CONSTITUTION. Version: 5.1 Effective Date: May 2017

CONSTITUTION Version: 5.1 Effective Date: May 2017 Status: Approved on the 26 May 2017 by the NHS Commissioning Board, hereafter known as NHS England Page 1 of 33

Information about this document Document Purpose Document Name Author Governance NHS Portsmouth Clinical Commissioning Group Publication Date May 2017 Description Cross Reference The purpose of this document is to set out the arrangements made by the Clinical Commissioning Group to meet its responsibilities for commissioning care for the people for whom it is responsible. It sets out the governing principles, rules and procedures that the CCG has established. This document is supported by a number of key policies, frameworks and strategies including: Standing orders Scheme of Reservation and Delegation Prime Financial Policies Standards of Business Conduct Policy HR Framework Procurement Strategy Governance Framework Statement to member practices Superseded Documents This Constitution is version 5.1. It supersedes version 4.1 which was effective from 4 th May 2016. Document Status Governing Board approval of proposed variation 16 th November 2016 Application for variation made to NHS England 27 th January 2017 NHS England approved 26 May 2017 Page 2 of 33

CONTENTS 1 PURPOSE... 4 2 NAME... 4 3 STATEMENT OF INTENT AND VALUES... 4 4 STATUTORY FRAMEWORK... 7 5 CONFIGURATION... 7 6 MEMBER PRACTICES... 8 7 KEY LEADERSHIP ROLES AND RESPONSIBILITIES... 9 8 DECISION MAKING: GOVERNANCE STRUTURE... 15 9 FUNCTIONS AND GENERAL DUTIES... 23 10 STANDARDS OF BUSINESS CONDUCT... 28 11 THE CCG AS EMPLOYER... 29 12 WHISTLEBLOWING... 29 13 TRANSPARENCY... 30 14 AMENDMENTS TO THE CONSTITUTION... 30 15 REVIEW ARRANGEMENTS... 30 16 STATUS... 30 17 ACCOMPANYING POLICIES AND DOCUMENTS... 31 Page 3 of 33

CONSTITUTION 1 PURPOSE 1.1 The purpose of this constitution is to set out the arrangements made by the clinical commissioning group (CCG) to meet its responsibilities for commissioning care for the people for whom it is responsible. 1.2 It sets out the governing principles, rules and procedures that the CCG will establish to ensure probity and accountability in the day to day running of the clinical commissioning group; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the CCG. 1.3 The constitution applies to all of the following, all of whom are required to adhere to it as a condition of their appointment: Member practices Employees Individual working on behalf of the CCG Members of the governing body and its sub committees 2 NAME 2.1 The name of the clinical commissioning group shall be the NHS Portsmouth Clinical Commissioning Group hereafter referred to as the CCG. 3 STATEMENT OF INTENT AND VALUES 3.1 Statement of intent 3.1.1 Our mission is Improving your health and wellbeing and getting the best for the Portsmouth pound. 3.1.2 We aim to enable you to live longer and healthier lives. We will strive to improve health and wellbeing through our GP surgeries as members working with our patients, the public and our partners. 3.1.3 Our strategic objectives are to: enable our GP surgeries as members to engage and drive commissioning engage with our patients and our public in our commissioning and our decision making work with our partners to collaborate on commissioning to deliver improvements in health outcomes invest in improving and better health and wellbeing manage our resources effectively ensure that our services are safe and focused on maintaining and improving quality develop the CCG as a mature organisation considered as credible and competent with the appropriate capacities and capabilities Page 4 of 33

3.2 Principles 3.2.1 In accordance with section 14L(2)(b) of the 2006 Act, 1 the CCG will at all times observe such generally accepted principles of good governance in the way it conducts its business. These include: a) the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business; b) The Good Governance Standard for Public Services; 2 c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles The seven principles are: Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. Openness Holders of public office should be as open as possible about all the decisions and actions 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. Leadership Holders of public office should promote and support these principles by leadership and example. Holders of public office are expected to promote and support these principles by their leadership and example. (Source: The First Report of the Committee on Standards in Public Life (1995) 3 ) d) The expectations set out in the Standards for Members of NHS Boards and Clinical Commissioning Groups (NHS England: November 2012) e) The NHS Constitution - sets out seven key principles that guide the NHS in all it does: 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 1 2 3 Inserted by section 25 of the 2012 Act The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004 Available at http://www.public-standards.gov.uk/ Page 5 of 33

