NHS OLDHAM CLINICAL COMMISSIONING GROUP CONSTITUTION

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1 NHS OLDHAM CLINICAL COMMISSIONING GROUP CONSTITUTION Version 0.7: April 2018 NHS England Effective Date: TBC Version 0.7: Effective Date: TBC Page 1 of 61

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3 FOREWORD NHS Oldham Clinical Commissioning Group (CCG) is made up of every family doctor in Oldham and is led by a Governing Body that also includes family doctors and other health professionals. As the CCG, we will look at what we want to spend money on and how much we want to spend in areas including: cancer, respiratory disease (breathing), mental health, hospital operations an d prescribing of drugs. We are committed to involving local people and stakeholders in our plans for the future. OUR VISION The vision is to improve health and healthcare for the people of Oldham, by commissioning the highest quality healthcare in services near to the patient, in an integrated fashion and at the best value for money. OUR OVERARCHING AIM To become an Accountable Care Organisation that is an alliance of GP practices, which involves the whole multidisciplinary practice team. All members will share risk and assume accountability for the resources used in enabling high quality care for the people of Oldham. OUR TRIPLE AIM OBJECTIVES Improving the health of the people of Oldham Improving the care they receive and their experience of it Delivering best value for money by using our resources effectively The constitution sets out the arrangements made by the CCG to meet its responsibilities for commissioning care for the people for whom it is responsible. It describes the governing principles, rules and procedures that the CCG will establish to ensure probity and accountability in the day-today running of the CCG; 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. The constitution includes: the name of the CCG the membership of CCG the area of CCG the arrangements for the discharge of CCG s functions and those of its Governing Body the procedure to be followed by the CCG and its Governing Body in making decisions and securing transparency in its decision making arrangements for discharging the CCG s duties in relation to registers of interests and managing conflicts of interest arrangements for securing the involvement of persons who are, or may be, provided with services commissioned by the CCG in certain aspects of those commissioning arrangements and the principles that underpin these. The constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment: the CCG s member practices the CCG s employees individuals working on behalf of the CCG anyone who is a member of the CCG s Governing Body (including the Governing Body s Audit and Remuneration committees) anyone who is a member of any other committee(s) or sub-committee(s) established by the CCG or its Governing Body. Version 0.7: Effective Date: TBC Page 3 of 61

4 CONTENTS Part Description Page Foreword 3 1 Introduction and Commencement Name Statutory framework Status of this constitution Amendment and variation of this constitution 6 2 Area Covered 6 3 Membership Membership of NHS Oldham CCG Eligibility Termination of Membership Member Representatives The Clusters 9 4 Vision, Values and Aims Vision Values Aims and Objectives Principles of Good Governance Accountability Annual General Meeting/Extraordinary General Meeting 12 5 Functions and General Duties Functions General duties General financial duties Other relevant regulations, directions and documents 23 6 Decision Making: The Governing Structure Authority to act Scheme of Reservation and Delegation General Committees of the CCG Council of Members Cluster Cabinet Primary Care Commissioning Committee Joint commissioning arrangements with other Clinical 26 Commissioning Groups 6.9 Joint commissioning arrangements with NHS England for the 27 exercise of CCG functions 6.10 Joint commissioning arrangements with NHS England for the 28 exercise of NHS England s functions 6.11 Joint Commissioning arrangements with Local Authorities Partnership Board Joint Management Executive (Oldham H&SC Leadership Team) Joint Appointments with other organisations The Governing Body Committees of the Governing Body 32 Version 0.7: Effective Date: TBC Page 4 of 61

