or registered with a member practice in accordance with the process and principles set out in schedule 2 of this constitution.
5.10.2 Two lay members shall have the lead roles in overseeing key elements of governance. These members will have recent financial and audit experience and one will act as Chairman of the Audit Committee and one Chairman of the Remuneration Committee.
5.10.3 One lay member will have expertise and knowledge of the local community and will have a lead role in championing public and patient involvement.
5.10.4 One of the lay members (not the Audit Committee Chair) will undertake the role of either Chairman or Vice Chairman of the Board.
5.10.5 The term of office of lay members will be three years, with the first year being a probationary period for both parties, after which the post will be subject to reappointment.
5.12 SECONDARY CARE SPECIALIST AND REGISTERED NURSE
5.11.1 One member shall be a Doctor who is an out of area secondary care specialist who has a high level of professional expertise and knowledge. This member will bring an understanding of patient care in the hospital setting.
5.11.2 One member shall be a registered nurse who will bring a broader view from the nursing perspective, on health and care issues, and especially the contribution of nursing to patient care.
5.11.3 The secondary care specialist and registered nurse shall be appointed in accordance with procedures set out in Schedule 3 to this Constitution.
30 6. ROLES OF THE BOARD AND RESPONSIBILITIES OF COMMITTEE MEMBERS
6.1 ROLE OF THE BOARD
The Board shall:-
6.1.1 Ensure that all providers of primary medical services in the Locality are Members of the Clinical Commissioning Group
6.1.2 Recognise where a Member who is a provider of primary medical services is a party to more than one contract for primary medical services, then that Member is to be treated as a separate provider in respect of each contract
6.1.3 Commit to the principles of devolved responsibility for commissioning decisions across the health community in the relevant locality
6.1.4 Support a varied and diverse approach to commissioning, particularly for practices to work proactively to improve efficiency and value and joint commissioning approaches with NHS England through co-commissioning arrangements.
6.1.5 Encourage innovation by enabling and supporting practices, clinicians and the public in creating changes
6.1.6 Ensure that the CCG discharges its duty of candour, promote a culture of openness and honesty in all of its relationships, and ensure that all its staff and those in wider stakeholder groups are encouraged to report failings and concerns without obstacles.
6.1.7 Ensure inclusion of patients, carers, public, communities of interest and geography, health and wellbeing boards and local authorities in the drive to improve outcomes and quality of services
6.1.8 Engage in a collaborative approach with the local NHS in securing new services for patients fully responsive to local health needs
31 6.1.9 Ensure that there are robust plans and responsibilities assigned to manage staff engagement, external relationships and communications
6.1.10 Facilitate the delivery of the required management cost savings whilst ensuring sustainable functions
6.1.11 Ensure that the views of individual patients are reflected in shared decision making and translated into commissioning decisions
6.1.12 Facilitate the delivery and implementation of any guidance or standards issued by any relevant regulatory body
6.1.13 Work with all local stakeholders to achieve delivery of the targets, policies and standards
6.1.14 Work with any other appropriate bodies, which are involved at any relevant time, in commissioning or provision of primary, community and secondary care services
6.1.15 Work collaboratively to deliver the outcomes and milestones set out in the Strategic Planning documentation.
6.1.16 Ensure effective liaison with and reporting to Members of the Clinical Commissioning Group and NHS England (as appropriate)
6.1.17 Develop and keep under review robust governance arrangements which shall be complied with by all Members within the Clinical Commissioning Group
6.1.18 Ensure effective systems are in place to enable to the CCG to maintain strategic oversight of risk and patient safety
6.1.19 Comply with all relevant procurement law and policy and adhere to the obligations placed on the Board and Clinical Commissioning Group with regard to all Providers applying the following principles of:
32 transparency and openness
support and assistance and training so as to permit compliance with the procurement law, competition law and any relevant policies
application of guidance “procurement guide for commissioners of NHS funded services” and the “principles and rules for co-operation and competition
equality of treatment
application of the principle of ‘Any Qualified Provider’
6.1.20 Ensure that all decisions made in relation to commissioning are fully recorded and auditable.
6.1.21 Be engaged in the day to day management and application of commissioning and related activity in the Locality and operate in good faith using all due skill and diligence.
6.1.22 Provide full reports of all activity including financial activity at all Board meetings. The reports shall be available to all Members prior to the Board’s monthly meetings and form part of the main agenda.
6.1.23 Ensure that all the Clinical Commissioning Group’s policies and procedures with regard to the involvement and consultation of patients and other relevant bodies are fully complied with at all times.
6.1.24 Fairly and equitably advertise any specific salaried posts.
6.1.25 Ensure that the Board approves any relevant business case and that any business case is duly considered by the Board for approval before implementation.
6.1.26 Stakeholder Members who are also Members of the Board shall be identified and policies with regard to conflict or potential conflict shall be applied as set out in part 8 of this constitution.
33 6.1.27 The board needs to ensure that there are high quality and efficient commissioning support arrangements in place.
6.1.28 Ensure that there are clear lines of accountability and systems in place for safeguarding within the governance structure of the CCG that take into account the mechanisms and policies recommended by the Local Safeguarding Boards
6.1.29 The Board shall as far as reasonably practicable:-
Establish strong relationships with and between member practices.
Develop effective communication links to ensure that, as far as reasonably practicable, the views of member practices are properly considered as part of its decision making processes.
Have in place plans that address local health inequalities.
Develop the vision, values and culture of the CCG and set the strategic direction of the CCG. Engage specifically with the Health and Wellbeing Board. Secure broad clinical engagement in the development and implementation of plans. Engage with representatives of the LMC and other primary care representative committees. Secure effective public involvement in the decisions of the CCG. Secure the safety and quality of services. Co-ordinate and plan for demand, financial and investment needs of the CCG. Secure the agreement of member practices to commissioning support arrangements that underpin clinically led commissioning in the locality.
6.1.30 The Board will ensure that the governing body functions in an open and honest way with particular focus on the duty of candour.
6.2 RESPONSIBILITIES OF THE BOARD MEMBERS
6.2.1 All Members of the Group’s Governing Body
34 6.2.1.1 The roles of members of the group’s governing body are set out in separate guidance. In summary, each member of the governing body shares responsibility as part of a team to ensure that the group exercises its functions effectively, efficiently and with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience.
6.2.2 The Chair of the Governing Body
6.2.2.1 The chair of the governing body is responsible for:
leading the governing body, ensuring it remains continuously able to discharge its duties and responsibilities as the overarching committee of the Group
building and developing the group’s governing body and its individual members
ensuring that the group has robust constitutional and governance arrangements in place
ensuring that, through appropriate support, information and evidence, the governing body is able to discharge its duties
supporting the accountable officer in discharging the responsibilities of the organisation
contributing to the building of a shared vision of the aims, values and culture of the organisation
leading and influencing to achieve clinical and organisational change to enable the group to deliver its commissioning intentions
overseeing governance and particularly ensuring that the governing body and the wider group behave with the utmost transparency and responsiveness at all times
Taking a key role in the development and leadership of an open, honest and transparent culture within the governing body and the CCG;
Ensuring that public and patients’ views are heard and their expectations understood and, as far as possible, met
Ensuring that the organisation is able to account to its local patients, stakeholders and NHS England
35 Ensuring that the group builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant local authority
6.2.2.2 Where the chair of the governing body is also the lead clinician of the group they will also have the following responsibilities:
lead the Group ensuring it is constantly committed to and able to discharge its functions
be the senior clinical voice of the group in interactions with all stakeholders including NHS England
have the respect and authority of the Group’s member practices.
6.2.3 The Vice Chair of the Governing Body
6.2.3.1 The Vice Chair of the governing body chairs the Board in the absence of the Chair, or where he or she is conflicted or is otherwise unable to act, 6.2.3.2 The chair of the governing body will also have a clinical deputy chair who will be an elected GP member, and member of the Board. This person shall deputise for the Chair in his absence, covering the general duties of the Chair, particularly those of Clinical Leadership, other than that of chairing the Board meetings.
6.2.4 Role of the Accountable Officer
6.2.4.1 The accountable officer of the group is a full member of the governing body.
6.2.4.2 Where the accountable officer is also the lead clinician of the group they will also have the following responsibilities
lead the group ensuring it is constantly committed to and able to discharge its functions
be the senior clinical voice of the group in interactions with all stakeholders including NHS England
have the respect and authority of the group’s member practices
6.2.4.3 The role of Accountable Officer has been summarised by the NHS Commissioning Board in its document “Clinical Commissioning Group governing body members: Roles outlines, attributes and skills” as:
Being responsible for ensuring that the clinical commissioning group fulfils its duties to exercise its functions effectively, efficiently and
36 economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money
At all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems.
Working closely with the chair of the governing body, the accountable officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (though the governing body) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities.
6.2.5 Role of the Chief Finance Officer
6.2.5.1 The Chief Finance Officer is a full member of its governing body. The Chief Finance Officer is responsible for the financial strategy, financial management and financial governance of the group. Specific responsibilities associated with this role include:
being the governing body’s professional expert on finance
ensuring through robust systems and processes the regularity and propriety of expenditure is fully discharged
ensuring appropriate arrangements are in place to support, monitor and report on the group’s finances.
ensuring propriety in the use of group’s resources through robust audit and governance arrangements.
responsible for advising the governing body on the effective, efficient and economic use of its allocation to remain within that allocation and deliver required financial targets and duties.
producing the financial statements for audit and publication in accordance with strategy requirements to demonstrate effective stewardship of public money and accountability to tax payers.
6.2.6 Role of Clinical Leaders
6.2.6.1 Elected clinical leaders have a more active role in the management and operation of the group. As members of the group, they bring their unique understanding of the group’s member practices to the discussion and
37 decision making of the governing body. The role of the clinical leaders are described in the Prospectus in Appendix 11
7. DECISION MAKING – THE GOVERNING STRUCTURE
38 7.1 AUTHORITY TO ACT
7.1.1 The clinical commissioning group is accountable for exercising the statutory functions of the group. It has granted authority to act on its behalf to:
any of its members
its governing body
employees
a committee or sub-committee of the group
7.1.2 The extent of the authority to act by the respective bodies and individuals depends on the powers delegated to them by the group as expressed through:
the group’s scheme of reservation and delegation, and
for committees, their terms of reference
7.2 SCHEME OF RESERVATION AND DELEGATION
7.2.1 The group’s scheme of reservation and delegation sets out:
those decisions that are reserved for the membership as a whole
those decisions that are the responsibilities of its governing body, its committees and sub-committees, individual members and employees
the clinical commissioning group remains accountable for all of its functions even those that it has delegated.
7.3 COMMITTEES OF THE GROUP
7.3.1 The following committees have been established by the group:
3.1.a) Governing Body (the Board)
3.1.b) Audit Committee
3.1.c) Remuneration Committee
3.1.d) Quality Committee
39 3.1.e) Finance and Performance Committee
3.1.f) Transformation and Delivery Committee
3.1.g) Operational Executive Committee
3.1.h) Strategic Commissioning Committee
7.3.2 Committees are able to establish their own sub-committees to assist them in discharging their respective responsibilities. If this responsibility had been delegated to them by the group or the committee they are accountable to.
7.3.3 Committees are able to merge functions to assist them in discharging their respective responsibilities and to improve efficiency. Any such merger must be agreed and approved by the two committees and the governing body.
7.4 BOARD GOVERNANCE
7.4.1 Every term of office shall commence on announcement of the outcome of any vote/ballot which shall take place at the outset of the meeting of the Board. Any term of office shall also subsequently cease after the announcement of new officers.
7.4.2 The Board shall have the authority to engage, employ or appoint any consultant, employee or private contractor in order to facilitate the performance of its duties. Such individuals may be present at any Board meetings at the discretion of the Board but shall not be entitled to any voting rights.
7.4.3 The board shall meet in public at least 6 times per year. Every Board member shall be given at least 14 days’ notice to attend
7.4.4 The venue, date and time of all Board meetings will be made public with at least 7 days’ notice on the CCG Website. The notice shall include the agenda and papers related to the agenda.
7.4.5 At any meeting of the Board or of a committee or sub-committee, the Chair of the Board, or committee or sub-committee, if any and if present, shall preside. If the Chair is absent from the meeting, the Vice Chair, if any and if present, shall preside.
7.4.6 If the chair is absent temporarily on the grounds of a declared conflict of interest the Vice Chair, if present, shall preside. If both the chair and Vice Chair are absent, or are disqualified from participating, or there is neither a chair or deputy a member of the Board, committee or sub-committee
40 respectively shall be chosen by the members present, or by a majority of them, and shall preside.
7.4.7 Any quorum of the Board or its sub-committees shall exclude any member affected by a Conflict of Interest under paragraph 8.2. If this paragraph has the effect of rendering the meeting inquorate, then the Chairman shall decide whether to adjourn the meeting to permit the appointment or co- option of additional members. If it is anticipated that for any item quoracy could be an issue due to conflict of interest, the Chair may co-opt enough members for that item to achieve quoracy.
7.4.8 All members of the Board shall be permitted to carry a vote on any decision of the Board, unless otherwise determined by the Board. No observer or co-opted member shall carry a vote. In the case of equality of votes, the Chairman shall carry the casting vote.
7.4.9 Any voting member of the Board shall be entitled to nominate a proxy to vote on his behalf in the event that he cannot attend a meeting of the Board. In those circumstances the Chairman (or acting Chairman) should be informed one week prior to the meeting of the non-attendance and shall receive a duly completed and authorised proxy form as per Schedule 4 of this Constitution.
7.4.10 The board may in its absolute discretion invite such persons as it thinks fit to attend the whole of any part of the board meeting (such persons shall not be permitted to vote)
7.4.11 The Chairman of the board can determine items that need to be discussed in the closed or 2nd part of the board
7.4.12 The Clinical Commissioning Group shall hold an Annual General Meeting (AGM) once in each financial year provided that no more than 15 months shall elapse between the date of one Annual General Meeting and that of the next.
7.4.13 The AGM shall be held in publically accessible premises within the geographical area of North East Essex.
7.4.14 The Board shall keep records and proper minutes of all Board Meetings, resolutions and business conducted.
7.4.15 Minutes of all formal meetings will be a matter of public record
7.4.16 In discharging their delegated responsibilities committees and individuals must:
comply with the group’s principles of good governance
41 operate in accordance with the group’s scheme of reservation and delegation
comply with the group’s standing orders
comply with the group’s arrangements for discharging its statutory duties
where appropriate, ensure that member practices have had the opportunity to contribute to the group’s decision making process.
In addition when discharging their delegated functions, committees must also:
operate in accordance with their approved terms of reference.
Where delegated responsibilities are being discharged collaboratively, the collaborative arrangements must:
identify the roles and responsibilities of those clinical commissioning groups who are working together
identify any pooled budgets and how these will be managed and reported in annual accounts
specify under which clinical commissioning group’s scheme of reservation and delegation and supporting policies the collaborative working operates
specify how the risks associated with the collaborative working arrangement will be managed between the respective parties
identify how disputes will be resolved and the steps required to terminate the working arrangements
specify how decisions are communicated to the collaborative partners
42 7.5 THE GOVERNING BODY
Functions -the governing body has the functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 of the 2012 Act, together with any conferred by regulations made and any other functions connected with its main functions as may be specified in regulations. It has responsibility for the following functions:
7.5.1 ensure that the group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the group’s principles of good governance
7.5.2 determining the remuneration, fees and other allowances payable to employees or other persons providing services to the group and the allowances payable under any pension scheme it may establish under Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;
7.5.3 Approving any functions of the group that are specified in regulation
7.5.4 Ensuring that the register of interests is reviewed and updated quarterly and published annually.
7.5.5 Ensuring that all conflicts of interest or potential conflicts of interest are declared
7.6 COMMITTEES OF THE GOVERNING BODY
The governing body has appointed the following committees and sub- committees:
7.6.1 Audit Committee –the audit committee is accountable to the governing body. (Terms of reference in Appendix 3)
7.6.2 Remuneration Committee – the remuneration committee is accountable to the governing body. (Terms of reference in Appendix 3)
7.6.3 Quality Committee – the quality committee reports to the governing body who approves its terms of reference ( see Appendix 3 for Terms of reference)
7.6.4 The Transformation and Delivery Committee reports to the Clinical Commissioning Group Board who approves its terms of reference (see Appendix 3 for terms of reference)
7.6.5 The Finance and Performance Committee reports to the Clinical Commissioning Group Board who approves its terms of reference (see appendix 3 for terms of reference)
43 7.6.6 The Operational Executive Committee – reports to the Clinical Commissioning Group Board who approves its terms of reference (see Appendix 3 for terms of reference)
7.6.7 The Strategic Commissioning Committee – reports to the Clinical Commissioning Group Board who approves its terms of reference (see Appendix 3 for terms of reference)
7.7 Voting process
7.7.1 Any matter that has been discussed at a decision-making meeting that requires a formal decision to be made can be decided by a simple majority of those voting members and present in the room at the time the question was put.
7.7.2 The Chairman has the casting vote. If there are equal numbers of votes for and against, the Chairman will have a second or casting vote. There will be no restriction on how the Chairman chooses to exercise a casting vote.
7.7.3 Voting at a Meeting of a Committee shall be by show of hands. The chairman will ask members to indicate before the vote if they wish to abstain.
7.7.4 The outcome of the vote will be recorded in the minutes and will show which members chose to abstain from the vote.
7.7.5 Right to require individual vote to be recorded - Where any member requests it immediately after the vote is taken, their vote will be so recorded in the minutes to show whether they voted for or against the motion or abstained from voting.
44 8.0 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST
8.1 STANDARDS OF BUSINESS CONDUCT
8.1.1 Employees, members, committee and sub-committee members of the group and members of the governing body (and its committees), will at all times comply with this constitution and be aware of their responsibilities as outlined in it and in the arrangements for their appointment. They should act in good faith and in the interests of the group and should follow the Seven Principles of Public Life, set out by the Committee on Standards in Public Life (the Nolan Principles). These principles are incorporated into this constitution at Appendix 2.
8.1.2 Regardless of their contractual status, individuals working on behalf of the group must comply with the group’s policies on Business Conduct, Conflicts of Interest, Hospitality, Sponsorship, national guidance contained in HSG (93) 5 on Standards of Business Conduct for NHS staff, the Code of Conduct for NHS Managers (2002) and the Association of British Pharmaceuticals Industry ‘Code of Professional Conduct’ relating to hospitality / gifts from the pharmaceutical / external industry. These policies are available on the group’s website.
8.1.3 It is an offence under the Prevention of Corruption Acts 1906 and 1916 for an employee of the group to accept corruptly any inducement or reward for doing, or refraining from doing, anything in their official capacity, or corruptly showing favour or disfavour in the handling of contracts. Breach of the provision of these acts makes them liable to prosecution and may also lead to the termination of their contracts of employment and superannuation rights within the NHS.
45 8.2 CONFLICTS OF INTEREST
8.2.1 As required by Section 140 of the 2006 Act, as inserted by section 25 of the 2012 Act, the clinical commissioning group will make arrangements to manage members’ and employees’ interests, to avoid potential or actual conflicts of interest, and ensure that decisions made by the group will be taken, and seen to be taken, without any possibility of the influence of external or private interest.
8.2.2. A Conflict of Interest may include but shall not be limited to:
. A direct pecuniary interest: where an individual may financially benefit from the consequences of a commissioning decision
. An indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision
. A non-pecuniary interest; where an individual holds a non-remunerative or not for profit interest in an organisation, that will benefit from the consequences of a commissioning decision
. A non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequences of a commissioning decision which cannot be given a monetary value
. Where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories
. A Member of the Board or any of its sub-committees holding partnership in, employment in, directorship or trusteeship of or majority or controlling shareholdings in or other significant associations with any Provider.
. Any interest the Member of the Board or its sub-committees if registered with the General Medical Council (GMC) would be required to declare in accordance with paragraph 55 of the GMC’s publication “Management for Doctors or any successor code” including the referral of any patient by a member to a Provider or the Board or its sub- committees in which the member has a Conflict of Interest.
46 . Any interest that the Member of the Board or its sub-committees if registered with the Nursing and Midwifery Council (NMC) would be required to declare in accordance with paragraph 7 of the NMC’s publication Code of Professional Conduct or any successor code including the referral of any patient by a member to a Provider in which the member has a Conflict of Interest.
. Any duty whatsoever imposed on any member of the Board or its sub- committees clinicians or any other codes of conduct to which the member is subject.
Any other interest whatsoever that should be dutifully declared under The Health and Social Care Act 2012 and guidance issued by Department of Health from time to time.
8.3 PRINCIPLES FOR MANAGING INTEREST
8.3.1 One of the overriding objectives of the clinical commissioning group is to ensure that decisions made by the group are both taken and seen to be taken without any possibility of the influence of external or private interest
8.3.2 As a general principle, anyone working for, or on behalf of, the clinical commissioning group who is involved in taking decisions, or who is able to influence a decision must declare their interests to the group. This will include:
8.3.3 All members of the group’s governing body
8.3.4 All members of the group’s committees
8.3.5 All members of the group’s sub-committees, where they have delegated authority to take decisions
8.3.6 Senior employees of the group, or individuals (including practice members who are contracted to work with the group), who are not members of the group’s governing body, its committees or sub-committees
8.4 The following principles will be integral to the commissioning of all services including decisions on whether to continue to commission a service, such as a contract extension. Conflicts of interest can be managed by:
Doing business appropriately
being proactive, not reactive
47 Assuming that individuals will seek to act ethically and professionally, but may not always be sensitive to all conflicts of interest
Being balanced and proportionate
Openness
Responsiveness and best practice
Transparency
Securing expert advice
Engaging with providers
Creating clear and transparent commissioning specifications
following proper procurement processes and legal arrangements
ensuring sound record-keeping, including up to date registers of interest
a clear, recognised and easily enacted system for dispute resolution
8.4 DECLARATION OF INTERESTS
8.4.1 The governing body of the Clinical Commissioning Group shall maintain a register of interests of all Members of the Board or its sub-committees recording all declarations of Conflicts of Interest in the form set out in Schedule 1.
8.4.2 The register of interests shall be kept by the Accountable Officer unless he/she is a GP in which case the responsibility for maintaining the register will pass to the Chief Finance Officer and shall be made available on written request.
8.4.3 Any Member of the Board or its sub-committees subject to a potential Conflict of Interest or to any change in circumstances which may bring to light a potential future Conflict of Interest or any previous or current Conflict of Interest shall:
8.4.3.1 Declare the nature and extent of any Interest (including any benefit already or expected to be received) to the Accountable Officer unless he/she is a GP in which case the responsibility will pass to the Chief Operating Officer to ensure inclusion on the register, in the form set out in Schedule 1 prior to any relevant discussion regarding any specification for or award of the goods or services to which the Conflict of Interest relates; within 28 days of appointment or as soon as such Interest becomes apparent- whichever is the sooner;
48 8.4.3.2 Declare the nature and extent of any Interest at the beginning of any meeting in which relevant discussion regarding any specification for or award of the goods or services to which the Interest relates;
8.4.4. All clinical members of the Board or its sub-committees seeks to refer a patient to a Provider he/she must in addition to paragraphs 8.4.4 and 8.4.5 declare the nature of any Interest to the patient and note the nature of the Conflict of Interest related to any referral on the patient’s medical record as suggested by Paragraph 76 of GMC’s Good Medical Practice code; and
8.4.5 Be refrained from discussing or voting on any matters related to such Interest, should there be deemed to be a Conflict by the Chair or CFO/COO8.4.6 All invitations to tender or contract issued by the Clinical Commissioning Group shall require any tendered or potential contractor to declare any potential Conflicts of Interest within 28 days in the form set out in Schedule 1.
8.5 MANAGING CONFLICTS OF INTEREST – GOVERNING BODY
8.5.1 Individual members of the governing body will comply with the arrangements determined by the governing body for managing conflicts or potential conflicts of interest 8.6 FAILURE TO DISCLOSE CONFLICTS OF INTEREST
8.6.1 Failure to disclose any Conflict or potential Conflict of Interest by any Member of the Board or its sub-committees may result in the disqualification of that Member by special resolution of the Board under the disqualification provisions detailed on page 39.
8.6.2 Failure to disclose any Conflict or potential Conflict of Interest by any member of the Board regarding a bid from a potential Provider, will not necessarily render any decision made by the Board or its properly constituted sub committees as invalid, although the Board shall reserve the right to declare any such contract invalid or impose such requirements or conditions upon that Member or any contract to which the Conflict of Interest pertains, as it sees fit.
8.7 MITIGATING CONFLICTS OF INTEREST
8.7.1 When a conflict of interest is known of prior to a meeting, the individual concerned must bring their interest to the attention of the Chair of the meeting who will determine whether or not they should take any part in that discussion at the meeting. Similarly, where it is established on a particular item of business during a meeting, the Chair of the meeting will determine whether the individual may continue to contribute to the discussion and decision or alternatively, if the interest is considered to be material, whether they should withdraw entirely from the relevant
49 discussion or decision. In the event of the Chair of the meeting being conflicted, the nominated vice-chair, or alternatively an individual nominated by members in attendance, will chair that particular discussion and will determine what part if any the Chair shall play. All decisions shall be recorded in the minutes of the relevant meeting.
8.7.1 Where more than 50% of the members of a governing body, or committee delegated to take decisions, are prevented from taking a decision because of a conflict of interest, the Chair of the meeting, who must not be conflicted, will determine whether or not the discussion can proceed.
8.7.3 In making his decision the Chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the terms of reference. Where the meeting is not quorate, due to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the governing body or committee, the Chair will have the discretion to invite others to make up the quorum so that the group can progress the item of business.
8.7.4 The group will take steps to manage and mitigate the risk of conflict occurring by:
setting out in its election and selection process any specific interests that are likely to give rise to a material conflict of interest, which will exclude members from being selected to represent their practice on the group’s governing body, committees or sub- committees
On appointment and in the event of subsequent changes in roles, requiring employees or individuals contracted to work with the group to confirm their interests
Establishing and publishing procurement procedures that comply with best practice
Publishing its conflict of interest policy and its register of interests on its website and updating the register at least annually
Sharing the register of interests with governing body, committee or sub-committee members so that they are each aware of each other’s interests on a quarterly basis.
Noting any interests at the start of each meeting of its governing body, committees or sub-committees and recording those interests in the minutes
50 Requiring all committees members to make the Chair of the meeting aware of any known potential conflicts of interest prior to the meeting in order that alternative arrangements can be made
Publishing its code of conduct for members of its governing body, committees and sub-committees with this constitution
8.7.5 The lay member of the governing body, with particular responsibility for governance, will make themselves available to provide advice to any individual who believes they have, or may have, a conflict of interest
8.7.6 In circumstances where there is an uncertainty the Audit Committee will be requested by the Chair make the final decision
8.8 TRANSPARENCY IN PROCURING SERVICES
8.8.1 The group recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. Procurement guidance and legislation calls for all commissioning organisations to procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.
8.8.2 The group will develop a Procurement Strategy for approval by its governing body which will ensure that:
All relevant clinicians (not just members of the group) and potential providers, together will local patients and the public, are engaged in the decision-making processes used to procure services;
Service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way
Copies of this Procurement Strategy will be available on the group’s website at www.neessexccg.nhs.uk.
51 52 9.0 DISQUALIFICATION OF MEMBERS OF THE BOARD AND ITS SUB- COMMITTEES
9.1 Members of the Board and its sub-committees shall vacate their office:-
9.1.1 If a receiving order is made against him or he makes any arrangement with his creditors.
9.1.2 If in the opinion of the Board (having taken appropriate professional advice in cases where it is deemed necessary) he becomes or is deemed to be of unsound mind.
9.1.3 If he ceases to be on the North East Essex Performers List as held by NHS England, other than those lay Members of the Board who have been duly selected, appointed or elected by the Board.
9.1.4 If he is suspended from providing primary medical services in which case the removal or suspension from the Board shall be at the discretion of the Board.
9.1.5 If he is suspended from the General Medical Council or the Nursing and Midwifery Council in which case the removal or suspension from the Board shall be at the discretion of the Board.
9.1.6 If he shall for a period of 5 consecutive meetings of the Board have been absent and shall at the discretion of the Board be vacated from his office.
9.1.7 If he shall be convicted of a criminal offence whereby the sentence imposed shall be for a minimum of 6 months imprisonment (whether such sentence is held to be suspended or conditional).Each case would be assessed on its individual merits by the Board.
9.1.8 If he shall have behaved in a manner or exhibited conduct which has or is likely to be detrimental to the honour and interest of the Board or the Clinical Commissioning Group and is likely to bring the Board and/or Clinical Commissioning Group into disrepute. This includes but is not limited to dishonesty, misrepresentation (either knowingly or fraudulently), defamation of any Member of the Board (being slander or libel), abuse of position, non-declaration of a known conflict of interest, seeking to lead or manipulate a decision of the Board in a manner that would ultimately be in favour of that Member whether financially or otherwise.
9.1.9 Where he has become ineligible to stand for a position as a result of the declaration of any Conflict of Interest under schedule 3.
53 10. ACCOUNTABILITY AND RULES OF ENGAGEMENT WITH MEMBER PRACTICES
10.1 GENERAL
10.1.1 The CCG is a membership organisation and will act on behalf of its member practices listed in Schedule 1. 10.1.2 This change in status and culture will be underpinned by a number of bilateral accountability measures detailed in Paragraphs 10.2 – 10.6.
10.1.3 The principles of accountability and rules of engagement with member practices is underpinned by the Memorandum of Agreement the CCG holds with each member practice
10.2 REGULAR MEETINGS
10.2.1 All member practices should receive one visit per year from representatives of the CCG to discuss practice level commissioning issues and priorities. 10.2.2 In addition to the AGM referred to in Paragraph 7.4.11, there will be at least two other CCG meetings annually for all member practices that do not have the public in attendance.
10.3 SURVEY OF PRACTICES
10.3.1 The Board will undertake an annual survey of its member practices to obtain feedback on levels of satisfaction and perceived engagement with the commissioning process. 10.3.2 The report will be discussed at one of the CCG’s public Board meetings.
10.4 POWER OF RECALL
10.4.1 The elected members of the Board will be appointed following a process detailed in Schedule 3. 10.4.2 Safeguards must exist to guard against the possibility of the Board becoming out of touch with the views and needs of its member practices. 10.4.3 A Power of Recall therefore forms part of the Constitution. This will allow the Elected members to be recalled following an EGM called by at least 75% of the CCG’s constituent GPs, provided that the response rate is at least 50% of eligible GPs.
10.5 RESPONSIBILITES OF MEMBER PRACTICES
The responsibilities of member practices to the CCG will include:-
10.5.1 Nominating commissioning and prescribing leads to a) represent the practice at CCG/forum meetings and b) represent the needs of the
54 practice’s patient population within the CCG c)represent the practice in decision making through the practice forums
10.5.2 Actively engaging with the CCG to help improve services within the area through Practice Forums.
10.5.3 Sharing appropriate referral, prescribing and emergency admissions data.
10.5.4 Following the clinical pathways and referral protocols agreed by the CCG (except in individual cases where there are justified clinical reasons for not doing this).
10.5.5 Managing the practice’s budgets including the acute and prescribing budgets.
10.5.6 Participating in and delivering, as far as possible, the clinical and cost effective strategies agreed by the CCG.
10.5.7 Establishing a practice reference group as a means of obtaining the views and experiences of patients and carers.
10.5.8 Working constructively with the CCG and practice forums.
10.5.9 Responding in a timely manner to information requests from the CCG.
10.6 MEMORANDUM OF AGREEMENT
10.6.1 The effective participation of each member practice will be essential in developing and sustaining high quality commissioning arrangements.
10.6.2 A Memorandum of Agreement between individual member practices and the CCG and between the member practices themselves will be put in place as a means of clarifying the expectations and obligations of both parties.
10.6.3 The Memorandum will document any agreements reached between the member practice and the CCG and between the member practices will be the formal mechanism for determining eligibility to any future incentive payment.
10.6.4 The Memorandum of Agreement will include:-
Parties to the Agreement Aims and objectives of the CCG Responsibilities of the member practice Responsibilities of the CCG Annual objectives/targets agreed with the member practice
55 Monitoring arrangements, frequency of meetings, data returns Details of any financial incentives agreed with the member practice Methodology for budget setting Financial resources made available by the CCG to support the member practice’s involvement in commissioning in the relevant financial year Dispute resolution Review of the Agreement Signatures to the Agreement The MOA is regarded as being adopted by all member practices once 75% have been agreed and signed
56 11. THE CCG AS AN EMPLOYER
11.1 The CCG recognises that its most valuable asset is its people. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work and priorities of the organisation
11.2 The CCG will seek to set an example of best practice as an employer and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.
