NHS Bedfordshire Clinical Commissioning Group Constitution. December 2012 version 7

Transcription

1 NHS Bedfordshire Clinical Commissioning Group Constitution December 2012 version 7

2 NHS Bedfordshire Clinical Commissioning Group Constitution Introduction Bedfordshire Clinical Commissioning Group, as a member organisation, seeks to ensure, through innovative, responsive clinical commissioning, that our population has access to the highest quality health care providing the best patient experience possible within available resources. BCCG is firmly built on the foundations of our practices within five localities Chiltern Vale, Bedford (Bedford Borough), Ivel Valley, Leighton Buzzard and West Mid Bedfordshire and we already have a strong track record of local commissioning. We intend to be in the vanguard of the new clinically led commissioning organisations developing across England, starting as we mean to go on, amongst the first to go forward for assessment to be granted full statutory responsibility for local NHS commissioning. As an organisation responsible for over 400m of public money we will operate to the highest standards of governance and stewardship. This constitution sets out in detail the arrangements we will have in place to discharge our functions efficiently and effectively on behalf of our population. Dr Paul Hassan Interim Clinical Chair

3 NHS Bedfordshire Clinical Commissioning Group Constitution Contents Constitution Part 1 Constitution This Constitution Interim Arrangements... 8 Part 2 The CCG Name Area Principal Purpose Status Composition Diagram: Structure Vision and Strategic Goals Duties Functions Principles of Good Governance Transparency Part 3 Members and Membership Eligibility for Membership Applications for Membership Local Commissioning Groups Register of Members Termination of Membership Member Representatives Inter-Practice Agreement Engagement with Members The Members Forum Members Duties and Responsibilities Part 4 Governing Body The Governing Body Composition Members of the Governing Body Appointment/Election/Removal of members to the Governing Body Meetings of the Governing Body Voting Rights of Appointed and Elected members of the Governing Body Functions... 19

4 4.8 Exercise of Functions Part 5 Committees Committees Audit and Risk Committee Remuneration Committee Quality and Patient Safety Committee Locality Commissioning Groups Other Committees Part 6 Commissioning Commissioning Plan Consulting on Commissioning Plans In particular, the CCG shall: Any Qualified Provider ( AQP ) Part 7 Annual Report Annual Report Part 8 Information Governance Permitted Disclosures of Information Part 9 Third Party Engagement/Collaborative Working The NHS Commissioning Board Patients and the Public Local Authority Health and Wellbeing Boards Other Clinical Commissioning Groups Stakeholder Forum Professional Committees Part 10 Conflicts of Interest Conflicts of Interest Registers of Interest Governing Body Members Forum Declaration of Interests Part 11 Employment, Remuneration and Expenses Staff Governing Body Accountable Officer Additional Powers in Respect of Payment of Allowances Schedules Schedule 1 Definitions Schedule 2 Constitution Schedule 3 CCG Duties, Responsibilities and Powers Schedule 4 Membership: Eligibility and Termination of Membership Schedule 5 Composition of the Governing Body Schedule 6 Eligibility for Membership of the Governing Body Schedule 7 Appointment and Roles of the Appointed Members Schedule 8 The Seven Principles of Public Life (the Nolan Principles) Schedule 9 CCG Functions Schedule 10 Annual Report: Contents and Publication Schedule 11 The NHS Commissioning Board... 68

5 Appendices Appendix 1: Areas Appendix 2: Register of Members Appendix 3: Inter Practice Agreement Appendix 4: Audit and Risk Committee Terms of Reference Appendix 5: Remuneration Committee Terms of Reference Appendix 6: Quality and Patient Safety Committee Terms of Reference Appendix 7: Conflict of Interests Policy Appendix 8: Standing Orders Appendix 9: Prime Financial Policies and Scheme of Delegation and Reservation Appendix 10: Locality Delegation Agreement and Terms of Reference for Locality Commissioning Boards

6 NHS Bedfordshire Clinical Commissioning Group Constitution Constitution

7 Part 1 Constitution 1.1 This Constitution The National Health Service Act 2006 (the Act ), as amended by the Health and Social Care Act 2012 requires that a Clinical Commissioning Group adopts a constitution This Constitution sets out the terms on which NHS Bedfordshire clinical commissioning group (the CCG ) 1 shall exercise its statutory function of commissioning services for the purposes of the health service in England This Constitution shall have effect from 5 December 2012, being the date on which the NHS Commissioning Board established the CCG This Constitution has been made between the Members of the CCG and has been adopted by the Bedfordshire CCG On becoming a Member of the CCG and on its signature of this Constitution each Member Practice confirms it will carry out its duties and responsibilities in respect of the CCG in accordance with the terms of this Constitution Words and expressions in this Constitution shall be interpreted in accordance with Schedule 1. Schedule 1 also sets out the general provisions that apply to this Constitution This Constitution reflects the values and rights set out in the NHS Constitution Further provisions in respect of the publication and variation of the Constitution are set out at Schedule This Constitution is supplemented by a number of documents which set out how the CCG will operate including: the CCG s Standing Orders which set out the arrangements for meetings and the appointment processes to elect the CCG s representatives and appoint to the CCG s 1 The name of the CCG must begin with NHS and end with Clinical Commissioning Group and must also include a geographical reference which fairly and accurately represents the CCG s area (Regulations 3 to 6, The National Health Service (Clinical Commissioning Groups) Regulations 2012 (the CCG Regulations )). 7

8 committees, including the Governing Body, a copy of which is appended to this constitution at Appendix 8; the Scheme of Reservation and Delegation which sets out those decisions which are the responsibility of the CCG, its Governing Body, its committees and subcommittees, individual members and employees; and Prime Financial Policies which sets out the arrangements for managing the CCG s financial affairs This constitution shall be deemed to incorporate all the provisions of the Act to the extent that such provisions apply to Clinical Commissioning Groups. 1.2 Interim Arrangements The CCG is currently established in shadow form as a sub-committee of NHS Bedfordshire & Luton Cluster (Bedfordshire PCT) and is not a body corporate (as described in paragraph 2.4). Details of the CCG structure and its duties can be found in Schedule The CCG shall not become a body corporate and shall not assume responsibility for the statutory functions described in this Constitution, unless or until the CCG s application to the NHS Commissioning Board for statutory status is successful and its establishment as a body corporate is confirmed by the NHS Commissioning Board in accordance with the Act During the period from the date the Member Practices sign this Constitution in respect of the shadow CCG until the date on which the CCG is established as a statutory body as described in paragraph above (the Interim Period ), the following arrangements shall apply: Composition of the CCG; Members and leaders; Duties delegated from the PCT; Accountability to the PCT; and The PCT s policies will apply to all activity undertaken by the PCT s CCG Committee. The CCG will, during the shadow period, adopt CCG policies consistent with the legal accountabilities of the PCT. 8

9 Part 2 The CCG 2.1 Name This Constitution sets out the governance arrangements adopted by Bedfordshire Clinical Commissioning Group (the CCG ). 2.2 Area The CCG shall carry out its functions in respect of the following geographical area: the combined area of Bedford Borough Council and Central Bedfordshire Council, as delineated on the map at Appendix Principal Purpose The principal purpose of the CCG is the commissioning of services for the purposes of the health service in England The vision and strategic goals of the CCG are set out at paragraph The duties of the CCG are set out at paragraph 2.8 and Schedule Status The CCG is an NHS Body as defined by the Act The CCG is accountable to Parliament by way of the Secretary of State and the NHS Commissioning Board The Secretary of State may arrange for the CCG to exercise any public health function of the Secretary of State in accordance with the Act Where the Secretary of State arranges for the NHS Commissioning Board to exercise a function, the NHS Commissioning Board may arrange for the CCG to exercise that function Where the CCG assumes responsibility for a function it shall be liable for any rights or liabilities arising in respect of the exercise by the CCG of that function. 9

10 2.5 Composition The CCG is a statutory body constituted by the Practices in the Area. Subject to the requirements set out in this Constitution: all Practices in the Area shall be eligible to become members of the CCG in accordance with Part 3 of this Constitution; The executive functions of the CCG shall be exercised by the Governing Body, which is composed of appointed and elected and nominated members; The Members shall be collectively known as the Members Forum; Each Member shall be represented on the Members Forum by a Member Representative nominated by each Member Practice; The Member Representatives shall be entitled to attend and vote at meetings of the Members Forum; and The Practice Members within each Locality shall elect the GP Locality Chairs who will be members of the Governing Body. 2.6 Diagram: Structure CCG 2.7 Vision and Strategic Goals The CCG will ensure, through innovative, responsive and effective clinical commissioning, that the population of Bedfordshire has access to the highest quality health care with the best patient experience possible, within available resources. The CCG s culture will be on which embeds our values of trust, inclusiveness, accountability, performance and delivery Trust We will do what we say we will do so that patients and other stakeholders have confidence in us to commission healthcare services for our population 10

11 Inclusion We will commission healthcare services in a fair, equitable and transparent way to meet the needs of the population in Bedfordshire Decisiveness We will make our commissioning decisions at an appropriate pace, ensure our systems remain fit for purpose and are aligned to delivering our values Accountability and Performance We are accountable for commissioning healthcare services for our local population and we will do this within a framework of effectiveness, efficiency and transparency, remaining within our resource limits Delivery We will achieve the goals and objectives that we set for ourselves ensuring that we meet the highest possible standards for quality, safety and patient experience within the resources available. 2.8 Duties The duties of the CCG are described in the Act and are set out in Schedule 3 of this Constitution. 2.9 Functions The CCG shall carry out the functions described in the NHS Act 2006, including, but not limited to: Commissioning certain health services (where the NHS Commissioning Board is not under a duty to do so) that meet the reasonable needs of: (a) (b) all people registered with Member Practices; and people who are usually resident within the Area and are not registered with a member of any other clinical commissioning group Commissioning emergency care for anyone present in the Area Determining the remuneration and travelling or other allowances of members of the Governing Body: Paying its employees remuneration, fees and allowance in accordance with the determinations made by the Governing Body and determining any other terms and conditions of service of the CCG s employees In discharging its functions the CCG shall act consistently with the discharge by the Secretary of State and the NHS Commissioning Board of their duty to promote a comprehensive health service and with the objectives and requirements placed on the NHS Commissioning Broad through the mandate published by the Secretary of State before the start of each financial year as set out in this constitution Principles of Good Governance 11

12 The CCG Shall conduct its business at all times in accordance with such generally accepted principles of good governance, including but not limited to: the highest standards of probity involving impartiality, integrity and objectivity in relation to the stewardship of public funds; the Nolan Principles (Schedule 8); Towards Establishment: Creating Responsive and Accountable Clinical Commissioning Groups; the Good Governance Standard for Public Services; The Healthy NHS Board: Principles for Good Governance (National Leadership Council 2010) the seven key principles of the NHS Constitution which are included in Schedule 8 of this Constitution; and the Equality Act Transparency All communications issued by the CCG, including the Commissioning Plan, Annual Report, notices of procurements, public consultations, reports, Governing Body meeting dates, times, venues and papers will be published on the CCG s website at The CCG may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public. 12

13 Part 3 Members and Membership The CCG is a membership body, comprising local GP Practice Members. Those Members will be entitled to nominate Member Representatives who may attend and vote at meetings of the Members Forum. The Members Forum will engage with the Governing Body to ensure commissioning decisions reflect the needs of the patients and the public and will elect Locality GP Chairs to the CCG s Governing Body. 3.1 Eligibility for Membership A Practice may become a Member of the CCG if it is situated within the Area and is a provider of primary medical services as described in the Act and the CCG Regulations. 3.2 Applications for Membership Applications for membership of the CCG should be made in writing to the Governing Body A Practice shall become a member of the CCG if the Practice: in the opinion of the Governing Body is eligible to become a Member; has, to the satisfaction of the Governing Body completed the Membership application process determined by the Governing Body, including the submission to the Governing Body of a declaration, signed on behalf of the Practice, that the Practice shall comply and be bound by the terms of this Constitution for the period of its Membership; has had its application approved by the Governing Body; and has had its name entered on the Register of Members by the Governing Body. 3.3 Local Commissioning Groups The CCG has formed five Local Commissioning Groups for the geographical areas covered by the former Bedfordshire County Council, Bedfordshire PCT and latterly by the Central Bedfordshire Council and Bedford Borough Council, as shown on the map at Appendix The practice and procedure of the Local Commissioning Groups is set out in the Locality Delegation Agreement, which is appended to this Constitution at Appendix

14 3.4 Register of Members The CCG shall establish and maintain a register of its Members (the Register of Members ) The Register of Members as amended from time to time by the Governing Body will be appended to this Constitution at Appendix Termination of Membership A Member may terminate its Membership of the CCG on giving 3 months notice to the Governing Body of such intention, in which case the Member s Membership shall terminate at the expiry of such notice period, or such later date set out in the notice, and that Member shall be removed from the Register of Members by the Governing Body A Member shall immediately cease to be a Member and shall be removed from the Register of Members and its Member Representative shall cease to be eligible to attend/vote at meetings of the Members Forum if: the Practice ceases to be eligible to be a Member. Further provisions detailing the eligibility requirements for Membership and the circumstances in which Membership may be terminated are described in Schedule Member Representatives Each Member Practice shall nominate an individual who is a GP and a Deputy (who is a GP or other healthcare professional) to represent the Member on the Members Forum (the Member Representative ) A Member may replace its Member Representative from time to time by notice in writing to the Governing Body The CCG shall be entitled to consider that the Member Representative has the authority to act on behalf of a Member until it receives notification of the replacement of that Member Representative in accordance with paragraph above Each Member shall authorise its Member Representatives to act on behalf of the Member as follows: attend and receive notice of any meetings of the Members Forum; vote at meetings of the Members Forum on behalf of the Member in accordance with this Constitution; sign any written resolution on behalf of the Member; receive any notices from the CCG on behalf of the Member and any notice delivered by the CCG to the Member Representative shall be deemed to have been made or served on the Member; appoint a proxy; and approve or provide any consent required of the Member by the CCG in respect of the powers and duties of the Member described in this Constitution. 3.7 Inter-Practice Agreement 14

15 Each Member Practice shall enter into an agreement (the Inter-Practice Agreement ) setting out details of how the Members will work together to further the objectives of the CCG. The Inter- Practice Agreement will be appended to this Constitution at Appendix Engagement with Members The CCG shall establish a strategy for engaging with its Members (the Communications and Engagement Strategy ). The Communications and Engagement Strategy will include details of how the CCG will gather and collate information from its Members and how that information will be incorporated into commissioning decisions undertaken by the Governing Body A copy of the Member Engagement Strategy shall be published on the CCG s website. 3.9 The Members Forum The Members Forum shall be composed of the Member Representatives nominated from time to time by each Member The Members Forum shall meet at least twice every 12 months Meetings of the Members Forum shall be chaired by the Chair of the Governing Body The practice and procedure of the Members Forum is based on the Standing Orders included within Appendix Members Duties and Responsibilities The duties of each Member are detailed in the Inter-Practice Agreement and include: to participate in the work of the CCG; to be involved in developing and ensuring awareness of the strategy, aims and objectives of the CCG and seek to deliver those aims and objectives; to work with the CCG Chair, Accountable Officer, Vice-Chair and the CCG to develop: (a) (b) (c) (d) (e) (f) (g) (h) (i) effective local commissioning; effective contracting arrangements; effective budget management arrangements; effective information sharing arrangements; effective partnership working arrangements with Service Providers; collaborative working arrangements and implementation of good practice to improve service delivery and effectiveness; effective involvement and participation in the development and implementation of service innovation and pathway redesign projects for commissioned services; effective referral review; adherence to good evidence based prescribing and appropriate referral patterns in line with NICE and local guidelines. The practice will 15

16 contribute to any local schemes for prescribing and referral management including those which form part of the QOF and will only contribute if there are good local reasons identified in advance and agreed by the CCG Committee to understand and manage conflicts of interest to adhere to the CCG Constitution to operate within the spirit of The NHS Constitution to abide by the confidentiality principles and codes of conduct within the CCG s Interim Constitution. 16

17 Part 4 Governing Body 4.1 The Governing Body The CCG must have a Governing Body to oversee the delivery of the CCG s Commissioning Plan, lead and set the strategy for the CCG and to be accountable for the delivery by the CCG of its functions as a statutory body. Member Practices will be entitled, through their Member Representatives, to elect members to the Governing Body to ensure the Members are represented and can contribute clinical expertise at the highest level within the CCG The NHS Act 2006 requires the CCG to establish a Governing Body. The CCG s Governing Body shall be known as the Bedfordshire CCG Governing Body The practice and procedure of the Governing Body is set out in the Standing Orders appended to this Constitution at Appendix Composition The CCG shall have a Governing Body comprising 16 members including: An Accountable Officer; A Chair; A Chief Financial Officer; At least 2 lay members including 1 patient and public lead member and 1 audit, remuneration and conflicts of interest lead member; A registered nurse, other than one who falls within Regulation 12 (1) of the CCG Regulations A secondary care specialist, other than one who falls within Regulation 12 (1) of the CCG Regulations; GP Locality Chairs (one from each of the 5 Localities) The Composition of the Governing Body is set out at Schedule 5. 17

18 4.3 Members of the Governing Body The following may become members of the Governing Body: a Member of the CCG who is an individual; an individual appointed by virtue of Regulations in the Act; individuals who are Health care Professionals; and individuals who are Lay Persons; Further provisions detailing the eligibility requirements for membership of the Governing Body and the circumstances in which membership of the Governing Body may be terminated are described in Schedule Appointment/Election/Removal of members to the Governing Body Appointed Members The CCG shall appoint individuals to the following positions on the Governing Body: Chair; Accountable Officer (which requires the approval of the NHS Commissioning Board); Chief Financial Officer; Together referred to as the Appointed Members. Provisions outlining the appointment and roles of the Appointed Members are set out in Schedule 7. The CCG shall also remove the Chair of the Governing Body in advance of their term of office expiring Elected Members 5 GP Locality Chairs shall be elected by the Members of the Localities in accordance with the process set out in Schedule 6. Candidates are only eligible if there are a practising GP in the Locality which they will represent, work a minimum of 2 clinical sessions per week and must be subject to assessment for suitability by the Chair of the CCG and the Accountable Officer Nominated Member The Director of Public Health shall be jointly nominated by Bedford Borough Council and Central Bedfordshire Council as a voting member. 4.5 Meetings of the Governing Body Meetings of the Governing Body must be held in public, except where the CCG has resolved that it would not be in the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the procedures to permit members of the public to attend a meeting or part of a meeting. Further provisions describing the practice and procedure of the Governing Body are set out in the Standing Orders appended to this Constitution at Appendix 8. 18

19 4.5.2 The CCG must also publish papers considered at meetings of its Governing Body, except where the Governing Body considers that it would not be in the public interest to do so in relation to a particular paper or part of a paper The Governing Body must publish information relating to determinations made under paragraphs and of the Constitution (which relates to remuneration, fees and allowances, including allowances payable under certain pension schemes) in accordance with Regulation 16 (Transparency) the CCG Regulations. The Governing Body must not publish such information if the Governing Body considers that it would not be in the public interest to publish it. 4.6 Voting Rights of Appointed and Elected members of the Governing Body Subject to the provisions of the Governing Body Terms of Reference, Appointed Members and Elected Members and Nominated Members shall each be entitled to vote at meetings of the Governing Body. 4.7 Functions The core functions of the Governing Body are to: ensure that the CCG has made appropriate arrangements to: exercise its functions effectively, efficiently and economically; and comply with such generally accepted principles of good governance as are relevant to it. In particular, the Governing Body shall ensure that appropriate arrangements are put in place to ensure the CCG complies with the Seven Principles of Public Life as described by the Nolan Committee (the Nolan Principles ) which are set out at Schedule 8 to this Constitution determine the remuneration, fees and allowances payable to the employees of the CCG or to other persons providing services to it; determine the allowances payable under a pension scheme established under the Act; and such other functions connected with the exercise of its main function as may be determined by the CCG and set out in this Constitution at Schedule The Governing Body shall have regard to any Guidance published by the NHS Commissioning Board in respect of the exercise by the Governing Body of the functions described at paragraphs and above. 4.8 Exercise of Functions The functions of the Governing Body may be exercised by any of the following on behalf of the Governing Body: any committee or sub-committee of the Governing Body; a member of the Governing Body; or a Member of the CCG who is an individual (but is not a member of the Governing Body); or 19

20 an employee of the CCG In discharging its functions the Governing Body (and its committees and individuals must): comply with the principles of good governance described in this Constitution; operate in accordance with the CCG s Scheme of Reservation and Delegation; comply with the CCG s Standing Orders; comply with the CCG s arrangements for discharging its statutory duties; and where appropriate ensure that Member Practices have had the opportunity to contribute to the CCG s decision making process. 20

21 Part 5 Committees The CCG may appoint committees and sub-committees to assist it in carrying out its functions. A CCG committee may be composed of individuals from outside the CCG enabling the CCG to benefit from the expertise of individuals with a broad range of skills and experience. 5.1 Committees The CCG may appoint committees or sub-committees. The committees or sub-committees may consist of or include persons other than Members or employees of the CCG The CCG shall ensure that each committee or sub-committee adopts and complies with terms of reference detailing the duties and responsibilities of the committee or sub-committee and the procedure of that committee or sub-committee The CCG shall ensure that any duties and responsibilities delegated to a committee of the CCG are described in the CCG s Scheme of Delegation and Reservation The following shall be formal sub-committees of the Board with delegated responsibilities as laid out in the relevant Appendices to this Constitution: Audit and Risk Committee (Appendix 4); Remuneration Committee (Appendix 5); and Quality and Patient Safety Committee (Appendix 6). 5.2 Audit and Risk Committee The Governing Body shall establish an Audit and Risk Committee. The Audit and Risk Committee shall have a Chair, to be appointed by the CCG for a term to be determined by the CCG and in accordance with the CCG Regulations The Audit and Risk Committee is accountable to the Governing Body, shall be chaired by a Lay Person Member and shall perform such financial monitoring, reviewing and other functions as are 2 This reflects the provisions of the CCG Regulations The CCG Regulations 2012 set out in more detail who can be appointed as Chair of the Audit Committee. Please note that the Chair of the Governing Body and the Chief Finance Officer cannot be members of the Audit Committee. 21