5 Part Description Page 6.17 Remuneration Committee Audit Committee Commissioning Committee Management Executive Team 34 7 Roles and Responsibilities All members of the CCG s Governing Body The Chair of the Governing Body The Vice Chair of the Governing Body The Accountable Officer / Chief Executive Officer The Chief Clinical Officer / Deputy CCG Accountable Officer The Chief Operating Officer / Strategic Director of Joint 37 Commissioning 7.7 The Strategic Director of Corporate Affairs and Resources The Chief Financial Officer The GP Representatives Other Health Professional Representatives The lay member with a lead role audit, governance and conflict of 39 interest matters 7.12 The lay member with a lead role on patient and public participation 39 matters 7.13 The lay member with a lead role on Equality and Diversity matters Other GP and Primary Care Health Professionals not on the Governing Body 40 8 Standards of Business Conduct and Managing Conflicts of Interest Standards of business conduct Conflicts of interest Declaring and registering interests Managing conflicts of interest: general Managing Conflicts of Interest: Primary Medical Care Managing conflicts of interest: contractors and people who provide 45 services to the Clinical Commissioning Group 8.7 Transparency in procuring services Disputes 45 9 NHS Oldham Clinical Commissioning Group as Employer Transparency, Ways of Working and Standing Orders General Standing orders 47 Appendix Description Page A Definitions of Key Descriptions used in this Constitution 48 B List of Member Practices 50 C Standing Orders 57 D Scheme of Reservation and Delegation 57 E Prime Financial Policies 57 F Nolan Principles 58 G Seven Key Principles of the NHS Constitution 59 H NHS Oldham CCG Committee Structure 60 I End notes 61 Version 0.7: Effective Date: TBC Page 5 of 61

6 1. INTRODUCTION AND COMMENCEMENT 1.1 Name The name of this CCG is NHS Oldham Clinical Commissioning Group. 1.2 Statutory Framework CCGs are established under the Health and Social Care Act 2012 ( the 2012 Act ). i They are statutory bodies that 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 ). ii The duties of CCGs are 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. iii NHS Commissioning Board (hereafter referred to as NHS England) is responsible for determining applications from prospective groups to be established as CCGs iv and undertake an annual assessment of each established group. v It has powers to intervene in a CCG where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so. vi CCGs are clinically led membership organisations made up of general practices. The members of the CCG are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. v ii 1.3 Status of this Constitution The inaugural constitution was made between the members of NHS Oldham Clinical Commissioning Group and had effect from 1 st April 2012, when NHS England established the CCG v iii. This version of the constitution has effect from 1 April 2018, subject to NHS England approval of proposed changes. The constitution is published on the CCG s website at This document will also be made available on request for inspection at our headquarters or will be available upon formal application by post: The Corporate Office NHS Oldham Clinical Commissioning Group Ellen House Waddington St Oldham OL9 6EE 1.4 Amendment and Variation of this Constitution This constitution can only be varied in two circumstances. ix a) where the CCG applies to NHS England and that application is granted; b) where in the circumstances set out in legislation NHS England varies the CCG s constitution other than on application by the CCG. Version 0.7: Effective Date: TBC Page 6 of 61

7 2. AREA COVERED 2.1 The geographical area covered by NHS Oldham CCG is fully coterminous with Oldham Council with the exception of one GP practice that is located in Tameside Borough; this arrangement is supported by the other member practices of the CCG. Version 0.7: Effective Date: TBC Page 7 of 61

8 3. MEMBERSHIP 3.1 Membership of NHS Oldham CCG The practices which comprise the members of the CCG can be found in Appendix B together with Practice name and addresses currently signed-up to this Constitution The practice as a whole is considered to be a member of the CCG. 3.2 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 x Membership is open to all GPs on the performer s list in Oldham and the GP practice located in Tameside, will confer membership of NHS Oldham CCG. Members will become part of an Integrated Care System responsible for commissioning services for all people living within the Oldham Council area and the Tameside practice. 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 Governing Body 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. Membership of the CCG is not transferable. Member representatives Each practice shall appoint a GP Practice Representative to represent their practice s views and act on behalf of the practice in matters relating to the CCG. The role of each member representative is to: a. Represent the Member Practice at meetings of the Council of Members; b. Act as the contact and communications lead for the Member Practice partners and staff in respect of all matters concerning the CCG, acting as the channel for two -way communications between the CCG and the Member Practice; c. Be committed to upholding the NHS Constitution and the Nolan Principles; d. Develop a sound understanding of clinical commissioning, the CCG and the wider interests of the health community; e. Secure the effective participation of practices in exercising of the CCG functions; f. Ensure that practices uses all reasonable endeavours so as to meet the objectives and assist in the development and delivery of the CCG s commissioning plans; g. Foster engagement of the Member Practice in Cluster wide and CCG wide initiatives and the implementation of the CCG s mission, values and aims through its operational plans; h. Ensure delivery of operational plans in the Member Practice; i. ensure that practices share lessons learned and adopt good practice as agreed by the Version 0.7: Effective Date: TBC Page 8 of 61