11.3 The CCG will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed within the organisation. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.
11.4 The CCG will maintain and publish policies and procedures (as appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management.
11.5 The CCG will ensure that its rules for recruitment and management of staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.
11.6 The CCG will ensure that employees' behaviour reflects the values, aims and principles detailed above.
11.7 The CCG shall implement a Code of Conduct for staff, and shall maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have a means through which their concerns can be voiced. The Standards of Business Contact Policy outlines the code of conduct the CCG expects for staff, members, and partners.
11.8 The CCG will ensure that it complies with all aspects of employment law
11.9 The CCG will ensure that its employees have access to such expert advice and training opportunities as they may require in order to exercise their responsibilities effectively.
57 11.10 A copy of the Code of Conduct, together with the other policies and procedures outlined in this chapter is available on the CCG’s website.
58 12 NOTICES
12.1 Any notice or other communication required to be given to the Clinical Commissioning Group shall be in writing and shall be delivered by hand or sent by pre-paid first-class post or other next working day delivery service at its principal place of business, or sent by fax to the Clinical Commissioning Group’s main fax number.
12.2 Any notice or communication shall be deemed to have been received if delivered by hand, on signature of a delivery receipt, or if sent by fax, at 9.00 am on the next Business Day after transmission, or otherwise at 9.00 am on the second Business Day after posting or at the time recorded by the delivery service.
59 13. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS
13.1 GENERAL
13.1.1 All communications issued by the group, including the commissioning plan, annual report, notices of procurements, public consultations, reports, governing body meeting dates, times, venues, and papers will be published on the group’s website
13.1.2 The group may use other means of communication including circulating information by post, or making information available in venues or services accessible by the public
13.2 This constitution is supported by a number of documents which provide further details on how the group will operate. They are the group’s:
13.2.1 Appendix 3: Terms of Reference - for the CCG Board and sub- committees
13.2.2 Appendix 4: Standing Orders – which sets out the arrangements for meeting, the appointment processes to elect the group’s representative and appoint to the group’s committees, including the governing body
13.2.3 Appendix 5: Scheme of Reservation and Delegation – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of its governing body, its committees and sub-committees, individual members and employees
13.2.4 Appendix 6: Standing Financial Instructions– which sets out the arrangements for managing the group’s financial affairs.
13.2.5 Appendix 12: Specific Delegated Powers – which sets out the levels of financial authority delegated to roles within the group
60 Appendix 1
To: NHS Commissioning Board Date:
NHS North East Essex Clinical Commissioning Group Constitution
We the undersigned member practices agree to sign up to the NEE CCG Constitution
Practice Signature Name Abbey Field Medical Centre (formerly Mersea Road) Ambrose Avenue Group Practice Ardleigh Surgery Bluebell Surgery Caradoc (Station Approach Surgery) Colchester Medical Practice (incorporating Castle Gardens Medical Centre, Shrub End & Wimpole Road Surgeries) Colne Medical Centre Creffield Medical Centre Crusader Surgery
East Hill Surgery East Lynne Medical Centre Epping Close Surgery Frinton Road Medical Centre Fronks Road Surgery Great Bentley Surgery Great Clacton Medical Practice (North Road)
61 Green Elms Surgery Harewood Surgery Hawthorn Surgery Highwoods Surgery Lawford Surgery Layer Road Surgery Mayflower Medical Centre Mersea Island Medical Practice Mill Road Surgery North Colchester Healthcare Centre North Hill Medical Group Old Road Medical Practice Parsons Heath Medical Practice Portland Medical Practice Ranworth Surgery Riverside Health Centre Rowhedge & University of Essex Medical Practice St James Surgery Thorpe-le-Soken Surgery Tiptree Medical Centre Tollgate Medical Centre Walton Medical Centre Winstree Medical Practice Wivenhoe Surgery
62 Appendix 2
Nolan Principles
Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends
Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties
Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit
Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office
Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands it
Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest
Leadership Holders of public office should promote and support these principles by leadership and example.
Appendix 3
63 NORTH EAST ESSEX CCG GOVERNING BODY
Terms of Reference
1. Principles
1.1 Clinical Commissioning must be focused on individual needs and promote the health and wellbeing of communities, as well as addressing health inequalities.
1.2 Clinical Commissioning must work in the spirit of public service, professionalism and selflessness to serve our local population
1.3 Clinical Commissioning should be driven by the health needs of the population, prioritising our commissioning towards work which delivers the greatest improvements in health and the best possible experience for all.
1.4 Clinical Commissioning will seek to continuously improve quality wherever possible and to embrace innovation to achieve this, within available resources and ensuring value for money
1.5 Clinical Commissioning must be drivers of strong clinical leadership and enablers of clinical empowerment.
1.6 Clinical Commissioning should take into account the views and experiences of patients, service users and the public when reviewing and commissioning services
2. Purpose
The Board remit includes
2.1 Robust stewardship in the use of resources to meet the reasonable health needs of all patients registered with member GP practices and people who are resident in the area but are not registered with a member practice of any clinical commissioning group.
2.2 Oversight of commissioning, delivery and performance of elective hospital care, rehabilitation, urgent and emergency care (including out of hours services), community health services, services for children and younger persons, maternity services, mental health and learning disability services.
2.3 Ensuring that providers are required to meet agreed national and local quality and performance standards for the safety and quality of commissioned services through robust contract management.
2.4 Ensuring the thoroughness of engagement with stakeholders in the commissioning and redesigning of services.
64 2.5 Ensuring that service redesign processes are clinically driven in an open, transparent, non-discriminatory and fair way.
3. Membership
Voting membership will always ensure a Non-executive majority and may be adjusted accordingly. Total number of voting members should not exceed 15 plus Chair.
Voting Members Chair (Casting vote only) Accountable Officer Chief Operating Officer Chief Financial Officer Director of Quality / Executive Nurse Director of Transformation and Strategy Elected Member (minimum 2; Maximum 4) (Non-Executive)* Lay Member (Minimum 2;Maximum 4) (Non- Executive)** Secondary Care Consultant (Non- Executive) Director of Integrated Commissioning from ECC Non-voting Members Clinical Director Elected Patient Representative NHS England Representative ECC Councillor (Speaker / Observer)
*of whom one will be the Clinical Deputy Chair. **of whom one will be Board Vice Chair and one will be Audit Committee Chair
4. Attendance
4.1 Any voting member of the Board should organise a suitable deputy agreed by the Chair, or may nominate a proxy vote on his/her behalf, in the event he/she cannot attend a meeting of the Board.
4.2 In those circumstances the Chair (or Vice Chair), should be informed at least 5 working days before the meeting of the non-attendance and shall receive a duly completed and authorised proxy form.
4.3 Deputies will be expected to have been fully briefed by the substantive member.
65 4.4 Voting members must inform the Chair should they have a potential conflict of interest relating to any of the agenda items within 2 working days of receiving the agenda.
4.5 Voting will be carried out in accordance with the arrangements set out in the CCG Constitution.
4.6 Others may be invited to attend meetings as required and as relevant, as non-voting members.
5. Quorum
5.1 This group will be considered quorate when 7 members are present of which the majority must be Non-Executive, as identified in the list of Membership. 5.2 The quorum must include the Chair or Vice chair, plus the Accountable Officer or the Chief Financial Officer, or their substitutes at the discretion of the Chair in exceptional circumstances.
6. General Duties
The CCG Board;
6.1 Is accountable to NHS England for fulfilling its statutory functions, and will take into account the views of the local population. 6.2 Will actively promote the NHS Constitution in its engagement with patients, the public, providers of services and other key stakeholders. 6.3 Will ensure that the principles upheld in the NHS Constitution are reflected in the Group’s values, practices and in its commissioning and operational plans. 6.4 Will ensure that the organisation complies with the NEE CCG Constitution. 6.5 Will promote and abide by the values of the Equality Act 2010 with particular focus on: o The need to eliminate unlawful discrimination harassment and victimisation and other conduct prohibited by the 2010 Act; o Advancing equality of opportunity between people who share a protected characteristic and those who do not; o fostering good relations between people who share a protected characteristic and those who do not. 6.6 Will at all times operate within its approved terms of reference 6.7 Will ensure that decisions taken by the Group are both taken, and seen to be taken, without any possibility of the influence of external or private interest
66 6.8 Will maintain a register of interests of all members of the Board and ensure that all conflicts of interest and potential conflicts of interest are recorded in the register. 6.9 Will publish its policy on managing the interests of appointed and elected members and staff, and its register of interests on its website and update the register at least annually 6.10 Will publish its code of conduct for members of its governing body, committees, sub-committees and all staff alongside its constitution. 6.11 Will accept that all members of the Board will share responsibility in ensuring that the CCG exercises its functions effectively, efficiently and with good governance and in accordance with the terms of the CCG constitution as agreed by its members 6.12 Should note that individual members to bring their unique perspective, informed by their expertise and experience. This will underpin decisions made by the Board 7. Board Subcommittees
7.1The Following Subcommittees shall support the Board: 7.1.1 Audit Committee 7.1.2 Quality Committee 7.1.3 Finance and performance Committee 7.1.4 Transformation and delivery Committee 7.1.5 Strategic Commissioning Committee 7.1.6 Remuneration Committee 7.2The Subcommittees’ Terms of Reference will be ratified by the Board 7.3The Subcommittees shall be chaired by lay members unless otherwise agreed by the Board. 8. Governance
When exercising its functions to commission health services, the Board will:
7.1 Act consistently with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service and with the objectives and requirements placed on NHS England through the mandate published by the Secretary of State. The Board will: a. Appoint independent lay members and non GP clinicians to its governing body b. Ensure that one or more lay member shall have a lead role in overseeing key elements of governance. This/These lay member(s) will have recent financial and audit experience and will act as Chairs of both the Audit and Remuneration Committees c. Receive assurance from the Chairs of subcommittees that, where necessary, within the remit of that Sub-Committee, steps are being taken
67 to ensure that the CCG is doing all that it can reasonably do to meet its statutory obligations. d. Ensure that one lay member will have expertise and knowledge of the local community and will have a lead role in championing public and patient involvement e. Ensure that one member shall be a doctor who is an out of area secondary care specialist who has a high level of professional expertise and knowledge. This member will bring an understanding of patient care in the hospital setting. f. Ensure that one member shall be a registered nurse who will bring a broader view from the nursing perspective, on health and care issues, and especially the contribution of nursing to patient care. g. Ensure that all providers of primary medical services in the Locality are member practices of the Clinical Commissioning Group. h. Recognise where a Member who is a provider of primary medical services is a party to more than one contract for primary medical services, then that Member is to be treated as a separate provider in respect of each contract. i. Develop and keep under review robust governance arrangements which shall be complied with by all Members of the Clinical Commissioning Group. j. Publish its constitution, standing orders and standing financial instructions k. Publish its annual report and annual accounts and hold its annual general meeting in public l. Publish its principal commissioning and operational policies m. Publish a comprehensive action plan on the steps that the Group will take to embed the NHS Constitution in its work n. Annually publish sufficient information to demonstrate compliance with public sector duty 7.3 Ensure that the CCG complies with all relevant regulations, directions and guidance issued by the Secretary of State for Health, the Department of Health, NHS England and other relevant health regulatory bodies in accordance with appropriate statute. 7.4 Specify under which clinical commissioning group’s scheme of reservation and delegation and supporting policies any collaborative working between CCGs operates; and also specify how the risks associated with any collaborative working arrangement between CCGs will be managed between the respective parties. 7.5 Identify how disputes will be resolved and the steps required to terminate the working arrangements 7.6 Ensure that service redesign processes are conducted in an open, transparent, non-discriminatory and fair way. 7.7 Ensure that there are robust plans and responsibilities assigned to manage staff engagement, external relationships and communications.
68 7.8 Ensure that there are robust processes in place which will allow the Board to monitor compliance in the field of public involvement. 7.9 To approve any functions of the CCG that are specified in regulations 8. Strategic Commissioning
8.1 To shape the vision, values and culture and t the strategic direction of the Group through recommendations from the Strategic Commissioning Committee. This will be supported by assurance received from the Transformation and Delivery Committee and Operational Executive Committee that best practice and innovation has been incorporated into the planning. 8.2 To commission certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of:- All people registered with member practices and
People who are resident in the area and are not registered with a member of any clinical commissioning group
8.3 To commission emergency services for anyone present in the group’s area
8.4 To provide additional resources where required to overcome barriers faced by hard to reach groups in accessing healthcare
8.5 To work with public health colleagues to identify key determinants of health inequalities and develop innovative interventions to address these
8.6 To work with public health colleagues on the health promotion and prevention agenda
8.7 To receive and recommend for publication the annual commissioning intentions.
8.8 To receive and recommend for publication the annual 1 or 2 year operational plan and 5 year strategic plan. This will include the organisation’s contestability plan.
8.9 To work in line with the agreed Schemes of Delegation within the North East Essex CCG Standing Orders and Standing Financial Instructions
8.10 To receive and sign off assurance that business cases have followed the correct procedures and processes through the sub-committee structure.
69 8.11 To approve and sign off business cases in line with the Schemes of Delegation
8.12 To receive assurance from the Transformation and Delivery Committee and the Operational Executive Committee that the correct procedures have been followed in developing service specifications. This would include assurance that the appropriate prioritisation methodology has been applied.
8.13 To consider and approve the development of strategic commissioning arrangements recommended by the Strategic Commissioning Committee and supported by the Transformation and Delivery Committee and Operational Executive Committee if appropriate.
8.14 To support the engagement of all relevant stakeholders as and when required to inform decision making.
8.15 To ensure that the views of individual patients are taken into account and that the views of the community are reflected in shared decision making and translated into commissioning decisions
8.16 To ensure that the CCG has adequate commissioning support services in place either internally or commissioned from external agencies.
8.17 To ensure that the services commissioned for the local population by NHS England are safe and of sufficient quality
9. Quality, Finance and Performance
9.1 To take responsibility for the on-going oversight and assurance of clinical governance, innovation and evaluation of services, with detailed scrutiny delegated to the Finance and Performance Committee and the Quality Committee, receiving support from the Transformation and Delivery Committee
9.2 To embed quality and clinical governance in the work of the group and receive assurance in respect of safety of services, clinical effectiveness and patient experience. 9.3 To ensure that the Group operates within its statutory financial limits and that a financial balance is achieved.
70 9.4 To facilitate the delivery of the required running cost savings whilst ensuring sustainable functions.
9.5 To receive and approve medium term financial plans 9.6 To receive, at minimum, bi-monthly reports on financial forecasts which examine current variances, forecast outturns, balance sheet positions, better payments information and cash (including the final accounts).
9.7 To receive and comment on, at a minimum, bi-monthly reports on the analysis of risk to financial performance and achievement of any QIPP plans as compiled by the Finance and Performance committee. 9.8 To receive assurance reports from the Audit Committee under the Group’s Governance/Assurance framework to inform level of compliance against statutory requirements.
9.9 To comply with the requirements of the Local Authority’s Health Overview and Scrutiny Committee 9.10 To receive, review and agree for recommendation the financial statements to Audit and agree them for publication in accordance with strategy requirements to demonstrate effective stewardship of public money and accountability to tax payers. 9.11 To comply with all relevant procurement law and policy, 9.12 To receive assurance from the Remuneration Committee that the Group’s employees are paid remuneration, fees and allowances in accordance with the determinations made by the Board and to receive assurance that the Remuneration Committee has determined any other terms and conditions of service of the group’s employees. 10. Engagement and collaboration
10.1 To engage in a collaborative approach with the local NHS, Local Authorities, Health and Wellbeing Board, patients, carers, public, communities of interest and all other relevant stakeholders, including our staff, to improve outcomes and quality of services through the delivery of plans, targets, policies and standards. 10.2 To secure wide clinical engagement and obtain appropriate advice from other clinicians and healthcare professionals, ensuring clinical leadership in commissioning and redesign of local health services. 10.3 To engage member practices in the development of strategies and plans 10.4 To publish information about health services on the Group’s website and through other media 10.5 To Establish, where appropriate, collaborative arrangement with other CCGs for commissioning, governance, operational and administrative activities
11. Frequency of Meetings
71 11.1 Meetings shall be held at least bi-monthly. Interim meetings may be called as necessary. The Board shall meet no less than 6 times a year.
11.2 The meetings will be held in 2 parts;
Part 1 This meeting will be open to attendance by the public, CCG employees, CCG members, clinical professionals and any other persons specifically invited by CCG Board members. The meeting is a meeting held in public and is not a Public meeting. Attendees will be given the opportunity to contribute at a point in the meeting designated by the Chair. Attendees may be called on to participate in items under discussion at the discretion of the Chair.
Part 2 This meeting will be closed to non-members. The meeting will typically deal with issues of a confidential or sensitive nature, or with items relating to matters that are not directly the responsibility of Clinical Commissioning, such as commissioning of Primary Care Services or Specialist Services. Items that do not meet these criteria should be held in Part 1.
11.3 The Board will hold an annual general meeting in public
12. Support to the Committee
12.1 The CCG Board will be supported by the Corporate Business Manager.
12.2 Notification of meetings to be on the website at least 5 working days before the meeting.
12.3 Papers for the meetings will be sent by email unless otherwise requested, at least 5 working days prior to the meeting.
12.4 The Chair will be responsible for ensuring papers are distributed to this timescale.
12.5 Apologies for absence and notification of deputy to be received at least 5 working days prior to the meeting, except in exceptional circumstances.
12.6 Papers for Part I of the meetings will be placed on the NEE CCG website at least 5 working days before the meeting is held.
12.7 Minutes from Part I of the meeting will be placed on the NEE CCG website
13. Monitoring Arrangements
The CCG Board shall report to NHS England as and when requested.
72 Date: 26th January 2016
Date of review: by 31st January 2017
Appendix 4
Standing Orders
1. Standing Orders
1.1. Introduction
1.1.1. These Standing Orders have been drawn up to regulate the proceedings of the NHS North East Essex Clinical Commissioning Group (CCG) so that the group can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the group is established.
1.1.2. The Standing Orders, together with the group’s Scheme of Reservations and Delegation1 and the group’s Standing Financial Instructions2, provide a procedural framework within which the group discharges its business. They set out:
a) the arrangements for conducting the business of the group;
b) the appointment of member practice representatives;
c) the procedure to be followed at meetings of the group, the Governing Body (the Board) and of any the committees or sub-committees to the Board;
d) the process to delegate powers,
e) the declaration of interests and standards of conduct.
1 See Appendix 5
2 See Appendix 6
73 These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate3 of any relevant guidance.
3 Under some legislative provisions the group is obliged to have regard to particular guidance but under other circumstances guidance is issued as best practice guidance.
74 1.1.2. The Standing Orders, Scheme of Reservations and Delegation and Standing Financial Instructions have effect as if incorporated into the group’s Constitution. Group members, employees, members of the Board, members of the Board’s committees and sub-committees and persons working on behalf of the group should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the Standing Orders, Scheme of Reservations and Delegation and Standing Financial Instructions 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 Reservations and Delegation
1.2.1. The 2006 Act (as amended by the 2012 Act) provides the group with powers to delegate the group’s functions and those of the CCG’s Governing Body to certain bodies (such as committees) and certain persons. The group has decided that certain decisions may only be exercised by the group in formal session. These decisions and also those delegated are contained in the groups Scheme of Reservation and Delegation (see Appendix 5).
2. The Board: Composition of Membership, Key Roles and Appointment Process
2.1. Composition of membership
2.1.1. Chapter 5 of the group’s Constitution provides details of the membership of the group (also see Appendix 1).
2.1.2 Paragraph 5.3.1. of the group’s Constitution sets out the composition of the members of the Board.
2.2. Key Roles
2.2.1. Chapter 5 and Chapter 6 sets out key roles and responsibilities within the group and the Board with Chapter 10 setting out the role of practice representatives.
2.2.2. Chapter 7 of the group’s Constitution provides details of the governing structure used in the group’s decision-making processes.
2.2.3. The Elected GP members are subject to the appointment process as set out in Schedule 3 of the Constitution. This includes the process for nominations, eligibility, appointment process and term of office and eligibility for reappointment.
2.2.4. Grounds for removal from office are stated under Chapter 9 of the Constitution.
2.2.5. Notice period relating to cessation of eligibility due to practice membership, is as follows;
75 i) A Member practice ceases to be a Member where that practice no longer satisfies the criteria of membership as set out in Schedule 3 of the group’s Constitution.
ii) The Member practice shall give written notice to the NHS England and the Board as soon as practicable in the event of any of the circumstances which may give rise to termination of membership, together with a formal request that his membership is terminated.
iii) The NHS England shall be entitled to terminate a practice’s membership of the CCG, if it becomes aware of any of the circumstances as set out in this paragraph and as applicable to any current Member practice.
iv) Any Member practice, if served with a notice of termination of membership shall have the right of appeal against that decision by application to the NHS England.
v) The decision of the NHS England on consultation with the CCG, Local Medical Committee and any other relevant party shall be final. The notice period is three months.
3. Meetings of the Board
3.1. Calling meetings
3.1.1. Ordinary meetings of the Board shall be held at regular intervals at such times and places as the Board may determine.
3.1.2. Meetings will be held in public at least 6 times per year.
3.1.3. The Chairman of the Board may call a meeting of the Board at any time.
3.1.4. One third or more members of the Board may requisition a meeting in writing. If the Chairman refuses, or fails, to call a meeting within seven days of a requisition being presented, the members signing the requisition may forthwith call a meeting.
3.2. Notice of meetings and the business to be transacted
3.2.1. Before each meeting of the Board will provide a written notice specifying the business proposed to be transacted shall be delivered to every member, or sent by post to the usual place of residence of each member, so as to be available to members at least seven clear days before the meeting. The notice shall be signed by the Chairman or by an officer authorised by the Chairman to sign on their behalf. Want of service of such a notice on any member shall not affect the validity of a meeting. Every Board member shall be given at least 14 days’ notice to attend.
76 3.2.2. In the case of a meeting called by members in default of the Chairman calling the meeting, the notice shall be signed by those members.
3.2.3. No business shall be transacted at the meeting other than that specified on the agenda, or emergency motions allowed under Standing Order 3.7.
3.2.4. A member desiring a matter to be included on an agenda shall make his/her request in writing to the Chairman at least 15 clear days before the meeting. The request should state whether the item of business is proposed to be transacted in the presence of the public and should include appropriate supporting information. Requests made less than 15 days before a meeting may be included on the agenda at the discretion of the Chairman.
3.2.5. Before each meeting of the Board a public notice of the time and place of the meeting, and the public part of the agenda, shall be displayed at the CCG’s principal offices and on the CCG’s website at least seven clear days before the meeting, (required by the Public Bodies (Admission to Meetings) Act 1960 Section 1 (4) (a)).
3.3 Petitions
Where a petition has been received by the CCG, the Chairman shall include the petition as an item for the agenda of the next Board meeting.
3.4 Notice of Motion
(1) Subject to the provision of ‘Motions: Procedure at and during a meeting’ and ‘Motions to Rescind a Resolution’, a member of the Clinical Commissioning Group’s Board wishing to move a motion shall send a written notice to the Accountable Officer who will ensure that it is brought to the immediate attention of the Chairman.
(2) The notice shall be delivered at least 15 clear days before the meeting. The Accountable Officer shall include in the agenda for the meeting all notices so received that are in order and permissible under governing regulations. This Standing Order shall not prevent any motion being withdrawn or moved without notice on any business mentioned on the agenda for the meeting.
3.5 Emergency Motions
Subject to the agreement of the Chairman, and subject also to the provision of ‘Motions: Procedure at and during a meeting’, a member of the Board may give written notice of an emergency motion after the issue of the notice of meeting and agenda, up to one hour before the time fixed for the meeting. The notice shall state the grounds of urgency. If in order, it shall be declared to the Board at the commencement of the business of the
77 meeting as an additional item included in the agenda. The Chairman's decision to include the item shall be final.
3.6 Motions: Procedure at and during a meeting
i) Who may propose? A motion may be proposed by the Chairman of the meeting or any member present. It must also be seconded by another member.
ii) Contents of motions
The Chairman may exclude from the debate at their discretion any such motion of which notice was not given on the notice summoning the meeting other than a motion relating to: the reception of a report; consideration of any item of business before the Board; the accuracy of minutes; that the Board proceed to next business; that the Board adjourn; that the question be now put. iii) Amendments to motions
A motion for amendment shall not be discussed unless it has been proposed and seconded.
Amendments to motions shall be moved relevant to the motion, and shall not have the effect of negating the motion before the Board.
If there are a number of amendments, they shall be considered one at a time. When a motion has been amended, the amended motion shall become the substantive motion before the meeting, upon which any further amendment may be moved.
iv) Rights of reply to motions
a) Amendments
The mover of an amendment may reply to the debate on their amendment immediately prior to the mover of the original motion, which shall have the right of reply at the close of debate on the amendment, but may not otherwise speak on it.
b) Substantive/original motion
The member who proposed the substantive motion shall have a right of reply at the close of any debate on the motion.
v) Withdrawing a motion
A motion, or an amendment to a motion, may be withdrawn;
vi) Motions once under debate
78 When a motion is under debate, no motion may be moved other than:
an amendment to the motion; the adjournment of the discussion, or the meeting; that the meeting proceed to the next business; that the question should be now put; the appointment of an 'ad hoc' committee to deal with a specific item of business; that a member/director be not further heard; a motion under Section l (2) or Section l (8) of the Public Bodies (Admissions to Meetings) Act l960 resolving to exclude the public, including the press (see Standing Order 3.18).
In those cases where the motion is either that the meeting proceeds to the ‘next business’ or ‘that the question be now put’ in the interests of objectivity these should only be put forward by a member of the Board who has not taken part in the debate and who is eligible to vote.
If a motion to proceed to the next business or that the question be now put, is carried, the Chairman should give the mover of the substantive motion under debate a right of reply, if not already exercised. The matter should then be put to the vote.
3.7 Motion to Rescind a Resolution
(i) Notice of motion to rescind any resolution (or the general substance of any resolution) which has been passed within the preceding six calendar months shall bear the signature of the member who gives it and also the signature of three other members, and before considering any such motion of which notice shall have been given, the Board may refer the matter to any appropriate Committee or the Accountable Officer for recommendation.
(ii) When any such motion has been dealt with by the Board it shall not be competent for any director/member other than the Chairman to propose a motion to the same effect within six months. This Standing Order shall not apply to motions moved in pursuance of a report or recommendations of a Committee or the Accountable Officer.
3.8. Chair of a meeting
3.8.1. At any meeting of the Board or of a committee or sub-committee, the chair of the Board, or committee or sub-committee, 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.
79 3.8.2. 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 Board, committee or sub- committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.
3.9. Chair's ruling
3.9.1. The decision of the chair of the Board 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.
3.10. Quorum
3.10.1. This group will be considered quorate when 7 members are present of which the majority must be non-executive, as mapped out within the constitution.
The quorum must include the Chair or Vice chair and the Accountable Officer or the Chief Financial Officer.
3.11 Voting
3.11.1 Any voting member of the Board shall be entitled to nominate a proxy vote on his/her behalf in the event he/she cannot attend a meeting of the Board.
In those circumstances the Chairman (or Deputy Chairman), should be informed one week prior to the meeting of the non-attendance and shall receive a duly completed and authorised proxy form.
Deputies will be expected to have been fully briefed by the substantive member.
3.11.2 Voting members must inform the chairman should they have a potential conflict of interest relating to any of the agenda items within 2 working days of receiving the agenda.
3.11.3 No Observer or co-opted member shall carry a vote. In the case of an equality of votes, the Chairman shall carry the casting vote.
3.11.4. At the discretion of the Chair all questions out to the vote shall be determined by oral expression or by show of hands, unless the Chair directs otherwise, or it is proposed, seconded and carried that a vote taken by paper ballot.
If at least one third of the members present so request, the voting on any question may be recorded as to show how each member present voted, or did not vote (except when conducted by paper ballot).
80 If a member so requests, their vote shall be recorded by name
3.12. Decision Making
3.12.1. Chapter 7 of the group’s Constitution, together with the Scheme of Reservations and Delegation, sets out the governing structure for the exercise of the group’s statutory functions. Generally it is expected that at the Board meetings or the committees or sub-Committees to the Board, 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 – Only designated members (listed in the composition) allowed to vote b) Majority necessary to confirm a decision – a 50% majority is required for a decision c) Casting vote – the Chair of the committee will have the casting vote d) Dissenting views - members taking a dissenting view, while losing a vote will have their dissent recorded in the minutes
3.12.2. For all of the Board’s committees and sub-committees, the details of the process for holding a vote are set out in the appropriate terms of reference.
3.13. Emergency powers and urgent decisions
3.13.1. The powers which the Board has reserved to itself within these Standing Orders may in emergency or for an urgent decision to be exercised by the Accountable Officer and the Chairman after having consulted at least two lay members. The exercise of such powers by the Accountable Officer shall be reported to the next formal meeting of the Board in public session for formal ratification.
3.13.2. The Board shall agree from time to time to the delegation of executive powers to be exercised by the Board’s sub committees which it has formally constituted. The constitution and terms of reference of these committees or subcommittee or joint committees and their specific executive powers shall be approved by the Board or by a committee of the Board for a sub-committee.
3.14. Suspension of Standing Orders
3.14.1. 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 a minimum of 50% of the group members are in agreement.
3.14.2. A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting.
81 3.14.3. A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Board’s audit committee for review of the reasonableness of the decision to suspend standing orders.
3.15. Variation and amendment of standing orders
3.15.1. These standing orders shall not be varied except in the following circumstances:
Upon notice or motion Upon a recommendation Or the Chair or Accountable Officer included on the agenda for the meeting that at least half of the Board members are present at the meeting where the variation or amendment is being discussed.
3.16. Record of Attendance
3.16.1. The names of all members of the Board present shall be recorded in the minutes of the Board. The names of all members of the Board’s committees / sub-committees present shall be recorded in the minutes of the respective Board’s committee / sub-committee meetings.
3.17. Minutes
3.17.1. The Board shall keep records and proper minutes of all Board meetings, resolutions and business conducted.
3.17.2. Minutes of all formal meetings will be a matter of public record
3.18. Admission of public and the press
3.18.1. The Board shall meet in public as a minimum 6 times per year. Every Board member shall be given at least 14 days’ notice to attend.
3.18.2. The date, time and venue of all Board meetings will be made public with at least 7 days’ notice on the CCG website. The notice shall include the agenda and papers related to the meeting.
3.18.3. At any meeting of the Board or of a committee or sub-committee, the chair of the Board, or committee or sub-committee, 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.
3.8.2. 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 Board, committee or sub-
82 committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.
4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES
4.1. Appointment of committees and sub-committees
4.1.1. The group may appoint committees and sub-committees of the Board, subject to any regulations made by the Secretary of State, and make provision for the appointment of committees and sub-committees of the Board.
4.1.2. Other than where there are statutory requirements, such as in relation to the Board’s Audit Committee or Remuneration Committee, the group 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 group.
4.1.3. The provisions of these standing orders shall apply where relevant to the operation of the Board, the Board’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. The Board’s terms of reference and the terms of reference of each of the committees and sub-committees of the Board are included in Chapter 7 of the group’s Constitution.
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 Board.
4.4. Approval of Appointments to Committees and Sub-Committees
4.4.1. The Board shall approve the appointments to each of the committees and sub-committees which it has formally constitute and shall agree such travelling or other allowances as it considers appropriate.
4.5. Delegation to Officers
4.5.1. Those functions of the CCG which have not been retained as reserved by the Board or delegated to committees or sub committees shall be exercised on behalf of the CCG by the Accountable Officer. The Accountable Officer shall determine which functions he/she will perform
83 personally and shall nominate officers to undertake the remaining functions for which he/she will still retain accountability to the CCG.
4.5.2. The Accountable Officer shall prepare a Scheme of Reservations and Delegation identifying his/her proposals which shall be considered and approved by the Board. The Accountable Officer may periodically propose amendment to the Scheme of Reservations and Delegation which shall be considered and approved by the Board.
4.5.3. Nothing in the Scheme of Reservations and Delegation shall impair the discharge of the direct accountability to the Board of the Chief Finance Officer to provide information and advise the Board in accordance with statutory or Department of Health requirements. Outside these statutory requirements the roles of the Chief Finance Officer shall be accountable to the Accountable Officer for operational matters.
4.6. Appointments for Statutory Functions
4.6.1. Where the Board is required to appoint persons to a committee and/or to undertake statutory functions as required by the Secretary of State, and where such appointments are to operate independently of the Board, such appointment shall be made in accordance with the regulations and directions made by the Secretary of State.