the NHS aspires to the highest standards of excellence and professionalism The NHS aspires to put patients at the heart of everything it does the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population the NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources the NHS is accountable to the public, communities and patients that it serves (Source: The NHS Constitution: The NHS belongs to us all (March 2013) 4 ) f) The Equality Act 2010. 5 3.3 Values 3.3.1 The values and behaviours that lie at the heart of the CCG s work are to be: Clinically led Putting the patient at the heart of everything we do Quality driven, compassionate and locally responsive Courageous, challenging, and fair Embracing innovation, best practice and education Open, accountable and acting with integrity 3.3.2 Good corporate governance arrangements are critical to achieving the CCG s objectives. The CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 3.4 Accountability 3.4.1 The CCG will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, including by: publishing its constitution; publishing registers in respect of any conflicts of interests, gifts and hospitality, and procurement decisions; appointing independent lay members and clinical independent members to its governing body; holding meetings of its governing body and Primary Care Commissioning Committee in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting); publishing annually a commissioning plan; complying with local authority health overview and scrutiny requirements; meeting annually in public to publish and present its annual report (which must be published); producing annual accounts in respect of each financial year which must be externally audited; publishing its register of interests declared by members, employees and others having a published and clear complaints process; complying with the Freedom of Information Act 2000; providing information to, and being held to account by, NHS England. 4 http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_132961 5 See http://www.legislation.gov.uk/ukpga/2010/15/contents Page 6 of 33

3.4.2 The governing body of the CCG will throughout each year have an ongoing role in reviewing the CCG s governance arrangements to ensure that the CCG continues to reflect the principles of good governance. 4 STATUTORY FRAMEWORK 4.1 Clinical commissioning groups are established under the Health and Social Care Act 2012 ( the 2012 Act ). 6 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 ( the 2006 Act ). 7 The duties of CCGs to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision. 8 4.2 CCGs may also undertake other functions delegated to it by NHS England as provided for under section 13Z of the 2012 Act and as set out in approved delegation agreements. The discharge of these functions is also covered by the CCGs constitution. 4.3 NHS England is responsible for determining applications from prospective groups to be established as CCGs 9 and undertakes an annual assessment of each established group. 10 It has powers to intervene in a CCG where it is satisfied that a CCG is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so. 11 4.4 CCGs are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. 12 5 CONFIGURATION 5.1 The geographical area covered by the CCG is Portsmouth City as defined by the Portsmouth City Council Local Authority boundaries. 5.2 The CCG is co-terminous with Portsmouth City Council 6 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 7 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 8 Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act 9 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 10 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 11 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 12 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued Page 7 of 33

6 MEMBER PRACTICES 6.1 Eligibility 6.1.1 Providers of primary medical services to a registered list of patients under a General medical Service, Personal Medical Services or Alternative Provider Medical Services contract, within the CCG s geography are eligible to be members of the CCG. 6.1.2 A member is defined as a holder of a contract i.e. one contract, one member, one vote. In the event of a new contract or a contract holder changing due to reasons such as procurement, resignation, retirement, merger or acquisition then the new contract holder will automatically be a member of the CCG subject to them being eligible. 13. 6.2 Member practices The following practices comprise the members of the CCG: Member (Contract) Provider & Provider Address Providing services at: Derby Road Group Practice Derby Road Group Practice 27-29 Derby Road, North End, PO2 8HP Derby Road Copnor Road Sunnyside Medical Centre Dr A R Tollast & Partners Pompey Centre, Fratton Way, PO4 8TA Sunnyside Medical Centre East Shore Partnership Dr E Fellows & Partners St Cuthbert s Church, Hayling Ave, PO3 6BH Baffins Surgery Milton Park Dr Atchison & Dr D G Atchison & Partners Queens Road Surgery Partners 8 Queens Road PO2 7NX John Pounds Medical Dr JPR Hogan John Pounds Surgery centre Lake Road Health Centre, Nutfield Place PO1 4JT Lake Road Practice Dr JPR Hogan Lake Road Health Centre, Nutfield Place PO1 4JT Lake Road Health Centre Trafalgar Medical Group Practice Dr Price & Partners 25 Osborne Road PO5 3ND Osborne Road Eastney Health Centre The Drayton Surgery Southsea Medical Centre The University Surgery Hanway Group Practice Kirklands Surgery North Harbour Medical Group Portsdown Group Practice Guildhall Walk Healthcare Centre Dr R J Gill & Partners 280 Havant Road PO6 1PA Dr I Minay & Partners Southsea Medical Centre, Carlisle Road PO5 1AT Drs Lawson & Alalade The Nuffield Centre PO1 2BH Hanway Group Practice 2 Hanway Road PO1 4ND Kirklands Surgery 111 Copnor Road PO3 5AF North Harbour Medical Group Cosham Health Centre, Vectis Way, PO6 3AW Portsdown Group Practice Crookhorn Lane PO7 5XP Portsmouth Health 27 Guildhall Walk PO1 2DD Drayton Surgery Wootton Street Southsea Medical Centre University Surgery 2 Hanway Road 81 Stubbington Avenue 111 Copnor Road Cosham Health Centre Cosham Park House Crookhorn Lane Heyward Road Kingston Crescent Paulsgrove Somerstown Hub Guildhall Walk Healthcare Centre 13 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Page 8 of 33