22 considered appropriate by the Governing Body. The duties and responsibilities of the Audit and Risk Committee shall include: assisting the CCG in discharging its functions under paragraph above; carrying out such other functions connected with the exercise of its main function at paragraph above as may be determined by the Governing Body and which are set out in the Audit and Risk Committee Terms of Reference which are appended to this Constitution at Appendix 4 and (where necessary) delegated to the Audit and Risk Committee under the CCG s Scheme of Delegation and Reservation; identifying strategic risks monitoring compliance; and providing assurance. 5.3 Remuneration Committee The Governing Body shall establish a Remuneration Committee. The Remuneration Committee shall have a Chair, to be appointed by the CCG for a term to be determined by the CCG and in accordance with the CCG Regulations The Remuneration Committee shall be chaired by a Lay Person Member and the duties and responsibilities of the Remuneration Committee shall include: making recommendations to the Governing Body as to the discharge of its functions under paragraphs and above; and carrying out such other functions connected with the exercise of the functions described at paragraph above as may be determined by the Governing Body and which are set out in the Remuneration Committee Terms of Reference which is appended to this Constitution at Appendix 5 and (where necessary) are delegated to the Remuneration Committee under the CCG s Scheme of Delegation and Reservation The Remuneration Committee must comply with any Regulations setting out provisions in respect of its functions. 5.4 Quality and Patient Safety Committee The Quality and Patient Safety Committee (Appendix 6) shall be chaired by the CCG Chair (with the Deputy Chair being the Nurse Member of the Governing Body) and have responsibility for: ensuring the Board is aware of the implications with regards to adopting a particular approach to clinical care; clinical governance of commissioned services for assurance of patient safety; quality outcomes and embedding a quality culture in all services; 3 This reflects the provisions of the CCG Regulations The CCG Regulations 2012 set out who can be appointed as Chair of the Remuneration Committee. Please bear in mind that all members of the Governing Body, other than lay members, are disqualified from being Chair. 22

23 combined approach to performance and delivery inclusive of clinical quality and financial control. 5.5 Locality Commissioning Groups The Governing Body shall establish 5 Committees known as Locality Clinical Commissioning Groups as described in clause 3.3 and their roles and responsibilities are set out within the Locality Delegation Agreement. 5.6 Other Committees Other committees of the CCG are: The Executive Management Team; The Prescribing Committee; The Individual Treatment Panel; and The QIPP Programme Board. 23

24 Part 6 Commissioning The CCG must have regard to any guidance published by the NHS Commissioning Board in respect of the exercise by the CCG of its commissioning functions. 6.1 Commissioning Plan The CCG shall prepare a commissioning plan before the start of each Financial Year in accordance with the Act (the Commissioning Plan ) and any guidance published by the NHS Commissioning Board. The Commissioning Plan must set out how the CCG proposes to exercise its functions during the relevant Financial Year. The Commissioning Plan must, in particular, explain how the CCG proposes to discharge its responsibilities in relation to its duties to: improve the quality of the Services; reduce inequalities; ensure public involvement and consultation, its financial duties in relation to expenditure; and additional controls on resource use The CCG shall publish the Commissioning Plan and supply a copy to the NHS Commissioning Board before any date specified by the NHS Commissioning Board in a direction and to any Relevant Health and Wellbeing Board The CCG may revise the Commissioning Plan after it has been published. Following a revision, the CCG must prepare and publish a document detailing the changes it has made to the Commissioning Plan. The CCG shall supply a copy of the revised Commissioning Plan to the NHS Commissioning Board before any date specified by them and to any Relevant Health and Wellbeing Board. If the CCG revises the Commissioning Plan in a way in which the CCG considers to be significant, the CCG must also publish a copy of the revised Commissioning Plan A copy of the Commissioning Plan as amended from time to time shall be available at the CCG s place of business and shall be published on the CCG s website. 6.2 Consulting on Commissioning Plans Where the CCG is preparing a Commissioning Plan or revising a Commissioning Plan in a way which the CCG considers significant, the CCG must: consult individuals for whom it has responsibility for the purposes of Section 3 of the NHS Act 2006; and 24

25 involve any Relevant Health and Wellbeing Board in revising or preparing the Commissioning Plan. 6.3 In particular, the CCG shall: give each Relevant Health and Wellbeing Board a draft of the Commissioning Plan or, as the case may be, a copy of the revised Commissioning Plan; and consult each Relevant Health and Wellbeing Board on whether the draft Commissioning Plan takes proper account of each Joint Health and Wellbeing Strategy published by the Relevant Health and Wellbeing Board which relates to the period (or any part of the period) to which the Commissioning Plan relates include in the published Commissioning Plan or, in circumstances where the CCG revises a published plan in a way in which the CCG considers significant, the revised Commissioning Plan: a summary of the views expressed by individuals consulted under above; an explanation of how the CCG took account of those views; and a statement of the final opinion of each Relevant Health and Wellbeing Board consulted in relation to the Commissioning Plan under paragraphs and above have regard to any guidance published by the NHS Commissioning Board in relation to drafting, revising and consulting on the contents of the Commissioning Plan. 6.4 Any Qualified Provider ( AQP ) In drafting the Commissioning Plan, the CCG must have regard to: the Procurement Guide for Commissioners of NHS-funded Services published on 30 July 2010 and any document which supersedes it; Operational Guidance to the NHS - Extending Patient Choice of Provider published on 19 July 2011 and any document which supersedes it; and any other documentation setting out how the AQP model is to function When commissioning services from those providers who are qualified to do so under the national list of services the CCG must ensure that those qualified still meet the requirements, namely that they: are registered with the Care Quality Commission and licensed by Monitor where required, or meet equivalent assurance requirements; will meet the Terms and Conditions of the NHS Standard Contract which includes a requirement to have regard to the NHS Constitution, relevant guidance and law; accept NHS prices; can provide assurances that they are capable of delivering the agreed service requirements and comply with referral protocols; and reach agreement with local commissioners on supporting schedules to the standard contract including any local referral thresholds or patient protocols. 25

26 Part 7 Annual Report 7.1 Annual Report In every Financial Year, save for its first Financial Year, the CCG shall prepare an Annual Report in accordance with the Act and any directions given to the CCG by the NHS Commissioning Board on how it has discharged its functions in the previous Financial Year Provisions describing the contents of and the procedures in respect of the publication of the Annual Report are set out in Schedule

27 Part 8 Information Governance 8.1 Permitted Disclosures of Information The CCG may disclose information obtained by it in the exercise of its functions if the disclosure is: made under or pursuant to regulations under Sections 113 or 114 of the Health and Social care (Community Standards) Act 2003 (Complaints About Health Care and Social Services); made in accordance with any enactment or court order; necessary or expedient for the purposing of protecting the welfare of an individual; made to any person in circumstances where it is necessary or expedient for the person to have the information for the purposes of exercising functions of that person under any enactment; made for the purposes of facilitating the exercise of any of the CCG s functions; made in connection with the investigation of a criminal offence (whether or not in the United Kingdom); made for the purpose of criminal proceedings (whether or not in the United Kingdom); or if the information has previously been lawfully disclosed to the public The CCG s right to disclose information under paragraphs , , and above may be exercised notwithstanding any rule of common law which would otherwise prohibit or restrict the disclosure The CCG will work within the national Information Governance Framework and, in particular, will comply with the requirements and submission of the Information Governance Toolkit as per the national timetable. It will identify a Caldicott Guardian to act as advisor on Information Governance within the CCG and it will identify a Senior Information Risk Owner (SIRO) to be accountable for ensuring all aspects of information governance are met within the organisation. 27

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29 Part 9 Third Party Engagement/Collaborative Working 9.1 The NHS Commissioning Board The CCG shall work with the NHS Commissioning Board to improve the quality of primary care services; ensuring that local service re-design promotes innovation and reducing health inequalities The CCG shall work with the NHS Commissioning Board to improve the quality of specialised services, ensuring that local service re-design promotes innovation and reducing health inequalities The CCG will be accountable to the NHS Commissioning Board. 9.2 Patients and the Public The Governing Body shall make arrangements to ensure that patients and the public are involved in the planning and development of the Commissioning Plan. Such arrangements shall include service commissioning in accordance with its duty at paragraph 12.1 of Schedule 3 of this constitution. Details of the CCG s strategy are contained within the Communications and Engagement Strategy as referred to in paragraph of Part 3 of this constitution The CCG shall apply the following principles when implementing the arrangements described at paragraph above: Be open, honest, timely and transparent in all conversations and interactions Ensure communication and engagement is meaningful, targeted and happens throughout all our commissioning decision making processes Embody the ethos of No decision about me, without me Ensure views of all sections of our diverse population are represented when and where appropriate Communications and engagement is everyone s responsibility within the CCG Locally to enable PPE to be embedded will require the CCG to ensure; 29

30 Processes are in place to collect, analyse and utilise the views of patients and the public to inform decision making, shape services and improve health outcomes GPs and other clinicians are supported to engage effectively with their patients and communities There is a recognition that meaningful engagement with seldom heard or harder to reach groups will, at times, require additional efforts and resources Patients are empowered and encouraged to become more engaged in decisions about their own health, promoting shared decision making and choice There is ongoing improvement and innovation in PPE year on year. 9.3 Local Authority The CCG will work in partnership with Central Bedfordshire Council and Bedford Borough Council to improve the health of the population, improve the safety and quality of local health and social care services and to reduce health and social inequalities There are no section 75 agreements which are inherited from Bedfordshire PCT. There is an agreement under section 256 of the Act with Central Bedfordshire Council and another section 256 agreement with Bedford Borough Council which are inherited from Bedfordshire PCT. It will be the CCG s intention that the rights and responsibilities under the section 256 agreements in place at the signing of this Constitution will be transferred from Bedfordshire PCT to the CCG The CCG is required to consult with the Overview and Scrutiny Committee with respect to any proposed and significant changes to the pattern or location of local services. The CCG will work collaboratively with the Overview and Scrutiny Committees of Bedford Borough and Central Bedfordshire Councils to support the Overview and Scrutiny Committees in their responsibility to: Review and scrutinise all matters relating to the planning, provision and operation of health services in the area of the local authority Make reports and recommendations to local NHS bodies and their local authority on any matter reviewed or scrutinised, and must be consulted by NHS bodies including the CCG on any proposal for a substantial development or variation in health services Have matters referred to them by PPI Forums and HealthWatch Require the attendance of a local NHS body including the CCG to provide information to them. 9.4 Health and Wellbeing Boards From April 2013 the CCG, as a member of the Health and Wellbeing Board for the Area shall work with the local authority to develop a Joint Strategic Needs Assessment for the Area and will hold the local authority to account for the delivery of the Joint Health and Wellbeing Strategy The CCG shall act in partnership with the Local Authority, Public Health and other agencies with a commitment to promoting the health and well-being of the Bedfordshire population to develop a shared vision of ambition for health improvement and health and social care services. 30

31 9.5 Other Clinical Commissioning Groups The CCG may work together with other Clinical Commissioning Groups in the exercise of its Commissioning Functions. The CCG will have a formal agreement in place with Luton Clinical Commissioning Group for the exercise of its Commissioning Functions The CCG may make arrangements with one or more Clinical Commissioning Groups in respect of: delegating any of the CCG s Commissioning Functions to another Clinical Commissioning Group; exercising any of the Commissioning Functions of another Clinical Commissioning Group; or exercising jointly the Commissioning Functions of the CCG and another Clinical Commissioning Group For the purposes of the arrangements described at paragraph 9.5.2, the CCG may: make payments to another Clinical Commissioning Group receive payments from another Clinical Commissioning Group; or make the services of its employees or any other resources available to another Clinical Commissioning Group; or receive the services of the employees or the resources available to another Clinical Commissioning Group For the purposes of the arrangements described at paragraph above, the CCG may establish and maintain a pooled fund made up of contributions by any of the Clinical Commissioning Groups working together pursuant to paragraph above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the Commissioning Functions in respect of which the arrangements are made Where the CCG makes arrangements with another Clinical Commissioning Group as described at paragraph above, the CCG shall develop and agree with that Clinical Commissioning Group, an Inter-Practice Agreement setting out the arrangements for joint working including details of: how the parties will work together to carry out their Commissioning Functions; the duties and responsibilities of the parties; how risk will be managed and apportioned between the parties; financial arrangements, including payments towards a pooled fund and management of that fund; contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph above. 9.6 Stakeholder Forum 31

32 9.6.1 The CCG will aim to establish a Stakeholder Forum comprising through which it will coordinate its PPI activities and ensure effective engagement. 9.7 Professional Committees The CCG commits to engage with the local statutory professional committees, as statutory representatives of the professions. It seeks to maintain and develop a constructive working relationship with the local professional committees. 32

33 Part 10 Conflicts of Interest 10.1 Conflicts of Interest The Governing Body shall develop and maintain a conflicts of interest policy (the Conflicts of Interest Policy ) A copy of the Conflicts of Interest Policy as amended from time to time by the Governing Body will be published on the CCG s website and shall be appended to this Constitution Registers of Interest The CCG shall be create and maintain registers of the interests of: Members (the practice individuals and also 1 st degree relatives)); Members of the Governing Body; The members of committees or sub-committees or of committees or sub-committee of the Governing Body; and CCG employees (the Registers of Interest ) recording all declarations of interest as set out below and in the CCG s Conflicts of Interest Policy. The Registers of Interest shall be available for public inspection on written request The CCG shall make arrangements to ensure that: a person referred to in paragraph above declares any conflict or potential conflict of interest that the person has in relation to a decision to be made in the exercise of the commissioning functions of the CCG; any such declaration is made as soon as practicable after the person becomes aware of the conflict or potential conflict and, in any event within 28 days; and any such declaration is included in the Registers of Interests. 33

34 The CCG shall make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that it does not and does not appear to, affect the integrity of the CCG s decision making processes The CCG shall have regard to guidance published by the NHS Commissioning Board on the discharge of CCG functions in respect of conflicts of interest Governing Body The CCG shall collate and maintain a Register of Interests of each Member of the Governing Body. The Register of Interests shall include all relevant personal or business interests as defined by the CCG s Conflicts of Interest Policy, held by a Governing Body Member All Members of the Governing Body must comply with the provisions of the Conflicts of Interest Policy, which includes a provision requiring Members of the Governing Body to notify the CCG of a relevant interest or a change to an existing interest noted on the Register of Interests. Failure by a Governing Body Member to so notify the CCG or to comply with the Conflicts of Interest Policy, may lead to the suspension and/or removal of the Governing Body Member from the Governing Body Where the business of the Governing Body requires a decision on an area in which a member holds a significant conflict of interest, the Chair of the Governing Body shall ensure that the Member Representative in question takes no part in the discussion or subsequent decision making. The CCG s Conflicts of Interest Policy describes examples of interests that are likely to be considered significant and the procedure for evaluating proposals where more than one member of the Governing Body holds a significant interest pertaining to the business of the Governing Body Members Forum The CCG shall collate and maintain a Register of Interests of each member of the Members Forum. The register of interests shall include all relevant personal or business interests as defined by the CCG s Conflicts of Interest Policy, held by a Member Representative on the Members Forum All Member Representatives of the Members Forum must comply with the provisions of the Conflicts of Interest Policy, which includes a provision requiring members of the Members Forum to notify the CCG of a relevant interest or a change to an existing interest noted on the register. Failure by a Member Representative to so notify the CCG or to fail to comply with the Conflicts of Interest Policy, may lead to the suspension and/or referral of the Member Representative to the NHSCB Where the business of the Members Forum requires a decision on an area in which a Member Representative holds a significant conflict of interest, the Chair of the Members Forum shall ensure that the Member Representative in question takes no part in the discussion or subsequent decision making. The CCG s Conflicts of Interest Policy describes examples of interests that are likely to be considered significant Declaration of Interests Each Governing Body member, Member Representative, CCG employee or any other person working on behalf of the CGG shall declare any personal or business interest as defined in the CCG s Conflicts of Interest Policy immediately on becoming aware of such interest. The CCG s 34

35 Conflicts of Interest Policy shall set out the procedure for making the declaration. Such declaration shall include details of the nature and extent of the interest, including details of any benefit already received or which is expected to be received Any question of whether an interest is a conflict of interest or potential conflict of interest as defined by the CCG s Conflicts of Interest Policy or whether an interest should be recorded or removed from the Register of Interests shall be for the consideration of the Accountable Officer Any member of the Governing Body or Member Representative, CCG employee or any other person working on behalf of the CGG must absent themselves from any meeting or part of a meeting in which any personal or business interests conflicts, or has the potential to conflict, with the business of the CCG in accordance with the CCG s Conflicts of Interest Policy. In such circumstances the individual shall not be counted as part of the quorum for the meeting and shall not be entitled to vote. 35

36 Part 11 Employment, Remuneration and Expenses 11.1 Staff The CCG may appoint such persons to be employees of the CCG as it considers appropriate The CCG must: employ its employees on such terms and conditions as the CCG considers appropriate; and pay its employees, remuneration and travelling or other allowances as determined by the Governing Body The CCG may, for or in respect of such of its employees as it may determine, make arrangements for providing pensions, allowances or gratuities. Such arrangements may include the establishment and administration, by the CCG or another party, or one of more pension schemes The arrangements described at paragraph above include arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of employees who suffer loss of office or employment or loss or diminution of emoluments Governing Body The CCG may pay members of the Governing Body such remuneration and travelling or other allowances, pensions and/or gratuities as it considers appropriate The arrangements described at paragraph above may include the establishment and administration, by the CCG or another party, of one or more pension schemes of which the members of the Governing Body may become members The arrangements described at paragraph include arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of any members of the Governing Body who suffer loss or diminution of emoluments Paragraph does not apply to Members or employees of Members of the CCG. 36

37 For the avoidance of doubt, the CCG may make arrangements for the provision of pensions for employees in accordance with paragraph and such employees shall not also be entitled to become members of any pension scheme established pursuant to paragraph by virtue of their membership of the Governing Body Accountable Officer The CCG must have an Accountable Officer The Accountable Officer is to be appointed by the NHS Commissioning Board The CCG may, for or in respect of its Accountable Officer, make arrangements for providing remuneration and travelling or other allowances, pensions, allowances or gratuities, including arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of the Accountable Officer where that Accountable Officer suffers loss of office or loss or diminution of emoluments Additional Powers in Respect of Payment of Allowances The CCG may pay such travelling or other allowances as it considers appropriate to any of the following: Members of the CCG who are individuals; Individuals, including Member Representatives, authorised to act on behalf of a Member in dealings between the Member and the CCG; and Members of any committee or sub-committee of the CCG or the Governing Body. 37

38 Clinical Commissioning Group Constitution Schedules

39 Schedule 1 Definitions 1.1. The following words and phrases shall be interpreted as set out below: Act Accountable Officer Annual Report Appointed Members Area Audit and Risk Committee CCG Regulations NHS Commissioning Board Commissioning Functions The National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) as amended from time to time An individual who is appointed to be accountable for the exercise by the CCG of any of its functions by the NHS Commissioning Board in accordance with the Act and whose duties and responsibilities are set out in this Constitution. The report prepared by the CCG at the end of each Financial Year, save for its first Financial Year, describing how the CCG has discharged its functions in the previous Financial Year. Members appointed to the Governing Body in accordance with paragraph 4.4. The geographical area to be covered by the CCG described in paragraph 2.2. The committee established by the Governing Body in accordance with paragraph 5.2. The National Health Service (Clinical Commissioning Groups) Regulations 2012 and any other regulations applicable to Clinical Commissioning Groups in force from time to time. The body established by the NHS Act 2006 (as amended by the Health and Social Care Act 2012). The functions of Clinical Commissioning Groups in arranging for the provision of services as part of the Health Service (including the function of making a request to the NHS Commissioning Board for the purposes of Section 1427). 39

40 Commissioning Plan The plan for commissioning prepared by the CCG in accordance with the NHS Act 2006 and pursuant to paragraph 6. Conflicts of Interest Policy Financial Year Governing Body GP Guidance Health and Wellbeing Board Health Care Professional Health-Related Services Inter-Practice Agreement Joint Health and Wellbeing Strategy Lay Person The policy developed and maintained by the Governing Body pursuant to paragraph 10 and appended to this Constitution at Appendix 7. Means a period of 12 consecutive months ending with 31 March in any year, and includes the period which begins on the day the CCG is established and ends on the following 31 March. The CCG Governing Body appointed pursuant to having the responsibilities set out in Part 4. Means a general practitioner registered on a performers list of the NHS Commissioning Board. Means applicable health or social care guidance, direction or determination which the CCG has a duty to have regard to. A committee of the local authority established by the NHS Act 2006 (as amended by the Health and Social Care Act 2012), on which the CCG will be represented. An individual who is a member of a profession regulated by a body mentioned in Section 25(3) of the National Health Service Reform and Health Care Professions Act Services that may have an effect on the health of individuals but are not health services or Social Care Services. The Inter-Practice Agreement described in paragraph 3.7 setting out how the Member Practices will work together to further the objectives of the CCG. A strategy under Section 116A of the Local Government and Public Involvement in Health Act 2007 which is prepared and published by a Health and Wellbeing Board by virtue of Section 195 of the Health and Social Care Act An individual who is not: (a) a member of the CCG; (b) a Healthcare Professional; or (c) an individual of prescribed description. Legislation Locality GP Chair Laws statutes, statutory instruments, regulations and directions issued from time to time applicable to the CCG. A GP or other Health Care Professional elected by the Members in each Locality Commissioning Group in accordance with paragraph of this Constitution who will represent the Members in that locality and who will each be a member of the Governing Body. 40

