Buckinghamshire Clinical Commissioning Group Annual Report 2020/21

1 | P a g e Contents

FOREWORD Page 3

OVERVIEW Page 4

PERFORMANCE REPORT Page 7 Importance of Clinical Leadership Page 9

ACCOUNTABILITY REPORT Page 29 Corporate governance report Page 29 Members report Page 29 Statement of Accountable Officer's responsibilities Page 40 Governance statement Page 42 Remuneration and staff report Page 58 Remuneration report Page 58 Staff report Page 64 Parliamentary accountability and audit report Page 67 Independent Auditor’s Report Page 68 Committee Attendance tables Page 73

Terms (Glossary) Page 74

ANNUAL ACCOUNTS Page 76

2 | P a g e Foreword from Clinical Chair It is my privilege to introduce the third annual report for NHS Buckinghamshire Clinical Commissioning Group (BCCG) for the year 2020/21 The headline story for the year has of course been the COVID-19 pandemic and the challenges it has created for our front-line services, our communities and each individual in Buckinghamshire. As with last year’s annual report, I would like to start by acknowledging the keyworkers in health and social care who worked with enormous energy and stamina to serve our population throughout the year under the most demanding of circumstances. The challenges presented by COVID-19 have been the greatest since the inception of the National Health Service. The way that those challenges have been met is a tribute to thousands of individuals in Buckinghamshire who have worked or volunteered as part of hundreds of organisations, big and small throughout the county. Health and social care services have adapted in a remarkable manner, innovating in ways that may have taken years months or years in normal times. I have huge admiration for the way that primary, community, secondary and the emergency care services have responded to the considerable challenges that each have faced, coping with pressures that are unprecedented. I am grateful to our CCG staff who have worked tirelessly and flexibly to ensure that the services available have met the needs of our residents in Buckinghamshire and the 48 GP practices that constitute the membership of our organisation for their continued support. As a CCG we remain aligned to the NHS Long Term Plan, working closely with our Primary Care Networks to develop community-based services that are responsive to the needs of the communities they serve. The work that the PCNs have done as part of the highly successful COVID-19 vaccination programme deserves particular mention as on several occasions it has attracted national media and ministerial attention. We anticipated the move towards greater integration as signalled in the Government White Paper (Integration and Innovation: working together to improve health and social care for all) published in February 2021. We are increasingly aligned with our colleagues in Berkshire West and Oxfordshire CCGs and as part of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS). We have further intensified our focus on the wider social determinants of good health, working closely with our local communities, Public Health and Buckinghamshire Council to empower more of the Buckinghamshire population to live a greater proportion of their lives in good health. A particular success in this regard has been the work that has been done, most notably in Wycombe and Aylesbury to increase COVID-19 vaccination uptake in different communities. We aim to learn from this success and build upon it in future endeavours. I hope that you find the annual report informative, and I wish you all well for the year ahead. Dr Raj Bajwa, Clinical Chair, NHS Buckinghamshire CCG

3 | P a g e Overview from Dr James Kent, Accountable Officer

No one could have predicted the extraordinary year that has passed; the COVID-19 pandemic has been all consuming and has touched each and every one of us in one way or another. My condolences to those who have lost loved ones; in the NHS we share in the sadness of those who have suffered a loss. In response to the pandemic, NHSE/I was given legal directions over the CCG 1 commissioning functions by the Government in order to direct health services to meet the emergency needs, each system established an incident structure reporting to NHSE/I SE Region and the normal financial regime was adjusted so the majority of providers were on block funding. During the pandemic health and social care organisations made rapid changes to how services operated, the infection, prevention and control measures that were in place, and other adjustments made to ensure all patients with COVID needing hospital treatment could be treated. Much of primary care and outpatients moved to on- line with face-to-face contacts restricted to where essential to reduce the risk of spreading the infection. Changes also included introducing telephone triage in primary care so that GP practices talk to all patients on the phone first. Many patients have been provided with advice, care and prescribed treatment without needing to visit their practice. For patients with the relevant technology, hospital appointments have been available using video conferencing so they can see, as well as speak to a doctor or healthcare practitioner. BHT has undertaken 758 video appointments and Oxford Health 170, plus 165,228 telephone appointments have taken place at BHT. Primary care carried out over 1.2 million telephone consultations in 2020/21; more than doubling of the 483,069 carried out in 2019/202. New services were also brought online quickly to support people throughout the pandemic such as the 24/7 mental health line across Buckinghamshire and Oxfordshire; these services were set up in April 2020 and continue to support people young and old to access the advice and support they need for their mental health and emotional wellbeing. GPs worked quickly to set up dedicated clinics (‘hot hubs’) for patients with suspected COVID- 19 to manage the risk of transmission from patients needing non-COVID related care GP practices introduced remote pulse oximetry service for COVID positive patients in at-risk groups; these measured a patient’s blood oxygen levels and could alert clinicians to possible problems without the need for the patient to attend an appointment outside their home. Some non-urgent services were stopped for a period of time during the first and then second waves of COVID to focus on treatment of patients with COVID-19 and to prioritise people with urgent care needs; this included some screening and routine referrals for hospital care. At the same time, mostly due to lockdown, referral levels also fell significantly. Services were re-started after both waves as soon as possible but for some the new ways of working through COVID have been maintained where these were felt to be better for patients. However, the infection controls and social distancing measures has meant we were not fully back to pre-COVID levels of planned care activity end March 21 though we will aim to exceed this as we move through 21/22. COVID-19 will continue to have profound impacts as we begin to reset the health system over the coming year and work our way through the backlog of patients who require non-urgent but necessary care and treatment. We recognise that this has led to an increase in the numbers of Buckinghamshire patients experiencing long waits for treatment as shown in the table

1 https://www.gov.uk/government/publications/the-exercise-of-commissioning-functions-by-the-nhs- commissioning-board-coronavirus-directions-2020?utm_source=fe01c604-789a-453e-90cb- 16dd1c965200&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate 2 https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice 4 | P a g e below: Number of patients waiting Number of patients waiting at at 31st March 2020 31st March 2021 Total number of patients waiting 32,861 38,495

Over 18 weeks for elective treatment 7,428 16,877

Over 52 weeks for elective treatment 13 6,106 Over 62 days for cancer treatment 171 79 (BHT)

Our response to the first phase of COVID-19 ensured that services, staffing and capacity could meet demand. Since that time, we have learned a lot; the Incident Control Centre (ICC) across the BOB ICS that was set up during Wave 1 was made more resilient with a greater number of staff for Wave 2 and this continues to be a conduit for cascading information, alerts and requests for action between NHSE and the three CCGs / place responses. The incident centre also facilitated and co-ordinated mutual aid requests for personal protective equipment (PPE) during the first wave in particular as well as other equipment. At the end of 2020, the Government announced approval of the Pfizer BioNTech vaccine against COVID-19, followed by approval for the Oxford AstraZeneca vaccine early in January 2021. Well before the announcement, plans were underway across the BOB ICS for the roll-out of the vaccination programme, starting with our most vulnerable population. Vaccinations started in the BOB area on 7 December 2020 at the first hospital hub in Oxford, followed swiftly by our GP-led local vaccination service across all three places on 14 December. Since then, more than a million vaccinations have been administered to the population of the BOB ICS 3, with three quarters of those delivered by primary care. A huge thanks to the thousands of people across the NHS, local authorities and volunteers who have contributed to this success. We are concerned that health inequalities have increased during the pandemic; we have addressed this head on through the vaccination programme with local health and care teams undertaking a range of communication, outreach and pop-up clinics to ensure good vaccination coverage in harder to reach groups. We are hoping that the trust we are building though this work will help as we move into 21/22 and continue to work to identify inequalities and implement evidence-based interventions to reduce the gap. We also entered the year facing significant financial challenges. These became less acute with the financial regime that was put in place for NHSE to direct the COVID response, but we will need to return to work through how to live within our means during 21/22. I joined as Accountable Officer mid-May as we were starting to come through the first wave. My year has been one working with three CCG Director teams, remotely, in unprecedented circumstances. The Governing Body operated separately through the first half of the year but with increased joint working and holding workshops together. Following the publication of the Integrating Care4 engagement document and the White Paper5 the Governing Body agreed the three CCGs would move to working in common for all core committees from 1

3 900,000 people had received at least one vaccination dose as at 31 March 2021

4 NHS England » Integrating care: Next steps to building strong and effective integrated care systems across England 5 Integration and innovation: working together to improve health and social care for all (HTML version) - GOV.UK (www.gov.uk) 5 | P a g e April 2021. As we move forward, we will establish a single management team over the three CCGs and ICS, first as an interim structure, then with substantive posts once NHSE guidance allows. I want to extend my gratitude to colleagues within all three CCGs; many have worked in different ways, in different roles and well beyond their contracted hours. The pandemic triggered new ways of working – all CCG staff have been working from home for the past year and will continue to do so, potentially in hybrid form, for the foreseeable future. But as we move into 21/22 I have been heartened to see colleagues step up to the challenge of the pandemic and am grateful for their efforts. All this at a time that is unsettling as we progress towards the development of a new, single, Integrated Care System. Despite the challenges of the pandemic, we must not lose sight of the innovation and benefits which it has brought about. Going forward, we must also build on the collaboration across the three CCGs and continue to integrate the NHS with local authority partners. More integrated working will bring improved quality of care and benefits to patients. The year ahead will concentrate on the development of the ICS into the new statutory commissioning organisation for the BOB and the implementation of place-based system recovery programmes, which will focus on inequalities and put the health, social and economic wellbeing of residents at its heart.

6 | P a g e Performance Report ‘Everyone working together so that the people of Buckinghamshire have happy and healthier lives’ What we do NHS Buckinghamshire Clinical Commissioning Group (BCCG) is the statutory organisation in Buckinghamshire that plans, buys and oversees health services for more than 530,000 people from a range of NHS, voluntary, community and private sector providers. BCCG is responsible for commissioning non-specialist hospital services, both urgent and planned care. As well as commissioning GP services, mental health and learning disability services, ambulance services and community services such as district nursing and physiotherapy. Specialist hospital services, dentistry, pharmacy and optician services are commissioned by NHS England (NHSE). Public Health services are provided by the Local Authority Buckinghamshire Council (BC) and includes drug and alcohol, sexual health, health visiting and health promotion services. BCCG is a member organisation of 48 GP practices in Buckinghamshire; we work with local people, voluntary sector organisations and partners BC, GPs and Primary Care Networks, Buckinghamshire Healthcare NHS Trust (BHT), Oxford Health NHS Foundation Trust (Oxford Health) and South Central Ambulance NHS Foundation Trust (SCAS). BCCG is part of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) which covers a population of 1.8 million across the three Clinical Commissioning Groups (CCGs), six NHS Trusts, 14 local authorities and 166 GP practices, working together as 45 Primary Care Networks. Integrated Care Systems aim to bring the NHS together with Local Authorities to further the integration of health and care; improve the health of local populations; transform the quality of care provided and ensure they are sustainable within allocated funding. In Buckinghamshire, the Health and Wellbeing Board (H&WB) is responsible for improving the health and wellbeing of the people of the county. The H&WB is a partnership between Local Government, the NHS and the people of Buckinghamshire; Board members include local GPs, senior Councillors, Healthwatch Buckinghamshire and senior officers from the NHS and Local Government. BCCG has a duty to improve the quality of services commissioned; reduce health inequalities; involve the public and patients in commissioning decisions and deliver a Health and Wellbeing Strategy. This Annual Report describes how BCCG carries out its duties. The joint Health and Wellbeing Strategy (2021 – 2024) – a shared plan for Buckinghamshire was refreshed during 2020/21 and approved by the Health and Wellbeing Board in February 2021. This set out 3 key priorities – Start Well, Live Well and Age Well. It aims to improve the health and wellbeing of local people and reduce health inequalities across the county. This strategy guides the work of BCCG over the coming years alongside our local implementation of the NHS Long Term Plan. The Health and Wellbeing Board has also produced its annual report for 2020/21. This report summarises the work of the Buckinghamshire Health and Wellbeing Board over the last year. It provides an overview of some of the work which the Board has been involved in to address its priority areas, meet its statutory requirements, develop its new strategy and direction, and respond to the COVID-19 outbreak. Through all these areas of work, the Health and Wellbeing Board has aimed to use partnership working to improve the health and wellbeing of our residents. During the reporting financial year 2020/21 the COVID-19 pandemic has continued; the 7 | P a g e scale of pandemic and the challenges faced by the NHS over the past 12 months has been unparalleled. The pandemic has had a significant impact on public sector resources; the NHS has been under considerable pressure, with new and changing working arrangements affecting teams in organisations to varying degrees. In response to the COVID-19 pandemic, guidance for annual reporting requirements has been issued by the Department of Health and Social Care in the Accounting Manual for 2020/21. In the guidance there is an ‘option to omit’ some information; this includes the omission of a full performance analysis and sickness absence data. As such the following performance report is an overview of key performance information; an overview from the Accountable Officer giving his perspective on the performance of the organisation and a summary of the key issues and risks of BCCG.

1 Department of Health and Social Care Group Accounting Manual 2020-21

Buckinghamshire’s Population

The information above is from the Director of Public Health Annual report for Buckinghamshire Council 2020 which provides information about the county’s population and the factors affecting health, wellbeing, and social care needs. It brings together information from different sources to create a shared evidence base. This informs BCCG’s strategy and supports its service planning and decision-making. To read more about the health needs of Buckinghamshire’s population visit the Buckinghamshire Council website

8 | P a g e Importance of Clinical Leadership CCGs are responsible for buying (commissioning) health services for their local community and were designed to put GPs at the heart of NHS planning decisions. Clinical involvement and clinical leadership are key to high-quality commissioning. This involves engaging with all GPs in the local area so their experience and expertise can inform the decisions being taken. Clinical leaders are working at all levels of the CCG, including the CCG Clinical Chair, GPs and other clinicians providing a majority sitting with senior managers at the CCG Board and other committees, driving service development and responding to the pandemic. Clinical leadership helps to ensure the CCG remains patient centred. The clinicians working for the CCG also all work in clinical practice with regular contact with patients, carers and families. During this past year, the COVID-19 pandemic has dominated the work of the CCG and our clinicians have been providing clinical leadership in decisions relating to healthcare and the vaccination programme. Despite the practical difficulties in maintaining services during the pandemic, with higher levels of staff absence and risks of infection, they supported the work needed to quickly revise the way practices organised their services to ensure patients could continue to access the care and support needed. They have also been working with health and care partners to ensure appropriate arrangements were in place for other services so that patients with urgent conditions such as cancer could continue to access care and treatment. Clinical events have been hosted online where clinical leaders shared the latest evidence for treating patients, the research into new treatments and advice on safe and effective services in primary care. These events have been led by clinicians with positive effects on recovery rates. Clinical leadership has been present and driving all major projects. Despite the pandemic, some areas of work have needed to continue while others have paused until the pandemic has passed. These projects benefit from clinical input from primary care, often working alongside clinical partners from community, mental health and hospital services. Developing the clinical leaders of the future is critical to sustaining this way of working. At the start of the COVID-19 pandemic, priority areas of work within each portfolio were identified by each clinical director and reviewed by the clinical chair. New areas of work were identified, and a clinical director identified for each. This was to ensure that the clinical leadership within the organisation was targeted to the most important areas to protect and improve patient care during. Later in this report there is a summary of the work and achievements of each of the clinical directors for Buckinghamshire CCG.

Improving the health and wellbeing of people in Buckinghamshire The Health and Wellbeing Board (HWB) is a partnership between local government, the NHS and the people of Buckinghamshire. It includes local GPs, councillors, Healthwatch Buckinghamshire and senior local government officers. The Board ensures that organisations across health and care work together to improve everyone’s health and wellbeing, especially those who have health problems or are in difficult circumstances. The Board provides strategic leadership for health and wellbeing across the county and will ensure that plans are in place and action is taken to realise those plans. While a considerable amount of work has been undertaken to deliver the Health and Wellbeing Strategy; on 11 March 2020, the World Health Organisation (WHO) declared the outbreak 9 | P a g e of a new type of Coronavirus, SARS-CoV-2, that causes COVID-19 respiratory disease, a global pandemic.

On 30 January 2020 the NHS declared a level 4 incident as part of its emergency preparedness, resilience, and response (EPRR) to the COVID-19 pandemic. This is an incident that requires NHS England National Command and Control to support the NHS response; at this time and during the past year ‘all’ NHS resources have been focused on our response to the COVID-19 pandemic. Our response to the COVID-19 pandemic The COVID-19 pandemic has spanned the entire NHS year and has led to profound and far- reaching changes to the way we all work and, as patients, to way we access healthcare. For the three clinical commissioning groups in Buckinghamshire, Oxfordshire and Berkshire West (BOB) 2020/21 has been one of immense challenges from the moment the first case of the virus in the UK was officially announced on 1 February 2020. The first phase of COVID-19 preparation and response ensured that services, staffing and capacity could meet the demands of the months ahead. Since that time, all partner organisations within the BOB area have been working together to help prevent the spread of infection, maintain critical services and protect the most vulnerable in our communities. Continued partnership working, strong clinical leadership and the efforts of all colleagues have meant that challenges have been overcome wherever possible. For example, close collaboration has enabled the supply of Personal Protective Equipment (PPE) to be maintained, a programme of testing was rolled out, sufficient critical care capacity was secured for patients with COVID-19, and new ways of looking after patients with other conditions and illnesses were found. By 23 March, all CCG teams were expected to work from home in line with Government lockdown guidance. It was important to do everything possible to support front line services to care for patients. Many of our key colleagues in our partner NHS organisations and councils were leading their organisational response and needing to redirect resources internally. To support them we reviewed our demands on their time (e.g., meetings, information requests) to consider what was best for the system, which meant delaying, cancelling or doing things in a different way. GP practices everywhere were provided with guidance to introduce telephone triaging and video consultations to reduce footfall at surgeries and reduce the risk of spreading infection. Face-to-face patient appointments were available when clinically appropriate and under careful infection control measures. In addition, GP practices were provided with additional IT equipment to allow more of their staff to work from home, thus protecting themselves and patients. Practices have also introduced electronic triage systems to help manage demand, provide advice and the option to request a call back (Ask NHS). These systems collect a patient’s medical or administrative request and either send it through to their GP practice or using computer-based decision tools to triage and provide recommendations for the right care for the patient. For patients who had phoned the 111 service but needed a call back or appointment with their GP, electronic direct booking was introduced to allow 111 to give the patients reassurance whilst on the call that their GP would contact them. Improvements were made to the Electronic Prescriptions Service to minimise the amount of paper used and therefore reduce the risk of infection. A detailed and effective joint communications strategy was implemented to ensure staff, patients and stakeholders kept up to date with a fast-moving situation. MS Teams was quickly adopted across the BOB CCGs, so staff were able to maintain close contact and

10 | P a g e share information, address current issues and plan for the months ahead. The virtual meeting space is now the norm for all CCG staff. At the beginning of the lockdown, the main focus was to support more people to be discharged from hospital and to avoid admissions, so our acute hospitals had the space and resources to care for patients affected by COVID-19. Many non-urgent elective operations and treatment were postponed, but urgent care including cancer continued. Some services were paused or were reduced to allow staff to be redeployed to support COVID-19. There was a significant drop in the number of patients attending Emergency Departments, minor injury units and primary care and in the number of urgent referrals as well as an increase in the number of missed appointments. It is reasonable to assume there were fewer accidents happening at this time, but it is also the case that some patients were (and continue to be) fearful of using health care facilities or are putting off seeking help. Several new ‘hot’ services to support patients with suspected or confirmed COVID-19 were opened across the BOB area to ease the burden on other healthcare facilities and free up hospital doctors to deal with more serious cases. The clinics were available for those people showing symptoms of COVID-19 but who did not need immediate hospital treatment. GP practices were also focused on ensuring that all shielded patients (those at highest risk) were identified, supported, and flagged on GP systems. They worked in partnership with local authorities and volunteer groups to ensure those patients had help with immediate needs including social care, safety concerns, urgent food requests and help with collecting medication. As the second wave of the pandemic progressed, hospitals across the BOB ICS saw a very steep increase of COVID-19 positive inpatients from December 2020 to the first two weeks of January 2021. At the peak of the pandemic hospitals across BOB were caring for 779 COVID-19 inpatients, 260 of whom were in critical care, which was three times more patients as our baseline capacity of 91 for critical care. Elective (non-urgent, planned) inpatient and day case activity was postponed, where appropriate, in order to focus on urgent and emergency care for COVID -19 and non-COVID-19 patients and to enable the redeployment of staff to treat this cohort of patients. Elective (non-urgent, planned) inpatient and day case activity was postponed, where appropriate, in order to focus on urgent and emergency care for COVID -19 and non- COVID-19 patients and to enable the redeployment of staff to treat this cohort of patients. The learning from the first wave enabled us to set up a BOB ICS wide Incident Control Centre (ICC) which was fully operational in time for the second wave. The ICC was the main point of contact for the NHS England (NHSE) regional team for COVID-19, winter pressures and the EU Exit. It was and continues to be a conduit for cascading information, alerts and requests for action between NHSE and the three CCGs / place responses. It has also facilitated and co-ordinated mutual aid request for personal protective equipment (PPE) during the pandemic and other equipment. And has overseen the BOB PPE warehouse, which enabled system partners to access PPE when there was shortfall or supply issues. It has also overseen and coordinated the roll out of the COVID-19 vaccine programme across the three places. It was and continues to be the link to all Directors of Public Health for system wide outbreak management. The ICC will continue its role as we enter 2021/22. Buckinghamshire’s response During the last year BCCG has been working closely with all NHS providers and the Local Authorities to respond to the challenges of the pandemic. The breadth and depth of system

11 | P a g e partnership working over this period has strengthened our ability to respond for the benefit of our local communities. During March and April 2020, the NHS in Buckinghamshire refocused capacity to ensure that patients with COVID-19 could be cared for; supporting discharge of all medically fit patients; increasing critical care capacity; establishing separate wards; developing a primary and community service response that separated potential COVID-19 patients from other patients; establishment of a 24/7 mental health helpline. In addition, all parts of the NHS rapidly introduced remote consultations either via phone or video wherever possible; this is now widespread in mental health and learning disability services, primary care and hospital outpatient services. While the NHS has remained open throughout (albeit in a different way) locally as well as nationally, we saw a decrease in attendances at A&E, emergency admissions and referrals for cancer, mental health and other conditions needing urgent attention. We worked together across Buckinghamshire, to support the national ‘Help us help you’ messaging to ensure that the public continue to seek medical help when they need it during the COVID- 19 pandemic. Since the beginning of the pandemic, we have continued to support the national campaigns and promote advice including the importance of handwashing and how to socially distance. This is ongoing and continues to be important as the lockdown begins to get lifted. This has been promoted both online and offline through the media, digital media, key community contacts and information has been made available in different languages. Supporting care homes to provide high quality care to some of our most vulnerable residents during the COVID-19 pandemic has been essential. Health and social care partners across Buckinghamshire worked closely with care home providers to develop and deliver a support plan for homes, their staff and residents. The focus of the work included preventative and proactive support for all care homes to ensure that education and understanding regarding care for residents, in line with national guidance, is in place; and focused support work with care homes which may have experienced outbreaks or particular challenges. We rolled out a 24/7 telemedicine solution across all care homes and supported living units in Buckinghamshire by June 2020 and supported Infection Prevention and Control training working in conjunction with the Buckinghamshire Fire & Rescue Service. The need to respond so quickly has radically altered the way patients access services; this may be through new routes (phone first/total triage and virtual consultations) or needing to attend in different locations as COVID-19 and non- COVID-19 patients are kept separate. BCCG worked with FedBucks and SCAS to establish a COVID-19-specific response across the county, known as the ‘Hot’ services. This saw the opening of two clinic sites for patients with suspected or confirmed COVID-19 who were finding it difficult to manage their symptoms at home. The clinics, in High Wycombe and Aylesbury, are supported by a visiting service for those patients unable to travel safely. Since the COVID-19 specific Hot service fully opened in April 2020 it has seen 3,904 patients. A care home visiting service and home visiting service were established where support was offered to those who had suspected or confirmed COVID-19 but needed a clinical visit. These services supporting local GPs, care home partners and minimised the risk to patients and staff in careful co-ordination of numbers of professionals required to visit. GP practices in Buckinghamshire introduced remote pulse oximetry for COVID-19 positive patients in at-risk groups. This measures a patient’s blood oxygen levels and can alert clinicians to possible problems without the need for the patient to attend an appointment outside their home. Work was also started to increase levels of Learning Disabilities and

12 | P a g e Severe Mental Illness health checks and improve ethnicity recording in recognition of the numbers of people seriously affected by COVID-19 in these groups. In addition, BCCG provided data searches and guidance to the Buckinghamshire GP practices providing direct engagement with vulnerable populations via text messaging to enhance supported self-care during COVID-19. This led to an increased number of self- referrals to the lifestyle hub. BCCG also provided a central resource of information and guidance for COVID-19 & Long- Term Conditions (LTCs) (Team Net), enabling primary care to best manage LTCs in the community during the COVID-19 pandemic period. BCCG was quick to adapt to providing on-line training for health professionals who could no longer attend in person due to the COVID-19 restrictions. A 24 hours a day, seven days a week mental health helpline was launched by Oxford Health to provide advice in Buckinghamshire. The round-the-clock helpline made it quicker and easier for people to get the right advice and support they need from mental health professionals. As the first wave of the pandemic receded in summer 2020, primary care saw a return to pre-COVID-19 demand for appointments, which have continued to be telephone triaged, carried out online, via video link, and face to face. Activity within Primary Care has seen a change in the way that it has been delivered throughout the year due to the impact of the COVID-19 pandemic. Nearly 50% of patients were seen by face to face appointments with the rest being seen remotely, mainly by telephone. Approximately 50% of the remote appointments were dealt with on the same day or within 24 hours of the request. The additional activity from the COVID-19 vaccination programme is not included in these figures. In April, due to the pandemic, Primary Care activity dropped to 35% of normal annual levels. By September activity had almost recovered to pre-pandemic levels and has since remained comparable to annual figures. These trends are replicated across the ICS.