The Devonshire Practice The Eastney Practice Craneswater Group Practice The Devonshire Practice 262 Devonshire Avenue PO4 9EH The Eastney Practice Eastney Health Centre, Highland Road PO4 9HU Waverley Road Surgery 34-36 Waverley Road, PO5 2PW 262 Devonshire Avenue Eastney Health Centre Salisbury Road Surgery Waverley Road Surgery 6.3 Communications 6.3.1 Genuine communication is a 2-way process between our practices & our Clinical Executive designed to promote ownership & produce clinical engagement. 6.3.2 The Clinical Executive has established a range of mechanism by which to do this: The Clinical Executive undertakes to visit each practice at least annually. This is primarily a listening exercise for our executive to inform our future plans and actions. Regular CCG newsletters, in addition to the prescribing newsletter which will continue, each month with key messages for practices hoping to reach all clinical staff & Practice Managers and will include web links to further detail, when appropriate. PIP provides a universally accessible platform for current information as well as a newsfeed. Feedback is encouraged on every page. Pathways and referral guidelines will be hosted on the PIP and will be signposted via email. Face-to-face events such as commissioning & prescribing events support twoway communication and engagement, as does Target. The latter will be encouraged to promote cost effective primary care through education, whilst linking to our commissioning needs. Opportunities will be put in place using events planned for member practice representatives to meet with the five elected clinical executives of the CCG to discuss the activities and plans of the CCG. Using Clinical Commissioning Leads as important ambassadors for the CCG working with member practices. They will be supported in work streams by other member clinicians, particularly those with a special interest. This will encourage a bottom-up approach to service redesign. Maintaining close links with the Practice Managers Group to capture their knowledge & expertise. They are a vital resource when communicating with practices & effecting change. Primary Care Engagement Team will work with practices, using DOCC, on understanding variation in practice and provide support in activities which may reduce demand. Practice support pharmacists will work with practices to encourage and support safe and cost effective prescribing. 7 KEY LEADERSHIP ROLES AND RESPONSIBILITIES 7.1 Overview 7.1.1 A number of key leadership roles have been identified both residing in primary care members and in the clinical commissioning group. These can be summarised as: Practice representatives Clinical leaders Governing body members Page 9 of 33

7.1.2 When working for the CCG individuals from practices as well as other individuals and employees will need to be aware of the CCG s policies and work within them. Specific attention is drawn to the CCG s Standards of Business Conduct policy. 7.2 Practice Representatives 7.2.1 Practice representatives represent their practice s views and act on behalf of the practice in matters relating to the CCG. Three key leadership roles have been identified: Practice Commissioning Lead GP Practice Prescribing Lead GP Practice Lead Manager 7.2.2 Practice representatives will be selected by the chosen method of each member practice and notified to the CCG s Clinical Leader 7.2.3 Practice Commissioning Lead GP: Each practice has a nominated commissioning GP lead. This individual is the key clinical contact within the practice and will work with their practice manager in its relationship with the CCG. Roles include: Practice clinical representative with the CCG with overall responsibility for the relationship between the practice and the CCG. Lead for quality improvement within the practice Leading on the practice's role in referral management and review Ensuring the practice is briefed and engaged with CCG activities and is clear on its role as a practice in the stewardship of NHS funds Participates in commissioning educational events run by the CCG and ensures key messages and learning are shared with other members of the practice Providing feedback from the practice on its views and comments on CCG work priorities and specific proposals Working with clinical leads on the commissioning work programme to ensure the views of the practice are reflected Raising with the CCG issues identified by the practice to consider from a clinical commissioning perspective Where there are significant changes proposed, or where a change is proposed which is directly relevant to primary care as a provider ensuring the practice is aware and able to respond to these proposals Come together as members of the Practice Members Forum to oversee the work of the Governing Body 7.2.4 Practice Prescribing Lead GP: Each practice has a nominated prescribing GP lead This role: Leads programme of quality improvement in relation to prescribing within the practice Acts as key point of contact for the practice based prescribing support pharmacists to agree and develop prescribing action plans Provides clinical leadership for the practice in respect of ensuring cost effective prescribing and engagement with the prescribing incentive scheme as part of the primary care CQUIN Page 10 of 33