41 Locality Delegation Agreement Locality Commissioning Groups Member Member Engagement Strategy Member Representative Members Forum Practice Prime Financial Policies Register of Interests Register of Members Regulations Relevant Health and Wellbeing Board Remuneration Committee Social Care Services Standing Orders The Locality Delegation Agreement described in paragraph setting out the practice and procedure of the Locality Commission Groups. Committees of the CCG for Ivel Valley; Leighton Buzzard; West Mid Beds; Bedford and Chiltern Vale whose duties and responsibilities are described in the Locality Delegation Agreement. A Practice which has successfully completed the application process for Membership of the CCG and whose name is recorded in the Register of Members in accordance with paragraph 3.4 of this Constitution (and Membership ) shall be construed accordingly). A strategy established by the CCGs for engaging with its Members in accordance with paragraph 3.8 of this Constitution. An individual nominated by a Member to represent that Member on the Members Forum in accordance with paragraph of this Constitution. The collective term for the Member Representatives. An individual or organisation that is a provider of primary medical services pursuant to: a general medical services contract; arrangements under section 83(2) of the Act; or arrangements under section 92 of the Act, for the provision of essential primary medical services to be registered patients during core hours (having the meaning set out in Regulation 2 of the CCG Regulations). The Prime Financial Policies described in paragraph and set out in Appendix 9. A written register as amended from time to time of the interests of each member of the Governing Body or Members Forum as described in paragraph 10.2 of this Constitution. A written register as amended from time to time of the names and addresses of the Members of the CCG established and maintained in accordance with paragraph 3.4 of this Constitution and appended to this Constitution at Appendix 2. Any applicable delegated or subordinate legislation or regulation. A Health and Wellbeing Board established by a Local Authority whose area is co-terminus with, or includes the whole or any part of the Area of the CCG. The committee established by the Governing Body in accordance with paragraph 5.3. Services that are provided in pursuance of the social services functions of local authorities (within the meaning of the Local Authority Social Services Act 1970). The Standing Orders described in paragraph and set out in 41

42 Appendix 8. The Local Government Act The NHS Constitution The Nolan Principles The Local Government and Public Involvement in Health Act 2007 as amended from time to time. The NHS Constitution published on 21 January 2009 as amended from time to time. The Seven Principles of Public Life expounded by the Nolan Committee and set out at Schedule 8 of this Constitution Unless the context otherwise requires, words in the singular shall include the plural and in the plural shall include the singular Unless the context otherwise requires, a reference to one gender shall include a reference to the other gender A reference to a statute or statutory provision is a reference to it as amended, extended or reenacted from time to time A reference to a statute or statutory provision shall include all subordinate legislation made from time to time under that statute or statutory provision A reference to writing or written includes faxes and , but not text messages or messages conveyed by way of social media websites Any words following the terms including, include, in particular or any similar expression shall be construed as illustrative and shall not limit the sense of the words, description, definition, phrase or term preceding those terms. 2. General Provisions 2.1. Confidential Information Confidential Information means any information which any Member may have or acquire in relation to the CCG or another Member. Information shall not be considered Confidential Information if it becomes public knowledge other than as a direct or indirect result of a breach of this provision Each Member shall at all times use all reasonable endeavours to keep confidential any Confidential Information and each Member agrees: to use Confidential Information only for the use for which the Confidential Information was disclosed to it; and not to disclose the Confidential Information to any third party or use it to the detriment of the CCG or any other Member A Member may disclose Confidential Information in the following circumstances: where it is required by the Member s professional advisors where such disclosure is for a purpose related to the operation of the CCG; or with the consent in writing of the Member to which the Confidential Information relates; or 42

43 where it is required by Iaw or regulation, in which case the Member shall supply a copy of the required disclosure to the Governing Body in sufficient time to enable the Governing Body to suggest and incorporate amendments to it; or to comply with the law; or to any tax authority; or if the Confidential Information is disclosed within the public domain otherwise then as a breach of this provision The obligations of each of the Members under this provision shall continue without limit of time. The Members agree that they shall not make or permit or authorise the making of any press release or other public statement or disclosure concerning the CCG or any of the Members without seeking the advice of the relevant Director of the CCG Notices A notice given to a party under or in connection with this Constitution shall be: in writing; in English; and for the CCGs sent to the address or to the fax number, or, in the case of a Member or the Member Representative, for that Member, the address set out from time to time in the Register of Members The following table sets out methods by which a notice may be sent and, if sent by that method, the corresponding deemed delivery date and time: Delivery method Delivery by hand. Pre-paid first class, recorded delivery post or other next working day delivery service. Fax. Deemed delivery date and time At the time the notice is left at the address. 48 hours after the date of posting. 2 hours after the time of transmission For the purpose of this clause and calculating deemed receipt: all references to time are to local time in the place of deemed receipt; and if deemed receipt would occur on a Saturday or Sunday or a public holiday when banks are not open for business, or outside normal business hours (meaning 9.00am to 5.00pm) on a business day, deemed receipt will take place at 9.00 am on the day when business next starts in the place of receipt To prove service it is sufficient to prove that: where a notice was delivered by hand, that the notice was delivered and left at the correct address; 43

44 where a notice was posted, that the envelope containing the notice was properly addressed and posted; and where a notice was sent by fax, a fax delivery report showing that the notice was properly addressed and despatched to the correct fax number. A notice given under this Constitution is not valid if sent by No Partnership or Agency Nothing in this Constitution is intended to, or shall be deemed to, establish any partnership or joint venture between any of the parties, constitute any party the agent of another party, nor authorise any party to make or enter into any commitments for or on behalf of any other party. 44

45 Schedule 2 Constitution Guidance The CCG must have regard to any Guidance published by the NHS Commissioning Board, including Guidance on the form, content or publication. Publication The CCG shall publish this Constitution on the CCG s website If this Constitution is varied, the CCG must publish the Constitution as so varied. The CCG must have regard to any Guidance published by the NHS Commissioning Board in respect of the publication of the Constitution. Variation For the purposes of this section (Variation), the Constitution shall include Parts 1 to 11 and the Schedules but shall not include the Appendices to this document. The CCG may apply to the NHS Commissioning Board to vary this Constitution. Such variation may include varying the CCG s Area or its list of members. The CCG shall have regard to any Guidance published by the NHS Commissioning Board and comply with the CCG Regulations and any other Regulations made in respect of varying this Constitution 4. The Act sets out further circumstances in which this Constitution may be varied otherwise than by an application by the CCG to the NHS Commissioning Board. 4 Schedule 2 of the CCG Regulations set out factors which the NHS Commissioning Board have to take into account when determining whether an application for variation should be granted. 45

46 Schedule 3 CCG Duties, Responsibilities and Powers The CCG s Duties The Members and officers of the CCG shall ensure that their conduct in the exercise of their duties to the CCG complies with such generally accepted principles of good governance as are relevant to it, in particular, the Nolan Principles. The following is a list of the statutory duties of the CCG under the Act. The CCG shall put in place arrangements to ensure it exercises its duties in accordance with Legislation and directions by the NHS Commissioning Board and having regard to any Guidance documenting them as necessary in this constitution, the CCG s scheme of reservation and delegation and other relevant CCG policies and procedures. The CCG shall in exercising these duties act consistently with the Secretary of State s duty to promote a comprehensive health service. 1 Duty to promote the NHS Constitution 1.1 The CCG shall adhere to the NHS Constitution s seven principles which are as follows: The NHS provides a comprehensive service, available to all; Access to NHS services is based on clinical need, not an individual s ability to pay; The NHS aspires to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on the patient experience; NHS services must reflect the needs and preferences of patients, their families and their carers; The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population; 46

47 1.1.6 The NHS is committed to providing best value for taxpayers money and the most costeffective, fair and sustainable use of finite resources; and The NHS is accountable to the public, communities and patients it serves. 1.2 The CCG shall, in the exercise of its functions: act with a view to securing that health services are provided in a way which promotes the NHS Constitution; and promote awareness of the NHS Constitution amongst patients, staff and members of the public. In this paragraph patients and staff have the same meanings as in Chapter 1 of Part 1 of the Health Act Duty as to Efficiency The CCG must exercise its functions effectively, efficiently and economically. 3 Duty as to Improvement in Quality of Services 3.1 The CCG must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness. In particular the CCG must act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services. These outcomes include, in particular, outcomes which show the: effectiveness of the services; safety of the services; and quality of the experience undergone by patients. 4 Duty in relation to Quality of Primary Medical Services The CCG must assist and support the NHS Commissioning Board in discharging its duty under Section 13 E of the Act (NHS Commissioning Board s duty as to improvement in quality of services) so far as it relates to securing continuous improvement in the quality of primary medical services. 5 Duties as to Reducing Inequalities and the Equality Duty 5.1 The CCG must, in the exercise of its functions, have regard to the need to: reduce inequalities between patients with respect to their ability to access health services; reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services; eliminate discrimination; harassment, victimisation and any other conduct that is prohibited under the Equality Act 2010; advance equality of opportunity between persons who share a relevant protected characteristic (under the Equality Act 2010) and persons who do not share it; 47

48 5.1.5 foster good relations between persons who share a relevant protected characteristic (under the Equality Act 2010) and persons who do not share it; and report annually on the CCG s progress in respect of paragraphs and above implement the Equality Delivery System (EDS) to ensure compliance with its duties in respect of equality. 6 Duty to Promote Involvement of each Patient 6.1 The CCG shall in the exercise of its functions, promote the involvement of patients, and their carers and representatives (if any), in decisions which relate to: the prevention or diagnosis of illness in the patients, or their care or treatment. 6.2 The CCG shall have regard to any guidance published by the NHS Commissioning Board in respect of its duty under paragraph 6.1 above. 6.3 The CCG must have regard to any Guidance issued by the NHS Commissioning Board in respect of this duty. 6.4 The CCG will adopt the principles set out in the NHS-wide paper Equity and Excellence Liberating the NHS (12 July 2010) and, in particular, the principle of Nothing about me, without me in all its activities. 7 Duty as to Patient Choice 7.1 The CCG must, in the exercise of its functions, act with a view to enabling patients to make choices with respect to aspects of health services provided to them. 7.2 The CCG will uphold the principles of patient choice in ensuring that every service it directly commissions promotes patient choice. 7.3 The CCG will ensure its Complaints function supports patients with issues over patient choice. 7.4 The CCG will measure its performance against national choice indicators, including patient experience/satisfaction surveys, to ensure appropriate compliance with its duty. 8 Duty to obtain Appropriate Advice 8.1 The CCG must obtain advice appropriate for enabling it effectively to discharge its functions from persons who together have a broad range of professional expertise in the prevention, diagnosis and treatment of illness and the protection or improvement of public health, including local representative bodies, local professional networks and clinical senates. 8.2 The CCG must have regard to any Guidance issued by the NHS Commissioning Board in respect of this duty. 8.3 The CCG will obtain appropriate specialist (e.g. legal) advice when required in order to execute its legislative requirements fully. 9 Duty to Promote Innovation 48

49 9.1 The CCG must, in the exercise of its functions, promote innovation in the provision of health services (including innovation in the arrangements made for their provision). 9.2 The CCG s Commissioning Plan will set out its annual intentions for securing innovation in the provision of health services and in the arrangements made for the provision of those health services. 9.3 The CCG will promote continuous improvement in its commissioned services. This will ensure better health outcomes are attained. 9.4 The CCG will promote health outcomes through a commitment to increasing the use of alternatives to block contracts, for example, payment by outcomes. 10 Duty in Respect of Research 10.1 The CCG must, in the exercise of its functions, have regard to the need to promote research on matters relevant to the health service and the use of the health service of evidence obtained from research The CCG will work with local providers and across organisational boundaries to understand how the latest evidence can be commissioned within its contracts. 11 Duty as to Promoting Integration 11.1 The CCG must exercise its functions with a view to securing that health services are provided in an integrated way where it considers that this would: improve the quality of those services (including the outcomes that are achieved from their provision) reduce inequalities between persons with respect to their ability to access those services; or reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services The CCG will work with local stakeholders and across organisational boundaries via Clinical Reference Groups and Task & Finish groups to develop needs and evidence based services The CCG will ensure understanding of whole-system pathways and explore opportunities for integration to improve overall outcomes The CCG must exercise its functions with a view to securing that the provision of health services is integrated with the provision of Health-Related Services or Social Care Services where the CCG considers that such integration would: improve the quality of the health services (including the outcomes that are achieved from the provision of those services); reduce inequalities between persons with respect to their ability to access those services; or reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services. 49

50 12 Duty as to promoting education and training 12.1 The CCG shall in exercising its functions, have regard to the need to promote education and training for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State of the duty under section 1F(1) of the Act. 13 Public Involvement 13.1 The CCG must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information in other ways): in the planning of the CCG s commissioning arrangements; in the development and consideration of proposals by the CCG for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them; and in decisions of the CCG affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact The CCG must have regard to any Guidance issued by the NHS Commissioning Board in respect of this duty The CCG will develop and maintain annually a Communication and Engagement Strategy and implementation plan. The plan will outline: how the CCG will work with HealthWatch and other local organisations to actively work with patients through Practice groups, locality groups and specific; and a shared understanding of consultation and the objectives to achieve between the CCG and patient groups/cohorts The CCG has implemented a public membership scheme to engage directly with patients and groups. The CCG may create a stakeholder forum that will act as a Patient Public Engagement reference group and advise the CCG on matters that support its statutory duties in respect of public engagement and to lead the initiatives to support the CCG in meeting those duties. 14 Financial Duties 14.1 Expenditure The CCG shall perform its functions so as to ensure that the CCG s expenditure does not exceed the aggregate of the CCG s allocations for the Financial year and expenditure which is attributable to the performance by the CCG of its functions in that Financial Year (including the CCG s capital resource use and its revenue resource use) does not exceed the amounts specified in the Act and/or by the NHS Commissioning Board for the relevant Financial Year Quality Payments The CCG shall publish an explanation of how the CCG spent any payment in respect of quality made to the CCG by the NHS Commissioning Board. 50

51 14.3 Use of Resources The CCG must ensure that the use by it of its capital and revenue resources do not exceed the amount specified by any direction of the NHS Commissioning Board. 15 Additional Powers of the CCG 15.1 Mergers The CCG may, together with one or more other Clinical Commissioning Group, make an application to the NHS Commissioning Board for the dissolution of the Clinical Commissioning Groups and the establishment of a new merged Clinical Commissioning Group. The requirements for such an application are described in the Act and the CCG Regulations Dissolution The CCG may make an application to the NHS Commissioning Board for the CCG to be dissolved. The CCG shall have regard to, and comply with, the CCG Regulations and any other Regulations made in respect of dissolution of the CCG Raising Additional Income The CCG may do anything specified in Section 7(2)(a), (b) and (e) to (h) of the Health and Medicines Act 1988 (provision of goods etc.) for the purpose of making additional income available for improving the health service only to the extent that its exercise does not to any significant extent interfere with the performance by the CCG of its functions Grants The CCG may make payments by way of grant or loan to a voluntary organisation which provides or arranges for the provision of services which are similar to the services in respect of which the CCG has functions. The payments may be made subject to such terms and conditions as the group considers appropriate. 16 Emergency Planning 16.1 The CCG must take appropriate steps for securing that it is properly prepared for dealing with a relevant emergency. 17 Procurement, Patient Choice and Competition 17.1 The CCG shall: adhere to good practice in relation to procurement; protect and provide the right of patients to make choices with respect to treatment or other healthcare services provided for the purposes of the health service; and 5 Schedule 1 of the CCG Regulations sets out factors relating to the granting of applications for a merger. 6 Schedule 3 of the CCG Regulations sets out factors which the NHS Commissioning Board have to take into account when determining whether a dissolution application should be granted. 51

52 put processes in place to ensure that the CCG does not engage in anti-competitive behaviour which is against the interests of people who use the services The processes and procedures by which the CCG shall secure compliance with this provision are set out in the Standing Orders and Prime Financial Policies and Detailed Financial Policies. 52

53 Schedule 4 Membership: Eligibility and Termination of Membership 1. Who may become a Member of the CCG? CCG Membership will be composed of GP practices and not individual GP s. To become a member of the CCG, a GP practice must hold a contract with NHS Bedfordshire for the provision of primary care services such as a GMS, PMS, APMS contract or another Primary Care contract and must have their Primary site located within the Borough of Bedfordshire. For further details on eligibility for membership of the CCG and the process for approval of Members by the Governing Body of the CCG please see the CCG Constitution. 2. Members Obligations A Member shall be entitled to retain its membership of the CCG as long as that Member: is eligible for Membership under the Constitution; carries out the Member Responsibilities described at section 3.10 of this Agreement; operates within the delegated budgets described in this Agreement; undertakes any remedial action requested by the Governing Body; achieves the objectives of the CCG; and Membership is dependent on Practices retaining their GP contract with NHS Bedfordshire or NHS Commissioning Board and acting in accordance with the responsibilities of that contract. Members commit to meeting the outcomes of the CCG s Operating Framework Failure by a Member to comply with its obligations under this Agreement may, at the absolute discretion of the Governing Body, result in the Member being referred to the NHS CB. The Inter- Practice Agreement sets out the remedial action the Governing Body may require the Member to take if that Member fails to meet any of its obligations under this Agreement as outlined. 53

54 Schedule 5 Composition of the Governing Body 1. The CCG Governing Body shall comprise 16 members and shall be composed of the following members: 1.1 An Accountable officer 1.2 A Chair 1.3 A Chief Financial Officer 1.4 At least 2 Lay Person members (including 1 patient and public lead member and 1 audit, remuneration and conflicts of interest lead member) 1.5 At least 2 secondary care clinicians including a: Registered Nurse who shall also be the accountable officer for clinical governance; and Secondary care specialist doctor 1.6 A Chief Operating Officer 1.7 A Director of Quality and Safety 1.8 A Director of Public Health 1.9 A Director of Strategy and Redesign 1.10 Elected members 5 Locality GP Chairs. 54

55 Schedule 6 Eligibility for Membership of the Governing Body 1 Terms of Office 1.1 The interim shadow CCG Chair will assume the role of Chair (which is expected to be for a 2-3 month period) until the substantive Chair is appointed by the process to be established by the CCG. 1.2 The Chair shall serve a 3 year period in accordance with the process established in national guidance issued by the NHS Commissioning Board. 1.3 Terms of office for clinical and Lay Person members of the Governing Body: Clinical and Lay Person members of the Governing Body shall serve for a term not exceeding three years; Clinical and Lay Person members of the Governing Body shall be eligible for reappointment in accordance with the process established in national guidance issued by the NHS Commissioning Board; and The term of office will commence at a time stipulated by the Chair, and this is expected to be communicated ahead of any appointments and/or election process for stated posts. 1.4 Individuals excluded from being lay members of the Governing Body, in accordance with Schedule 4 of the CCG Regulations include: An employee of a local authority in England and Wales or of any equivalent body in Scotland or Northern Ireland; An officer or employee of the Department of Health; A chairman, director, member or employee of an NHS body, other than a CCG, an NHS foundation trust or a Primary Care Trust; A chairman, director, governor, member of employee of an NHS foundation trust; An employee of a Primary Care Trust; 55

56 1.4.6 A member or employee of the Care Quality Commission; A member or employee of Monitor; An individual who provides any services as part of the health service pursuant to arrangements made by the CCG in the exercise of its commissioning functions, or an employee or member (including shareholder) of, or a partner in, a body which does so (for the purposes of this paragraph, a CCG s commissioning functions are the functions of the group in arranging for the provision of services as part of the health service); An individual who provides any services as part of the health service pursuant to arrangements made by the NHS Commissioning Board in the exercise of its commissioning functions, or an employee or member (including shareholder) of, or a partner in, a body which does so (for the purposes of this paragraph, the NHS Commissioning Board s commissioning functions are the functions of the Board in arranging for the provision of services as part of the health service); A person who contracts with a local authority to provide services in pursuance of the social services functions of the authority within the meaning of the Local Authority Social Services Act 1970, or any employee of such a person; An employee of a party to arrangements to perform dental services pursuant to arrangements made under section 25 of the National Health Service (Scotland) Act 1978 or section 57 of the National Health Services (Wales) Act 2006, where the employee is employed for purposes connected with the provision of those services; An employee of a party to arrangements to perform ophthalmic services pursuant to arrangements made under section 26 of the National Health Service (Scotland) Act 1978 or section 71 of the National Health Service (Wales) Act 2006, where the employee is employed for purposes connected with the provision of those services; An employee of a party to arrangements to provide pharmaceutical services under section 27 or 27A of the National Health Service (Scotland) Act 1978 or section 80 or 81 of the National Health Service (Wales) Act 2006, or provide local pharmaceutical services under section 92 of, or Schedule 7 to, the National Health Service (Wales) Act 2006, where the employee is employed for purposes connected with the provision of those services (for the purposes of this paragraph a person included in a pharmaceutical list is a party to arrangements to provide pharmaceutical services); and An employee of a party to arrangements to perform primary medical services under section 17C of the National Health Service (Scotland) Act 1978 or section 41 of the National Health Service (Wales) Act 2006, where the employee is employed for purposes connected with the provision of those services. 1.5 Terms of Office and Election Process for appointing Locality GP Chairs Locality GP Chairs shall be appointed to the Governing Body automatically following a locality election to appoint them as Locality GP Chairs; Each Locality used the following local election methodology to elect the 5 Locality GP Chairs in post on the date of authorisation: candidates put themselves forward for election and advertised their interest; each Practice had one vote and each Locality could only vote for its own Locality GP Chair. 56