9 CCG; j. Ensure all staff attend training or otherwise ensure education appropriate to their practice development plans and compliance with accredited pathways, protocols and policies; k. Vote on proposals when required to do so (or a Deputy Practice Representative in accordance with paragraph 3.6 of Appendix C (Standing Orders)); l. Represent the majority view of the Council of Members within the Member Practice Member Practices shall also have a Deputy Practice Representative to deputise for the Practice Representative when he/she is unavailable for any reason. The Clusters Member Practices are organised in five Clusters: North, South, East, West and Central. The Clusters do not have delegated strategic or CCG wide operational decision making powers. They have the following functions, to: Discuss Cluster priorities and inform the Governing Body of these, so that the Governing Body can take them into account in its preparation of commissioning plans and budgets for the CCG, prior to submitting them to the Council of Members for approval; Working within the CCG s strategy and national policy guidelines to design services to address the needs of their population by: undertaking local service re-design for services within the CCG geographic locality; and by contributing to wider Health and Social Care service re-design both at CCG, economy-wide, and regional levels; Facilitate communications between Member Practices within the Clusters and between the Member Practices and the Governing Body; Implement any project specific operational plans delegated to the Clusters by the Governing Body, Chief Clinical Officer, Chief Officer, Chief Financial Officer or any committee; Supporting member practices development including referral management, clinical practice, and prescribing activity Facilitate Member Practices working together and supporting one another to achieve improvements in services; Providing a forum for patient participation group cluster representatives to share their views on clinical and commissioning initiatives and innovations. Each Cluster will have a GP member representative as a Governing Body Member. Version 0.7: Effective Date: TBC Page 9 of 61

10 4. VISION, VALUES AND AIMS 4.1 Vision The vision of NHS Oldham CCG is to improve health and healthcare for the people of Oldham by commissioning the highest quality healthcare services, provided near to the patient, in an integrated fashion and representing best value for money The CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 4.2 Values Good corporate governance arrangements are critical to achieving the CCG s objectives Our core values have been developed from those of the NHS Constitution and reflect the internal culture we need to underpin our overarching aim and objectives: Commitment to Quality of Care we strive to commission high quality care for health and wellbeing that is individualised, appropriate, safe and effective. We assume accountability for the cost and the quality of the care that we commission. Respect and Dignity we value diversity and recognise each person as an individual. We respect each individual s aspirations and commitments and seek to understand their priorities and needs. We understand the importance of what others have to say and the importance of an honest dialogue about what we are and are not able to do. Improving Lives we work hard to improve the health of our population and their experiences of health care. We value excellence, professionalism, innovation and a commitment to service improvement and doing things better. Listening and Engaging with others we find the time to listen and talk where it is needed and make every effort to understand the needs and perspectives of others. We welcome feedback, learn from our mistakes and build on our successes. Working Together we put our patients first and at the heart of everything we do. We will work across localities, Local Medical Committee, organisations and sectors to best understand and meet their needs. Everyone Counts we will work to ensure that we use our resources to best meet the needs of the whole community. We accept that some need more help than others and that our resources are best used in addressing the highest levels of need. We recognise that every single community and staff member has a part to play in making our communities healthier. Clinically Led we are committed to the model of clinical leadership and engagement described in our constitution. We will continue to develop opportunities for clinicians to be further involved within NHS Oldham CCG structures and decision-making forum. Being Responsible we accept that we must work within the resources available and put these to best use for the people of Oldham. We will always strive to reduce costs and/or to improve productivity to get the best value we can without compromising care quality. We will recognise excellence but will also hold our providers to account for the care we commission from them. Employer of Choice although we will not directly employ many staff, we will seek to be a responsible employer. We will look after the health, safety and welfare of our staff whilst they are at work and seek to offer them learning and development to further improve clinical Version 0.7: Effective Date: TBC Page 10 of 61

