NHS MANCHESTER CLINICAL COMMISSIONING GROUP CONSTITUTION

Transcription

1 NHS MANCHESTER CLINICAL COMMISSIONING GROUP CONSTITUTION Version: 1.0 NHS England Effective Date: 1 April 2017

2 [Page left intentionally blank] NHS Manchester Clinical Commissioning Group s Constitution 2

3 CONTENTS Part Description Page Foreword 5 1 Introduction and Commencement 1.1 Name Statutory framework Status of this constitution Amendment and variation of this constitution 6 2 Area Covered 8 3 Membership 3.1 Membership of the CCG Eligibility Termination of Membership 9 4 Mission, Values and Aims 4.1 Mission Values Aims Principles of good governance Accountability 11 5 Functions and General Duties 5.1 Functions General duties General financial duties Other relevant regulations, directions and documents 21 6 Decision Making: The Governing Structure 6.1 Authority to act General The Commissioning Board The Partnership Board The Governing Body Scheme of Reservation and Delegation Joint Arrangements Joint Commissioning Arrangements with Local Authorities Joint Commissioning Arrangements with other Clinical Commissioning Groups Joint Commissioning with NHS England for the exercise of Clinical 33 Commissioning Group Functions Joint commissioning arrangements with NHS England for the 34 exercise of NHS England s Functions 6.7 Joint Appointments with other Organisations 35 NHS Manchester Clinical Commissioning Group s Constitution - 3 -

4 Part Description Page Roles and Responsibilities 6.8 Practice representatives Other GPs or primary care health professionals All members of the CCG s Commissioning Board, Partnership Board 36 and Governing Body 6.11 The Chair of the Commissioning Board, Partnership Board and 37 Governing Body 6.12 The Deputy Chair of the Commissioning Board and Partnership 37 Board 6.13 The Vice Chair of the Governing Body Role of the Accountable Officer Role of the Chief Finance Officer Role of the Secondary Care Doctor Role of the Registered Nurse Role of the Lay Member for Audit and Finance Role of the Lay Member for Governance Role of the Lay Member for Patient and Public Involvement 40 7 Standards of Business Conduct and Managing Conflicts of Interest 7.1 Standards of Business Conduct Conflicts of interest Declaring and registering interests Managing Conflicts of Interest: General Transparency in Procuring Services 43 8 The CCG as an Employer 44 9 Transparency, Ways of Working and Standing Orders 9.1 General Standing orders 46 Appendix Description Page A Definitions of Key Descriptions used in this Constitution 48 B List of Member Practices 51 C Standing Orders of the Members 55 D Shared Standing Orders of the Commissioning Board and Partnership 59 Board E Standing Orders of the Governing Body 67 F Scheme of Reservation and Delegation including financial scheme of 72 delegation G Prime Financial Policies 85 H Lower Super Output Areas (LSOAs) 97 I The Nolan Principles 102 NHS Manchester Clinical Commissioning Group s Constitution - 4 -

5 J The Seven Key Principles of the NHS Constitution 103 K Terms of Reference 104 L Delegation Agreement Schedule 2 tbc NHS Manchester Clinical Commissioning Group s Constitution - 5 -