57 1.5.3 Locality GP Chairs shall serve for a term not exceeding three years, with their terms of office staggered such that their terms of office do not come to end on the same date. At the end of their term Locality GP Chairs shall be eligible for re-appointment. 1.6 All Member Representatives will be required to sign a conduct form setting out the behaviour expected of them. 2 Disqualification of members of the Governing Body 2.1 Members of the Governing Body (clinical and non-clinical) shall vacate their office if any of the following occurs: If they are suspended from providing primary medical services; If in the opinion of the Governing Body (having taken appropriate professional advice in cases where it is deemed necessary) the Member becomes or is deemed to be of unsound mind; If the member has behaved in a manner or exhibited conduct which has or is likely to be detrimental to the honour and interest of the Governing Body or the CCG and is likely to bring the Governing Body or the CCG into disrepute. This includes but it is not limited to dishonesty; misrepresentation (either knowingly or fraudulently); defamation of any member of the Governing Body (being slander or libel); abuse of position; non declaration of a known conflict of interest; seeking to manipulate a decision of the Board in a manner that would ultimately be in favour of that member whether financially or otherwise. The CCG will work closely with the NHS Commissioning Board to determine whether the behaviour fits these criteria; If a Member is not eligible to work in the UK; If a Member has at any time been removed from the management or control of a charity; If a Member s partner or spouse is on the governing body. 57

58 2.2 In accordance with Schedule 5 of the CCG Regulations, the following individuals shall be disqualified from membership of the Governing Body: A Member of Parliament, Member of the European Parliament or member of the London Assembly; A member of a local authority in England and Wales or of an equivalent body in Scotland or Northern Ireland; An individual who, by arrangement with the CCG, provides it with any service or facility in order to support the CCG in discharging its commissioning functions, or an employee or member (including shareholder) of, or a partner in, a body which does so; A person who, within the period of five years immediately preceding the date of the proposed appointment, has been convicted in the United Kingdom of any office, or outside the United Kingdom of an offence which, if committed in any part of the United Kingdom, would constitute a criminal offence in that part and, in either case, the final outcome of the proceedings was a sentence of imprisonment (whether suspended or not) for a period of not less than three months without the option of a fine; A person who is subject to a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986, sections 56A to 56K of the Bankruptcy (Scotland) Act 1985 or Schedule 2A to the Insolvency (Northern Ireland) Order 1989 (which relate to bankruptcy restrictions orders and undertakings); A person who, has been dismissed within the period of five years immediately preceding the date of the proposed appointment, otherwise than because of redundancy, from paid employment by any of the following the NHS Commissioning Board, a CCG, a Strategic Health Authority, a Primary Care Trust an NHS trust, an NHS foundation trust, a Special Health Authority, a Local Health Board, a Health Board or Special Health Board, a Scottish NHS trust, the Care Quality Commission, the Health Protection Agency, 58

59 Monitor, the Wales Centre for Health, the Common Services Agency for the Scottish Health Service Healthcare Improvement Scotland, the Scottish Dental Practice Board, the Northern Ireland Central Services Agency for the Health and Social Services, the Regional Health and Social Care Board, the Regional Agency for Public Health and Wellbeing, the Regional Business Services Organisation, Health and Social Care trusts (formerly known as Health and Social Services trusts), Special health and social care agencies (formerly known as Special health and social services agencies), the Patient and Client Council, the Health and Social Care Regulation and Quality Improvement Authority a health care professional or other professional person who has at any time been subject to an investigation, by any body which regulates or licenses the profession concerned, in connection with the person s fitness to practise or any alleged fraud, the final outcome of which was the person s suspension from a register held by the regulatory body, where the suspension has not been terminated, the person s erasure from such a register, where the person has not been restored to the register, a decision by the regulatory body which had the effect of preventing the person from practising the profession in question, where that decision has not been superseded, or a decision by the regulatory body which had the effect of imposing conditions on the person s practice of the profession in question, where those conditions have not been lifted A person who is subject to A disqualification order or disqualification undertaking under the Company Directors Disqualification Act 1986 or the Company Directors Disqualification (Northern Ireland) Order 2002, or an order made under section 429(2) of the Insolvency Act 1986 (disabilities on revocation of administration order against an individual). 59

60 60

61 Schedule 7 Appointment and Roles of the Appointed Members The Accountable officer, Chair, Chief Financial Officer and 2 Lay members and secondary care clinicians will be appointed in accordance with the process established in national guidance issued by the NHS Commissioning Board; the Best Practice Resource Toolkit of appointment of Lay Members to CCGs and the Guidance on Remuneration for Senior Executives. The Chief Operating Officer; Director of Quality and Safety and Director of Strategy and Redesign will be appointed by a panel which includes the Accountable Officer and other clinical representation The Chair of the Governing Body The chair of the Governing Body is responsible for: a) leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this constitution; b) building and developing the group s Governing Body and its individual members; c) ensuring that the group has proper constitutional and governance arrangements in place; d) ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties; e) supporting the accountable officer in discharging the responsibilities of the organisation; f) contributing to building a shared vision of the aims, values and culture of the organisation; g) leading and influencing to achieve clinical and organisational change to enable the group to deliver its commissioning responsibilities; h) overseeing governance and particularly ensuring that the Governing Body and the wider group behaves with the utmost transparency and responsiveness at all times; i) ensuring that public and patients views are heard and their expectations understood and, where appropriate as far as possible, met; j) ensuring that the organisation is able to account to its local patients, stakeholders and the NHS Commissioning Board; 61

62 k) ensuring that the group builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant local authority(ies) In addition the Chair may be responsible for such other matters as the Governing Body decide The chair will be recruited and appointed in accordance with NHSCB guidelines The Deputy Chair of the Governing Body The Governing Body shall elect a deputy chair A deputy chair of the Governing Body shall deputise for the chair of the Governing Body where he or she has a conflict of interest or is otherwise unable to act Where the deputy chair of the Governing Body is also the senior clinical voice of the group they will take the lead in interactions with stakeholders, including the NHS Commissioning Board Role of the Accountable Officer The accountable officer of the group is a member of the Governing Body This role of accountable officer has been summarised in a national document 7 as including: a) being responsible for ensuring that the clinical commissioning group fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money; b) at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems. c) working closely with the chair of the Governing Body, the accountable officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its members and staff. d) such other duties as may be specified by the Governing Body In addition to the accountable officer s general duties, where the accountable officer is also the senior clinical voice of the group they will take the lead in interactions with stakeholders, including the NHS Commissioning Board The Accountable Officer will be recruited and appointed in accordance with NHSCB guidelines Role of the Chief Finance Officer The chief finance officer is a member of the Governing Body and is responsible for providing financial advice to the clinical commissioning group and for supervising financial control and accounting systems This role of chief finance officer has been summarised in a national document 8 as including: a) being the Governing Body professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged; b) making appropriate arrangements to support, monitor on the group s finances; 7 8 See the latest version of the NHS Commissioning Board Authority s Clinical commissioning group Governing Body members: Role outlines, attributes and skills See the latest version of the NHS Commissioning Board Authority s Clinical commissioning group Governing Body members: Role outlines, attributes and skills 62

63 c) overseeing robust audit and governance arrangements leading to propriety in the use of the group s resources; d) being able to advise the Governing Body on the effective, efficient and economic use of the group s allocation to remain within that allocation and deliver required financial targets and duties; and e) producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to the NHS Commissioning Board; f) such other duties as may be specified by the Governing Body The Chief Finance Officer will be recruited and appointed in accordance with NHSCB guidelines. 63

64 Schedule 8 The Seven Principles of Public Life (the Nolan Principles) SELFLESSNESS Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other material benefits for themselves, their family, or their friends. INTEGRITY Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. OBJECTIVITY In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. ACCOUNTABILITY Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. OPENNESS Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. HONESTY Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. 64

65 LEADERSHIP Holders of public office should promote and support these principles by leadership and example. 65

66 Schedule 9 CCG Functions 1. The statutory functions of the CCG to be exercised on behalf of the CCG by the Governing Body are as follows: 1.1. The Governing Body shall carry out the following functions: ensuring the Register of Interests is reviewed regularly and updated as necessary; ensuring that all conflicts of interest or potential conflicts of interest are declared leading the settling of vision and strategy approving commissioning plans monitoring performance against plans providing assurance of strategic risk. 66

67 Schedule 10 Annual Report: Contents and Publication The Annual Report shall include the details required by the Act. In particular, the Annual Report must: (a) (b) explain how the CCG has discharged its duties under the Act in respect of improving the quality of the services and its duties under the Act in respect of public involvement and consultation; and having consulted any Relevant Health and Wellbeing Board, review the extent to which the CCG has contributed to the delivery of any Joint Health and Wellbeing Strategy to which it was required to have regard under Section 116B(1)(b) of the Local Government and Public in Health Act. The CCG shall give a copy of the Annual Report to the NHS Commissioning Board before any date specified by the NHS Commissioning Board. The CCG shall publish the Annual Report on the CCG website and present the Annual Report at the Annual General Meeting of the CCG. The Annual Report will comply with any requirements set out by the NHS Commissioning Board for the inclusion of information relating to its annual accounts and to audit opinions as necessary. 67

68 Schedule 11 The NHS Commissioning Board 1. Provision of Documents to the NHS Commissioning Board The Act gives the NHS Commissioning Board the power to request documents from the CCG in certain circumstances prescribed by the Act. The CCG shall ensure arrangements are in place to ensure the CCG or any of its Members or employees comply with any such request made by the NHS Commissioning Board, including, where requested by the NHS Commissioning Board, supplying any documents or records kept by means of computer in legible form. 2. Power to Require Explanation The CCG must comply with any request by the NHS Commissioning Board under the NHS Act 2006 for the CCG to provide it with an explanation of any matter which relates to the exercise by the CCG of its functions, including an explanation of how the CCG is proposing to exercise any of its functions. 3. Intervention Powers of the NHS Commissioning Board The NHS Commissioning Board has powers under the Act to direct and dissolve the CCG. In particular, the NHS Commissioning Board may direct the CCG or the Accountable Officer of the CCG to cease to perform any functions for such period as may be specified by the NHS Commissioning Board in any direction. In such circumstances, and where the NHS Commissioning Board is exercising a function of the CCG or has directed another CCG to do so, the CCG must co-operate with the NHS Commissioning Board or, as the case may be the other CCG or its Accountable Officer as required by the Act. 68

69 Clinical Commissioning Group Constitution Appendices

70 Appendix 1 Area 70

71 71

72 Appendix 2 Register of Members IVEL VALLEY LOCALITY Practice Full Address Phone Number Practice Code Practice Manager GPs Arlesey Medical Centre, (Sunnyhill Health Care) High Street, Arlesey, Beds SG15 6SN Y00260 Richard Stead richard.stead@nhs.net Attias M, Holt A Shefford Health Centre Robert Lucas Drive, Hitchin Road, Shefford, Beds, SG17 5FS E81033 Vivien Kinch-Jameson vivien.kinchjameson@nhs.net Cakebread S R, Griffith S K W (PL), Baxter M J, Moffitt S, Boodhun R, Sekaran S A, Narayanan S, Steward JC (Salaried), Dhinakharan S(Salaried) The Surgery 109 Station Road, Lower Stondon, SG16 6JJ E81061 Jill Watson jill.watson@nhs.net Collins H E, Carragher, MS (PL), Yahya Nasreen 72

73 The Surgery 27B Kings Road, Sandy, SG19 1EJ E81059 Alison Parry Dr Jonathan Graffy, Gledhill P (PL), Bourke B Greensands Medical Practice (Main Surgery) Brook End, Potton SG19 2QS And E81012 Nicola Gauge nicola.gauge@nhs.net Baker M R, Taine D L, Drake L K (PL), Von Blumenthal H, Jackson D M, Jarvis, C P, Vedavanam T The Medical Centre (Branch Surgery) Stocks Lane, Gamlingay, Sandy, Beds SG19 3JR Ivel Medical Centre The Baulk, Biggleswade, SG18 0PX E81036 Christina Ward christina.ward@nhs.net Hollington W A, Hartree J F, Smith NPD (PL), Zahorski A Sandy Health Centre Medical Practice Northcroft, Sandy SG19 1JQ E81035 Rosena Morris Rosena.Morris2@nhs.net Kapur A K, Patel A M, Baxter J, Higgins S (PL), Neelagiri K G, Nina Djuric The Health Centre (Main Surgery) Saffron Road, Biggleswade,SG18 8DJ E81057 Jenny Morley jenny.morley@nhs.net Kirkham J A, Curtin M E, Taylor A J, Low A, Edwards A R, Acharya M (PL), Sabey S, Olmos Berrio N (Branch Surgery) And 111 Church Street, Langford, Beds SG18 9QA Larksfield Surgery Medical Partnership, Arlesey Road, Stotfold, SG5 4HB E81022 Philippa Smith Philippa.Smith@nhs.net Seaman RAJ (PL), Hodgson M J, Radford R (t), Lewis R, Southall A, Mehta P reg, Clapham R - reg 73

74 WEST MID BEDFORDSHIRE LOCALITY Practice Full Address Phone Number Practice Code Practice Manager GPs Greensands Surgery The Health Centre, Oliver Street, Ampthill, Beds MK45 2SB E81002 Dawn Moore P G Rowe, J M Shortland, S Truckle, H Hill Flitwick Surgery (Dr S J Morris & Partners) Highlands, Flitwick, Bedfordshire, MK45 1DZ E81015 Margaret Roberts margaret.roberts7@nhs.net W T De Groot, S J Morris, R J Haywood, T Mearza, S Short, K Shergill, A Karia, A Herbert The Surgery Hexton Road, Bartonle-Clay MK45 4TA E81046 Gill Hiscox gill.hiscox@nhs.net M E Glaze, D J Sydenham, S P Hughes, S D Wilden, A Sulakshana, D Beale, K Gajan Asplands Medical Centre Wood Street, Woburn Sands, Milton Keynes, Bucks MK17 8QP E81050 Emma Barter emma.barter@gp-e81050.nhs.uk C J L Logan, J G H Nott, M J Rogers, F Anderson, C Freeman, I M Wallace, J Durairaj Houghton Close Surgery 1 Houghton Close, Ampthill, Beds MK45 2TG E81074 Debra Barry debra.barry@nhs.net N M Scott, A Mishra, A S Khan, M Saint, H J Smith, E Soeng The Oliver Street Practice The Health Centre, Oliver Street, Ampthill MK45 2SB E81077 Alan Robinson alanr@gp-e81077.nhs.uk W J Lockley, S Haque, J Bietzk 74

75 LEIGHTON BUZZARD LOCALITY Practice Full Address Phone Number Practice Code Practice Manager GPs Bassett Road Surgery Bassett Road Surgery, 29 Bassett Road, Leighton Buzzard LU7 1AR E81003 Chrystel Dooley Dr RG Chapman, Dr J Henderson, Dr M Horkan, Dr RM Lucy, Dr N Jamal, Dr CJ Stewart, Dr I Knight, Registrars - Dr Lawrence, Dr Virji Salisbury House Surgery Salisbury House Surgery, Lake Street, Leighton Buzzard LU7 1RS E81004 Gill Day gill.day2@nhs.net Dr CDW Marshal, Dr FJ Fry, Dr KSB Smith, M Hoque, M Josephidou, C Calisir, Dr Dry Grovebury Road Surgery (Lakehouse/Europa House merger) Grovebury Road Surgery, Grovebury Road, Leighton Buzzard LU7 4SF E81072 Chris Jarrett christine.jarratt@nhs.net Dr A Day, Dr S Sivakumar, Dr T Sathiyaseelan, Dr Ejike Leighton Road Surgery Leighton Road Surgery, 1 Leighton Road, Linslade, E81044 Stephen King stephen.king@nhs.net Dr B Taylor, Dr A Turner, Dr A Patel, Dr F Parva, Dr T Hafez, Dr T Patel, Dr A Esteki Leighton Buzzard LU7 1LB 75

76 CHILTERN VALE LOCALITY Practice Full Address Phone Number Practice Code Practice Manager GPs Kingsbury Court Surgery Kingsbury Court Church Street Dunstable Beds LU5 4RS E81045 Margaret Godfrey E81045.nhs.uk Dr N A Benedikt, K M Hawking, J Fsadni, K S Dogra, A Haider, M A Charbonne (Locum) Wheatfield Surgery 60 Wheatfield Road Luton Beds LU4 0TR E81008 Debbie Wilkins debbiewilkins@nhs.net Dr S Sharma, R Robinson,T Palit C K A Owusu-Yianoma, T Thit T Archdeacon, A Esteki Chiltern Hills Practice 106 High Street North Dunstable Beds LU6 1LN E81636 Sandra McLaughlan s.mclaughlan@nhs.net Dr Don Obih The Health Centre Priory Gardens, Church Street Dunstable, Beds LU6 3SU E81014 Sue Carmalt susan.carmalt@nhs.net Dr P C Hassan, R Jain, S Islam, M Bhatt,H Master West Street Surgery 89 West Street Dunstable, Beds LU6 1SF E81009 Carolyn Boyd Carolyn.Boyd1@nhs.net Dr K A Freeman, J Peters, C F Quartly, J E Berry, S V Price, B J Ella, G White (Locum) Houghton Regis Medical Centre Peel Street, Houghton Regis,Beds, LU5 5EZ E81027 Bina Beant Bina.Beant@nhs.net Dr P K Goutam, A K Mallik, J E Jinmi, S A Mumtaz, K Alva Eastgate Surgery Eastgate House Church Street Dunstable, Beds LU5 4RR E81635 ShahidaHaq Shahida.Haq@nhs.net DrMFHaq The Surgery 33 Manor Road E81069 Marie Dunn Dr S V Howard, K E Elliott, T H Verity, A O Kuku, J A 76

77 Caddington, Beds LU1 4EE Luckhurst Toddington Medical Centre Luton Road, Toddington, Beds LU5 6DE E81034 Nadia Shaw Dr A C Long, J D A Perkins, R C Neal, S D Sharma, H Corns (Salaried) Kirby Road Surgery 58 Kirby Road Dunstable, Beds LU6 3JH E81052 Steve Wilson Steve.Wilson@nhs.net Dr O B O Toole, N E Curt, C M Sykes, M Schutte, N Corriette, G White, L Thomas (Locum Sat am) BEDFORD LOCALITY Practice Full Address Phone Number Practice Code Practice Manager GPs Drs Agrawal 8 Ashburnham Rd Bedford E81615 Fraser Simpson fraser.simpson@nhs.net Dr Murari Agrawal, Partner Dr Prabha Agrawal, Partner MK40 1DS Dr Vinita Manjure, Long Term Locum Cater Street Surgery 1 Cater Street Kempston E81023 Susan Hunter susan.hunter@nhs.net Dr Altaf Ali, Partner Dr Simon Marner, Senior Partner Bedford Dr Anthony Nicolaou, Partner MK42 8DR Clapham Road Surgery 46 Clapham Road Bedford E81062 Hayley Allen hallen2@nhs.net Dr P N Lathia, Partner Dr A K Patel, Salaried MK41 7PW Dr Andrew Gray, Partner Cranfield Surgery 137 High Street Cranfield E81043 Liz Turner elizabeth.turner@nhs.net Dr Regina Reddy, Partner Dr Marcus Thomas, Senior Partner Bedford Dr Anna Passmore, Salaried MK43 0HZ Dr Imran Ismail, Partner 77

78 Dr Caroline Eeles, Salaried Dr R J Phillips, Salaried Dr Dela Dillon Gbekor, Locum Dr Das & Partners 12 Goldington Rd Bedford Y00328 Pauline McGovern pmcgovern@nhs.net Dr Vidya Das, Partner Dr Ratan Das, Partner MK40 3NE Dr Edmund Rupasinghe, Locum De Pary's Avenue 23 De Pary's Ave Bedford E81037 Jon Atkinson jon.atkinson@nhs.net Dr Nigel Brookes, Partner Dr Penny Bartlett MK40 2TX Dr Simon Lowe, Partner Dr Christopher Jones, Partner Dr John Goulding, Partner Dr Morgan Walters, Partner Dr Sheelen Chotai, Salaried Dr Christine Hopper, Salaried Dr Griffiths 85 Goldington Ave Bedford E81047 Sue Adams sadams@nhs.net Dr Pete Tatman, Partner Dr Richard Gallivan, Partner MK40 3DB Dr Silke Vahar-Matiar, Partner Dr J Cross, Salaried Dr F Khatri, Registrar Dr Toovey & Partners 2 Goldington Rd Bedford E81011 Janice Potter janice.potter@nhs.net Dr Anthony Toovey, Partner Dr Angela Toovey, Salaried MK40 3NG Dr Dan Fenske, Partner Dr Mary Fenske, Partner Dr Janet Butlin, Partner Dr J Murphy, Partner Dr A Pacuka, Partner Dr Andrew Haverson, Salaried 78