5. OVERLAP WITH OTHER GROUP’S POLICY STATEMENTS/PROCEDURES, REGULATIONS AND THE STANDING FINANCIAL INSTRUCTIONS
5.1 Policy statements: general principles
The Board will from time to time agree and approve Policy statements/ procedures which will apply to all or specific groups of staff employed by the group. The decisions to approve such policies and procedures will be recorded in an appropriate Board minute and will be deemed where appropriate to be an integral part of the group’s Standing Orders and Standing Financial Instructions.
5.2 Specific Policy statements
These Standing Orders and Standing Financial Instructions must be read in conjunction with the following Policy statements:
- The Standards of Business Conduct and National Conflicts of Interest Guidance;
- Code of Conduct for NHS Managers 2002;
- ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry;
84 - The staff Disciplinary and Appeals Procedures adopted by the group both of which shall have effect as if incorporated in these Standing Orders.
5.3 Standing Financial Instructions
Standing Financial Instructions adopted by the Board in accordance with the Financial Regulations shall have effect as if incorporated in these Standing Orders.
5.4 Specific guidance
These Standing Orders and Standing Financial Instructions must be read in conjunction with the following guidance and any other issued by the Secretary of State for Health:
Caldicott Guardian 1997;
Human Rights Act 1998;
Freedom of Information Act 2000.
Equality Act 2010
6. DUTIES AND OBLIGATIONS OF BOARD MEMBERS/DIRECTORS AND SENIOR MANAGERS UNDER THESE STANDING ORDERS
6.1. The standards of business conduct and managing conflicts of interest are stated in Chapter 8 of the group’s Constitution. Chapter 8 is therefore part of these Standing Orders.
7. Waiver of Standing Orders made by the Secretary of State of Health
(1) Under regulation 11(2) of the NHS (Membership and Procedure Regulations SI 1999/2024 (“the Regulations”), there is a power for the Secretary of State to issue waivers if it appears to the Secretary of State in the interests of the health service that the disability in regulation 11 (which prevents a chairman or a member from taking part in the consideration or argument of, or voting on any question with respect to, a matter in which he has a pecuniary interest) is removed. A waiver has been agreed in line with sub-sections (2) to (4) below.
(2) Definition of ‘Chairman’ for the purpose of interpreting this waiver
The “relevant chairman” is– at a meeting of the Board, the Chairman of the Board;
(3) Application of waiver
85 A waiver will apply in relation to the disability to participate in the proceedings of the Board or its committees on account of a pecuniary interest.
It will apply to:
(i) A member of the Board, or the Board Committee, who is a healthcare professional, within the meaning of regulation 5(5) of the Regulations, and who is providing or performing, or assisting in the provision or performance, of–
a.a)services under the National Health Service Act 1977; or
a.b)services in connection with a pilot scheme under the National Health Service (Primary Care) Act 1997;
for the benefit of persons for whom the Board is responsible.
(ii) Where the pecuniary interest of the member in the matter which is the subject of consideration at a meeting at which he is present:-
(a) arises by reason only of the member’s role as such a professional providing or performing, or assisting in the provision or performance of, those services to those persons;
(b) has been declared by the relevant chairman as an interest which cannot reasonably be regarded as an interest more substantial than that of the majority of other persons who:–
are members of the same profession as the member in question;
are providing or performing, or assisting in the provision or performance of, such of those services as he provides or performs, or assists in the provision or performance of, for the benefit of persons for whom the Board is responsible.
(4) Conditions which apply to the waiver and the removal of having a pecuniary interest
The removal is subject to the following conditions:
(a) the member must disclose his interest as soon as practicable after the commencement of the meeting and this must be recorded in the minutes;
(b) the relevant chairman must consult the Accountable Officer before making a declaration in relation to the member in question
86 pursuant to paragraph 7.3.3 (2) (b) above, except where that member is the Accountable Officer;
(c) in the case of a meeting of the Board:
(i) the member may take part in the consideration or discussion of the matter which must be subjected to a vote and the outcome recorded; but
(ii) may not vote on any question with respect to it.
(d) in the case of a meeting of the Board Committee:
(i) the member may take part in the consideration or discussion of the matter which must be subjected to a vote and the outcome recorded; and
(ii) may vote on any question with respect to it; but
(iii) the resolution which is subject to the vote must comprise a recommendation to, and be referred for approval by the Board.
8. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND STANDING FINANCIAL INSTRUCTIONS
8.1. 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 Board for action or ratification. All members of the group and staff have a duty to disclose any non-compliance with these standing orders to the accountable officer as soon as possible.
9. USE OF SEAL AND AUTHORISATION OF DOCUMENTS
9.1. Clinical Commissioning Group’s Seal
9.1.1. The group 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 chair of the Board; c) the chief finance officer; d) the chief operating officer
9.1.2. Execution of a document by signature
87 The following individuals are authorised to execute a document on behalf of the group by their signature.
a) the accountable officer b) the chair of the Board c) the chief finance officer d) the chief operating officer
10. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS
10.1. Policy statements: general principles
10.1.1. The group will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS North East Essex CCG. The decisions to approve such policies and procedures will be recorded in an appropriate group minute and will be deemed where appropriate to be an integral part of the group’s Standing Orders.
88 Appendix 5.
Scheme of Reservations and Delegation
SECTION 5 - SCHEME OF RESERVATION AND DELEGATION
REF THE CCG DECISIONS RESERVED TO THE CLINICAL COMMISSIONING GROUP’S BOARD BOARD
CCG BOARD The Clinical Commissioning Board, may determine any matter, for which it has delegated or statutory authority, it wishes in full session within its statutory powers. Regulations and Control CCG BOARD 1. Approve the Standing Orders (SOs), a schedule of matters reserved to the Board and Scheme of Delegation and Standing Financial Instructions for the regulation of the CCG proceedings and business. 2. Suspend the Standing Orders. 3. Vary or amend the Standing Orders. 4. Approve a Scheme of Delegation of powers from the Board to the Operational Executive Committee and other committees. 5. Require and receive the declaration of Board members’ interests which may conflict with those of the CCG and, taking account of any waiver which the Secretary of State for Health may have made in any case, determining the extent to which that member may remain involved with the matter under consideration. 6. Require and receive the declaration of officers’ interests that may conflict with those of the CCG – and to receive the declaration of Executive Committee and CCG Board members’ interests which may conflict with those Committees. 7. Approve arrangements for dealing with complaints. 8. Adopt the organisation structures, processes and procedures to facilitate the discharge of business by the CCG and to agree modifications thereto. 9. Receive reports from committees including those that CCG’s are required, by the Secretary of State or other regulation, to establish and to action appropriately. 10. Confirm the recommendations of the Board’s committees where the committees do not have executive powers.
89 REF THE CCG DECISIONS RESERVED TO THE CLINICAL COMMISSIONING GROUP’S BOARD BOARD
11. Receive and approve terms of reference and reporting arrangements of all committees and sub-committees that are established by the Board. 12. Authorise use of the CCG seal. 13. Discipline members of the Board, Operational Executive Committee or employees who are in breach of statutory requirements or Standing Orders 14. Approve any urgent decisions taken by the Board Chairman and the Accountable Officer for ratification by the Board. 15. Delegate powers to selected members of the Board, as agreed at a Board meeting, in order to take decisions on behalf of the Board, when the need to take a particular course of action by a certain time is not possible due to the meeting schedule of the Board and no other reasonable alternative is possible. Appointments/ Dismissal CCG BOARD 1. Appoint and dismiss members of the Operational Executive Committee. 2. Appoint the Vice Chairman of the Board by vote of the Board . 3. Appoint and dismiss other committees (and individual members) that are directly accountable to the Board. 4. Appoint, appraise, discipline and dismiss officer members (subject to SO 2.2). 5. Confirm appointment of members of any committee of the Board as representatives on outside bodies. 6. Appoint appraise, discipline and dismiss the Secretary (if the appointment of a Secretary is required under Standing Orders). Strategy, Operating Plans and Budgets CCG BOARD 1. Approve the strategic aims and objectives of the CCG. The Board will develop the Organisational priorities, the Strategic and the Operating plans. 2. Approve plans in respect of the application of available financial resources to support the agreed Operating Plan. The Board will develop the financial plans which will be subject to the approval of the Board 3. Approve proposals for ensuring quality and developing clinical governance in services provided by the CCG or the constituent practices, having regard to any guidance issued by the Secretary of State. The Board is responsible for quality and clinical governance within their functions. 4. Approve (with any necessary appropriate modification) the annual commissioning strategy or plans that have been developed. 5. Approve annually (with any necessary appropriate modifications) the Operating Plan. 6. Approve the CCG’s policies and procedures for the management of risk.
90 REF THE CCG DECISIONS RESERVED TO THE CLINICAL COMMISSIONING GROUP’S BOARD BOARD
7. Approve budgets which have been developed by the Operational Executive Committee. 8. Approve annually CCG proposed organisational development proposals made by the Executive 9. Ratify Operational Executive Committee’s proposals for primary care development, proposed GMS Local Development Schemes and proposed new or changes in existing GMS infrastructure reimbursement payments to GP practices. 10. Approve the opening of bank accounts. 11. Approve the Operational Executive Committee’s proposals on individual contracts or services (other than NHS contracts) of a capital or revenue nature amounting to, or likely to amount to, over £3,000,000, per annum (or over £4,500,000 total if contract exceeds 12 months). 12. Approve the Audit Committee’s proposals in individual cases for the write off of losses or making of special payments above the limits of delegation to the Accountable Officer and Chief Finance Officer (for losses and special payments). Losses up to Chief Finance Officer/Accountable Officer limits approved by those individuals but all to be reported to the Audit Committee 13. Approve individual compensation payments above £25,000 where the proposed payments are above the delegated limits or outside the delegated powers of the delegated officers or decision making panel. Payments up to £25,000 should be reviewed and noted by the Audit Committee. 14. Approve proposals for action on litigation against or on behalf of the CCG. The Board is responsible for their own areas although all proposals are to be approved at the Board
CCG BOARD Policy Determination 1. Ratify CCG Board management policies including personnel policies incorporating the arrangements for the appointment, removal and remuneration of staff. CCG BOARD Audit 1. Approve the appointment (and where necessary dismissal) of External Auditors and advise the Audit Commission on the appointment (and where necessary change/removal) of External Auditors and receive reports of the Audit Committee meetings and take appropriate action. 2. Receive the annual management letter received from the External Auditors and agreement of the CCG Executive Committee and the CCG Board’s proposed action, taking account of the advice, where appropriate, of the Audit Committee. 3. Receive the annual report from the Internal Auditor and agree action on recommendations where appropriate of the Audit Committee.
CCG BOARD Annual Report and Accounts
91 REF THE CCG DECISIONS RESERVED TO THE CLINICAL COMMISSIONING GROUP’S BOARD BOARD
1. Receipt and of the CCG’s Annual Report and Annual Accounts
CCG BOARD Monitoring 1. Receipt of such reports as the Board sees fit from the Operational Executive Committee in respect of its exercise of powers delegated.
DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE AUDIT COMMITTEE
The CCG delegates all audit committee responsibilities to the Audit Committee. AUDIT COMMITTEE For the Board functions the Audit Committee will:
1. Advise the Board on internal and external audit services; 2. 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 (both clinical and non-clinical),that supports the achievement of the CCG’s objectives; 3. Monitor compliance with Standing Orders and Standing Financial Instructions; 4. Review schedules of losses and compensations and make recommendations to the Board; 5. Approve the CCG’s Annual Report and Annual Accounts prior to submission to the Board. 6. Approve the opening or closing of any bank account.
The CCG delegates all Remuneration and Terms of Service responsibilities to the Remuneration and Terms of
REMUNERATION Service Committee AND TERMS OF Decide on appropriate remuneration and terms of service for the Accountable SERVICE COMMITTEE Officer, GP representatives and other senior employees including: o all aspects of salary (including any performance-related elements/bonuses) oprovisions for other benefits, including pensions and cars; oarrangements for termination of employment and other contractual terms;
92 Decide on any proposed remuneration for individual Board Members for specific work in addition to their corporate Executive role, so as to ensure that the individual is fairly rewarded for their individual contribution to the Board while having proper regard to the CCG’s circumstances and performance, and to the requirements of fair and open tendering or recruitment policies; Make recommendations to the Board on the remuneration and terms of service of senior employees to ensure they are fairly rewarded for their individual contribution to the Board- having proper regard to the Board circumstances and performance and to the provisions of any national arrangements for such staff; Oversee the proper calculation and scrutiny of termination payments, taking account of such national guidance as is appropriate, advise on and oversee appropriate contractual arrangements for such staff For the purpose of performance evaluation and remuneration decisions, the Committee will see and approve the Accountable Officers objectives and note the objectives of the leadership team. With specific input from the Accountable Officer and the Board Chair, monitor performance, review and set the remuneration of the posts that fall within the remit of the Committee. (The Accountable Officer will not be present during the discussions on his/her own remuneration and performance (see appendix 1 for annual review for Accountable Officer)). Report in writing to the Board the basis for its recommendations. The Committee shall be conducted in accordance with the provisions of Standing Orders, Standing Financial Instructions and Scheme of Delegation as set out in the Corporate Governance Manual.
DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE
REF DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE
CGM OPERATIONAL EXECUTIVE 4.8.13 Regulation and Control COMMITTEE 1. Approve a scheme of delegation of powers from the Operational Executive Committee to sub-committees, Operational Executive Committee members and employees.
93 REF DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE 2. Require and receive the declaration of any Operational Executive Committee member’s interests which may conflict with those of the CCG and taking account of any waiver which the SofS may have made in any case, and after consultation with the Chief Officer, determining the extent to which that member may participate in the consideration of a matter in which he/she has an interest. 3. Provide assurance on quality and clinical governance for the relevant functions having regard to any guidance by the Secretary of State, and including preparation of proposals to develop and monitor clinical standards in the CCG and its constituent practices. 4. Ratify or otherwise instances of failure to comply with Standing Orders brought to the Accountable Officer’s attention in accordance with SO 5.6. Such failures to be reported to the Cluster Board in formal session. OPERATIONAL Strategy, Plans and Budgets – for the Operational Executive functions: EXECUTIVE COMMITTEE 5. Advise the Board on the strategic aims and objectives of the CCG. 6. Review annually draft plans in respect of the application of available financial resources to support the agreed Operating Plan and to further relevant and agreed elements of the Operating Plan for approval by the Cluster Board. 7. Prepare and review annually the draft CCG’s annual commissioning strategy or plan for approval by the Board. 8. Prepare proposals (having regard to any guidance by the Secretary of State) for CCG or practice incentive schemes. Monitor and review schemes. 9. Develop the CCG’s policies and procedures for the management of risk.
94 REF DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE Direct Operational Decisions for the Operational Executive functions: OPERATIONAL EXECUTIVE 10. Approve the introduction or discontinuance of any significant activity or operation. An activity or operation COMMITTEE shall be regarded as non-significant if it has a gross annual income or expenditure (that is before any set off) less than £500,000. 11. Approve individual tendered contracts (other than NHS contracts) or new services of a revenue nature amounting to, or likely to amount to over £500,000 per annum (£750,000 in total if exceeds a 12 month period) but less than £3,000,000 per annum (or £4,500,000 if contract extends over 12 months). 15. Consider and make recommendations to the Board on action on litigation against or on behalf of the CCG.
OPERATIONAL Financial and Performance Reporting Arrangements for the CCG Executive functions: EXECUTIVE COMMITTEE 16. Continuous appraisal of the affairs of the CCG by means of the provision to the Board as they may require from directors, committees, and officers of the CCG as set out in management policy statements. All monitoring returns required by the Department of Health shall be reported, at least in summary, to the Operational Executive Committee. 17. Receive and approve a schedule of NHS contracts signed in accordance with arrangements agreed with the Accountable Officer. 18. Together with the CCG Board, the Operational Executive Committee will jointly prepare, consider and endorse the CCG’s draft Annual Report (including the annual accounts) for approval by the Board. 19. Oversee and make recommendations to the Board on any Project Initiation Documents and associated business cases that require board approval in accordance with scheme of delegation
FINANCE AND The Finance and Performance Committee will provide an assurance and scrutiny role on behalf of the CCG PERFORMANCE Board of all aspects of the CCGs financial performance and strategy, commissioning and contracting activities COMMITTEE including QIPP delivery, and performance with the exception of quality indicator. It will:-
Monitor and scrutinise all aspects of the CCGs financial performance, to receive and comment on monthly financial forecasts, monthly analysis of financial risk and agree and make recommendations to the Board on financial plans for the next financial year(s) Ensure the CCG and its committees operate within budget within the strategic
95 REF DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE framework set by the Board and operate within the schemes of delegation Oversee the annual planning cycle and to make recommendations to the Board each contracting year on the CCGs commissioning Intentions Monitor and scrutinise the implementation and delivery of the CCGs Operational Business Plan and Integrated Plan including the delivery of organisational productivity and efficiency initiatives (QIPP) Monitor and scrutinise the commissioning activities of the CCG Monitor the contract management and monitoring of all commissioned services Monitor and scrutinise the overall performance of the CCG in the achievement of local and national Key Performance Indicators (including Operating Framework)and to agree plans to mitigate underperformance, reporting these to the CCG Board and NCB where required through exception reporting Undertake the above activities within the context of the overall delivery of the CCGs Integrated Plan and strategy Ensure the appropriate mechanisms are in place to assure the Board that systems, policies and resources are in place and operating in a way that is effectively focussed on key risks and priorities to drive the delivery of the CCG objectives Monitor performance of practices delivery of responsibilities relating to financial and performance in accordance with of terms of Memorandum of Agreement Act as the custodians of engagement and involvement of member practices in accordance with the CCG Constitution At all times champion the values of the CCG to develop and promote an organisational wide culture which enables the CCG, clinicians, managers and staff to work in partnership and individually Ensure compliance with the Principles and Rules for Co-operation and Competition, and drawing on specialist advice if necessary. Receive and note various sub committees namely:-
a.i. Provider Performance & Contracting Groups
96 REF DECISIONS DELEGATED BY THE BOARD TO, AND RESERVED BY, THE OPERATIONAL EXECUTIVE COMMITTEE
QUALITY 1. To provide the Board with an expert and objective review of all aspects of quality and safety relating to the COMMITTEE provision of care and services, with the aim of getting the best clinical outcomes and experience for patients. 2. It will assure the Board that the organisation is aligned to the statutory quality and safety requirements of existing legislation. This includes providing assurance to the Board and the Audit Committee that the structures, systems and processes are in place and functioning to monitor the quality of care and services. 3. To bring to the attention of the Board any issues that may jeopardise the CCG’s ability to commission the delivery of excellent quality care and services. 4. To encourage innovation. 5. Authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any member of staff and all members of staff would be directed to co-operate with any request made by the Committee
TRANSFOR- 1. To provide the board with assurance in relation to any assigned or delegated actions and processes relating MATION AND to the CCG’s clinical development initiatives. DELIVERY 2. To provide effective leadership that oversees all aspects of clinical transformation and delivery on behalf of COMMITTEE the CCG to ensure that the CCG achieves its key clinical developments and provides high quality services, promoting patient choice. 3. To manage the delivery of the commissioning plan on behalf of the board. 4. To have direct responsibility for ensuring wide engagement of public, patients, clinicians and partners within each of the elements of the commissioning cycle for which they are responsible. 5. To ensure patients and the local community, as well as local government and other partners, are properly involved in the process of deciding priorities.
Direct Operational Decisions for the Transformation and Delivery Committee functions: TRANSFORMATIO N AND DELIVERY 1. Approve the introduction or discontinuance of any significant activity or operation. An activity or operation COMMITTEE shall be regarded as non-significant if it has a gross annual income or expenditure (that is before any set off) less than £500,000. 2. Approve individual tendered contracts (other than NHS contracts) or new services of a revenue nature amounting to, or likely to amount to over £500,000 per annum (£750,000 in total if exceeds a 12 month period) but less than £3,000,000 per annum (or £4,500,000 if contract extends over 12 months).
97 DECISIONS/DUTIES DELEGATED BY THE CLUSTER BOARD TO COMMITTEES
SCHEME OF DELEGATION DERIVED FROM THE ACCOUNTABLE OFFICER MEMORANDUM
REF DELEGATED TO DUTIES DELEGATED
10 ACCOUNTABLE OFFICER Accountable through the NHS Accountable Officer Memorandum to Parliament for stewardship of CCG (AO) resources.
12 AO AND CHIEF Ensure the accounts of the CCG are prepared under principles and in a format directed by the Secretary of FINANCIAL OFFICER State. Accounts must disclose a true and fair view of the CCG’s income and expenditure and its state of (CFO) affairs. Sign the accounts on behalf of the CCG Board. 13 AO Sign a statement in the accounts outlining responsibilities as the Accountable Officer. Sign a statement in the accounts outlining responsibilities in respect of Internal Control. 15 & 16 AO Ensure effective management systems that safeguard public funds and assist the CCG Board Chairman to implement requirements of corporate governance including ensuring managers: have a clear view of their objectives and the means to assess achievements in relation to those objectives; be assigned well defined responsibilities for making best use of resources; have the information, training and access to the expert advice they need to exercise their responsibilities effectively.
15 CCG BOARD Implement requirements of corporate governance CHAIRMAN 18 AO Achieve value for money from the resources available to the CCG and avoid waste and extravagance in the CCG’s activities. Follow through the implementation of any recommendations affecting good practice as set out in reports from such bodies as the Audit Commission and the National Audit Office (NAO).
98 REF DELEGATED TO DUTIES DELEGATED
Use to best effect the funds available for commissioning healthcare, developing services and promoting health to meet the needs of the local population. 20 CFO Operational responsibility for effective and sound financial management and information. 20 AO Primary duty to see that the Chief Financial Officer discharges this function. 21 AO Ensuring that expenditure by the CCG complies with Parliamentary requirements 22 AO The Codes of Conduct and Accountability incorporated in the Corporate Governance Framework issued to NHS Boards by the Secretary of State are fundamental in exercising Chief Officer responsibilities for regularity and probity. As a Board member the Accountable Officer has explicitly subscribed to the Codes; the Accountable Officer should promote their observance by all staff. 23 AO and CFO The Accountable Officer, supported by the Chief Financial Officer, to ensure appropriate advice is given to the CCG Board, the CCG Executive Team on all matters of probity, regularity, prudent and economical administration, efficiency and effectiveness. 24 AO If the Accountable Officer considers that the CCG Board, the CCG Board Chairman, the CCG Executive Team or the CCG Board is doing something that might infringe probity or regularity; he/she should set this out in writing to the Chair of Audit Committee, and if necessary NHS England and Department of Health. 25 AO If the CCG Executive Team or the CCG Board is contemplating a course of action that raises an issue not of formal propriety or regularity but affects the Accountable Officer‘s responsibility for value for money, the Accountable Officer should draw the relevant factors to the attention of the CCG Board, the CCG Executive Team. If the outcome is that the Accountable Officer is overruled it is normally sufficient for the Accountable Officer to ensure that his/her advice and the overruling of it are clearly apparent from the papers. Exceptionally, the Accountable Officer should inform the NHS England and the DH. In such cases, and in those described in paragraph 24, the Accountable Officer should, as a member of the CCG Board, vote against the course of action rather than merely abstain from voting.
99 SCHEME OF DELEGATION DERIVED FROM THE CODES OF CONDUCT AND ACCOUNTABILITY
REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
1.3.1.7 CCG BOARD Approve procedure for declaration of hospitality and sponsorship. CCG Executive Team responsible for process in relevant functions
1.3.1.8 CCG BOARD Ensure proper and widely publicised procedures for voicing complaints, concerns about maladministration, breaches of Code of Conduct, and other ethical concerns. CCG Executive Team responsible for process in relevant functions
1.31.9 & ALL CCG BOARD Subscribe to Code of Conduct for NHS Managers. Any breaches of the NHS Managers Code of 1.3.2.2 MEMBERS, CCG Conduct will be investigated under the CCG Disciplinary Policy and Procedures by the CCG Executive EXECUTIVE COMMITTEE Team or the CCG Board as appropriate MEMBERS, CLINICAL COMMISSIONING BOARD MEMBERS, ALL SUB- COMMITTEE MEMBERS AND MEMBERS OF STAFF CCG Board members share corporate responsibility for all decisions of the CCG Board. 1.3.2.4 CCG BOARD CCG Board Chairman and non-officer members are responsible for monitoring the executive 1.3.2.4 CCG BOARD management of the CCG and are responsible to the SofS for the discharge of those responsibilities. CHAIRMAN AND NON- OFFICER MEMBERS The CCG Board has six key functions for which it is held accountable by the Department of Health on 1.3.2.4 CCG BOARD behalf of the Secretary of State:
1. to ensure effective financial stewardship through value for money, financial control and financial planning and strategy; 2. to ensure that high standards of corporate governance and personal behaviour are maintained in the conduct of the business of the CCG; 3. to appoint, appraise and remunerate senior executives; 4. on the recommendation of the CCG Executive Committee, to ratify the strategic direction of the organisation within the overall policies and priorities of the Government and the NHS, define its annual
100 REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED and longer term objectives and agree plans to achieve them; 5. to oversee the delivery of planned results by monitoring performance against objectives and ensuring corrective action is taken when necessary; 6. to ensure that the CCG Executive and the CCG Board lead effective dialogues with communities on their plans and performance and that these are responsive to the communities’ needs. It is the CCG Board’s duty to: 1.3.24 CCG BOARD 1. act within statutory financial and other constraints; 2. establish the CCG Executive Committee and CCG Board 3. be clear what decisions and information are appropriate to the CCG Board and draw up Standing Orders, a Schedule of Decisions Reserved to the CCG Board or CCG Executive Committee and CCG Board and Standing Financial Instructions to reflect these; 4. ensure that management arrangements are in place to enable responsibility to be clearly delegated to senior executives for the main programmes of action and for performance against programmes to be monitored and senior executives held to account; 5. establish performance and quality measures that maintain the effective use of resources and provide value for money; 6. specify its requirements in organising and presenting financial and other information succinctly and efficiently to ensure the CCG Board can fully undertake its responsibilities; 7. establish an Audit Committee and a Remuneration and Terms of Service Committee on the basis of formally agreed terms of reference which set out the membership of the subcommittees, the limit to their powers, and the arrangements for reporting back to the CCG Board.
It is the CCG Board Chairman's role to: 1.3.2.5 CCG BOARD CHAIRMAN 1. provide leadership to the CCG Board; 2. enable all CCG Board members to make a full contribution to the CCG Board's affairs and ensure that the CCG Board acts as a team; 3. ensure that key and appropriate issues are discussed by the CCG Board in a timely manner; 4. ensure the CCG Board has adequate support and is provided efficiently with all the necessary data on which to base informed decisions; 5. lead Lay CCG Board members through a formally appointed Remuneration and Terms of Service Committee of the CCG Board on the appointment, appraisal and remuneration of the Accountable Officer and (with the latter) other executive CCG Board members;
101 REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED 6. appoint Lay CCG Board members to an Audit Committee of the CCG Board;. 1.3.2.5 AO The Accountable Officer is accountable to the CCG Board Chairman and Lay CCG Board members of the CCG Board for ensuring that its decisions are implemented, that the CCG works effectively, in accordance with Government policy and public service values and for the maintenance of proper financial stewardship. The Accountable Officer should be allowed full scope, within clearly defined delegated powers, for action in fulfilling the decisions of the CCG Board. The other duties of the Accountable Officer are laid out in the Accountable Officer Memorandum. Lay CCG Board members are appointed to bring independent judgement to bear on issues of strategy, 1.3.2.6 LAY CCG BOARD performance, key appointments and accountability to the local communities. MEMBERS Declaration of conflict of interests. 1.3.2.8 CCG BOARD CHAIRMAN AND MEMBERS NHS Boards must comply with legislation and guidance issued by the Department of Health on behalf of 1.3.2.9 CCG BOARD the Secretary of State, respect agreements entered into by themselves or on their behalf and establish terms and conditions of service that are fair to the staff and represent good value for taxpayers' money.
102 SCHEME OF DELEGATION FROM STANDING ORDERS
SO REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
1.1 CCG BOARD Final authority in interpretation of Standing Orders CHAIRMAN
2.4 CCG BOARD Appointment of CCG Board Vice-Chairman.
3.2 CCG BOARD Calling meetings. CHAIRMAN
3.8 CCG BOARD Chair all CCG Board meetings and associated responsibilities. CHAIRMAN
3.11 CCG BOARD Give final ruling in questions of order, relevancy and regularity of meetings. CHAIRMAN
3.13 CCG BOARD Having a second or casting vote. CHAIRMAN
3.14 CCG BOARD Suspension of Standing Orders
3.14 AUDIT COMMITTEE Audit Committee to review every decision to suspend Standing Orders
3.15 CCG BOARD Variation or amendment of Standing Orders
4.7 CCG BOARD The CCG Board shall approve the appointments to each of the committees which it has formally constituted subject to the national accreditation
5.2 CCG BOARD The powers which the CCG Board has retained to itself within these Standing Orders may in emergency be CHAIRMAN & AO exercised by the CCG Board Chairman and Accountable Officer after having consulted at least two lay members
5.3 CCG BOARD Formal delegation of powers to the CCG Executive Committee and other committees, sub-committees or joint committees and approval of their constitution and terms of reference. (The Accountable Officer may approve Constitution and terms of reference of sub-committees.) 5.4 AO The Accountable Officer shall prepare a Scheme of Delegation identifying his/her proposals, which shall be considered and approved by the CCG Board, subject to any amendment agreed during the discussion.
103 SO REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED Disclosure of non-compliance with Standing Orders to the Accountable Officer as soon as possible. 5.6 ALL
7.1 ALL CCG BOARD, AND Declare relevant and material interests. CCG EXECUTIVE COMMITTEE 7.2 CFO Maintain Registers of Interests.
7.1 CHAIRMAN OF A Making a declaration on a declared interest. MEETING
7.4 ALL STAFF Comply with national guidance contained in HSG 1993/5 “Standards of Business Conduct for NHS Staff”.
7.4 ALL Disclosure of relationship between self and candidate for staff appointment. (CCG to report the disclosure to the CCG Board/CCG Executive Committee). 8.1/8.3 AO Keep seal in a safe place and maintain register of sealing.
8.5 AO/ EXECUTIVE Approve and sign all documents which will be necessary in legal proceedings. DIRECTOR
* Nominated officers and the areas for which they are responsible should be incorporated into the CCG’s Scheme of Delegation document.
104 SCHEME OF DELEGATION FROM MODEL STANDING FINANCIAL INSTRUCTIONS
SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
10.1.3 CFO Approval of all financial procedures. 10.1.4 CFO Advice on interpretation or application of SFIs.
10.1.6 ALL MEMBERS OF THE CCG Have a duty to disclose any non-compliance with these Standing Financial Instructions to the Chief BOARD, THE CCG Financial Officer as soon as possible. EXECUTIVE COMMITTEE AND EMPLOYEES 10.2.4 AO Responsible as the Accountable Officer to ensure financial targets and obligations are met and have overall responsibility for the System of Internal Control.
10.2.4 AO & CFO Accountable for financial control but will, as far as possible, delegate their detailed responsibilities 10.2.5 AO To ensure all CCG Board members, officers and employees, present and future, are notified of and understand Standing Financial Instructions. 10.2.6 CFO Responsible for: a) Implementing the CCG’s financial policies and co-coordinating corrective action; b) Maintaining effective systems of financial control including ensuring detailed financial procedures and systems are prepared and documented; c) Ensuring that sufficient records are maintained to explain CCG transactions and financial positions; d) Providing financial advice to members of the CCG Board and staff; e) Maintaining such accounts, certificates etc. as are required for the CCG to carry out their statutory duties.
10.2.7 ALL MEMBERS OF THE CCG Responsible for security of CCG property, avoiding loss, exercising economy and efficiency in using BOARD AND EMPLOYEES resources and conforming to Standing Orders, Standing Financial Instructions and financial procedures. 10.2.8 AO Ensure that any contractor or employees of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income are made aware of these instructions and their requirement to comply. 11.1.1 AUDIT COMMITTEE Provide independent and objective view on internal control and probity.
105 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED Raise the matter at the CCG Board meeting where the Audit Committee considers there is evidence of 11.1.2 CHAIRMAN OF AUDIT ultra vires transactions or improper acts. COMMITTEE
11.1.3 & CFO Ensure an adequate internal audit service, for which he/she is accountable, is provided (and involve the 11.2.1 Audit Committee in the selection process when/if an internal audit service provider is changed.) 11.2.1 CFO Decide at what stage to involve police in cases of misappropriation and other irregularities not involving fraud or corruption.