11 commissioning The values that lie at the heart of the CCG s work are built upon, and enable the achievement of our Vision and Triple Aim Objectives. 4.3 Aims and Objectives The CCG s aims are to: a) establish the model of an Integrated Care System, which is an alliance of Commissioners and Providers comprising the whole multidisciplinary teams, whereby all partners share the risk and assume accountability for the various resources spent caring for the population and for the quality of that care. b) provide a structure within which each clinician is enabled to contribute to commissioning decisions made on their behalf, both within Oldham and through CCG representation at North East Sector and Greater Manchester levels. Membership of NHS Oldham CCG will offer true representation in commissioning decisions through an appointed Governing Body and associated structures NHS Oldham CCG s objectives are: Our key objectives are built upon those of the Triple Aim principles: a) To improve the health of the people of Oldham; b) To improve the care they receive and their experience of it; c) To deliver best value for money by using our resources effectively NHS Oldham CCG will operate with a clear focus on quality as its driving principle by ensuring that clinical outcomes and quality are integral to all commissioning plans and decisions Essential to the effectiveness of this integration is clinical leadership, engagement and the individual professional accountability of all members of the CCG. It is through these that transformational change will be enabled and a clear focus on continuous quality improvement in primary care and within all commissioned services will be established. 4.4 Principles of Good Governance In accordance with section 14L (2)(b) of the 2006 Act, xi 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; xii c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles xiii d) the seven key principles of the NHS Constitution; xiv e) the Equality Act xv Version 0.7: Effective Date: TBC Page 11 of 61

12 4.5 Accountability The CCG will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, including by: a) publishing its constitution; b) appointing independent lay members and non-gp clinicians to its Governing Body; c) holding meetings of its 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); 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) providing information to NHS England as required In addition to these statutory requirements, the CCG will demonstrate its accountability by: a) publishing its principal commissioning and operational policies, e.g. a policy about funding exceptional cases b) holding engagement events The Governing Body of the CCG will throughout each year have an on-going role in reviewing the CCG s governance arrangements to ensure that the CCG continues to reflect the principles of good governance. 4.6 Annual General Meeting / Extraordinary General Meeting The quorum for the annual general meeting (AGM) will be one-third of the voting members (individuals, not practices) of the Constitution who are either present or have submitted proxy papers A member who is unable to attend may send a proxy form to NHS Oldham CCG administrator or to an officer appointed by NHS Oldham CCG It has been agreed that an extraordinary general meeting (EGM) can be called at the written request of one-third of NHS Oldham CCG membership. The written request must include the item(s) to be raised at this meeting and be signed by all members requesting the EGM. The written request must be submitted to the Chair and the Administrator of the Committee On receipt of such a request for an EGM, the Chair and Administrator must arrange such a meeting within one calendar month of receipt of the request Each member of NHS Oldham CCG will be entitled to one vote. Version 0.7: Effective Date: TBC Page 12 of 61

13 5. FUNCTIONS AND GENERAL DUTIES 5.1 Functions The functions that NHS Oldham CCG is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health s Functions of CCGs: a working document. 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 memb er of any CCG; b) commissioning emergency care for anyone present in NHS Oldham 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 Governing Body, and of other persons providing services to it. This will be the responsibility of NHS Oldham CCG Remuneration Committee; e) appropriately and effectively manage conflicts of interest In discharging its functions the CCG will, on behalf of NHS England,: a) act xv i, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service xv ii and with the objectives and requirements placed on NHS England through the mandate xv iii published by the Secretary of State before the start of each financial year by: having a Scheme of Reservation and Delegation, Standing Orders and Prime Financial Policies in place and mechanisms in place to ensure adherence to these; developing an annual commissioning plan in accordance with the requirement of the Health and Social Care Act 2012; requiring progress of delivery of the duty to be monitored through the CCG s reporting mechanisms; having robust governance arrangements in place that are monitored through an appropriate committee or sub-committee. b) meet the public sector equality duty xix : NHS Oldham CCG recognises its duty to each of its stakeholders and (in particular) its employees, patients and service users. NHS Oldham CCG recognises the importance and obligation it has to promote equality through the services it commissions and to pay particular attention to groups or sections of society where improvements in health and life expectancy are unequal to others within the general population. It will, therefore, meet the public sector equality duty by ensuring that it monitors progress on compliance to the following: specifying a policy which sets out how the CCG intends to discharge this duty; requiring progress of delivery of the duty to be monitored through NHS Oldham CCG s Version 0.7: Effective Date: TBC Page 13 of 61