79 Elstow Medical Centre (Branch Surgery) Medical Centre Abbeyfields Elstow E81019 Von Balodis Dr P K Kirubakaran Dr Jaison Mathew Dr N U R Choudhry London Road Health Centre (Main Surgery) Health Centre London Rd Bedford Dr Clive Binns, Partner Dr John Kedward, Partner Dr Sadaf Javed Great Barford Surgery 26 Silver Street Bedford E81031 Sandra Mabbott sandra.mabbott@nhs.net Dr Anoop Agrawal, Partner Dr C Ramanathan, Partner MK44 3HX Dr R Al Ghazzi, Salaried GP The Village Medical Centre Kingswood Way Great Denham Bedford Y00522 Deb Williams deb.williams@tvmcgtdenham.nhs.uk Dr Andrew Gray, Partner Dr Anu George, Salaried Dr Jason Reddy, Salaried MK40 4GH Dr Jenny Wilson Harrold Medical Practice Peach's Close Harrold E81007 Caroline Rigg caroline.rigg@gp-e81007.nhs.uk Dr Frances Ross, Partner Dr Gert Slaghuis, Partner Bedford Dr M Giles Limond, Partner MK43 7DX King Street Surgery 273 Bedford Rd Kempston E81038 Ann Lewis ann.lewis1@nhs.net Dr Peter Wilkinson, Partner Dr Roshan Jayalath, Salaried Bedford Dr Toni Munno, Partner MK42 8QD Dr Vijay Nayar, Partner Dr Abitalib Khanbhai, Partner Dr Annette Ochola, Partner Dr Jacquelyn Farhoud, Partner Dr Janani Dias, Salaried 79

80 Dr Jane Kocen, Salaried Dr G George, Salaried Lansdowne Road Surgery 6 Lansdowne Road Bedford E81020 Richard White rich.white@nhs.net Dr Alison Hayes, Partner Dr Richard Norris, Partner MK40 2BU Dr Ruben Cortes-Martin, Partner Dr Tom Inskip, Partner Dr Tom Thomas, Partner Dr Navita Srivastava, Partner Linden Road Surgery 13 Linden Road Bedford E81060 Maxine Skipper maxine.skipper@nhs.net Dr S Kanungo, Partner Dr V Patil, Partner MK40 2BA Pemberley Avenue Surgery The Surgery, 32 Pemberley Ave E81017 Janet Griffin janet.griffin@nhs.net Dr Paul Wright, Partner Dr Peter Parry Okeden, Partner Bedford Dr David Howard, Partner MK40 2LA Dr Joanna Rogers, Salaried Dr Julian Lane, Partner Dr Simon Rogers, Partner Dr Emily Wilkinson, Dr in Training Priory Medical Centre 48 The Glebe, Clapham E81049 Valerie Gibson valerie.gibson@nhs.net Dr Janet Tredget, Partner Dr Kirkbride-Jamu, Partner Bedford Dr Roy Jackson, Partner MK41 6GA Putnoe Medical Centre 93 Queens Drive Bedford E81029 Sam Paul (Acting PM) sam.paul@nhs.net Dr S Elangovan, Partner Dr Bharat Mehta, Partner MK41 9JE Dr Emmanuel Ochola, Partner Dr Harsha Vemuru, Salaried Dr Rajarshi Raha, Salaried Dr Andrew Potter 80

81 Queens Park Surgery (Branch Surgery) Riverfield Drive (Main Surgery) Rothsay Surgery Shakespeare Road Surgery Sharnbrook Surgery Shortstown Surgery Queens Park HC 23 Carlisle Road Bedford MK40 4HR 8 Honeysuckle Way, Riverfield Drive Bedford MK41 0TF 14 Rothsay Place Bedford MK40 3PX 17 Shakespeare Rd Bedford MK40 2DZ Templars Way, Sharnbrook Beds MK44 1PZ 2 Quantrelle Court Shortstown Bedford, MK42 0US St. John's Surgery 16 St. John's St Dr Ruth Collins, Salaried Dr Sabbiah Tamilarasi, Salaried Dr Syed Raza, Salaried Dr Imke Halberstadt, Salaried E81021 Jen Gough Dr M Fayeye, Partner jen.gough@nhs.net Dr Tariq Khokher, Partner Dr Sohail Shad, Partner Dr E Thompson, Salaried Dr A Gupta, Salaried Dr F Farrukh, Salaried E81611 Lorraine Pearson Dr John Hood, Senior Partner lpearson@nhs.net E81030 Alison Bampton Dr Anna Ungaro, Partner a.bampton@nhs.net Dr Anu George, Long term locum Dr Serajul Haque, Long term locum E81024 Leslie Walters Dr John Rochford leslie.walters@nhs.net Dr Jonathan Wali Dr Mark Hedges Dr Nicola Bailey Y00561 Sue Richardson Dr E Kruszewska, Partner sue.richardson@shortstown.net E81056 Gill Rees Dr Kevin Au, Partner 81

82 Kempston Dr R Amin, Partner Bedford Dr Stephen Jones, Partner MK42 8EP Victoria Road Medical Practice 10a Victoria Road Bedford E81626 Bubli Basra b.basra@nhs.net Dr S Basra Dr C Prasannan MK42 9JS Dr S Ponnala Wootton Vale Healthy LIving Centre Health Living Centre Fields Road Wootton, Y00560 Richard Short richie.short@woottonvale.com Dr Lindsay MacKenzie, Partner Bedford MK43 9JJ 82

83 Appendix 3 Inter Practice Agreement ] Bedfordshire Clinical Commissioning Group Inter-Practice Agreement 83

84 Introduction Purpose of the Agreement This is an Agreement between: each of the GP Practices listed in Appendix 1 (the Members ); and the Members and NHS Bedfordshire as host of Bedfordshire Clinical Commissioning Group (the CCG ). The CCG is a membership organisation. It cannot meet its objectives without the commitment and contributions of the GP practices which make up its membership. This Agreement describes how the Members, the CCG will work together to ensure that the CCG develops into an organisation that has the capability to commission safe, high quality and cost effective services that meet the needs of the patients in its area. The CCG has developed a constitution (the Constitution ) which sets out how the CCG will function. This Agreement explains how the Members, as individual GP practices, will contribute to the design, development and business of the CCG as it develops from a hosted organisation within Bedfordshire PCT to a statutory body accountable to the Secretary of State. That transition will require input from all the Members to some extent and this Agreement sets how the Members will support the CCG s application for statutory status during this interim period. Term of the Agreement The Members agree that this Agreement shall be legally binding on each of them for as long as they remain Members of the CCG and from [insert date of authorisation] or, if later, the date on which the CCG is authorised as a statutory body corporate. Membership Who may become a Member of the CCG? CCG Membership will be composed of GP practices rather than individual GPs. To become a member of the CCG, a GP practice must be located within the relevant area and hold a contract with NHS Bedfordshire for the provision of primary medical services. The Constitution contains more details around eligibility for membership of the CCG and the process for approval of Members by the Governing Body of the CCG. This Agreement sets out the remedial action the Governing Body may require the Member to take if that Member fails to fulfil its obligations under this Agreement. Engagement with Members The CCG s strategy for engaging with its Members is set out in the CCG s Member Engagement Strategy. The CCG CCG Structure The CCG currently operates as a committee of NHS Bedfordshire. The internal structure and practice and procedure of the CCG is set out in the Constitution. Each Member shall comply, and ensure that its Member Representative and any other person working on behalf of the Member, complies with any relevant provisions of the Constitution. Objectives/Vision The objectives of the CCG are described in the Constitution. Each Member agrees to co-operate in good faith with other Members, the CCG and NHS Bedfordshire to contribute to the furtherance of these objectives. Member Representation Member Representatives Each Member shall appoint an individual who is a GP or other Healthcare Professional as a Member Representative to represent the Member on the Members Forum. The Members shall also appoint an individual who is a GP or other 84

85 Healthcare Professional as a deputy Member Representative to act with the full authority of the Member where the Member Representative is unavailable. Members Forum The Member Representatives together shall be referred to as the Members Forum. Member Representatives] shall be entitled to attend and vote at meetings of the Members Forum. The practice and procedure of the Members Forum is set out in their Terms of Reference. Voting at Meetings of the Members Forum For the avoidance of doubt each Member Representative shall have one vote. Local Commissioning Groups Localities The CCG has formed 5 committees of the CCG known as Local Commissioning Groups for the following geographical areas: Ivel Valley Leighton Buzzard West Mid Beds Bedford and Chiltern Vale Locality Leads The Member Representatives for each Local Commissioning Group shall elect an individual who is a GP within one of the Member practices within that Locality to represent the Members in that Locality. Each Member Representative shall have one vote. The person elected in each Local Commissioning Group shall be known as the GP Locality Chair for that Locality. The practice and procedure of the Local Commissioning Groups is set out in their Terms of Reference. For the avoidance of doubt each GP Locality Chair shall be entitled to one vote at meetings of the Governing Body. The GP Locality Chairs shall also be members of the Governing Body in accordance with the Constitution. Support for Members Management Support and Budgets The details of the allocation of management/support budgets to the Members will be set out in the Locality Delivery Plans. Members shall be notified by the CCG of the support available, events and leadership development training available. The Members acknowledge the importance of ongoing training and development in building the success of the CCG and shall use all reasonable endeavours to ensure that relevant Member representatives attend or engage with the programme of support provided for the benefit of the Members. Duties and responsibilities of Members Member Responsibilities Each Member agrees to carry out the following duties and responsibilities: Duty to cooperate Each Member shall co-operate and ensure that its Member Representative and or GP Locality Chair cooperates with other Members, the CCG and any other clinical commissioning group with which the CCG is working/co-operating, the NHS Commissioning Board, NHS Bedfordshire, the Local Authorities and any other key partners, at all times in respect of its involvement with the CCG. 85

86 Duty to act in good faith Each Member agrees that it will act in good faith and ensure that anyone working on behalf of the Member acts in good faith and does not do anything in connection with its engagement with the CCG or otherwise which might have an adverse effect (of any kind) on the CCG or its Members. Any failure to comply with this duty may result in the referral by the CCG to the NHSCB Compliance with Standing Orders and Standing Financial Instructions As a committee of NHS Bedfordshire, the CCG must operate in accordance with the Standing Orders ( SOs ) and Standing Financial Instructions ( SFIs ) of NHS Bedfordshire. The duties delegated to the CCG by NHS Bedfordshire are described in the PCT s Scheme of Delegation and Reservation of Powers ( SD&R ). Each Member shall ensure that their Member Representatives and any other person working on behalf of the Member acts within the terms of NHS Bedfordshire SD&R and complies with the SOs and SFIs when undertaking commissioning duties which are delegated to the Member by the CCG. Attendance at Meetings The Members acknowledge that their engagement with the CCG will be central to ensuring the needs of patients and their families in Bedfordshire shape the services commissioned by the CCG and by the Members themselves. Attending meetings of the CCG, will be a key indicator of a Member s commitment to the CCG. In recognition of this, the Governing Body will monitor attendance by Members and/or their representatives at meetings of the Members Forum, the Localities and the Governing Body. Members shall ensure that Member Representatives and GP Locality Chairs attend, or arrange for a deputy to attend in their place, all meetings at which they are required of the Members Forum, Locality Commissioning Groups and the Governing Body. Where a Member representative fails to attend 3 meetings in any 6 month period the Governing Body may issue the Member in question with a remedial plan for ensuring that the Member s future engagement with the CCG is sufficient to meet the Conditions of Membership. QIPP Programme The QIPP programme is a national Department of Health strategy which aims to improve the quality and delivery of NHS care while reducing costs to make 20bn efficiency savings by 2014/15. The NHS Bedfordshire QIPP programme. The engagement of Members will be crucial to NHS Bedfordshire meeting the QIPP target identified in the QIPP programme. Members acknowledge and agree that they will support the delivery of the relevant QIPP projects as se out in the Locality Delivery Plan. Commissioning Plan The CCG has a statutory duty to prepare a Commissioning Plan each financial year setting out how the CCG will carry out its functions in the next financial year. Input from Members will be crucial to ensure that the Commissioning Plan reflects the needs of patients and their families within the CCG s area. Each Member agrees to co-operate with the Governing Body and provide such information as the Governing Body requires to complete the Commissioning Plan. Annual Report The CCG has a statutory duty to prepare an Annual Report reflecting on the discharge of its functions over the past year. Each Member agrees to co-operate with the Governing Body and provide such information as the Governing Body requires to complete the Annual Report. Commissioning and Delegated Budgets Each Member will receive an indicative commissioning budget (including prescribing). Performance will be monitored at the Locality Board. Action Plans will be requested in those areas requiring improvement in performance. Public/Patient Engagement The Members acknowledge that engagement with patients and the public will be central to shaping services in Bedfordshire. The CCG has developed a patient and public engagement plan and the Members agree to co- 86

87 operate with the CCG in the exercise of that plan and to carry out any Member responsibilities outlined in that plan. Performance and Appraisal Performance Management The Governing Body shall develop and adopt a policy in conjunction with Members, for appraising Members compliance with this Agreement and for resolving instances where Member s fail to do so. The policy shall include the following details of the practical steps for: engaging with the Member with a view to ensuring the obligations under this Agreement are met going forward; the financial and reporting requirements of membership; referral of a Member to the NHSCB where in the reasonable opinion of the Governing Body that Member s membership of the CCG is no longer tenable; an appeal by a Member against a referral to the NHSCB. General Conflicts of Interest Each Member shall comply, and ensure that its Member Representative and any other person working on behalf of the Member, complies with the provisions of the CCG s Conflicts of Interest policy. Dispute Resolution The Governing Body has developed a disputes procedure to deal with any disputes between the Members, the CCG, the Local Commissioning Groups and/or NHS Bedfordshire. The Members agree to act reasonably and in good faith in respect of any disagreement arising from their membership of the CCG and shall use all reasonable endeavours to promote the resolution of any dispute as swiftly as possible and to mitigate any impact on the resources of the Member, the CCG, NHS Bedfordshire and South Midlands and Hertfordshire Local Area Team.. Confidential Information Each Member shall at all times use all reasonable endeavours to keep confidential any confidential information relating to the CCG or its business. Each Member agrees to comply, and ensure that its Member Representatives and any other person working on behalf of the Member, complies with the provisions around confidential information set out in the Constitution. For the purposes of this section, the term Confidential Information shall be defined in accordance with the Constitution. Notices A notice given to a party under or in connection with this Agreement shall be in writing, in English and in the case of a Member or the Member Representative for that Member, the address set out from time to time in the CCG Register of Members. A notice given under this Agreement is not valid if sent by . No Partnership or Agency Nothing in this Agreement is intended to, or shall be deemed to, establish any partnership or joint venture between any of the parties, constitute any party the agent of another party, nor authorise any party to make or enter into any commitments for or on behalf of any other party. Counterparts This Agreement may be signed in any number of counterparts, each of which so executed will be an original, but together will constitute one and the same instrument. 87

88 Signatures Each party hereby confirms its agreement to the terms contained in this Agreement. Date:... Signature:... duly authorised for and on behalf of [Insert name of Practice Member] 9 Date: 31 August 2012 Signature: Felicity Cox, Chief Executive of NHS Bedfordshire and Luton duly authorised for and on behalf of NHS Bedfordshire and Luton Cluster Date: 31 August 2012 Signature: Dr Paul Hassan, Chief Clinical Officer of Bedfordshire Clinical Commissioning Group duly authorised for and on behalf of BCCG 10 9 Separate copies of the Agreement may be signed by each Member. 10 The Agreement should be executed in accordance with the PCT s SOs, SFIs and SD&R. 88

89 Appendix 1 [list of Member GP Practices, please see Appendix 2] 89

90 Appendix 4 Audit and Risk Committee Terms of Reference 1.Authority 1.1. The Audit and Risk Committee is constituted as a standing committee of the CCG s Governing Body. Its constitution and terms of reference shall be as set out below, subject to amendment at future Governing Body meetings. The Audit and Risk Committee shall not have executive powers in addition to those delegated in these terms of reference The Audit and Risk Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any member of staff or member of the CCG and all members of staff and members of the CCG are directed to co-operate with any request made by the Audit and Risk Committee The Audit and Risk Committee is authorised by the Governing Body to obtain outside legal or other independent professional advice. The committee is authorised by the Governing Body to request the attendance of individuals and authorities from outside the CCG with relevant experience and expertise if it considers this necessary or expedient to the carrying out of its functions The Audit and Risk Committee will have primary responsibility for monitoring and reviewing financial and other risks and associated controls, corporate governance and financial assurance These terms of reference and the composition of the Audit and Risk Committee will accord with any published national guidance. 2.Purpose 2.1. The Governing Body is responsible for ensuring effective internal control including: exercising its functions effectively, efficiently and economically complying with such generally accepted principles of good governance as are relevant to it managing the CCG s activities in accordance with statute, regulations and guidance establishing and maintaining a system of internal control to give reasonable assurance that assets are safeguarded, waste or inefficiency avoided and reliable financial information produced, and that value for money is continuously sought. 90

91 2.2. The Audit and Risk Committee shall provide the Governing Body with a means of independent and objective review of financial and corporate governance, assurance processes and risk management across the whole of the CCG s activities (clinical and non-clinical). In addition the Audit and Risk Committee shall: assist the CCG in discharging its functions under paragraph 2.1 above provide assurance of independence for external and internal audit ensure that appropriate standards are set and compliance with them is monitored, in non-financial, non-clinical areas that fall within the remit of the Audit and Risk Committee monitor corporate governance (e.g. Compliance with Constitution, Standing Orders, Prime Financial Policies, maintenance of Registers of Interests). 3.Membership 3.1. The committee shall be composed of not less than two lay members of the Governing Body, at least one of whom should have recent and relevant financial experience and not less than 2 Locality GP Chairs. The CCG chair is excluded from membership A quorum shall be two members at least one of whom must be a Lay Member The committee shall be chaired by a lay person member. 4.Attendance 4.1. The Accountable Officer and Chief Financial Officer shall generally attend routine meetings of the Audit and Risk Committee A representative of the external auditors may normally also be invited to attend meetings of the Audit and Risk Committee Members of the Governing Body and/or staff and executives shall be invited to attend those meetings in which the Audit and Risk Committee will consider areas of risk or operation that are their responsibility The CCG chair may be invited to attend meetings of the Audit and Risk Committee as required A representative of the local counter fraud service may be invited to attend meetings of the Audit and Risk Committee Member Representatives will be invited to attend meetings of the Audit and Risk Committee The Audit and Risk Committee will be provided with administrative support and advice by the Head of Corporate Services. The duties of the CCG secretary in this regard include but are not limited to: agreement of the agenda with the chair of the Audit and Risk Committee and attendees together with the collation of connected papers taking the minutes and keeping a record of matters arising and issues to be carried forward advising the Audit and Risk Committee as appropriate reviewing every decision to suspend the standing orders. 5.Frequency of Meetings 5.1. Meetings shall be held at least four times per year with additional meetings where necessary The external auditor shall be afforded the opportunity at least once per year to meet with the Audit and Risk Committee without the Accountable Officer; Chief Financial Officer present The Audit and Risk Committee members shall be afforded the opportunity to meet at least once per year with no others present. 91

92 6.Duties 6.1.Internal control and risk management To establish the strategic direction of the CG approach to risk management ensuring best practice and adherence to principles of effective risk management To ensure the provision and maintenance of an effective system of financial risk identification and associated controls, reporting and governance To maintain an oversight of the CCG s general risk management structures, processes and responsibilities, including the production and issue of any risk and control-related disclosure statements To review the adequacy of the policies and procedures in respect of all counter-fraud work To review the adequacy of the CCG s arrangements by which CCG staff may, in confidence, raise concerns about possible improprieties in matters of financial reporting and control and related matters or any other matters of concern To review the adequacy of underlying assurance processes that indicate the degree of achievement of corporate objectives and the effectiveness of the management of principal risks To receive and review risk registers from within the organisation and recommend any necessary actions To ensure the adequacy of policies and procedures for ensuring compliance with relevant regulatory, legal and conduct requirements. 6.2.Internal audit To review and approve the internal audit strategy and programme, ensuring that it is consistent with the needs of the organisation To oversee on an ongoing basis the effective operation of internal audit in respect of: adequate resourcing its co-ordination with external audit meeting mandatory nhs internal audit standards providing adequate independence assurances; having appropriate standing with the CCG meeting the internal audit needs of the CCG To consider the major findings of internal audit investigations; the Governing Body response and their implications and monitor progress on the implementation of recommendations To consider the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal To conduct an annual review of the internal audit function. 6.3.External audit To make a recommendation to the Governing Body in respect of the appointment, re-appointment and removal of an external auditor. To the extent that that recommendation is not adopted by the Governing Body, this shall be included in the annual report, along with the reasons that the recommendation was not adopted To discuss with the external auditor, before the audit commences, the nature and scope of the audit, and ensure co-ordination, as appropriate, with other external auditors in the local health economy. This should 92