COVID-19 Vaccination Programme across the BOB ICS In December 2020, as cases rose again significantly across the UK, the Government announced approval of the Pfizer Biontech vaccine against COVID-19, followed by approval for the Oxford Astra Zeneca vaccine early in January 2021. The BOB vaccination programme was established at the beginning of November 2020. The team has been responsible for working with the NHS South East Region, provider organisations and local authority colleagues to deliver vaccinations to the population of BOB in accordance with the Joint Committee on Vaccination and Immunisation (JVCI) advice. The initial stages of the programme focused on the planning and mobilisation of staff to deliver the vaccine programme. That work has continued through roll-out, adapting as the vaccination stock has become available and the deadlines for vaccination of priority groups are brought forward. This will continue as further vaccine becomes available and vaccination sites change. Thanks to the hundreds of NHS workers, local authority staff and volunteers involved across BOB (all three CCG areas) by 31 March 2021, we had achieved: • 900,000 people had received at least one vaccination dose • 100% of care homes had been visited

13 | P a g e • All frontline health and social care workers had been offered the vaccine • Nearly 95% of our population aged 60+ vaccinated with at least one dose • More than 90% of our clinically extremely vulnerable had been vaccinated • More than 80% of over 50s had been offered a vaccination appointment By 15 April 2021, we had achieved our target of offering a first dose of the vaccine to all nine priority groups as directed by the JCVI. Current projections see us completing all first doses for adults aged 18 and over by July 2021 and second doses by the end of September / early October. This has been a huge logistical challenge being delivered at the same time as managing the increased pressures on health and care services caused by the pandemic. Delivering the vaccination programme in Buckinghamshire In Buckinghamshire, BCCG together with our NHS provider and local authority partners we began the enormous task of rolling out the biggest ever mass vaccination programme in the UK’s history. The Buckinghamshire Vaccination Cell was set up to oversee the programme and includes colleagues from BCCG, Buckinghamshire Healthcare NHS Trust, Public Health and Buckinghamshire Council. It has overseen the establishment of two hospital vaccination hubs; 9 GP-led local vaccination sites; a mass vaccination centre at the Bucks New University Campus in Aylesbury and 10 Community Pharmacy sites across the county.

All this has been achieved at the same time as supporting GP practices to balance the vaccination roll-out with ‘business as usual’ responsibilities. As we move into the next stage of pandemic recovery, we will work together as a Buckinghamshire system to build on and embed the innovation and new ways of providing services developed through our COVID- 19 response. Tackling urgent care pressures in the county The effects of the pandemic on the health system made it even more important for health and social care professionals across the Buckinghamshire system to work together to deliver responsive and joined-up services throughout the year. The Urgent and Emergency 14 | P a g e Care team’s priority was to ensure people who needed medical treatment were able to access services to get the care they needed. There was communication throughout the pandemic for patients to think using the 111 First national programme so that we could ensure the BHT Emergency Department was seeing patients with genuinely life-threatening conditions. Encouragement of self-care and prevention, including signposting to the NHS 111 service, for advice and re-direction of patients to the best place for care, was advocated. Working with our BOB ICS colleagues we had a comprehensive flu vaccination plan seeing the highest uptake since this started and including a new cohort of the over 50’s. During 2020/21 GP practices and other services found new and innovative ways to deliver flu clinics to those patients eligible for the free flu jab, to ensure safety during the pandemic. Flu figures are cumulative and collected until flu season ends in March. The data below is a snapshot for Buckinghamshire CCG at 28th February 2021. The achievement for the full year will be published later in the year, but not expected to show a lot of change as the majority of vaccinations are administered between September and January.

2020/21 Aged 2 years Age 3 years Age 65+ years Under 65years at Age 50 –64 years Pregnant Target clinical risk (all ages) 75% 60.3% 62.4% 82.2% 55.5% 46.6% 44.1%

As pressures in local hospitals grew, especially during the winter period and the second wave of the pandemic, families were reminded of their pivotal role in making it easier for older people to get home when they are ready to be discharged from hospital. The ‘Home First’ initiative, involving an integrated health and social team, helps patients leaving hospital to identify what support they need to regain independence and confidence. Our local community and therapy teams worked to support frail and vulnerable people when they get home by continuing nursing, therapy and rehabilitation needs. In November 2020, a new initiative was launched across the BOB ICS to encourage residents to contact NHS 111 First if they are thinking of attending an Emergency Department (ED). NHS 111 is the national system that people can contact if they need clinical advice – either by phone or online. The new initiative means that people who need clinical advice but are not in a life-threatening emergency are encouraged to contact NHS 111 first before attending their local Emergency Department (A&E). They are then assessed and, if appropriate, booked into their local ED. However, if it is more appropriate for them to receive clinical help and / or advice elsewhere, they are advised on: • how to self-care if required • visiting their local pharmacy, dentist, optician, or their own GP for help • visiting an Urgent Treatment Centre NHS 111 First was designed to improve outcomes and experiences for patients in healthcare settings, to help EDs maintain social distancing therefore reducing the risk of COVID-19 transmission as well as the transmission of seasonal illnesses like flu and colds. The service also ensures that people receive the right care in the right place.

Cancer waiting times In recognition of the COVID-19 pandemic, cancer systems have been under significant pressure to deliver treatment for all patients. This has included systems across the BOB ICS. BHT, along with other hospitals across BOB, has been working with the Thames Valley Cancer Alliance (TVCA) in the development of a recovery plan for cancer services with the 15 | P a g e aims of: • Reducing unmet need and tackling health inequalities, working with GPs and the public locally to restore the number of people coming forward and appropriately being referred with suspected cancer to at least pre-pandemic levels • Managing the immediate growth in people requiring cancer diagnosis and/or treatment returning to the service • Reducing the number of patients waiting for diagnostics and/or treatment longer than 62 days on an urgent pathway, or over 31 days on a treatment pathway, to pre-pandemic levels, with an immediate plan for those waiting longer than 104 days

Year-End Standard Period Standard Month Performance Description 2 Week Waits 93% 97.4% 95.2% 2 WW Breast 93% 100.0% 85.2% 31D 1st Treatment 96% 97.3% 95.7% 31D Sub - Drug 98% 98.4% 99.1% Cancer 31D Sub -Radio Mar 21 94% 100.0% 97.9% 31D Sub - Surgery 94% 96.6% 91.7% 62D Urgent Referral 85% 79.9% 78.6% 62D Screening 90% 90.9% 90.3% 62D Upgrade 86% 88.0% 84.7%

Cancer Care Review (CCR) Implementation Support Scheme The CCR Implementation Support Scheme is part of the Thames Valley Cancer Alliance’s five-year delivery plan to improve outcomes for people with cancer by 2020 and it aligns with the national cancer strategy ‘Achieving World-Class Cancer Outcomes (A Strategy for England 2015-2020)’. The scheme is looking for all GP practices to adopt the standardised CCR template and undertake a second cancer care review with each patient (the first cancer care review is part of the primary care Quality Outcomes Framework). Across the BOB ICS, the Buckinghamshire and Oxfordshire schemes went live in December 2020. An engagement event was held with speakers from primary and secondary care, and the voluntary sector. More than 80 primary care clinicians joined the event, which is available to watch here. In Berkshire West, year one of the scheme closed in October 2020 with 457 reviews carried out by primary care. The launch of Year 2 of the scheme was delayed to April 2021 to support primary care to set up COVID-19 vaccination services.

Vague Symptoms Pathway Following the development of the Oxford “Scan Pathway” and support from TVCA, Buckinghamshire has developed a similar model known as the Vague Symptoms Pathway (VSP). The VSP is specifically designed for patients who present with vague symptoms that could indicate a cancer (low risk, but not no risk). Patients are referred to the service by their GP if they have symptoms such as unexplained fatigue or unintended weight loss. If patients meet the VSP criteria, they undergo a CT scan and other diagnostic tests. If cancer is detected, they are referred directly on to the appropriate consultant so they can start treatment quickly. VSP has already made a big difference to patients with suspicious presentations as the cancer detection rate on the pathway is circa 10%, which is higher than the England cancer detection rate of 7.3%. Patients who do not ultimately have cancer but have other pathology identified are also being picked up quickly and referred to the appropriate clinician. VSP represents a collaborative pathway between primary and secondary care.

16 | P a g e Elective care Early in the pandemic, routine referrals and elective operations and treatments were paused across the BOB ICS in line with national guidance from NHS England & NHS Improvement (NHSE&I). In Buckinghamshire BHT stopped receiving routine referrals from GPs in order to focus on the treatment of patients with COVID-19. During that time, urgent and suspected cancer referrals were still accepted and BHT continued to carry out urgent and emergency treatment. As the levels of COVID-19 declined over the summer of 2020, BHT reinstated services to support routine referrals. Significant work has been undertaken and continues to ensure patients with greater needs and / or those waiting a long time are identified to prioritise treatment appropriately. To support the resumption of elective care BHT has worked with BCCG and other NHS partners as well as the independent sector partners so patients could be seen as soon as possible. BHT also: • Maximised the use of peripheral clinic capacity because updated Infection Prevention and Control guidance has reduced the number of patients who can be seen safely in hospital outpatient clinics, due to the need to maintain safe social distancing in light of COVID-19 • Ran outpatient clinics 7 days per week in some specialties • Increased the use of independent sector outpatient capacity for some specialties • Increased the number of patients who could have ‘virtual’ appointments e.g., video consultations, telephone appointments etc. (throughout the COVID-19 pandemic, BHT continued to offer outpatient appointments both face-to-face and virtually with over 60% appointments delivered via video, and similar numbers delivered over the phone) • Worked closely with partners across BOB ICS to identify capacity in neighbouring acute hospitals Recovery work commenced in August 2020; however, this was paused again as the second wave of the pandemic progressed with a steep rise in the number of COVID- 19 positive patients admitted to Buckinghamshire hospitals in January. Hospital staff were caring for more than twice the number of COVID-19 positive patients than at the peak of the first wave of coronavirus in Spring 2020. To respond to this unprecedented situation, BHT had to focus on urgent and emergency care, including cancer care, and redeploying clinical staff to work in COVID-19 areas in particular. However, BHT were able to continue to accept referrals to support patients and primary care. 2021/22 will concentrate on the restarting of elective services and recovering from the impact of pandemic which has presented an extraordinary challenge to the NHS and our local communities, which we have never seen in our lifetime. In addition to these services, work has continued to redesign and deliver services in a different way to meet the challenge of the pandemic, examples of which are: Personalised Care: Over 50 new members of personalised care staff have been embedded in to PCNs, including social prescribing link workers, care coordinators and health and wellbeing coaches. These roles will ask ‘what matters to you’ and support patients with their health and wellbeing needs using a personalised care approach. Training in ‘Making Every Contact Count’, motivational interviewing and personalised care and support planning has been delivered virtually to enable health care professionals to empower patients to manage their own health. The CCG were short listed in the Self Care Forum Awards 2020, for our series of patient 17 | P a g e online education sessions in collaboration with Bucks Adult Learning to support self-care, including, eating well, becoming more active and dealing with stress and anxiety. The ‘COPD & Me’ training programme was delivered by our specialist respiratory nurse, a successful pilot with a local PCN. This will now be offered throughout Buckinghamshire and in collaboration with BHT to offer the sessions to those currently on the pulmonary rehabilitation waiting list. The Personalised Care team have worked across system partners to embed Physical Activity in to our IAPT services, recognising the benefit of incorporating physical activity in the support and treatment of people with common mental health problems thus improving their outcomes. Blood Pressure Monitoring: Bucks CCG is participating in the Blood Pressure Monitoring @ Home initiative from NHSE/I and NHSX to support patients to self-monitor remotely using blood pressure monitors at home. The initial pilot is targeted at practices in areas of deprivation. All monitors have been distributed to the participating practices and searches set up to identify at- risk cohorts of patients and for monitoring purposes. Wider expansion of the programme will be rolled out in the coming months. Improving diabetes care and prevention: BCCG has a diabetes dashboard which is used to indicate clinical variance across the county. The CCG is then able to identify practices/PCNs which may require additional practical support depending on the challenges of the practice or population health of their patients. Support such as clinical upskilling and bespoke team training, assistance with templates and searches and the sharing of initiatives from other general practices can be provided. BCCG created a single point of access for diabetes resources covering advice, guidance, risk stratification, patient self-monitoring and training schedule. BCCG practices continue to refer patients to the NDPP Healthier You programme. The communication and activity plans at place have been refreshed along with BOB wide plans to engage at PCN level to encourage further opportunistic referral to the programme as patients’ numbers return to practices. Patient education for type 2 diabetes self-management continues to offer a choice of remote group sessions or one to one tailored sessions with on-line digital resources and use of an App for ongoing support. Building on the success of the DiRECT study BCCG is participating in the Oviva Diabetes 800 pilot delivered over 12 months which includes 12 week 800-kcal/day dietary approach. Delivery of mental health services for adults Throughout the past year work has continued to develop mental health services to support mental wellbeing and improve outcomes for people suffering from mental health conditions. As part of the NHS Long Term Plan, the Community Mental Health Framework is a new way of working that aims to improve joining up mental health services so that GPs, mental health teams and other support organisations in the community work better together and improve the experience of people with significant mental health conditions using services. BCCG have worked with people who use services, their families, third sector organisations and communities; working together to shape what is needed and ensure they continue to be part of the delivery going forward. Similar to CAMHS, mental health services for adults and older people were fully operational throughout 2020/21 and quickly set up digital support at the start of the pandemic. There was also investment and expansion of mental health crisis services in the community, such as the extension the Safe Haven hours and increasing capacity in the Crisis Home Treatment team alongside the introduction of a 24/7 mental health helpline to provide people with mental health advice during the pandemic.

18 | P a g e The round-the-clock helpline aims to make it quicker and easier for people in Buckinghamshire to get the right advice they need for their mental health and emotional wellbeing. The service is for all ages including children and older adults and operates 24 hours a day, seven days a week for people who need mental health care when their situation is not life threatening. During 2020/21 a new Step Down Housing initiative was successful in providing short-term housing following hospital discharge for people who may become homeless and having housing difficulties and included housing workers embedded in hospital wards to support staff to facilitate quicker discharge when people were medically fit and linking people with support in the community. The county’s improving access to psychological therapies service TalkingSpace has been integral to local system planning to deliver an integrated post COVID-19 group programme of supporting access to therapies. Across the BOB ICS work continues to support online booking systems, long COVID- 19 training and supervision, in reach work for black ethnic and minority ethnics (BAME) communities, a feasibility study for ‘Live Chat’ and a marketing campaign to reach more older adults and BAME communities to improve their mental wellbeing.

Supporting children and young people with their mental wellbeing Throughout the pandemic, Buckinghamshire CAMHS (Children & Adolescent Mental Health Services) has continued to support young people in need of mental health support. Whilst some pathways were initially paused to focus on critical activity, the service responded to COVID-19 with the following: • Rapid implementation of virtual assessments and interventions with the majority of therapeutic contact moved to an online and electronic platform. • One particular area of challenge was play therapy and trauma work due to need for face to face intervention, these were resumed where safe to do so and for others these have been delivered virtually. • Some pathways continued to offer face to face appointments using appropriate precautions e.g., for Eating disorders clinic • The teams that support schools (MHSTs) continued to offer support to all schools in Buckinghamshire (not just those who are signed into the scheme) and were also redeployed to assist other teams within CAMHS supporting the reduction of the waiting list for those needing lower level support. Since returning to schools the team has expanded their reach and is meeting the needs of more schools. There will be an increased focus on offering support to young people whereby there is an increased risk of inequalities. • Neurodevelopmental screening and assessments remain a pressure in the Buckinghamshire system with increasing numbers of young people requiring assessment. The CCG have been working collaboratively with the providers of the service to review and consider ways to address this growing demand and reduce wait times. In year, additional assessment capacity was commissioned via an online provider to help reduce the number of young people waiting; the CCG also continue to work with partners from across the BOB footprint exploring in particular the benefits of pre-diagnostic support. • All group interventions were delivered through virtual means with positive outcomes – as a result there is a plan to use combination of face to face and online moving forward • A 24/7 mental health helpline was implemented at the peak of the pandemic; this has now developed into an established provision for CAMHS which people are able to 19 | P a g e access through NHS 111. A member of CAMHS staff is now working directly into A&E within Stoke Mandeville Hospital (SMH) to expedite assessment following admission as a result of self - harm or suicidality. • The CAMHS service has seen an increase in demand across most pathways comparatively to 2019/20; in particular there has been increased demand within Eating Disorder services, since the start of the pandemic. Additional investment was provided to facilitate the recruitment of additional staff to address some of the increased need. Eating Disorder services is recognised as a priority area for further expansion to sustain the ambitions of the long- term plan. Ensuring there is parity of esteem for patients Additional funding has been invested into mental health services in 2020/21 in line with the national mental health investment standard (MHIS), introduced to ensure that there is parity with physical health services. This funding has enabled: • Additional support for children in the care system to be provided • Additional staff to be recruited to tackle the increased demand on eating disorder services • Improved crisis services providing more treatment at home for people that are at risk of admission to an acute mental health hospital • Additional staff recruited to Buckinghamshire’s Healthy Minds service enabling an increase of people with mild to moderate mental health needs accessing psychological therapies In response to the pandemic and as an alternative to emergency department attendance 24 hours a day, seven days a week mental health helpline for children and young people and adults was launched by Oxford Health NHS Foundation Trust to provide advice and support for peoples’ mental health in Buckinghamshire. The round-the-clock helpline is led by Oxford Health NHS Foundation Trust and can be accessed across Buckinghamshire and Oxfordshire via 111. This has made it quicker and easier for people to get the right advice and support they need from mental health professionals. People with a severe mental illness (SMI) The pandemic has further impacted the number of people with SMI who have accessed annual physical health assessment as they, like many others have not attended the GP. Additional NHSE funding has enabled the PCNs to recruit motivator roles to encourage the take up of physical health checks. Of note 75% of those on the SMI register had their first COVID-19 vaccination by the beginning of April 2021. Developing services and support for people with learning disabilities The BOB ICS is developing a three-year delivery plan for people with learning disabilities and / or autism. The plan aims to improve outcomes for people with learning disabilities and / or autism; tackle the causes of morbidity and preventable deaths, reduce the waiting time for specialist support and work with people with learning disabilities and / or autism to improve their health and wellbeing. To help us do this in Buckinghamshire, we have worked closely with both our primary and secondary care providers to improve the quality and uptake of Annual Health Checks for people with Learning Disabilities. We were successful in achieving over 83%, exceeding the target of 67% which was set by NHS England. This has meant that during the past year of the pandemic, we have ensured our LD population continue d to receive essential ongoing care, including flu and COVID-19 vaccines.

20 | P a g e Medicines optimisation The safe and effective use of medicines is an essential element of healthcare. Medicines optimisation teams, which include pharmacists, work across the BOB ICS supporting clinicians, patients and carers in making decisions about which medications to use for the best possible outcomes. The teams have and continue to be closely involved in COVID-19 related work supporting changes in clinical pathways, the extension of services provided by community pharmacies, support to care homes, accreditation of GP led primary care network COVID-19 vaccine sites and supporting vaccine clinics. In addition, the teams regularly published lists of ‘frequently asked questions’ on CCG websites to keep prescribers up to date on changes and recommendations during the pandemic. Staff were also redeployed to support moving patients out of a hospital to a community setting and supporting vaccination sites. Alongside this, in 2020/21, BCCG’s medicines optimisation team continued to support appropriate prescribing across Buckinghamshire, including the review and implementation of clinical guidelines, collaborative work with providers including Primary Care Networks, the introduction of new pathways and the review of governance arrangements. Improving Quality Improving the quality of healthcare provided to people in Buckinghamshire is at the heart of BCCG’s work. We work together with our partners to improve patient experience, improve the quality of services and learn from incidents to reduce the risk of them happening again. BCCG and partners do this in many ways; below gives a flavour of some of the work undertaken to improve quality. During 2020/2021 the Quality Team continued to ensure high quality care for the population of Buckinghamshire a well as adapting to support the needs of the pandemic. Members of the CCG’s Quality team were redeployed to support the incident response, including support to community facing services. The team also supported a variety of activities during the mobilization of the pandemic response to include Care Homes and other settings IPC training, roll out of information technology within primary care and support for complex case reviews and COVID-19 safe quality support visits related to safeguarding and quality concerns. Throughout the past year, the Quality Team at NHS Buckinghamshire CCG monitored and reviewed feedback from primary care on a routine basis. All feedback was reviewed and passed on to secondary care services, who have reviewed and acted on the information provided. Services were asked to respond to concerns within 30 days unless an identified immediate response was required and responses were reviewed by BCCG. This information is valuable to the services to identify concerns specific to a patient, or wider concerns and safety risks. BCCG also utilises this information to identify any developing issues and to ensure that work is undertaken to prevent any patient safety incidents as a result, this has led to reviews of pathways for patients and remains a focus for sharing information and learning within our local place based system. The GP Feedback continued throughout the pandemic, including at peak waves and national lockdowns – with a focus of addressing immediate safety concerns responses during particularly busy periods, this included liaison with system partners to address issues for patient pathways and ensure collaboration to minimize clinical harms. Our Complaints and Patient Advice and Liaison Service continued to provide services during the pandemic, helping members of the public navigate services and have supported other work streams including roll out of technology support to Care Homes and providing support into Primary Care for booking appointments for patients. Another core duty of the Quality Team at BCCG is to review Serious Incidents (as defined in the Serious Incident Framework, 2015) from all our providers – the focus is to act as a critical

21 | P a g e friend to providers and services to ensure that the issues identified in a Serious Incident are addressed with robust measures to prevent future patient safety incidents. There has been a decrease in Serious Incidents reported in 2020/21 (96) compared to the 2019/20 financial year (110) – the decrease can be attributed to fewer patients attending outpatient visits and independent providers. Addressing health inequalities Work continues across Buckinghamshire, Oxfordshire and Berkshire West to reduce health inequalities: a BOB wide equalities group has been established with representation from all three areas to do more to tackle inequalities. The main aim of the group is to identify inequalities and implement evidence-based interventions to reduce the gaps by working with our local communities and ensure we share learning and best practice across the ICS on local interventions that make a difference. It will also develop an equalities strategy to help deliver the population side of NHS South East England’s ‘Turning the tide’; a strategy developed in response to the challenges faced by black and ethnic minority communities during COVID-19. While developed in response to COVID-19, the strategy has informed the South East region’s wider approach to reducing racial inequalities in health. There is also a specific piece of work across BOB that aims to promote confidence in the COVID-19 vaccination programme and enable optimal vaccine uptake. The team leading this work is reviewing and monitoring COVID-19 vaccine uptake data across BOB to identify groups with the lowest levels of vaccine uptake, they are working to promote vaccine uptake and reduce inequalities by working with local communities to increase confidence, increase convenience (access) and reduce complacency where there are low levels of COVID-19 vaccine uptake. In Buckinghamshire, we have a have a multi-agency approach to reducing inequalities. During COVID-19 considerable work has been undertaken to reach black, ethnic and minority groups and areas of inequality to ensure information on the pandemic, outbreak management and vaccine programme are accessible Examples of activity include: • “Pop up” clinics in community venues. Successful “pop up” clinics have been delivered at mosque and community centres aimed at people in BAME communities that have not previously taken up the offer for vaccination. Feedback suggests that there has been a subsequent positive impact as some people from the target communities have gone on to attend other sites for vaccination. • Outreach clinics for people in emergency accommodation have been offered via a community based clinic at a homeless hub. Ongoing engagement with Homeless services continues encouraging and supporting further take up and access. Work is ongoing to deliver vaccines in local hostels and supported housing facilities. • A Ramadan Communications Plan is delivering targeted messages about the access to the vaccine during the period. Messages were also promoted via a direct letter to mosque leaders about a Safer Ramadan from the Director of Public Health. • Community engagement continues to build insight with our priority groups (e.g. GRT, BAME, people with disabilities). A structured tool has been developed to collect insights. Numerous meetings between faith and community leaders from ethnic minority communities and Public Health have been held to gather insight and share messages. A focus group was held with Asian women via the Healthy Living Centre. The Council community engagement team are exploring links with local Chinese communities. • Targeted work is underway to follow up social care staff that have not taken up the