Ensure practice is reviewing its prescribing activities regularly and ensuring practices are current and in line with recommended practice, and comply with local formulary and best practice in the broader sense. Participates in prescribing educational events run by the CCG medicines management team and ensures key messages and learning are shared with other members of the practice Support prescribing advisors to have access to the practice to help them review prescribing behaviour and to facilitate audit. 7.2.4 Practice Lead Manager: Practice Lead managers (sometimes referred to as practice managers, business managers or business practice managers) play a pivotal role in the relationship between the CCG and the individual practice. They work alongside, and in support of, the nominated commissioning GP lead as well as with the prescribing GP lead in respect of their clinical portfolios. Specific roles include: Ensuring effective two way communications between the practice and the CCG Supporting the Practice Commissioning Lead GP to ensure communications with all members (clinical and non-clinical) of the practice regarding CCG business Supporting the Practice Commissioning Lead GP to ensure the practice is aware of its responsibilities as a member of the CCG Providing feedback to the CCG generated by the practice or its practice population Supporting the Practice Commissioning Lead GP to lead the process for the practices engagement in commissioning such as participation in the primary care CQUIN, audit, data gathering, using DOCC to interrogate and analyse practice population usage of commissioned services Working with the Practice Commissioning Lead GP to put in place arrangements for engagement of the practice population using PPGs, individual consultations, notice boards and other communications, to obtain meaningful patient and public involvement in the priorities of the CCG both generally and in specific aspects of the commissioning work programme - to inform CCG decision making Reviewing with the Practice Commissioning Lead GP, where relevant, proposed services changes to identify impact on the practice as a provider and informing the CCG of any opportunities, issues or alternative approaches to be considered before decisions are taken 7.2.5 Other key roles: The CCG will have, at times, specific tasks where it will need clinical and practice manager input, working on behalf of the City. This will be on a voluntary basis where individuals are keen to be involved/ interested in the subject matter and where their practice is agreeable to them participating. Such involvement supports the CCG's succession planning arrangements in respect of clinical leaders and in particular Clinical Executives. Where such roles are deemed to be significant and outside the role of normally funded activities/responsibilities funded by the primary care CQUIN, then the CCG will provide limited remuneration or backfill to allow full participation in the task on a time limited basis 7.2.6 In this way the CCG aspires to gain involvement from a broader membership of primary care in developing and delivering its work programme than just those members involved in the CCG. Page 11 of 33

7.3 Clinical Leaders 7.3.1 A number of key clinical leadership roles have been identified to form both the governing body and the Clinical Executive Committee and to provide specific support to commissioning. These include: Clinical Executives (who sit on the Governing Body) Clinical Commissioning Leads (who sit on the Clinical Strategy Committee) Task and Finish Clinical Leads ( for specific programmes of work) 7.3.2 In addition the CCG also has Practice Manager representatives (one who sits on the Governing Body and one who sits on the Clinical Strategy Committee) 7.3.3 Clinical Executive - These are elected clinical leaders who have an active role in the management and operation of the CCG. As members of the CCG s governing body, they bring their unique understanding of the CCG s member practices to the discussion and decision making of the governing body. 7.3.4 There are five clinical executive elected by practice members onto the governing body who also form the clinical executive (supported by the Chief Strategic Officer, Chief Operating Officer and Chief Finance Officer). Elections are independently administered by the LMC on behalf of practice members. 7.3.5 One of the elected clinical executives will be selected by the five clinical executives to be the clinical leader of the CCG. This person must be either the Accountable Officer or Chair of the CCG. 7.3.6 One of the elected clinical executives will be selected by the CCG s Governing Body to take on the Chair role. 7.3.7 The role of clinical executive includes: Fulfil the role of a member of the CCG s governing body as set out in national guidance 14 Ensures CCG clinical representatives have access to appropriate leadership development including succession planning for the future Is visible at national and regional events and committees as appropriate Act as the Governing Body s executive team to advise them on the formation of vision and strategies and to oversee the delivery of the Governing Body s and its sub-committees decisions and plans 7.3.8 Clinical Commissioning Leads Clinical Commissioning Leads will be members, alongside Clinical Executives, on the Clinical Strategy Committee. 7.3.9 Task and Finish Clinical Leads will lead or provide clinical input to specific commissioning work programmes of the CCG. 7.3.10 Both Clinical Commissioning Leads and Task and Finish Clinical Leads will support the CCG s Clinical Executive in developing and delivering its commissioning work programme, including full engagement with its member GP practices. For specific 14 Clinical commissioning group governing body members Role Outlines, Attributes and Skills, NHS Commissioning Board Authority, October 2012 Page 12 of 33