6 FOREWORD Manchester is an inspirational city, from its talented and diverse population - which includes an army of active volunteers - to its parks, canals and open spaces, universities, industries and world-leading health care facilities. Manchester s people are both its future and its greatest strength. It s this recognition of the very essence of Manchester that leads our drive for a joined up health and social care system - that enables people who live here to stay well or avoid illness, that provides excellent care during illness, and works with people to manage their long term conditions. But that s only a part of the health and social care picture. We also know that we need to connect and strengthen the other building blocks that affect mental and physical wellbeing from shelter and housing, education, employment, to good food, a good environment, clean air and active, healthy lifestyles. As you read this, the foundations to achieve our ambitions will be moving into place, starting with this: Manchester Health and Care Commissioning, followed by the single hospital service and then the local care organisation. These are the three key pillars outlined in the city s locality plan which is its vision for integrated care. These pillars will support and improve the health and wellbeing of Manchester people and reduce inequalities in health. They will also help people to achieve their full potential by supporting all that is marvellous about the city and it s long-term economic and growth prospects described in the Our Manchester strategy. We now have a once-in-a-lifetime opportunity to have a radical effect on the health outcomes of our population, through our locality plan, the transformation funds which Greater Manchester devolution has brought us, and, perhaps even more importantly by working together. Manchester Health and Care Commissioning (MHCC) embodies this approach - as a partnership of the city council and Manchester Clinical Commissioning Group we can be stronger, more efficient, and more effective. Along with its many positives Manchester has significant challenges, in particular around the conditions and illnesses associated with poverty and health outcomes which are among some of the worst in England. Too often members of our communities develop long-term conditions earlier than they need to and we miss opportunities to prevent the preventable. Rescuing people in crisis through expensive hospital services is how our system typically responds. We now need to become much more proactive and prevent those crises by working with people earlier on, and in community settings closer to home that help to keep people independent. Any barriers we have between our services working together must come down; just as any obstacles must be removed that create a divide between mental and physical health. To achieve our ambitions, primary care - in particular GP services, and also pharmacies, ophthalmologists and dentistry - need to feature at the very heart of our plans, building a sustainable, flexible and responsive system which can meet the range of needs of our population. NHS Manchester Clinical Commissioning Group s Constitution - 6 -

7 That voice for primary care will continue to be heard through Manchester CCG as a clinically-led organisation whose membership includes every general practice in the city, which in turn speak for patients. Listening to and understanding the needs of patients and of our practices, providing support, and challenging unwarranted variation will always be a vital role. And now, that role also fits within a wider picture in Manchester: one that marries health and social care services and recognises all aspects of a person s wellbeing, to help people fulfil both ambitions and their potential. Dr Philip Burns Chair NHS Manchester Clinical Commissioning Group s Constitution - 7 -

8 1. INTRODUCTION AND COMMENCEMENT 1.1. Name The name of this clinical commissioning group is NHS Manchester Clinical Commissioning Group (CCG) Statutory Framework Clinical commissioning groups are established under the Health and Social Care Act 2012 ( the 2012 Act ). 1 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 ). 2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution Status of this Constitution This constitution is made between the members of NHS Manchester Clinical Commissioning Group and has effect from 1 April 2017, when the NHS Commissioning Board (hereafter referred to as NHS England) established the CCG. 5 The constitution is published on the CCG s website at Amendment and Variation of this Constitution This constitution can only be varied in two circumstances. 6 a) where the CCG applies to NHS England and that application is granted; or See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act Duties of clinical commissioning 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 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 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued NHS Manchester Clinical Commissioning Group s Constitution - 8 -

9 b) where in the circumstances set out in legislation NHS England varies the CCG s constitution other than on application by the CCG. NHS Manchester Clinical Commissioning Group s Constitution - 9 -

10 2. AREA COVERED 2.1. The geographical area covered by NHS Manchester Clinical Commissioning Group is fully coterminous with Manchester City Council The extent of the coverage for MCCG within Manchester City Council is defined in the 244 Lower Super Output Areas (LSOA s) The map below shows the geographical area of NHS Manchester CCG. 8 7 Appendix I, Lower Super Output Areas (LSOAs) 8 Appendix B, List of Member Practices NHS Manchester Clinical Commissioning Group s Constitution