93 include discussion regarding the local evaluation of audit risks and assessment of the CCG associated impact on the audit fee To assess the external auditor s work and fees on an annual basis and, based on this assessment, make a recommendation to the Governing Body with respect to the re-appointment or removal of the auditor. This assessment should include the review and monitoring of the external auditor s independence and objectivity and effectiveness of the audit process in light of relevant professional and regulatory standards To oversee the conduct of a market testing exercise for the appointment of an auditor at least once every (five) years and, based on the outcome, make a recommendation to the Governing Body with respect of the appointment of the auditor To review external audit reports, including the annual audit letter, together with the Governing Body response, and to monitor progress on the implementation of recommendations To develop and implement a policy on the engagement of the external auditor to supply non-audit services To consider the provision of the external audit service, the cost of the audit and any questions of resignation and dismissal. 6.4.Annual accounts review To review the annual statutory accounts, before they are presented to the Governing Body (who will in turn provide them to the Commissioning Board Authority in accordance with statutory requirements), to determine their completeness, objectivity, integrity and accuracy. This review will cover but is not limited to: the meaning and significance of the figures, notes and significant changes areas where judgment has been exercised adherence to accounting policies and practices adherence to the requirements and any directions given to the CCG by the Commissioning Board Authority explanation of estimates or provisions having material effect the schedule of losses and special payments any unadjusted statements any reservations and disagreements between the external auditors and the Governing Body which have not been satisfactorily resolved To review the annual report before it is submitted to the Governing Body and presented to Members of the CCG at the Annual General Meeting of the CCG, to determine completeness, objectivity, integrity and accuracy. The Governing Body will provide the annual report to the Commissioning Board Authority in accordance with statutory requirements To review all accounting and reporting systems for reporting to the Governing Body, including in respect of budgetary control. 6.5.Standing orders, Prime Financial Policies and standards of business conduct To review on behalf of the Governing Body the operation of, and proposed changes to, the standing orders and prime financial policies, the constitution, codes of conduct and standards of business conduct; including maintenance of registers To examine the circumstances of any significant departure from the requirements of any of the foregoing, whether those departures relate to a failing, an overruling or a suspension. 93

94 To review the scheme of delegation at least annually. 6.6.Other To review performance indicators relevant to the remit of the Audit and Risk Committee To examine any other matter referred to the Audit and Risk Committee by the Governing Body and to initiate investigation as determined by the Audit and Risk Committee To annually review the accounting policies of the CCG and make appropriate recommendations to the Governing Body To develop and use an effective assurance framework to guide the Audit and Risk Committee s work. This will include utilising and reviewing the work of the internal audit, external audit and other assurance functions as well as reports and assurances sought from members of the Governing Body and other investigatory outcomes so as fulfil its functions in connection with these terms of reference To consider the outcomes of significant reviews carried out by other bodies which include but are not limited to regulators and inspectors within the health (and social care) sector and professional bodies with responsibilities that relate to staff performance and functions To review the work of all the other committees of the CCG in connection with the Audit and Risk Committee s assurance function. 7.Reporting 7.1. The minutes of all meetings of the Audit and Risk Committee shall be formally recorded and submitted, together with recommendations where appropriate, to the Governing Body. The submission to the Governing Body shall include details of any matters in respect of which actions or improvements are needed. This will include details of any evidence of potentially ultra vires, otherwise unlawful or improper transactions, acts, omissions or practices or any other important matters. To the extent that such matters arise, the chair of the Audit and Risk Committee shall present details to a meeting of the Governing Body in addition to submission of the minutes The Audit and Risk Committee will report annually to the Governing Body in respect of the fulfilment of its functions in connection with these terms of reference. Such report shall include but not be limited to functions undertaken in connection with the effectiveness of risk management within the CCG; the integration of and adherence to governance arrangements and any pertinent matters in respect of which the Audit and Risk Committee has been engaged The CCG s annual report shall include a section describing the work of the Audit and Risk Committee in discharging its responsibilities. 8. Review 8.1. The terms of reference of the Audit and Risk Committee shall be reviewed by the Governing Body at least annually. 9.Required Frequency of Attendance by Members 9.1. Members of the Audit and Risk Committee must attend at least [set number] of all meetings each financial year but should aim to attend all scheduled meetings. 94

95 95

96 Appendix 5 Remuneration Committee Terms of Reference Authority The remuneration [and appointments] committee is constituted as a standing committee of the CCG s Governing Body. Its constitution and terms of reference shall be as set out below, subject to amendment at future Governing Body meetings. The remuneration [and appointments] committee shall not have executive powers in addition to those delegated in these terms of reference. The remuneration [and appointments] committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any member of staff or member of the CCG and all members of staff and members of the CCG are directed to co-operate with any request made by the remuneration [and appointments] committee. The remuneration [and appointments] committee is authorised by the Governing Body to obtain outside legal or other independent professional advice. The committee is authorised by the Governing Body to request the attendance of individuals and authorities from outside the CCG with relevant experience and expertise if it considers this necessary or expedient to the carrying out of its functions. These terms of reference and the composition of the remuneration [and appointments] committee will accord with any published national guidance. Remuneration Role To make recommendations to the Governing Body in relation to the remuneration, fees and allowances payable to the employees of the CCG employees or other persons providing services to it, including: salary, including any performance-related pay or bonus To monitor the performance of the CCG senior officers and approve any changes in salary (including performance related pay or bonus), benefits or allowances, To monitor, review and approve the senior officers proposals on overall senior management changes to salary (including performance related pay or bonus), benefits or allowances monitor, review and approve senior officer and senior management proposals on overall staff changes to salary (including performance related pay or bonus), benefits or allowances, provisions for other benefits, including pensions and cars 96

97 allowances. To monitor and evaluate the performance of the CCG s employees or other persons providing services to it. To adhere to all relevant laws, regulations and company policy in all respects, including (but not limited to) determining levels of remuneration that are sufficient to attract, retain and motivate employees of the CCG whilst remaining cost effective. To advise upon and oversee contractual arrangements for employees of the CCG, including but not limited to termination payments. [Nominations Role The remuneration [and appointments] committee(s) will: periodically review the balance of skills, knowledge, experience and diversity of the Governing Body and made recommendations to the Governing Body with regard to the outcome of the review give consideration to succession planning for the Governing Body in the course of its work, taking into account the challenges and opportunities facing the CCG and the skills and expertise needed on the Governing Body in the future keep the leadership needs of the CCG under review to ensure the continued ability of the CCG to operate effectively in the health economy keep up to date and fully informed about strategic issues and commercial changes affecting the CCG and the environment in which it operates Membership The membership of the committee shall consist of the chair and two lay members. The committee will normally be chaired by the CCG chair. Where the chair has a conflict of interest, for example when the committee is considering the chair s re-appointment the committee will be chaired by one of the lay members of the CCG. A quorum shall be three members. Attendance Meetings of the committee may be attended by the Accountable Officer and Chief Operating Officer; the CCG secretary; and any other person who has been invited to attend a meeting by the committee so as to assist in deliberations. Frequency of Meetings Meetings shall be held at least quarterly. Minutes and Reporting The minutes of all meetings of the committee shall be formally recorded. The nomination committee will report to the Governing Body after each meeting. The nominations committee shall ensure that Governing Body emoluments are accurately reported in the required format in the CCG s annual report. Review The terms of reference of the committee shall be reviewed by the Governing Body at least annually. 97

98 Appendix 6 Quality and Patient Safety Committee Terms of Reference Title Accountable to How is accountability demonstrated? Patient Safety & Quality Committee Bedfordshire CCG Board Reports from the Patient Safety & Quality Committee will be presented at the Board meetings. Purpose The Patient Safety and Quality Committee will provide assurance that appropriate processes are in place to demonstrate delivery of the organisation s priorities and objectives in the context of all national quality and safety standards. Terms of Reference The Committee will ensure that there is an objective and systematic approach to the identification and assessment of quality and safety. Specifically it will: 1. Ensure that the interests and safety of patients are paramount through the systematic monitoring of clinical governance and patient safety related activities. 2. Ensure that all national requirements and best practice are included in the PCT commissioning and implementation processes through a robust and comprehensive governance framework and ensuring that quality is built into contracts with providers by commissioners. 3. Ensure that the commissioned providers are meeting their statutory responsibilities in respect of compliance with the requirements, including registration, of regulatory organisations i.e. The Care Quality Commission and other external bodies e.g. NHS Litigation Authority, Audit Commission. 4. Implement and monitor the process for the sign off of provider quality accounts before they are presented to the Board for formal approval. 5. Monitor providers for whom Bedfordshire CCG are the lead commissioner including KPI s, contracts and patient experience. 6. Monitor the quality of services that are delivered by primary care providers (GP s, dentists, pharmacists and optometrists) and ensure that corrective action is taken as required by the NHSCB where appropriate. This will not relate to performance management of 98

99 contractual matters which will be an NHSCB matter. 7. Monitor compliance with the Care Quality Commission assessment Framework, including baseline assessment reports and development of action plans which detail corrective actions where required, for reporting to the Board and Care Quality Commission. 8. Receive reports of serious clinical and non-clinical incidents and monitor follow up action. Ensure the learning from SIs and trends in incidents are disseminated and practice, including policies and procedures, are revised in light of recommendations. 9. Receive reports on significant failings or weaknesses in internal control; arrange for an investigation to be carried out into the cause; and ensure that corrective action is taken. 10. Receive Safeguarding Adults and Children reports. 11. Receive reports from NHS Bedfordshire s Individual Funding Panel and NHS Luton s Individual Treatment Panel on a 6 monthly basis. 12. Monitor implementation of the Equality Delivery System to ensure that target dates are achieved. 13. Carry out other duties at the request of the PCT Boards that are relevant to this area of the Trust s statutory duties. Chair of the Group Membership: Secretary Lay Member Lay Member Accountable Officer Chief Operating Officer Director of Public Health Director Director of Strategy Director of Quality & Safety Locality GP Chair x 2/3 Clinical Directors Patient Safety Facilitator Quorum Delegated limits Decision making Papers Minutes of meetings A minimum of 4 members, one of whom shall be a Lay member, one a executive director and one a GP Chair plus the Chair No budgetary powers are vested in the Committee. Consensus of members present, otherwise recorded in minutes. Majority decision with Chair having casting vote. Under exceptional circumstances, Chair s action is taken to progress urgent matters. Such matters to be reported electronically, verbally or by urgent meeting at earliest opportunity in order that decision is formally ratified. Papers will be circulated to Committee members five working days before the meeting other than in exceptional circumstances as agreed by the Chair. The minutes will record the decisions and key actions agreed during the meeting. The minutes of the previous meeting will be reviewed at the commencement of each meeting. Confidentiality Meetings are held in private. Information which requires commercial confidentiality will be exempt from the Freedom of Information Act. All other information is available on request. Frequency of meetings Bi-Monthly. Governance arrangements Unless otherwise agreed, the committee/group will be governed by the 99

100 standing orders and standing financial instructions of Bedfordshire CCG Amendments to the Terms of Reference Amendments to these terms of reference shall only be made with the authority of the Bedfordshire CCG Board and in line with its constitution 100

101 Appendix 7 Conflict of Interests Policy Bedfordshire CCG Conflict of Interests and Dispute Resolution policy 101

102 1. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST 1.2 Standards of Business Conduct Employees, members, committee and sub-committee members of the Bedfordshire CCG and members of the Governing Body (and its committees) will at all times comply with this constitution and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the Bedfordshire CCG and should follow the Seven Principles of Public Life, set out by the Nolan Principles. The Nolan Principles are incorporated in the constitution. They must comply with the Bedfordshire CCG s policy on business conduct, including the requirements set out in this policy for managing conflicts of interest. Individuals contracted to work on behalf of the Bedfordshire CCG or otherwise providing services or facilities to the Bedfordshire CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services. 1.3 Conflicts of Interest As required by section 14O of the 2006 Act, as inserted by section 25 of the 2012 Act, Bedfordshire CCG will make arrangements to manage conflicts and potential conflicts of interest that decisions made by the Bedfordshire CCG will be taken and seen to be taken without any possibility of the influence of external or private interest A conflict of interest will include: a direct pecuniary interest: where an individual may financially benefit from the consequences of a commissioning decision (for example, as a provider of services); an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision; a non-pecuniary interest: where an individual holds a nonremunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract); a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services 102

103 which might result in the closure of a busy clinic next door to an individual s house); where an individual is closely related to (incl spouse, son/daughter), or in a relationship, including friendship, with an individual in the above categories Where an individual, i.e. an employee, Bedfordshire CCG member, member of the Governing Body, or a member of a committee or a subcommittee of the Bedfordshire CCG or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests with the Bedfordshire CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this policy and the constitution If in doubt, the individual concerned should assume that a potential conflict of interests exists. 1.4 Declaring and Registering Interests The Bedfordshire CCG will maintain one or more registers of the interests of: the members of the Bedfordshire CCG; the members of its Governing Body; the members of its committees or sub-committees and the committees or sub-committees of its Governing Body; and its employees. Individuals will declare any interest that they have, in relation to a decision to be made by Bedfordshire CCG, in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware Where an individual is unable to provide a declaration in writing, for example, if a conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter to the Governing Body The Governing Body will ensure that the register(s) of interest is reviewed regularly, and updated as necessary. The lay member of the Governing Body, with particular responsibility for governance, will make themselves available to provide advice to any individual who believes they have, or may have, a conflict of interest The Governing Body will take such steps as it deems appropriate, and request information it deems appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared. 103

104 1.5 Managing Conflicts of Interest: general Where an interest has been declared, either in writing or by oral declaration, the declarer will ensure that before participating in any activity connected with the Bedfordshire CCG s commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Governing Body The Governing Body will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the Bedfordshire CCG s decision making processes Arrangements for the management of conflicts of interest are to be determined by the Governing Body and will include the requirement to put in writing to the relevant individual arrangements for managing the conflict of interests or potential conflicts of interests, within a week of declaration The arrangements will confirm the following: at what point an individual should withdraw from specified activity, on a temporary or permanent basis; monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual In any meeting where an individual is aware of an interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the chair, together with details of arrangements which have been confirmed by the Governing Body for the management of the conflict of interests or potential conflict of interests. Where no arrangements have been confirmed, the chair may require the individual to withdraw from the meeting or part of it Where the chair of any meeting of the Bedfordshire CCG, including committees, sub-committees, or the Governing Body, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting Where arrangements have been confirmed with the Governing Body for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one. 104

105 1.5.9 Any declarations of interests, and arrangements agreed in any meeting of the Bedfordshire CCG, committees, sub-committees, or the Governing Body, will be recorded in the minutes In any transaction undertaken in support of the Bedfordshire CCG s commissioning functions (including conversations between two or more individuals, s, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Governing Body, of the transaction. 1.6 Managing Conflicts of Interest: Governing Body Individual members of the Governing Body will comply with the arrangements determined by the Governing Body for managing conflicts or potential conflicts of interest Where a Governing Body member is aware of an interest which has not been declared, either in the register or orally to the Governing Body, they will declare this at the start of the meeting. The Governing Body will then determine how this should be managed and inform the member of their decision. The member will then comply with these arrangements, which must be recorded in the minutes of the meeting Where more than 50% of the members of the Governing Body are required to withdraw from a meeting or part of it, owing to the arrangements agreed by the Governing Body for the management of conflicts of interests or potential conflicts of interests, the remaining chair will determine whether or not the discussion can proceed In making this decision the chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the Bedfordshire CCG s standing orders/constitution. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened Where a quorum cannot be convened from the membership of the Governing Body, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair may invite on a temporary basis one or more of the following to make up the quorum so that the Bedfordshire CCG can progress the item of business: a member of the Bedfordshire CCG; an individual appointed by a member to act on its behalf in the dealings between it and the Bedfordshire CCG; 105

106 a member of a relevant Health and Wellbeing Board; a member of a Governing Body of another clinical commissioning group These arrangements must be recorded in the minutes. 1.7 Managing Conflicts of Interest: contractors Anyone seeking information in relation to a procurement, or participating in a procurement, or otherwise engaging with the Bedfordshire CCG in relation to the potential provision of services or facilities to the Bedfordshire CCG, will be required to make a declaration of interest Anyone contracted to provide services or facilities directly to the Bedfordshire CCG will be subject to the same provisions of this constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services. 1.8 Transparency in Procuring Services The Bedfordshire CCG recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The Bedfordshire CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers The Bedfordshire CCG will publish a Procurement Strategy approved by its Governing Body which will ensure that: all relevant clinicians (not just members of the Bedfordshire CCG) and potential providers, together with local members of the public, are engaged in the decision-making processes used to procure services; service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way 2. Dispute Resolution 2.2 Where disputes arise we would hope that in most cases these could be resolved informally, without recourse to a formal process which would include, for example, referring the matter to the LMC. If however the dispute cannot be resolved informally, this document sets out the process by which the perceived breach will be handled. 2.3 The design of the procedure is based on the principle that disputes should be resolved at the most local level possible The first port of call is the Bedfordshire CCG If the provider is unhappy with the Bedfordshire CCG response it should be escalated to the National Commissioning Board. 106

107 2.4 Objectives of the procedure The objectives of the procedure are as follows: To provide the Bedfordshire CCG with an appropriate mechanism for dealing with reasonable disputes To resolve disputes transparently, fairly and consistently. To assure providers that the process is fair and transparent. To mitigate risks and protect the reputation of the Bedfordshire CCG To prevent where possible legal challenge/ expensive external referral processes When handling disputes, Bedfordshire CCG will: Commit to transparency Communicate the process and decision making criteria widely and in advance Engage all relevant stakeholders Enforce declarations of interest Publish findings within and across the Bedfordshire CCG to enable consistency Be objective and base the analysis and the decision on objective information and criteria Maintain an audit trail 2.5 The Procedure The Bedfordshire CCG dispute resolution procedure is made up of the following stages: Stage 1: Making the Complaint Any complaint must be submitted to the Chair of the Bedfordshire CCG in writing. The complaint will be acknowledged within five working days. Stage 2: Triage Following the receipt of the complaint, the Bedfordshire CCG may get in contact with the complainant at this stage and request clarification or further information. If the complaint is not deemed to warrant proceeding further the complainant is notified that the complaint will not progress. 107

108 If the complaint should be fast tracked to another organisation, the claimant is informed of the course of action. Where the complaint is in scope and not subject to fast tracking, it will proceed to the next stage. In most cases we would envisage that the triage process will be carried out within five working days. Stage 3: Chair review Following the triage, the Bedfordshire CCG Chair will review the complaint to determine whether a swift resolution can be achieved without the need to involve the Governing Body. The Chair may call a meeting of the parties concerned to discuss the matter informally and without prejudice. Stage 4: The Governing Body If the complaint cannot be resolved by the Chair, the Governing Body will then formally review the complaint and may refer this to the Audit and Risk Committee to advise. In most cases this review will be based on a consideration of documentary evidence, although the Bedfordshire CCG may invite representations in person if they deem this to be necessary. Stage 5: The decision Once the Governing Body has made the decision, it will write to the complainant notifying them of the decision, explaining the rationale and necessary the course of action. It will also notify the National Commissioning Board of the dispute and the outcome. If the complainant does not believe that the case has been satisfactorily resolved it can appeal. The Governing Body may convene a separate forum to advise on the appeal. In most cases, this stage of the process is expected to take no longer than 20 days. While the timescales set out for each stage above are illustrative, the process as a whole will take no longer than three months. 2.6 Right of Appeal The expectation is that most complaints will be successfully resolved. However, if the complainant is unsatisfied by the results of this procedure, they can refer the complaint to the NHS CCB process. Appeals to the NHS CCB must be made within 3 months of the complainant being informed of the Bedfordshire CCG s decision. 108

109 Appendix 8 Standing Orders 1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction These standing orders have been drawn up to regulate the proceedings of the Bedfordshire Clinical Commissioning Group ( CCG ) so that the CCG can fulfil its obligations, as set out largely in the NHS Act 2006, as amended by the Health and Social Care Act 2012 (the Act ) and related regulations. They are effective from the date the CCG is established The standing orders, together with the CCG s scheme of reservation and delegation and the CCG s prime financial policies, provide a procedural framework within which the CCG discharges its business. They set out: a) the arrangements for conducting the business of the CCG; b) the appointment of member practice representatives; c) the procedure to be followed at meetings of the CCG, the Governing Body and any committees or sub-committees of the CCG or the Governing Body; d) the process to delegate powers, e) the declaration of interests and standards of conduct. These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate of any relevant guidance The standing orders, scheme of reservation and delegation and prime financial policies have effect as if incorporated into the CCG s constitution (the Constitution ). CCG members, employees, members of the Governing Body, members of the Governing Body committees and sub-committees, members of the CCG s committees and sub-committees and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the 109

110 standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal Schedule of matters reserved to the clinical commissioning CCG and the scheme of reservation and delegation The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to delegate the CCG s functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The CCG has decided that certain decisions may only be exercised by the CCG in formal session. These decisions and also those delegated are contained in the CCG s scheme of reservation and delegation of the Constitution) The practise and procedure of each of the bodies and committees to which the CCG has delegated matters, including but not limited to the Board of Director s committees such as the audit and remuneration committees are set out in the relevant body s or committee s terms of reference. The CCG s committee and the associated governance documents and published on the CCG s website at 2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS 2.1. Composition of membership The CCG is a membership body composed of local GP practice members (the Members ) Part 3 of the CCG s Constitution provides details of the membership of the CCG The CCG is required by its Constitution to maintain a register of its Members. The Register of Members is set out at Appendix 2 of the CCG s Constitution The Constitution sets out the eligibility requirements for membership of the CCG at Schedule The duties and responsibilities of the Members will be set out in the Members Forum terms of reference The Inter-Practice Agreement appended to the Constitution at Appendix 3 sets out the relationship amongst the Individual Members, Practices and the NHS Commissioning Board within the CCG Key roles Paragraph of the CCG s Constitution sets out the composition of the CCG s Governing Body and Parts 3 and Schedule 7 of the CCG s Constitution identifies certain key roles and responsibilities within the CCG and its Governing Body. These standing orders set out how the CCG appoints individuals to these key roles. 110