areas of the work programme they will ensure the development and delivery of robust plans for the population, ensuring the delivery of financial sustainability and balance, and meeting of key performance/quality standards. 7.3.11 Clinical Commissioning Leads and Task and Finish Clinical Leads will be selected on the basis of interest and expertise against the business needs of the CCG. 7.3.12 Practice Manager Representatives - The CCG will have practice manager representation on both its Governing Body and Clinical Strategy Committee to support the CCG in ensuring its work is appropriate and relevant to member practices. 7.3.13 They will be elected by vote from each practice manager from member practices within the City. 7.4 Governing Body Members 7.4.1 All members of the CCG s Governing Body - Guidance on the roles of members of the CCG s governing body is set out in a separate document 15. 7.4.2 In summary, each member of the governing body should share responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience. 7.4.3 The Chair of the Governing Body has the following responsibilities: Provide strong leadership to the Governing Body at all times Ensuring that the Governing Body acts in the best interests for the health of the local population at all times Ensure, through the appropriate support, information and evidence, that the Governing Body is continuously able to discharge its duties and responsibilities as set out in the CCG s constitution Plan and chair Governing Body (and other) meetings with multi- professional and/or multiple stakeholder involvement and take an active role in other committees as required or directed by the Governing Body Ensure that the CCG generally and the Governing Body in particular complies with the organisation's arrangements such that conflicts of interests are managed Ensure that a succession plan is in place for key members of the Governing Body, including the Accountable Officer and Clinical Leader roles Ensure that the CCG's constitutional and governance arrangements are robust and compliant with the law and recommended practice, including from NHS England, and that good governance remains a priority at all times Ensure that public and patients views are heard and that their expectations are understood and, where appropriate, met Ensure that the organisation is able to account to its local patients, stakeholders and NHS England Ensure that decisions are taken with regard to securing the best use of public money 15 Clinical commissioning group governing body members Role Outlines, Attributes and Skills, NHS Commissioning Board Authority, October 2012 Page 13 of 33

Uphold the Nolan Principles of Public Life and reflect them through personal conduct and the development of the CCG culture Support the Clinical Leader and the Accountable Officer to ensure that the CCG remains clinically led (as defined in the constitution) and patient centred Represent and uphold the values of the CCG and be an appropriate role model, promoting equality and diversity for all its patients, staff and other stakeholders 7.4.4 The Chair will be an elected Clinical Executive on the Governing Body and will be selected by Governing Body members. 7.4.5 The Deputy Chair of the Governing Body deputises for the chair of the governing body where he or she has a conflict of interest or is otherwise unable to act or absent. 7.4.6 The Deputy Chair will be one of the lay members appointed to the CCG s Governing Body and will be selected by the CCG s governing body members. 7.4.7 The Accountable Officer of the CCG is a member of the governing body and is responsible for the overall direction and management of the CCG. 7.4.8 The role of accountable officer has been summarised in a national document 16 as: 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; at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems. working closely with the chair of the governing body, the accountable officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (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. 7.4.9 The Accountable Officer will be selected from within the elected Clinical Executives on the governing body in line with national guidance 17. 7.4.10 The Clinical Leader of the CCG will be the senior clinical voice of the CCG in interactions with all stakeholders including NHS England. The Clinical Leader will be an elected clinical executive who is either the Accountable Officer or the Chair of the CCG. 7.4.11 Role of Chief Finance Officer is a member of the governing body and is responsible for providing financial advice to the CCG and for supervising financial control and accounting systems. 16 17 Clinical commissioning group governing body members Role Outlines, Attributes and Skills, NHS Commissioning Board Authority, October 2012 Clinical commissioning group guidance on senior appointments, including accountable officer, NHS England, October 2015 Page 14 of 33