11 3. MEMBERSHIP 3.1. Membership of the CCG The practices which comprise the members of the CCG can be found in Appendix B together with the signatures of the practice representatives confirming their agreement to this constitution Membership of the CCG is open to all practices that sit within the wards of Ancoats, Ardwick, Baguley, Bradford, Brooklands, Burnage, Charlestown, Cheetham, Chorlton, Chorlton Park, City Centre, Clayton, Crumpsall, Didsbury, East Didsbury, Fallowfield, Gorton North, Gorton South, Harpurhey, Higher Blackley, Hulme, Levenshulme, Longsight, Miles Platting, Moss Side, Moston, Newton Heath, Northenden, Old Moat, Rusholme, Sharston, West Didsbury, Whalley Range, Withington, Woodhouse Park and Wythenshawe The CCG may extend membership to any other practice seeking membership via formal request to the Commissioning Board. Such applications will be assessed on an ad hoc basis by the Commissioning Board, following consultation with local member practices, with a recommendation to the next Group meeting for ratification. Reasons for leaving their current CCG must also be included. NHS England approval will also be required Membership is determined by signatory to this agreement by the practice representative who may be a partner or equivalent. The practice as a whole is considered to be a member of the CCG Membership will continue thereafter unless the practice resigns Eligibility Providers of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this CCG Termination of Membership A member practice ceases to be a member if: a) a member formally resigns from being a member of the CCG by giving at least six months written prior notice of their resignation to the Commissioning Board and that the written notice includes prior consent from NHS England. b) NHS England removes a member of the CCG in accordance with the Act. c) that practice merges with any other practice, unless that other practice is an existing member. d) if a member practice no longer holds a primary medical services contract. 9 See section 14A(4) of the 2006 Act, inserted by section 25 of the Regulations to be made NHS Manchester Clinical Commissioning Group s Constitution

12 Membership of the CCG is not transferable. 4. MISSION, VALUES AND AIMS 4.1. Mission The mission of the CCG is: a) We are determined to make Manchester a city where everyone can live a healthier life. b) We will support you and your loved ones, investing in what you tell us is important to you. c) We will make sure you receive the right care in the right place and at the right time, delivered by kind, caring people that you can trust. d) We will make the most of our money by reducing waste and funding the things we know will work. e) We will forge strong partnerships with people and organisations, in the city and across the region, and put health and wellbeing at the heart of the plans for developing Manchester's future as a thriving city Values The values that lie at the heart of the CCG s work are: a) Positive b) Collaborative c) Fair 4.3. Aims The CCG s aims are to: To improve the health and wellbeing of people in Manchester. To strengthen the social determinants of health and promote healthy lifestyles. To ensure services are safe, equitable and of a high standard with less variation. To enable people and communities to be active partners in their health and wellbeing. To achieve a sustainable system. NHS Manchester Clinical Commissioning Group s Constitution

13 4.4. Principles of Good Governance In accordance with section 14L(2)(b) of the 2006 Act, 10 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; 11 c) the standards of behaviour published by the on Standards in Public Life (1995) known as the Nolan Principles ; 12 d) the seven key principles of the NHS Constitution; 13 e) the Equality Act 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 Accountability The CCG will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, this will include: a) publishing its constitution; b) appointing independent lay members and non GP clinicians to its Governing Body; c) holding meetings of its Commissioning Board, Partnership Board and Governing Body in public (except where the CCG considers that it would not be in the public interest in relation to all or part of a meeting); 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 See Appendix J See Appendix K See NHS Manchester Clinical Commissioning Group s Constitution

14 d) ensuring lay involvement in decisions about functions delegated by NHS England; e) publishing annually a commissioning plan; f) complying with local authority health overview and scrutiny requirements; g) meeting annually in public to publish and present its annual report; h) producing annual accounts in respect of each financial year which must be externally audited; i) having a published and clear complaints process; j) complying with the Freedom of Information Act 2000; k) delivering an ongoing programme of patient, public and stakeholder engagement to inform the CCG s commissioning activity; l) developing and utilising a number of external communication channels including an accessible website and a range of social media platforms; m) its membership of Manchester Health and Wellbeing Board; and n) providing information to NHS England as required The Governing Body of the CCG will have an ongoing role in reviewing the CCG s governance arrangements to ensure that the CCG continues to reflect the principles of good governance. NHS Manchester Clinical Commissioning Group s Constitution