111 The Governing Body will determine the appointment process for each member of the Governing Body The roles and responsibilities of each of these key roles are set out either in paragraph or Schedule 7 of the CCG s Constitution. 3. MEETINGS OF THE CLINICAL COMMISSIONING GROUP 3.1. Calling meetings Ordinary meetings of the CCG shall be held at regular intervals at such times and places as the CCG may determine The Chair of the CCG may call a meeting of the CCG at any time Fifty per cent of the members of the Governing Body may requisition a meeting in writing. If the Chair refuses, or fails, to call a meeting within seven days of a requisition being presented, the members signing the requisition may forthwith call a meeting Agenda, supporting papers and business to be transacted Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair at least 14 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least nine working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least seven working days before the date the meeting will take place Agendas and certain papers for the CCG s Governing Body including details about meeting dates, times and venues - will be published on the CCG s website at Petitions Where a petition has been received by the CCG, the chair of the Governing Body shall include the petition as an item for the agenda of the next meeting of the Governing Body Chair of a meeting At any meeting of the CCG or its Governing Body or of a committee or subcommittee, the chair of the CCG, Governing Body, committee or subcommittee, if any and if present, shall preside. If the chair is absent from the meeting, the deputy chair, if any and if present, shall preside If the chair is absent temporarily on the grounds of a declared conflict of interest the deputy chair, if present, shall preside. If both the chair and deputy chair are absent, or are disqualified from participating, or there is neither a chair or deputy a member of the CCG, Governing Body, committee or sub-committee 111

112 respectively shall be chosen by the members present, or by a majority of them, and shall preside Chair's ruling The decision of the chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final Quorum The quorum will be 50% of the members including the Chair or Vice Chair of which three will be clinicians and at least one lay member. No business shall be transacted at a meeting unless the following are present: a) the chief financial officer or the accountable officer; and b) the chair or vice chair For all other of the CCG s committees and sub-committees, including the Governing Body committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference If Governing Body members have sent representation, they will count towards the quorum if they have formal acting up status. They will not count towards the quorum if they have no formal acting up status Decision making Part 4 of the CCG s Constitution, together with the scheme of reservation and delegation, sets out the CCG s structure and the arrangements made by the CCG for the exercise of the CCG s statutory functions. Generally it is expected that at meetings of the CCG, decisions will be reached by consensus and a unanimous decision will be reached. Should this not be possible then a vote of members will be required, the process for which is set out below: a) Eligibility all Members can vote. Any member with a voting right is entitled to nominate a proxy to vote on their behalf if they cannot attend a meeting. In such circumstances, the member should notify the chair one week prior to the meeting and shall be required to complete a proxy form for their named depute to have their vote; b) Majority necessary to confirm a decision - simple majority; c) Casting vote in the case of an equality of votes the person chairing the meeting shall have a casting vote; 112

113 d) Dissenting views - members taking a dissenting view but losing a vote can have their dissent recorded in the minutes; Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting For all other of the CCG s committees and sub-committees, including the Governing Body committees and sub-committees, the details of the process for holding a vote are set out in the appropriate terms of reference Emergency powers and urgent decisions The powers which the CCG has reserved to itself within these Standing Orders may in emergency or for an urgent decision be exercised by the Chair and the Accountable Officer after having consulted at least one lay person and one GP member. The exercise of such powers by the Chair and Accountable Officer shall be reported to the next formal meeting of the CCG in public session for formal ratification Suspension of Standing Orders Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or the NHS Commissioning Board, any part of these standing orders may be suspended at any meeting of the Governing Body, provided 75% of the CCG members are in agreement A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Governing Body Audit and Risk Committee for review of the reasonableness of the decision to suspend standing orders Record of Attendance The names of all members of the meeting present at the meeting shall be recorded in the minutes of the CCG s meetings. The names of all members of the Governing Body present shall be recorded in the minutes of the Governing Body meetings. The names of all members of the Governing Body committees / sub-committees present shall be recorded in the minutes of the respective Governing Body committee / sub-committee meetings Minutes The minutes of the proceedings of a meeting shall be drawn up and submitted for agreement at the next ensuing meeting where they shall be signed by the person presiding at it No discussion shall take place upon the minutes except upon their accuracy or where the Chair considers discussion appropriate. 113

114 Minutes shall be circulated in accordance with members wishes. Where providing a record of a public meeting the minutes shall be made available to the public as required by Code of Practice on Openness in the NHS Admission of public and the press The public and representatives of the press may attend all meetings of the CCG Governing Body, but shall be required to withdraw upon the Governing Body making the following resolution that: representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest, Section 1(2), Public Bodies (Admission to Meetings) Act APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES 4.1. Appointment of committees and sub-committees The CCG may appoint committees and sub-committees of the CCG, subject to any regulations made by the Secretary of State, and make provision for the appointment of committees and sub-committees of its Governing Body. Where such committees and sub-committees of the CCG, or committees and subcommittees of its Governing Body, are appointed they are included in Chapter 6 of the CCG s Constitution Other than where there are statutory requirements, such as in relation to the Governing Body Audit and Risk Committee or remuneration committee, the CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG The provisions of these standing orders shall apply where relevant to the operation of the Governing Body, the Governing Body committees and subcommittee and all committees and sub-committees unless stated otherwise in the committee or sub-committee s terms of reference Terms of Reference Terms of reference shall have effect as if incorporated into the Constitution and shall be added to this document as an appendix Delegation of Powers by Committees to Sub-committees Where committees are authorised to establish sub-committees they may not delegate executive powers to the sub-committee unless expressly authorised by the CCG Approval of Appointments to Committees and Sub-Committees The CCG shall approve the appointments to each of the committees and subcommittees which it has formally constituted including those the Governing 114

115 Body. The CCG shall agree such travelling or other allowances as it considers appropriate. 5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES 5.1. If for any reason these standing orders are not complied with, full details of the noncompliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the CCG and staff have a duty to disclose any noncompliance with these standing orders to the accountable officer as soon as possible. 6. USE OF SEAL AND AUTHORISATION OF DOCUMENTS 6.1. CCG s seal The CCG may have a seal for executing documents where necessary. The following individuals or officers are authorised to authenticate its use by their signature: a) the accountable officer; b) the chair of the Governing Body; c) the chief finance officer; d) the Chief Operating Officer Execution of a document by signature The following individuals are authorised to execute a document on behalf of the CCG by their signature. a) the accountable officer b) the chair of the Governing Body c) the chief finance officer d) the Chief Operating Officer. 7. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS 7.1. Policy statements: general principles The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by the CCG. The decisions to approve such policies and procedures will be recorded in an appropriate CCG minute and will be deemed where appropriate to be an integral part of the CCG s standing orders. 115

116 Appendix 9 Prime Financial Policies 1. INTRODUCTION 1.1. General These prime financial policies and supporting detailed financial policies shall have effect as if incorporated into the CCG s Constitution The prime financial policies are part of the CCG s control environment for managing the organisation s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and chief finance officer to effectively perform their responsibilities. They should be used in conjunction with the scheme of reservation and delegation In support of these prime financial policies, the CCG has prepared more detailed policies, approved by the Chief Finance Officer, known as detailed financial policies. The CCG refers to these prime and detailed financial policies together as the CCG s financial policies These prime financial policies identify the financial responsibilities which apply to everyone working for the CCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The Chief Finance Officer is responsible for approving all detailed financial policies A list of the CCG s financial and other policies will be published and maintained on the CCG s website at The CCG will also maintain a publication scheme in order for information to be accessed Should any difficulties arise regarding the interpretation or application of any of the prime financial policies then the advice of the Chief Finance Officer must be sought before acting. The user of these prime financial policies should also

117 be familiar with and comply with the provisions of the CCG s Constitution, standing orders and scheme of reservation and delegation Failure to comply with prime financial policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal Overriding Prime Financial Policies If for any reason these prime financial policies are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Governing Body Audit and Risk Committee for referring action or ratification. All of the CCG s members and employees have a duty to disclose any non-compliance with these prime financial policies to the chief finance officer as soon as possible Responsibilities and delegation The roles and responsibilities of CCG s members, employees, members of the Governing Body, members of the Governing Body committees and sub-committees, members of the CCG s committee and sub-committee (if any) and persons working on behalf of the CCG are set out in Parts 3, 4 and 5 of this Constitution The financial decisions delegated by members of the CCG are set out in the CCG s scheme of reservation and delegation Contractors and their employees Any contractor or employee of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Accountable Officer to ensure that such persons are made aware of this.

118 1.5. Amendment of Prime Financial Policies To ensure that these prime financial policies remain up-to-date and relevant, the Chief Finance Officer will review them at least annually. Following consultation with the Accountable Officer and scrutiny by the Governing Body Audit and Risk Committee, the Chief Finance Officer will recommend amendments, as fitting, to the Governing Body for approval. As these prime financial policies are an integral part of the CCG s Constitution, any amendment will not come into force until the CCG applies to the NHS Commissioning Board and that application is granted. 2. INTERNAL CONTROL POLICY the CCG will put in place a suitable control environment and effective internal controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity and compliance with laws and policies 2.1. The Governing Body is required to establish an Audit and Risk Committee with terms of reference agreed by the Governing Body The Accountable Officer has overall responsibility for the CCG s systems of internal control The Chief Finance Officer will ensure that: i) financial policies are considered for review and updated annually; ii) a system is in place for proper checking and reporting of all breaches of financial policies; and iii) a proper procedure is in place for regular checking of the adequacy and effectiveness of the control environment. 3. AUDIT POLICY the CCG will keep an effective and independent internal audit function and fully comply with the requirements of external audit and other statutory reviews 3.1. In line with the terms of reference for the Governing Body Audit and Risk Committee, the person appointed by the CCG to be responsible for internal audit and the Audit Commission appointed external auditor will have direct and unrestricted access to Audit and Risk Committee members and the chair of the Governing Body, Accountable Officer and chief finance officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

119 3.2. The person appointed by the CCG to be responsible for internal audit and the external auditor will have access to the Audit and Risk Committee and the Accountable Officer to review audit issues as appropriate. All Audit and Risk Committee members, the chair of the Governing Body and the Accountable Officer will have direct and unrestricted access to the head of internal audit and external auditors The Chief Finance Officer will ensure that: i) the CCG has a professional and technically competent internal audit function; and ii) the Governing Body Audit and Risk Committee approves any changes to the provision or delivery of assurance services to the CCG. 4. FRAUD AND CORRUPTION POLICY the CCG requires all staff to always act honestly and with integrity to safeguard the public resources they are responsible for. The CCG will not tolerate any fraud perpetrated against it and will actively chase any loss suffered 4.1. The Governing Body Audit and Risk Committee will satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme The Governing Body Audit and Risk Committee will ensure that the CCG has arrangements in place to work effectively with NHS Protect. 5. EXPENDITURE CONTROL 5.1. The CCG is required by statutory provisions to ensure that its expenditure does not exceed the aggregate of allotments from the NHS Commissioning Board and any other sums it has received and is legally allowed to spend The Accountable Officer has overall executive responsibility for ensuring that the CCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money The Chief Finance Officer will:

120 provide reports in the form required by the NHS Commissioning Board; ensure money drawn from the NHS Commissioning Board is required for approved expenditure only is drawn down only at the time of need and follows best practice; be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the CCG to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of the NHS Commissioning Board. 6. ALLOTMENTS 6.1. The CCG s Chief Finance Officer will: periodically review the basis and assumptions used by the NHS Commissioning Board for distributing allotments and ensure that these are reasonable and realistic and secure the CCG s entitlement to funds; prior to the start of each financial year submit to the Governing Body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and regularly update the Governing Body on significant changes to the initial allocation and the uses of such funds. 7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING POLICY the CCG will produce and publish an annual commissioning plan that explains how it proposes to discharge its financial duties. The CCG will support this with comprehensive medium term financial plans and annual budgets The Accountable Officer will compile and submit to the Governing Body a commissioning strategy which takes into account financial targets and forecast limits of available resources Prior to the start of the financial year the chief finance officer will, on behalf of the Accountable Officer, prepare and submit budgets for approval by the Governing Body The Chief Financial Officer shall monitor financial performance against budget and plan, periodically review them, and report to the Governing Body. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets.

121 7.4. The Accountable Officer is responsible for ensuring that information relating to the CCG s accounts or to its income or expenditure, or its use of resources is provided to the NHS Commissioning Board as requested The Accountable Officer will approve consultation arrangements for the CCG s commissioning plan. 8. ANNUAL ACCOUNTS AND REPORTS POLICY the CCG will produce and submit to the NHS Commissioning Board accounts and reports in accordance with all statutory obligations, relevant accounting standards and accounting best practice in the form and content and at the time required by the NHS Commissioning Board The Chief Finance Officer will ensure the CCG: prepares a timetable for producing the annual report and accounts and agrees it with external auditors; prepares the accounts according to the timetable approved by the Governing Body; complies with statutory requirements and relevant directions for the publication of annual report; considers the external auditor s management letter and fully address all issues within agreed timescales; and publishes the external auditor s management letter on the CCG s website at 9. INFORMATION TECHNOLOGY POLICY the CCG will ensure the accuracy and security of the CCG s computerised financial data The Chief Finance Officer is responsible for the accuracy and security of the CCG s computerised financial data and shall devise and implement any necessary procedures to ensure adequate (reasonable) protection of the CCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

122 ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system; ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment; ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the chief finance officer may consider necessary are being carried out; ensure compliance with the National Framework for Information Governance as set out by the NHS Commissioning Board In addition the Chief Finance Officer shall ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation. 10. ACCOUNTING SYSTEMS POLICY the CCG will run an accounting system that creates management and financial accounts The Chief Finance Officer will ensure: the CCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of the NHS Commissioning Board; that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes Where another health organisation or any other agency provides a computer service for financial applications, the Chief Finance Officer shall periodically seek assurances that adequate controls are in operation. 11. BANK ACCOUNTS

123 POLICY the CCG will keep enough liquidity to meet its current commitments The Chief Finance Officer will: review the banking arrangements of the CCG at regular intervals to ensure they are in accordance with Secretary of State directions, best practice and represent best value for money; manage the CCG's banking arrangements and advise the CCG on the provision of banking services and operation of accounts; prepare detailed instructions on the operation of bank accounts The Audit Committee shall approve the banking arrangements. 12. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS POLICY the CCG will operate a sound system for prompt recording, invoicing and collection of all monies due seek to maximise its potential to raise additional income only to the extent that it does not interfere with the performance of the CCG or its functions ensure its power to make grants and loans is used to discharge its functions effectively The Chief Financial Officer is responsible for: designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due; establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments; approving and regularly reviewing the level of all fees and charges other than those determined by the NHS Commissioning Board or by statute. Independent professional advice on matters of valuation shall be taken as necessary; for developing effective arrangements for making grants or loans.

124 13. TENDERING AND CONTRACTING PROCEDURE POLICY the CCG: will ensure proper competition that is legally compliant within all purchasing to ensure we incur only budgeted, approved and necessary spending will seek value for money for all goods and services shall ensure that competitive tenders are invited for o the supply of goods, materials and manufactured articles; o the rendering of services including all forms of management consultancy services (other than specialised services sought from or provided by the Department of Health); and o for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals The CCG shall ensure that the firms / individuals invited to tender (and where appropriate, quote) are among those on approved lists or where necessary a framework agreement. Where in the opinion of the chief finance officer it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the Accountable Officer or the CCG s Governing Body and reported to the Audit and Risk Committee on an annual basis The Governing Body may only negotiate contracts on behalf of the CCG, and the CCG may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with: the CCG s Standing Orders; the Public Contracts Regulation 2006, any successor legislation and any other applicable law; and take into account as appropriate any applicable NHS Commissioning Board or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with above In all contracts entered into, the CCG shall endeavour to obtain best value for money. The Accountable Officer shall nominate an individual who shall oversee and manage each contract on behalf of the CCG. 14. COMMISSIONING POLICY working in partnership with relevant national and local stakeholders, the CCG will commission certain health services to meet the reasonable requirements of the

125 persons for whom it has responsibility The CCG will coordinate its work with the NHS Commissioning Board, other clinical commissioning CCGs, local providers of services, local authority(ies), including through Health & Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans The Accountable Officer will establish arrangements to ensure that regular reports are provided to the Governing Body and Locality Commissioning Boards detailing actual and forecast expenditure and activity for each contract The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality. 15. RISK MANAGEMENT AND INSURANCE POLICY the CCG will put arrangements in place for evaluation and management of its risks The Governing Body will receive the assurance framework at least quarterly and the process used to populate/score the assurance framework will be overseen by the Audit and Risk Management Committee. 16. PAYROLL POLICY the CCG will put arrangements in place for an effective payroll service The chief finance officer will ensure that the payroll service selected: is supported by appropriate (i.e. contracted) terms and conditions; has adequate internal controls and audit review processes; has suitable arrangements for the collection of payroll deductions and payment of these to appropriate bodies.

126 16.2. In addition the chief finance office shall set out comprehensive procedures for the effective processing of payroll 17. NON-PAY EXPENDITURE POLICY the CCG will seek to obtain the best value for money goods and services received The Governing Body will approve the level of non-pay expenditure on an annual basis and the Accountable Officer will determine the level of delegation to budget managers The Accountable Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services The Chief Finance Officer will: advise the Audit and Risk Management Committee on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of reservation and delegation; be responsible for the prompt payment of all properly authorised accounts and claims; be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable. 18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS POLICY the CCG will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of the CCG s fixed assets The Accountable Officer will ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans; be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

127 shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges; be responsible for the maintenance of registers of assets, taking account of the advice of the chief finance officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year The Chief Finance Officer will prepare detailed procedures for the disposals of assets. 19. RETENTION OF RECORDS POLICY the CCG will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance The Accountable Officer shall: be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance; ensure that arrangements are in place for effective responses to Freedom of Information requests; publish and maintain a Freedom of Information Publication Scheme. 20. TRUST FUNDS AND TRUSTEES POLICY the CCG will put arrangements in place to provide for the appointment of trustees if the CCG holds property on trust The chief finance officer shall ensure that each trust fund which the CCG is responsible for managing is managed appropriately with regard to its purpose and to its requirements.

128 SCHEME OF RESERVATION & DELEGATION 1. SCHEDULE OF MATTERS RESERVED TO THE CLINICAL COMMISSIONING GROUP AND SCHEME OF DELEGATION 1.1. The arrangements made by the group as set out in this scheme of reservation and delegation of decisions shall have effect as if incorporated in the group s constitution The clinical commissioning group remains accountable for all of its functions, including those that it has delegated.

129 Policy Area REGULATION AND CONTROL Decision Determine the arrangements by which the members of the group approve those decisions that are reserved for the membership. Consideration and approval of applications to the NHS Commissioning Board on any matter concerning changes to the group s constitution, including terms of reference for the group s Governing Body, its committees, membership of committees, the overarching scheme of reservation and delegated powers, arrangements for taking urgent decisions, standing orders and prime financial policies. Exercise or delegation of those functions of the clinical commissioning group which have not been retained as reserved by the group, delegated to the Governing Body or other committee or sub-committee or [specified] member or employee Require and receive the declaration of interests from members of the Governing Body Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Require and receive the declaration of interests from members, practice representatives and employees of the group Approve arrangements for dealing with complaints Adopt the organisation structures, processes and procedures to facilitate the discharge by the group of its statutory and other functions and to agree modifications Chief Financial Officer Other (stated)

130 Policy Area Decision Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Other (stated) thereto. Receive reports from committees that the group is required by statute or other regulation to establish and to take action upon those reports as necessary. Confirm the recommendations of the groups committees where the committees do not have executive powers. Approve arrangements relating to the discharge of the groups responsibilities as a corporate trustee for funds held on trust. Note the terms of reference of subcommittees established by committees of the group and/or Governing Body. Take steps to ensure members of the group, practice representatives, members of the Governing Body or employees comply with statutory requirements or the groups standing orders. Approve any urgent decisions taken by the Chair of the Governing Body and the Accountable Officer for ratification by the group in public session. Ratify or otherwise instances of failure to comply with the standing orders brought to the attention of the accountable officer. Such failures to be reported to the group in formal session. Approve procedure for the declaration of hospitality and/or hospitality received.