7.4.12 The role has been summarised in national guidance 18 as : being the governing body s professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged; making appropriate arrangements to support, monitor on the CCG s finances; overseeing robust audit and governance arrangements leading to propriety in the use of the CCG s resources; being able to advise the governing body on the effective, efficient and economic use of the CCG s allocation to remain within that allocation and deliver required financial targets and duties; and producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS England; 7.4.13 The Chief Finance Officer will be selected by an assessment and recruitment processes. 8 DECISION MAKING: GOVERNANCE STRUCTURE 8.1 Authority to act 8.1.1 The CCG is accountable for exercising specified statutory functions. These functions may be supplemented by functions delegated by NHS England as provided for under section 13Z of the 2012 Act and as set out in approved delegation agreements. It may grant authority to act on its behalf to: Any of its members Its governing body Employees A committee or sub-committee of the group 8.1.2 The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the CCG as expressed through: this constitution the CCG s scheme of reservation and delegation; and for committees, their terms of reference 8.2 Scheme of Reservation and Delegation 8.2.1 The CCG s scheme of reservation and delegation sets out: those decisions that are reserved for the membership as a whole; those decisions that are the responsibilities of its governing body (and its committees), individual members and employees 8.2.2 The clinical commissioning group remains accountable for all of its functions including those it has delegated. 18 Clinical commissioning group governing body members Role Outlines, Attributes and Skills, NHS Commissioning Board Authority, October 2012 Page 15 of 33

8.3 General 8.3.1 In discharging functions of the CCG that have been delegated to its governing body (and its committees), joint committees and individuals they must: comply with the CCG s principles of good governance, 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, Where appropriate, ensure that member practices have had the opportunity to contribute to the CCG s decision making process. 8.3.2 When discharging their delegated functions, committees, sub committees and joint committees must also operate in accordance with their approved terms of reference 8.3.3 Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: Identify how partners will work together to carry out their commissioning functions Identify the duties and responsibilities of each partner identify of financial arrangements including any pooled budgets and how these will be managed and reported; specify how the risks associated with the collaborative working arrangement will be managed and proportioned between the respective parties; Identify contributions from each partner including details around assets, employees and equipment to be used under the joint working arrangements identify how disputes will be resolved and the steps required to terminate the working arrangements; Specify how decisions are communicated to the collaborative partners. 8.4 Committees of the CCG 8.4.1 The following forum and committee have been established by the CCG: Practice members forum Governing Body (known locally as the Governing Board) 8.4.2 These are able to establish their own sub-committees, to assist them in discharging their respective responsibilities. 8.5 Local Collaborative arrangements 8.5.1 The CCG has entered into joint arrangements with the following clinical commissioning groups: NHS Fareham and Gosport Clinical Commissioning Group NHS South Eastern Hampshire Clinical Commissioning Group 8.5.2 A COMPACT agreement has been developed to summarise the collaborative working arrangements of the three CCGs centred around the shared local health system of Portsmouth and South East Hampshire including: Page 16 of 33

shared commissioning support integrated approach to shared business with local providers participation in a Portsmouth and South East Hampshire Commissioning Collaborative (PSECC) to bring together collective business and agree actions and way forward. 8.5.3 The CCG also has joint arrangements with Portsmouth City Council including: Section 75 agreement for a single integrated commissioning team reporting to the Clinical Strategy Committee of the Governing Body. Section 75 agreement for a single continuing healthcare team reporting to the Clinical Strategy Committee of the Governing Body. Section 75 agreement for the Better Care Fund Section 113 agreement for the joint appointment of a person to be the CCG's Chief Operating Officer and the Council's Director of Adult Social Services a service level agreement for services from Public Health to support the CCG in its business service level agreements for the provision of a number of support services a range of important partnership mechanisms including: Health and Wellbeing Board Public Services Board Adult Safeguarding Board Children s Safeguarding Board Children s Trust Board Safer Portsmouth Partnership Board 8.6 Joint or Delegated Commissioning with other CCGs 8.6.1 The CCG may wish to work formally together with other CCGs in exercise of its commissioning functions and may make arrangements with one or more CCG in respect of: Delegating any of the CCG s commissioning functions to another CCG Exercising any of the commissioning functions of another CCG, or Exercising jointly the commissioning functions of the CCG and another CCG 8.6.2 For the purposes of the arrangements described at 8.6.1 the CCG may: Make payments to another CCG Receive payments from another CCG Make the services of its employees or any other resources available to another CCG Receive the services of the employees or any other resources available to another CCG 8.6.3 Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions Page 17 of 33