15 5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions The functions that the CCG is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. They relate to: a) commissioning certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of: all people registered with member GP practices; and people who are usually resident within the area and are not registered with a member of any clinical commissioning group. b) commissioning emergency care for anyone present in the CCG s area; c) paying its employees remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the CCG s employees; d) determining the remuneration and travelling or other allowances of members of its Commissioning Board, Partnership Board or Governing Body or committees as appropriate; e) appropriately and effectively manage conflicts of interest In discharging its functions the CCG will: a) act 15, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and the NHS England of their duty to promote a comprehensive health service 16 and with the objectives and requirements placed on NHS England through the mandate 17 published by the Secretary of State before the start of each financial year by: a) setting out its commissioning priorities and commissioning intentions in the Commissioning Plan; b) having a Scheme of Reservation and Delegation, Standing Orders and Prime Financial Policies in place and mechanisms in place to ensure adherence to these; c) requiring progress of delivery of the duty to be monitored through its performance reporting and other general reporting mechanisms; d) having robust governance arrangements in place that are monitored through an appropriate committee or sub-committee See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

16 b) meet the public sector equality duty 18 by: a) working in partnership with patients, public and staff to raise awareness of and promote the positive aspects of equality, diversity and inclusion in everything we do; b) requiring the Accountable Officer to ensure the strategy follows legislative frameworks, mandatory requirements, best practice guidance and monitor progress; c) publishing annually a report to demonstrate compliance with this general duty across all functions; d) ensuring that equality, diversity and inclusion is embedded into the CCG s culture and that it is incorporated in its values, processes and behaviours; e) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee. c) Work in partnership with its local authority to develop joint strategic needs assessments 19 and joint health and wellbeing strategies 20 by: a) creating a single commissioning function in Manchester, jointly led by the CCG and Manchester City Council; b) having appropriate representation as members of Manchester s Health and Wellbeing Board; c) having systems and processes in place to work in partnership with Manchester City Council to achieve partnership working and promote public health; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee General Duties in Discharging its Functions Further discharge of the CCG s statutory functions will: Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements 21 by: a) working in partnership with patients, carers and the local community to secure the best care for them; See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

17 b) ensuring patient, public involvement and patient experience is valued and local people s views have an identifiable impact on our decision making; c) our patient and public engagement mechanisms and methods are sufficiently varied to meet the needs of our diverse population; d) publish information about health services on our website, and through other media, encouraging and acting on feedback through our Public and Patient Advisory Group and other engagement mechanisms; e) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee. f) Statement of principles: i. Ensure co-production, engagement and involvement of patients, carers, public and communities of identity/interest in the development of our commissioning decisions; ii. Ensure engagement and involvement of health and wellbeing boards and local authorities in everything we do, including our commissioning decisions; iii. Develop and maintain mechanisms for gaining a broad range of views then analysing and acting on these; iv. Ensure that the views of individual patients and carers are translated into commissioning decisions; v. Ensure that the voice of each GP practice and their population is sought and acted on; vi. Promote shared decision making with patients about their care; vii. Develop robust governance mechanisms to ensure that the above objectives are achieved and can clearly be demonstrated Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 22 by: a) actively promoting the NHS Constitution within our organisation and via the CCG s website, and in our engagement with the public, providers of services, patients and other key stakeholders; b) acting consistently with regards to decision making and commissioning actions by delegating responsibility to the appropriate committees; c) cross-referencing our commissioning and operational planning to the NHS Constitution; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee. 22 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act) NHS Manchester Clinical Commissioning Group s Constitution