14 reporting mechanisms at least annually; eliminate unlawful discrimination harassment and victimisation and other conduct prohibited by the Equality Act 2010; advance equality of opportunity between people who share a protected characteristic and those who do not; foster good relations between people who share a protected characteristic and those who do not; Putting in place and publishing an Equality Strategy, and Equality Analyses on all plans, service changes and policy decisions. NHS Oldham CCG will adopt the findings from previous Equality Impact Assessments and conduct an Equality Analysis on each programme area and annual work-plan. NHS Oldham CCG will ensure that it meets the specific duties under the Act by: Publishing information about their workforce and ensure that its providers (and through contracts) also provide information about its stakeholders, service users, patients and / or carers. Reviewing its equality objectives annually and setting equality objectives at least every four years. c) work in partnership with its local authority to develop joint strategic needs assessments xx and joint health and wellbeing strategies xxi by: creating a single commissioning function in Oldham, jointly led by the CCG and OMBC; promoting the integration of health services with health-related and social care services; having appropriate representation at the Oldham Health and Wellbeing Board; charging the Public Health Consultant (on behalf of the CCG) with responsibility to ensure the Joint Strategic Needs Assessment and the joint Health and Wellbeing Strategy are developed in partnership; requiring the Governing Body to review at least annually the progress of the Oldham Health and Wellbeing Strategy and findings of the Joint Strategic Needs Assessment; and to monitor the delivery of NHS Oldham CCG responsibilities; 5.2 General Duties - in discharging its functions the CCG 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 xxii by: a) Maximising breadth (the total number of people engaged); b) Maximising depth (reaching people who would not usually engage); c) Ensuring sustainability (the engagement model can be delivered with available r esources); d) The following Statement of Principles will be adopted: Create an organisational culture that encourages and enables involvement; Be inclusive and proactive in resolving barriers to effective involvement and participation; Make clear the purpose of involvement and the extent to which people can expect their views to influence development of local health services; Recognise the importance of providing feedback to people who have made their views known; Work in partnership with other agencies to avoid duplication where possible when approaching the public; Version 0.7: Effective Date: TBC Page 14 of 61

15 Build upon best practice and be open to innovative and proven approaches from within and out with the NHS; Provide support and training to staff to equip them for this role. e) In delivering the Statement of Principle, NHS Oldham CCG will: Work in partnership with patients and the local community to secure the best care for them; Adapt engagement activities to meet the specific needs of the different patient groups and communities; Publish information about health services on the CCG s website and through other media; Encourage and act on feedback; Identify how the CCG will monitor and report its compliance against this statement of principles; f) by ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge NHS Oldham CCG has adopted three key principles to guide its engagement work which set out an ethical framework against which it invites the public to judge its engagement activity against: a) Accessibility, equitability and supporting involvement b) Honesty, accountability and transparency c) Responsive engagement with clear outcomes NHS Oldham CCG s public involvement activities will be compliant with the relevant legislation and guidance. In accordance with Section 14Z2(2) of the 2006 Act (inserted by section 26 of the 2012 Act), NHS Oldham CCG will make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information in other ways): a) in the planning of the commissioning arrangements by the CCG; b) in the development and consideration of proposals by the CCG for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which services are delivered to the individuals or the range of service available to them, and c) in the decisions of the CCG affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact Where it is intended that services will change, NHS Oldham CCG will engage with Oldham Council s Health Overview and Scrutiny Committee. Where NHS Oldham CCG has to formally consult on changes, it will take account of the Cabinet Office s Code of Practice on Consultation Promote awareness of, and act with a view to securing health services which are provided in a way that promotes awareness of, and have regard to the NHS Constitution xxiii by: a) the CCG s values reflecting the values set out in the NHS Constitution; b) all policies having regard to the NHS Constitution in their development; c) ensuring that all decisions made by the Governing Body are assessed for regard to the Version 0.7: Effective Date: TBC Page 15 of 61