11.3 HEAD OF INTERNAL AUDIT Review, appraise and report in accordance with the NHS Internal Audit Manual and best practice. Ensure cost-effective External Audit & Internal Audit 11.4 AUDIT COMMITTEE
11.5 AO & CFO Monitor and ensure compliance with SofS Directions on fraud and corruption including the appointment of the Local Counter Fraud Specialist. 11.6 AO Monitor and ensure compliance with Directions issued by the Secretary of State for Health on NHS security management including appointment of the Local Security Management Specialist for the CCG 12.1.1 AO Has overall responsibility for the activities of the CCG 12.1.4 CFO Will provide reports to the SofS as required, ensure draw down is for approved expenditure and timely and follows best practice in Cash Management. 12.1.4 CFO Ensure monitoring systems are in place to enable the CCG not to exceed their limits. 13.1.1 CFO Periodically review assumptions, submit a report to the CCG annually showing total allocations received and their proposed distribution. 13.1.1 CFO Regularly update the CCG on significant changes to the initial allocations and the uses of such funds 13.2.1 AO Compile and submit to the CCG Board the Operating Plan which takes into account financial targets and forecast limits of available resources. The plan will contain: a statement of the significant assumptions on which the plan is based; details of major changes in workload, delivery of services or resources required to achieve the plan 13.2.2 & CFO Submit budgets to the CCG Board for approval. 13.2.3 Monitor performance against budgets; submit to the CCG Board financial estimates and forecasts.
106 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
13.2.5 CFO Ensure adequate training is delivered on an ongoing basis to budget holders. 13.3.1 AO Delegate budget to budget holders.
13.3.2 AO & BUDGET HOLDERS Must not exceed the budgetary total or virement limits set by the CCG Board. 13.4.1 CFO Devise and maintain systems of budgetary control. Ensure that: 13.4.2 BUDGET HOLDERS a) no overspend or reduction of income that cannot be met from virement is incurred without prior consent of the CCG Board; b) approved budget is not used for anything other than the specified purpose subject to rules of virement; c) no permanent employees are appointed without the approval of the AO other than those provided for within available resources and manpower establishment.
13.4.3 AO Identify and implement cost improvements and income generation activities in line with the plans 13.6.1 AO Submit monitoring returns. 14.1 CFO Preparation of annual accounts and reports. 15.1 CFO Managing banking arrangements, including provision of banking services, operation of accounts, preparation of instructions and list of cheque signatories. (CCG Board approves arrangements.) 16. CFO Income systems, including system design, prompt banking, review and approval of fees and charges, debt recovery arrangements, design and control of receipts, provision of adequate facilities and systems for employees whose duties include collecting or holding cash.
16.2.3 ALL EMPLOYEES Duty to inform CFO of money due from transactions which they initiate/deal with. 17. AO Tendering and contracting procedure. 17.5.3 AO Waive formal tendering procedures. 17.5.3 AO Report waivers of tendering procedures to the Audit Committee. 17.5.5 CFO Where a supplier is chosen that is not on the approved list the reason shall be recorded in writing to the AO, the CCG Executive or the CCG Board
107 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
17.6.2 AO Responsible for the receipt, endorsement and safe custody of tenders received. 17.6.3 AO Shall maintain registers to show each set of competitive tender invitations despatched.
17.6.4 AO AND CFO Where one tender is received will assess for value for money and fair price. 17.6.6 AO No tender shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the Accountable Officer. 17.6.8 AO Will appoint a manager to maintain a list of approved firms. 17.6.8 AO Shall ensure that appropriate checks are carried out as to the technical and financial capability of those firms that are invited to tender or quote. 17.7.2 AO The Accountable Officer or his/her nominated officer should evaluate the quotation and select the quote which gives the best value for money. 17.7.4 AO or CFO No quotation shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the Accountable Officer. 17.10 AO The Accountable Officer shall demonstrate that the use of private finance represents value for money and genuinely transfers risk to the private sector. 17.10 CCG Board All PFI/LIFT proposals must be agreed by the CCG Board. 17.11 AO The Accountable Officer shall nominate an officer who shall oversee and manage each contract on behalf of the CCG. 17.12 AO The Chief Officer shall nominate officers with delegated authority to enter into contracts of employment, regarding staff, agency staff or temporary staff service contracts. 17.15 AO The Accountable Officer shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis. 17.15.5 AO The Accountable Officer shall nominate an officer to oversee and manage each contract on behalf of the CCG 18.1.1 AO Must ensure the CCG enters into suitable contracts with service providers for the provision of NHS services
108 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
18.3 AO As the Accountable Officer, ensure that regular reports are provided to the CCG Board detailing actual and forecast expenditure against the contract. 19.2.1 AO As the Accountable Officer, ensure secondary services are commissioned in line with the Operating Plan and reach the required standards. 19.2.3 AO As the Accountable Officer, ensure regular reports are provided to the CCG Board detailing actual and forecast expenditure for each contract. 19.2.4 AO As the Accountable Officer, ensure that all agreements for provision of services with non-NHS providers achieve quality and are cost effective. 19.3.1 CFO Will maintain a system of control to ensure effective accounting of expenditure against contracts. 19.3.2 CFO Must account for Non contracted activity in accordance with national guidelines.
20.1.1 CCG BOARD Establish a Remuneration & Terms of Service Committee. 20.1.2 REMUNERATION AND TERMS Advise and make recommendations to the CCG Board on the remuneration and terms of service of the OF SERVICE COMMITTEE AO, other officer members and senior employees to ensure they are fairly rewarded having proper regard to the CCG’s circumstances and any national agreements.
Monitor and evaluate the performance of individual senior employees.
Advise on and oversee appropriate contractual arrangements for such staff, including proper calculation and scrutiny of termination payments. This section also applies to CCG Board members, other committee members and officers subject to the national accreditation process
20.1.3 REMUNERATION AND TERMS Report in writing to the CCG Board its advice and its bases about remuneration and terms of service of OF SERVICE COMMITTEE directors and senior employees.
20.1.4 CCG BOARD Approve proposals presented by the AO for setting of remuneration and conditions of service for those employees and officers not covered by the Remuneration and Terms of Service Committee. 20.2.2 AO Approval of variation to funded establishment of any department. 20.4.1 and CFO Payroll: 20.4.2 a) specifying timetables for submission of properly authorised payroll notifications; b) final determination of pay and allowances;
109 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED c) making payments on agreed dates; d) agreeing method of payment; e) issuing instructions (as listed in SFI 10.4.2).
NOMINATED MANAGERS, 20.4.3 Submit payroll notifications in the required form AS PER SCHEDULE OF Submitting termination forms in prescribed form and on time. AUTHORISED SIGNATORIES 20.4.4 CFO Ensure that the chosen method for payroll processing is supported by appropriate (contracted) terms and conditions, adequate internal controls and audit review procedures and that suitable arrangements are made for the collection of payroll deductions and payment of these to appropriate bodies.
Ensure that all employees are issued with a Contract of Employment in a form approved by the CCG 20.5 NOMINATED MANAGER* Board and which complies with employment legislation; Deal with variations to, or termination of, contracts of employment. The CCG Board will approve the level of non-pay expenditure on an annual basis. 21.1 CCG BOARD 21.1 AO Determine, and set out, levels of delegation of non-pay expenditure to budget managers, including a list of managers authorised to place requisitions, the maximum level of each requisition and the system for authorisation above that level. 21.1.3 AO Set out procedures on the seeking of professional advice regarding the supply of goods and services.
21.2.1 NOMINATED MANAGER In choosing the item to be supplied (or the service to be performed) shall always obtain the best value for money for the CCG. In so doing, the advice of the CCG’s adviser on supply shall be sought. 21.2.2 CFO Shall be responsible for the prompt payment of accounts and claims. 21.2.3 CFO a) Advise the CCG Board regarding the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in standing orders and regularly reviewed; b) Prepare procedural instructions (where not already provided in the Scheme of Delegation or procedure notes for budget holders) on the obtaining of goods, works and services incorporating the thresholds; c) Be responsible for the prompt payment of all properly authorised accounts and claims; d) Be responsible for designing and maintaining a system of verification, recording and payment of all
110 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED amounts payable; e) A timetable and system for submission to the CFO of accounts for payment; provision shall be made for the early submission of accounts subject to cash discounts or otherwise requiring early payment; f) Instructions to employees regarding the handling and payment of accounts within the Finance Department; g) Be responsible for ensuring that payment for goods and services is only made once the goods and services are received.
21.2.4 APPROPRIATE EXECUTIVE Make a written case to support the need for a prepayment. DIRECTOR 21.2.4 CFO Approve proposed prepayment arrangements.
21.2.4 BUDGET HOLDER Ensure that all items due under a prepayment contract are received (and immediately inform CFO if problems are encountered). 21.2.5 AO Authorise who may use and be issued with official orders.
21.2.6 MANAGERS AND OFFICERS Ensure that they comply fully with the guidance and limits specified by the CFO 21.2.7 AO & CFO Ensure that the arrangements for financial control and financial audit of building and engineering contracts and property transactions comply with the guidance contained within CONCODE and ESTATECODE. The technical audit of these contracts shall be the responsibility of the relevant Director. 21.3 CFO Lay down procedures for payments to local authorities and voluntary organisations made under the powers of section 256 of the NHS Act 2006. 22 CFO Ensure that CCG Board members are aware of the Financial Framework and ensure compliance 23.1.1 & 2 AO Capital investment programme: a) ensure that there is an adequate appraisal and approval process for determining capital expenditure priorities and the effect that each has on plans; b) responsible for the management of capital schemes and for ensuring that they are delivered on time and within cost; c) ensure that capital investment is not undertaken without availability of resources to finance all revenue consequences; d) ensure that a business case is produced for each proposal. 23.1.2 CFO Certify professionally the costs and revenue consequences detailed in the business case for capital
111 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
investment. 23.1.3 AO Issue procedures for management of contracts involving stage payments. 23.1.4 CFO Assess the requirement for the operation of the construction industry taxation deduction scheme. 23.1.5 CFO Issue procedures for the regular reporting of expenditure and commitment against authorised capital expenditure. 23.1.6 AO Issue manager responsible for any capital scheme with authority to commit expenditure, authority to proceed to tender and approval to accept a successful tender. Issue a scheme of delegation for capital investment management. 23.1.7 CFO Issue procedures governing financial management, including variation to contract, of capital investment projects and valuation for accounting purposes. 23.2.1 CFO Demonstrate that the use of private finance represents value for money and genuinely transfers significant risk to the private sector. 23.2.1 CCG BOARD Proposal to use PFI/LIFT must be specifically agreed by the CCG Board. 23.3.1 AO Maintenance of asset registers (on advice from CFO). 23.3.5 CFO Approve procedures for reconciling balances on fixed assets accounts in ledgers against balances on fixed asset registers. 23.3.8 CFO Calculate and pay capital charges in accordance with Department of Health requirements. 23.4.1 AO Overall responsibility for fixed assets. 23.4.2 CFO Approval of fixed asset control procedures.
23.4.4 CCG BOARD, EXECUTIVE Responsibility for security of CCG assets including notifying discrepancies to CFO, and reporting losses in MEMBERS AND ALL SENIOR accordance with CCG procedures. STAFF 24.2 AO Delegate overall responsibility for control of stores (subject to CFO responsibility for systems of control). Further delegation for day-to-day responsibility subject to such delegation being recorded. (Good practice to append to the scheme of delegation document.) 24.2 CFO Responsible for systems of control over stores and receipt of goods.
24.2 NOMINATED OFFICERS* Security arrangements and custody of keys.
112 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
24.2 CFO Set out procedures and systems to regulate the stores. 24.2 CFO Agree stocktaking arrangements. 24.2 CFO Approve alternative arrangements where a complete system of stores control is not justified. 24.2 CFO Approve system for review of slow moving and obsolete items and for condemnation, disposal and replacement of all unserviceable items.
24.2 NOMINATED MANAGER* Operate system for slow moving and obsolete stock, and report to CFO evidence of significant overstocking. 24.3.1 AO Identify persons authorised to requisition and accept goods from NHS Logistics 25.1.1 CFO Prepare detailed procedures for disposal of assets including condemnations and ensure that these are notified to managers. 25.2.1 CFO Prepare procedures for recording and accounting for losses, special payments and informing police in cases of suspected arson or theft.
25.2.2 ALL STAFF Discovery or suspicion of loss of any kind must be reported immediately to either head of department or nominated officer. The head of department / nominated officer should then inform the AO and CFO. 25.2.2 CFO Where a criminal offence is suspected CFO must inform the police if theft or arson is involved. In cases of fraud and corruption CFO must inform the relevant LCFS and CFSMS Regional Team in line with SofS directions. 25.2.2 CFO Notify LCFS,CFSMS and External Audit of all frauds. 25.2.3 CFO Notify CCG Board and External Auditors of losses caused by theft, arson, neglect of duty or gross carelessness (unless trivial).
25.2.4 CCG BOARD Approve write off of losses (within limits delegated by DH). 25.2.6 CFO Consider whether any insurance claim can be made. 25.2.7 CFO Maintain losses and special payments register 26.1 CFO Responsible for accuracy and security of computerised financial data. 26.1 CFO Satisfy him/herself that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken
113 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
by another organisation assurance of adequacy must be obtained from them prior to implementation.
26.1.3 NOMINATED OFFICER Publish and maintain a Freedom of Information Scheme. CCG Executive and CCG Board will be responsible for providing responses to Freedom of Information requests that relate to their functions
26.2.1 BUDGET HOLDERS Send proposals for general computer systems to CFO. 26.3 CFO Ensure that contracts with other bodies for the provision of computer services for financial applications clearly define responsibility of all parties for security, privacy, accuracy, completeness and timeliness of data during processing, transmission and storage, and allow for audit review.
Seek periodic assurances from the provider that adequate controls are in operation. 26.4 CFO Ensure that risks to the CCG from use of IT are identified and considered and that business continuity plans are in place. 26.5 CFO Where computer systems have an impact on corporate financial systems satisfy him/herself that: a) systems acquisition, development and maintenance are in line with corporate policies; b) data assembled for processing by financial systems is adequate, accurate, complete and timely, and that a management rail exists; c) CFO and staff have access to such data; d) Such computer audit reviews are being carried out as are considered necessary. 27 CFO Ensure all staff are made aware of the CCG’s policies on the acceptance of gifts and other benefits in kind by staff. 28 AO Ensure lists of all contractors are maintained up to date and systems are in place to deal with applications, resignations, inspection of premises etc. within contractors’ terms of service. 28 CFO Ensure only contractors included on the CCG lists receive payments; maintain a system of control to ensure prompt and accurate payments and validation of same. 29 AO Retention of document procedures in accordance with Department of Health guidance. 30 AO Risk management programme.
30 CCG BOARD Approve and monitor risk management programmes
30 CCG BOARD Decide whether the CCG will use the risk pooling schemes administered by the NHS Litigation Authority or self-insure for some or all of the risks (where discretion is allowed). Decisions to self-insure should be
114 SFI REF DELEGATED TO AUTHORITIES/DUTIES DELEGATED
reviewed annually. 30 CFO Where the CCG Board decides to use the risk pooling schemes administered by the NHS Litigation Authority the CFO shall ensure that the arrangements entered into are appropriate and complementary to the risk management programme. The CFO shall ensure that documented procedures cover these arrangements
Where the CCG Board decides not to use the risk pooling schemes administered by the NHS Litigation Authority for any one or other of the risks covered by the schemes, the CFO shall ensure that the CCG Board is informed of the nature and extent of the risks that are self insured as a result of this decision. The CFO will draw up formal documented procedures for the management of any claims arising from third parties and payments in respect of losses that will not be reimbursed. 31 CFO Ensure documented procedures cover management of claims and payments below the deductible.
*Nominated officers and the areas for which they are responsible should be incorporated into the CCG’s Detailed Scheme of Delegation
115 Appendix 6.
SECTION 6 - STANDING FINANCIAL INSTRUCTIONS
10. INTRODUCTION
10.1 General
10.1.1 Clinical Commissioning Groups (CCGs) are established under the Health and Social Care Act 2012. They are statutory bodies which have the function of commissioning services for the purposes of the health services in England and are treated as NHS bodies for the purposes of the NHS Act 2006. The duties of CCGs are set out in Section 3 of the 2006 Act as amended by Section 13 of the 2012 Act and the regulations made under that provision.
10.1.2 These Standing Financial Instructions detail the financial responsibilities, policies and procedures adopted by the CCG. They are designed to ensure that the CCG’s financial transactions are carried out in accordance with the law and with Government policy in order to achieve probity, accuracy, economy, efficiency and effectiveness. They should be used in conjunction with the Schedule of Decisions Reserved to the Governing Body and the Scheme of Delegation adopted by the CCG.
10.1.3 These Standing Financial Instructions identify the financial responsibilities which apply to everyone working for the CCG including the officers, members of the Governing Body as well as all members of staff and all of its Committees and Sub-Committees. They do not provide detailed procedural advice and should be read in conjunction with the detailed departmental and financial procedure notes. All financial procedures must be approved by the CFO.
10.1.4 Should any difficulties arise regarding the interpretation or application of any of the Standing Financial Instructions then the advice of the CFO must be sought before acting. The user of these Standing Financial Instructions should also be familiar with and comply with the provisions of the CCG’s Standing Orders.
10.1.5 The failure to comply with Standing Financial Instructions and Standing Orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.
10.1.6 Overriding Standing Financial Instructions – If for any reason these Standing Financial Instructions are not complied with, full details of the non- compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Audit Committee for referring action or ratification. All members of the
116 Governing Body and CCG staff have a duty to disclose any non-compliance with these Standing Financial Instructions to the CFO as soon as possible.
10.2 Responsibilities and delegation
10.2.1 The Governing Body
The Governing Body exercises financial supervision and control by:
(a) Formulating the financial strategy;
(b) Requiring the submission and approval of budgets within approved allocations/overall income;
(c) Defining and approving essential features in respect of important procedures and financial systems (including the need to obtain value for money within the CCG);
(d) Defining specific responsibilities placed on members of the Governing Body, the Operational Executive Committee, the Transformation and Delivery Committee and the CCG and employees as indicated in the Scheme of Delegation document.
10.2.2 The Governing Body has resolved that certain powers and decisions may only be exercised by the Governing Body in formal session. These are set out in the ‘Schedule of Matters Reserved to the Board’ document. All other powers have been delegated to the Operational Executive Committee, the Transformation and Delivery Committee and such other committees as the Governing Body has established.
10.2.3 The Governing Body will delegate responsibility for the performance of its functions in accordance with the Scheme of Delegation document adopted by the CCG.
10.2.4 The Accountable Officer and Chief Financial Officer
The AO and CFO will, as far as possible, delegate their detailed responsibilities, but they remain accountable for financial control.
Within the Standing Financial Instructions, it is acknowledged that the AO is ultimately accountable to the Governing Body, and to the Secretary of State, for ensuring that the Governing Body meets its obligation to perform its functions within the available financial resources. The AO has overall executive responsibility for the CCG’s activities; is responsible to the Governing Body Chairman and the Governing Body for ensuring that its financial obligations and targets are met and has overall responsibility for the CCG’s system of internal control.
10.2.5 It is a duty of the AO to ensure that members of the Governing Body, the Operational Executive Committee, the Transformation and Delivery
117 Committee and all other Committees, employees and all new appointees are notified of, and put in a position to understand their responsibilities within these Instructions.
10.2.6 The Chief Financial Officer
The CFO is responsible for:
(a) implementing the CCG’s financial policies and for co-coordinating any corrective action necessary to further these policies;
(b) maintaining an effective system of internal financial control including ensuring that detailed financial procedures and systems incorporating the principles of separation of duties and internal checks are prepared, documented and maintained to supplement these instructions;
(c) ensuring that sufficient records are maintained to show and explain the CCG’s transactions, in order to disclose, with reasonable accuracy, the financial position of the CCG at any time;
and, without prejudice to any other functions of the CCG, and
employees of the CCG, the duties of the CFO include:
(d) the provision of financial advice to the Governing Body, the Operational Executive Committee, the Transformation and Delivery Committee and employees;
(e) the design, implementation and supervision of systems of internal financial control; and
(f) the preparation and maintenance of such accounts, certificates, estimates, records and reports as the CCG may require for the purpose of carrying out its statutory duties.
10.2.7 Governing Body, Operational Executive Committee, Transformation and Delivery Committee and Employees
All members of the Governing Body, the Operational Executive Committee and Transformation and Delivery Committee and employees, severally and collectively, are responsible, within their functions, for:
(a) The security of the CCG’s property
(b) Avoiding loss;
(c) Exercising economy and efficiency in the use of resources; and
(d) Conforming to the requirements of Standing Orders, Standing Financial Instructions, Financial Procedures and the Scheme of Delegation.
118 10.2.8 Contractors and their employees
Any contractor or employee of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the AO to ensure that such persons are made aware of this.
10.2.9 For all members of the Governing Body, the Operational Executive Committee, the Transformation and Delivery Committee and employees who carry out a financial function, the form in which financial records are kept and the manner in which members of the Governing Body, the Operational Executive Committee, the Transformation and Delivery Committee and employees discharge their duties must be to the satisfaction of the CFO.
11. AUDIT
11.1 Audit Committee
11.1.1 An independent Audit Committee is a central means by which a Board ensures effective internal control arrangements are in place. In addition, the Audit Committee provides a form of independent check upon the executive arm of the Governing Body. In accordance with Standing Orders the Governing Body shall formally establish an Audit Committee, with clearly defined terms of reference and following guidance from the NHS Audit Committee Handbook (2011) to perform the following tasks on behalf of the Governing Body;
(a) Ensuring there is an effective internal audit function established by management that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, AO and Governing Body.
(b) Reviewing the work and findings of the external auditors appointed by the Public Sector Audit Appointments Ltd and considering the implications of and management’s responses to their work;
(c) Reviewing the findings of other significant assurance functions, both internal and external to the organisation, and considering the implications for the governance of the organisation;
(d) Review the work of other committees within the organisation, whose work can provide relevant assurance to the Audit Committee’s own scope of work (especially the Governing Body’s Quality & Commissioning Committee)
(e) ensuring that the systems for financial reporting to the Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Governing Body;
119 (f)Reviewing financial and information systems and monitoring the integrity of the financial statements and reviewing significant financial reporting judgements;
(g) Reviewing the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities (both clinical and non- clinical) that supports the achievement of the CCG’s objectives;
(h)Monitoring compliance with Standing Orders and Standing Financial Instructions;
(i)Reviewing schedules of losses and compensations and making recommendations to the Governing Body;
(k) Review the annual financial statements prior to submission to the Governing Body focusing particularly on;
(i) the wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee;
(ii) changes in, and compliance with, accounting policies, practices and estimation techniques; (iii) unadjusted mis-statements in the financial statements; (iv) significant judgements in the preparation of the financial statements; (v) significant adjustments resulting from the audit (vi) letter of representation (vii) qualitative aspects of financial reporting
(l) Reviewing the external auditor’s report on the financial statements and the annual management letter;
(m) Approve amendments to the CCG’s major accounting policies;
(n) Satisfy itself that the CCG have adequate arrangements in place for countering fraud and review the outcome of counter fraud work;
(o) Reviewing any objectives and effectiveness of the internal audit services including its working relationship with external auditors;
(p) Reviewing major findings from internal and external audit reports and ensure appropriate action is taken by the Operational Executive Committee, the Transformation and Delivery Committee or the Governing Body as appropriate;
(q) Reviewing ‘value for money’ audits reporting on the effectiveness and efficiency of the selected departments or activities;
120 (r) Reviewing the mechanisms and levels of authority (e.g. Standing Orders, Standing Financial Instructions, Delegated limits) and make recommendations to the Governing Body;
(s) Reviewing the scope of both internal and external audit including the agreement on the number of audits per year for approval by the Governing Body;
(t) Investigating any matter within its terms of reference, having the right of access to any information relating to the particular matter under investigation;
(u) Reviewing all waivers to Standing Orders;
(v) Reviewing hospitality and sponsorship registers;
(w) Monitoring the integrity of any formal announcements relating to the CCG’s financial performance
11.1.2 The minutes of the Audit Committee meetings shall be formally recorded and submitted to the Governing Body. The Chairman of the Audit Committee shall draw to the attention of the Governing Body any issues that require executive action. The Audit Committee will report to the Governing Body annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embedded awareness of risk management in the organisation and the integration of governance arrangements
11.1.3 Where the Audit Committee considers there is evidence of ultra vires transactions, evidence of improper acts, or if there are other important matters that the Committee wishes to raise, the Chairman of the Audit Committee should raise the matter at a full meeting of the Governing Body. Exceptionally, the matter may need to be referred to NHS England.
11.2 Chief Financial Officer
11.2.1 The CFO is responsible for:
(a) ensuring there are arrangements to review, evaluate and report on the effectiveness of internal financial control including the establishment of an effective Internal Audit function;
(b) ensuring that the Internal Audit function meets the NHS mandatory audit standards and provides sufficient independent and objective assurance to the Audit Committee, and the AO;
121 (c) deciding at what stage to involve the police in cases of misappropriation and other irregularities not involving fraud or corruption.
(d) ensuring that annual Internal Audit reports are prepared for the consideration of the Audit Committee and the Governing Body. The report must cover:
(i) a clear opinion on the effectiveness of internal control in accordance with current assurance framework guidance issued by the National Commissioning Board including, for example, compliance with control criteria and standards;
(ii) major internal financial control weaknesses discovered;
(iii) progress on the implementation of Internal Audit recommendations;
(iv) progress against plans over the previous year;
(v) strategic audit plans covering the coming three years;
(vi) detailed plans for the coming year.
11.2.2 The CFO or designated internal or external auditors are entitled without necessarily giving prior notice to require and receive:
(a) access to all records, documents and correspondence relating to any financial or other relevant transactions, including documents of a confidential nature whether held by the Operational Executive Committee or its officers, the Transformation and Delivery Committee or its officers or the Governing Body or its officers;
(b) access at all reasonable times to any premises or members of the Governing Body, the Operational Executive Committee, the Transformation and Delivery Committee or employee of the CCG;
(c) the production of any cash, stores or other property of the CCG under a member of the Governing Body’s or an employee's control; and
(d) explanations concerning any matter under investigation.
11.3 Role of Internal Audit
11.3.1 Internal Audit is an independent and objective appraisal service which provides:
122 (i) an independent and objective opinion to the AO, the Governing Body, and the Audit Committee on the degree to which risk management, control and governance support the achievement of the organisation’s agreed objectives;
(ii) an independent and objective consultancy service specifically to help line management improve the organisation’s risk management, control and governance arrangements.
11.3.2 Internal Audit will review, appraise and report upon policies, procedures and operations in place to;
(a) establish and monitor the achievement of the CCG’s objectives;
(b) identify, assess and manage the risks to achieving the CCG’s objectives;
(c) ensure the economical, effective and efficient use of resources;
(d) ensure compliance with established policies (including behavioural and ethical expectations), procedures, laws and regulations;
(e) safeguard the CCG’s assets and interests from losses of all kinds, including those arising from fraud, irregularity or corruption;
(f) ensure the integrity and reliability of information, accounts and data, including internal and external reporting and accountability processes.
11.3.3 The Head of Internal Audit will provide to the Audit Committee;
(a) Risk-based plans of internal audit work, agreed with management of the CCG and approved by the Audit Committee, based upon the management’s Assurance Framework that will enable the auditors to collect sufficient evidence to give an opinion on the adequacy and effective operation of the CCG;
(b) Regular updates on the progress against plans;
(c) Reports of management’s progress on the implementation of action agreed as a result of internal audit findings;
(d) Annual opinions, based upon and limited to the work performed, on the overall adequacy and effectiveness of the CCG’s risk management, control and governance processes (i.e. the organisation’s systems of internal control). This opinion is used by the Governing Body to inform the Annual Governance Statement and by NHS England as part of its performance management role;
(e) Additional reports as requested by the Audit Committee
123 11.3.4 Whenever any matter arises in the CCG which involves, or is thought to involve, irregularities concerning cash, stores, or other property or any suspected irregularity in the exercise of any function of a pecuniary nature, the CFO must be notified immediately.
11.3.5 The Head of Internal Audit will normally attend Audit Committee meetings and has a right of access to all Audit Committee members, the Governing Body Chairman and AO.
11.3.6 The Head of Internal Audit reports to the Audit Committee and is managed by the CFO. The reporting system for Internal Audit shall be agreed between the CFO, the Audit Committee and the Head of Internal Audit. The agreement shall be in writing and shall comply with the guidance on reporting contained in the NHS Internal Audit Standards. The reporting system shall be reviewed at least every three years.
11.3.7 The appointment and termination of the Head of Internal Audit and/or the Internal Audit Service must be approved by the Audit Committee. (Authority to approve the appointment of the Internal Audit and Local Counter Fraud Specialist (LCFS) is delegated to the Chairman of the Audit Committee and the CFO where the appointment process is part of a joint tender/appointment process undertaken with other NHS organisations.)
11.4 External Audit
The external auditors are appointed by Public Sector Audit Appointments Ltd and paid for by the CCG. The Audit Committee must ensure a cost effective service. Should there be a problem, then this should be raised with the external auditors and referred on to Public Sector Audit Appointments Ltd if the issue cannot be resolved.
11.5 Fraud and Corruption
11.5.1 In line with their responsibilities, the AO and CFO shall monitor and ensure compliance with Directions issued by the Secretary of State for Health on fraud and corruption.
11.5.2 The CCG shall nominate a suitable person to carry out the duties of the LCFS as specified by the NHS Counter Fraud and Corruption Manual and guidance.
11.5.3 The LCFS shall report to the CFO and shall work with staff in the NHS Counter Fraud Service (NHS CFS) and the Operational Fraud Team (OFT) in accordance with the NHS Counter Fraud and Corruption Manual.
11.5.4 The LCFS will provide a written report, at least annually, on counter fraud work within the CCG.
124 11.5.5 All staff will be required to comply with their professional codes of conduct and NHS Code of Conduct for Managers as relevant. Any breaches in complying with these codes will be investigated under the CCG’s Disciplinary Policy and Procedures.
11.6 Security Management
11.6.1 In line with their responsibilities, the AO will monitor and ensure compliance with Directions issued by the Secretary of State for Health on NHS Protect.
11.6.2 The CCG shall nominate suitable persons to carry out the duties of the Local Security Management Specialist (LSMS) for the CCG as specified by the Secretary of State for Health guidance on NHS Protect.
11.6.3 The AO has overall responsibility for controlling and coordinating security. However, key tasks are delegated to the CCG Security Management Director (SMD) and the appointed Local Security Management Specialist (LSMS).
12. RESOURCE LIMIT CONTROL
12.1.1 The CCG is required by statutory provisions not to exceed its Resource Limits. The AO has overall executive responsibility for the CCG’s activities and is responsible to the Governing Body for ensuring that the CCG stays within its Resource Limit. In addition, the Operational Executive Committee and the Transformation and Delivery Committee are responsible for ensuring that the cost of their functions are within allocated budget and the Governing Board are responsible for containing budget within their resources.
12.1.2 The definition of use of resources is set out in RAB Directions on use of resources (available on the Department of Health Finance Manual web-site).
12.1.3 Any sums received on behalf of the Secretary of State excluding charges arising under Part II of the 1977 NHS Act is treated as sums received by the CCG.
12.1.4 The CFO will:
(a) provide reports in the form required by the Secretary of State and/or NHS England;
(b) ensure money drawn from the NHS England against the financing requirements arising from the Resource Limits is required for approved expenditure only, and is drawn down only at the time of need, follows best practice as set out in ‘Cash Management in the NHS’;
(c) be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the CCG to fulfil its statutory
125 responsibilities not to exceed its Annual Revenue and Capital Resource Limits.
13. ALLOCATIONS, DELIVERY PLANS, BUDGETS, BUDGETARY CONTROL AND MONITORING
13.1 Allocations
13.1.1 The CFO will:
(a) periodically review the basis and assumptions used by the NHS England for distributing allocations and ensure that these are reasonable and realistic and secure the CCG’s entitlement to funds;
(b) prior to the start of each financial year submit to the Governing Body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve;
(c) regularly update the Governing Body on significant changes to the initial allocations and the uses of such funds.
13.2 Preparation and Approval of Delivery Plan and Budgets
13.2.1 The AO, working with the Operational Executive Committee and the Transformation and Delivery Committee, will compile and submit to the Governing Body a Delivery Plan which takes into account financial targets and forecast limits of available resources. The plan will contain:
(a) a statement of the significant assumptions on which the plan is based;
(b) details of major changes in workload, delivery of services or resources required to achieve the plan.
13.2.2 Prior to the start of the financial year the CFO will, working with the Operational Executive Committee and the Transformation and Delivery Committee, on behalf of the AO, prepare and submit budgets for approval by the Governing Body. Such budgets will:
(a) be in accordance with the aims and objectives set out in the plans;
(b) accord with workload and manpower plans;
(c) be produced following discussion with appropriate budget holders;
(d) be prepared within the limits of available funds;
(e) identify potential risks.