18 Act effectively, efficiently and economically 23 by: a) commissioning value for money services and being innovative using best practice models and evidence; b) focusing on maximising patient care resources; c) ensuring the CCG operates within the corporate governance framework (Standing Orders, the Scheme of Reservation & Delegation and Prime Financial Policies) Act with a view to securing continuous improvement to the quality of services 24 by: a) embedding quality in the culture of the organisation through its mission; b) putting in place performance management systems and defining robust outcomes that assess quality, patient safety processes, patient complaints, trends and acting on information; c) working jointly with other commissioning organisations to ensure continuous improvement in the quality of the system wide services; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Assist and support NHS England in relation to the Board s duty to improve the quality of primary medical services 25 by: a) supporting practices by encouraging member practices to share clinical best practice; b) requiring progress of delivery of this duty to be monitored through the CCG s reporting mechanisms; c) working with NHS England to ensure effective commissioning of primary medical services; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Assist and support NHS England in its responsibility to improve the quality of specialised services by: a) working collaboratively with Greater Manchester Health and Social Care Partnership and Greater Manchester CCGs; b) ensuring effective reporting and monitoring through the CCG s reporting mechanisms Have regard to the need to reduce inequalities 26 by: See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

19 a) identifying a senior clinical lead with responsibility for this area; b) requiring progress of delivery of the duty to be monitored through the CCG s performance reporting mechanisms; c) work with Manchester City Council to target our commissioning to improve the health of those with the poorest health outcomes; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Promote the involvement of patients, their carers and representatives in decisions about their healthcare 27 by: a) informing local people about health, health services and the CCG s activities; b) listening to local people s experiences and needs; c) ensuring the providers we commission listen to, co-design and act upon, the view of local people; d) enabling people to live healthily and manage their conditions; e) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Act with a view to enabling patients to make choices 28 by: a) ensuring that patients are informed about the options they have so they can be fully involved in managing their care; b) ensuring that patients are empowered to make choices about how their health is managed including self-care when appropriate; c) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Obtain appropriate advice 29 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) taking advice and guidance from local professional groups when commissioning for the community and voluntary sector, primary and secondary services; b) working with organisations such as NICE and Public Health Manchester to ensure evidence based interventions are incorporated into our service redesign, clinical senates and strategic clinical networks as they become established; c) complying with board membership requirements to include the appropriate clinical, managerial and lay member skill mix; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

20 Promote innovation 30 by: a) forging strong links with local universities and other academic institutions; b) forging strong links with national and collegiate organisations promoting innovations in healthcare; c) harnessing the innovation and ideas which exist within our communities and our local voluntary and community sector; d) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Promote research and the use of research 31 by: a) working with local, national and international partners and stakeholders to develop research in our health economy; b) assessing best practice and research findings and incorporating into service redesign and specifications in both hospital and out of hospital care; c) forging links with local universities and other academic institutions; d) monitoring progress of the delivery of the duty by the relevant committee or sub-committee Have regard to the need to promote education and training 32 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 for Health in the discharge of his related duty 33 by: a) having structures in place to engage with providers about implementing the CCG s Commissioning Strategy and Operational Plans; b) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the CCG considers that this would improve the quality of services or reduce inequalities 34 by: a) working collaboratively with our partners including the voluntary sector; b) delivering one of the three priority work streams within our Commissioning Strategy which is focused on integrating care; c) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee; See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

21 d) working collaboratively with Manchester City Council. Manchester City Council may delegate its responsibilities to commission health and adult social care the CCG. The CCG and the Council will establish a Commissioning Board, as a of the CCG. The Commissioning Board will act as the decision-making body and will integrate the commissioning of the provision of health, social care, public health and related public services for the City of Manchester General Financial Duties the CCG will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 35 by: a) keeping accurate accounts; b) supporting member practices to achieve balanced budgets; c) managing our resources effectively; d) supporting the delivery of transformation plans and locality plan; e) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by NHS England for the financial year 36 by: a) sharing information between practices; b) providing support with managing areas including referrals, prescribing, activity monitoring, mental health and continuing care; c) using our financial performance dashboard; d) monitoring practices to ensure they take ownership of their budgets; e) supporting the transformation agenda and delivery of the locality plan; f) requiring progress of the delivery of the duty to be monitored through the appropriate committee Take account of any directions issued by NHS England in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHS England 37 by: a) having in place contingency funds; b) effectively managing budgets; c) requiring progress of the delivery of the duty to be monitored through the appropriate committee Publish an explanation of how the CCG spent any payment in respect of quality made to it by NHS England 38 by: See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