131 Policy Area Decision Reserved to the Membership PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF THE GOVERNING BODY STRATEGY AND PLANNING Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Other (stated) Appoint and remove practice representatives. Member Practice Appoint the Chair of the Governing Body Remove the Chair of the Governing Body in advance of their term of office expiring Appoint the Deputy Chair(s) of the Governing Body Remove the Deputy Chair(s) of the Governing Body in advance of their term of office expiring Appoint and dismiss other committees (and individual members) that are directly accountable to the Governing Body Appoint, appraise, discipline and dismiss employee members of the Governing Body Confirm the appointment of members of any committee or group as representatives of the group on outside bodies. Note the proposals of the Remuneration Committee and to note the proposals of the accountable officer for those staff not considered by the Remuneration Committee

132 Policy Area Decision Define the strategic aims and objectives of the group Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Other (stated) Identify key strategic risks, evaluate them and ensure adequate responses are in place and are monitored Approve plans in respect of the application of available financial resource to support the agreed local commissioning priorities Approve proposals for ensuring quality and developing clinical governance in services provided by the groups contractors having regard to any guidance issued by the National Commissioning Board Modify as necessary and approve the group s annual commissioning strategy plan. Approve outline and final business cases for capital investment if this represents a variation from the strategic plan. Approve all budgets of the group Approve annually the organisational development proposals of the group Ratify the Governing Body s proposals for the development of the group Ratify proposals for the acquisition, disposal or change of use of real property Approve banking arrangements. Audit and Risk Committee

133 Policy Area Decision Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Other (stated) Approve proposals in individual cases fro the write off of losses or making special payments above the limits of delegation to the accountable officer and chief financial officer (for losses and special payments). Approve individual compensation payments Approve the group s strategies as recommended by committees or the employee members of the Governing Body Ratify the group s strategies as recommended by the Governing Body Note the group s corporate and clinical policies as advised by committees with delegated powers of approval as contained in their terms of reference to approve policies on behalf of the Governing Body. Approve group policies as defined for Governing Body approval. Note group policies as approved by the Governing Body and/or its committees Budget Responsibilities including the approval of business cases for service developments up to a value of 1million over the lifetime of the contract governing the service line in question Localities in accordance with Locality Delegation Agreement ANNUAL REPORTS AND ACCOUNTS Receive the annual management letter received from the external auditor and agreement of the proposed action(s), taking

134 Policy Area HUMAN RESOURCES Decision account of the advice, where appropriate of the Audit and Risk Management Committee. Receive an annual report from the internal auditor and agree action(s) on the recommendations where appropriate of the Audit and Risk Management Committee. Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Receipt and approval of the group s annual accounts. Receipt of the Annual Report and Accounts for funds held on trust, if any. Receipt of such reports as the Governing Body sees fit from its committees and/or other committees of the group in respect of their exercise of powers delegated to them Approve the terms and conditions, remuneration and travelling and other allowances for members of the Governing Body, including pensions and gratuities. Approve terms and conditions of employment for all employees of the group, including, pensions, remuneration, fees and travelling or other allowances payable to employees and to other persons providing services to the group. Other (stated) Remuneration Committee makes recommendation to Governing Body Remuneration Committee makes recommendation to Governing Body Approve any other terms and conditions of service for the group s employees. Remuneration

135 Policy Area Decision Reserved to the Membership Reserved or delegated to Governing Body Accountable Officer Chief Financial Officer Other (stated) Determine the terms and conditions of employment for all employees of the group. Determine pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the group. Committee makes recommendation to Governing Body Remuneration Committee makes recommendation to Governing Body Remuneration Committee makes recommendation to Governing Body

136 QUALITY AND SAFETY Approve disciplinary arrangements for employees, including the accountable officer (where they are and employee and/or member of the group) and for other persons working on behalf of the group. Remuneration Committee Review disciplinary arrangements where the accountable officer is an employee of the group. Approval of arrangements for discharging the group s statutory duties as an employer. Approve human resources policies for employees and for other persons working on behalf of the group. Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes. Approve arrangements for supporting the NHS Commissioning Board in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services. Quality and Patient Safety Committee OPERATIONAL AND RISK MANAGEMENT Prepare and recommend an operational scheme of delegation that sets out who has responsibility for operational decisions within the group.

137 INFORMATION GOVERNANCE Approve the group s counter fraud and security management arrangements. Approval of the group s risk management arrangements. Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other clinical commissioning groups or pooled budget arrangements under section 75 of the NHS Act 2006). Approval of a comprehensive system of internal control, including budgetary control, that underpin the effective, efficient and economic operation of the group. Approve proposals for action on litigation against or on behalf of the clinical commissioning group. Approve the group s arrangements for business continuity and emergency planning. Audit and Risk Management Committee Audit and Risk Management Committee Approve the group s arrangements for handling complaints. Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data. The CCG will identify a Caldicott Guardian to act as advisor on Information Governance and it will identify a Senior Information Risk

138 Owner (SIRO) to be accountable for ensuring all aspects of information governance are met within the organisation. TENDERING AND CONTRACTING PARTNERSHIP WORKING Approval of the group s contracts for any commissioning support. Approval of the group s contracts for corporate support (for example finance provision). Approve decisions that individual members or employees of the group participating in joint arrangements on behalf of the group can make. Such delegated decisions must be disclosed in this scheme of reservation and delegation. Approve decisions delegated to joint committees established under section 75 of the 2006 Act. COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES Approval of the arrangements for discharging the group s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and Audit and Risk Management Committee

139 consultation. Approve arrangements for co-ordinating the commissioning of services with other groups and or with the local authority(ies), where appropriate Audit and Risk Management Committee

140 COMMUNICATIONS Approving arrangements for handling Freedom of Information requests. Determining arrangements for handling Freedom of Information requests.

141 26

142 Locality Delegation Agreement Bedfordshire Clinical Commissioning Group Locality Delegation Agreement April

143 Locality Delegation Agreement (LDA) 1. Background: There is a long history of locality working within Bedfordshire. Bedfordshire is a large and diverse county and there is a good history of localities working together, especially since the CCG in Bedfordshire has been forming. The CCG has five strong Localities namely: Ivel Valley Leighton Buzzard West Mid Beds Bedford and Chiltern Vale Each Locality is supported by an elected GP clinical lead, known as the Locality Chair, who will be a member of the Board of Directors. Added to that, GPs in the localities offer additional support by taking on clinical lead positions for specific work streams (for example, planned care, urgent care, mental health and each GP Practice in the Locality is committed to engaging with their commissioning responsibilities through regular LCG clinical forums. The overall structure for the Localities and the inter-relationship with the Board of Directors is included within annex B of this LDA. 2. Purpose: The objectives of the CCG are outlined within the Constitution and Inter Practice Agreement. The purpose of the Locality Delegation Agreement (LDA) is to: set out the mechanics of how the LCG s will conduct their business on a day to day basis, contributing to the overall CCG objectives. outline and describe key relationships, responsibilities and accountabilities between the LCG and its related groups, such as the CCG outline Locality commissioning, contracting, delivery and monitoring processes. 3. LCG structure, member representatives and sub committees Each Locality will have a Locality Commissioning Group (LCG). Each LCG is composed of: a Locality Commissioning Board; a Locality Management Team; a Locality Clinical Forum; and a Locality Business Manager Locality Commissioning Board Each Locality will have a Locality Commissioning Board which will act in governance terms, as a sub-committee of the CCG Board. By being a sub-committee, there will be clear accountability arrangements, which will enable the Locality Board to have greater autonomy in what it does and also discharge its responsibilities to the CCG. The Locality board will meet on a monthly basis and the procedure for these meetings is set out within Annex A of the LDA. The composition of the LCB is as follows: a designated representative from each practice who will be the link between the locality and the practice. 28

144 a GP clinical lead who will be elected as Locality Chair for each Locality and will also be a full member of the Board of Directors. Locality Management Team The Locality Board will be supported by the Locality Management Team. This team will be led by the Locality Chair with support from the Locality Business Manager. It is important that the locality is clinically led, but managerially supported to mirror the arrangements of the CCG. Localities will agree a scheme of delegation to their Business Manager and Managers so that they can work efficiently. The clinicians need to be working strategically where possible, but there will be times when their knowledge will be required for more detailed decision making. The Locality Management Team will meet on a fortnightly basis. Locality Clinical Forum To ensure clinical engagement a clinical forum will be established at locality level. This will ensure there is a real focus on the quality of clinical services. The clinical leads will be key members of this group, and will be able to coordinate other GPs and other local non-gp clinicians who are involved in service redesign. The Locality Clinical Forum will meet as required. LCG LCG Clinical Forum LCG Management Team Meets as required Attendees: - Locality Chair - Locality Business Manager or equivalent - Member Representatives - Other non-gp clinicians - PPI Representative - Public Health Representative - Local Authority Representative Meets Fortnightly Attendees: - Locality Chair - Locality Business Manager or equivalent - Additional clinical support (determined by each locality) 4. Objectives and Functions of the LCG To enable local delivery of the CCG objectives the following have been drawn as functions of LCGs: To produce an annual plan, to be approved by the Board of Directors, detailing how the locality will deliver its contribution to the CCG annual plan To carry out functions effectively, efficiently and economically To improve quality and safety of general practice and primary care services 29

145 Ensure good financial controls; responsible for devolved budgets and ensuring no overspend Members of the relevant LCG are responsible for holding each other to account where performance negatively impacts delegated responsibilities. Monitor contracts together with the Locality Business Manager or equivalent To involve patients and the public in developing, considering and making decisions on any proposals that would have a significant impact on service delivery or the range of health services available. To commission healthcare to the extent the LCG considers necessary to meet the unmet health need of patients registered with the GP practices who are members of the LCG. In line with the CCG operating plan to commission healthcare for other groups of patients, as defined in regulations, which it is intended will include: opeople who live within the LCG s defined geographic area who are not registered with any GP practice opeople present in the LCG s geographic area who need access to emergency care Demonstrate joint working in design of local services To exercise their functions with a view to securing continuous improvements in the quality of services for patients and in outcomes, with particular regard to clinical effectiveness, safety and patient experience. Focus on and assist the CCG with continuous improvement in quality of services, including general practice and out of hours services, through various initiatives including a Locality Pathway GP for specialities when needed Work towards reducing health inequalities pan Bedfordshire and at Locality level in access to healthcare and healthcare outcomes, promote patient and carer involvement in decisions about them ( no decision about me without me ) and enable patients to make choices with respect to aspects of their healthcare. Ensure health services are provided in an integrated way: oto co-operate with local authorities and for the Locality to participate in the delivery of the relevant Health & Wellbeing Board s strategy othe LCG may agree to commission health improvement services jointly with local authorities and may choose to buy in support from other external organisations including private and voluntary sector bodies within any delegated budget. oto ensure that the LCG obtains advice from people with professional expertise in relation to the population s health. othe LCG can arrange for provision of services that aim to secure improvements in physical and mental health, or in the prevention, diagnosis and treatment of illness, for the people for whom the LCG is responsible. oto co-operate with other NHS bodies and providers of NHS Commissioned Services othe LCG, acting in accordance with the Business Case Process; Standing Orders, Prime Financial Policies and Scheme of Delegation (the Accountability Framework ) may choose to enter the CCG into NHS contracts and to arrange for another health body to provide services. othe LCG, acting in accordance with the Accountability Framework, can act jointly with another LCG in exercising commissioning functions or for one LCG to exercise such functions on behalf of another. Promote health service innovation and research; the LCG can conduct or commission research etc. 30

146 To take appropriate steps to ensure that it is prepared to deal with emergency situations that might affect the LCG (for example, pandemic flu). 4.1 Locality Responsibilities The LCG is responsible for three key areas: Commissioning Performance and Finance Engagement Commissioning Locality Initiatives The locality initiatives, typically based on public health needs assessment, that the Locality, with its resources and expertise, can specifically influence and have control over delivery and improvement. Each practice along with PPI, Local Authority and Public Health representatives and other local clinicians should be involved in the development of the Locality Initiatives to address local health & well-being, quality, safety and cost improvement issues Performance and Finance Performance targets Monitoring and managing performance is critical to achieving the objectives of the CCG. This includes identifying key indicators of activity, quality and financial performance, regularly monitoring progress against them, and developing systems to deal with variations in performance. The majority of performance targets have financial and quality implications. Alongside this the Locality will contribute to the successful delivery of the Quality, Innovation, Productivity and Prevention (QIPP) programme. Localities are well-placed to take a lead on monitoring and managing indicators which can be split to practice level, as they are close to the front-line and are building strong working relationships with their constituent members. The CCG will agree with the Localities those relevant national targets and performance measures associated with devolved responsibilities and set out these out in the annual Locality Delivery Plan. They will be monitored as part of the monitoring arrangements set out in the LDP. This will involve quarterly accountability review meetings; a review of relevant activity and performance measures and a review of the locality objectives set out in the LDP. The locality management team will take the lead in managing and monitoring performance; they will be responsible of informing practices of indicators, plans and promoting schemes which will contribute to an improvement in performance. The CCG needs to remain aware that it has a responsibility for the practice s performance as a CCG member. Any action taken by the CCG should not relate to performance management of practices against their GMS/PMS/APMS roles. The NHS Commissioning Board will have sole responsibility for the administration and management of practice contracts. Budgetary responsibility Re-investment budget (previously known as Freed up Resources) The Locality will be expected to make rational decisions for re-investing any annual savings (based upon the overall delegated locality budget), in line with the Business Case Process; Standing Orders, Prime Financial Policies and Scheme of Delegation (the Accountability Framework ), that occur into areas that will positively support the Locality to attain outcomes linked to key objectives. 31

147 Delegated budget The locality will be responsible for ensuring no overspend and that practices participate in annual review, development and contribution to safe and effective use of the budget Engagement PPI The LCG will consult with patient group(s) to ensure they are central to commissioning decisions, outcomes and performance on behalf of the population. The LCG will involve patients and the public in developing, considering and making decisions on any proposals that would have a significant impact on service delivery or the range of health services available. This includes the duty to consult the relevant Overview and Scrutiny Committee in the Local Authority when considering significant changes in services. The annual Locality Development Plan will demonstrate how Locality based commissioning will strengthen PPI from practice through to locality level. Clinical Engagement The LCG will: obuild active clinical engagement across all professions to improve local services and performance targets oconsult with practices as and when the need arises including their contribution to the LDP oinform practices of wider CCG developments and to reflect practice views within the CCG Board oencourage shared learning and development across the locality osupport to practices via the established practice manager and practice nurse fora 5. Key Relationships NHS Commissioning Board Authority (NHS CBA): The NHS CBA will provide assistance to the CCG to support them in the successful delivery of their commissioning functions. The CCG will provide the NHS CBA with specific information, if considered necessary by the Secretary of State for the purposes of carrying out his functions in relation to the health services (this is likely to be primarily financial information). The LCG will act as the local arm of the CCG, helping it to carry out its functions at a local level and providing local services for its local population. 32

148 Health and Wellbeing Boards: Health and Wellbeing Boards will strengthen joint working between local government and the NHS. They will bring together locally elected and accountable councillors, directors of adult social services, children s services and public health, CCGs, LCGs and patients. Local Authorities: LCGs need strong shared leadership with Local authorities to commission services where integration of health and social care is vital. The LCG will also need to be able to access public health input when required, via the LCG forums and committees. 6. Planning, Reporting and Monitoring: The LCG will develop a Locality Delivery Plan (LDP) that will detail how the LCG intends to exercise its responsibilities outlined within section 4.1. It will act as a means to monitor progress and monitor performance against the plan throughout the year. The following specific monitoring and requirements for each of the responsibilities of the LCG are outlined below. These must be captured within the LDP. Devolved tasks Local Initiatives Requirements Agree local initiatives at the start of each financial year. LCG Monitoring & Reporting LCG management teams (monthly) Locality Clinical Forum (monthly) LES Contracts Budget Responsibilities including the approval of business cases for service developments up to a value of 1million over the lifetime of the contract governing the service line in question As per delegation of Local Enhanced Services (LES) Budgets to Locality Groups. (appendix) Performance against Local Enhanced Service finance, quality and activity targets in accordance to the business planning cycle. Be responsible for the localities share of the relevant commissioning budget and ensuring no overspend (Includes prescribing, Re-Investment, LES contracts) and ensure compliance with the Accountability Framework. LCG management teams (monthly) Locality Clinical Forum (monthly) To be agreed at LCG Board meetings subject to delegated limits and the Accountability Framework. For the avoidance of doubt, business cases for service developments over a value of 1million over the lifetime of the contract governing the service line in question, require the approval of the CCG Board. LCG management teams (monthly) Locality Clinical Forum (monthly) PPI Locality action plan to be developed as part of the LDP. LCG management teams (monthly) Locality Clinical Forum (monthly) Clinical Engagement Locality action plan to be developed, supporting the CCG engagement strategy 33 LCG management teams (monthly)

149 Locality Clinical Forum (monthly) Other reporting duties of the LCG are: To report as required to the Board of Directors, Executive Management Team and/other forum when required and in line with reasonable requests on progress against key metrics, initiatives, risks and issues. 7. Evaluation and Performance Escalation framework: CCGs monitoring LCGs The CCG will monitor the LCG against agreed objectives and commissioning responsibilities in accordance with the Accountability Framework. These documents set out the monitoring process and sanctions for failure to comply with or breach of the LCG s delegated responsibilities. They also describe the process for approving the budget delegated to the LCG and the sanctions to be applied when this process is not followed. Accountability Meetings: The LCG and the CCG will meet on a quarterly basis. This will enable the CCG to ensure that the LCG is discharging its duties in accordance with delegated authority and that the LCG is complying with the Accountability Framework. Notwithstanding the above and the terms of this LDA, the Board of Directors of the CCG reserves the right to suspend or otherwise prevent the LCG from committing expenditure and resources in any way which they consider to be incompatible with the work of the CCG or the processes set out within the Accountability Framework. The CCG will receive monthly activity and financial reports from the Commissioning Support Service, broken down by locality. The CCG will provide these to each Locality on a monthly basis to enable the LCG to monitor activity against its objectives. The LCG will report to the CCG at the quarterly Accountability Meeting on these financial reports to enable them to assess the LCG s activity against its objectives and compliance with the Accountability Framework. LCG s monitoring Practice Members As per Inter-Practice Agreement and Evaluation and Performance Reporting Framework. 8. Role of the LCG Clinical Lead (Locality Chair) The LCG Clinical Lead (the Locality Chair) is elected for a 3 year period in accordance with the process included within Schedule 6 of the constitution and is employed on an NHS Contract basis. The role of the LCG Clinical Lead (Locality Chair) is: To ensure effective communication with all stakeholders To ensure the LCG is governed effectively and in line with legislative requirements To provide strong, effective and visible leadership of the Locality Clinical Forum and Locality Management Team To act as a conduit between its GP constituents and the CCG To be responsible to the CCG to ensure delivery of outcomes in the Locality To take ownership of the financial challenges at a Locality level To ensure that all members contribute to the development of the LCG To work closely with the Locality Business Manager to ensure outcomes from the LDP are delivered 34

150 To ensure all Practices are signed up to the GP Commissioning Engagement Scheme Responsible for key areas: ocommissioning operformance oengagement 9. Role of the LCG Locality Business Manager The LCG Locality Business Manager is an appointed post (employed by the CCG) and is subject to contract. The role of the LCG Locality Manager is to: -Input into service re-design (both locally and at a corporate CCG level) -Facilitate and co-ordinate local projects and initiatives -Take responsibility for budget management (including LESs). -Empower and enable practices to be involved in commissioning -Assist, develop and deploy strategies for Patient and Public Involvement (PPI) at a local level under the support of the CCGs PPI Manager -Develop capacity and competency in commissioning in the Locality -Monitor Locality performance against agreed targets (such as the LDP, LESs and DESs) 10. Disclosure of information Members Representatives are required to declare conflicts of interest, in line with the COI policy. A register of interest for localities member s forums will be held. 11. Voting at LCGs Each Member Practice has a vote at the LCG Board for those decisions where the Chair determines that a vote should be taken. 12. Duties and Responsibilities of Member Representatives: The practice commissioning lead attending the Locality Clinical Forum will act as the conduit between LCG and practice staff responsible for ensuring, where necessary, items are communicated effectively. All members should refer and abide to the following policies and requirements: CCG Conflicts of interest policy Dispute resolution policy CCG communication strategy Gifts and Hospitality policy Safeguarding adults and children s policy To meet requirements of the Data Protection Act and Freedom of Information Act. To meet Health and Safety requirements, including duty of care towards anyone working for the LCG and towards visitors. Have regard to the NHS Constitution. To have regard to commissioning guidance published by the NHS CB. 35

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152 Annex A to Locality Delegation Agreement: Terms of Reference for Locality Commissioning Board Title: Accountable to: Purpose: (Insert Name) Locality Commissioning Board CCG Board of Directors To enable practices within the locality to set and deliver strategy and objectives that meet the needs of the local population and contribute to the overall aims and objectives of the CCG. The locality will agree with the CCG an annual Locality Delivery Plan (LDP). This will set out specific locality objectives for the year based upon the CCG s annual plan and objectives. Commissioning To develop local commissioning strategies within the context of the CCGs Strategic Plan Initiating service improvement projects to deliver local priorities using the CCG wide commissioning and business case processes To develop commissioning capacity and capability in local Clinical and multi-professional leadership Improving quality of services (e.g. SOVA, antibiotics) through general performance measures Performance and Finance To manage relevant secondary care, community, mental health and prescribing budgets as agreed with the CCG and ensure budgets meet expected plan, initiating mitigating actions to correct adverse variances. To ensure delivery of delegated key performance indicators Negotiate and manage agreed contracts with providers on behalf of the CCG Engagement To ensure active and demonstrable engagement and communication with local people, local authority, providers and local clinicians Build active clinical engagement to improve local services and performance targets Consult with practices as and when the need arises including their contribution to the LDP Inform practices of wider CCG developments and to reflect the views of local people, GP practices and clinician within the CCG Board Encourage shared learning and development across the locality Chair The Chair will be elected from the GPs within the constituent practices. Terms of office will be for 3 years. Membership GP Chair Representative from each constituent practice as nominated by the practice. Locality Business Manager or equivalent A vice chair will be nominated from practice members Frequency The Board will meet monthly Quorum 50% of members Conflicts of Interest Members shall declare potential conflicts in accordance with the CCG Conflicts of Interest policy. Voting For decisions requiring a vote of the board each practice will have one vote. In the event of an equality of voting, the Chairman should have a second, casting vote 37

153 Governance The Board will operate within the Constitution, Standing Financial Instructions and Scheme of Delegation of Bedfordshire CCG at all times. 38

154 Annex B to Locality Delegation Agreement: 39