8.6.4 For the purposes of the arrangements described at 8.6.1 the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made 8.6.5 Where the CCG makes arrangements with another CCG as described in 8.6.1, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working including those areas set out in 8.3.3. 8.6.6 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to 8.6.1 8.6.7 Only arrangements that are safe and in the interests of patients will be approved by the Governing Board. 8.6.8 Terms of reference for any joint committee established will be agreed with reporting into the Governing Board or other specified committee. The terms of reference will be approved by the CCG through is formal governance and the minutes and any relevant reports will be presented to the Governing Board or specified committee. 8.6.9 Regular reports on all joint commissioning arrangements will be made to the Governing Board and will be reviewed annually in conjunction with the Practice Members Forum. 8.6.10 Should a joint committee arrangement prove to be unsatisfactory then any party may decide to withdraw from the arrangement but will be required to (unless otherwise mutually agreed) give six months notice to other partners, with new arrangements starting from the beginning of the next new financial year. 8.7 Joint or Delegated Commissioning with NHS England for the exercise of CCG Functions 8.7.1 The CCG may wish to work together with NHS England in the exercise of its commissioning functions and may make arrangements to exercise any of the CCG s commissioning functions jointly. 8.7.2 These arrangements may include other CCGs 8.7.3 Where joint commissioning arrangements outlined in 8.7.1 are entered into, the parties may establish a joint committee to exercise the commissioning functions in question. 8.7.4 Arrangements made will be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG. 8.7.5 Where the CCG makes arrangements with NHS England (and another CCG if relevant), the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working including those areas set out at 8.3.3. 8.7.6 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to 8.7.1. 8.7.7 The CCG will act in accordance with any guidance issued by NHS England. Page 18 of 33

8.7.8 Only arrangements that are safe and in the interests of patients will be approved by the Governing Board. 8.7.9 Terms of reference for any joint committee established will be agreed with reporting into the Governing Board or other specified committee. The terms of reference will be approved by the CCG through is formal governance and the minutes and any relevant reports will be presented to the Governing Board or specified committee. 8.7.10 Regular reports on all joint commissioning arrangements will be made to the Governing Board and will be reviewed annually in conjunction with the Practice Members Forum. 8.7.11 Should a joint committee arrangement prove to be unsatisfactory then any party may decide to withdraw from the arrangement but will be required to (unless otherwise mutually agreed) give six months notice to other partners, with new arrangements starting from the beginning of the next new financial year. 8.8 Joint or Delegated Commissioning with NHS England for the exercise of NHS England Functions 8.8.1 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specific NHS England functions. The CCG may enter into such arrangements to: Exercise such functions as specified by NHS England under delegated arrangements Jointly exercise such functions as specified with NHS England 8.8.2 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question. 8.8.3 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties. 8.8.4 For the purposes of the arrangements described at 8.8.1 NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. 8.8.5 Where the CCG makes arrangements with NHS England (and another CCG if relevant), the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working including those areas set out at 8.3.3. 8.8.6 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to 8.7.1. 8.8.7 The CCG will act in accordance with any guidance issued by NHS England. 8.8.8 Only arrangements that are safe and in the interests of patients will be approved by the Governing Board. Page 19 of 33

8.8.9 Terms of reference for any joint committee established will be agreed with reporting into the Governing Board or other specified committee. The terms of reference will be approved by the CCG through is formal governance and the minutes and any relevant reports will be presented to the Governing Board or specified committee. 8.8.10 Regular reports on all joint commissioning arrangements will be made to the Governing Board and will be reviewed annually in conjunction with the Practice Members Forum. 8.8.11 Should a joint committee arrangements prove to be unsatisfactory then any party may decide to withdraw from the arrangement but will be required to (unless otherwise mutually agreed) give six months notice to other partners, with new arrangements starting from the beginning of the next new financial year. 8.9 Practice Members Forum 8.9.1 The practice member s forum will normally meet annually to oversee the work of the governing body. It will review the annual report produced by the governing body and ensure that the constitution remains valid for the future. 8.9.2 Membership of the practice member s forum will be the nominated commissioning GP representative, nominated prescribing GP representative and practice manager from each member practice (or their nominated deputy/ies). 8.10 The Governing Body 8.10.1 Functions - the governing body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution. The governing body has responsibility for: ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCGs principles of good governance 19 (its main function); ensuring that the CCG has appropriate arrangements in place to exercise any functions formally delegated to it by NHS England under section 13Z of the 2012 Act as set out in agreed delegation agreements determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; approving any functions of the CCG that are specified in regulations; 20 leading the setting of vision and strategy approving commissioning plans including the production of annual plan monitoring performance against plans and producing an annual report ensuring that expenditure and use of resources do not exceed the limits set providing assurance of strategic risk producing an annual report oversight of declaration and registration of interests and management of conflicts of interest 19 See section 3.2 on Principles of Good Governance above 20 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act Page 20 of 33