22 | P a g e vaccination including outreach clinics delivered on site at care homes, with an extensive communication plan targeting areas of inequality and populations with lower take up. Engaging the public and local communities BCCG believes that communicating and engaging with its local population is key to achieving its vision. The organisation is committed to putting the patient first and applying the principle of ‘No decision about me without me’ in its commissioning approach. BCCG uses the NHS England Principles for Participation to guide its public involvement activities. Our Communication and Engagement Strategy sets out the overall strategy for engagement. The methods used for engagement vary depending on the activity and who we need to talk to. The population of Buckinghamshire is diverse and each community has different needs. It is important for us to understand this diversity to ensure health services are planned properly and provide equity in terms of access, experience and outcomes for everyone. BCCG looks carefully at each project and considers the scale, who should be involved and what methods to use. For bigger projects, it is likely that the engagement will involve more people and require some publicity to ensure those with an interest are aware of the opportunity to get involved. For smaller pieces of work, it might be possible to work with a patient group or individuals in a targeted way. During the past year as this report has already shown, the COVID-19 pandemic has had a fundamental impact on the NHS across the country and all resources, including communications and engagement staff, were diverted to supporting frontline services in continuing to support patient care. Information and guidance to support clinicians working across the local NHS needed to be refreshed and updated as guidance was issued. In addition, the need to protect patients and staff from infection meant that face-to- face methods of engaging patients and the public were not used and this continues to be the case. This includes meetings in public which have moved to be organised online and require members of the public to have access to the internet to be able to participate. More information about the guidance BCCG follows, including the principles for engagement is available here. While the pandemic has meant fewer engagement projects, below outlines a couple of examples from the past year. Buckinghamshire’s Case for Change: In 2019, a strategic case for change was developed to transform health and care services. Having been paused due to the pandemic and then with COVID-19 fundamentally changing the way we provide health and social care we used this as a lens to reset our services, develop the case for change and engage the public. We recognised that our approach to undertaking engagement on this important subject needed to consider the impact of COVID-19 on how we can engage with our population and stakeholders. As a result, it was undertaken in 2 phases. The purpose of Phase 1 was to help us start to explore experiences of our services in recent years and during COVID-19 and was centred around four themes: 1) Non face-to- face services: accessing care using technology such as video, telephone, apps and emails; 2) Community services: organisations working together to promote independence and deliver care in people’s homes and communities; 3) Keeping People Safe: delivering services differently to prevent the spread of infections; 4) Reducing health inequalities: improving health for vulnerable groups and people living in deprived areas. There were two ways in which people could get involved: • Online engagement survey with a detailed engagement document to help us understand Buckinghamshire residents as well as our staff’s views on changes that have been made during COVID-19. 23 | P a g e • Engagement toolkit – to allow groups, families, town and parish councils, Patient Participation Groups etc. to hold their own discussions and then feedback to us. BCCG worked with the Getting Buckinghamshire Involved Steering group to review the plan, survey and narrative. As a result of their feedback, significant changes were made to simplify the online survey. After Phase 1, the results were fed back to this group, including demonstrating the changes that were made. After the meeting several attendees expressed their appreciation of the honest feedback. Phase 2 was undertaken by an independent provider, Verve Communications. The purpose of this phase was to ensure we reached specific demographics (People aged under 24, over 75, Ethnic minorities, people with disabilities, Carers, LGBTQ+ people and those living in areas of deprivation) in Buckinghamshire through a workshop, focus groups and depth interviews. The findings were shared with the Buckinghamshire Integrated Care Partnership Board, Buckinghamshire Council’s Health & Adult Social Care Select Committee and the Buckinghamshire Health and Wellbeing Board, and they will be used to inform future services across Buckinghamshire. Future of the Long Crendon Surgery: As this surgery could not be made COVID-19-safe during the pandemic it had remained closed. Unity Health was proposing the permanent closure of this surgery. Working with BCCG, a full consultation took place with an online survey being made available on Your Voice Bucks, BCCGs digital engagement tool. To ensure all patients were reached, BCCG also supported with press releases, text to patients, general statements, FAQs, engagement with residents’ action group, briefings for local councillors and the Health and Adult Social care Select Committee. 554 responses were received to the consultation and as a result of the feedback both through the survey and direct to Unity Health, BCCG with Unity Health are now exploring alternative primary health provision in Long Crendon.

How does BCCG manage its money? Due to the COVID-19 pandemic the planning process was suspended by NHSE and a plan derived centrally for the first 4 months and then extended to 6 months. This plan was calculated using the month 11 19/20 actuals and adjusting for growth and acute Independent Sector providers for services centrally procured. As such this plan provided a breakeven position. For months 7 to 12 the CCG was able to generate a plan which incorporated pressures that were being seen and a deficit plan was submitted showing an in-year deficit of £5m. The expectation set by NHS England has been to deliver an in-year breakeven financial position. The CCG carried forward a cumulative historic deficit of £3.2m into 2020/21 which is not expected to be cleared in 2020/21. At the end of the year the CCG achieved a small surplus of £139k, which means that the CCG exceeded its financial plan of a £5m deficit. This will be added to the historic deficit and £3.0m will be carried forward to future years. For the financial year 2020/21, BCCG’s total funding was £846.2m. Of this, £835.7m was allocated for healthcare programmes and £10.5m for the CCG’s running costs. The table below which summarises our budget (plan) and actual expenditure for 2020/21:

24 | P a g e Summary of position Annual Year to Date Month 12 March 2021 Variance Plan Actual £'000£'000£'000

Allocation 843,178846,345 (3,167)

Commissioning Planned and Unscheduled Care420,197418,824 1,373 Prescribing 74,87474,526 347 Mental Health & Joint Care 73,97173,489 481 Community 63,19563,404 (209) Continuing Healthcare 67,11066,152 957 Delegated Co-Commissioning 75,96375,963 0 Primary Care IT 2,3263,322 (995) Other / Reserves 63,18960,543 2,646 Commissioning sub-total 840,825836,2224,602 Running Costs 10,5099,984 526 Total CCG Expenditure 851,334846,2065,128 Planned deficit (4,989) 0 (4,989) Surplus/Deficit In Year (3,167) 139 (3,028)

BCCG has formal delegated responsibility from NHS England for GP Primary Care Commissioning and the CCG received an allocation of £75.9m to deliver this. During 2020/21 the COVID-19 pandemic which was declared at the beginning of March and continued through the year with NHS England maintaining COVID-19 level four incident - the highest level of emergency preparedness planning. As such the NHS began a significant mobilisation to respond to the pandemic. Through the year BCCG claimed for £31.5m of additional revenue expenditure directly related mainly to Primary care to enable remote management of patients and to enable management of COVID-19 positive patients in the community. There was also additional expenditure in relation to hospices and to the hospital discharge programme which was aimed at freeing up hospital capacity for the anticipated level of COVID-19 patients. During the year, BCCG continued joint commissioning and pooled budget arrangements with Buckinghamshire Council. These pooled budgets covered - the Better Care Fund (BCF), Children and Adolescence Mental Health Services (CAMHS), Speech and Language Therapy, Residential Respite Short Breaks, Integrated Community Equipment Service Contract Management, Integrated Community Equipment Service, Section 117 and Integrated Commissioning Team. BCCG’s contribution to the pooled budgets in 2020- 21 was £58.5m while BC contributed £26.8m. For the next financial year 2021/22, national arrangements have been put in place to ensure that NHS providers receive cash as required by means of a national block contracting arrangement through CCGs and CCG’s developing plans with a view to returning to more usual commissioning and contracting arrangements. In line with national policy direction for the NHS, Buckinghamshire CCG continues to work more closely with the BOB ICS. Organisations now work more closely together to make choices and decisions about how the Buckinghamshire pound (£) is spent. Improved system working across Buckinghamshire and across the wider BOB ICS area will contribute to getting the best possible value from the Buckinghamshire pound (£). It is not yet clear what form the “new normal” for the NHS will take, post the COVID-19 pandemic but it is clear that both place (Buckinghamshire) and system (BOB) based commissioning arrangements will continue to play a key role in the planning and delivery of NHS services. 25 | P a g e Constitutional Targets The table below outlines the NHS constitutional targets BCCG has a duty to meet. Due to COVID-19 illness and the need to release capacity across the NHS to support the response, the collection and publication of data and official statistics was paused delayed transfers of care, mixed sex accommodation and cancelled operations.

How does BCCG monitor performance? The BCCG Governing Body is responsible for discharging the duties of its constitution, which includes monitoring and scrutinising the performance of service providers. The Governing Body receives an integrated performance report at the bi-monthly meetings in public. Formal committees of the Governing body scrutinise in more detail how BCCG and health providers are delivering contracted services; these are the Finance Committee, Audit Committee, Quality & Performance Committee, Integrated Care Executive Committee and the BCCG Executive Committee (for more information about the committees and their purpose please see page 45). In addition to the monitoring requirements outlined above, the Urgent & Emergency Care Board also has a role to play in monitoring performance. Its members include the Chief Operating Officers and Governing Body level representatives from NHS organisations in Buckinghamshire and Buckinghamshire Council. The group aims to develop and maintain resilience across the urgent care services and improve the flow of patients through A&E, admission, treatment and discharge. How is BCCG monitored? NHS England has a statutory duty to undertake annual assessment of CCGs. This is undertaken using the NHS Oversight Framework for 2019/20 which replaced the CCG Improvement and Assessment Framework (IAF). The new framework is intended as a focal point for joint work, support and dialogue between NHS England, NHS Improvement, CCGs, providers and integrated care systems. Each CCG receives an overall assessment that places their performance in one of four categories: outstanding, good, requires improvement, or inadequate. BCCG received an overall rating of GOOD in 2019/20 which is the latest published assessment.

26 | P a g e Managing risk Reducing risk across the health system is a priority for BCCG to ensure patients receive high standards of care. Risks are events or scenarios which can hamper BCCG's ability to achieve its objectives. These risks, divided into strategic and operational, are identified, assessed and managed by the organisation and reviewed at every BCCG Governing Body meeting in public. They are continually reviewed at Governing Body meetings including the Audit Committee, Finance Committee, Primary Care Commissioning Committee, Quality & Performance Committee, Integrated Care Executive Committee and the BCCG Executive Committee. Governing Body and CCG directors review all risks on a bi-monthly basis. The report on BCCG's principal, strategic and operational risks and mitigations as of 31 March 2021 can be found on BCCGs website.

The year ahead Through the year 2021/22 BCCG will remain the statutory organisation for commissioning health services in Buckinghamshire. We will be focused on three core goals. First, NHSE issued the Operating Plan Guidance 16 which contained a number of priorities for every system. This included recovery of elective care and non-COVID services as well as continuing to manage the vaccination programme and prepare for any future COVID waves. The year ahead will also concentrate on the Buckinghamshire’s system-wide approach to recovery, which places the health, social and economic wellbeing of Buckinghamshire residents at its heart. ‘Way ahead’ is an ambitious programme of work that considers the interdependencies between socio-economic factors, health outcomes, the economy, environmental matters and communities, and seeks to identify innovative joint solutions to shared challenges. The devastating impact of COVID-19 has presented a challenge to our communities and across our services which we have never seen in our lifetime. We do not underestimate the challenges of dealing with the backlogs are immense that have built up through the COVID pandemic. Second, we need to prepare for organisational changes with the potential close down of the CCG and the safe transfer of CCG functions into an ICS body. In February 2021 the Department of Health and Social Care published a white paper7 outlining a broad set of proposals for legislation which will be introduced to parliament later this year with a view that they will be enacted ahead of March 2022. The white paper proposes putting each ICS onto a statutory footing and the core CCG functions are subsumed into the ICS. While there is much that will be defined in guidance and legislation over the course of 2021 it is likely that a new commissioning organisation will be created across BOB that will launch in April 2022. We are already taking steps on governance arrangements for the three CCGs across BOB geography and to start developing ‘committees in common.’ We will be establishing a comprehensive transformation programme to manage this transition in the early part of 2021/22. Thirdly, we need to ensure we can deliver the CCGs functions effectively and efficiently in 2021/22 whilst we also plan the transition of these functions to the new ICS body We will only achieve these goals through our staff, partners and the volunteers who come together to help us deliver. COVID working is different and for many the work they are doing is different; the challenges of dealing with the backlogs is immense; and we are also all going through a period of organisation transition and dealing with the uncertainly that inevitably comes with change. We will be strengthening the support we give our staff

6 Operating Plan Guidance (england.nhs.uk) 7 Integration and innovation: working together to improve health and social care for all (HTML version) - GOV.UK (www.gov.uk) 27 | P a g e throughout the year and working with them in co-design of the new organisation. Finally, I’d like to offer my thanks in advance to staff, partners, volunteers and the public for their help, challenge comments and scrutiny that I know will combine to deliver better health services for the residents of Buckinghamshire over the coming year.

Dr James Kent, Accountable Officer 14 June 2021

28 | P a g e Accountability Report Corporate Governance Report Members Report Buckinghamshire CCG’s 50 member practices are grouped in 12 Primary Care Network (PCN) areas covering the registered population, each with their own Clinical Directors:

North Bucks PCN Dashwood PCN Mid Chiltern PCN 7 practices 6 practices 5 practices Clinical Director: Clinical Directors: Clinical Directors: Dr Satheesh Ramamsamy Dr Arnab Bera Dr Shaheen Jonah Dr Russell Manaphuza Dr Clare Gabe • The Swan Practice • Whitchurch Surgery • Stokenchurch Medical Centre • Hughenden Valley Surgery • Norden House Surgery • Chiltern House Medical Centre • John Hampden Surgery • Ashcroft Surgery • Cressex Health Centre • Prospect House Surgery • Waddesdon Surgery • Carrington House Surgery • Rectory Meadow Surgery • Wing Surgery / Stewkley • Riverside Surgery • Amersham Health Centre Road • Wye Valley Surgery • Edlesborough Surgery

Central BMW PCN Central MAPLE PCN Westongrove Partnership 3 practices 3 practices 1 practice Clinical Director: Clinical Director: Clinical Director: Dr Toby Gillman Dr Kavitha Mallya Dr Alex Bates

• Berryfields Medical Centre • The Mandeville Practice • Westongrove Partnership • Meadowcroft Surgery • Oakfield Surgery (Aston Clinton, Bedgrove) • Whitehill Surgery • Poplar Grove Practice

Aylesbury Vale South (AVS) Chesham & Little Chalfont PCN Cygnet PCN PCN 3 practices 4 practices 4 practices Clinical Directors: Clinical Director: Clinical Directors: Dr Martin Thornton Dr Stephen Burr Dr Andrea Roberts Dr Nicola Well Dr Amanda Bartlett

• Cross Keys Surgery • Water Meadow Surgery • Desborough Surgery • Haddenham Medical • The New Surgery / Dr Firth • Kingswood Surgery Centre • Gladstone Surgery • Priory Surgery • Unity Health • Little Chalfont Surgery • Tower House Surgery

The Chalfonts PCN South Bucks PCN The Arc Network 3 practices 5 practices 6 practices Clinical Director: Clinical Director: Clinical Director: Dr Nicola Turner Dr Conan Hassim Dr Penny Macdonald

• The Misbourne Practice • Denham Medical Centre • Cherrymead Surgery • The Allan Practice • Burnham Health Centre • Highfield Surgery • The Hall Practice • Southmead Surgery • Marlow Medical Group • Threeways Surgery • Millbarn Medical Centre • Iver Medical Centre • The Simpson Centre • The Bourne End & Wooburn Green Medical Centre

29 | P a g e Members of the Governing Body The names of the Clinical Chair and the Accountable Officer for Buckinghamshire CCG are: • Dr Raj Bajwa, Clinical Chair, Buckinghamshire CCG • Fiona Wise, Chief Executive and Accountable Officer and Integrated Care System (ICS) Executive Lead – to 17 May 2020 • Dr James Kent, Accountable Officer, Buckinghamshire CCG and Executive Lead for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) – from 18 May 2020 The Governing Body comprises GP representatives, lay members and executive management directors. Individual profiles are available on BCCG’s website here. The composition of the Governing Body as at 31 March 2021 (in addition to the Chair and Accountable officer) is:

Lay Members Robert Parkes Lay Member / Vice Lay Chair / Chair of Audit Committee Anthony Dixon Lay Member - Finance Committee Chair Graham Smith Lay Member - Primary Care Commissioning Committee Chair Registered Nurse and Secondary care Doctor Dr Crystal Oldman CBE Registered Nurse Dr Robin Woolfson Secondary Care Specialist Doctor Management Directors Kate Holmes Interim Chief Finance Officer Robert Majilton Deputy Chief Officer Louise Smith Interim Director of Primary Care and Transformation (co-opted as an additional voting member only in circumstances of Conflict of Interest material to member GPs/Chair) Member GPs – Clinical Directors appointed by the Governing Body Dr Dal Sahota Clinical Director – Urgent and Emergency Care Dr Rashmi Sawhney Clinical Director – Health Inequalities and The Primary Care Network DES Dr Karen West Member GP/Clinical Director Quality and Integration/Caldicott Guardian From the CCG Clinical Directors

Dr Karen West Clinical Director for Quality and Integration Caldicott Guardian As the Clinical Director for Quality and Integration, my main focus over the last year has been helping to develop a flexible way of monitoring quality during this difficult and unprecedented time. We initially held informal weekly quality meetings, via Teams, across the ICP to update on areas of concern which have reduced to fortnightly. We continue to have a weekly safeguarding calls across the ICP. Alongside the ICP updates, we have regular CCG quality team calls and a monthly Quality and Performance committee call. I have worked closely with our deputy director for quality and ICP colleagues to create a Clinical Harms Group. This has been one of my key drives over the last year, following concerns that non-COVID issues were going to be overlooked during the pandemic, as the national focus was on managing COVID demand and care. We developed a framework which enables us to review non-COVID harm and prioritisation regularly.

30 | P a g e As Caldicott Guardian, I continue to provide clinical advice re IG issues and have signed off various COVID projects. We have also continued with IG meetings via Teams with our Oxfordshire colleagues. As a clinical lead for IFR I provide clinical triage of IFR cases, as well as attendance at case panels when required. I also attend the Thames Valley Priorities Committee, which has continued virtually over the last year. Within CHC, I provide clinical input into CHC case reviews, which have restarted in the last couple of months. I also provide clinical input into the CHC transformation group held monthly, which has been focusing on discharge to access over the last year. A national group of clinical and professional leaders has been developed during the pandemic and I have been involved in the network focused on shaping an ICS. I have provided clinical oversight to the local Aylesbury COVID Vaccination Hub, as duty doctor, on a weekly basis, which has been done as part of my CCG role, as well as in my own time. This has been a tremendous venture, with fantastic support from colleagues and great feedback from patients. CCG Boards, Committees & Groups member • Governing Body • Executive Committee • Quality and Performance Committee • Safeguarding Steering Group • IG Steering Group (with OCCG) • Clinical Teams Meeting

ICP Boards, Committees, Groups & Forums member • Health and Wellbeing Board • Integrated Executive Commissioning Team • ICP Quality Forum • ICP Safeguarding Call • CHC Transformation Group

Networks member • Thames Valley Priorities Committee • STP and ICS Clinical and Professional Leaders Network – Shaping an ICS

Dr Sian Roberts Clinical Director for Mental Health, Learning Disabilities and Dementia As an Executive Clinical Director of Buckinghamshire CCG my role is to drive the clinical work of the CCG with the aim of improving outcomes for people with mental health problems, learning disabilities and dementia. Thirty seven percent of people with a learning disability die from avoidable causes, compared with 8.8% of the general population. My aim is to tackle the causes of morbidity and preventable deaths and reduce the waiting time for specialist support for people with learning disabilities (LD). I have been the driving force behind a multiagency group in the county to focus on improving the uptake and quality of annual health checks for people with learning disabilities; health checks offer us an opportunity to identify and treat health conditions in those with LD. Along with nurses from the Community LD Team, I have given 1:1 support

31 | P a g e to practices and we have worked with the County Council to promote the importance of the annual health check with care homes / supported living providers. In Buckinghamshire in 2019/20, 48.6% of those living with LD had a health check. The challenge in 2020/21 was to increase the uptake in this group to at least 67%, with the additional challenge of doing these checks safely during the pandemic. I am proud that we have exceeded the target set by NHS England with 83% of people with LD having received a health check over the past year. My work in dementia focuses on the need to provide timely diagnosis to ensure people and their carers have access to good post diagnostic support to live well with dementia. Throughout the past year I have helped deliver webinars to support care home staff during the pandemic; have developed a dementia care toolkit for primary care with a personalised approach to dementia care and a toolkit to support care homes to manage patients living with dementia. Within mental health my aim is to improve timely access to mental health support across all the age groups, as determined in the NHS Long Term Plan, and reduce the mortality gap of 20 years of those living with serious mental health illness. Throughout the past year I have led work to develop mental health services to support mental wellbeing and improve outcomes for people suffering from mental health conditions. I have done this through working with our local provider Oxford Health and primary care, supporting quality improvements projects and transformation. An example of this includes the development of a Community Mental Health Framework to support seamless and readily accessed mental health care in the community.

CCG Boards, Committees & Groups member • Executive Committee • Mental Health and Learning Disability and Autism Board • Health and Wellbeing Board • Staying healthy and well with LD • Community Mental Health Framework • Dementia Strategy Group • Mental Health Strategic Response group • Mental Health Voluntary Sector Response group

Networks member • NHSE South East Clinical Delivery Network - Clinical Lead for Dementia • National RCGP Intellectual Disability Group

Dr Shona Lockie Clinical Director for Medicines Optimisation Clinical Director & Co-Lead for COVID Vaccination Programme

Across Buckinghamshire we spend more than £110m on medicines. It is estimated nationally that 30%-50% of all medicines are not taken as intended and 5%-8% of all hospital admissions are medicines related. Medicines optimisation looks at the value which medicines deliver, making sure they are clinically effective and cost effective. It is about ensuring people get the right choice of medicines, at the right time, and are engaged in the process by their clinical team. Medicines are part of nearly every aspect of the work the CCG undertakes and therefore I am part of many groups, not only medicines optimisation, but pathway design, innovation, 32 | P a g e and education. To enable the delivery of work across such a wide remit, I have built good relationships with partners across Buckinghamshire. I am particularly proud to have been involved over the last three years in developing a new Medicines Optimisation governance structure across Buckinghamshire, which included provider colleagues from Oxford Health NHS FT, GP federations, Buckinghamshire Health Trust, as well as colleagues from the Local Medical Committee and Local Pharmaceutical Committee. This rapidly stepped up during COVID to weekly governance meetings to approve new drugs, and guidelines for management of COVID-related illness. Business as usual work has also continued during the last year: for example contributing to clinical guidelines in Buckinghamshire and across the BOB area; communications with primary care through newsletters, forums, etc; reducing variation; quality and safety improvement.

I helped to rapidly set up a Frailty working group with Dr Raj Thakkar at the beginning of the pandemic, and he has continued to lead. I have supported medical optimisation in care homes in the development of frailty pathways, and the Care Homes Steering Group. Having driven a proof of concept trial in North Buckinghamshire, this is now being developed across the county. There is work across the system to improve safety of monitoring of high-risk drugs, bringing care close to home.

I have supported changes in prescribing for the Epilepsy Centre and new prescribing guidance for anticoagulation.

During the pandemic I worked to develop FAQ guidance on medicines optimisation for primary care across BOB. I led a webinar for care home staff on the importance of having the vaccination. I was part of an End of Life task and finish group to develop guidance on prescribing at end of life in the community for patients with COVID. I supported the development of a COVID visiting service and home saturations monitoring service. I have been part of our vaccination roll-out its high uptake rates.