16 NHS Constitution; d) promoting the NHS Constitution on the CCG s website and internally with all staff; e) incorporating compliance with the NHS Constitution in all contracts with commissioned services NHS Oldham CCG s vision is to improve health and healthcare for the people of the borough by commissioning the highest quality healthcare services, provided near to the patient. It aims to ensure services are safe and effective, focussed on patient experience and available to everyone in Oldham when they need it. It promotes equality through the services it commissions and aims to improve health outcomes and increase life expectancy in order to reduce health inequalities between the more affluent and deprived parts of Oldham and different communities. NHS Oldham CCG is committed to providing value for money from the available resources and to ensuring every penny is spent wisely. Through effective and innovative clinical leadership; working together with the public, patients, providers and partners; and the individual professional accountability of all members of NHS Oldham CCG, it will be able to bring about transformational change and improve the quality of all current and future commissioned health services. It works jointly with local authorities and a wide range of other private, public and third sector organisations to deliver improvements in health and wellbeing. It is responsible and accountable for taking decisions in the NHS and ensuring these are transparent and clear to the public, patients and staff. NHS Oldham CCG will also endeavour to promote awareness of the NHS Constitution to members of the public. The ways in which it will do this are: Include information on the website about the NHS Constitution with a link to the DH website; Include a paragraph in corporate documents and press releases about the NHS Constitution; Include direction to be mindful of the NHS Constitution in Governing Body paper templates; Create and send out a poster to all GP practices for display for members of the public Act effectively, efficiently and economically xxiv by: ensuring the CCG operates within the corporate governance framework (Standing Orders, the Scheme of Reservation & Delegation and Prime Financial Policies). requiring progress of delivery of the duty to be monitored through the CCG s reporting mechanisms; requiring the Governing Body to establish an Audit committee to review and test that the plans and processes established are effective and being fully implemented The three principles of acting effectively, efficiently and economically will be assured by NHS Oldham CCG s governance structures and modus operandi. Its Governing Body will establish and proactively maintain agreed decision-making processes and structures and will act to ensure that the organisation obtains and retains the required core capabilities to discharge its duties responsibly. Value based quality appraisals will form a fundamental component of assessing NHS Oldham CCG s strategic triple aim Act with a view to securing continuous improvement to the quality of services xxv : Version 0.7: Effective Date: TBC Page 16 of 61

17 a) quality improvement is the role of every NHS Oldham CCG employee and the organisation s leadership culture and structural support will reinforce this principle. For example, employees and partners will work with core programme teams to capture improvement opportunities and monitor progress in a systematic fashion. Standard systems and processes will be developed to benchmark, plan, implement and review quality improvement initiatives. This will include the use of statistical process control techniques, performance measurement, capacity and demand modelling, clinical audit and sampling to name a few. b) working jointly with other commissioning organisations to ensure continuous improvement in the quality of the system wide services; c) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee; d) NHS Oldham CCG has a quality strategy which sets the framework for securing continuous improvements in the quality of commissioned services and outcomes for patients with regard to clinical effectiveness, safety and patient experience to contribute to improved patient outcomes across the NHS Outcomes Framework. e) NHS Oldham CCG has the experience to contribute to improved patient outcomes across the NHS Outcomes Framework Assist and support NHS England in relation to the Board s duty to improve the quality of primary medical services xxvi by: a) Implementing properly designed and operationally managed peer-review systems which can greatly improve healthcare standards. Therefore, peer-review will be the focus of NHS Oldham CCG s quality improvement activities in relation to primary medical services. Variation amongst primary care providers will be investigated and sought to be understood to inform quality improvement plans. b) Carrying out quarterly reviews using the practice assurance framework and an improvement plan to address poor performance will be followed where applicable. NHS Oldham CCG recognises that reasonable access to a GP, provided efficiently, is fundamental to the success of the local healthcare system and this will be a key measure within the practice assurance framework. c) Delegating through the Primary Care Commissioning Committee to the Primary Care Programme Board and its sub-committees, the responsibility for the undertaking of NHS Oldham CCG s duties with regards to improving quality within primary medical service providers 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 xxvii by: a) ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge; b) developing an annual commissioning plan in accordance with the requirement of the Health Version 0.7: Effective Date: TBC Page 17 of 61