22 a) requiring progress of the delivery of the duty to be monitored through the appropriate committee. 5.4 Other Relevant Regulations, Directions and Documents The CCG will: a) comply with all relevant regulations; b) comply with directions issued by the Secretary of State for Health or NHS England; and c) take account, as appropriate, of documents issued by NHS England The CCG will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant CCG policies and procedures. 38 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act NHS Manchester Clinical Commissioning Group s Constitution

23 6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act The CCG is accountable for exercising the statutory functions of the CCG. It may grant authority to act on its behalf to: a) the Commissioning Board; b) the Partnership Board c) its Governing Body; d) a committee or sub-committee of the CCG as appropriate; e) any of its members; f) employees General In discharging functions of the CCG that have been delegated to them, the Commissioning Board (and its sub-committees), the Partnership Board, (and its committees), the Governing Body (and its committees), and any other committee, sub-committee, member or individual must: a) comply with the CCG s principles of good governance; b) operate in accordance with the CCG s scheme of reservation and delegation; c) comply with the CCG s standing orders; d) comply with the CCG s duties set out in Chapter 5 of this constitution and its arrangements for discharging them; e) comply with the statutory guidance on conflicts of interest f) where appropriate, ensure that member practices have had the opportunity to contribute to the CCG s decision making process When discharging their delegated functions, committees, sub-committees and joint committees must also operate in accordance with their approved terms of reference and/or standing orders. NHS Manchester Clinical Commissioning Group s Constitution

24 A committee of the CCG may consist of or include persons other than members or employees of the CCG A committee of the CCG can include a joint committee of the CCG and one or more other clinical commissioning groups and/or one or more local authorities and/or NHS England. Additional members may be co-opted onto a committee at the discretion of the committee or its Chair All decisions are taken in good faith at a meeting of any committee or subcommittee and shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting, or the appointment of a member attending the meeting. In such an event the relevant decision will be reviewed by the Governing Body when next fully constituted and if appropriate ratified s will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the CCG or the committee they are accountable to Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) identify the roles and responsibilities of those statutory organisations who are working together; b) identify any pooled budgets and how these will be managed and reported in annual accounts; c) specify under which body s scheme of reservation and delegation and supporting policies the collaborative working arrangements will operate; d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties; e) identify how disputes will be resolved and the steps required to terminate the working arrangements; f) specify how decisions are communicated to the collaborative partners. Overview The key components of the CCG s governance structure are as follows: 6.3. The Commissioning Board NHS Manchester Clinical Commissioning Group s Constitution

25 The CCG shall have a committee known as the Commissioning Board which shall be accountable to the members in accordance with the arrangements set out in Appendix C The Commissioning Board s standing orders are as set out at Appendix D The Commissioning Board may appoint other committees of the CCG on its behalf as the Commissioning Board considers may be appropriate and delegate to them the exercise of any functions of the CCG which the Commissioning Board in its discretion considers to be appropriate but excluding the functions exercisable by the Partnership Board and the Governing Body The Commissioning Board shall approve and keep under review the terms of reference for each committee which includes information on the membership The Commissioning Board shall exercise all the functions exercisable by the CCG which are not otherwise delegated in accordance with this constitution. Such functions include but are not limited to: a) Approving and overseeing the arrangements for discharging the CCG s statutory duties associated with its commissioning functions not covered by the Partnership Agreement with Manchester City Council, 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 consultation; b) Overseeing the exercise of the Primary Care commissioning functions delegated by NHS England; c) Efficient joint decision making and clearer decision making; d) Approving arrangements for co-ordinating the commissioning of services with other CCGs and or with the local authority(ies), where appropriate; e) Approving the CCG s commissioning plan; f) Approving the CCG s contracts for any corporate and commissioning support; g) Developing, agreeing and monitoring service transformation plans; h) Overseeing quality of services across the city and making decisions on any improvement action required; NHS Manchester Clinical Commissioning Group s Constitution