CCG Boards, Committees & Groups member • Executive Board • Co-Chair Medicines Optimisation Board • Deputy Chair Medicines Value Group • COVID vaccination Allocations Bureau

Networks member • Voting Member Regional Medicines Optimisation Committee (South)

Dr Raj Thakkar Clinical Director for Planned Care The scope of planned care includes cancer care, radiology, surgical specialties and some medical specialties, including dermatology and gastroenterology. In addition to being the clinical director for planned care, I am also the subject matter expert for cardiovascular disease at Buckinghamshire CCG. I have always promoted the ethos that if we deliver high quality care to our population, efficiencies will follow. That ethos, together with promoting a focus on patients who need healthcare the most, has led to several awards and publications over the years, including an all-party parliamentary award, 2 AFA pioneer awards and HSJ finalist awards. The pandemic has accelerated significant change in the way care needs to be delivered. 33 | P a g e Planned care recognised this in the first wave and highlighted the need to focus on several key areas including how we manage care despite COVID. To that end, I am a member of the system restoration and recovery board. In addition, I started the Buckinghamshire frailty group which recognised the need for education, identification of clinically frail patients and provision of individual care plans with community support. This work has had significant positive impact on patients and system resilience, including a reduction in 30-day re-admissions from 17.8% in the year to January 2020 to 15.9% in January 2021. Readmissions within seven days had also reduced, as did mean length of stay in hospital. Significant work is going on around detecting cancer and cardiovascular risk in areas of deprivation. Like frailty, this is a cross organisational piece of work that is outcome focussed. There are 17,000 more cases of hypertension to identify, and I am part of a group to support this work. There is also work across Buckinghamshire to transform the way outpatient services are delivered to enable people to connect with consultants virtually, at the right time and in some cases initiated by patients themselves. I am leading on a collaborative project to detect and treat patients at high risk of cardiovascular disease, including those with inherited lipid disorders called familial hypercholesterolaemia. This will have profound benefits for patients across the population. As part of my work with the Oxford AHSN and regional work, I have been a key lead in delivering diabetes and hypertension urine checks at home across the South East region. Urine ACRs can detect patients who are at risk of developing cardiovascular disease and renal failure. Early adopters in Buckinghamshire have shown a 90% response rate and 25% of those tests changed management which can have a significant impact on reducing cardiovascular risk. I’m leading on atrial fibrillation work in a COVID-safe way, which offers remote digital checks for irregular pulses and can lead to further significant reduction in stroke risk. Equally, the excellence in heart failure programme has increased prevalence by over 15% in practices which took part and has just been restarted across the county. The planned care team is dedicated to the patients of Buckinghamshire and committed to transform and deliver the best care possible. CCG Boards, Committees & Groups member • Executive Body • Restoration and Recovery Board • Planned care Board • Elective Care Board • Transforming Outpatients’ Group • Cancer Strategy Group • Clinical Harms Group • Cardiovascular /Hypertension Groups • Frailty Delivery Group

Networks member • Primary care cardiology lead, Oxford Academic Health Science Network • Thames Valley Cancer Alliance • South East Region accelerated access collaborative on urine ACR • National NHS Long Term Plan steering group for heart failure and heart valve disease

34 | P a g e • GP member: national cardiac pathways improvement programme

Dr Juliet Sutton Clinical Director for Children’s and Young People’s Services I am passionate about improving the health and wellbeing of our young people and believe we need to focus more of our efforts on the preventative agenda. The COVID pandemic has hit children and young people hard, and they will live with the psychological, social, and economic consequences of the pandemic for years to come. I have always worked as part of a joint commissioning team with Buckinghamshire Council colleagues. I am proud to have moved forward with the creation of strong links with secondary care colleagues, with the vision of an integrated children’s team. Ultimately this integrated picture should have the voice of children and families at the centre of everything it hopes to achieve. In the last year I have been involved in several projects including work around acute care/COVID hubs for children. We have expanded and consolidated the integrated children’s care programme (which I championed and set up in Buckinghamshire) with four consultant paediatricians being linked with four Primary Care Networks (PCNs). These PCNs were identified due to high levels of deprivation, many young families and high urgent care attendance. Monthly multi-disciplinary team (MDT) meetings to discuss cases have been held virtually and have been successful with increased inclusiveness. Working relationships have been built across teams in both primary and secondary care and knowledge has been expanded. Paediatrician-led community clinics are scheduled to restart soon. I have been working with colleagues across Berkshire HT and Oxford Health NHS Foundation Trust (OHFT) to improve and enhance the existing mental health pathway as demands for the service escalate. I have offered clinical overview and support following the review of the Neurodevelopmental Pathway. I have also been working to provide clinical supervision and support for our Designated Clinical Officer for SEND During the earlier wave of the pandemic, I provided clinical support to all the care home projects, drawing on my experience in primary care and previous role as the clinical lead care homes. I have helped to support the setting up and provision of the COVID-19 vaccination centre at the Aylesbury PCN site. I hope that going forward we will continue to focus on the needs of children and young people and give them the priority that they deserve. CCG Boards, Committees & Groups member • Executive Committee • Health & Wellbeing Board • Safeguarding Board • Integrated Commissioning Executive Team • Children’s Urgent Care Advisory Group

35 | P a g e Dr Dal Sahota Clinical Director for Urgent and Emergency Care I have served the county as a working clinician and clinician Director for several years. Collectively we strive to provide the highest quality care, listening to our patients their families and carers with a focus to continually improve the quality of care that patients receive. All of my work this year has relied on a few leadership strengths, the ability to connect people, facilitate difficult conversations, endanger trust quickly by transparent interactions- these are the other than “clinical” skills I have bought to the role. Our clinical team meetings have provided a forum for us to be able to truthfully speak to areas of service we must make improvements on. The area of urgent and Emergency care has undoubtedly been one of the most challenging during the pandemic, however as a group of clinical directors we were also acutely aware of ensuring appropriate timely care for non-COVID-19 related illness, be that emergency or elective care. I was aware of the tremendous task ahead of all of us, and as such ensured gaining up to date knowledge from national webinars throughout. The urgent care team have continued Business as usual and I have overseen both the winter and flu plans for our organisation. I have also worked as a clinician champion for “think 111 first”, both locally and at regional level. Lastly, I have been the clinical director for the Buckinghamshire system COVID-19 tactical group- an essential communication and action group throughout the pandemic. COVID-19 Services - During the last year I have provided consistent leadership and steer for our community covid services. (hot hubs, community home visiting including care homes and LD homes) From inception, service design, clinical pathways, SOP’s, integrating collaborative working between different partner organisations, liaising with LMC to gain support to drive the work on at pace; all whilst ensuring appropriate governance. The later part of the year has involved continual monitoring and evaluation, allowing for checking for any health inequalities in access. Creating thresholds for stepping down as well as clear and simple re -escalations for services during subsequent waves. Following on from this I provided system leadership support to our trust in setting up of Virtual wards. I was the lead clinician working with the academic health science network, ensuring Buckinghamshire was able to learn from other national models- ultimately this was to allow safe discharge of covid patients home once stabilised with outreach follow from the respiratory team. In conjunction with this, I also led the service initiation of pulse oximetry at home at home for managing cases of covid in the community. Children’s urgent care - We continued our Children’s Urgent Care Group meetings and worked proactively with our clinical director for children’s services to send out comms to schools and via other media to relay to the public to please consult with general practice for sick children. We have a trusted network of consultants, managers, and comms team who are able to meet and proactively make changes to improve and safeguard our children and young people. Mental health - I have worked to connect colleagues in SCAS and Oxford health to ensure pathways are in place to direct conveyance to Mental health services rather than A&E. Review with CAMHS and Paediatrics to evaluate how changes in the service are working at ward level, with very positive feedback Discharge to Assess - For inpatients who have recovered from an acute illness in hospital, we continue to enact the home first principle. There has been additional domiciliary capacity commissioned to care for residents at home. Where this has not been possible, patients have been placed in care homes settings once medically fit awaiting their 36 | P a g e assessments for onward care needs. I have led the team working closely with primary care and the LMC as well as our IT team to meet the general practice needs of this cohort of temporary residents. Important co production and close working with colleague in the council, linking with Immedicare as well as working with care homes. This has spanned across two acute hospital trusts; we have commissioned a D2A follow up clinic at Frimley and plan to replicate this at BHT. Working as a local GP, this has included dealing with easy access to colleagues in general practice availability for 1:1 calls. Working in tandem with our quality team picking up individual complaints and any themes arising from issues. The most important part of my role is and continues to be challenge, to keep questioning to seek assurance that we are doing the best we can with our resource for our population. CCG Boards, Committees & Groups member • Governing Body (June 2020) • Executive committee • Urgent and Emergency Care Board – Deputy Chair • 24/7 and Out of Hours Contract Review Meetings - Chair

ICP Boards, Committees, Groups & Forums member • BOB UEC systemwide Board (as of April 2021)

Networks member • Think 111 first regional clinical reference group

Dr Stuart Logan Clinical Director for Long Term Conditions, Ill Health Prevention, Supported Self- care and End of Life Care

As a Clinical Director my role is to drive the clinical work of the CCG to try and slow the development of long term medical conditions, help people and their carers to cope better when they have a long term condition (LTC) and enable patients reaching the end of their life to die with dignity. I work closely with a team of managers and specialist nurses along with Bucks Public Health and colleagues from secondary care and mental health services. 40% of the population of Buckinghamshire have an incurable condition that can be managed by lifestyle measures and medication. The older you are the more likely you are to have more than one long-term condition and over the age of 75 you are most likely to have three Long term conditions include diabetes, high blood pressure, kidney disease, heart disease, the effects of a stroke, asthma and chronic obstructive lung disease, COPD). We deliver education through our small team at the CCG to help primary care staff who do the bulk of care for patients with LTC. We also commission education for our patients with diabetes, heart disease and COPD. It has been shown that education helps patients and carers manage LTC’s more effectively. During the COVID-19 pandemic we developed text messages to patients with LTC signposting them to online help a measure which one national recognition gaining us a self-care award. Our population has like the rest of England growing levels of obesity which along with smoking, alcohol, inactivity and poor diet are the main contributors to developing ill health. We therefore jointly with the council deliver a central portal for lifestyle services including the option of help in managing the anxiety and depression which often hampers patients’ 37 | P a g e ability to manage their long term condition. This can be accessed by self-referral, primary care team referral and by anyone in health or social care. During the recent pandemic, with the pressures across the system, health has struggled to deliver the normally very high standards of care to the population of Bucks with data suggesting a drop in attainment of ‘targets’ for best health in LTC although when compared to other areas nationally we have done better than many other systems. The challenge now will be to create the environment moving forward that will allow patients to understand and be able to measure their own numbers to better support themselves and already we are active participants in the blood pressure at home, oximetry at home and urinary protein measurement at home schemes. In essence to try and gain something positive from the pandemic. We are also working closely with our colleagues in the hospital sector to bring care closer to our communities with the development of multidisciplinary team meetings and community diagnostic hubs. CCG Boards, Committees & Groups member • Executive Committee • Population Health Management Board • Diabetes group • Respiratory group • Cardiovascular Group • Integrated Care System Long Term Conditions Forum

Networks member • NHSE South East Clinical Delivery Network ICS representative for diabetes

Rashmi Sawhney Clinical Director for Health Inequalities & PCN Direct Enhanced Services (DES) As the Clinical Director for Health Inequalities and the Primary Care Network Direct Enhanced Services (DES), my main focus over the last year has been developing services to support and address both COVID-19 and non-COVID-19 related health inequalities. This has been achieved through playing an active role in clinical aspects of the Buckinghamshire COVID-19 vaccination programme. The concept of the national vision of mass vaccination was a formidable task, however I was able to lead on conversations with a group of practices / PCN to engage with this and sign up to the vaccination programme. The population of Buckinghamshire is multi-cultural and it was important to work with our local Muslim leaders to develop ways in which we could communicate and convey COVID- 19 messages, while respecting their religious obligations e.g. Ramadan. This was achieved through a WhatsApp group to share COVID-19 appropriate messages for the community. I participated in the BBC 3 Counties Radio Questions & Answers about the COVID-19 vaccination, BAME communities’ uptake and myths, aiming to provide support and reassurance. I presented the work being undertaken on COVID-19 and Health Inequalities by Buckinghamshire CCG to the Governing Body and Health and Scrutiny Committee. This COVID-19 and BAME inequalities work continues and the achievements and outcomes will be published in due course. COVID-19 has unfortunately created long waiting times for patients requiring hospital care, potentially increasing the risk of clinical harm. To ensure that this is minimised, along with other clinicians and health care managers across the system I was involved in the

38 | P a g e development of the recommendations of the Clinical Harms Group, which continues to meet on a monthly basis My role requires me to provide clinical advice and support to a variety of development projects within the CCG, with my main focus areas being the delivery of the PCN Direct Enhanced Services (DES), care delivered in the local care homes, as well as the point of contact to support the CCG Primary Care team. The last year has been difficult in many ways and the CCG has worked hard to ensure that the needs of the population, communities have been addressed and health inequalities recognised within all the services that have been developed. At the start of the pandemic new services included GP-led ‘Hot Hubs’ which were set up to diagnose and advise COVID-19 patients who were not in hospital and a care homes visiting service for COVID- 19 patients. I also supported the rapid setting up of the supplementary network service (SNS) with the aim of improving care for patients. This involved a holistic approach with all key stakeholders: primary, secondary and community care involved in its development. As a clinician I reviewed various COVID-19 risk assessment tools, sharing the findings and recommendations across all the GP practices for primary care BAME risk assessments and COVID-19 wellbeing support. In conjunction with BHT, training for these tools was developed and offered to practice managers. As we come out of lockdown, it is important that we continue to develop other non-COVID- 19 projects to ensure that the Buckinghamshire population remains safe and healthy. These include linking in with the frailty strategy for 2021-22 and setting SMART outcome measures for the SNS going forward and also leading the blood pressure BP@home pilot. I have been a GP in High Wycombe since 1997 and part of the CCG’s clinical team since its inception in 2012. In addition to these roles, I’m also a GP trainer and appraiser in Buckinghamshire. CCG Boards, Committees & Groups member • Governing Body • Executive committee • Primary Care Committee • Primary Care Operational group • COVID-19 Care homes steering group • Equality diversity and inequalities group • Learning disability task and finish group • Primary care and community transformation group • Public Health Management System workshops • Cancer Assurance Meeting • Reducing mortality from inequalities: attend when meeting falls on non- clinical days

ICP Boards, Committees, Groups & Forums member • Population Health Management Board • BHT integrated Elderly and Community Care Division: Business Board • Community Care Recovery Delivery Group • Addressing Inequalities in COVID in BAME communities • Clinical Harms Steering Group • Frailty delivery group • Oxfordshire and Bucks Cancer strategy Steering group

39 | P a g e Statement of Disclosure to Auditors

Each individual who, on 31 March 2021, is a member of the Governing Body confirms: • so far as the Governing Body member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware and; • that the Governing Body member has taken all the steps that they ought to have taken as a member to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information. Please see the Annual Governance Statement on page 42 for information about the committees of the Governing Body including membership and attendance. The Governing Body Membership Register of Interests is available on the CGGs website here Personal Data Related Incidents There have been no personal data related incidents formally reported to the Information Commissioner’s office. Modern Slavery Act BCCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015. Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Dr James Kent to be the Accountable Officer of NHS Buckinghamshire Clinical Commissioning Group. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for: • The propriety and regularity of the public finances for which the Accountable Officer is answerable, • For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction), • For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). • The relevant responsibilities of accounting officers under Managing Public Money, • Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)), • Ensuring that the CCG complies with its financial duties under Sections 223H to

40 | P a g e 223J of the National Health Service Act 2006 (as amended). Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its income and expenditure, Statement of Financial Position and cash flows for the financial year. In preparing the accounts, the Accounting Officer is required to comply with the requirements of the Government Financial Reporting Manual and in particular to: • Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis • Make judgements and estimates on a reasonable basis • State whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts; and, • Prepare the accounts on a going concern basis; and • Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable. The responsibilities of an Accounting Officer, including responsibility for the propriety and regularity of the public finances for which the Accounting Officer is answerable, for keeping proper records and for safeguarding Buckinghamshire CCG’s assets, are set out in Managing Public Money published by the HM Treasury. As the Accounting Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that NHS Buckinghamshire Clinical Commissioning Group auditors are aware of that information. So far as I am aware, there is no relevant audit information of which the auditors are unaware. I also confirm that, as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.

Dr James Kent, Accountable Officer 14 June 2021

41 | P a g e Annual Governance Statement NHS Buckinghamshire Clinical Commissioning Group is a body corporate established by NHS England on 1 April 2018 under the National Health Service Act 2006 (as amended). The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As of 1 April 2021, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006. Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement. Governance arrangements and effectiveness The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. In accordance with Part I, Section 6.4.1 of the CCG Constitution, the CCG has the following statutory committees: • The Audit Committee • The Remuneration Committee • The Primary Care Commissioning Committee It has also established delegated committees of the Governing Body as shown in Appendix D of the CCG constitution: • Executive Committee • Finance Committee • Quality & Performance Committee

42 | P a g e • Integrated Commissioning Executive Team The Integrated Commissioning Executive Team (ICET) is co-chaired by the CCG and also accountable to the Health and Wellbeing Board, to jointly manage and monitor shared issues and oversee strategy and performance.

The terms of reference for each of these committees have been ratified by the Governing Body, and the minutes are publicly available along with those of the Governing Body meeting papers (with the exception of the remuneration committee). Buckinghamshire Integrated Care Partnership (ICP) and Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) The Buckinghamshire Integrated Care Partnership (ICP) facilitates better collaboration at county level between the CCG and partner organisations. This is managed through an ICP Partnership Board (made up of system Accountable Officers/Chief Executives) The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) operate to support each ICP and organisation within the system for the delivery of services, constitutional standards and requirements of the NHS Long Term Plan. This also includes groups for system leaders to regularly meet, along with financial and delivery oversight.

Governing Body The names of the Clinical Chair and the Accountable Officer for Buckinghamshire CCG are: • Dr Raj Bajwa, Clinical Chair, Buckinghamshire CCG • Fiona Wise, Chief Executive and Accountable Officer and Integrated Care System (ICS) Executive Lead – to 17 May 2020 • Dr James Kent, Accountable Officer, Buckinghamshire CCG and Executive Lead for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) – from 18 May 2020 The Governing Body comprises GP representatives, lay members and executive management directors. Individual profiles are available on BCCG’s website here. The composition of the Governing Body as at 31 March 2021 (in addition to the Chair and Accountable officer) is: Lay Members Robert Parkes Lay Member / Vice Lay Chair / Chair of Audit Committee Anthony Dixon Lay Member - Finance Committee Chair Graham Smith Lay Member - Primary Care Commissioning Committee Chair Registered Nurse and Secondary care Doctor Dr Crystal Oldman CBE Registered Nurse Dr Robin Woolfson Secondary Care Specialist Doctor Management Directors Kate Holmes Interim Chief Finance Officer Robert Majilton Deputy Chief Officer Interim Director of Primary Care and Transformation (co-opted as an additional Louise Smith voting member only in circumstances of Conflict of Interest material to member GPs/Chair) Member GPs – Clinical Directors appointed by the Governing Body

43 | P a g e Dr Dal Sahota Clinical Director – Urgent and Emergency Care Clinical Director – Health Inequalities and The Primary Dr Rashmi Sawhney Care Network DES

The Governing Body includes three GPs as representatives from member practices, all of which are also members of the Executive Committee. The member practices aim to meet at least once a year to influence strategy and key organisational decisions. Member practices are able to influence strategy and key decisions such as expressing confidence (or otherwise) in the Governing Body or Executive Committee. The responsibilities of the CCG are detailed within section 5 of the Constitution (functions and general duties), and the roles and responsibilities of members of the Governing Body are in section 7. The standing orders, the prime financial policies and the scheme of reservation and delegation are contained within section 8 and 10, as well as Appendices C and D. Through adoption of the Constitution the Practice Members have agreed that the Governing Body will be responsible for: • Assurance including audit and remuneration • Assuring the decision-making arrangements • Oversight of arrangements for dealing with conflict of interest • Leading the setting of vision and strategy • Quality • Financial stewardship of public funds • Promoting patient and public engagement • Approving commissioning plans on behalf of the CCG • Monitoring performance against plan • Providing assurance on strategic risks The Practice Members are represented on the Governing Body through three member GPs who are appointed in line with Standing Orders. The Governing Body agenda for the CCG in 2020/2021 has included reporting and decisions on: • Budget setting and arrangements for annual report and accounts • Standing items on quality, finance, contracting and performance • Review of Quality, Innovation, Productivity and Prevention (QIPP) plans • Review of strategic risks through the Governing Body Assurance Framework • Ratification of policies and procedures as required • NHS Long Term Plan and 5 year strategy • Issues where decisions at Executive Committee and Primary Care Commissioning Committee were subject to conflicts of interest • Annual Reports on safeguarding and data, security and protection

44 | P a g e • Communications and engagement activity • Buckinghamshire Integrated Care Partnership (ICP) finances and transformation investments/commitments • Developing Primary Care Networks • Developing the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System • Emergency Preparedness. Resilience and Response (EPRR) and winter preparedness • Response to and recovery from COVID-19, including governance accountability and compliance with statutory duties The Governing Body also reviewed its own governance arrangements and effectiveness, as well as the Terms of Reference of its committees, the CCG’s constitution and the Scheme of Reservation and Delegation. The registers of conflicts of interest and gifts and hospitality were both reviewed, and all members made an annual public declaration of their commitment to the NHS Standards for Members of CCG Governing Bodies. Governing Body Committees All committees outlined provide assurance to the Governing Body and may also undertake self- assessments of their effectiveness. Audit Committee Reviews critically the CCG’s financial reporting and internal control principles; ensures that all the CCG activities are managed in accordance with legislation and regulations governing the NHS; ensures adequate assurance is in place over the management of significant risks; and ensures that appropriate relationships with both internal and external auditors are maintained. The Committee met 8 times in 2020-21. This included extraordinary Audit Committee meetings in April and May 2020 to approve the submission of the draft and final 2019/20 Statutory Accounts and Annual Reports. The CCG’s Clinical Chair is also invited to review the annual accounts. Audit Committee Members as at 31 March 2021

Lay Member - Audit Chair & Lay Member - Finance Lay Member - Primary Care Vice Chair Committee Chair Commissioning Committee Chair Robert Parkes Anthony Dixon Graham Smith

Internal Audit Local Counter Fraud Specialist External Audit Representative Representative (LCSF)

Deputy Accountable (Chief) Interim Chief Finance Officer Officer Robert Majilton Kate Holmes

Lay Member (non-executive) Standing Invitee - Non Voting

45 | P a g e The Committee receives regular reports to provide it with assurance from: • the Chief Finance Officer and deputies on finances and performance, losses and special payments and single tender waivers • Internal Audit and External Audit – including reports on the outcome of reviews together with recommendations on any necessary actions • the Local Counter Fraud Specialist (LCSF) • the Chief Finance Officer and Head of Governance/Board Secretary in respect of the risk registers and the Governing Body Assurance Framework • The Head of Governance/Board Secretary in respect of corporate governance including conflicts of interest exceptions, gifts, hospitality, sponsorship, joint working agreements • The Data Protection Officer, Caldicott Guardian and Senior Information Risk Owner (ISRO) in respect of data security and protection arrangements The Chief Officer and other executive directors attend meetings as requested. Representatives of internal audit, external audit and local counter fraud service attend each meeting. A meeting in private session with the Lay Members is also held at least once per annum. The agenda of the Audit Committee is governed by its annual business cycle. Remuneration Committee This Committee reviews the framework for the Remuneration, Allowances and Terms of Service for employees of the CCG and for people who provide services to the CCG. It makes recommendations to ensure effective oversight of the performance of the CCG’s Chair, Chief Officer, Chief Finance Officer, and other senior posts, and for scrutiny of any redundancy payments. The committee met 3 times in 2020/21. Remuneration Committee Members as at 31 March 2021

Lay Member - Audit Chair & Lay Member - Finance Lay Member - Primary Care Vice Chair Committee Chair Commissioning Committee Chair Robert Parkes Anthony Dixon Graham Smith

Human Resources Representative (NHS South CCG GP Clinical Chair Central and West Dr Raj Bajwa Commissioning Support Unit) Harriet Yeoman

Accountable (Chief) Officer Deputy Accountable (Chief) and Integrated Care Interim Chief Finance Officer Officer System (ICS) Executive Lead Kate Holmes Robert Majilton Dr James Kent

Lay Member Clinical - standing invitees non-voting

Managerial - standing invitees or by invitation - non-voting

46 | P a g e The overall purpose of this committee is to assure the Governing Body that the duty to act effectively, efficiently and economically has been met, and that use of resources for remuneration does not exceed any amount specified. Primary Care Commissioning Committee The Committee is established in accordance with the statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in Buckinghamshire under delegated authority from NHS England. Meetings are held quarterly and in public. The Primary Care Commissioning Committee is directly accountable to the Governing Body, and additionally to the Finance Committee for financial investment matters. Health and Wellbeing Board representatives and NHS England are also invited to attend in accordance with the Delegation Agreement. The CCG chair is not a voting member. The Committee met 5 times in 2020/2021.