working with NHS England to improve the quality of primary medical services, particularly to take account of need and unexpressed demand Working with NHS England to improve the quality of specialist services Working with the Local Authority on health promotion, prevention and protection matters and as part of the Health and Wellbeing Board 8.10.2 Composition of the Governing Body All members of the governing body have voting rights. The Governing Body will have no fewer than thirteen voting members:: The CCG's Clinical Leader (who will be either the Accountable Officer or Chair of the Governing Body) Chair of the Governing Body (who will also be a Clinical Executive) Accountable Officer (who will be a Clinical Executive) Three other Clinical Executives as representatives of member practices Practice Manager representative of member practices Four Lay Members: i) One with a lead role in overseeing key elements of financial management and audit ii) One with a lead role in championing patient and public participation involvement iii) One with a lead role in respect of the CCG's delegated primary care commissioning responsibilities iv) One with a portfolio of responsibilities to be determined from time to time by the CCG v) One of i) or ii) will also be appointed deputy chair One registered nurse clinical independent representative One secondary care specialist doctor clinical independent representative The chief finance officer The chief operating officer The Director of Public Health from Portsmouth City Council (who will lead on reducing on health inequalities for the Governing Body) The Chief Executive from Portsmouth City Council 8.10.3 Other individuals may be invited to attend in a non-voting capacity depending on the nature of the business to be transacted. 8.10.4 Committees of the Governing Body the governing body has appointed the following committees: a) Audit Committee the audit committee, which is accountable to the CCG s governing body, will support the governing body discharge its functions related to overseeing efficiency, effectiveness, economy and governance, including by approving the annual accounts, annual report, risk management arrangements and internal control framework. The committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG s activities that support the achievement of the CCG s objectives. This will include providing the governing body with an independent and objective view of the CCG s financial systems, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to finance. The governing Page 21 of 33

body has approved and keeps under review the terms of reference for the audit committee, which includes information on the membership of the audit committee. b) Remuneration Committee - the remuneration committee, which is accountable to the CCG s governing body makes recommendations to the governing body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The governing body has approved and keeps under review the terms of reference for the remuneration committee, which includes information on the membership of the remuneration committee. c) Clinical Strategy Committee The Clinical Strategy Committee, which is accountable to the CCG s governing body, undertakes the following roles: drives service transformation and design making recommendations to the Governing Board Considers options for future service delivery and commissioning strategies Oversight of patient, public, stakeholder and member practice engagement in the development of commissioning ideas and strategies Management of prospective procurements and approval of procurements within delegated limits oversees the planning and prioritisation process, oversees development of solutions to needs and delivery, including the CCG s QIPP requirements, promotes a culture of continuous improvement and innovation, with respect to safety of services clinical effectiveness and patient experience The governing body has approved and keeps under review the terms of reference for the Clinical Strategy Committee, which includes information on the membership. d) Primary Care Commissioning Committee - the primary care commissioning committee, which is accountable to the CCG s governing body, is the corporate decision-making body for the management of the CCGs delegated primary care commissioning responsibilities and the exercise of delegated powers from NHS England. The governing body has approved and keeps under review the terms of reference for the primary care commissioning committee, which includes information on the membership of the primary care commissioning committee. 8.10.5 The Governing Body may establish other committees, and the Clinical Strategy Committee may form other sub-committees to assist them in discharging their responsibilities. Any such committee or sub-committees will have terms of reference approved by either the Governing Body or Clinical Strategy Committee, as appropriate, which will include information on the membership. 8.11 Decision Making 8.11.1 To support its decision making process the CCG has a prioritisation framework to be used in its decision making and prioritisation processes. The purpose of the prioritisation framework is to support and underpin the decision making process of the CCG through: Page 22 of 33