26 i) Reviewing and evaluating services, making decisions on commissioning and decommissioning as appropriate; j) Approving decisions using delegated powers under section 75 of the 2006 Act, apart from in the case of decisions reserved to the Partnership Board within its terms of reference; k) Making decisions on the review, planning, funding and procurement of primary medical services in Manchester, under delegated authority from NHS England; l) Approving decisions that individual members or employees of the CCG participating in joint arrangements on behalf of the CCG can make; m) Approving arrangements for financial risk sharing and or risk pooling with other organisations; n) Approving variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the CCG s ability to achieve its agreed strategic aims; o) Approving the CCG s arrangements for engaging patients and their carers in decisions concerning their healthcare; p) Approving the CCG s arrangements for safeguarding children and vulnerable adults; q) Approving arrangements for supporting NHS England in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services; r) Approving arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes; s) Subject to the approval of the Governing Body, adopting and amending the CCG s overarching scheme of reservation and delegation for inclusion in the CCG s constitution; t) Subject to the approval of the Governing Body,adopting and amending the CCG s financial scheme of delegation that underpins the CCG s overarching scheme of reservation and delegation as set out in its constitution; u) Approving who can execute a document by signature / use of the seal; NHS Manchester Clinical Commissioning Group s Constitution

27 v) Approving the CCG s operating structure; w) Agreeing the vision, values and overall strategic direction of the CCG; x) Approving the arrangements for discharging the CCG s statutory financial duties; y) Approving the CCG s budgets that meet the financial duties as set out in the constitution; z) Approving the arrangements for discharging the CCG s statutory duties as an employer; and aa) Together with the Partnership Board providing assurance to the Governing Body, CCG members and other relevant parties on delivery of statutory functions and responsibilities exercisable by the CCG The composition of the Commissioning Board is: GP Chair (v) GP Board Members x 3 (v) Lay Member for Governance (v) Lay Member for Audit and Finance (v) Lay Member for Patient and Public Involvement (v) Executive Councillor as nominated by Manchester City Council (Deputy Chair) (v) Executive Councillor as nominated by Manchester City Council (v) Secondary Care Doctor (v) Board Nurse (v) Chief Accountable Officer (v) Chief Finance Officer (v) Director of Strategic Commissioning (including the statutory DASS role) (v) Executive Director of Planning and Operations Executive Director of Population Health and Wellbeing Clinical Director Executive Director of Nursing and Safeguarding City Treasurer Those roles with a (v) after them are the voting members of the Commissioning Board. save that when the Commissioning Board exercises primary care commissioning functions delegated by NHS England, its composition shall be: Lay Member for Governance NHS Manchester Clinical Commissioning Group s Constitution

28 Lay Member for Audit and Finance Lay Member for Patient and Public Involvement Executive Councillor as nominated by Manchester City Council (Chair) Executive Councillor as nominated by Manchester City Council Secondary Care Doctor Board Nurse Chief Accountable Officer Chief Finance Officer Director of Strategic Commissioning (including the statutory DASS role) Executive Director of Planning and Operations Executive Director of Population Health and Wellbeing Clinical Director Executive Director of Nursing and Safeguarding City Treasurer Sub-committees of the Commissioning Board The Board shall have the following sub-committees: Finance and Contracting This committee ensures that all issues relating to finance, contracting information and performance relevant to NHS Manchester CCG are discussed and key actions and recommendations reported to the Board. Governance This committee is responsible for giving assurance to the Board that the organisation is well run and its key areas of risks are known and managed sufficiently. Clinical This committee is responsible for overseeing work relating to service improvement and commissioning within the City of Manchester. Clinical Quality & Performance This committee is responsible for promoting a culture of quality within Manchester as a means by which the CCG s strategic objects are met. Executive The Executive is responsible for the operational delivery of organisational objectives and the effective running of the organisation. They will also advise and support the Board in setting strategic direction and decision making in line with the Scheme of Reservation and Delegation. Patient and Public Advisory Group Provide advice, guidance and assurance on CCG decision making from a patient, public and community perspective. NHS Manchester Clinical Commissioning Group s Constitution