126 13.2.3 The CFO will monitor financial performance against budgets and plans, periodically review them, and report to the Governing Body.
13.2.4 All budget holders must provide information as required by the CFO to enable budgets to be compiled.
13.2.5 The CFO has a responsibility to ensure that adequate training is delivered on an on-going basis to budget holders to help them manage successfully.
13.3 Budgetary Delegation
13.3.1 The AO may delegate the management of a budget to permit the performance of a defined range of activities. This delegation must be in writing and be accompanied by a clear definition of:
(a) the amount of the budget;
(b) the purpose(s) of each budget heading;
(c) individual and group responsibilities;
(d) authority to exercise virement;
(e) achievement of planned levels of service;
(f) the provision of regular reports.
13.3.2 The AO and delegated budget holders must not exceed the budgetary total or virement limits set by the Governing Body.
13.3.3 Any budgeted funds not required for their designated purpose(s) revert to the immediate control of the AO, subject to any authorised use of virement.
13.3.4 Non-recurrent budgets should not be used to finance recurring expenditure without the authority in writing of the AO, as advised by the CFO.
13.3.5 On Call Executives
In the event of an Emergency the On Call Manager can commit resources of the CCG as required
13.4 Budgetary Control and Reporting
13.4.1 The CFO will devise and maintain systems of budgetary control. These will include:
(a) monthly financial reports to the Governing Body in a form approved by the Governing Body containing:
127 (i) income and expenditure to date showing trends and forecast year- end positions;
(ii) movements in working capital;
(iii) movements in cash and capital;
(iv)capital project spend and projected outturn against plans;
(v) explanations of any material variances from plans;
(vi)details of any corrective action where necessary and the AO’s and/or CFO’s view of whether such actions are sufficient to correct the situation;
(b) the issue of timely, accurate and comprehensible advice and financial reports to each budget holder, covering the areas for which they are responsible;
(c) investigation and reporting of variances from financial, workload and manpower budgets;
(d) monitoring of management action to correct variances;
(e) arrangements for the authorisation of budget transfers.
13.4.2 Each Budget Holder is responsible for ensuring that:
(a) any likely overspending or reduction of income which cannot be met by virement is not incurred without the prior consent of the Governing Body;
(b) the amount provided in the approved budget is not used in whole or in part for any purpose other than that specifically authorised, subject to the rules of virement;
(c) no permanent employees are appointed without the approval of the AO other than those provided for within the available resources and manpower establishment as approved by the Governing Body.
(d) that realistic forecast outturns are provided to the Finance Team in order to inform the monthly finance reports to the Governing Body and for the NHS England returns.
13.4.3 The AO is responsible for identifying and implementing cost improvements in accordance with the requirements of the Delivery Plan and balanced budgets. The Operational Executive Committee and the Transformation and Delivery Committee will, on behalf of the AO, formulate and deliver these cost improvements.
128 13.5 Capital Expenditure
13.5.1 The general rules applying to delegation and reporting shall also apply to capital expenditure. (The particular applications relating to capital are contained in SFI 23).
13.6 Monitoring Returns
13.6.1 The AO is responsible for ensuring that the appropriate monitoring forms are submitted to the requisite monitoring organisation.
14. ANNUAL ACCOUNTS AND REPORTS
14.1 The CFO, with the assistance of the Operational Executive Committee, will:
(a) prepare financial returns in accordance with the accounting policies and guidance given by the NHS England and the Treasury, the CCG accounting policies, and generally accepted accounting practice;
(b) prepare and submit annual financial reports to the NHS England certified in accordance with current guidelines;
(c) submit financial returns to the NHS England for each financial year in accordance with the timetable prescribed by the NHS England.
14.2 The annual accounts must be audited by an auditor appointed by Public Sector Audit Appointments Ltd. The audited annual accounts must be presented to a public meeting and made available to the public.
14.3 The Operational Executive Committee and the Transformation and Delivery Committee will work in conjunction with the Governing Body to publish an annual report, in accordance with guidelines on local accountability, and present it at a public meeting. The document will comply with the NHS England's Manual for Accounts and CCG Annual Reporting Manual.
15. BANK AND GOVERNMENT BANKING SERVICE ACCOUNTS
15.1 General
15.1.1 The CFO is responsible for managing the CCG’s banking arrangements and for advising the Governing Body on the provision of banking services and operation of accounts. This advice will take into account guidance/ Directions issued from time to time by the NHS England. In line with ‘Cash Management in the NHS’ CCGs should minimize the use of commercial bank accounts and consider using Government Banking Service (GBS) accounts for all banking services.
15.1.2 The Governing Body shall approve the banking arrangements.
15.2 Bank and GBS Accounts
129 15.2.1 The CFO is responsible for:
(a) bank accounts and GBS accounts;
(b) ensuring payments made from bank or GBS accounts do not exceed the amount credited to the account except where arrangements have been made;
(c) reporting to the Governing Body all arrangements made with CCG bankers for accounts to be overdrawn;
(d) monitoring compliance with NHS England guidance on the levels of cleared funds.
15.3 Banking Procedures
15.3.1 The CFO will prepare detailed instructions on the operation of bank and GBS accounts which must include:
(a) the conditions under which each bank and GBS account is to be operated;
(b) those authorised to sign cheques or other orders drawn on the CCG accounts.
15.3.2 The CFO must advise the CCG’s bankers in writing of the conditions under which each account will be operated.
15.4 Tendering and Review
15.4.1 The CFO will review the banking arrangements of the CCG at regular intervals to ensure they reflect best practice and represent best value for money by periodically seeking competitive tenders for the CCG’s banking business.
15.4.2 Competitive tenders should be sought at least every 5 years. This review is not necessary for GBS accounts. The results of the tendering exercise should be reported to the Governing Body.
16. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS
16.1 Income Systems
16.1.1 The CFO is responsible for designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due.
130 16.1.2 The CFO is also responsible for the prompt banking of all monies received.
16.2 Fees and Charges
16.2.1 The CFO is responsible for approving and regularly reviewing the level of all fees and charges other than those determined by the NHS England or by Statute. Independent professional advice on matters of valuation shall be taken as necessary.
16.2.2 All employees must inform the CFO promptly of money due arising from transactions which they initiate/deal with, including all contracts, leases, tenancy agreements, private patient undertakings and other transactions.
16.3 Debt Recovery
16.3.1 The CFO is responsible for the appropriate recovery action on all outstanding debts.
16.3.2 Income not received should be dealt with in accordance with losses procedures.
16.3.3 Overpayments should be detected (or preferably prevented) and recovery initiated.
16.4 Security of Cash, Cheques and other Negotiable Instruments
16.4.1 The CFO is responsible for:
(a) approving the form of all receipt books, agreement forms, or other means of officially acknowledging or recording monies received or receivable;
(b) ordering and securely controlling any such stationery;
(c) the provision of adequate facilities and systems for employees whose duties include collecting and holding cash, including the provision of safes or lockable cash boxes, the procedures for keys, and for coin operated machines;
(d) prescribing systems and procedures for handling cash and cheques on behalf of the CCG
16.4.2 Official money shall not under any circumstances be used for the encashment of private cheques or IOUs.
16.4.3 All cheques and cash etc., shall be banked intact. Disbursements shall not be made from cash received, except under arrangements approved by the CFO.
131 16.4.4 The holders of safe keys shall not accept unofficial funds for depositing in their safes unless such deposits are in special sealed envelopes or locked containers. It shall be made clear to the depositors that the CCG is not to be held liable for any loss, and written indemnities must be obtained from the organisation or individuals absolving the CCG from responsibility for any loss.
16.5 Money Laundering Policy
The CCG does not accept payment made in cash for any single transaction that exceeds Euro 8,000 or the equivalent thereof.
17. TENDERING AND CONTRACT PROCEDURE
17.1 Duty to comply with Standing Orders and Standing Financial Instructions
The procedure for making all contracts by or on behalf of the CCG shall comply with these Standing Orders and Standing Financial Instructions (except where Standing Order No. 3.14 Suspension of Standing Orders is applied).
17.2 EU Directives Governing Public Procurement
a) The NHS and the wider public sector procurement is subject to EU rules and regulations, national policy and specific sector guidance. The Operational Executive Committee, the Transformation and Delivery Committee and the Governing Body shall comply with the following: NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (where the commissioner is NHS England or a CCG)
The Public Contracts Regulations 2006 for services governed by the NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (where the commissioner is NHS England or a CCG)
The Public Contracts Regulations 2015 for goods, works and services NOT governed by the NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 (where the commissioner is NHS England or a CCG)
Cabinet Office Guidelines
Crown Commercial Service Guidance
(b) Directives by the Council of the European Union promulgated by the Department of Health (DH) prescribing procedures for awarding all
132 forms of contracts shall have effect as if incorporated in these Standing Orders and Standing Financial Instructions.
(c) The CCG should consider obtaining support from external agencies for procurements where internal capacity does not exist to ensure compliance when engaging in tendering procedures.
17.3 e-Procurement
The CCG should ensure that all tender opportunities (that exceed the procurement thresholds) are processed using an electronic tendering system that is compliant with the legal aspects of Procurement Law.
Detailed information is available in section 17.6.
17.4 Capital Investment Manual
The CCG shall comply as far as is practicable with the requirements of the Department of Health "Capital Investment Manual" in respect of capital investment.
17.5 Formal Competitive Tendering
17.5.1 General Applicability
The CCG shall consider the definitions of Supplies, Works and Services that are as follows:-"Supplies" contracts are essentially those for the supply (including purchasing, leasing and installation where appropriate) or hire of products.
"Works" is the execution and/or design of works, working being defined as "the outcome of building or civil engineering, works taken as a whole that is sufficient of itself to fulfil an economic and technical function".
"Services" includes, for example, services such as maintenance of equipment, transportation, consultancy, technical services, health services etc.
17.5.2 Health Care Services
The CCG will comply with the EU Procurement Directives as incorporated in UK law through the ‘Public Contracts Regulations 2015’. The only exception is the procurement of healthcare services that are subject to the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 which is still governed by Public Contracts Regulations 2006 until 18th April 2016. Where the decision is taken to competitively tender ”Supplies”, “Works” or “Services” these Standing Orders and Standing Financial Instructions shall apply as far as they are applicable to the tendering procedure and need to be read in conjunction with Standing Financial Instruction No. 18 and No. 19.
133 17.5.3 Exceptions and instances where formal tendering need not be applied
Formal tendering procedures need not be applied:
(a) where the estimated expenditure or income derived from the total value of the contract does not, or is not reasonably expected to, exceed i) £172,514 for Supplies and Services not covered by the PCCR 2013 Regulations or ii) £172,514 until 18th April 2016, at which point the threshold will rise to £625,050 for Healthcare services (that are subject to the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013), whichever is lower; or
(b) where the supply is proposed under special arrangements negotiated by the NHS England in which event the said special arrangements must be complied with;
(c) where the supply can be obtained under a framework agreement that has itself been procured in compliance with the duties set out at SFI paragraph 17.2 above, and where the CCG is entitled to access such framework agreement. Participation in newly agreed frameworks should be reported into the Operational Executive Committee Governing Body and incorporated where applicable into contracts issued by the CCG;
(d) where the CCG would be unable to fulfil its statutory functions because of limitations in the supply market, which do not arise from the failure to plan a procurement properly or where specialist expertise is required and can be demonstrated to be available from only one source, then single tender action may be appropriate. In such circumstances, the approval of the AO and the CFO will be required, and the matter should be reported to the Audit Committee or the Governing Body, as appropriate to the value of the proposal. These values are stated in the Scheme of Delegation.
(e) for healthcare services where a completed contestability questionnaire provides objective evidence that competition is not the most appropriate way to comply with the Procurement, Patient Choice and Competition) (No 2) Regulations 2013 by ensuring ‘Commissioners’ should commission services from the providers who are best placed to deliver the needs of their patients and population.
(f) regarding disposals as set out in Standing Financial Instructions No. 25;
Formal tendering procedures may be waived in the following circumstances:
134 (g) in very exceptional circumstances where the AO decides that formal tendering procedures would not be practicable or the estimated expenditure or income would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate CCG record;
(h) where the requirement is covered by an existing contract and there is an agreed and signed record of a contestability and value for money assessment.;
(i) where a consortium arrangement is in place and a lead organisation has been appointed to carry out tendering activity on behalf of the consortium members;
(j) where the timescale genuinely precludes competitive tendering (failure to plan the work properly would not be regarded as a justification for a single tender);
(k) where specialist expertise is required and is available from only one source;
(l) when the task is essential to complete the project, and arises as a consequence of a recently completed assignment and engaging different consultants for the new task would be inappropriate;
(m) there is a clear benefit to be gained from maintaining continuity with an earlier project. However in such cases the benefits of such continuity must outweigh any potential financial advantage to be gained by competitive tendering;
(n) for the provision of legal advice and services providing that any legal firm or partnership commissioned by the CCG is regulated by the Law Society for England and Wales for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel’s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned.
The CFO will ensure that any fees paid are reasonable and within commonly accepted rates for the costing of such work.
The waiving of competitive tendering procedures should not be used to avoid competition or for administrative convenience or to award further work to a consultant or contractor originally appointed through a competitive procedure.
Where it is decided that competitive tendering is not applicable and should be waived, the fact of the waiver and the reasons should be documented and recorded in an appropriate CCG record and reported to the Audit Committee at each meeting
135 17.5.4. Fair and Adequate Competition
All healthcare services (that are subject to the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013) with an estimated contract value over the term of the contract that is equal to or in excess of £ £172,514 until 18th April 2016, at which point the threshold will rise to £625,050 shall be advertised on OJEU and Contracts Finders. . All supplies, works and services NOT governed by the NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 shall be advertised in OJEU and Contracts Finder. .
Where the exceptions set out in SFI 17.5.3 apply, the CCG shall ensure that invitations to quote are sent to a sufficient number of firms or individuals to provide fair and adequate competition as appropriate, and in no case less than two firms or individuals, having regard to their capacity to supply the goods or materials or to undertake the services or works required.
17.5.5 List of Approved Firms
(a) For non-healthcare services, the CCG shall ensure that the firms/individuals invited to tender (and, where appropriate, quote) are among those on approved lists. Where in the opinion of the CFO it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the AO, or the Governing Body as appropriate (see SFI 17.6.8 List of Approved Firms) and details retained in a log maintained by the CFO.
(b) For supplies, works and services, the CCG procurement guide requires equality of treatment, ensuring that all providers and sectors have equal opportunity to complete. A robust evaluation process will apply.
17.5.7 Items that subsequently breach thresholds after original approval
Items estimated to be below the limits set in this Standing Financial Instruction for which formal tendering procedures are not used which subsequently prove to have a value above such limits shall be reported to the AO (or other appropriate approving authority), and be recorded in an appropriate CCG record.
17.6 Contracting/Tendering Procedure
The CCG will conduct all tenders (that exceed the procurement thresholds) electronically, using an e-Tendering portal. The CCG will ensure that the necessary education and training for the staff and the supply market is
136 reviewed for each tender to be implemented. In exceptional circumstances only, the CCG will use the manual procedures also set out in this document.
Each tender will have a designated Procurement Lead, who will ensure that the necessary approvals are obtained from the appropriate approving authority across the period of the procurement activity.
All invitations to tender on a formal competitive basis shall state the date and time as being the latest time for the receipt of tenders and that no tender will be considered for acceptance unless submitted through the appropriate process, as instructed within the tender documentation electronically using the e-Tendering service.
Every tender for supplies, works and services shall embody the adopted NHS contract terms and conditions as appropriate with the contract form required for the specific goods and services.
All clinical specifications used as part of a tender will be approved by the Governing Body or appropriate Committee. For non-clinical tenders, subject matter experts will be used to ensure specification validity where appropriate.
All NHS employees participating in the development and evaluation of an Invitation to Tender will be required to sign (i) a confidentiality agreement
(ii) a specific declaration of interest.
The CCG will use the declarations of interest to effectively prevent, identify and remedy conflicts of interest arising in the conduct of procurement procedures so as to avoid any distortion of competition and to ensure equal treatment of all economic operators. Managing conflicts of interest and potential conflicts of interest will ensure they do not affect, or appear to affect, the integrity of the CCG’s decision making processes.
Every tender must require suppliers to give:
(i) a written undertaking to maintain confidentiality
(ii) not to engage in collusive tendering or other restrictive practice,
(iii) a completed declaration under Regulation 57 of the Public Contracts Regulations 2015.(or Regulation 23 of the Public Contracts Regulations 2006 where relevant)
Every tender will contain detailed guidance on the application of the commercial terms for that tender, including responsibility for bidder costs of procurement.
17.6.1 Opening of Tenders submitted through e-procurement arrangements
137 a) Receipt, Safe Custody and Record of Formal Tenders
i) Electronic Tenders
An auditable date/time stamp of all documentation and actions is automatically created through the e-Tendering portal. This audit trail is available for review in real-time by all officers with appropriate access rights and cannot be edited.
Tenders may not be ‘opened’ until the pre-defined time and date for opening has passed.
All messaging / communications for any part of the electronic tender process from Expression-of-Interest through to Awarding of Contract is to be done through the e-Tendering portal, this includes communications to and from commissioners and potential suppliers. All communications received externally to the e-Tendering system whether paper or electronic should be put into a format that can be uploaded to the e-Tendering project folder and be clearly marked with context and name of the organisation.
b) Opening Formal Tenders
i) Electronic Tenders
The Procurement Lead will be responsible for the setting up of all tenders. The Procurement Lead will designate and agree a list of officers who will be able to access the electronic tenders and release them once the time and date for opening has passed.
Opening tenders and register of tenders
Electronic process for procurements over thresholds
An auditable log of actions, which may not be edited, is created including, but not limited to:
Procurement actions
• Time/date stamp of ‘publication’ of tender by buyer.
• Time/date stamp of any amendments to a ‘published’ tender (e.g.-: if any buyer tender document attachments are added/ amended during the process).
• Time/date stamp of any buyer messages communicated via the integrated messaging area (including the content, which suppliers received the message, when it was opened etc.). All messages are
138 delivered in a “blind copy” format to ensure suppliers cannot view who else has received a message.
• Time/date stamp of opening information including (buyer name by time/date stamp by individual response envelope).
• Time/date stamp of confirmation of buyer acceptance of supplier bids.
• Time/date stamp of confirmation of buyer acceptance of supplier evaluation scores.
• Time/date stamp of confirmation of buyer award decisions.
Supplier actions:
• Time/date stamp of initial registration within the e-Tendering service.
• Time/date stamp by supplier of when the specific tender was first accessed.
• Time/date stamp of any supplier messages communicated via the integrated messaging area (including the content, which buyer received the message, when it was opened etc.).
• Time/date stamp of any individual components of a ‘published’ tender accessed (e.g. buyer tender document attachments).
• Time/date stamp of official ‘submission’ of tender response.
Incomplete tenders, i.e. those from which information necessary for the adjudication of the tender is missing, and amended tenders i.e., those amended by the tenderer upon his/her own initiative either orally or in writing after the due time for receipt, but prior to the opening of other tenders, should be dealt with in the same way as late tenders.
c) E-auctions (Reverse auctions)
Additionally the CCG will use, where appropriate, an e-Sourcing facility to conduct e-auctions on its behalf and will determine throughout the year the most appropriate product areas that will achieve the best value by being managed through an e-auction.
The results of the e-auction will be made available in electronic format for scrutiny and ratification using a similar process to that of electronic tenders, and a record will be kept of the full submissions.
139 17.6.2 Invitation to tender (manual system)
In exceptional circumstances where the tender process is not undertaken through the e-Tendering system this manual process should be followed.
(i) All invitations to tender shall state the date and time as being the latest time for the receipt of tenders.
(ii) All invitations to tender shall state that no tender will be accepted unless:
submitted in a plain sealed package or envelope bearing a pre- printed label supplied by the CCG (or the word "tender" followed by the subject to which it related) and the latest date and time for the receipt of such tender addressed to the AO or nominated Manager;
tender envelopes/ packages shall not bear any names or marks indicating the sender. The use of courier/postal services must not identify the sender on the envelope or on any receipt so required by the deliverer.
(iii) Every tender for supplies, works and services or disposals shall embody such of the NHS Standard Contract Conditions as are applicable.
(iv) Every tender must have given, or give a written undertaking, not to engage in collusive tendering or other restrictive practice and a completed declaration under Regulation 57 of the Public Contract Regulations 2015 (or Regulation 23 of the Public contract Regulations where relevant)
(v) Every tender requested through the manual system should be returned in paper format, together with at least two electronic (CD) copies. The distribution, tracking and storage of paper documents and CDs will be the responsibility of the Lead Procurement Officer.
17.6.2 Receipt and safe custody of tenders
Electronic Tenders
140 The Procurement Lead will designate and agree a list of officers who will be able to access the electronic tenders and release them once the time and date for opening has passed.
Manual Tenders
The CFO or his/her nominated representative will be responsible for the receipt, endorsement and safe custody of tenders received until the time appointed for their opening.
The date and time of receipt of each tender shall be endorsed on the tender envelope/package. The packaging shall be retained for a period of six months following the date of Contract Award, or if the tender is declared void and does not proceed, then six months from that date.
17.6.3 Opening tenders and Register of manual tenders
(i) As soon as practicable after the date and time stated as being the latest time for the receipt of tenders, they shall be opened by two senior officers/managers designated by the CFO and not from the originating department.
(ii) Two officers or members of the Operational Executive Committee or Transformation and Delivery Committee as appropriate, and not from the originating department, will be required to be present for the opening of all formal tenders. The rules relating to the opening of tenders will need to be read in conjunction with any delegated authority set out in the CCG’s Scheme of Delegation.
(iii) The ‘originating’ Department will be taken to mean the Department sponsoring or commissioning the tender.
(iv) The involvement of Finance Directorate staff in the preparation of a tender proposal will not preclude the CFO or any approved Senior Manager from the Finance Directorate from serving as one of the two senior managers to open tenders.
(v) All officers/members will be authorised to open tenders regardless of whether they are from the originating department provided that the other authorised person opening the tenders with them is not from the originating department.
(vi) Every tender received shall be marked with the date of opening and initialled by those present at the opening.
(vii) A register shall be maintained by the AO, or a person authorised by him, to show for each set of competitive tender invitations despatched:
141 - the name of all firms individuals invited; - the names of firms individuals from which tenders have been received; the date the tenders were receives and opened;
- the persons present at the opening;
- the price shown on each tender; - a note where price alterations have been made on the tender and suitably initialled.
Each entry to this register shall be signed by those present.
A note shall be made in the register if any one tender price has had so many alterations that it cannot be readily read or understood.
(viii) Incomplete tenders, i.e. those from which information necessary for the adjudication of the tender is missing, and amended tenders i.e., those amended by the tenderer upon his/her own initiative either orally or in writing after the due time for receipt, but prior to the opening of other tenders, should be dealt with in the same way as late tenders. (Standing Order No. 17.6.5 below).
17.6.4 Admissibility
i) If for any reason the designated officers are of the opinion that the tenders received are not strictly competitive (for example, because their numbers are insufficient or any are amended, incomplete or qualified) no contract shall be awarded without the approval of the AO.
(ii) Where only one tender is sought and/or received, the AO and CFO shall, as far practicable, ensure that the price to be paid is fair and reasonable and will ensure value for money for the CCG.
17.6.5 Late tenders
(i) Tenders received after the due time and date, but prior to the opening of the other tenders, may be considered only if the AO or his/her nominated officer decides that there are exceptional circumstances i.e. despatched in good time but delayed through no fault of the tenderer.
(ii) Only in the most exceptional circumstances will a tender be considered which is received after the opening of the other tenders
(iii) While decisions as to the admissibility of late, incomplete or amended tenders are under consideration, the tender documents shall be kept strictly confidential by the nominated officer.
142 (iv) Accepted late tenders and the reasons for their acceptance will be reported to the Governing Body.
17.6.6 Acceptance of formal tenders (See overlap with SFI No. 17.7)
(i) Any discussions with a tenderer which are deemed necessary to clarify technical aspects of his/her tender before the award of a contract will not disqualify the tender. Any such discussion shall be recorded and included in the records of the procurement.
(ii) The CCG shall base the award of the contracts on the most economically advantageous tender assessed from the point of view of the CCG. That tender shall be identified on the basis of the price or cost, using a cost-effectiveness approach, such as life-cycle costing in accordance with regulation 68, and may include the best price-quality ratio, which shall be assessed on the basis of criteria, such as qualitative, environmental and/or social aspects, linked to the subject- matter of the contract in question
(iii) No tender shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the AO as appropriate.
(iv) The use of these procedures must demonstrate that the award of the contract was:
(a) not in excess of the going market rate / price current at the time the contract was awarded;
(b) that best value for money was achieved.
(v) All Tenders should be treated as confidential and should be retained for inspection.
17.6.7 Tender reports to the Governing Body
Reports to the Governing Body will be made on an exceptional circumstance basis only in line with delegated limits.
17.6.8 List of approved firms (see SFI No. 17.5.5)
(a) Responsibility for maintaining list
For supplies, works and services, a nominated manager shall, on behalf of the CCG, maintain lists of approved firms (or may nominate approved lists held by other NHS partners in procurement) from who tenders and quotations may be invited. These shall be kept under frequent review. The lists shall include all firms who have applied for permission to tender and as to whose technical and financial
143 competence the CCG is satisfied. All suppliers must be made aware of the CCG’s terms and conditions of contract.
(b) Financial Standing and Technical Competence of Contractors
The CFO may make or institute any enquiries he/she deems appropriate concerning the financial standing and financial suitability of approved contractors. The Director of Nursing with lead responsibility for clinical governance will similarly make such enquiries as is felt appropriate to be satisfied as to their technical / medical competence.
17.6.9 Exceptions to using approved contractors
If in the opinion of the AO and the CFO or the Governing Body member with lead responsibility for clinical governance it is impractical to use a potential contractor from the list of approved firms/individuals (for example where specialist services or skills are required and there are insufficient suitable potential contractors on the list), or where a list for whatever reason has not been prepared, the AO should ensure that appropriate checks are carried out as to the technical and financial capability of those firms that are invited to tender or quote.
An appropriate record in the contract file should be made of the reasons for inviting a tender or quote other than from an approved list.
17.7 Quotations: Competitive and non-competitive
Quotations are required where formal tendering procedures are not adopted and where the intended expenditure or income exceeds, or is reasonably expected to exceed £500 but not exceed £172,514.
The value of the goods and services should be the total contract value not the annual value. Where the number of years is not specified or open ended (from year to year) a 3 year period should be assumed for the purpose of this calculation.
17.7.1 Verbal quotations
A minimum of two verbal quotations are required for goods/services from £501 to £5,000. The resulting requisition must be accompanied by an appropriately signed record of the quotations received.
17.7.2 Competitive Quotations
(i) For amounts between £5,001 and £50,000, quotations should be obtained from at least 3 companies or individuals based on specifications or terms of reference prepared by, or on behalf of, the CCG.
144 (ii) For amounts between £50,001 and £172,514, at least 4 quotations should be obtained using the Competitive Quote procedure with a written specification and a detailed option appraisal.
(iii) Quotations should be in writing unless the AO or his nominated officer determines that it is impractical to do so in which case quotations may be obtained by telephone. Confirmation of telephone quotations should be obtained as soon as possible and the reasons why the telephone quotation was obtained should be set out in a permanent record.
(iv) All quotations should be treated as confidential and should be retained for inspection.
(v) The AO or his nominated officer should evaluate the quotation and select the quote which gives the best value for money. If this is not the lowest quotation if payment is to be made by the CCG or the highest if payment is to be received by the CCG, then the choice made and the reasons why should be recorded in a permanent record.
(vi) The relevant Officer will maintain a full audit trail of the process used to secure the supply, which will include a list of the suppliers contacted, their responses to that request for quotation, the evaluation criteria used and a record of the outcome of that evaluation.
Summary
Form of From No: SFI Value (Range) Quote Suppliers Reference £500 - £5,000 Verbal 2(+) 17.7.1 £5,001 - £50,000 Written 3(+) 17.7.2 £50,001 - £172,514 Written 4(+) 17.7.2 £172,515 + Tender, subject to 17.5.3
17.7.3 Non-Competitive Quotations
Non-competitive quotations in writing may be obtained in the following circumstances:
145 (i) the supply of proprietary or other goods of a special character and the rendering of services of a special character, for which it is not, in the opinion of the Responsible Officer, possible or desirable to obtain competitive quotations;
(ii) the supply of goods or manufactured articles of any kind which are required quickly and are not obtainable under existing contracts;
(iii) miscellaneous services, supplies and disposals;
(iv) where the goods or services are for building and engineering maintenance the responsible works manager must certify that the first two conditions of this SFI (i.e.: (i) and (ii) of this SFI) apply.
17.7.4 Quotations to be within Financial Limits
No quotation shall be accepted which will commit expenditure in excess of that which has been allocated to the Operational Executive Committee, the Transformation and Delivery Committee and the Governing Body’s functions and which is not in accordance with Standing Financial Instructions except with the authorisation of either the AO or CFO.
17.8 Authorisation of Tenders and Competitive Quotations
Providing all the conditions and circumstances set out in these Standing Financial Instructions have been fully complied with, formal authorisation and awarding of a contract may be decided by staff in accordance with the delegated powers set out in Section C. Delegated Matters – Use of Resources Scheme of Delegation Section 3. The delegated authority varies according to value of the contract.
Formal authorisation must be put in writing. In the case of authorisation by the Governing Body this shall be recorded in their minutes.
17.8.1 Signing of Contracts
Dependant on the value and nature of contracts, some will require official sealing. Please see section 9 of the Standing Orders, which is dominant and dictates the criteria for the sealing of documents. After compliance with SO9, where a contract does not need sealing, the following approval limits apply:
(i) All contracts up to £50,000 (£75,000 for Tier 4 contract exceeding 12 months)
(ii) All contracts from £50,001 to £100,000 Tier 3 (£75,001 to £150,000 for contract exceeding 12 months)
146 (iii) All contracts from £100,001 to £500,000 Tier 2 (£150,001 to £750,000 for contract exceeding 12 months)
(iv) All contracts from £500,001 to £1,000,000 Tier 1 to sign – Op (£750,001 to £1,500,000 for contracts Exec Committee or exceeding 12 months) TDC to agree.
(v) All contracts from £1,000,001 to £3,000,000 AO & CFO to sign – (£1,500,001 to £4,500,000 for contracts Op Exec Committee exceeding 12 months) or TDC to agree
(vi) All contracts from £3,000,001 (£4,500,000 AO & CFO to sign – for contracts exceeding 12 months) Governing Body to agree
All contracts other than contracts with NHS Organisations or government bodies including Local Authorities that exceed £1,000,000 need to be sealed. Signature requirements for these contracts are as per the limits set out above.
17.9 Instances where formal competitive tendering or competitive quotation is not required
Where competitive tendering or a competitive quotation is not required, the CCG should adopt one of the following alternatives:
(a) the CCG shall use procurement services through Attain for procurement of all goods and services unless the AO or nominated officers deem it inappropriate. The decision to use alternative sources must be documented.
(b) if the CCG does not use Attain - where tenders or quotations are not required, because expenditure is below £5,000, the CCG shall procure goods and services in accordance with procurement procedures approved by the CFO.
(d) Attain, in conjunction with the CFO, will draft and implement detailed policies and procedures to guide staff in the implementation of these SFIs and other best practice guidance. All such policies will need to be considered and approved by the Operational Executive Committee, the Transformation and Delivery Committee and the Governing Body.
17.11 Compliance requirements for all contracts
147 The Governing Body may only enter into contracts on behalf of the CCG within the statutory powers delegated to it by the Secretary of State and shall comply with:
(a) The CCG’s Standing Orders and Standing Financial Instructions;
(b) EU Directives and other statutory provisions;
(c) Such of the NHS Standard Contract Conditions as are applicable;
(d) Care Quality Commission standards, criteria and associated quality requirements;
(e) Contracts with Foundation Trusts must be in a form compliant with appropriate NHS guidance;
(f) Where appropriate contracts shall be in or embody the same terms and conditions of contract as was the basis on which tenders or quotations were invited;
(g) In all contracts made by the CCG, the Governing Body shall endeavour to obtain best value for money by use of all systems in place. The AO shall nominate an officer who shall oversee and manage each contract on behalf of the CCG.
17.12 Personnel and Agency or Temporary Staff Contracts
The AO shall nominate officers with delegated authority to enter into contracts of employment, regarding staff, agency staff or temporary staff service contracts.
The CCG will use the relevant framework agreements developed on behalf of the NHS unless there are extenuating circumstances. In such instances the advice of the Human Resources Service will be sought and approval given by the AO or CFO.