Primary Care Commissioning Committee Members as at 31 March 2021

Lay Member - Primary Care Lay Member - Audit Chair Lay Member - Finance Committee Commissioning Committee & Vice Chair Chair Chair Graham Smith Robert Parkes Anthony Dixon

Clinical Director for Quality Clinical Director -Health Inequalities CCG GP Clinical Chair and Integration/Caldicott and The Primary Care Networks Dr Raj Bajwa Guardian Directed Enhanced Service (DES) Dr Karen West Dr Rashmi Sawhney

Accountable (Chief) Officer Deputy Accountable (Chief) and Integrated Care System Interim Chief Finance Officer Officer (ICS) Executive Lead Kate Holmes Robert Majilton Dr James Kent

Associate Director of Digital Head of Primary Care Head of Primary Care and IM&T Network (PCN) Jessica Newman Anna Lewis Development & Delivery

Local Medical Committee NHS England Health and Well Being Board (LMC) Representatives Representatives Representatives

Lay Member (non-executive) Clinical - standing invitees non- voting Managerial - voting members Managerial - standing invitees non-voting External parties - standing invitees The Committee undertakes the following activities: • Review and monitor GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract) and enhanced services (“Local Commissioned Services” and “Directed Enhanced Services”) • Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF) • Decision making on whether to establish new GP practices in an area and to

47 | P a g e approve practice mergers and making decisions on ‘discretionary’ payments • To plan, including needs assessment, primary care services in Buckinghamshire and undertakes and delivers a primary care estates strategy across the Buckinghamshire area • To undertake reviews and manage the budget for commissioning of primary care services in Buckinghamshire and to co-ordinate a common approach to the commissioning of primary care services generally • To assist and support NHS England in discharging its duty under section13E of the NHS Act 2006 (as amended by the Health and Social Care Act2012) so far as relating to securing continuous improvement in the quality of primary medical services Executive Committee The Executive Committee is responsible for the overall management and delivery of the operational plan and its associated work programmes and has the responsibility for day-to- day management of the CCG and certain functions as delegated by the Governing Body. Some of the delivery of these functions is delegated to committees of the Executive Committee such as the Programme Boards. The Committee met 11 times in 2020/21, although a number of these meetings were shortened to essential business due to the COVID-19 pandemic.

Executive Committee Members As at 31 March 2021

Clinical Director - Mental Clinical Director - CCG GP Clinical Chair Health & Learning Children's Dr Raj Bajwa Disabilities Dr Juliet Sutton Dr Sian Roberts

Clinical Director -Health Clinical Director for Clinical Director - Inequalities and The Quality and Clinical Director - Unplanned Acute Primary Care Networks Integration/Caldicott Planned Care Care Directroed Enhanced Guardian Dr Raj Thakkar Dr Dal Sahota Service (DES) Dr Karen West Dr Rashmi Sawhney

Clinical Director - Long Clinical Director - Clinical Lead for End Term Conditions, Medicines of Life Care Prevention and supported Management Dr Malcolm Jones Self-Care Dr Shona Lockie Dr Stuart Logan

Accountable (Chief) Officer and Interim director of Deputy Accountable (Chief) Interim Chief Finance Integrated Care primary care and Officer Officer System (ICS) transformation Robert Majilton Kate Holmes Executive Lead Louise Smith Dr James Kent

Clinical Managerial

Certain matters are considered at most meetings as part of a standing agenda including the Chief (Accountable) Officer’s Report as well as Finance, Performance and Quality Reports alongside corporate risks.

48 | P a g e In addition to the standing items, also undertakes the following activities which include discussion, reporting and decision making under delegated authority: • Approval of recommendations for Procedures of Limited Clinical Value (PLCV), as well as an Ethical Framework and Standard Operating Procedure • Ratification of policies and procedures as required on human resources and continuing healthcare • Digital Work Programme and annual report as required • Developing Primary Care Networks • Developing the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System • Formal support for Buckinghamshire Devolution Proposal • Termination of Pregnancy and anticoagulation procurements • Review of terms of reference and corporate objectives • Response to and recovery from COVID-19 – including hospital discharge, command and control arrangements and local outbreak control plan • Emergency Preparedness. Resilience and Response (EPRR), winter preparedness, flu outbreak planning and CCG business continuity plans Any items where there are specific items of Conflict of Interest are escalated to the Governing Body or Primary Care Commissioning Committee for decision. While the Executive Committee does not meet in public, its minutes are available to the public within the Governing Body papers.

The CCG also works across the Health and Social Care system on Urgent Care through the Urgent & Emergency Care Delivery Board. This includes representatives of key providers and commissioners of Urgent Care Services. The Board escalates to the Executive as and when there is a perceived need to do so. Finance Committee The Finance Committee shall undertake on behalf of each Governing Body objective scrutiny of the financial plans and performance in relation to key national targets and in support of the delivery of the outcomes included in the NHS Long Term Plan. It also takes relevant decisions as required under delegated authority, such as business cases. The Committee reviews monthly reports, identifying key issues and risks and gives opinion and assurance to Governing Body on the stewardship of CCG financial resources and their going concern status. Additionally, the Governing Body may request that the Finance Committee reviews specific aspects of financial performance where they require additional scrutiny and assurance. The Committee met 12 times in 2020/21.

49 | P a g e Finance Committee Members as at 31 March 2021

Deputy Accountable (Chief) Interim Chief Finance Deputy Chief Finance Officer Officer Officer Alan Cadman Robert Majilton Kate Holmes

Lay Member - Audit Chair & Lay Member - Finance Lay Member - Primary Care Vice Chair Committee Chair Commissioning Committee Chair Robert Parkes Anthony Dixon Graham Smith

Lay Member (non-executive) Managerial

The work of the Committee also includes the following activities: • Monitor use of financial resources and to ensure that value for money can be demonstrated and that the best possible value is secured for the Buckinghamshire pound • Scrutiny of Quality, Innovation, Productivity and Prevention (QIPP) and Cost Improvement Programmes (CIPs) • Evaluate, scrutinise and quality assure the financial validity of the investment, disinvestment and business case framework. • Maintain an overview of the value for money provided by the CCG’s expenditure, contracts and support arrangements (for example, the contract provided by NHS South, Central and West Commissioning Support Unit) • Approves the release of finance from allocated reserves to support investments and to make recommendations to the Governing Body as appropriate. • Advise the Governing Body on relevant reports by NHS England, regulators and other national bodies, and, where appropriate, management’s response to these. • Monitors and provides a scrutiny function across other areas of financial activity.

Quality and Performance Committee Reviews and assures provider performance; has oversight of the quality and safety of commissioned services; ensures that the patient voice is heard; reviews reports on Serious Incidents and Never Events; ensures that there are processes in place to safeguard adults and children; considers national quality inspection reports; monitors arrangements relating to equality and diversity; reviews the corporate risk register; and receive chairs reports from various subcommittees for oversight and assurance. It promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness, outcomes and patient experience. This includes a responsibility to promote research and the use of research and monitor reports made to the National Reporting and Learning System. The Committee met 8 times in 2020/21, although a number of these meetings were shortened to essential business due to the COVID-19 pandemic

50 | P a g e Quality and Performance Committee Members As at 31 March 2021 Clinical Director for Quality and Secondary Care Deputy Director of Deputy Accountable Integration/Caldicott Doctor Quality (Chief) Officer Guardian Dr Robin Woolfson David Williams Robert Majilton Dr Karen West

Clinical

Managerial

The work of the Committee also includes the following activities: • Assure the Governing Body in respect of constitutional standards e.g., Stroke services, cancer waiting times and A&E performance etc., alongside safeguarding, infection control, incident management, complaints, workforce data, staff surveys, reporting of quality accounts, or any other area of quality • Receive assurance on performance and quality and clinical risks, and compliance with National Institute for Health and Care Excellence (NICE) Quality Standards • Receive assurance on Quality Impact Assessments (QIAs), to assess any impact on quality and performance, in order to provide challenge where necessary • Ensure that there is a continuing structured process for leadership, accountability and working arrangements for quality and performance within the CCG • Approval and ratification of policies relating to quality and patient safety Integrated Commissioning Executive Team The Integrated Commissioning Executive Team (ICET) has two key purposes: • To provide scrutiny, assurance and oversight of areas of collaborative commissioning activity between Buckinghamshire Council (BC) and Buckinghamshire Clinical Commissioning Group (BCCG). This includes commissioning activity across all ages of the population set out through joint funding agreements including those covered by Section 75 pooled budget or aligned budget arrangements. • To have oversight of the strategic planning of integrated commissioning and future commissioned service delivery across health and social care in Buckinghamshire ensuring qualitative and efficiency improvements are delivered. It supports the ambition of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) and of the Buckinghamshire Integrated Care Partnership (ICP) to create ‘One Buckinghamshire, one integrated health and care system’. The Committee met 7 times in 2020/21, with some meetings cancelled due to the COVID-19 pandemic.

51 | P a g e Integrated Commissioning Executive Team Members As at 31 March 2021

Specialist Commissioning Commissioning Service Director Manager - Corporate Specialist Manager – of Integrated Direct Care and Director (Adults, Commissioning Direct Care and Commissioning - Support Health and Manager – Housing Support Co Chair Services & Housing) & Equipment Services & Tracey Integration with Gillian Quinton Andrew Evans Integration Ironmonger Health with Health Erica Boylett Adam Willison

Deputy Clinical Director – Head of Service Accountable Interim Chief Deputy Director Quality & - Integrated (Chief) Officer - Finance Officer of Quality Integration Commissioning Co-Chair Kate Holmes David Williams Dr Karen West Sally Parkinson Robert Majilton

Adult Health Finance Head of Consultant in Clinical Director Director/Adult Community Models Public Health - Children's Health of Care Tiffany Birch Dr Juliet Sutton Accountant Ian Cave Deborah Spencer

Clinical Director - Mental Health & Learning Disabilities Dr Sian Roberts

Unitary Council Representatives CCG Representatives It oversees discrete areas of collaborative commissioning activity such as the implementation of the older people's commissioning strategy, out of hospital services, Integrated Community Equipment Services (ICES) and Section 117 mental health after care arrangements, further integration of learning disabilities services and responsibility for the Better Care Fund (BCF). Compliance with the UK Corporate Governance Code NHS Bodies are not required to comply with the UK Code of Corporate Governance. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider relevant to the clinical commissioning group and best practice. This Corporate Governance Report is intended to demonstrate the clinical commissioning group compliance with the principles set out in the Code. For the financial year ended 31 March 2021 and up to the signing of the statement, we complied with the provisions set out in the Code and applied the principles of the Code. Discharge of Statutory Functions The clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I, the Accountable Officer, can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all the clinical commissioning group’s statutory duties. BCCG

52 | P a g e report the financial positions to the Governing Body as well as the audit and finance committees. Risk management arrangements and effectiveness The CCG’s arrangements for risk management and assurance are published on its website: Strategies, Policies and Procedures | Buckinghamshire CCG Other sources of assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. Annual audit of conflicts of interest management The CCG recognises the potential for interests of members to conflict with the business of the CCG; consequently the CCG has embedded in its governance documents, several policies, protocols and processes to ensure that conflicts are recognised and managed, and that decisions are made only by those who do not have a vested interest. The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. The CCGs internal auditors carried out this audit for 2020-21 and made one low priority action recommendation to ensure Governing Body members are compliant with statutory and mandatory training requirements. Data Quality The sourcing of data and management of provider data quality is achieved via contracts. The data contract management processes are well established in Buckinghamshire, and we continue to capitalize on strong relationships between NHS South Central and West Commissioning Support Unit and information governance teams within provider organisations to drive continuous improvement. Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

53 | P a g e The CCG submitted a Data Security and Protection Toolkit that met all the required standards in March 2020/21. The CCG places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. An information governance management framework and processes and procedures are in place and aligned to the information governance toolkit. All staff undertake annual information governance training, and a staff information governance handbook is promoted to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. In 2020/21, there were no incidents which required reporting to the information Commissioner’s Office. Information Governance is reported to the Audit Committee as a standing agenda item in each meeting and is reviewed regularly through the CCG management meetings. Business Critical Models The CCG is aware of the Macpherson Report on government business critical models and quality assurance mechanisms, and of its findings. The CCG does not operate any business- critical models as defined in the report. Third party assurances Where the CCG relies on third party providers, it gains assurance through service level agreement and contract specifications; regular review meetings with providers on multiple levels; the use of performance data and external regulatory inspection reports; and monitoring and review by appropriate Programme Boards and committees, with onwards reporting into the Governing Body. Control Issues The Month 9 Governance Statement return to NHS England included the following in relation to significant control issues: • Referral to Treatment/52 week wait/cancer referral activity below normal levels because of the cancellation and suspension of routine work due to COVID-19. • Serious impact on hospital handovers with long delays being experienced. • Some meetings and committees as described within the CCG Constitution either shortened or cancelled due to capacity constrains whilst staff were re-deployed to support the pandemic response. Given the ongoing COVID-19 pandemic and known challenging in restoring and recovering services to reduce increased waiting lists across the NHS, then the control issues identified could undermine the integrity or reputation of the CCG and/or wider NHS. These known issues are known with separate action plans in place to address them in line with national guidance as is published now and in future.

But these control issues are not deemed to affect or put at risk: • Delivery of the standards expected of the Accounting Officer

54 | P a g e • Make it harder to resist fraud or other misuse of resources, or resources from another significant aspect of the business • Have a material impact on the accounts? • National security of data integrity

Review of economy, efficiency & effectiveness of the use of resources

The CCG has well-established systems and processes for managing its resources effectively, efficiently, and economically. In addition to the committee structure, the Chief Finance Officer has delegated responsibility to determine arrangements to ensure a sound system of financial control. An audit programme is followed to ensure that resources are used economically, efficiently, and effectively. The Audit Committee met regularly throughout the 2020/21 financial year to review and monitor the CCG’s financial reporting and internal control principles; to ensure that the CCG activities were managed in accordance with legislation and regulations governing the NHS; and to ensure that appropriate relationships were maintained with internal and external auditors. The Finance Committee met throughout the year to monitor contract and financial performance, savings plans and overall use of resources; to approve business cases and release of finance from allocated reserves; and to monitor and provide a scrutiny function to deliver various projects and initiatives. The CCG has processes in place to secure economy, efficiency and effectiveness through its procurement, contract negotiation and contract management processes. The Chief Finance Officer has met regularly with the CCG’s finance team and held monthly meetings with the CSU’s finance leads to review month-end reporting. Regular meetings are also held with the local authorities’ finance leads. The CCG informs its control framework by the work over the year of the Internal and External Audit functions. As part of their annual audit, the CCG’s external auditors are required to satisfy themselves that the CCG has made proper arrangements for securing economy, efficiency, and effectiveness in the use of its resources. Their audit work is made available to and reviewed by the Audit Committee and Governing Body. The CCG has not yet received the annual rating from NHSE&I. Delegation of functions The CCG’s Scheme of Reservation and Delegation outlines the control mechanisms in place for delegation of functions and is found in the Constitution. The Governing Body receives reports from each of its Committees detailing the delivery of work, and associated risks, within their specific remit. Additionally, the Governing Body maintains a high-level overview of the organisation’s business and identifies and assesses risks and issues straddling Committees. These risks are owned and overseen at Governing Body level and scrutinised at each meeting to ensure appropriate management and reporting. Internal Audit is used to provide an in-depth examination of any areas of concern.

55 | P a g e Counter fraud arrangements The CCG is committed to reducing the risk from fraud and corruption and discharges its counter fraud responsibilities locally through its appointed Local Counter Fraud Specialist (LCFS) who acts as the “first line of defence” against fraud, bribery, and corruption, working closely with the CCG and NHSCFA. The Chief Finance Officer is the Executive Lead for Counter Fraud. The CCG has a Counter Fraud and Corruption Policy and Response Plan in place, and this was last reviewed in November 2020. Fraud awareness material, including fraud alerts and information on bribery, is regularly circulated to CCG staff. Fraud referrals are investigated by the LCFS and the progress and results of investigations are reported to the Chief Finance Officer and the Audit Committee. Audit Committee receives a report each meeting on an aspect of counter-fraud work. There is a proactive risk-based work plan aligned to the NHSCFA Standards for Commissioners to maintain and improve compliance and performance against each of the standards is assessed on an annual basis. The CCG also participates in the National Fraud Initiative Exercise now run by the Cabinet Office which is a mandatory exercise that matched electronic data within and between public and private sector bodies to prevent and detect fraud. It has been run every two years since 1996. Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: Head of Internal Audit opinion 2020/21

The Head of Internal Audit opinion has been reviewed by Erst & Young LLP as part of the Annual Governance Statement review which is part of Statutory Audit. During the year, Internal Audit issued the following audit reports:

Area of Audit Level of Assurance Given Management Letter – COVID-19 Financial Governance No opinion / Advisory Arrangements [⚫] COVID-19 Governance No opinion / Advisory [⚫] COVID-19 Financial Governance Arrangements – Part 2 Substantial Assurance [⚫] Secure Remote Working, Information Security and Reasonable Assurance Operational Resilience [⚫] Delegated Commissioning Substantial Assurance [⚫] Conflicts of Interest Reasonable Assurance [⚫] Risk Management and Assurance Framework Substantial Assurance [⚫]

56 | P a g e Key Financial Controls Substantial Assurance [⚫] Data Security Protection Toolkit No opinion / Advisory [⚫] Action plans are in place to address recommendations from those audits identified with reasonable assurance. The Audit Committees have confirmed that there were no significant control issues for the financial year ending 31 March 2021. We have considered the outcomes of the Service Auditor Reports for 2020-21 and we conclude that there is no material impact on the CCG.

Review of the effectiveness of governance, risk management and internal control My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed. I have been advised on the implications of the result of this review by internal audit and external audit. There is good wording around how I have been assured of the effectiveness of governance, risk and internal control. Conclusion Internal Audit:

The conclusion reached on key financial controls was:

the CCG had robust and well-designed key financial controls in place for each of the above areas covered as part of the audit. Additionally, we noted that for elements of financial activities administered by the CSU and SBS, assurances are provided to the CCG by service audit reports for each organisation. Our review found no exceptions with the design of or compliance with the control framework.

Leading to a substantial assurance rating.

Dr James Kent Accountable Officer 14 June 2021

57 | P a g e Remuneration and Staff Report Remuneration policy The CCGs use Agenda for Change terms and conditions for all employees except those classified as Very Senior Managers (VSMs). The Remuneration Committee has a standing agreement that VSM pay and expenses are up lifted in accordance with Agenda for Change awards as made by the national Pay Review Body. This agreement is reviewed at each Agenda for Change award to ensure that it remains an appropriate strategy. Senior managers’ remuneration is set through a process that is based on a consistent framework and independent decision-making based on accurate assessments of the content of the roles and individuals’ performance in them. This ensures a fair, independent and transparent process for setting the pay of the senior managers. No individual is involved in deciding his or her own remuneration. Executive senior managers are on permanent NHS contracts. The length of contract, notice period and compensation for early termination are set out in the Agenda for Change, NHS terms and conditions of service handbook. Remuneration Committee The overall purpose of this committee is to assure the Governing Bodies that the duty to act effectively, efficiently and economically has been met, and that use of resources for remuneration does not exceed any amount specified. Membership of the Remuneration Committee is drawn from the Governing Bodies. The Chief Finance Officer and Chief Officer would normally attend in addition a representative from Human Resources. No member is present for matters involving their personal remuneration. Additional lay members can be co-opted to ensure relevant experience is available. The committee met 3 times in 2020/21.

Directors' emoluments and compensation - 2020/21

Total Bonuses Taxable Compensation Benefit in Total of Salary & Salary & Fees expense for loss of office Kind emoluments and Fees applicable to allowances compensation Buckinghamshire Buckinghamshire CCG CCG Name Title £000 £000 £000 £000 £000 £000 £000

James Kent (1) Accountable Officer 164 50 0 0 0 0 50 Gary Heneage (2) Chief Finance Officer 58 58 0 0 0 0 58 Kate Holmes (3) Interim Chief Finance Officer 84 84 0 0 0 0 84 Robert Majilton Deputy Accountable Officer 114 114 0 0 0 0 114 Fiona Wise (4) Acting Accountable Officer and ICS Lead 39 18 0 0 0 0 18 Dr Raj Bajwa GP Clinical Chair 72 72 0 0 0 0 48 Dr Karen West Clinical Director for Integrated Care & Quality Lead 49 49 0 0 0 0 72 Dr Malcolm Jones Clinical Lead for End of Life Care 12 12 0 0 0 0 12 Dr Stuart Logan Clinical Director - Long Term Conditions, Prevention and supported Self-Care 28 28 0 0 0 0 28 Dr Juliet Sutton Clinical Director - Children's 25 25 0 0 0 0 25 Louise Smith Associate Director Commissioning & Locality Delivery 99 99 0 0 0 0 99 Dr Robin Woolfson Secondary Care - Specialist Doctor 14 14 0 0 0 0 14 Dr Dal Sahota Clinical Director - Unplanned Acute Care 50 50 0 0 0 0 50 Dr Raj Thakkar Clinical Director - Planned Care 78 78 0 0 0 0 78 Clinical Director -Health Inequalities and The Primary Care Dr Rashmi Sawhney 48 Networks DES 48 48 0 0 0 0 Dr Sian Roberts Clinical Director - Mental Health & Learning Disabilities 37 37 0 0 0 0 37 Dr Shona Lockie Clinical Director - Medicines Management 37 37 0 0 0 0 37 Non Executive Board Robert Parkes Lay Member 11 11 0 0 0 0 11 Anthony Dixon Lay Member 13 13 0 0 0 0 13 Colin Seaton (5) Non Exec Director 0 0 0 0 0 0 0 Graham Smith Lay Member 8 8 0 0 0 0 8 Dr Crystal Oldman (6) Registered Nurse - Governing Body 0 0 0 0 0 0 0

(1) James Kent was appointed as Accountable Officer for Oxfordshire Clinical Commissioning Group and West Berkshire Clinical Commissioning Group on a shared basis in May 2020. The salary quoted above relates to the Buckinghamshire Clinical Commissioning Group and a charge of £114k has been invoiced to Oxfordshire Clinical Commissioning and West Berkshire Clinical Commissioning Group (2) Gary Henage left the CCG in October 2020 (3) Kate Holmes replaced Gary Henage in October 2020 (4) Fiona Wise was Acting Accountable Officer and ICS Lead for Oxfordshire Clinical Commissioning Group and West Berkshire Clinical Commissioning Group on a shared basis for three months. The salary quoted above relates to the Buckinghamshire Clinical Commissioning Group and a charge of £21k has been invoiced to Oxfordshire Clinical Commissioning and West Berkshire Clinical Commissioning Group. Was then replaced by James Kent (5) Colin Seaton left in October 2020 (6) Dr Crystal Oldman Payments paid to Queen’s Institute

58 | P a g e The Remuneration package does not include any performance related bonuses and no remuneration has been paid in relation to this. All appointments to the Governing Bodies, other than those described as "officers" are substantive employees of the CCGs. Those who are officers have fixed term contracts with their specific arrangements described in the table below:

The following is the remuneration of the Governing Bodies, Executive and Non-Executive members for 2020/21

Salaries & Allowances of the Buckinghamshire CCG Board members including Senior Managers 2020/21 2020-21

TOTAL Buckinghamshire CCG Taxable benefit Annual Performance Long Term Performance All Pension TOTAL Title Salary & Fees Salary & Fees (rounded to Related Bonuses Related Bonuses Related Benefits Buckinghamshire CCG Name (Bands of £5000) (Bands of £5000) nearest £100) (Bands of £5000) (Bands of £5000) (Bands of £2500) (Bands of £5000) £000 £000 £00 £000 £000 £000 £000 Board members James Kent (1) Accountable Officer 160-165 45-50 0 0-5 0-5 35-37.5 85-90 Gary Heneage (2) Chief Finance Officer 55-60 55-60 0 0-5 0-5 45-47.5 100-105 Kate Holmes (3) Interim Chief Finance Officer 80-85 80-85 0 0-5 0-5 80-82.5 160-165 Robert Majilton Deputy Accountable Officer 110-115 110-115 0 0-5 0-5 25-27.5 140-145 Acting Accountable Officer and ICS 35-40 Fiona Wise (4) Lead 15-20 1 0-5 0-5 0-2.5 15-20 Dr Raj Bajwa GP Clinical Chair 70-75 70-75 0 0-5 0-5 15-17.5 85-90 Clinical Director for Integrated Care & 45-50 Dr Karen West Quality Lead 45-50 0 0-5 0-5 7.5-10 55-60 Dr Malcolm Jones Clinical Lead for End of Life Care 10-15 10-15 0 0-5 0-5 0-2.5 10-15 Clinical Director - Long Term Conditions, 25-30 Dr Stuart Logan Prevention and supported Self-Care 25-30 0 0-5 0-5 0-2.5 25-30 Dr Juliet Sutton Clinical Director - Children's 20-25 20-25 0 0-5 0-5 0-2.5 25-30 Associate Director Commissioning & 95-100 Louise Smith Locality Delivery 95-100 1 0-5 0-5 37.5-40 135-140 Dr Robin Woolfson Secondary Care - Specialist Doctor 10-15 10-15 0 0-5 0-5 0-2.5 10-15 45-50 Dr Dal Sahota Clinical Director - Unplanned Acute Care 45-50 0 0-5 0-5 7.5-10 55-60 Dr Raj Thakkar Clinical Director - Planned Care 75-80 75-80 0 0-5 0-5 0-2.5 75-80 Clinical Director -Health Inequalities and 45-50 Dr Rashmi Sawhney The Primary Care Networks DES 45-50 0 0-5 0-5 0-2.5 45-50 Clinical Director - Mental Health & 35-40 Dr Sian Roberts Learning Disabilities 35-40 0 0-5 0-5 7.5-10 45-50 Clinical Director - Medicines 35-40 Dr Shona Lockie Management 35-40 0 0-5 0-5 2.5-5 40-45 Non Executive Board Robert Parkes Lay Member 10-15 10-15 0 0-5 0-5 0-2.5 10-15 Anthony Dixon Lay Member 10-15 10-15 0 0-5 0-5 0-2.5 10-15 Colin Seaton (5) Lay Member 0-5 0-5 0 0-5 0-5 0-2.5 0-5 Graham Smith Lay Member 5-10 5-10 0 0-5 0-5 0-2.5 5-10 Dr Crystal Oldman (6) Registered Nurse - Governing Body 0-5 0-5 0 0-5 0-5 0-2.5 0-5

(1) James Kent was appointed as Accountable Officer for Oxfordshire Clinical Commissioning Group and West Berkshire Clinical Commissioning Group on a shared basis in May 2020. James Kent is contractually eligible for performance bonus for 2020-21 which have not been included as a result of not yet settled in the year. (2) Gary Henage left the CCG in October 2020 (3) Kate Holmes replaced Gary Henage in October 2020 (4) Fiona Wise was Acting Accountable Officer and ICS Lead for three months then was replaced by James Kent (5) Colin Seaton left in October 2020 (6) Dr Crystal Oldman Payments paid to Queen’s Institute

59 | P a g e The following is the remuneration of the Governing Bodies, Executive and Non-Executive members for 2019/20.