29 The terms of reference can be found in Appendix K and on the CCG website at The Commissioning Board may appoint such other sub-committees as it considers appropriate to exercise functions that are exercisable by it insofar as such functions may be sub-delegable The Partnership Board The CCG shall have a committee known as the Partnership Board which shall be accountable to the members in accordance with the arrangements set out in Appendix C The Partnership Board s standing orders are set out at Appendix D The Partnership Board shall: a) Exercise the CCG s NHS Functions and the Council Health-related Functions in accordance with the Partnership Agreement; b) Together with the Commissioning Board provide assurance to the Governing Body, CCG members and other relevant parties on delivery of statutory functions and responsibilities exercisable by the CCG The composition of the Partnership Board is the members of the Commissioning Board in post from time to time The Partnership Board may appoint sub-committees as it considers appropriate to exercise any functions that are exercisable by it insofar as any such functions may be sub-delegable The Governing Body The Governing Body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 of the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations. The Governing Body has responsibility for: a) ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG s principles of good governance (its main function); b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under NHS Manchester Clinical Commissioning Group s Constitution

30 paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; c) approving any decision taken by the Commissioning Board to enter into the Partnership Agreement; and, if it considers it appropriate, initiate and approve the CCG s exit from the Partnership Agreement; d) approving any recommendation made by the Commissioning Board to change the CCG s overarching scheme of reservation and delegation; e) proposing to the members any amendments to this constitution which will assist in supporting a) above The composition of the Governing Body is the following members of the Commissioning Board in post from time to time: GP Chair GP Board Members x 3 Lay Member for Governance Lay Member for Audit and Finance Lay Member for Patient and Public Involvement Secondary Care Doctor Board Nurse Chief Accountable Officer Chief Finance Officer s of the Governing Body- the Governing Body shall have the following committees: a) Audit the audit committee, which is accountable to the Governing Body, provides the Governing Body with an independent and objective view of the CCG s governance arrangements including the controls environment, financial systems, financial information and compliance with laws, regulations and directions governing the CCG. The Governing 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. The Audit may include individuals who are not members of the Governing Body. b) Remuneration the remuneration committee, which is accountable to the 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 NHS Manchester Clinical Commissioning Group s Constitution

31 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. The Remuneration may only include individuals who are members of the Governing Body The Governing Body may appoint such other sub-committees as it considers appropriate to exercise functions exercisable by it The audit committee may include individuals who are not members of the Governing Body. The other committees of the Governing Body (other than the remuneration committee) may include individuals who are: a) Members, officers or Governing Body members of the Group or another clinical commissioning group; b) Partners or employees of members of the Group or another clinical commissioning group; c) Officers of NHS England Each such committee shall regulate its proceedings in accordance with its terms of reference s will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the Governing Body or the committee they are accountable to All decisions taken in good faith at a meeting of the Governing Body or any committee or subcommittee of it shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting, or the appointment of a member attending the meeting The s are accountable to the CCG s Governing Body. The Governing Body shall approve and keep under review the terms of reference for each committee which includes information on the membership Scheme of Reservation and Delegation The CCG s scheme of reservation and delegation sets out: a) those decisions that are reserved for the membership as a whole; b) those decisions that are the responsibilities of its Commissioning Board (and its sub-committees), the Partnership Board (and its subcommittees),governing Body (and its committees), the CCG s other committees and sub-committees, members and employees. 39 See Appendix F NHS Manchester Clinical Commissioning Group s Constitution