17.13 Not used
17.14 Disposals (See overlap with SFI No. 25)
Competitive Tendering or Quotation procedures shall not apply to the disposal of:
(a) any matter in respect of which a fair price can be obtained only by negotiation or sale by auction as determined (or pre- determined in a reserve) by the AO or his nominated officer;
148 (b) obsolete or condemned articles and stores, which may be disposed of in accordance with the supplies policy of the CCG;
(c) items to be disposed of with an estimated sale value of less than £5,000, this figure to be reviewed on a periodic basis;
17.15 In-house Services
17.15.1 The AO shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis. The CCG may also determine from time to time that in-house services should be market tested by competitive tendering.
17.15.2 In all cases where the Governing Body, the Operational Executive Committee and the Transformation and Delivery Committee determine that in-house services should be subject to competitive tendering the following groups shall be set up:
(a) Specification group, comprising the AO or nominated officer/s and specialist.
(b) In-house tender group, comprising a nominee of the AO and technical support.
(c) Evaluation team, comprising normally a specialist officer, a procurement officer and senior member of the Finance Department. For services having a likely annual expenditure exceeding £500,000, a lay member should be a member of the evaluation team.
17.15.3 All groups should work independently of each other and individual officers may be a member of more than one group but no member of the in-house tender group may participate in the evaluation of tenders.
17.15.4 The evaluation team shall make recommendations to the Operational Executive Committee, the Transformation Delivery and Committee or the Governing Body as appropriate.
17.15.5 The AO shall nominate an officer to oversee and manage the contract on behalf of the Governing Body.
18. NHS CONTRACTS FOR PROVISION OF SERVICES
18.1 Contracts
18.1.1 The AO is responsible for ensuring the CCG enters into suitable contracts with service providers for the provision of NHS services, in accordance with the guidance from NHS England on the use of Standard Contracts, which will be updated from time to time.
149 All contracts should aim to implement the agreed priorities contained within the Delivery Plan and wherever possible, be based upon integrated care pathways to reflect expected patient experience. In discharging this responsibility, the AO should take into account:
the standards of service quality expected;
the relevant national service framework (if any);
the provision of reliable information on cost and volume of services;
that contracts build where appropriate on existing Integrated Plans;
that contracts clearly set out the arrangements and information requirements in the event of termination of contract.
18.2 Involving Partners and jointly managing risk
A good contract will result from a dialogue of clinicians, users, carers, public health professionals and managers. It will reflect knowledge of local needs and inequalities. This will require the AO to ensure that the CCG works with all partner agencies involved in both the delivery and the commissioning of the service required. The contract will apportion responsibility for handling a particular risk to the party or parties in the best position to influence the event and financial arrangements should reflect this. In this way the CCG can jointly manage risk with all interested parties. Due consideration in all provider/purchaser arrangements must be observed as the NHS continues to implement ‘Equity and Excellence; Liberating the NHS’.
18.3 Reports to Governing Body on Contracts
The AO will need to ensure that regular reports are provided to the Governing Body detailing actual and forecast expenditure against the Contracts.
19. COMMISSIONING
19.1 Role of the CCG in Commissioning Secondary Services
19.1.1 The CCG has responsibility for commissioning secondary services on behalf of the resident population. This will require the CCG to work in partnership with NHS England, local NHS Trusts and FTs, local authority, users, carers and the voluntary sector to develop a Delivery Plan.
150 19.2 Role of the Accountable Officer
19.2.1 The AO has responsibility for ensuring secondary services are commissioned in accordance with the priorities agreed in the Delivery Plan. This will involve ensuring contracts are put in place with the relevant providers, based upon integrated care pathways.
19.2.2 Contracts will be the key means of delivering the objectives of the Delivery Plan and therefore they need to have a wider scope. The AO will need to ensure that all contracts;
Meet the standards of service quality expected;
Fit the requirement of the Care Quality Commission Regulation as relevant to the provider;
Fit the relevant national service framework (if any);
Enable the provision of reliable information on cost and volume of services;
that contracts build where appropriate on existing Integrated Plans;
that contracts are based upon cost-effective services;
that contracts are based on integrated care pathways.
Are based on national standard templates where applicable incorporating good industry practice
19.2.3 The AO will need to ensure that regular reports are provided to the Governing Body detailing actual and forecast expenditure and activity for each contract.
19.2.4 Where the CCG makes arrangements for the provision of services by non- NHS providers it is the AO who is responsible for ensuring that the agreements put in place have due regard to the quality and cost- effectiveness of services provided. Before making any agreement with non- NHS providers, the CCG should fully explore the scope to make maximum cost-effective use of NHS facilities.
19.3 Role of Chief Financial Officer
19.3.1 A system of financial monitoring must be maintained by the CFO to ensure the effective accounting for expenditure under contracts. This should provide a suitable audit trail for all payments made under the agreements, but maintain patient confidentiality.
19.3.2 The CFO must account for Non Contracted Activity financial adjustments in accordance with national guidelines.
151 20. TERMS OF SERVICE, ALLOWANCES AND PAYMENT OF MEMBERS OF THE GOVERNING BODY AND EMPLOYEES
20.1 Remuneration and Terms of Service (see overlap with SO No. 4)
20.1.1 In accordance with Standing Orders the Governing Body shall establish a Remuneration and Terms of Service Committee, with clearly defined terms of reference, specifying which posts from the Governing Body fall within its area of responsibility, its composition, and the arrangements for reporting. (See NHS guidance contained in the Higgs report).
20.1.2 The Committee will:
(a) advise the Governing Body about appropriate remuneration and terms of service for the AO, other officer members employed by the CCG and other senior employees including:
(i) all aspects of salary (including any performance-related elements/bonuses);
(ii) provisions for other benefits, including pensions and cars;
(iii) arrangements for termination of employment and other contractual terms;
(b) make such recommendations to the Governing Body on the remuneration and terms of service of officer members of the Governing Body, (and other senior employees) to ensure they are fairly rewarded for their individual contribution to the CCG - having proper regard to the CCG’s circumstances and performance and to the provisions of any national arrangements for such members and staff where appropriate;
(c) advise on and oversee appropriate contractual arrangements for such staff including the proper calculation and scrutiny of termination payments taking account of such national guidance as is appropriate.
20.1.3 The Committee shall report in writing to the Governing Body the basis for its recommendations. The Governing Body shall use the report as the basis for their decisions, but remain accountable for taking decisions on the remuneration and terms of service of officer Executive Governing Body members. Minutes of the Governing Body's meetings should record such decisions.
20.1.4 The Governing Body will consider and need to approve proposals presented by the AO for the setting of remuneration and conditions of service for those employees and officers not covered by the Remuneration Committee if outside of Agenda for Change.
152 20.1.5 The CCG will pay allowances to the Governing Body Chairman and lay members of the Governing Body in accordance with instructions issued by the Secretary of State for Health.
20.2 Funded Establishment
20.2.1 The manpower plans incorporated within the annual budgets will form the funded establishment.
20.2.2 The funded establishment may not be varied without the approval of the AO.
20.3 Staff Appointments
20.3.1 No officer or member of the Operational Executive Committee, the Transformation and Delivery Committee, the Governing Body or any employee may engage, re-engage, or re-grade employees outside of existing establishment, either on a permanent or temporary nature, or hire agency staff, or agree to changes in any aspect of remuneration:
(a) unless authorised to do so by the Operational Executive Committee; and
(b) within the limit of their approved budget and funded establishment.
20.3.2 The Governing Body will approve procedures presented by the AO for the determination of commencing pay rates, condition of service, etc, for employees.
20.4 Processing Payroll
20.4.1 The CFO is responsible for:
(a) specifying timetables for submission of properly authorised payroll notifications;
(b) the final determination of pay and allowances;
(c) making payment on agreed dates;
(d) agreeing method of payment.
20.4.2 The CFO will issue instructions regarding:
(a) verification and documentation of data;
(b) the timetable for receipt and preparation of payroll data and the payment of employees and allowances;
153 (c) maintenance of subsidiary records for superannuation, income tax, national insurance and other authorised deductions from pay;
(d) security and confidentiality of payroll information;
(e) checks to be applied to completed payroll before and after payment;
(f) authority to release payroll data under the provisions of the Data Protection Act;
(g) methods of payment available to various categories of employee and officers;
(h) procedures for payment by cheque, BACS, or cash to employees and officers;
(I) procedures for the recall of cheques and bank credits;
(j) pay advances and their recovery;
(k) maintenance of regular and independent reconciliation of pay control accounts;
(l) separation of duties of preparing records and handling cash;
(m) a system to ensure the recovery from those leaving the employment of the CCG of sums of money and property due by them to the CCG
20.4.3 Appropriately nominated managers and Operational Executive Committee and Governing Body members have delegated responsibility for:
(a) submitting payroll notifications in accordance with agreed timetables;
(b) completing payroll notifications in accordance with the CFO’s instructions and in the form prescribed by the CFO;
(c) submitting termination forms in the prescribed form immediately upon knowing the effective date of an employee's or officer’s resignation, termination or retirement. Where an employee fails to report for duty or to fulfil Operational Executive Committee, Transformation and Delivery Committee or Governing Board obligations in circumstances that suggest they have left without notice, the CFO must be informed immediately.
20.4.4 Regardless of the arrangements for providing the payroll service, the CFO shall ensure that the chosen method is supported by appropriate (contracted) terms and conditions, adequate internal controls and audit review procedures and that suitable arrangements are made for the collection of payroll deductions and payment of these to appropriate bodies.
154 20.5 Contracts of Employment
20.5.1 The Governing Body shall delegate responsibility to an officer for:
a) ensuring that all employees are issued with a Contract of Employment in a form approved by the Governing Body and which complies with employment legislation; and
b) dealing with variations to, or termination of, contracts of employment.
c) Ensuring that honorary contracts are in place as appropriate for Governing Body members and others not directly employed by the CCG
21. NON-PAY EXPENDITURE
21.1 Delegation of Authority
21.1.1 The Governing Body will approve the level of non-pay expenditure on an annual basis and the AO will determine the level of delegation to budget managers.
21.1.2 The AO will set out:
(a) the list of managers who are authorised to place requisitions for the supply of goods and services;
(b) the maximum level of each requisition and the system for authorisation above that level.
21.1.3 The AO shall set out procedures on the seeking of professional advice regarding the supply of goods and services.
21.2 Choice, Requisitioning, Ordering, Receipt and Payment for Goods and Services (see overlap with Standing Financial Instruction No. 17)
21.2.1 Requisitioning
The requisitioner, in choosing the item to be supplied (or the service to be performed) shall always obtain the best value for money for the CCG. In so doing, the advice of the CCG’s adviser on supplies shall be sought. Where this advice is not acceptable to the requisitioner, the CFO (and/or the AO) shall be consulted.
21.2.2 System of Payment and Payment Verification
The CFO shall be responsible for the prompt payment of accounts and claims. Payment of contract invoices shall be in accordance with contract terms, or otherwise, in accordance with national guidance.
155 21.2.3 The CFO will:
(a) advise the Governing Body regarding the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in Standing Orders and Standing Financial Instructions and regularly reviewed;
(b) prepare procedural instructions or guidance within the Scheme of Delegation on the obtaining of goods, works and services incorporating the thresholds;
(c) be responsible for the prompt payment of all properly authorised accounts and claims;
(d) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable. The system shall provide for:
(i) A list of Governing Board members/employees (including specimens of their signatures) authorised to certify invoices.
(ii) Certification that:
goods have been duly received, examined and are in accordance with specification and the prices are correct;
work done or services rendered have been satisfactorily carried out in accordance with the order, and, where applicable, the materials used are of the requisite standard and the charges are correct;
in the case of contracts based on the measurement of time, materials or expenses, the time charged is in accordance with the time sheets, the rates of labour are in accordance with the appropriate rates, the materials have been checked as regards quantity, quality, and price and the charges for the use of vehicles, plant and machinery have been examined;
where appropriate, the expenditure is in accordance with regulations and all necessary authorisations have been obtained;
the account is arithmetically correct;
156 the account is in order for payment.
(iii) A timetable and system for submission to the CFO of accounts for payment; provision shall be made for the early submission of accounts subject to cash discounts or otherwise requiring early payment.
(iv) Instructions to employees regarding the handling and payment of accounts within Finance
(v) be responsible for ensuring that payment for goods and services is only made once the goods and services are received. The only exceptions are set out in SFI No. 21.2.4 below.
21.2.4 Prepayments
Prepayments are only permitted where exceptional circumstances apply. In such instances:
(a) Prepayments are only permitted where the financial advantages outweigh the disadvantages (i.e. cash flows must be discounted to NPV using the National Loans Fund (NLF) rate plus 2%).
(b) The appropriate officer member of the Operational Executive Committee, Transformation and Delivery Committee or Governing Body must provide, in the form of a written report, a case setting out all relevant circumstances of the purchase. The report must set out the effects on the CCG if the supplier is at some time during the course of the prepayment agreement unable to meet his commitments;
(c) The CFO will need to be satisfied with the proposed arrangements before contractual arrangements proceed (taking into account the EU public procurement rules where the contract is above a stipulated financial threshold);
(d) The budget holder is responsible for ensuring that all items due under a prepayment contract are received and they must immediately inform the CFO if problems are encountered.
21.2.5 Official orders
Official Orders must:
(a) be consecutively numbered;
(b) be in a form approved by the CFO;
(c) state the CCG’s terms and conditions of trade;
157 (d) only be issued to, and used by, those duly authorised by the AO.
21.2.6 Duties of Managers and Officers
Managers and officers of the Operational Executive Committee, the Transformation and Delivery Committee and the Governing Body must ensure that they comply fully with the guidance and limits specified by the CFO and that:
(a) all contracts (except as otherwise provided for in the Scheme of Delegation), leases, tenancy agreements and other commitments which may result in a liability are notified to the CFO in advance of any commitment being made;
(b) contracts above specified thresholds are advertised and awarded in accordance with EU rules on public procurement;
(c) where consultancy advice is being obtained, the procurement of such advice must be in accordance with guidance issued by NHS England;
(d) no order shall be issued for any item or items to any firm which has made an offer of gifts, reward or benefit to members, officers or employees, other than:
(i) isolated gifts of a trivial character or inexpensive seasonal gifts, such as calendars;
(ii) conventional hospitality, such as lunches in the course of working visits;
(This provision needs to be read in conjunction with Standing Order No. 6 and the principles outlined in the national guidance contained in HSG 93(5) “Standards of Business Conduct for NHS Staff”; the Code of Conduct for NHS Managers 2002); the ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry and the Bribery Act 2011)
(e) no requisition/order is placed for any item or items for which there is no budget provision unless authorised by the CFO on behalf of the AO;
(f) all goods, services, or works are ordered on an official order except works and services executed in accordance with a contract and purchases from petty cash;
(g) verbal orders must only be issued very exceptionally - by an employee designated by the AO and only in cases of emergency or urgent necessity. These must be confirmed by an official order and clearly marked "Confirmation Order";
158 (h) orders are not split or otherwise placed in a manner devised so as to avoid the financial thresholds;
(i) goods are not taken on trial or loan in circumstances that could commit the CCG to a future uncompetitive purchase;
(j) changes to the list of members/employees and officers authorised to certify invoices are notified to the CFO;
(k) purchases from petty cash are restricted in value and by type of purchase in accordance with instructions issued by the CFO;
(l) petty cash records are maintained in a form as determined by the CFO.
21.3 Joint Finance Arrangements with Local Authorities and Voluntary Bodies (see overlap with Standing Order No. 9.1)
21.3.1 Payments to local authorities and voluntary organisations made under the powers of section 256 of the NHS Act 2006 shall comply with procedures laid down by the CFO which shall be in accordance with that Act. (See overlap with Standing Order No. 9.1)
22. FINANCIAL FRAMEWORK
22.3.1 The CFO should ensure that members of the Governing Body are aware of the Financial Framework. This document contains directions which the CCG must follow. It also contains directions to the NHS England regarding resource and capital allocation and funding to the CCG. The CFO should also ensure that the direction and guidance in the framework is followed by the CCG.
23. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS
23.1 Capital Investment
23.1.1 The AO:
(a) shall ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans;
(b) is responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;
159 (c) shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges.
23.1.2 For every capital expenditure proposal the AO shall ensure:
(a) that a business case is produced setting out:
(i) an option appraisal of potential benefits compared with known costs to determine the option with the highest ratio of benefits to costs;
(ii) appropriate project management and control arrangements;
(b) that the CFO has certified professionally to the costs and revenue consequences detailed in the business case and involved appropriate CCG personnel and external agencies in the process.
23.1.3 For capital schemes where the contracts stipulate stage payments, the AO will issue procedures for their management.
The CFO shall issue procedures for the regular reporting of expenditure and commitment against authorised expenditure.
23.1.4 The approval of a capital programme shall not constitute approval for expenditure on any scheme.
The AO shall issue to the manager responsible for any scheme:
(a) specific authority to commit expenditure;
(b) authority to proceed to tender (see overlap with SFI No. 17.5);
(c) approval to accept a successful tender (see overlap with SFI No. 17.5).
The AO will issue a scheme of delegation for capital investment management in accordance with the CCG’s Standing Orders.
23.1.5 The CFO shall issue procedures governing the financial management, including variations to contract, of capital investment projects and valuation for accounting purposes. These procedures shall fully take into account the delegated limits for capital schemes included in Annex C of HSC (1999) 246, Health Service Circular.
23.2 Not Used
23.3 Asset Registers
160 23.3.1 The AO is responsible for the maintenance of registers of assets, taking account of the advice of the CFO concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.
23.3.2 The CCG shall maintain an asset register recording fixed assets.
23.3.3 Additions to the fixed asset register must be clearly identified to an appropriate budget holder and be validated by reference to:
(a) properly authorised and approved agreements, supplier's invoices and other documentary evidence in respect of purchases from third parties;
(b) stores, requisitions and wages records for own materials and labour including appropriate overheads;
(c) lease agreements in respect of assets held under a finance lease and capitalised.
23.3.4 Where capital assets are sold, scrapped, lost or otherwise disposed of, their value must be removed from the accounting records and each disposal must be validated by reference to authorisation documents and invoices (where appropriate).
23.3.5 The CFO shall approve procedures for reconciling balances on fixed assets accounts in ledgers against balances on fixed asset registers.
23.3.6 The value of each asset shall be assessed and, if appropriate, revalued to ensure that assets are held at ‘modern equivalent asset’ value at the final accounts date.
23.3.7 The value of each asset shall be depreciated using an appropriate method.
23.3.8 The CFO shall calculate and pay capital charges.
23.4 Security of Assets
23.4.1 The overall control of fixed assets is the responsibility of the AO.
23.4.2 Asset control procedures (including fixed assets, cash, cheques and negotiable instruments, and also including donated assets) must be approved by the CFO. This procedure shall make provision for:
(a) recording managerial responsibility for each asset;
(b) identification of additions and disposals;
(c) identification of all repairs and maintenance expenses;
(d) physical security of assets;
161 (e) periodic verification of the existence of, condition of, and title to, assets recorded;
(f) identification and reporting of all costs associated with the retention of an asset;
(g) reporting, recording and safekeeping of cash, cheques, and negotiable instruments.
23.4.3 All discrepancies revealed by verification of physical assets to fixed asset register shall be notified to the CFO.
23.4.4 Whilst each employee and officer has a responsibility for the security of property of the CCG, it is the responsibility of Governing Body members and senior employees in all disciplines to apply such appropriate routine security practices in relation to NHS property as may be determined by the Governing Body. Any breach of agreed security practices must be reported in accordance with agreed procedures.
23.4.5 Any damage to the CCG’s premises, vehicles and equipment, or any loss of equipment, stores or supplies must be reported by Governing Body members and employees as appropriate in accordance with the procedure for reporting losses.
23.4.6 Where practical, assets should be marked as CCG property.
24. STORES AND RECEIPT OF GOODS
24.1 General position
24.1.1 Stores, defined in terms of controlled stores and departmental stores (for immediate use) should be:
(a) kept to a minimum;
(b) subjected to annual stock take;
(c) valued at the lower of cost and net realisable value.
24.2 Control of Stores, Stocktaking, condemnations and disposal
24.2.1 Subject to the responsibility of the CFO for the systems of control, overall responsibility for the control of stores shall be delegated to an employee by the AO. The day-to-day responsibility may be delegated by him/her to employees and stores managers/keepers, subject to such delegation being entered in a record available to the CFO. The control of any Pharmaceutical stocks shall be the responsibility of a designated Pharmaceutical Officer; the control of any fuel oil and coal of a designated estates manager.
162 24.2.2 The responsibility for security arrangements and the custody of keys for any stores and locations shall be clearly defined in writing by the designated manager/Pharmaceutical Officer. Wherever practicable, stocks should be marked as health service property.
24.2.3 The CFO shall set out procedures and systems to regulate the stores including records for receipt of goods, issues, and returns to stores and losses.
24.2.4 Stocktaking arrangements shall be agreed with the CFO and there shall be a physical check covering all items in store at least once a year.
24.2.5 Where a complete system of stores control is not justified, alternative arrangements shall require the approval of the CFO.
24.2.6 The designated Manager shall be responsible for a system approved by the CFO for a review of slow moving and obsolete items and for condemnation, disposal, and replacement of all unserviceable articles. The designated Officer shall report to the CFO any evidence of significant overstocking and of any negligence or malpractice (see also overlap with SFI No. 25 Disposals and Condemnations, Losses and Special Payments). Procedures for the disposal of obsolete stock shall follow the procedures set out for disposal of all surplus and obsolete goods.
24.3 Goods supplied through NHS Central Purchasing Arrangements
24.3.1 For goods supplied via the NHS central purchasing arrangements, the AO shall identify those authorised to requisition and accept goods from the central stores/suppliers. The authorised person shall check receipt against the delivery note before forwarding this to Serco for payment. The CFO shall satisfy himself that arrangements are in place to verify that the goods have been received before payment is made.
25. DISPOSALS AND CONDEMNATIONS, LOSSES AND SPECIAL PAYMENTS
25.1 Disposals and Condemnations
25.1.1 Procedures
The CFO must prepare detailed procedures for the disposal of assets including condemnations, and ensure that these are notified to managers.
25.1.2 When it is decided to dispose of a CCG asset, the authorised officer or employee will determine and advise the CFO of the estimated market value of the item, taking account of professional advice where appropriate.
25.1.3 All unserviceable articles shall be:
163 (a) condemned or otherwise disposed of by an employee authorised for that purpose by the CFO;
(b) recorded by an authorised officer or employee in a form approved by the CFO which will indicate whether the articles are to be converted, destroyed or otherwise disposed of. All entries shall be confirmed by the countersignature of a second employee authorised for the purpose by the CFO.
25.1.4 The authorised officer or employee shall satisfy himself as to whether or not there is evidence of negligence in use and shall report any such evidence to the CFO who will take the appropriate action.
25.2 Losses and Special Payments
25.2.1 Procedures
The CFO must prepare procedural instructions on the recording of and accounting for condemnations, losses, and special payments.
25.2.2 Any employee or officer discovering or suspecting a loss of any kind must either immediately inform their line manager, who must immediately inform the AO and the CFO as appropriate or inform an officer charged with responsibility for responding to concerns involving loss. This officer will then appropriately inform the CFO and/or AO. Where a criminal offence is suspected, the CFO must immediately inform the police if theft or arson is involved, and the CCG’s Security Management Officer. In cases of fraud and corruption or of anomalies which may indicate fraud or corruption, the CFO must inform the relevant LCFS and Operational Fraud Team (OFT) in accordance with the Secretary of State for Health’s Directions.
25.2.3 Suspected fraud
The CFO must notify the NHS CFS and the relevant External Auditor of all frauds.
25.2.4 For losses apparently caused by theft, arson, neglect of duty or gross carelessness, except if trivial, the CFO must immediately notify:
(a) the Governing Body, and
(b) the External Auditor.
25.2.5 Within limits delegated to it by the NHS England, the Governing Body shall approve the writing-off of losses.
25.2.6 The CFO shall be authorised to take any necessary steps to safeguard the CCG’s interests in bankruptcies and company liquidations.
164 25.2.7 For any loss, the CFO should consider whether any insurance claim could be made.
25.2.8 The CFO shall maintain a Losses and Special Payments Register in which write-off action is recorded.
25.2.9 No special payments exceeding delegated limits shall be made without the prior approval of the NHS England.
25.2.10 All losses and special payments must be reported to the Audit Committee at every meeting.
26. INFORMATION TECHNOLOGY
26.1 Responsibilities and duties of the CFO
26.1.1 The CFO, who is responsible for the accuracy and security of the computerised financial data of the CCG, shall:
(a) devise and implement any necessary procedures to ensure adequate (reasonable) protection of the CCG’s data, programs and computer hardware for which he/she is responsible from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 2010;
(b) ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;
(c) ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment;
(d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the CFO may consider necessary are being carried out.
26.1.2 The CFO will need to ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.
26.1.3 The Information Governance Manager shall publish and maintain a Freedom of Information (FOI) Publication Scheme, or adopt a model Publication Scheme approved by the Information Commissioner. A Publication Scheme is a complete guide to the information routinely published by a public authority. It describes the classes or types of information about the CCG that we make publicly available.
165 26.2 Responsibilities and duties of other Officers in relation to computer systems of a general application
26.2.1 In the case of computer systems which are proposed General Applications (i.e. normally those applications which the majority of CCGs in the Region wish to sponsor jointly) all responsible Officers and employees will send to the CFO:
(a) details of the outline design of the system;
(b) in the case of packages acquired either from a commercial organisation, from the NHS, or from another public sector organisation, the operational requirement.
26.3 Contracts for computer services with other health bodies or outside agencies
The CFO shall ensure that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.
Where another health organisation or any other agency provides a computer service for financial applications, the CFO shall periodically seek assurances that adequate controls are in operation.
26.4 Requirements for computer systems which have an impact on corporate financial systems
Where computer systems have an impact on corporate financial systems the CFO shall need to be satisfied that:
(a) systems acquisition, development and maintenance are in line with corporate policies such as an Information Technology Strategy;
(b) data produced for use with financial systems is adequate, accurate, complete and timely, and that a management (audit) trail exists;
(c) finance staff have access to such data;
(d) such computer audit reviews as are considered necessary are being carried out. 27. ACCEPTANCE OF GIFTS BY STAFF AND LINK TO STANDARDS OF BUSINESS CONDUCT (see overlap with SO No. 6 and SFI No. 21.2.6 (d))
166 The CFO shall ensure that all staff are made aware of the CCG’s policy on acceptance of gifts and other benefits in kind by staff. This includes Governing Body members and employees. This policy follows the guidance contained in the Department of Health circular HSG (93) 5 ‘Standards of Business Conduct for NHS Staff’; the Code of Conduct for NHS Managers 2002; the ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry and the Bribery Act 2011 and is also deemed to be an integral part of these Standing Orders and Standing Financial Instructions (see overlap with SO No. 6).
Governing Body members are required to sign that they have read, accepted and are committed to the Codes of Conduct and Accountability documents required of NHS Boards.
28. PAYMENTS TO INDEPENDENT CONTRACTORS
28.1 Role of the CCG
The CCG will approve additions to, and deletions from, approved lists of contractors, taking into account the health needs of the local populations, and the access to existing services. All applications and resignations received shall be dealt with equitably, within any time limits laid down in the contractors NHS terms and conditions of service.
28.2 Duties of the Accountable Officer
The AO shall:
(a) ensure that lists of all contractors, for which the CCG is responsible, are maintained in an up to date condition;
(b) ensure that systems are in place to deal with applications, resignations, inspection of premises, etc., within the appropriate contractor's terms and conditions of service.
28.3 Duties of the Chief Financial Officer
The CFO shall:
(a) ensure that contractors who are included on the CCG’s approved lists receive payments;
(b) maintain a system of payments such that all valid contractors' claims are paid promptly and correctly, and are supported by the appropriate documentation and signatures;
(c) ensure that regular independent verification of claims is undertaken, to confirm that:
167 (i) rules have been correctly and consistently applied;
(ii) overpayments are detected (or preferably prevented) and recovery initiated;
(iii) suspicions of possible fraud are identified and subsequently dealt with in line with the Secretary of State for Health’s Directions on the management of fraud and corruption.
(d) ensure that arrangements are in place to identify contractors receiving exceptionally high, low or no payments, and highlight these for further investigation; and
(e) ensure that a prompt response is made to any query raised by NHS Prescription Services of the NHS Business Services Authority, regarding claims from contractors submitted directly to them.
29. RETENTION OF RECORDS
29.1 The AO shall be responsible for maintaining archives for all records required to be retained in accordance with Records Management Code of Practice Part 2 (Retention Periods) – last revised 8th January 2009
29.2 The records held in archives shall be capable of retrieval by authorised persons.
29.3 Records held in accordance with Records Management Code of Practice Part 2 (Retention Periods) – last revised 8th January 2009 shall only be destroyed at the express instigation of the AO. Detail shall be maintained of records so destroyed.
30. RISK MANAGEMENT AND INSURANCE
30.1 Programme of Risk Management
The AO shall ensure that the Governing Body has a programme of risk management, in accordance with current NHS England assurance framework requirements, which must be approved and monitored by the Governing Body.
The programme of risk management shall include:
a) a process for identifying and quantifying risks and potential liabilities;
b) engendering among all levels of staff a positive attitude towards the control of risk;
c) management processes to ensure all significant risks and potential liabilities are addressed including effective systems of internal control,
168 cost effective insurance cover, and decisions on the acceptable level of retained risk;
d) contingency plans to offset the impact of adverse events;
e) audit arrangements including; internal audit, clinical audit, health and safety review;
f) a clear indication of which risks shall be insured;
g) arrangements to review the risk management programme.
The existence, integration and evaluation of the above elements will assist in providing a basis to make a statement on the effectiveness of internal control within the Annual Report and Accounts as required by current NHS England guidance.
30.2 Insurance: Risk Pooling Schemes administered by NHSLA
The Governing Body shall decide if the CCG will insure through the risk pooling schemes administered by the NHS Litigation Authority or self-insure for some or all of the risks covered by the risk pooling schemes. If the Governing Body decides not to use the risk pooling schemes for any of the risk areas (clinical, property and employers/third party liability) covered by the scheme this decision shall be reviewed annually.
30.3 Insurance arrangements with commercial insurers
30.3.1 There is a general prohibition on entering into insurance arrangements with commercial insurers.
30.4 Arrangements to be followed by the Governing Body in agreeing Insurance cover
(1) Where the Governing Body decides to use the risk pooling schemes administered by the NHS Litigation Authority the CFO shall ensure that the arrangements entered into are appropriate and complementary to the risk management programme. The CFO shall ensure that documented procedures cover these arrangements.
(2) Where the Governing Body decides not to use the risk pooling schemes administered by the NHS Litigation Authority for one or other of the risks covered by the schemes, the CFO shall ensure that the Governing Body is informed of the nature and extent of the risks that are self-insured as a result of this decision. The CFO will draw up formal documented procedures for the management of any claims arising from third parties and payments in respect of losses which will not be reimbursed.
169 (3) All the risk-pooling schemes require Scheme members to make some contribution to the settlement of claims (the ‘deductible’). The CFO should ensure documented procedures also cover the management of claims and payments below the deductible limit.