NHS Buckinghamshire CCG - Pension Benefits – Greenbury Disclosure 2020/21

Total Lump sum Real Real increase accrued at pension Real Cash Cash Employer's increase in in pension pension at age related increase Equivalent Equivalent contribution pension at lump sum at pension to accrued in Cash Transfer Transfer to pension age pension age age at 31 pension at Equivalen Name Title Value at 1st Value at 31 stakeholder (bands of (bands of March 2021 31 March t Transfer April 2020 March 2021 pension £2,500) £2,500) (bands of 2021 (bands Value £5,000) of £5,000)

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Board members James Kent (1) Accountable Officer 2.5-5 0-2.5 0-5 0-5 25 38 67 0 Gary Heneage (2) Chief Finance Officer 0-2.5 0-2.5 15-20 0-5 152 20 189 0 Kate Holmes (3) Interim Chief Finance Officer 2.5-5 2.5-5 25-30 65-70 433 39 519 0 Robert Majilton Deputy Accountable Officer 0-2.5 0-2.5 45-50 55-60 578 37 626 0 Fiona Wise (4) (7) Acting Accountable Officer and ICS Lead 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Dr Raj Bajwa GP Clinical Chair 0-2.5 0-2.5 20-25 55-60 422 30 459 0 Dr Karen West Clinical Director for Integrated Care & Quality Lead 0-2.5 0-2.5 10-15 25-30 203 13 220 0 Dr Malcolm Jones Clinical Lead for End of Life Care 0-2.5 0-2.5 10-15 30-35 237 6 247 0 Dr Stuart Logan (7) Clinical Director - Long Term Conditions, Prevention and supported Self-Care 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Dr Juliet Sutton Clinical Director - Children's 0-2.5 0-2.5 10-15 25-30 215 8 227 0 Louise Smith Associate Director Commissioning & Locality Delivery 2.5-5 0-2.5 25-30 60-65 416 42 466 0 Dr Robin Woolfson (7) Secondary Care - Specialist Doctor 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Dr Dal Sahota Clinical Director - Unplanned Acute Care 0-2.5 0-2.5 10-15 20-25 180 13 196 0 Dr Raj Thakkar Clinical Director - Planned Care 0-2.5 0-2.5 5-10 20-25 131 3 137 0 Dr Rashmi Sawhney (6) Clinical Director -Health Inequalities and The Primary Care Networks DES 0-2.5 0-2.5 10-15 30-35 286 0 0 0 Dr Sian Roberts Clinical Director - Mental Health & Learning Disabilities 0-2.5 0-2.5 5-10 0-5 74 11 86 0 Dr Shona Lockie Clinical Director - Medicines Management 0-2.5 0-2.5 15-20 35-40 286 11 303 0 Non Executive Board Robert Parkes Lay Member 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Anthony Dixon Lay Member 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Colin Seaton Lay Member 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Graham Smith Lay Member 0-2.5 0-2.5 0-5 0-5 0 0 0 0 Dr Crystal Oldman (5) Registered Nurse - Governing Body 0-2.5 0-2.5 0-5 0-5 0 0 0 0

(1) James Kent joined in May 2020 (2) Gary Henage left the CCG in October 2020 (3) Kate Holmes replaced Gary Henage in October 2020 (4) Fiona Wise was Acting Accountable Officer and ICS Lead for three months then was replaced by James Kent (5) Dr Crystal Oldman Payments paid to Queen’s Institute (6) Dr Rashmi Sawhney - For Members over 60 years old in the 1995 Pension scheme the NHS BSA do not provide Cash Equivalent Transfer Values (CETV) (7) Fiona Wise, Dr Stuart Logan and Dr Robin Woolfson are not memebers of the NHS Pension Scheme

* Change in CETV: The opening balances on some of the Cash Equivalent Transfer Vlaues (CETV) have changed from the prior year audited accounts. The reason for the change is that some of the factors used in the calculation of the closing 2017/18 position have been updated and this has resulted in a change specifically for members in the 2015 scheme

McCloud - The calculations above do not take account of the recent McCloud ruling (This is a legal case concerning age discrimination over the manner in which UK public service pensions schemes introduced a CARE benefit design in 2015 for all but the eldest members who retained a Final Salary design). We confirm that Buckingham CCG is unaffected by the McCloud Judgment. As such we do not anticipate any adjustments to the pension positions of its employees to occur due to this ruling.

60 | P a g e NHS Buckinghamshire CCG - Pension Benefits – Greenbury Disclosure 2019/20

* Change in CETV: The opening balances on some of the Cash Equivalent Transfer Values (CETV) have changed from the prior year audited accounts. The reason for the change is that some of the factors used in the calculation of the closing 2017/18 position have been updated and this has resulted in a change specifically for members in the 2015 scheme McCloud - The calculations above do not take account of the recent McCloud ruling (This is a legal case concerning age discrimination over the manner in which UK public service pensions schemes introduced a CARE benefit design in 2015 for all but the eldest members who retained a Final Salary design). We confirm that Buckingham CCG is unaffected by the McCloud Judgment. As such we do not anticipate any adjustments to the pension positions of its employees to occur due to this ruling. Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee

61 | P a g e (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Exit Packages 2020/21 There were no exit packages in the year 2020/21 and consequently no associated payments. Analysis of Other Agreed Departures There were no departures made in the year 2020/21 or the previous year 2019/20 in respect of voluntary redundancy, ill health retirements, mutually agreed resignations, early retirements in the efficiency of the service, payments in lieu of notice, exit payments following employment tribunals or court orders or non-contractual payments requiring HMT approval. Redundancy and other departure costs would be paid in accordance with the provisions of BCCG’s Compulsory Redundancy Scheme in line with Agenda for Change standard entitlements where applicable. Any exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure. BCCG has not agreed any early retirements. If it had, the additional costs would be met by BCCG and not by the NHS Pension Scheme and would be included in the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are not included in the tables. No non-contractual payments (£0) were made to individuals where the payment value was more than 12 months of their annual salary. The Remuneration Report would include the disclosure of exit payments payable to individuals named in that Report. However, none were made during 2020/21. Workforce Remuneration Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid member of the governing body in the CCG in the financial year 2020-21 was £130k-£135k (2019-20: £105k-£110k) on an annualised basis. This was 2.6 times (2019-20: 2.4 times) the median remuneration of the workforce, which was £50,119 (2019-20: £45,251). In 2020-21, there are no employees (2019-20: 4 employees) received remuneration in excess of the highest paid member of the governing body. Remuneration ranged from £11,500 to £135,000 (2019-20: £11,500 to £145,000). The financial year 2020-21 figures from the Workforce Remuneration section has been updated in accordance with NHS GAM. Total remuneration includes salary, non- consolidated performance-related pay and benefits-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions. Expenditure on consultancy Expenditure on consultancy was £263k in 2020/21 (£272k in 2019/20) as per Note 5 to the accounts’ page 92. Off-payroll Engagements Following the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012, Departments and their arm's length bodies (this is taken to include all those bodies included within the DH reporting boundary) must publish information on their highly paid and/or senior off-payroll engagements.

62 | P a g e For all off-payroll engagements as of 31 March 2021, for more than £245 per day and that last longer than six months: Number Number of existing engagements as of 31 March 2021 0 Of which, the number that have existed: for less than one year at the time of reporting 0

Confirmation that all existing off-payroll engagements have at some point been subject to a risk-based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought. For all new off-payroll engagements between 1 April 2020 and 31 March 2021, for more than £245 per day and that last longer than six months: Number Number of new engagements, or those that reached six months in duration, 0 between 1 April 2020 and 31 March 2021

Number of new engagements which include contractual clauses giving the 0 Buckinghamshire CCG the right to request assurance in relation to income tax and National Insurance obligations (IR35)

Number for whom assurance has been requested 0 Of which:

Assurance has been received 0 Assurance has not been received 0 Engagements terminated as a result of assurance not being received 0 Number of off-payroll engagements of Governing Body members, and/or senior 0 officers with significant financial responsibility, during the year Number of individuals that have been deemed “Governing Body members, and/or 0 senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements

63 | P a g e Staff Report Staff sickness absence The BCCG overall staff absence rate for 2020/21 was 2.94% with a total of 1,288 days lost. Both the short and long term absence rates fluctuated throughout the year with the increase potentially attributed to the impact of COVID-19. However, both rates reported in March 2021 were an improvement from April 2020 Apr-20 Mar-21 Short term staff absence rate 0.92% 0.36% Long Term staff absence rate 1.50% 0.67%

Health & wellbeing of staff BCCG proactively promotes the health and wellbeing of staff in line with its Health and Wellbeing Strategy. The CCG has a Wellbeing Champion who has been working hard to support colleagues with various initiatives since before the start of the pandemic: • Weekly Wellbeing Wednesday sessions began in March 2020 and are open to all BCCG staff and those across the BOB ICS; these sessions provide mindfulness activities and stretching exercises for staff to follow. • A virtual coffee morning has been put in place on Fridays to encourage staff to have some downtime and network with other members of staff • The CCG have several Mental Health First Aiders who are available for staff to talk to and are supportive, and able to sign post the member of staff accordingly • Wellbeing Champion promotes various nationwide initiatives and sessions amongst others: Recognising Stress & Anxiety, Eating for Health, The Importance of Physical Actively, Looking after Ourselves to support staff keep well both mentally and physically • BCCG are part of the Mindful Employer network and have signed up to their Charter to support mental health in the workplace The activities have been based on MS Teams since the pandemic began and have been well received and attended by staff across a range of teams and directorates. The Employee Assistant Programme (EAP) is a free service for staff to anonymously access impartial advice and counselling services. The service supports staff with a range of things including managing stress, coping with bereavement, relationship breakdown, debt advice or a challenge or issue which could benefit from being talked through. A weekly staff email update is sent by the Wellbeing Champion and commenced before the beginning of the pandemic, this has continued throughout the year; it includes lots of work-related information and also signposts to resources for mental and physical wellbeing. The weekly update has been well received by staff across the organisation.

64 | P a g e Staff numbers and gender analysis

Bucks CCG Female Male Total 4 (+ 1 not Governing Body 7 11 +1 employed) Very Senior 0 2 2 Managers All other Employees 70 26 96

Total Employees 74 33 107

Trade union official facility time No matters occurred during the year requiring this time

Staff Policies BCCG recognises and value the importance of maintaining positive working relationships with its staff and their representatives. The Staff Partnership Forum (SPF) is its joint management and staff forum for staff engagement and consultation. In December 2020 the SPF joined together with staff partnership forums from Oxfordshire and Berkshire West CCGs to form a single BOB wide forum; a key focus of the BOB SPF was wellbeing and inclusion of staff. BCCG have actively and successfully worked in partnership on several issues affecting staff including the development and review of human resources policies. We are also aligning policies with those of Oxfordshire and Berkshire West CCGs to support the BOB ICS. Policies are ratified by BCCG’s Executive prior to publication. The BOB SPF is representative of the workforce and BCCG recognises all the trade unions outlined in the national NHS Terms and Conditions of Service Handbook who have members employed within the organisation. BCCG has a Health and Wellbeing Strategy and an active Wellbeing Champion to promote Wellbeing. Events are held throughout the year with a large number of staff participating. Events have included fund raising activities, annual sporting challenge and events aimed to support employee’s wellbeing. BCCG with the BOB SPF have developed a range of methods to communicate and encourage meaningful, two-way dialogue with staff include: • Weekly BOB ICS Accountable Officer Staff Briefings • CCG and BOB ICS Staff surveys to drive improvement in staff experience • Staff development / training sessions with opportunities across the BOB ICS The results of the staff surveys have been assessed by the BOB SPF, themes identified and an action plan developed by staff to address different aspects of the feedback. This has resulted in the development of a more agile working approach and focus on BCCG values. Managers hold regular one-to-one meetings with staff and use the values-based appraisal system ensuring all staff work towards clearly defined personal objectives and standards of behaviour. These are supported with learning, training and development opportunities detailed in individual Personal Development Plans.

65 | P a g e Disability information BCCG has developed an integrated approach to delivering workforce equality so it does not have a separate policy for disabled employees or for any other protected characteristics. Equalities issues are incorporated in policies covering all aspects of the employee lifecycle ranging from recruitment to performance. BCCG’s aim is to provide an environment in which all staff are engaged, supported and developed throughout their employment and to operate in ways which do not discriminate our potential or current employees by virtue of any of the protected characteristics specified in the Equality Act 2010. BCCG is also committed to supporting employees to maximise their performance including making any reasonable adjustments that may be required on a case by case basis. BCCG is committed to implementing the Workforce Race Equality Standards (WRES) and will work with those organisations it commissions services from and partners to ensure employees from black and ethnic minority backgrounds have equal access to career opportunities and receive fair treatment in the workplace. The 2020 WRES return is available on the CCGs website. Equality and Diversity For information of the Workforce Race Equality Standard and how we give ‘due regard’ to eliminating discrimination please see the annual submission which is available on our website. Health and safety BCCG recognises that the maintenance of a safe workplace and safe working environment is critical to our continued success and accordingly, we view our responsibilities for health, safety and welfare with the upmost importance. However the past year the majority of staff have been working from home. During this time, considerable effort has gone into supporting staff as they continue to work from home. This included all staff undertaking risk assessments of their ‘at home’ working environment and purchasing equipment (for example office chairs and monitor) to accommodate individual staff need. Health and Safety training forms part of the suite of statutory and mandatory training which is undertaken by all employees. Whistleblowing BCCG has a whistleblowing policy that is communicated to all staff and available on the CCG staff intranet.

Auditable elements Please note that the elements of this remuneration and staff report that have been subject to audit are the tables of salaries and allowances of senior managers and related narrative notes on pages 58 to 60, pension benefits of senior managers and related narrative on page 60 to 61, the pay multiples and related narrative notes on pages 62 and exit packages and any other agreed departures on page 62.

Dr James Kent, Accountable Officer 14 June 2021

66 | P a g e Parliamentary Accountability and Audit Report Buckinghamshire Clinical Commissioning Group is not required to produce a Parliamentary Accountability and Audit Report, however has opted to include disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges in this Accountability Report. For 2020/21 there is nothing to disclose.

Dr James Kent, Accountable Officer 14 June 2021

67 | P a g e Independent Auditor’s report to the Members of the Governing Body of NHS Buckinghamshire Clinical Commissioning Group Opinion We have audited the financial statements of NHS Buckinghamshire Clinical Commissioning Group for the year ended 31 March 2021 under the Local Audit and Accountability Act 2014. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes 1 to 20. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2020/21 HM Treasury’s Financial Reporting Manual (the 2020/21 FReM) as contained in the Department of Health and Social Care Group Accounting Manual 2020/21 and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction).

In our opinion the financial statements:

• give a true and fair view of the financial position of NHS Buckinghamshire Clinical Commissioning Group as at 31 March 2021 and of its net operating costs for the year then ended; And

• have been prepared properly in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.

Basis for opinion We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report below. We are independent of the clinical commissioning group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard and the Comptroller and Auditor General’s (C&AG) AGN01 and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the Clinical Commissioning Group’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

68 | P a g e Our responsibilities and the responsibilities of the Accountable Officer with respect to going concern are described in the relevant sections of this report. However, because not all future events or conditions can be predicted, this statement is not a guarantee as to the CCG’s ability to continue as a going concern. Other information The other information comprises the information included in the annual report set out on pages 3-75, other than the financial statements and our auditor’s report thereon. The Accountable Officer is responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in this report, we do not express any form of assurance conclusion thereon.

Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of the other information, we are required to report that fact.

We have nothing to report in this regard. Opinion on other matters prescribed by the Health and Social Care Act 2012 In our opinion the part of the Remuneration and Staff Report to be audited has been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.

Matters on which we are required to report by exception

We are required to report to you if:

• in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or

• we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or

• we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or

• we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014; or

• we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2021.

69 | P a g e We have nothing to report in these respects. Responsibilities of the Accountable Officer As explained more fully in the Statement of Accountable Officer’s Responsibilities in respect of the Accounts, set out on page 40-41, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. The Accountable Officer is also responsible for ensuring the regularity of expenditure and income. In preparing the financial statements, the Accountable Officer is responsible for assessing the Clinical Commissioning Group’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the Accountable Officer either intends to cease operations, or has no realistic alternative but to do so. As explained in the Annual Governance Statement the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. Auditor’s responsibility for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect irregularities, including fraud. The risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional misrepresentations, or through collusion. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below. However, the primary responsibility for the prevention and detection of fraud rests with both those charged with governance of the entity and management.

• We obtained an understanding of the legal and regulatory frameworks that are applicable to the CCG and determined that the most significant are the Health and Social Care Act 2012 and other legislation governing NHS CCGs, as well as relevant employment laws of the United Kingdom. In addition, the CCG has to comply with laws and regulations in the areas of anti-bribery and corruption and data protection.

70 | P a g e • We understood how NHS Buckinghamshire Clinical Commissioning Group is complying with those frameworks by understanding the incentive, opportunities and motives for non-compliance, including inquiring of management and those charged with governance and obtaining and reviewing documentation relating to the procedures in place to identify, evaluate and comply with laws and regulations, and whether they are aware of instances of non-compliance. • We assessed the susceptibility of the CCG’s financial statements to material misstatement, including how fraud might occur by planning and executing a journal testing strategy, testing the appropriateness of relevant entries and adjustments. We have considered whether judgements and estimates made in relation financial performance, especially in months 12 and 13, are indicative of potential bias, and considered whether the CCG is engaging in any transactions outside the usual course of business. • Based on this understanding we designed our audit procedures to identify noncompliance with such laws and regulations. Our procedures involved enquiry of management and those charged with governance, reading and reviewing relevant meeting minutes of those charged with governance and the Governing Body and understanding the internal controls in place to mitigate risks related to fraud and non-compliance with laws and regulations.

A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at https://www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified reporting criteria issued by the Comptroller and Auditor General in April 2021, as to whether the CCG had proper arrangements for financial sustainability, governance and improving economy, efficiency and effectiveness. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2021.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place.

71 | P a g e We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Report on Other Legal and Regulatory Requirements Regularity opinion We are responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Local Audit and Accountability Act 2014 (the "Code of Audit Practice". We are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. In our opinion, in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Certificate Delay in certification of completion of the audit We cannot formally conclude the audit and issue an audit certificate until we have completed our procedures on the CCG’s value for money arrangements for the year ended 31 March 2021. We are satisfied that this work does not have a material effect on the financial statements. We will report the outcome of our work on the CCG’s arrangements in our commentary on those arrangements within the Auditor’s Annual Report. Our audit completion certificate will set out any matters which we are required to report by exception. Until we have completed these procedures, we are unable to certify that we have completed the audit of the accounts in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice issued by the National Audit Office. Use of our report This report is made solely to the members of the Governing Body of NHS Buckinghamshire Clinical Commissioning Group in accordance with Part 5 of the Local Audit and Accountability Act 2014 and for no other purpose Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the members as a body, for our audit work, for this report, or for the opinions we have formed.

Janet Dawson Key Audit Partner Ernst & Young LLP (Local Auditor) London

72 | P a g e Table of Attendance for Governing Body and Committee Meetings (Membership in line with Constitution dated 1 October 2020)

Finance Quality & Executive Integrated Committee Committee Committee Committee Committee Performance Primary Care Remuneration Commissioning Commissioning Governing Body Executive Team Audit CommitteeAudit Anthony Dixon 7/7 7/8 10/12 4/5 3/3 Crystal Oldman 6/7 Colin Seaton 0/5 0/5 0/3 to Oct 2020 Dr Dal Sahota 6/6 9/12 Gary Heneage 5/5 4/6 5/5 7/7 0/5 1/1 1/2 to Oct 2020 Kate Holmes 2/2 5/6 3/3 5/5 1/1 4/5 from Oct 2020 Graham Smith 6/7 7/8 12/12 4/5 1/3 Dr James Kent 5/6 0/11 0/5 1/2 Dr Juliet Sutton 11/12 5/7 Dr Karen West 5/7 11/12 5/5 4/7 Louise Smith 5/6 6/12 3/5 Dr Malcom Jones 0/12 Dr Raj Bajwa 7/7 11/12 5/5 2/2 Dr Raj Thakkar 9/12 Robert Majilton 7/7 10/12 7/8 9/12 5/5 6/7 Robert Parkes 6/7 7/8 12/12 1/1 2/3 Dr Rashmi Sawhney 5/6 10/12 4/4 Dr Robin Woolfson 7/7 5/5 Dr Sian Roberts 11/12 4/7 Dr Stuart Logan 7/12 Dr Shona Lockie 11/12

73 | P a g e Terms Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS): The NHS and local authorities across Buckinghamshire, Oxfordshire and Berkshire West are working together to support delivery of NHS England’s Five Year Forward View to deliver better health, better patient care and improved NHS efficiency. Buckinghamshire Healthcare NHS Trust – an integrated acute and community healthcare organisation delivering care in a range of ways; from community health services provided in people’s homes or from one of local bases, to hospitals at Stoke Mandeville, Wycombe and Amersham Buckinghamshire Joint Health and Wellbeing Strategy: The story of how the NHS, councils and Healthwatch work together to improve the health and wellbeing of people in Buckinghamshire. The strategy has been developed with input from the people of Buckinghamshire. Buckinghamshire Joint Health Overview Scrutiny Committee: looks at the work of the NHS clinical commissioning groups, healthcare trusts, and the NHS England Local Area Team. The committee acts as a 'critical friend' by suggesting ways that health related services might be improved. Care Quality Commission: monitors, inspects and regulates hospitals, care homes, GP surgeries, dental practices and other care services to make sure they meet fundamental standards of quality and safety Clinical Chair: medical doctor at the head of Buckinghamshire Clinical Commissioning Group. Delayed Transfer of Care (DTOC): when a patient is medically fit to leave a hospital or similar care provider but is still occupying a bed. Delays can occur when patients are being discharged home or to a supported care facility, such as a residential or nursing home, or are awaiting transfer to a community hospital or hospice. Frimley Health NHS Foundation Trust - provides NHS hospital services for people across Berkshire, Hampshire, Surrey and south Buckinghamshire GP Federation: a group of GP practices which come together to provide a greater range of services to patients in their local area e.g. FedBucks, Health and Wellbeing Board (HWB Board): key leaders from the health and social care services and Healthwatch work together to improve the health and wellbeing of their local population and reduce health inequalities Healthwatch: UK consumer watchdog for patients which aims to improve health and social care Joint Strategic Needs Assessment for Buckinghamshire: provides information about the county’s population and the factors affecting health, wellbeing, and social care needs. Local Authorities: the elected bodies responsible for the most strategic local government services in the county. Local Health Resilience Partnership: a group for local health organisations (including private and voluntary sector where appropriate) which looks at readiness and planning for major health emergencies Local Medical Committee: a statutory body for local GPs which looks after the interests of family doctors Locality Plans: intended to build resilient, sustainable primary care for the future based on local need. The plans are intended to support the vision for health services where

74 | P a g e patients will receive more care closer to home and be supported out of hospital as much as possible. Medicines Optimisation Team: helps health professionals and patients make the right treatment and medicines choices by promoting cost effective and evidence based clinical practice and effective risk management National Institute for Clinical Excellence: provides national guidance and advice to improve health and social care. It aims to help medical practitioners deliver the best possible care, give people the most effective treatments based on the latest evidence, to provide value for money, to reduce inequalities and variation NHS Long Term Plan: The NHS Long Term Plan, published in January 2019, is a 10 year plan for the NHS to improve the quality of patient care and health outcomes. Its ambitions include measures to prevent 150,000 heart attacks, strokes and dementia cases, and better access to mental health services for adults and children. Oxford Health Foundation Trust (OHFT): provides physical, mental health and social care for people of all ages across Buckinghamshire. Its services are delivered at community bases, hospitals, clinics and people’s homes. Oxford University Hospitals NHS Foundation Trust (OUHFT): is one of the largest teaching hospitals in England. It is made up of four hospitals - the John Radcliffe Hospital, the Churchill Hospital and the Nuffield Orthopaedic Centre, all in Oxford, and the Horton General Hospital in Banbury. It provides a wide range of clinical services, specialist services (including cardiac, cancer, musculoskeletal and neurological rehabilitation), medical education, training and research. Patient Participation Groups (PPG): Patient representatives from a GP practice who advise and inform the practice on what matters most to patients and to help identify solutions to problems as a ‘critical friend’ PINCER risk stratification tool: This is a tool that has been developed to identify at- risk patients so that corrective action can be taken to reduce clinically important medication errors in primary care. Primary Care: most people’s first point of contact with health services, for example, GPs, dentists, pharmacists or optometrists Primary Care Networks: Primary care networks bring general practices together to work at scale. This helps to recruit and retain staff; manage financial and estates pressures; provide a wider range of services to patients and to more easily integrate with the wider health and care system. All GP practices are expected to come together in geographical networks covering populations of approximately 30– 50,000 patients by June 2019. Referral to Treatment Times: The period of time from referral by a GP or other medical practitioner to hospital for treatment in the NHS South Central Ambulance NHS Foundation Trust (SCAS): SCAS provides and accident and emergency service to respond to 999 calls; the NHS 11 service for when medical help is needed fast but not a 999 emergency and a non-urgent patient transport service. It covers the counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire Social prescribing: This process enables GPs, nurses and other primary care professionals to refer people to a range of local, non- clinical services.