170 Appendix 7 – NHS Constitution http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/ Overview.aspx
171 Appendix 8 – CCG Board Lead Roles
Caldicott Guardian TBA, Elected GP Board Member Lisa Llewelyn, Director of Nursing and Quality, Deputy Senior Information Responsible Officer Kate Vaughton Chief Operating Officer Information Governance Policy Kirsty Denwood, CFO TBA, Elected GP Member Data Protection and Confidentiality Policy Kirsty Denwood, CFO TBA, Elected GP Member Information Lifecycle Management Kirsty Denwood, CFO Policy, Procedure and Strategy TBA, Elected GP Member Information Risk Policy Kirsty Denwood, CFO TBA, Elected GP Member Information Sharing Policy Kirsty Denwood, CFO TBA, Elected GP Member Safe Haven Policy Kirsty Denwood, CFO TBA, Elected GP Member Access to Information Policy (FOI, SAR, Kirsty Denwood, CFO AHRA) TBA, Elected GP Member Information and Cyber Security Policy Lisa Llewelyn, Director of Nursing and Quality TBA, Elected GP Member Acceptable Use of E-Communications Lisa Llewelyn, Director of Nursing and and Devices Policy Quality TBA, Elected GP Member Safeguarding Adults and Children Lisa Llewelyn, Director of Nursing and Policies Quality Safeguarding Adults and Children Pam Donnelly. Lay Member and Quality Champion Committee Chair Health and Safety Policy Kate Vaughton, COO Health and Safety Champion Lizzy Firmin. Lay Member, PPI and TDC Chair Security Management Workplan Kirsty Denwood CFO Jerry Wedge. Lay Member and Audit Chair Equality and Diversity Policy Lisa Llewelyn, Director of Nursing and Quality Equality and Diversity Champion Dr Freda Bhatti, Elected GP Board Member Whistle-blowing Policy, Kirsty Denwood, CFO Whistle-blowing and Bullying Jerry Wedge. Lay Member and Audit Champion Chair Mental Health Executive lead (Including Lisa Llewelyn, Director of Nursing and Mental Capacity Act - Deprivation of Quality Liberty) Mental Health Champions Pam Donnelly. Lay Member and Quality Committee Chair Dr Mark Roberts, Elected GP Board Member Research and innovation Executive Lead Pam Green, Director of Transformation and Strategy Research and innovation Champion Dr Max Hickman, Elected GP Board
172 Member Education and Training Executive Lead Kirsty Denwood, CFO Dr Max Hickman, Elected GP Board Member Education and Training Champion Dr Max Hickman, Elected GP Board Member Patient Choice Executive Lead Lisa Llewelyn, Director of Nursing and Quality Patient Choice Champion Dr Freda Bhatti, Elected GP Board Member Risk Management Policy Kate Vaughton, COO Martyn Hanlon. Lay Member, F&P Committee Chair and Remuneration Committee Chair Anti-Fraud, Bribery Policy Kirsty Denwood, CFO Anti-Fraud and Bribery Champion Jerry Wedge. Lay Member and Audit Chair Overpayment Recovery Policy Kirsty Denwood, CFO Jerry Wedge. Lay Member and Audit Chair
Procurement Strategy and Policy Kate Vaughton, COO Dr Max Hickman, Elected GP Board Member Standards of Business Conduct Policy Kirsty Denwood, CFO Jerry Wedge. Lay Member and Audit Chair Incident Reporting and Management Lisa Llewelyn, Director of Nursing and Policy Quality Pam Donnelly. Lay Member and Quality Committee Chair Serious Incident Management Policy Lisa Llewelyn, Director of Nursing and Quality Pam Donnelly. Lay Member and Quality Committee Chair Complaints and PALS policy Lisa Llewelyn, Director of Nursing and Quality Pam Donnelly. Lay Member and Quality Committee Chair Forensic Readiness Policy Lisa Llewelyn, Director of Nursing and Quality Martyn Hanlon. Lay Member, F&P Committee Chair and Remuneration Committee Chair Business Continuity and Management Kate Vaughton, COO System and Policy Martyn Hanlon. Lay Member, F&P Committee Chair and Remuneration Committee Chair Prior Approval, Individual Funding and Pam Green, Director of Transformation Exceptional Cases Request Policy and Strategy Dr Mark Roberts, Elected GP Board Member Clinical Priorities Policy Pam Green, Director of Transformation and Strategy
173 Dr Prashant Arora. Elected GP Board Member Member Practices Champion Martyn Hanlon. Lay Member, F&P Committee Chair and Remuneration Committee Chair
All the policies outlined above have an Executive lead responsible for presentation of that policy to the Board, and a Non-Executive lead responsible for leading the scrutiny of that policy at the Board. In addition there are "themed areas" that have an Executive lead responsible for ensuring that these themes are recognised and taken into account in key policy decisions, and a Non-Executive lead, designated as "Champion," responsible for ensuring that this is the case.
Appendix 9 – Memorandum of Agreement
MEMORANDUM OF AGREEMENT
between
NORTH EAST ESSEX CLINICAL COMMISSIONING GROUP LTD
174 & Insert name of practice
SCHEME: CLINICAL COMMISSIONING
TYPE OF AGREEMENT: Memorandum of agreement outlining the responsibilities, duties and actions required to achieve successful Clinical commissioning in North East Essex
PERIOD OF AGREEMENT: 1st April 2012 – 31st March 2013
CONTACT: North East Essex Clinical Commissioning Group C/O Chief Operating Officer, PCC, Turner Road, Colchester, CO4 5JR
TELEPHONE NUMBER Tel: 01206 286693 FAX NUMBER
PRACTICE: Insert name & Address of Practice
PRACTICE LEAD(S): Insert name of Practice Lead(s)
TELEPHONE NUMBER: Insert contact details
AUTHOR North East Essex Clinical Commissioning Group
Additional support provided by Essex LMCs
Schedule 1a – Sign up Sheet 2012/13
Practice to complete both Schedule 1a and schedule 1b and return
Part 1: The North East Essex Clinical Commissioning Group
NAME OF SIGNATURE NAME OF DATE
175 NORTH EAST SIGNATORY ESSEX CLINICAL COMMISSIONIN G GROUP North East Essex Clinical Commissioning Group
Part 2: The Practice
NAME OF SIGNATURE NAME OF DATE PRACTICE SIGNATORY
Schedule 1b – Sign up Sheet 2012/13
Practice to complete both Schedule 1a and schedule 1b and return
Part 1: The North East Essex Clinical Commissioning Group
176 NAME OF SIGNATURE NAME OF DATE NORTH EAST SIGNATORY ESSEX CLINICAL COMMISSIONIN G GROUP North East Essex Clinical Commissioning Group
Part 2: The Practice
NAME OF SIGNATURE NAME OF DATE PRACTICE SIGNATORY
Schedule 2 – Responsibilities
RESPONSIBILITIES OF NORTH EAST ESSEX CCG
1.1 Commissioning and Procurement
177 1.1.1 Working with practices to ensure that the spend on commissioned services remains within the CCG resource allocation; 1.1.2 Commission health services for the patients of our practices on the basis of need; 1.1.3 To collaborate with neighbouring CCGs on commissioning local providers; 1.1.4 To negotiate contracts on behalf of practices for commissioned services; 1.1.5 Take ownership of the QIPP Agenda; 1.1.6 Identify potential providers for services; 1.1.7 Meeting national procurement regulations; 1.1.8 Monitor contracts and develop specification with robust Key Performance Indicators 1.1.9 Development of alternative models of provision; 1.1.10 Work with stakeholders to improve the quality of GP Services.
1.2 Partnerships and external relationships
1.2.1 To develop a framework that delivers outcomes for public and patient engagement; 1.2.2 To collaborate with neighbouring CCGs when commissioning services from providers when appropriate; 1.2.3 To work in partnership with the North Essex PCT Cluster to define the running costs and HR needs of the CCG; 1.2.4 To proactively communicate with practices on issues relating to the effective and efficient functioning of Clinical Commissioning; 1.2.5 Help develop partnerships with relevant stakeholders; 1.2.6 Support and respect staff working within Practices; 1.2.7 To continually develop the knowledge and skills of those connected to the CCG and Clinical Commissioning.
1.3 Governance
1.3.1 Develop the governance arrangements for decision making which are robust, transparent and responsive to change; 1.3.2 To recognise the requirements of information governance, data protection laws and data sharing agreements; 1.3.3 To work within the requirements of the Memorandum and Articles of Association of the Company.
1.4 Performance
1.4.1 To jointly produce and agree methodologies for peer review with practices. 1.4.2 To facilitate and assure peer review of performance and offer support to practices to improve performance where required; 1.4.3 To hold practices to account for the use of resources (i.e. Acute Budget);
178 1.4.4 To take responsibility for any other area of performance delegated to the consortium; 1.4.5 Develop and adhere to Dispute Resolution Procedures.
1.5 Information and Budget setting
1.5.1 To establish the information requirements from providers within the procurement and contracting process as Key Performance Indicators; 1.5.2 Establish an approach to hospital data validation including the consideration of IT investment; 1.5.3 Develop guidance on how additional funding through discretionary budgets should be used; 1.5.4 To receive, analyse and present information from providers that assist practices with managing demand and improving patient care. This will be, wherever possible, at patient level. Information Governance and data protection rules will be applied to the data we hold; 1.5.5 Facilitate the development of budget setting methodologies for practice allocations.
2 RESPONSIBILITIES OF PRACTICES
2.1 Engagement
2.1.1 Actively participate with local and CCG- wide public and patient engagement. Practice should consider the establishment of Patient Participation groups; 2.1.2 Release nursing staff for the Clinical commissioning Nurse Forums; 2.1.3 Each practice is to designate both a clinical and a management staff member to liaise and take a leading role for Clinical Commissioning. They will be responsible for disseminating relevant information within their practice; 2.1.4 Take part in Clinical Commissioning practice visits; 2.1.5 Vote in elections pertaining to North East Essex Clinical Commissioning; 2.1.6 Engage with helping to deliver and support Clinical Commissioning; 2.1.7 Maintain a willingness to appreciate that Clinical Commissioning is a shared responsibility between Practices; 2.1.8 Support and respect staff working within with the Clinical Commissioning organisation; 2.1.9 Respond to information requests in a timely manner; 2.1.10 Attend and participate in Practice Forums.
2.2 Commissioning and Procurement
2.2.1 Help support the development and improvement of services including patient pathways;
179 2.2.2 Inform Clinical Commissioners about issues arising from provider performance; 2.2.3 Maintaining an open mind with regard to how services might be developed.
2.3 Development and review
2.3.1 Engage fully in regular peer-review such as hard budgets, Quality and Productivity, incentive schemes and any other relevant area to improve performance; 2.3.2 Participate in local training events and “Shutdowns”; 2.3.3 Share specialist skills within the consortium and also “lessons learnt” and best practice; 2.3.4 Attend and engage with Practice Forums
2.4 Quality and performance
2.4.1 Use best practice and agreed pathways; 2.4.2 Manage resources and make every effort to remain within Budget, be prepared to offer a reasonable explanation if unable to do so, and to show that mechanisms have been put into effect to bring spending back into line; 2.4.3 Participate in any reasonable process for performance management.
180 Appendix 10
181 Appendix 11
Prospectus for
CCG Elected Members
North East Essex Clinical Commissioning Group Primary Care Centre, Turner Road, Colchester. CO4 5JR Tel: 01206 286500 Web: www.neessexccg.nhs.uk
Page 182 of 234 Contents
1. Foreword Page 3
2. Our Vision and Values Page 4
3. A clinically-led organisation Page 5
4. Roles of elected members Page 6
5. Skills Page 7
6. Responsibilities Page 8
7. Personal development opportunities Page 9
Appendix 1 How to apply Page 10
Appendix 2 CCG Board, Committees and Groups Page 11
Appendix 3 Nolan Principles for Standards in Public Life Page 13
Page 183 of 234 Dear colleagues,
Welcome to this prospectus for elections for the vital roles of clinical members for 2016.
North East Essex CCG is clinically led, spending around £450 million each year, made up of 40 member practices in Colchester and Tendring
We face difficult times over the next few years with a need to meet a significant financial challenge. With strong clinical leadership, we aim to commission in new ways to ensure that people in North East Essex receive high quality, integrated care, delivered in a way that is sustainable in the future.
This prospectus sets out both the main roles and responsibilities of elected members, and what you as Practices can expect from us. We are keen to use and develop the skills of our elected members to make us one of the best clinical commissioning groups in the country. Our elected members have a key role in helping us to shape our plans, be a critical friend and ensure that we stay closely connected to our member Practices. The only way we will guarantee great health services for our patients is through leading the way ourselves – we are closest to our patients!
We are looking for 8 colleagues from our member Practices to join us in taking forward our exciting and challenging agenda. We would like 6 clinicians and 2 PMs with our elected members equally divided between Tendring and Colchester.
To make sure that we are able to provide continuity of clinical leadership within the organisation, we intend to equally divide the tenure between two groups. Half of the elected members will have a three year tenure with the other half having two years.
Our commissioning plans are set out in the North East Essex Five Year Strategic Plan which can be found under the Library / plans tab on the CCG website – neessexccg.nhs.uk - or click here
The elections are being run by North Essex LMC and details about how to apply and the pre-selection process can be found in Appendix 1.
If you have any questions, please get in touch with myself ([email protected]) We look forward to receiving your applications,
Best wishes
HMC
GP & Clinical Director NHS North East Essex Clinical Commissioning Group
Page 184 of 234 Values Values
What it means for local people CCG Values What it means for our team We work in the spirit of PUBLIC INTEGRITY Be HONEST with ourselves and each SERVICE, PROFESSIONALISM and other. Decisions will be made on MERIT. SELFLESSNESS to serve our local population Always CHALLENGE each other in a respectful way
We ensure services RESPOND to PERSON People are our biggest asset. Select people as INDIVIDUALS, CENTERED and encourage people to be BETTER INVOLVING them in care decisions THAN US, create OPPORTUNITIES for and planning of services them to grow
Our decisions are driven by the INCLUSIVE LISTEN to what people tell us, SEEK NEEDS OF THE WHOLE POPULATION OUT their views. CELEBRATE our joys and prioritises the and successes GREATEST IMPROVEMENTS
Our communities require HIGH IMPROVEMENT DREAM BIG! Pursue THE BEST for QUALITY SERVICES. We will local people. REFLECT on what works; seek to always IMPROVE QUALITY stop doing what doesn’t! and embrace innovation to do this LEAD BY EXAMPLE
The CCG promotes and abides by the Nolan Principles for Standards in Public Life – see Appendix 3
Traditionally, health and social care has been organised more around specific services, rather than the needs of each individual person.
We want to work in partnership with public, patients and carers in North East Essex to help them have greater choice, control and responsibility for health and wellbeing services:
People will be encouraged and supported to look after their own health and social care needs including their mental health and emotional well being Carers will receive the support they need. Patients, public and community groups will take up opportunities to be involved in planning and developing services and feeding back on their experience of care Services will be centred around the patient and will be high quality, evidence based, cost effective and sustainable People will receive seamless and joined up services across their health and social care needs
Page 185 of 234 NE Essex CCG became a statutory organisation on 1st April 2013
Understanding that clinicians need to understand and be consulted on what the issues and potential solutions could be – it simply raises clinicians’ antibodies to be told “this is the problem and this is the solution” not view these leadership positions as transitional along differences between a PCT and CCG are:
Page 186 of 234 We are looking to fill roles as Board Members and TDC Members. Details about purpose, frequency and length of meetings are shown in Appendix 2.
We are looking for 4 governance members and 4 service development leads.
Governance members – your main duties will be as a CCG Board member plus a member of TDC. You will have a key role in ensuring that the CCG carries out its statutory functions and you will have an interest in the organisation as a whole, in addition to a focus on clinical excellence and engagement plus visits to provider units.
Service Development members – your main interests will lie in improving services for patients and ensuring that clinical quality, safety and patient experience are at the heart of what the CCG does. You will be a member of TDC and a Programme Board and will also take part in seasonal strategic planning meetings, plus visits to provider units.
All elected members will be expected to attend Board development sessions and to attend the Clinical Reference Group meetings when not attending Board or TDC. We will also encourage you to take up opportunities for personal development - see p9.
We are also looking for non-elected clinical members to be specialty leads for specific projects now and in the future. If you are interested, please see Appendix 1.
ROLES SESSIONS DUTIES
Governance 4 per Board PLUS CRG Elected members Board and members month* TDC meetings Personal Practice development
Service 4 per TDC PLUS CRG Elected members Board and Development month* Programme meetings Personal members Board Practice Visits development
Specialty leads 1 per week Project group Personal (non-elected) (Fixed Strategy/ development term) CQRG / etc. *1 session lasts for 4 hours
Remuneration will be at the following rates:
GP - £90 per hour Practice Manager - £43 per hour Practice Nurse - £40 per hour
Page 187 of 234
Your responsibilities to the CCG
Be a positive ambassador for the NHS and Challenge thinking in a constructive way our CCG
Own the CCG’s agenda Help to find and develop solutions
Support the CCG to deliver its strategy Communicate effectively with primary care & patients
Give a clinical perspective as we work Be a champion for the patients of NE Essex together
Lead and support innovation and Leave your practice interests at the door improvement in services
Page 188 of 234 Our responsibilities to you
Help you keep up to date with national and local Support you in your personal development as a initiatives clinical commissioner
Involve you in the development of strategy and Give you the tools you need to be a clinical plans commissioner
Seek out your views and listen to your advice Involve you in service development initiatives
Give you opportunities to use and develop your Give you opportunities to act as an ambassador leadership skills for the CCG
Help you develop your management and project Support you in your work with member skills practices and providers
Page 189 of 234 We recognise that it takes time to fully develop into the role of an elected CCG member and so we take personal and organisational development seriously.
The CCG will provide you with development opportunities, for up to 10% of your contracted hours as follows:-
5% of Structured E.g. courses, Courses and contracted development conferences, CCG conferences will hours Board Development need to be agreed sessions in advance with the AO in terms of relevance and cost 5% of Individual E.g. Research, contracted development study, job hours shadowing
Where additional hours are required to undertake structured development, these will be considered by the Chief Officer on a case by case basis
Board development sessions take place bi-monthly and we have a programme of both internal and external speakers. Sessions are interactive, with plenty of time for questions and discussion.
Appendix 1 – How to apply
Page 190 of 234 a) To be an elected member
The job descriptions and person specification are embedded below:-
Please email your application, CV and a supporting statement to [email protected] with “NEE CCG Elections” in the subject line by close of business on Friday 15th January 2016. Your supporting statement should include:-
How you can contribute to delivering the CCG vision Your skills and experience in:- o Leadership eg practice meetings, working groups o Service development eg QP pathways o Engagement and communication eg patient and professional groups
Guidance notes for applicants and an Equal Opportunities Monitoring Form can be found below. (Completion of the Equal Opportunities Monitoring Form is optional).
All applications will be assessed by the LMC against the person specification and applicants who meet the standard will be eligible to stand for election, should this prove necessary. All applicants will be informed of the outcome of the LMC assessment by Friday 1st November 2013.
b) To be a non-elected specialty lead
Please submit a 250 word statement covering:-
Your specialty area/s The skills and experience you can bring to service development in your area/s
Please email your application to [email protected] with “Specialty Lead application” in the subject line. There is no deadline – we welcome applications at any time.
Each application will be held on file and will be assessed on its own merits. When there is a need for input in that service area we will then contact you to check that you are still interested and to discuss details with you.
Page 191 of 234 Appendix 2 – Summary of role of CCG Board, Committees and Groups
Board / committee / group Main functions Frequency (and length of meetings)
CCG Board Commissioning those services Bi-monthly (4 hours) within its remit, making optimal use of resources to meet the reasonable needs of all patients in NE Essex Care Closer to Home Project Group Responsible to Programme Bi-monthly (1.5 hours) Board for delivering this project Clinical Audit Assure quality and contractual Hours as required, depending on compliance with contracts scope of audit Contracts meetings To ensure that all services Monthly or quarterly (dependant delivered under the contract on provider) (2 hours) There are meetings with each attain the appropriate levels provider of quality and are compliant with all aspects of the Contract Clinical Quality Review Groups x 4 To provide the Contract Each Group meets monthly 1. CHUFT Performance Monitoring (2 hours) 2. ACE Group with an independent 3. RAMSAY and objective review of all aspects of quality and safety 4. OOH relating to the provision of care and services in support of getting the best clinical outcomes and experience for patients Clinical Reference Group To provide clinical support to Tuesday PM (4 hours) CCG through weekly meetings Elected Members meetings To provide updates and allow Monthly (1.5 hours) time for discussions with senior managers on specific issues End of Life Care Project Group Responsible to Programme Bi-monthly (1.5 hours) Board for delivering this project Independent Living Project Group Responsible to Programme Bi-monthly (1.5 hours) Board for delivering this project Local Economy SHMI Group Review, analysis and Monthly (2 hours) reporting of SHMI. (Summary Hospital-level Investigate outliers. Mortality Indicator) Identify and implement improvements across local economy Mental Health Advisory Group Provide advice to the three Monthly ( 2 hours ) North Essex CCGs and Essex County Council on mental health commissioning
NE Essex Health Forum Public membership Forum Committee meets organisation that works with monthly (2 hours) and the three the CCG to ensure that the Local Engagement Forums each patient, carer and public voice meet bi-monthly (2 hours) Page 192 of 234 is heard
Quality Committee To provide the CCG Board Monthly (3 hours) with an independent and objective review of all aspects of quality and safety relating to the provision of care and services in support of getting the best clinical outcomes and experience for patients Quality, Innovation, Productivity The QIPP Programme Board Monthly (2 hours) and Prevention is authorised by the CCG Executive to oversee QIPP delivery and performance, encompassing finance and performance information. Practice Visits Peer quality reviews and One per practice per annum (1 support hour each) Programme Board Ensure delivery of CCG’s Monthly (1.5 hours) Integrated Plan TDC To manage the delivery of the Monthly (4 hours) commissioning plan on behalf of the CCG Board System Resilience Group Developing and overseeing Weekly (2 hours) implementation of urgent care strategy for NE Essex
Page 193 of 234 Appendix 3 Nolan Principles for Standards in Public Life
Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends
Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties
Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit
Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office
Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands it
Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest
Leadership Holders of public office should promote and support these principles by leadership and example.
Page 194 of 234 Appendix 12
SPECIFIC DELEGATED POWERS
The following delegation limits are the lowest levels to which authority is delegated and the authorisation of the AO is required for any delegation below these levels.
Financial delegations must be formalised in an appropriately authorised ‘Delegated Powers to Office’ form.
In the absence of the AO, the Deputy AO holds full authority for the AO’s delegations listed below. The CFO will nominate one of his/her Senior Managers to hold his/her delegations in his/her absence.
KEY Tier 1 Accountable Officer or Chief Financial Officer Tier 2 Chief Operating Officer, Director of Nursing, Medical Director and other nominated senior managers Tier 3 Head of Service Tier 4 Business Delivery Managers BHR Budget Holder Representative GB Governing Board (the CCG Board) EXEC Operational Executive Committee TDC Transformation Delivery Committee AO Accountable Officer of the CCG
Page 195 of 234 CFO Chief Financial Officer of the CCG COO Chief Operating Officer of the CCG DoN Director of Nursing
DELEGATED REFERENCE MATTER DOCUMENTS
1. Approval of Budgets The Governing Body will approve GB SFI 13.2.2 the CCG budgets including the split of budgets between Cost 2. Centres CFO SFI 13.2.3
Monitoring of Financial Performance Management of Budgets: a) At individual budget level (Pay and All budget holders SFI 13.3 & SFI 13.4 non-Pay) within delegated limit b) Summary budgets Tiers 1&2 c) Financial Reserves and Provisions CFO d) Approving expenditure greater than CFO tender price up to a maximum of 10% or £30k whichever is higher e) Approving expenditure greater than Exec or TDC as relevant to tender price of more than 10% or contract £30k
3. Maintenance/Operation of Bank Accounts Day to day operation of Trust bank CFO – all changes in banking arrangements are to be reported to the SFI 15.1, 15.2, 15.3 accounts Audit Committee
Authorisation of cash limit draw CFO or nominated deputy down
Page 196 of 234 DELEGATED REFERENCE MATTER DOCUMENTS
Authorisation of cheque requests up to £10,000 All budget holders CFO or nominated deputy (cheque requests should only be raised for £10,001 and over amounts in excess of £10,000 in exceptional circumstances) SFI 21 & SFI 23 4. Non-pay Revenue and Capital Expenditure All values quoted are inclusive of VAT regardless of whether that VAT is reclaimable or not Requisitioning /Ordering /Payment of Goods & Services
Before any order is placed, the budget holder must confirm that budgets are available and that procurement processes have been complied with a) Up to £5,000 BHR SFI 17 From £5,001 to £50,000 Tier 4 From £50,001 to £100,000 Tier 3 From £100,001 to £500,000 Tier 2 From £500,001 to £1,000,000 Tier 1 From £1,000,001 CFO & AO
b) Where there is a signed contract and the sums invoiced are included in the signed contract or covered in a signed contract variation, higher limits may be agreed for these invoices only. Such exceptions should be formalised by a ‘Delegated Powers to Office’ form
Page 197 of 234 DELEGATED REFERENCE MATTER DOCUMENTS
authorised by both the relevant Tier 2 staff member and the CFO (i) Invoices up to £500,000 Tier 3 (ii) Invoices from £500,001 to Tier 2 £2,500,000 (iii) Invoices from £500,001 to Tier 1 £15,000,000 c) Requisitions exceeding 12 month AO or CFO period d) Non pay expenditure for which no AO or CFO specific budget has been set up and which is not subject to funding under delegated powers of virement (subject to the limits specified above in (a)) e) All contracts for goods & services and subsequent variations to contracts. Calculated with original contract plus variation giving total value limits for period of contract – if rolling contract base assume 3 years for purposes of this calculation;
All contracts up to £50,000 (up to Tier 4 SFI 17.8.1 £75,000 for contracts exceeding 12 Tier 3 months) All contracts from £50,001 to £100,000 (£75,001 to £150,000 for contracts exceeding 12 months) All contracts from £100,001 to Tier 2
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£500,000 (£150,001 to £750,000 for contracts exceeding 12 months) All contracts from £500,001 to Tier 1 to sign – Exec or TDC to £1,000,000 (£750,001 to £1,500,000 agree for contracts exceeding 12 months) All contracts from £1,000,001 to AO and CFO to sign – Exec or £3,000,000 (£1,500,001 to TDC to agree £4,500,000 for contracts exceeding 12 months) Either AO or CFO sign off.
Financial variations to contract (Financial variations relate to a liability for NEECCG) which are Either AO or CFO sign off. below 10% of the contract value. AO and CFO to sign – Exec or For contract variations with no TDC to agree monetary value
Contract Variations which then puts contract value over £1M in 1 year or £4.5M over life of contract.
All contracts from £3,000,001 AO and CFO to sign – GB to (£4,500,001 for contracts exceeding agree 12 months)
Either AO or CFO sign off. Financial variations to contract (Financial variations relate to a liability for NEECCG) which are below 10% of the contract value. Either AO or CFO sign off.
For contract variations with no
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monetary value
f) All staff when on call are On Call Managers permitted to authorise expenditure up to the value of £5000 in order to deal with an urgent issue where a financial commitment is required. This is for on call out of hours and only if the CFO/AO are not available. Retrospective authorisation is required after the event in accordance with these instructions
4.2 Reprofiling of Budgets All reprofiling Budget Holder with finance
4.3 Virements
a) Virements up to £50,000 Tier 4 b) Virements from £50,001 to £100,000 Tier 3 d) Virements from £100,001 to Tier 2 £500,000 e) Virements from £500,001 Tier 1 to sign and details reported to Governing Body
SFI 23 5. Capital Schemes
Approval of annual capital plans Governing Body
Approval of changes to the Finance and Performance Committee Board agreed capital plans Financial monitoring and reporting CFO SFI 23.1.5
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on all capital scheme expenditure and leasing of equipment and other assets
SFI 17 6. Quotation, Tendering & Contract Procedures for expenditure /income proposals, whether capital or revenue, purchases or disposals
The value of the goods and services should be the total contract value, not the annual value. Where the number of years is not specified or is open ended from year to year, a 3 year period should be assumed for the purpose of this calculation.
a) From £501 to £5,000, obtain a All minimum of 2 verbal quotations and detail on the ‘Record of Verbal Quotation.
b) From £5,001 to £50,000, obtain a All minimum of 3 written quotations
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c) From £50,001 to £100,000, follow All the Competitive Quote procedure to d) All obtain a minimum of 4 written quotations against a written specification with a detailed option appraisal Follow tender procedures for goods and services with a contract value above £100,000 e) Waiving of quotations & tenders AO or CFO – to be reported to the subject to SOs and SFIs Audit Committee
7. Engagement of Staff Not on the Establishment
a) Engagement of CCG’s Solicitors Nominated Officer
b) Booking of Interim or Agency Staff Tiers 1-4 (within auth limits) SFI 17.2 (Subject to guidance issued by Using the East of England Secretary of State for Health and/or Collaborative Procurement Hub NHS England on off-payroll staffing.) agreements as first point of supply to ensure staff are recruited in accordance with current regs
c) Tier 2 or above SFI 17 Consultancy Staff Subject to guidance from the Secretary of State for Health and/or NHS England. Where aggregate commitment in any one year (or the total commitment) is less than £50,000 and within budget
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8. Agreements/Licences
a) Entering new leases and extensions CFO to existing leases
9 Condemning & Disposal SFI 25.1
Appropriate risk assessments, such as ensuring that the condition of goods is safe and fit for purpose, need to be carried out prior to disposal
For items for disposal exceeding a sale value of £5,000, competitive tender may be required
Items obsolete, obsolescent, Tier 3 or above redundant, irreparable or cannot be Tier 2 or above repaired cost effectively:
Replacement purchase cost up to £250 Replacement purchase cost > £250 SFI 16.3, SFI 25.2.2 10 Losses, Write Off & Compensation
a) Losses due to theft, fraud, overpayment, fruitless payments, non-contracted activity, compensation payments (i) Up to £5,000 CFO & AO (ii) Between £5,001 and £25,000 Audit Committee Page 203 of 234 DELEGATED REFERENCE MATTER DOCUMENTS
(ii) Over £25,000 Governing Body b) Redress payments made in respect of Continuing Care costs (i) Up to £10,000 CFO (ii) Over £10,001 CCG CHC Panel
c) Patients and staff for loss of personal effects (i) Up to £100 All budget holders (ii) Between £101 and £500 Tier 2 (iii) Between £501 and £1,000 Tier 1 (iv) Over £1,000 Audit Committee d) Write off of Non NHS Debtors Up to £500 CFO Between £501 and £5,000 AO & CFO Over £5,000 Audit Committee ALL INSTANCES OF LOSSES OR WRITE OFF WILL BE REPORTED TO THE AUDIT COMMITTEE
11 Reporting of Incidents to the Police a) Where a criminal offence is SFIs Sections 11.2.1(c) & 25 suspected (i) criminal offence of a violent Notify on call manager but also nature informing CCG Security Lead (ii) other On call manager and CFO if fraud is suspected 12 Petty Cash Disbursements a) Expenditure up to £25 per claim Petty Cash Holder SFIs Section 16.4
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b) Expenditure from £25 to £75 per Budget Holders SFIs Section 16.4 claim
13 Implementation of Internal and CFO to oversee, actioning officer as specified in individual audit reports SFIs Section 11 External Audit Recommendations
14 Maintenance & Update on Trust CFO SFIs Section 10 Financial Procedures
15 Personnel & Pay SFI Section 20
a) Authority to fill funded post on the Tier 3 or above establishment with permanent staff. (subject to any special measures & guidance issued by the Secretary of State for Health and/or NHS England on VSM staff with a total remuneration package over £142,500 pa & those returning from retirement) b) Authority to appoint staff to post not Tier 2 or above on the formal establishment (subject to budget constraints measures & guidance issued by the Secretary of State for Health and/or NHS England on VSM staff with a total remuneration package over £142,500 pa & those returning from retirement)) c) Upgrading & Regrading – including CFO if supported by Agenda for SFI 20.3.1 accelerating a member of staff up Change matching process the scale Page 205 of 234 DELEGATED REFERENCE MATTER DOCUMENTS d) Whilst in a period of financial recovery all recruitment requests or changes to hours or rates of pay for all staff must be approved by the e) Operational Executive Committee
Pay – all within approved budgets Authority to complete standing data Budget Holders for all grades below forms affecting pay, new starters, own variations and leavers Budget Holders for all grades Authority to complete and authorise below own reporting forms Authority to authorise overtime Tier 2 and above Authority to authorise travel & Budget Holders for all grades subsistence expenses below own Approval of Performance Related Remuneration Committee Pay Assessment Tier 2 and above Renewal of fixed term contract f) Leave
Approval of annual leave Line Manager Agenda for Change (AfC) Annual leave - approval of carry Line Manager forward (up to maximum of 5 days or one working week). Annual leave - approval of carry Tier 2 and above over in excess of 5days or one working week – only permitted in extreme cases where business need has prevented staff member from taking in year Compassionate leave up to 3 days Tier 3 and above Compassionate leave from 4 to 6 Tier 2 and above days Page 206 of 234 DELEGATED REFERENCE MATTER DOCUMENTS
Special leave arrangements Tier 2 and above Leave without pay Tier 2 and above Time off in lieu Line Manager Maternity & Paternity leave Automatic approval with guidance from HR g) Sick Leave
Extension of sick leave on half pay Tier 2 with Head of HR up to three months On advice from GP (through fit Return to work part-time on full pay note) and/or Occupational Health to assist recovery with HR
Extension of sick leave on full pay Tier 1 h) Removal Expenses, Excess Rent and House Purchases Authorisation of payment of removal expenses incurred by officers taking up new appointments (providing consideration was promised at interview)
up to £5,000 AO or CFO with appropriate HR advice From £5,001 AO and CFO with appropriate HR advice i) Grievance Procedure All grievances cases must be dealt Trust Grievance Procedure with strictly in accordance with the Grievance Procedure and the advice of an HR Manager must be sought when the grievance reaches Tier 2
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level j) Redundancy Authorisation of any redundancy Remuneration Committee payments, subject to Secretary of state for Health and/or NHS England guidance. l) Ill Health Retirement Decisions to pursue retirement on AO or CFO with HR the grounds of ill-health n) Dismissal In accordance with CCG Disciplinary Procedures Authorisation of any dismissal of Procedure staff
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Register of Interests
Declaration of Interest
Name:
Position or relationship with the CCG or NHS England:
Interests
Type of Interest Details Personal interest or that of a family member, close friend or other acquaintance? Roles and responsibilities held within member practices Directorships, including non- executive directorships, held in private companies or PLCs Ownership or part- ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or with NHS England Shareholdings (more than 5%) of companies in the field of health and social care Any connection with a voluntary or other organisation contracting for NHS services Research funding/grants that may be received by the individual or any organisation they have an interest or role in. Any other interest, role or relationship which the public could perceive would impair or otherwise influence the individual’s judgment or actions in their role within the CCG and/or with NHS England. All members should include the interests of all relevant individuals from their own organisations which have a relationship with the CCG and are in a position to benefit.
Declaration:
To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly and no longer than annually. I give my consent for the information to be used for the purposes described in the CCG’s Constitution and published accordingly.
Signed:
Date:
Schedule 2
Lay Member Appointment Process When appointing to lay members for the governing body, the CCG will take some time to consider the current requirements of the organisation, with consideration to the skill mix on the existing governing body and the requirements of the constitution.
Adequate time will be invested in planning the process and agreeing policies and procedures, with one person identified to co-ordinate the appointments process.
Lay members will fulfill a 3 year tenure, with the option to extend for a further term. The terms and conditions for a lay member role are shown in the attached document: We will ensure that robust processes are in place to ensure timeliness and consistency. This approach affords a level of protection in the unlikely event that an appointment decision is challenged, by showing that candidates were appointed on merit using procedures that were transparent, fair and open. It will also help to make sure that people with the right skills are appointed who are able to contribute effectively to the CCG and its governing body, promoting good governance and inspiring public confidence.
We will consider the best practice guidance below when planning the appointments process:
Make sure that resources and responsibility are allocated before starting the campaign. Consider the availability of key personnel and allocation of a person responsible for coordinating the process. Establish the timescales outlining key milestones, i.e. publicity date, closing date, interview and appointment dates. Consult with key stakeholders, agreeing relevant involvement at key stages, how their views will be taken into account and the way the process is to be conducted. Review and agree the role description and selection criteria with relevant stakeholders, ensuring that the representative is a local resident of the CCG Identify the most appropriate methods to attract suitable applicants. Decide on the most appropriate application format Make arrangements to provide applications forms and / or information in alternative formats e.g. Braille, audio, large print etc. Establish how applicants will be managed through the process, including sifting, shortlisting, any additional assessment and how they will be told about of the progress and outcome of their application. Decide on the composition of your selection panel, including a credible independent perspective. Establish interview/assessment arrangements, including how reasonable adjustments and accessibility requirements will be met. Decide on the due diligence checks to be taken such as requesting proof of qualifications, use of the internet to find out if there is anything about the candidate in the public domain, or checking social media sites. Consider level of risk associated with the appointment and how it can be managed effectively Ensure that data is handled sensitively, confidentially and in line with Data Protection and Freedom of Information requirements. Schedule 3
Appointment Process of clinical and non-clinical member practice representatives to NHS North East Essex Clinical Commissioning Group
Background
Clinical Commissioning Groups are a cornerstone of the Government’s reforms to give frontline professionals a strong leadership role in commissioning
Clinical and non-clinical practice representatives with the requisite skills require a mandate from their local colleagues in member practices to work as part of the group on their behalf
Principles
Elections to the Clinical Commissioning Group (CCG) should be fair, transparent and promote equality of opportunity.
The CCG is its practices. All clinical and management staff in practices will be able to have a say in who leads the CCG.
The CCG is a clinically led organisation and our electoral processes will reflect this.
The application and electoral processes should be administered by a trusted external agency, to provide confidence in impartiality. Unless there is a capacity or conflict of interest issue this would be the Essex LMC. Electoral College and Electoral Register
All clinical and senior management staff in GP member practices within the CCG will be eligible to vote.
This includes all partners, directly employed medical, nursing and AHP staff as well as practice managers, business managers and deputy practice managers.
Regular sessional staff are included
Staff may be employed at more than one member practice but will only be allocated one vote. It is the responsibility of the practice to ensure that any member of staff who may have an opportunity to vote through another practice has a process for declaring which practice they wish to vote through.
Member practices will be required to keep an Electoral Register and to submit this to the CCG from time to time as required (no more than quarterly).
All those on the Electoral Register will be entitled to vote in any election. They can vote for any candidate.
Professional Groups
The CCG is a clinically led organisation, therefore the majority of elected roles are reserved for clinical staff. The CCG would want to ensure that all professional groups, including sessional and salaried staff are represented if possible.
8 posts will be reserved for GP members
4 posts will be reserved for Nurse and AHP members
2 posts will be reserved for Practice Manager members
Roles of Elected Members
Elected members may be asked to fulfil a variety of roles within the CCG. Allocation of these roles will be decided by agreement between the elected members.
Roles will include governance, service development and engagement
Further details will be available in the “Prospectus for CCG Elected Members” which the CCG will produce in conjunction with the LMC and which will be updated annually
NHS North East Essex Clinical Commissioning Group would encourage all clinical and non-clinical staff to consider whether they would like to make a contribution to the CCG. Elected and non-elected members are a valuable resource for the CCG and we would welcome those individuals who are not able or willing to commit to be an elected member at the present time to become involved in the clinical leadership of commissioning.
NHS North East Essex Clinical Commissioning Group will ensure that clinical or non- clinical members considering putting themselves forward for election will have an opportunity to express an interest in which roles they would be interested in providing.
Eligibility of Elected Members
The applicant should:
have a long term arrangement through either a contract or partnership agreement to provide services to a member practice.
not hold an officer role in the Local Medical Committee (this is defined as chair or vice chair) however this does not preclude membership of the LMC.
not have been suspended from providing primary medical services.
must have up to date NMC registration if they are a Nursing applicant.
perform the majority of their clinical work in primary care.
be eligible to work in the UK.
have not received a prison sentence or suspended sentence of 3 months or more in the last 5 years.
not be the subject of a bankruptcy order or interim order.
not have been dismissed (except by redundancy) by any NHS body.
have not been removed from acting as a trustee of a charity.
have not been subject to a disqualification order set out under the company Directors Disqualification Act 1986.
Nominations
The CCG will ensure that all member practices, those on the electoral register, and the Local Medical committee receive in writing, notification of any vacancies. The CCG will seek applications and will provide a job description and person specification.
The CCG will ensure that there is sufficient time for individuals to submit a nomination, this will be no less than 3 weeks from the time of notification to the closing date.
It will be the responsibility of the individual putting themselves forward for nomination to ensure that the member practice they are currently affiliated to are in full agreement with the nomination.
It will be the responsibility of the individual putting themselves forward for nomination to declare any specific interests that are likely to give rise to a material conflict of interest which may exclude them from being selected to represent their practice.
All candidates undertake an external assessment process against a raft of competencies. Candidates that satisfy that process will go forward for election
Returning Officer
The returning officer will not be employed by the CCG but will be part of the organisation commissioned to run the election process and will be completely impartial (usually the LMC).
Voting Mechanism
Uncontested posts will be filled without voting, following satisfactory completion of the assessment process
For contested posts, voters will have the same number of votes as there are vacancies. Therefore, if the CCG has 3 vacancies, each member on the register in that category has 3 votes and selects the 3 that they would like to see filling those vacancies.
Candidates with the highest number of votes in each professional group will be elected until all the posts have been filled
If posts remain unfilled at the end of this process candidates with the next highest number of votes, from any professional group, will be elected until all the posts have been filled. This will be capped to a maximum of 50% of the original number of posts agreed for each profession. For example 2 additional nurses/AHPs and 1 additional practice manager.
Frequency of Elections
Half of the elected members will have a three year tenure of office and half will have two years. This is intended to ensure that we do not have all members coming up for election at the same time in the future (this is taken from the Prospectus – would it be better for everyone to have a 3 year tenure, with elections for half the posts every 18 months? 2 yrs seems rather short in terms of elected members being able to get properly involves in projects etc.
Procedure for election of GP Board Members (The process usually takes 8-10 weeks)
1. CCG to provide an up-to-date practice list to LMC
2. LMC will establish the following:- those who are eligible to apply for the Board position and to vote in any elections that may be required (any GP working in a practice, whether a partner, salaried, or locum – but not Registrars)
Onus is on practices to tell LMC who is working there.
3. Job Description and Personnel Specification to be supplied by the CCG. CCG needs to set minimum score against the criteria.
4. LMC write out to all GPs listed as working, or letter to practice asking them to circulate it, and invite applications. They are asked to provide a CV and supporting statement showing how they meet the criteria in the personnel spec. Deadline usually 3 weeks.
5. Applications, with a supporting statement (i.e. addressing the personnel spec) are returned to the LMC.
6. LMC constitute a panel, which normally comprises representatives from:-
Local Authority
NHS England
Secondary Care (usually from Broomfield, e.g. Medial Director or Assistant Med Director)
3 LMC representatives from South Essex Committee
Panel is sent copies of applications/supporting statement and are asked to score whether applicants meet the criteria.
7. If there are more applicants that meet the criteria than there are posts available, an election is held.
8. LMC administer the election and charge the CCG for the work involved in the whole process. LMC representatives on the panel also charge.
Elected members will be issued with a workers agreement that outlines the terms and conditions for the duration of their tenure. Schedule 4
PROXY FORM
North East Essex Clinical Commissioning Group (CCG) Board Meeting
[NAME AND ADDRESS OF BOARD MEMBER]
Before completing this form, please read the explanatory notes overleaf
I being a Board member of the CCG appoint the Chairman of the Board meeting or (see note 3)
as my proxy to attend, speak and vote on my behalf at the Board Meeting of the CCG to be held on [DATE] at [TIME] and at any adjournment of the meeting.
I direct my proxy to vote on the following resolutions as I have indicated by marking the appropriate box with an 'X'. If no indication is given, my proxy will vote or abstain from voting at his or her discretion and I authorise my proxy to vote (or abstain from voting) as he or she thinks fit in relation to any other matter which is properly put before the meeting.
RESOLUTIONS For Against [ORDINARY BUSINESS] 1. [INSERT TEXT OF RESOLUTION] 2. [INSERT TEXT OF RESOLUTION] 3. [INSERT TEXT OF RESOLUTION] [SPECIAL BUSINESS] 4. [INSERT TEXT OF RESOLUTION] 5. [INSERT TEXT OF RESOLUTION]
Signature Date
Notes to the proxy form
1. As a Board member of the CCG you are entitled to appoint a proxy to exercise all or any of your rights to attend, speak and vote at a general meeting of the CCG. You can only appoint a proxy using the procedures set out in these notes.
2. Appointment of a proxy does not preclude you from attending the Board meeting and voting in person. If you have appointed a proxy and attend the Board meeting in person, your proxy appointment will automatically be terminated.
3. A proxy does not need to be a Board member of the CCG but they must attend the meeting to represent you. To appoint as your proxy a person other than the Chairman of the meeting, insert their full name in the box. If you sign and return this proxy form with no name inserted in the box, the Chairman of the meeting will be deemed to be your proxy. Where you appoint as your proxy someone other than the Chairman, you are responsible for ensuring that they attend the Board meeting and are aware of your voting intentions. If you wish your proxy to make any comments on your behalf, you will need to appoint someone other than the Chairman and give them the relevant instructions directly.
4. To direct your proxy how to vote on the resolutions mark the appropriate box with an "X". If no voting indication is given, your proxy will vote or abstain from voting at his or her discretion. Your proxy will vote (or abstain from voting) as he or she thinks fit in relation to any other matter which is put before the Board meeting.
5. To appoint a proxy using this form, the form must be:
Completed and signed; Sent or delivered to the Board of the CCG at [ADDRESS]; and Received by the Board of the CCG no later than [DATE AND TIME].
6. Any power of attorney or any other authority under which this proxy form is signed (or a duly certified copy of such power or authority) must be included with the proxy form.
7. As an alternative to completing this hard-copy proxy form, you can appoint a proxy electronically by [GIVE DETAILS]. For an electronic proxy appointment to be valid, your appointment must be received by the Board of the CCG no later than [DATE AND TIME].
8. If you submit more than one valid proxy appointment, the appointment received last before the latest time for the receipt of proxies will take precedence.
9. For details of how to change your proxy instructions or revoke your proxy appointment see the notes to the notice of the Board meeting.
10. You may not use any electronic address provided in this proxy form to communicate with the CCG for any purposes other than those expressly stated.
Schedule 5
DISPUTE RESOLUTION PROCEDURES
Background It is almost inevitable that on occasions practices will disagree with decisions made by their commissioning group or in some cases, actions taken by other practices that impact on them. It is important that all practices have the ability to appeal against any such decisions and have the right to request that any dispute is resolved by means of an agreed Dispute Resolution Procedure that forms part of the commissioning group’s constitution.
The arrangements to deal with disputes arising from the new commissioning responsibilities will follow closely existing procedures already in place in a number of PCTs which involve a three staged process.
Stage 1: The Informal Process
Informal resolution helps develop and sustain a partnership approach between practices and between practices and commissioning groups.
Each party should involve the LMC at this stage in either an advisory or mediation role.
It is a requirement that the Informal Process must have been exhausted before either party is able to escalate the dispute to Stage 2: The Local Dispute Resolution Panel.
Stage 2: The Formal Local Process
In cases where either party remains dissatisfied with the outcome of Stage 1, then they have the right to request Formal Local Dispute Resolution in writing, including grounds for the request to the Accountable Office of the commissioning group.
Other than in cases, which in the opinion of the Accountable Officer and following consultation with the LMC, are considered to be frivolous or vexatious, a Local Dispute Resolution Panel (LDRP) will be convened to hear the dispute and make a determination.
Members of the LDRP
The Panel will consist of:-
A clinical member of the Board of another commissioning group
A GP conciliator (from a Panel to be established by the LMCs)
An LMC representative (from a different part of Essex)
Panel Secretary (non-voting)
The Panel will agree its own Chairman.
The Hearing
The hearing will be held within 20 working days of the request being lodged. At least 7 working days’ notice of the hearing date will be given to all participants.
Documentation
All relevant documentation will be provided to all parties and panel members at least 5 working days before the hearing. Procedure at the LDRP Hearing
The discussion of the Panel will remain confidential. The Panel Secretary will keep a record of the hearing.
The Appellant will be asked to present their case. Members of the Panel will be given the opportunity to ask any questions relevant to the case.
The Respondent will be asked to present their response. Members of the Panel will be given the opportunity to ask any questions relevant to the case.
The Appellant and the Respondent will then withdraw.
Following the presentation of the facts the Panel will deliberate and reach a decision on the case based on a majority of the voting panel members.
The Panel Chair will notify both parties of the decision including any recommendations in writing within 7 days after the hearing.
If either party disputes the decision of the LDRP and the decision relates directly to provisions in its GMS/PMS contract, then it may refer the matter to the Family Health Services Appeal Unit (FHSAU) of the NHS Litigation Authority in line with relevant NHS Regulations, for dispute resolution under the “NHS Dispute Resolution Procedure”.
Stage 3: Appeal to The Secretary of State through the FHSAU – NHS Dispute Resolution Procedure
Written requests must be directed to the FHSAU, 1 Trevelyan Square, Boar Lane, Leeds, LS1 6AE within three years beginning on the date on which the matter giving rise to the dispute happened or should reasonably have come to the attention of the party wishing to refer the dispute.
Disputes should be addressed directly to the FHSAU and must include:-
The names and addresses of the parties to the dispute. A copy of the contract. A brief statement describing the nature and circumstances of the dispute.
Inter Practice Disputes
It is envisaged that the Stage 2 Formal Process will be used in the main to deal with disputes between individual practices and commissioning groups.
In cases where the dispute is between practices and it is an issue that warrants formal dispute resolution, then the same process and timescales will apply.
The only proposed change is that the LMC representative on the LDRP will be a representative from an LMC outside of Essex. It is extremely unlikely that any disputes between practices will be appropriate for referral to the Secretary of State for determination as detailed in Stage 3. Schedule 6
PROCESS FOR APPOINTMENT CHAIR
Purpose The purpose of this document is to outline the proposed approach for the recruitment of the Chair to NHS North East Essex Clinical Commissioning Group.
Background CCGs are required to design and implement their own approach to recruitment which needs to be in line with the national HR Guidance which has been released by the National Commissioning Board (NCB). The process proposed in this document reflects the required elements of the national guidance and builds on local preferences for the CCG. This document outlines a process for the appointment of the chair.
NHSE have a reasonable expectation that the Chair of the CCG is suitably qualified clinician and this would be their preference. If the CCG was unable to recruit a Clinical Chair, then discussions would need to be held with NHSE to discuss next steps, and establishing a most appropriate way forward.
Proposed Approach to Chair Recruitment
The CCG will lead the process for recruiting the Chair of the governing body. The job description and person specification along with the advert will be circulated to all member practices, and clinical stakeholders for information. NHS NEE CCG are proposing to initially include the following groups in the recruitment process:
Member practices
If this is unsuccessful then the pool will be widened to include:
Local Clinical providers Lay chair
Applicants will be asked to submit their CV and a supporting statement Members of the interview panel will undertake shortlisting from the applicants in line with good practice.
Stakeholder engagement should be a key part of the process involving input primarily from member practises, but other stakeholders too. This could include systems wide leaders, lay members and staff.
With effect from September 2015, it is no longer obligatory to conduct HAY assessments when appointing a chair. However the organisation should have a means of assessment in place that stands up to scrutiny and challenge.
A recommended approach is to remove the 360 element from the HAY assessment; reduce the extent of psychometric testing, limited to having one in place that supports the desired personality traits (e.g. OPQ)
Interview Assessment
The interview panel for the NEE CCG Chair will comprise of:
2 CCG clinical representatives Representative from the Essex Health and Well Being Board Representative from the Member practices CCG Accountable Officer Representative from the NHSCB or independent assessor
NHSE representation on the interview panel is not required, but a discussion following the interview can always be had.
The appointment should be subject to the NHS Employment Check Standards, including the tests for Fit & Proper Persons. Schedule 7
Procurement Strategy
NEE/CCG/2014/056
Document Information
Title /Version Number/(Date) Procurement Strategy /v2.1/January 2016 Document Status (for For circulation to all staff, and immediate information/ action etc) implementation and Accountable Executive Chief Operating Officer Responsible Post holder/Policy Attain Commissioning Services Owner Date Approved 26th January 2016 Approved By Board Review Date January 2017 or earlier if required by changes in local or national requirements Author Maninder Singh Dulku, Associate Director
Equality Impact Assessment EQUALITY IMPACT ASSESSMENT This document has been assessed for equality impact on the protected groups, as set out in the Equality Act 2010. This Policy is applicable to the Board, every member of staff within the CCG irrespective of their age, disability, sex, gender reassignment, pregnancy, maternity, race (which includes colour, nationality and ethnic or national origins), sexual orientation, Contact details for further All queries to Chief Operating Officer information
Document Control Sheet
Version Page/ Para No Description of change Date Received
1 Full Document To be reviewed by 24th April 2014 Management Executive 1.1 Various Updates by SH 16th April 2014
1.2 Various Updates by MD 17th September 2015 2.0 Full Document To be reviewed by Audit 11th December 2015 Committee. Policy formatted. 2.1 Various Following Board suggested 28th January 2016 amendments, patients and carers reference within and Accountable Executive amended to COO Contents
Page No 1 Introduction 4
2 Legal Framework 5
3 How we will work 6
4 Aims 6
5 Principles 7
6 Approach 9
7 Process 10
8 Accountability & Authorisation 10
9 Complaints 10
10 Guidance and Training 11
11 Review 11
NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 226 of 234 NHS North East Essex CCG Procurement Strategy
1 INTRODUCTION
1.1 NHS North East Essex CCG (CCG) is an NHS body created by the enactment of the Health and Social Care Act 2012. The CCG has received authorisation to commission healthcare services on behalf of the registered patients of 43 GP practice members of the CCG. This amounts to approximately 330,000 patients.
1.2 The CCG is led by a Governing Body with a Clinical Chair and a majority of non- executive members including elected members.
1.3 The primary purpose and responsibility of the CCG is to commission (plan, purchase and organise) health services on behalf of the registered patients of the member practices. It does this in partnership and collaboration with other commissioners for health and social care services covering the same population, as well as with patients and the public.
1.4 This Procurement Strategy provides the overview of our approach to procurement. Each procurement decision will be taken on its individual merits, in the context of this strategy, and in accordance with the relevant legal and policy requirements. This Strategy sets the context and strategic aims of the CCG in using procurement as a tool to improve service outcomes for patients. It does not set out detailed procurement processes or approval mechanisms as these will depend on the scale and nature of any procurement and comply with UK law, CCG Corporate Governance requirements, financial policies and EU and national and local procurement policies and procedures.
1.5 All CCG procurement takes place against this context with the intention to secure high quality, safe and cost effective health and social care services for the registered and local populations.
1.6 The CCG has the following Vision, Aims and Values which under pin this Procurement Strategy:-
Vision
North East Essex CCG vision is “Embracing Better Health for All” describes how we want to work with people in North East Essex to help them have greater choice, control and responsibility for health services.
Mission
Our aim is to:- ensure that the people of North East Essex receive the best care NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 227 of 234 possible within the funds available encourage people to take control of their own health and well being help people get involved with us in making our local NHS the best it can be.
Values
The values that lie at the heart of the work of the CCG are:- Integrity – We will work in the spirit of public service, professionalism and selflessness to serve our local population. Inclusiveness - Our commissioning will be driven by the health needs of the whole population. We will prioritise our commissioning towards work which delivers the greatest improvements in health and the best possible experience for all people throughout their care and treatment. Improvement - Our communities require high-quality services. This means services which are safe, personalised and deliver good clinical outcomes. We will seek to continually improve quality wherever possible and to embrace innovation to achieve this. Patient-centred – We will ensure that services respond to people as individuals, involving them in their individual care decisions and also in the planning of services .
2 LEGAL FRAMEWORK
2.1 The Health and Social Care Act 2012, and the associated NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 provide the framework for procurement of health care services by the CCG. When procuring health care services, the 2013 Regulations require NHS commissioners (CCGs and NHS England) to act with a view to (a) securing the needs of the people who use those services (b) improving the quality of services and (c) improving efficiency in the provision of the services. The 2013 Regulations require commissioners to procure services from providers who are most capable of delivering these objectives and who provide best value for money in doing so. The Regulations also prohibit commissioners from engaging in anti-competitive behaviour unless this is in the interests of patients.
2.2 Monitor – the sector regulator for health services in England - has the role of protecting and promoting the interests of patients and has been granted powers to set and enforce a framework of rules for providers and commissioners. Monitor has published its ‘Substantive guidance on the Procurement, Patient Choice and Competition Regulations’ (December 2013) (“Substantive Guidance”) designed to support CCG’s and NHS England. Monitor’s Substantive Guidance makes it clear that it is for commissioners to decide which services to procure and how best to
NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 228 of 234 secure them in the interests of patients.
3 HOW WE WILL WORK
3.1 In line with our vision, aims and values, we will work in partnership with patients, carers and families, partner organisations across public, voluntary and private sectors to develop high quality, safe and cost effective locality based services.
3.2 We will hold providers of services to account for the quality, safety and performance of their services. We expect local providers to aspire to be the best in their field and to involve and seek feedback on a regular basis from local patients and carers.
3.3 We will be held to account by NHS England and Local Health & Wellbeing Boards as well as local patients and partner organisations for commitments we have entered into.
3.4 We will be open and transparent on our decision making and regularly hold meetings of our Governing Body in public and in different locations to improve access for people.
3.5 We welcome constructive feedback and suggestions on ways we can improve our commissioning and integration of services for the benefit of local people and to improve their outcomes of care.
3.6 We will engage with members of the public and our resident patient population in accordance with the principles set out in the CCG’s Communications, Membership and Engagement Strategy.
3.7 We wish to ensure our commissioning and contracting is based on clearly assessed population needs, clinically led and focuses on achieving improved measurable outcomes of care from integrated services for local patients, carers and their families.
3.8 We will comply with and implement the NHS Constitution, deliver the NHS Mandate locally and respond to the local population’s healthcare needs in a fair and equitable way living within the resources we are allocated.
3.9 We will comply with the Principles set out in section 5 below.
4. AIMS
4.1 This Procurement Strategy is intended to support the CCG in achieving its statutory aims and objectives:-
1.a) To secure the needs of health care service users; 1.b) To improve the quality of services; and
NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 229 of 234 1.c) To improve the efficiency with which services are provided.
4.2 In addressing these aims and objectives, the CCG will seek to :-
2.a) engage with all fellow commissioners, stakeholders, patients, carers and relevant parties when a procurement is undertaken, including seeking Joint Commissioning wherever this opportunity arises in the best interests of local patients; 2.b) undertake and understand relevant policy and guidance regarding procurement type, (e.g. AQP/full tender/single provider tender); 2.c) ensure safe, high quality and equitable services are achieved and maintained across the CCG; 2.d) ensure that the CCG achieves value for money in its procurement activities; 2.e) ensure that the CCG makes clear and transparent decisions on whether any procurement is necessary in the interests of the local population; 2.f) ensure the CCG avoids possible conflicts of interest by ensuring transparency of all decision making through recorded declaration of interests and, if unavoidable, the effective management of any conflicts of interest; 2.g) ensure that each procurement complies with all relevant guidance and legal regulations; and 2.h) ensure the CCG complies with all legal requirements and best practice on procurement, including sustainability policies.
5. PRINCIPLES
5.1 The CCG will conduct its procurement activities in compliance with the following principles as set out in legislation and national guidance. When procuring health care services, the CCG will seek to act so as:-
1.a) To secure the needs of patients who use services and to improve the quality and efficiency of those services, including through providing them in an integrated way; 1.b) To act transparently and proportionately, and to treat providers in a non- discriminatory way; 1.c) To procure services from providers that are most capable of delivering the overall objective and that provide evidence based, best practice and best value for money; and 1.d) To consider ways of improving services (including through services being provided in a more integrated way, enabling providers to compete and allowing patients to choose their provider).
5.2 In relation to each purchasing decision for a major service area concerning health care and social care services, the CCG will test proposals and:
2.a) Consider the extent to which any form of competition is required and consider the most appropriate process and procedure for awarding the relevant contract or contracts; 2.b) In that regard, give consideration to whether the use of a framework agreement, including the use of approved lists, is NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 230 of 234 the most appropriate means of appointing providers. The CCG will appoint the best provider, offering the best quality services that are affordable regardless of who the provider is as they will have passed the fit and responsible test in the first instance; 2.c) When there is a joint procurement with Local Authorities, the CCG will ensure that it complies with applicable NHS Guidance; and 2.d) Purchasing decisions will be led by priorities based on population needs and addressing inequalities, clinical needs and measurable improvement in outcomes with clear clinical leadership informed by gathering patient needs from the outset to provide evidence based services.
5.3 The CCG will, wherever possible and where it is consistent with legal requirements, ensure that contractual provisions, procurement procedures and selection and award criteria are designed to ensure that contractors and providers:
3.a) Are good employers who comply with all relevant employment legislation, including the Public Interest Disclosure Act 1998; 3.b) Maintain acceptable standards of health and safety and comply fully with all legal obligations; 3.c) Meet all tax and national insurance obligations; 3.d) Meet all equal opportunities legislation; 3.e) Are reputable in their standards of business conduct; 3.f) Respect the environment and take appropriate steps to ensure they minimise their environmental impact; 3.g) Can evidence an appropriate record of involving patients in their services and providing high quality services; 3.h) Can demonstrate an appropriate record of successful partnership working with commissioners and other providers in the best interests of patients and public; and 3.i) Are open and transparent with commissioners on all Patient Safety and Quality issues within their services with accurate information and reporting.
5.4 The CCG will, in each procurement and consistently in compliance with the relevant law, exclude companies which have been convicted of offences, or whose director(s) or another person or company who has powers of representation, decision or control of the company has or have been convicted of offences in the conduct of their business of committed an act of grave professional misconduct in the conduct of their business. However, any corrective/remedial action taken by the company in response to such an offence will also be taken into account in determining the suitability as a bidder.
5.5 The CCG will, in each procurement, and consistently within relevant EU and international law, ensure that contractual provisions, procurement procedures and selection and award criteria prohibit or restrict contractors’ use of offshore jurisdictions and/or improper tax avoidance schemes or arrangements NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 231 of 234 and /or exclude companies which use such jurisdictions and/or such schemes or arrangements
5.6 The CCG will only negotiate contracts on behalf of the CCG, and the CCG may only enter into contracts within the statutory framework set up by the 2006 Act, as amended by the 2012 Act and associated regulations.
6. APPROACH
6.1 The CCG recognises that effective engagement with stakeholders, carers and patients is an essential requirement of all NHS organisations and will also offer substantial benefits to the generation of outcome-based service specifications. Therefore the CCG will engage with stakeholders, carers and patients at all appropriate times during the commissioning and procurement processes in accordance with the principles set out in the CCG’s Communications and Engagement Strategy.
6.2 Stakeholder engagement including patient involvement with new and existing providers, and the involvement of members of the public, clinicians and other service users will occur at key points in the service review and procurement processes. 6.3 Input from the above groups, including the Patient Reference Group where appropriate which has a wide range of relevant experience, will be used to ensure the views of patients are included in the services being commissioned and the CCG will engage with patients and patient groups to ensure that their views are included.
6.4 The CCG will decide on the most appropriate procurement route on a case by case basis, as set out above and in accordance with the framework of principles set out in Monitor’s ‘Substantive Guidance’ on the 2013 Regulations.
6.5 When making decisions on procurement options, the CCG will work with Commissioning Partners and will seek to ensure that the final decision complies with relevant legislation and regulations.
6.6 The procurement approach will be proportionate to the likely contract value and the commissioning objectives.
6.7 Further guidance in relation to the EU principles and national legislation and how they apply to a specific case may be required and, where relevant, guidance will be sought from the identified Procurement Support Framework providers, who will able to provide access to appropriate legal or other specialist advice on these issues, if considered necessary.
6.8 Any decision taken by the CCG to procure services without a competitive tender will be clearly explained by the CCG, documented and discussed/signed off by the Governing Body.
NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 232 of 234 7. PROCESS
7.1 The CCG will comply with the EU Procurement Directives, the Pubic Contracts Regulations 2006, the Public Contracts Regulations 2015 (which detail the rules that public bodies must follow for the procurement of goods and services) and the 2013 Regulations. The CCG will also take into consideration and seek to comply with Monitor’s ‘Substantive Guidance’ on the 2013 Regulations (December 2013).
7.2 The CCG will ensure that clear performance measures and effective contract levers are central to any agreed contract to provide evidence of compliance with its public sector duties. The CCG will ensure that the procurement process is adequately resourced to ensure compliance with the above strategy and principles.
7.3 The CCG will ensure that:-
3.a) Opportunities are be advertised on Contracts Finder and OJEU as required; 3.b) Evaluation processes, award criteria and decisions regarding procurement are published; 3.c) Any conflicts of interest are declared and effectively managed; 3.d) All potential providers are treated equally; 3.e) Evaluation criteria are objective, non-discriminatory and carried out in accordance with the published methodology; 3.f) All potential providers have the opportunity to apply for any opportunity the CCG wishes to tender; 3.g) Any procurement process is not unduly onerous and will be applied with consideration as to the complexity, risk and value of the service being commissioned; and 3.h) Any procurement process will be non-discriminatory and compliant with all legal obligations.
8. ACCOUNTABILITY AND AUTHORISATION
8.1 At each stage of any procurement the CCG will ensure that the project is authorised in accordance with the CCG’s Governance arrangements, which are overseen by the Audit Committee.
8.2 Where the CCG uses external Procurement Support Services the final decision on any contract award will be made by the CCG Governing Body or delegated subcommittee or Officer in line with Standing Orders.
9. COMPLAINTS
The CCGs Procurement Agent will have in place a complaints process to hear any complaints from organisations who consider that the CCG has
NEE/CCG/2014/056 Version 2.1 Approved: 26th January 2016 by Board Review date: January 2017 Page 233 of 234 not complied with this Strategy, or any of the CCG’s applicable Policies and Procedures.
10. GUIDANCE AND TRAINING
The CCG will produce internal guidance for staff to support the implementation of this Strategy. Appropriate training will also be provided.
11. REVIEW
This Strategy will be reviewed on an annual basis or earlier if required by changes in local or national requirements
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