75 | P a g e FINANCIAL ACCOUNTS

FOR THE PERIOD ENDED 31 MARCH 2021

NHS BUCKINGHAMSHIRE COMMISSIONING GROUP

Financial Information - Accounts Year Ended 31 March 2021 These accounts for the year ended 31st March 2021 have been prepared by Buckinghamshire Clinical Commissioning Group under a Direction issued by the NHS Commissioning Board, now known as NHS England under the National Health Service Act 2006.

Buckinghamshire Clinical Commissioning Group management have assessed the entity’s ability to continue as a going concern. The management are not aware of any material uncertainties related to events or conditions that may cast significant doubt on the entity’s ability to continue as a going concern.

76 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

CONTENTS Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2021 78 Statement of Financial Position as at 31st March 2021 79 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2021 80 Statement of Cash Flows for the year ended 31st March 2021 81

Notes to the Accounts Accounting policies Note1 82 Other operating revenue Note 2 89 Revenue Note 3 89 Employee benefits and staff numbers Note 4 90 Operating expenses Note 5 92 Better payment practice code Note 6 94 Operating leases Note 7 94 Property, plant and equipment Note 8 95 Intangible non-current assets Note 9 96 Inventories Note 10 96 Trade and other receivables Note 11 97 Cash and cash equivalents Note 12 97 Trade and other payables Note 13 98 Borrowings Note 14 98 Provisions Note 15 98 Financial instruments Note 16 99 Operating segments Note 17 100 Joint arrangements - interests in joint operations Note 18 101 Related party transactions Note 19 103 Events after the end of the reporting period Note 20 106 Financial performance targets Note 21 106

77 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Statement of Comprehensive Net Expenditure for the year ended 31 March 2021

2020-21 2019-20 Note £'000 £'000

Income from sale of goods and services 2 (1,506) (1,939) Other operating income 2 (84) (692) Total operating income (1,590) (2,631)

Staff costs 4 5,371 5,711 Purchase of goods and services 5 839,833 751,665 Depreciation and impairment charges 5 445 563 Provision expense 5 729 284 Other Operating Expenditure 5 1,417 570 Total operating expenditure 847,795 758,793

Net Operating Expenditure 846,205 756,162

Total Net Expenditure for the Financial Year 846,205 756,162

Comprehensive Expenditure for the year 846,205 756,162

The notes on pages 82 to 106 form part of this statement

78 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Statement of Financial Position as at 31 March 2021 2020-21 2019-20

Note £'000 £'000 Non-current assets: Property, plant and equipment 8 377 705 Intangible assets 9 2 119 Total non-current assets 379 824 Current assets: Inventories 10 1,027 2,140 Trade and other receivables 11 3,828 8,657 Cash and cash equivalents 12 114 0 Total current assets 4,969 10,797

Total current assets 4,969 10,797

Total assets 5,348 11,621

Current liabilities Trade and other payables 13 (72,018) (56,213) Borrowings 14 0 (94) Provisions 15 (764) (625) Total current liabilities (72,782) (56,932)

Non-Current Assets plus/less Net Current Assets/Liabilities (67,434) (45,311)

Non-current liabilities Provisions 15 (711) (156) Total non-current liabilities (711) (156)

Assets less Liabilities (68,145) (45,467)

Financed by Taxpayers’ Equity General fund (68,145) (45,467) Total taxpayers' equity: (68,145) (45,467)

The notes on pages 82 to 106 form part of this statement

The financial statements on pages 78 to 81 were approved by the Governing Body on 14th June 2021 and signed on its behalf by:

Dr James Kent Kate Holmes Accountable Officer Interim Chief Finance Officer

79 31 March 2021 Total General fund reserves £'000 £'000 Changes in taxpayers’ equity for 2020-21

Balance at 01 April 2020 (45,467) (45,467) Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 Adjusted NHS Clinical Commissioning Group balance at 31 March 2020 (45,467) (45,467)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2020-21 Net operating expenditure for the financial year (846,205) (846,205)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial year (846,205) (846,205) Net funding 823,527 823,527 Balance at 31 March 2021 (68,145) (68,145)

Total General fund reserves £'000 £'000 Changes in taxpayers’ equity for 2019-20

Balance at 01 April 2019 (43,820) (43,820) Transfer of assets and liabilities from closed NHS bodies 0 0 Adjusted NHS Clinical Commissioning Group balance at 31 March 2020 (43,820) (43,820)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2019-20 Net operating costs for the financial year (756,162) (756,162)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (756,162) (756,162)

Net funding 754,515 754,515

Balance at 31 March 2020 (45,467) (45,467)

The notes on pages 82 to 106 form part of this statement

80 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Statement of Cash Flows for the year ended 31 March 2021 2020-21 2019-20 Note £'000 £'000 Cash Flows from Operating Activities Net operating expenditure for the financial year (846,205) (756,162) Depreciation and amortisation 5 445 563 (Increase)/decrease in inventories 10 1,113 (1,213) (Increase)/decrease in trade & other receivables 11 4,829 (1,110) Increase/(decrease) in trade & other payables 13 15,805 3,230 Provisions utilised 15 (35) (120) Increase/(decrease) in provisions 15 729 284 Net Cash Inflow (Outflow) from Operating Activities (823,319) (754,528)

Cash Flows from Investing Activities (Payments) for property, plant and equipment 0 (91) Net Cash Inflow (Outflow) from Investing Activities 0 (91)

Net Cash Inflow (Outflow) before Financing (823,319) (754,619)

Cash Flows from Financing Activities Grant in Aid Funding Received 823,527 754,515 Net Cash Inflow (Outflow) from Financing Activities 823,527 754,515

Net Increase (Decrease) in Cash & Cash Equivalents 12 208 (104)

Cash & Cash Equivalents at the Beginning of the Financial Year (94) 10 Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 114 (94)

The Bank overdraft shown in 2019/20 of £94k was treated as Borrowings - Note 14

The notes on pages 82 to 106 form part of this statement

81 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2020-21 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical Commissioning Group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Clinical Commissioning Group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going Concern

These accounts have been prepared on a going concern basis, in accordance with the definition as set out in Section 4 of the Department of Health and Social Care (DHSC) Group Accounting Manual 2020/21, which outlines the interpretation of IAS1 'Presentation of Financial Statements' as 'anticipated continuation of the provision of a service in the future, as evidenced by the inclusion of financial provision for that service in published documents'. For non-trading entities in the public sector, the anticipated continuation of the provision of a service in the future, as evidenced by inclusion of financial provision (funding allocation) for that service in published documents, is normally sufficient evidence of going concern.

DHSC group bodies must therefore prepare their accounts on a going concern basis unless informed by the relevant national body or DHSC sponsor of the intention for dissolution without transfer of services or function to another entity. A trading entity needs to consider whether it is appropriate to continue to prepare its financial statements on a going concern basis where it is being, or is likely to be, wound up.

In carrying out its assessment, the Governing Body have taken into account the following key considerations.

2021/22 to 2023/24 Indicative financial planning The CCG has been notified formally of the level of allocations it will receive from the Department of Health, through NHS England, for the years 2021/22 to 2023/24 as set out in the table below:

NHS England has indicated that legislation may be passed during the 2021 calendar year to put Integrated Care Services (ICSs) on a statutory footing by 1 April 2022. CCGs will still be the statutory commissioners of NHS services until that point. The commissioning of health services (continuation of service) will continue after April 2022 but may be located in a different structure within the Department of Health umbrella. Mergers or a change to the NHS Structure, such as an ICS way of working, is not considered to impact on going concern. Conclusion Our considerations cover the period through to 30 June 2022, being 12 months beyond the date of authorisation of these financial statements. Taking into account these considerations and the governance structures in place both within the CCG and through the NHS E/I assurance process, the Governing Body have a reasonable expectation that the CCG will have adequate resources to continue in operational existence for the foreseeable future. For this reason, we continue to adopt the going concern basis in preparing these financial statements. 1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 Movement of Assets within the Department of Health and Social Care Group

Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.4 Pooled Budgets

The Clinical Commissioning Group has entered into a pooled budget arrangement with Buckinghamshire Council in accordance with section 75 of the NHS Act 2006. Under the arrangement, funds are pooled for the provision of health and social care services and Note 17 provides details of the income and expenditure. · The assets the Clinical Commissioning Group controls; · The liabilities the Clinical Commissioning Group incurs; · The expenses the Clinical Commissioning Group incurs; and, · The Clinical Commissioning Group’s share of the income from the pooled budget activities.

The pools are hosted by Buckinghamshire Council. The Clinical Commissioning Group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement

82 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

1.5 Operating Segments

The Clinical Commissioning Group has one operating segment - commissioning healthcare for the population of Buckinghamshire and as such the Income and expenditure are analysed in the Revenue and expenditure notes.

1.6 Revenue

In the application of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows:

• As per paragraph 121 of the Standard the Clinical Commissioning Group will not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less, • The Clinical Commissioning Group is to similarly not disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date. • The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the Clinical Commissioning Group to reflect the aggregate effect of all contracts modified before the date of initial application.

The main source of funding for the Clinical Commissioning Group is from NHS England. This is drawn down and credited to the general fund. Funding is recognised in the period in which it is received.

Payment terms are standard reflecting cross government principles. There are no significant terms agreed.

The value of the benefit received when the Clinical Commissioning Group accesses funds from the Government’s apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these funds are paid directly to an accredited training provider, non-cash income and a corresponding non-cash training expense are recognised, both equal to the cost of the training funded.

1.7 Employee Benefits

1.7.1 Short-term Employee Benefits

Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.7.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Schemes. These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as if they were a defined contribution scheme; the cost recognised in these accounts represents the contributions payable for the year. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the Clinical Commissioning Group commits itself to the retirement, regardless of the method of payment.

The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year.

1.8 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

1.9 Property, Plant & Equipment 1.9.1 Recognition

Property, plant and equipment is capitalised if: · It is held for use in delivering services or for administrative purposes; · It is probable that future economic benefits will flow to, or service potential will be supplied to the Clinical Commissioning Group; · It is expected to be used for more than one financial year; · The cost of the item can be measured reliably; and, · The item has a cost of at least £5,000; or, · Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,

· Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

83 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

1.9.2 Measurement

All property, plant and equipment is measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management.

Assets that are held for their service potential and are in use are measured subsequently at their current value in existing use. Assets that were most recently held for their service potential but are surplus are measured at fair value where there are no restrictions preventing access to the market at the reporting date

IT equipment, transport equipment, furniture and fittings, and plant and machinery that are held for operational use are valued at depreciated historic cost where these assets have short useful economic lives or low values or both, as this is not considered to be materially different from current value in existing use.

1.9.3 Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written- out and charged to operating expenses.

1.10 Intangible Assets 1.10.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only: · When it is probable that future economic benefits will flow to, or service potential be provided to, the Clinical Commissioning Group; · Where the cost of the asset can be measured reliably; and, · Where the cost is at least £5,000.

Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: · The technical feasibility of completing the intangible asset so that it will be available for use; · The intention to complete the intangible asset and use it; · The ability to sell or use the intangible asset; · How the intangible asset will generate probable future economic benefits or service potential; · The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and, · The ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.10.2 Measurement

Intangible assets acquired separately are initially recognised at cost. The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of amortised replacement cost or the value in use where the asset is income generating . Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. Revaluations and impairments are treated in the same manner as for property, plant and equipment.

1.10.3 Depreciation, Amortisation & Impairments

Freehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Clinical Commissioning Group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over the shorter of the lease term and the estimated useful life.

At each reporting period end, the Clinical Commissioning Group checks whether there is any indication that any of its property, plant and equipment assets or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

84 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

1.11 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

1.12 Inventories

Inventories are valued at the lower of cost and net realisable value.

1.13 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Clinical Commissioning Group’s cash management.

1.14 Provisions

Provisions are recognised when the Clinical Commissioning Group has a present legal or constructive obligation as a result of a past event, it is probable that the Clinical Commissioning Group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows:

All general provisions are subject to four separate discount rates according to the expected timing of cashflows from the Statement of Financial Position date: • A nominal short-term rate of 0.02% (2019-20: 0.51%) for inflation adjusted expected cash flows up to and including 5 years from Statement of Financial Position date. • A nominal medium-term rate of 0.18% (2019-20: 0.55%) for inflation adjusted expected cash flows over 5 years up to and including 10 years from the Statement of Financial Position date. • A nominal long-term rate of 1.99% (2019-20: 1.99%) for inflation adjusted expected cash flows over 10 years and up to and including 40 years from the Statement of Financial Position date. • A nominal very long-term rate of 1.99% (2019-20: 1.99%) for inflation adjusted expected cash flows exceeding 40 years from the Statement of Financial Position date.

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

A restructuring provision is recognised when the Clinical Commissioning Group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

1.15 Clinical Negligence Costs

NHS Resolution operates a risk pooling scheme under which the clinical commissioning group pays an annual contribution to NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with clinical commissioning group.

1.16 Non-clinical Risk Pooling

The Clinical Commissioning Group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Clinical Commissioning Group pays an annual contribution to the NHS Resolution and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.17 Carbon Reduction Commitment Scheme

The Carbon Reduction Commitment scheme is a mandatory cap and trade scheme for non-transport CO2 emissions. The Clinical Commissioning Group is registered with the CRC scheme, and is therefore required to surrender to the Government an allowance for every tonne of CO2 it emits during the financial year. A liability and related expense is recognised in respect of this obligation as CO2 emissions are made.

The carrying amount of the liability at the financial year end will therefore reflect the CO2 emissions that have been made during that financial year, less the allowances (if any) surrendered voluntarily during the financial year in respect of that financial year.

85 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

The liability will be measured at the amount expected to be incurred in settling the obligation. This will be the cost of the number of allowances required to settle the obligation.

Allowances acquired under the scheme are recognised as intangible assets.

1.18 Contingent liabilities and contingent assets

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non- occurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Clinical Commissioning Group. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingent liabilities and contingent assets are disclosed at their present value.

1.19 Financial Assets

Financial assets are recognised when the Clinical Commissioning Group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories: · Financial assets at amortised cost; · Financial assets at fair value through other comprehensive income and ; · Financial assets at fair value through profit and loss.

The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition.

1.19.1 Financial Assets at Amortised cost

Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset.

1.19.2 Financial assets at fair value through other comprehensive income

Financial assets held at fair value through other comprehensive income are those held within a business model whose objective is achieved by both collecting contractual cash flows and selling financial assets and where the cash flows are solely payments of principal and interest.

1.19.3 Financial assets at fair value through profit and loss

Financial assets measure at fair value through profit and loss are those that are not otherwise measured at amortised cost or fair value through other comprehensive income. This includes derivatives and financial assets acquired principally for the purpose of selling in the short term.

1.19.4 Impairment

For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments designated at fair value through other comprehensive income), lease receivables and contract assets, the Clinical Commissioning Group recognises a loss allowance representing the expected credit losses on the financial asset.

The Clinical Commissioning Group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month expected credit losses (stage 1).

HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The Clinical Commissioning Group therefore does not recognise loss allowances for stage 1 or stage 2 impairments against these bodies. Additionally Department of Health and Social Care provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodies and the Clinical Commissioning Group does not recognise allowances for stage 1 or stage 2 impairments against these bodies.

For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset's gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset's original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss.

86 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

1.20 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the Clinical Commissioning Group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de- recognised when the liability has been discharged, that is, the liability has been paid or has expired.

1.20.1 Financial Guarantee Contract Liabilities

Financial guarantee contract liabilities are subsequently measured at the higher of: · The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and, · The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.20.2 Financial Liabilities at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability.

1.20.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health and Social Care, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.21 Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.22 Foreign Currencies

The Clinical Commissioning Group’s functional currency and presentational currency is pounds sterling and amounts are presented in thousands of pounds unless expressly stated otherwise. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise.

1.23 Third Party Assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Clinical Commissioning Group has no beneficial interest in them.

1.24 Losses & Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the Clinical Commissioning Group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.25 Critical accounting judgements and key sources of estimation uncertainty

In the application of the Clinical Commissioning Group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.25.1 Critical accounting judgements in applying accounting policies

The following are the judgements, apart from those involving estimations, that management has made in the process of applying the Clinical Commissioning Group's accounting policies and that have the most significant effect on the amounts recognised in the financial statements. · The Clinical Commissioning Group generates provisions to cover future liabilities of more than one year. These provisions are estimated by management based on knowledge of the business, assumptions of probability and are reviewed on an annual basis. · The Provision relates to Continuing Healthcare claims that have to be assessed. There is a potential uncertainty in respect of the number of successful claims resulting in financial cost. Actual claims settled may differ from those calculated.

87 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Notes to the financial statements

1.25.2 Sources of estimation uncertainty

The following are the key estimations that management has made in the process of applying the Clinical Commissioning Group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements: · Accruals are calculated utilising management knowledge, market intelligence and contractual arrangements. These accruals cover areas such as prescribing and contracts for healthcare and non healthcare services. Actual results may differ from those calculated.

1.26 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Department of Health and Social Care GAM does not require the following IFRS Standards and Interpretations to be applied in 2020-21. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2022/23, and the government implementation date for IFRS 17 still subject to HM Treasury consideration. ● IFRS 16 Leases – The Standard is effective 1 April 2022 as adapted and interpreted by the FReM. ● IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption is not therefore permitted.

The impact of adopting IFRS 16 has been assessed. Leased assets will in future be disclosed on the SOFP subject to transitional arrangements set out in he FREM. There is one property lease that falls within the scope of he standard. If this had been accounted for in 2020-21, in accordance with IFRS 16 and using HM Treasury Discount rate of 1.99%, the CCG would have recognised a right of use asset of £0.6m and a lease liability of £0.6m in the SOFP. The impact on the SOCNE would have been an additional cost of approximately £1k.

88 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

2 Other Operating Revenue 2020-21 2019-20 Total Total £'000 £'000

Income from sale of goods and services (contracts) Non-patient care services to other bodies 1,222 1,189 Prescription fees and charges 284 750 Total Income from sale of goods and services 1,506 1,939

Other operating income Other non contract revenue 84 692 Total Other operating income 84 692

Total Operating Income 1,590 2,631

Revenue in this note does not include cash received from NHS England which is drawn down directly into the bank account of the Clinical Commissioning Group and credited to the General Fund.

The Clinical Commissioning Group has no other revenue from that of the supply of services.

3.1 Disaggregation of Income - Income from sale of good and services (contracts)

Non-patient Prescription care services fees and to other bodies charges £'000 £'000 Source of Revenue Non NHS 1,222 284 Total 1,222 284

Non-patient Prescription care services fees and to other bodies charges £'000 £'000 Timing of Revenue Point in time 1,222 284 Total 1,222 284

3.2 Transaction price to remaining contract performance obligations

The Clinical Commissioning Group has no Contract revenue expected to be recognised in the future periods related to contract performance obligations not yet completed at the reporting date.

89 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

4. Employee benefits and staff numbers

4.1.1 Employee benefits Total 2020-21 Permanent Employees Other Total £'000 £'000 £'000 Employee Benefits Salaries and wages 3,766 220 3,986 Social security costs 545 0 545 Employer Contributions to NHS Pension scheme 836 0 836 Apprenticeship Levy 4 0 4 Gross employee benefits expenditure 5,151 220 5,371

Total - Net admin employee benefits including capitalised costs 5,151 220 5,371

Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 5,151 220 5,371

4.1.1 Employee benefits Total 2019-20 Permanent Employees Other Total £'000 £'000 £'000 Employee Benefits Salaries and wages 4,423 85 4,508 Social security costs 466 0 466 Employer Contributions to NHS Pension scheme 727 0 727 Apprenticeship Levy 10 0 10 Gross employee benefits expenditure 5,626 85 5,711

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 Total - Net admin employee benefits including capitalised costs 5,626 85 5,711

Less: Employee costs capitalised 0 0 0 Net employee benefits excluding capitalised costs 5,626 85 5,711

Employee Benefits is shown net of recharges covering:

1) Recharge of a proportion of the Chief Officers employee benefits to NHS Oxfordshire Clinical Commissioning Group and Berkshire West Clinical Commissioning Group

2) Recharge of staff members to NHS Oxfordshire Clinical Group who host the Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Partnership (STP)

90 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

4.2 Average number of people employed 2020-21 2019-20 Permanently Permanently employed Other Total employed Other Total Number Number Number Number Number Number

Total 75.68 2.00 77.68 80.62 0.59 81.21

The Clinical Commissioning Group has no whole time equivalent people engaged on capital projects in 2020-21 (nil for 2019-20).

The Clinical Commissioning Group has not had any Exit packages in 2020-21 nor in 2019-20.

4.3 Pension costs

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.

These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.

Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the Clinical Commissioning Group of participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting period.

The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year.

The employer contribution rate for NHS Pensions increased from 14.3% to 20.6% from 1st April 2019. From 2019/20, NHS CCGs continued to pay over contributions at the former rate with the additional amount being paid by NHS England on CCGs behalf. The full cost and related funding has been recognised in these accounts.

4.3.1 Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2019, is based on valuation data as 31 March 2018 updated to 31 March 2019 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

4.3.2 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019. The Department of Health and Social Care have recently laid Scheme Regulations confirming that the employer contribution rate will increase to 20.6% of pensionable pay from this date.

The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap set following the 2012 valuation. Following a judgment from the Court of Appeal in December 2018 Government announced a pause to that part of the valuation process pending conclusion of the continuing legal process.

91 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

5. Operating expenses 2020-21 2019-20 Total Total £'000 £'000

Purchase of goods and services Services from other CCGs and NHS England 5,715 5,889 Services from foundation trusts 197,549 197,322 Services from other NHS trusts 329,766 285,649 Purchase of healthcare from non-NHS bodies 142,089 109,053 Prescribing costs 72,031 69,227 General Ophthalmic services 25 54 GPMS/APMS and PCTMS 84,278 78,507 Supplies and services – clinical 1,164 290 Supplies and services – general 1,693 1,898 Consultancy services 263 272 Establishment 4,566 1,534 Transport 0 1 Premises 151 1,249 Audit fees 102 102 Other non statutory audit expenditure · Internal audit services 45 44 · Other services 27 7 Other professional fees 115 352 Legal fees 250 189 Education, training and conferences 4 26 Total Purchase of goods and services 839,833 751,665

Depreciation and impairment charges Depreciation 328 434 Amortisation 117 129 Total Depreciation and impairment charges 445 563

Provision expense Provisions 729 284 Total Provision expense 729 284

Other Operating Expenditure Chair and Non Executive Members 146 161 Grants to Other bodies 0 258 Inventories consumed 1,113 0 Other expenditure 158 151 Total Other Operating Expenditure 1,417 570

Total operating expenditure 842,424 753,082

92 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

5.1 COVID Expenditure

In response to the COVID pandemic that was identified in late 2019/20 the CCG was required to support the impact to the population of Buckinghamshire by providing additional services that enabled the safe and secure delivery of healthcare.

This support covered the need for more people to be discharged from hospital and to avoid admissions so our acute hospitals had the space and resources to care for patients affected by COVID-19, to enable GP practices to introduce telephone triaging to reduce footfall at surgeries and reduce the risk of spreading infection. Face-to-face patient appointments were available when clinically appropriate and under careful infection control measures and through additional IT equipment and software that allowed more staff to work from home, thus protecting themselves and patients

All of the expenditure incurred has been fully funded by NHS England.

The elements of expenditure: 2020-21 £'000 Supply of PPE 155 Support to GP practises, infection control, backfill, additional hrs, digital services, text messaging etc 3,069 COVID Line Triage, Swabbing Services, Hot Hubs, Visiting Service On -call etc 3,552 COVID additional PC capacity 1,366 Continuing Healthcare Assessments 416 Hospital Discharge Programme Scheme 1 13,604 Hospital Discharge Programme Scheme 2 9,364

Total Expenditure 31,526

Hospital Discharge Programme scheme 1 was put in place for the 1st six months which enabled Medically Fit For Discharge patients to be moved from the Acute Hospitals promptly to free capacity to treat COVID patients into a community care setting either in a care home or at home with appropriate support. During in this time no assessments were processed to determine any funding and the CCG has been fully funded. During the second six months the assessments have been completed and funding needs resolved Hospital Discharge Programme scheme 2 is an extension of scheme 1 with the change being that the CCG is funded for a maximum of 6 six weeks whilst the assessments are processed.

This expenditure is included in the following categories of Note 5: 2020-21 £'000 Employee Costs 144 Establishment 5 GPMS/APMS 1,384 Services from other NHS Foundation Trusts 129 Services from other NHS trusts 364 Purchase of healthcare from non-NHS bodies 29,500 Total 31,526

93 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

6.1 Better Payment Practice Code

Measure of compliance 2020-21 2020-21 2019-20 2019-20 Number £'000 Number £'000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 11,972 137,438 11,630 122,936 Total Non-NHS Trade Invoices paid within target 11,522 136,268 11,269 121,471 Percentage of Non-NHS Trade invoices paid within target 96.24% 99.15% 96.90% 98.81%

NHS Payables Total NHS Trade Invoices Paid in the Year 1,522 531,252 3,559 458,410 Total NHS Trade Invoices Paid within target 1,498 530,687 3,497 455,825 Percentage of NHS Trade Invoices paid within target 98.42% 99.89% 98.26% 99.44%

The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay 95% of all valid invoices by the due date or within 30 days of receipt of an invoice, whichever is later.

7. Operating Leases 2020-21 2019-20 Buildings Other Total Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 Payments recognised as an expense Minimum lease payments 150 1 151 187 4 191 Total 150 1 151 187 4 191

The Clinical Commissioning Group occupies and pays rent on offices located at Amersham Hospital and at New County Hall in Aylesbury. The rent is paid to Buckinghamshire Healthcare Trust and Buckinghamshire Council respectively. Under paragraph 9 of IFRIC4 these arrangements are a lease and as such accounted for in accordance with IAS17. Payments in respect of these arrangements for 2020-21 are disclosed above.

7.1.2 Future minimum lease payments 2020-21 2019-20 Buildings Other Total Buildings Other Total £'000 £'000 £'000 £'000 £'000 £'000 Payable: No later than one year 150 0 150 0 0 0 Total 150 0 150 0 0 0

94 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

8 Property, plant and equipment

Information Furniture & 2020-21 technology fittings Total £'000 £'000 £'000 Cost or valuation at 01 April 2020 2,072 46 2,118

Cost/Valuation at 31 March 2021 2,072 46 2,118

Depreciation 01 April 2020 1,379 34 1,413

Charged during the year 319 9 328 Depreciation at 31 March 2021 1,698 43 1,741

Net Book Value at 31 March 2021 374 3 377

Purchased 374 3 377 Total at 31 March 2021 374 3 377

Asset financing:

Owned 374 3 377 Total at 31 March 2021 374 3 377

The IT assets relate to the following projects:

The Clinical Commissioning Group has purchased Tangible IT assets required by the Interoperability and Integration project including Softcat (Interoperability) and Airedale projects which is a Buckinghamshire wide project to enable IT to work across various platforms and environments - e.g visibility of patient records 8.1 Economic lives

Minimum Life Maximum Life (years) (Years) Information technology 2 5 Furniture & fittings 5 10

95 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

9 Intangible non-current assets

Computer Software: 2020-21 Purchased Total £'000 £'000 Cost or valuation at 01 April 2020 646 646

Cost / Valuation At 31 March 2021 646 646

Amortisation 01 April 2020 527 527

Charged during the year 117 117 Amortisation At 31 March 2021 644 644

Net Book Value at 31 March 2021 2 2

Purchased 2 2 Total at 31 March 2021 2 2

The Clinical Commissioning Group has purchased Intangible IT assets required by the Interoperability and Integration project. This relates to software to cover projects including Softcat (Interoperability) and Airdale projects which is a Buckinghamshire wide project to enable IT to work across various platforms and environments - e.g visibility of patient records.

9.1 Economic lives Minimum Life Maximum Life (years) (Years)

Computer software: purchased 2 5

10 Inventories

Consumables Total £'000 £'000 Balance at 01 April 2020 2,140 2,140

Additions - - Inventories recognised as an expense in the period (1,113) (1,113) Write-down of inventories (including losses) - - Reversal of write-down previously taken to the statement of comprehensive net expenditure - - Transfer (to) from -Goods for resale - - Balance at 31 March 2021 1,027 1,027

Inventories relate to equipment that is out in the Community being used by the patients to aid recovery from illness or to improve their lives.

The stock value will be reassessed each financial year.

96 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

11.1 Trade and other receivables Current Non-current Current Non-current 2020-21 2020-21 2019-20 2019-20 £'000 £'000 £'000 £'000

NHS prepayments 0 0 1,628 0 NHS accrued income 18 0 394 0 NHS Non Contract trade receivable (i.e. pass through funding) 1,279 0 5,685 0 Non-NHS and Other WGA receivables: Revenue 818 0 88 0 Non-NHS and Other WGA prepayments 1,556 0 3 0 Non-NHS and Other WGA accrued income 49 0 44 0 Non-NHS and Other WGA Non Contract trade receivable (i.e. pass through funding) 108 0 777 0 Expected credit loss allowance-receivables (17) 0 (17) 0 VAT 17 0 55 0 Total Trade & other receivables 3,828 0 8,657 0

Total current and non current 3,828 8,657

Included above: Prepaid pensions contributions 0 0

The great majority of trade is with NHS Organisations and Local Government Organisations. As NHS organisations and Local Government organisations are funded by Government to provide funding to Clinical Commissioning Groups to commission services no credit scoring of them is considered necessary.

11.2 Receivables past their due date but not impaired 2020-21 2020-21 2019-20 2019-20 DHSC Group Non DHSC DHSC Group Non DHSC Bodies Group Bodies Bodies Group Bodies £'000 £'000 £'000 £'000 By up to three months 22 270 185 741 By three to six months 0 638 1 0 By more than six months 0 0 0 (4) Total 22 908 186 737

Trade and other Other financial receivables - Total assets Non DHSC 11.3 Loss allowance on asset classes Group Bodies £'000 £'000 £'000 Balance at 01 April 2020 (17) 0 (17) Total (17) 0 (17)

12 Cash and cash equivalents 2020-21 2019-20 £'000 £'000 Balance at 01 April 2020 (94) 10 Net change in year 208 (104) Balance at 31 March 2021 114 (94)

Made up of: Cash with the Government Banking Service 114 0 Cash and cash equivalents as in statement of financial position 114 0

Bank overdraft: Government Banking Service 0 (94) Total bank overdrafts 0 (94)

Balance at 31 March 2021 114 (94)

The 2019-20 ledger bank balance is in overdraft as a result of a payment run of £513k on 30/03/20 not clearing until 01/04/20, in 20-21 there was no comparable issue.

97 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

Current Non-current Current Non-current 13 Trade and other payables 2020-21 2020-21 2019-20 2019-20 £'000 £'000 £'000 £'000

NHS payables: Revenue 1,388 0 4,967 0 NHS accruals 1,227 0 5,817 0 Non-NHS and Other WGA payables: Revenue 3,285 0 3,515 0 Non-NHS and Other WGA accruals 63,682 0 40,436 0 Social security costs 66 0 66 0 Tax 62 0 61 0 Other payables and accruals 2,308 0 1,351 0 Total Trade & Other Payables 72,018 0 56,213 0

Total current and non-current 72,018 56,213

Included above are liabilities of £0, for 0 people, due in future years under arrangements to buy out the liability for early retirement over 5 years (31 March 2020: £0 for 0 people).

Other payables include £667k outstanding pension contributions at 31 March 2021.

14 Borrowings Current Current 2020-21 2019-20 £'000 £'000 Bank overdrafts: · Government banking service 0 94 Total overdrafts 0 94

Total Borrowings 0 94

Total current and non-current 0 94

15 Provisions Current Non-current Current Non-current 2020-21 2020-21 2019-20 2019-20 £'000 £'000 £'000 £'000 Continuing care 764 711 625 156 Total 764 711 625 156

Total current and non-current 1,475 781

Continuing Care Total £'000 £'000 2019/20

Balance at 01 April 2020 781 781 Balance at 1/4/19 617

Arising during the year 729 729 284 Utilised during the year (35) (35) (120) Balance at 31 March 2021 1,475 1,475 781

Expected timing of cash flows: Within one year 764 764 625 Between one and five years 711 711 156 After five years 0 0 0 Balance at 31 March 2021 1,475 1,475 781

£0 is included in the Provisions of the NHS Litigation Authority as at 31 March 2021 in respect of clinical negligence liabilities of the Clinical Commissioning Group (31 March 2020 £0)

Provision for Continuing Healthcare of £1,475k. The Clinical Commissioning Group is responsible for providing Continuing Healthcare to its population once potential patients have been assessed and deemed to meet criteria to qualify for funding. The provision covers those who have not been assessed where there could be a high probability of a financial liability.

98 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

16 Financial instruments

16.1 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because NHS Buckinghamshire Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by other business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. NHS Buckinghamshire Clinical Commissioning Group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Clinical Commissioning Group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Buckinghamshire Clinical commissioning group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Buckinghamshire Clinical Commissioning Group and internal auditors.

16.1.1 Currency risk

The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The NHS clinical commissioning group and therefore has low exposure to currency rate fluctuations.

16.1.2 Interest rate risk

The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Clinical Commissioning Group therefore has low exposure to interest rate fluctuations.

16.1.3 Credit risk

Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

16.1.4 Liquidity risk

NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

16.1.5 Financial Instruments

As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non- financial items in line with NHS England's expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk.

99 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

16 Financial instruments cont'd

16.2 Financial assets

Financial Assets measured at amortised cost Total 2020-21 2020-21 £'000 £'000

Trade and other receivables with other DHSC group bodies 1,253 1,253 Trade and other receivables with external bodies 1,019 1,019 Other financial assets - - Cash and cash equivalents 114 114 Total at 31 March 2021 2,386 2,386

16.3 Financial liabilities

Financial Liabilities measured at amortised cost Total 2020-21 2020-21 £'000 £'000

Trade and other payables with NHSE bodies 354 354 Trade and other payables with other DHSC group bodies 2,336 2,336 Trade and other payables with external bodies 69,200 69,200 Total at 31 March 2021 71,890 71,890

17 Operating segments

The Clinical Commissioning Group consider there is only one segment: Commissioning of healthcare services.

100 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

18 Joint arrangements - interests in joint operations

The NHS Clinical Commissioning Group has entered into a pooled budget agreements with Buckinghamshire Council and these agreements are hosted by Buckinghamshire Council.

The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year were:

2020-21 2019-20 £'000 £'000 Income 58,541 54,804 Expenditure (58,541) (54,804)

Under the arrangement funds are pooled under section 75 of the NHS Act 2006 for provision of Mental Health and Continuing Care Services within the Buckinghamshire community.

The memorandum accounts for pooled budgets are :

Children and Adolescence Mental Health Services (CAMHS)

This is a Pool Budget with Buckinghamshire Clinical Commissioning Group and Buckinghamshire Council for the provision of Children and Adolescence Mental Health Service. This covers the period 1 April 2020 to 31 March 2021. Buckinghamshire Council is the host and lead authority for this pooled fund arrangement.

2020-21 2019-20 £'000 £000 Expenditure

Pooled fund CAMHS 10,231 9,228

Income

Contribution from Buckinghamshire Council (2,517) (2,270) Contribution from NHS Buckinghamshire Clinical Commissioning Group (7,714) (6,958)

Total (10,231) (9,228)

Balance 0 0

Speech and Language Therapy Pooled Budget

The Pooled budget is between Buckinghamshire Commissioning Group and Buckinghamshire Council for the provision of Speech & Language Therapies. This covers the period 1st April 2020 to 31st March 2021. Buckinghamshire County Council is the host and lead authority.

2020-21 2019-20 £'000 £'000 Expenditure

Pooled Fund SALT 3,792 3,509

Income

Contribution from Buckinghamshire Council (1,744) (1,462) Contribution from NHS Buckinghamshire Clinical Commissioning Group (2,048) (2,047)

Total (3,792) (3,509)

Balance 0 0

TheResidential Pooled Respitebudget Shortis between Breaks Buckinghamshire Pooled Fund Commissioning Group and Buckinghamshire Council for the provision of Residential Respite Short Breaks This covers the period 1st April 2020 to 31st March 2021. Buckinghamshire County Council is the host and lead authority.

2020-21 2019-20 £'000 £'000 Expenditure

Pooled fund Residential Respite Short Breaks 1,950 1,967

Income

Contribution from Buckinghamshire Council (1,418) (1,430) Contribution from NHS Buckinghamshire Clinical Commissioning Group (532) (537)

Total (1,950) (1,967)

Balance 0 0

101 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

18 Joint arrangements - interests in joint operations cont'd

Integrated Community Equipment Service Contract Management Pooled Fund

The Pool Budget between Buckinghamshire Clinical Commissioning Group and Buckinghamshire Council for the provision of Integrated Community Equipment Service Contract Management. The agreement covers the period 1st April 2020 to 31st March 2021. Buckinghamshire Council is the host and lead authority for this pooled fund arrangement.

2020-21 2019-20 £'000 £'000 Expenditure Pooled fund expenditure 85 114 Income Contribution from Buckinghamshire Council (28) (37) Contribution from NHS Buckinghamshire Clinical Commissioning Group (57) (77) Total Income (85) (114)

Balance 0 0

Integrated Community Equipment Service Pooled Budget

The Pool Budget between Buckinghamshire Clinical Commissioning Group and Buckinghamshire Council covers the provision of Integrated Community Equipment Service (including Adult Social Care, Telecare and Children and Young People's Service) for the period of 1st April 2020 to 31st March 2021. Buckinghamshire Council is the host and lead authority for this pooled fund arrangement. The Joint Pooled Fund supports procurement, storage, delivery, installation and technical demonstration as well as subsequent collection, cleaning, recycling, maintenance and repair of equipment, for use by eligible clients.

2020-21 2019-20 £'000 £'000 Expenditure

Pooled fund expenditure 11,133 9,378

Income Contribution from Buckinghamshire Council (3,510) (2,954) Contribution from NHS Buckinghamshire Clinical Commissioning Group (7,623) (6,424) Total Income (11,133) (9,378)

Balance 0 0

Better Care Fund The Pool Budget between Buckinghamshire Clinical Commissioning Group and Buckinghamshire Council for the provision of the Better Care Fund, for health and social care, to cover the period of 1st April 2020 to 31st March 2021. The Joint Pooled Fund supports the provision of community health teams and social care activites for the population of Buckinghamshire. Buckinghamshire Council is the host and lead authority for this pooled fund arrangement.

2020-21 2019-20 £'000 £'000 Pooled Fund Expenditure 40,255 38,582

Contribution from Buckinghamshire Council (8,476) (8,476) Contribution from NHS Buckinghamshire Clinical Commissioning Group (31,425) (29,770) Contribution from NHS Milton Keynes Clinical Commissioning Group (354) (336) Total Income (40,255) (38,582)

0 0

S117 The Pool Budget between Buckinghamshire Clinical Commissioning Group and Buckinghamshire Council covers the provision of Section 117 aftercare, to cover the period 1st April 2020 to 31st March 2021, providing care packages that are suitable for the clients requirements. Buckinghamshire County Council is the host and lead authority for this pooled fund arrangement. 2020-21 2019-20 £'000 £'000 Pooled Fund S117 Expenditure 18,284 17,982

Income Contribution from Buckinghamshire Council (9,142) (8,991) Contribution from NHS Buckinghamshire Clinical Commissioning Group (9,142) (8,991) Total (18,284) (17,982)

Balance 0 0

102 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

19 Related party transactions

Details of related party transactions with individuals are as follows:

Receipts Amounts Amounts Payments to from due from owed to Related Party £ Related Related Related Party (expenditure ) party £ Party at at 31st Mar 20-21 (income) 31st Mar 2021 (CR) Name Title Relationship Related Party Mar 21 2021 (DR) GP Partner & 50% owner Little Chalfont Surgery 849,972 0 0 0 Member FedBucks 9,769,918 0 111,255 55,936 Partner in a GP practice in the Dr Raj Bajwa (63501) Clinical GP Chair Chesham and Little Chalfont Chesham and Little Chalfont Primary Care Network (PCN) Primary care Network 0 0 0 0 Spouse is a community Lloyds Pharmacy Group pharmacist 0 0 0 0 Member GP / Clinical GP Partner Haddenham Medical Centre 1,182,934 0 0 0 Dr Karen West Commissioning Director Member FedBucks 9,769,918 0 111,255 55,936 for Integrated Care Husband Brain Lab - Medical Software and Hardware Innovators 0 0 0 0 Wife is a senior Pharmacist employed by the Chalfont's PCN Hall Practice and Chalfont PCN and the Hall Practice 0 0 0 0 John Storey, Chief Executive of Chief/Accountable Porthaven Porthaven, is a friend 2,410,175 0 0 0 Dr James Kent Officer (BOB CCG's) A Director of Curzon Partners & ICS Executive Lead Curzon Partners Limited Limited 0 0 0 0 Member of The Royal Foundation Covid-19 Grant The Royal Foundation Covid-19 Grant Response Fund Committee Response Fund Committee 0 0 0 0

103 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

19 Related party transactions Cont'd

Where the Clinical Commissioning Group has a transactional (financial) relationship , then these values are included in the following tables. If the related party is not shown then the Clinical Commissioning Group does not have a transactional (financial) relationship. Details of related party transactions with individuals for 20/21 are as follows:

Receipts from Payments to Related Amounts due Related Party £ Amounts owed to party £ from Related (expenditure) at Related Party at (income) Party at 31st Related Party 31st Mar 2021 31st Mar 2021 31st Mar 21 Mar 21 (DR) (CV Health) Chiltern Health 0 0 0 0 Oxford Health NHS Foundation Trust 49,590,609 901,837 0 0 Queen's Nursing Institute 0 0 0 0 NHS Confederation 13,975 0 0 0 Buckinghamshire Healthcare NHS Trust 312,164,666 (15,000) 668,383 121,308 Frimley Health NHS Foundation Trust 65,310,198 0 0 0 Oxford University Hospitals NHS Foundation Trust 21,807,153 0 0 0 Milton Keynes NHS FT 12,632,442 0 0 0 South Central Ambulance Service NHS Foundation Trust 26,003,495 0 0 0 NHS South Central and West CSU 6,046,369 12,813 0 0 NHS England 575,924 63,361 2,648,100 359,253 NHS Oxfordshire CCG 13,768,416 15,500 0 0 NHS Berkshire West CCG 37,340 0 0 0 Totals 507,950,587 978,511 3,316,483 480,561

Previous year comparable 19-20

Receipts Amounts due Payments to Amounts owed to from from Related Related Party Related Party Related Party Party £ £ £ £ (CV Health) Chiltern Health 0 0 0 0 Oxford Health NHS Foundation Trust 47,006,941 3,876,554 0 0 Queen's Nursing Institute 5,524 0 0 0 NHS Confederation 7,783 6,685 0 0 Buckinghamshire Healthcare NHS Trust 279,204,882 24,175,174 321,802 303,376 Frimley Health NHS Foundation Trust 64,560,003 5,347,127 0 0 Oxford University Hospitals NHS Foundation Trust 21,724,385 1,824,296 0 0 Milton Keynes NHS FT 12,455,855 1,007,812 0 0 South Central Ambulance Service NHS Foundation Trust 24,604,422 2,105,291 0 0 NHS South Central and West CSU 5,337,261 2,014,666 0 0 NHS England 153,204 0 598,928 831,347 Totals 455,060,260 40,357,605 920,730 1,134,723

104 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

19 Related party transactions Cont'd

2019-20 2020-21 Payments Payments to to Related Party £ Related Party £ Buckinghamshire CCG Practices (expenditure) (expenditure)

ASHCROFT SURGERY 888,292 827,922 BERRYFIELDS MEDICAL CENTRE 1,078,648 951,619 CROSS KEYS SURGERY 1,761,364 1,842,582 EDLESBOROUGH SURGERY 1,452,832 1,367,966 HADDENHAM MEDICAL CENTRE 1,182,934 1,157,142 MANDEVILLE PRACTICE 1,593,399 1,572,251 MEADOWCROFT SURGERY 1,726,497 1,578,390 NORDEN HOUSE SURGERY 556,227 1,862,886 OAKFIELD SURGERY AYLESBURY 601,996 583,462 POPLAR GROVE SURGERY 2,478,301 2,608,658 UNITY HEALTH SURGERY 3,564,614 3,505,295 WING SURGERY 2,884,101 932,111 WADDESDON SURGERY 1,376,997 1,169,580 WESTONGROVE PARTNERSHIP 4,343,399 4,400,014 WHITCHURCH SURGERY AYLESBURY 293,680 987,177 WHITEHILL SURGERY 1,503,905 1,521,794 SWAN SURGERY 4,620,485 4,280,649 AMERSHAM HEALTH CENTRE 1,380,844 1,377,711 BURNHAM HEALTH CENTRE 2,510,544 2,510,059 CARRINGTON HOUSE SURGERY 1,150,997 1,053,111 CHERRYMEAD SURGERY 1,353,498 1,280,087 CHILTERN HOUSE MEDICAL CENTRE 677,902 400,358 CRESSEX HEALTH CENTRE 1,397,376 1,438,429 DENHAM MEDICAL CENTRE 1,588,138 1,297,819 DESBOROUGH AVENUE SURGERY 1,456,536 1,409,469 DR ALLAN AND PARTNERS 3,345 3,693 GLADSTONE SURGERY 538,789 519,377 HALL PRACTICE 1,106,960 1,038,248 HIGHFIELD SURGERY HIGH WYCOMBE 803,733 782,394 HUGHENDEN VALLEY SURGERY 16,000 45,730 IVER MEDICAL CENTRE 998,564 1,038,375 JOHN HAMPDEN SURGERY 380,876 363,357 KINGSWOOD SURGERY HIGH WYCOMBE 1,197,836 931,278 LITTLE CHALFONT SURGERY 849,972 800,711 MARLOW MEDICAL GROUP 3,284,142 3,262,730 MILLBARN MEDICAL CENTRE 867,889 895,887 MISBOURNE SURGERY 1,528,821 1,523,343 PRACTICE PROSPECT HOUSE 415,062 444,022 PRIORY AVENUE SURGERY HIGH WYCOMBE 1,429,061 1,395,434 RECTORY MEADOW SURGERY 1,154,825 1,167,730 RIVERSIDE SURGERY 1,156,238 1,127,392 SIMPSON CENTRE 1,993,869 1,931,686 SOUTHMEAD SURGERY 743,069 791,903 STOKENCHURCH MEDICAL CENTRE 1,068,175 1,007,608 THREEWAYS SURGERY 775,487 781,756 TOWER HOUSE SURGERY HIGH WYCOMBE 1,029,657 1,021,134 WATER MEADOW SURGERY 1,429,759 1,448,218 WYE VALLEY SURGERY 1,051,109 1,096,741 NEW SURGERY 1,005,411 972,133

TOTAL 68,252,155 66,307,420

105 NHS Buckinghamshire Clinical Commissioning Group - Annual Accounts 2020-21

20 Events after the end of the reporting period

The Clinical Commissioning Group is not aware of any events that will impact on the reporting period.

21 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:

2020-21 2020-21 2019-20 2019-20 Duty Duty Target Performance Achieved Target Performance Achieved Expenditure not to exceed income 847,935 847,796 Yes 758,856 758,793 Yes Capital resource use does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes Revenue resource use does not exceed the amount specified in Directions 846,344 846,205 Yes 756,225 756,162 Yes Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes Revenue administration resource use does not exceed the amount specified in Directions 10,509 9,984 Yes 11,888 10,764 Yes

106