18 and Social Care Act 2012 which sets out the CCG s role and plans in relation to reducing the gap in health inequalities; c) ensuring that the Governing Body members who are responsible for working with partners on the Health and Wellbeing Board contribute to addressing the wider determinants of health and to contribute to implementing the Health and Wellbeing Strategy in relation to commissioning of health services. This is a key part of the Clinical Directors role; 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 xxviii by: a) ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge; b) ensuring that standards are contained within contracts with commissioned services requiring procedures to be in place to ensure patients, their carers and representatives are able to make informed decisions about their healthcare; c) 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 xxix by: a) ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge; b) embodying the requirements of patient choice within the CCG s Choice Policy; c) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Obtain appropriate advice xxx from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) obtaining appropriate advice in the exercise of its functions, either through individual members of the Governing Body or, where appropriate, through invitation to individuals to attend as appropriate to provide advice on its functions, or by seeking advice through external bodies such as a clinical senate or other expert or independent organisation; b) delegating responsibility within their Terms of Reference to the Chair of each committee or sub-committee to ensure that they obtain appropriate advice in the exercise of its functions, either through individual members of the committee or sub-committee, through invitation to individuals to attend as appropriate to provide advice or by seeking advice through external bodies such as a clinical senate or other expert or independent organisation; c) taking advice and guidance from local professional groups when commissioning for the community and voluntary sector, primary and secondary services; d) 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; Version 0.7: Effective Date: TBC Page 18 of 61

19 e) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Promote innovation xxxi by: a) ensuring innovation is a constant priority and embedded throughout the organisation. Innovation is fundamental to converting NHS Oldham CCG s vision into reality. Simple, small solutions can make a profound difference and the increasing demands for healthcare require innovation in all areas to ensure productivity rises to match. b) ensuring innovative, efficient patient pathways, joined up services and cost-effective technologies are key priorities for the Clinical Directors and reflected in the programme area measures of performance. c) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee Promote research and the use of research xxxii by: a) being linked closely to the development and delivery of primary health services; helping to promote and shape innovative developments on the basis of existing knowledge; and evaluating the impact and effectiveness of services as requested. Much research will continue to need specialist skills and expertise, e.g. in the area of service redesign. b) understanding why people choose to seek health care from a range of potential sources; how doctors, nurses and other clinicians make decisions about appropriate treatments; and how best to measure the outcomes of treatment to ensure the success of NHS Oldham CCG. c) the Programme Budget approach to commissioning lends itself to the development of a systematic approach to embedding research into integrated disease pathways with the potential for primary, community and secondary care involvement. Embedding research into Programme Budget areas would help skills development, attract high quality staff and bring financial benefits to programme areas. NHS Oldham CCG will consider the strategy and opportunities for research and development and to make improvements quickly. It will need to know what has been tried elsewhere, whether it works and with what costs and benefits. This information will be needed quickly and in forms which are easy to understand and to relate to local practice. 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 xxxiii 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 xxxiv by: a) ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge; b) encouraging and supporting the continuous learning and development of its employees so that they are able to carry out their role confidently and effectively, achieve their individual potential and contribute fully to the objectives of the CCG; c) monitoring progress of the delivery of the duty by the relevant committee or sub-committee. Version 0.7: Effective Date: TBC Page 19 of 61

20 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 xxxv : a) implementing systems thinking to optimise integration. This is vital in a complex healthcare environment with multiple providers involved in delivering services along a patient pathway; b) working collaboratively with OMBC. OMBC may delegate its responsibilities to commission health and adult social care to the CCG. The CCG and the Council will establish a section 75 Joint Committee of the CCG, the Commissioning Partnership Board. The Commissioning Partnership 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 Oldham; c) holding Clinical Directors responsible for defined clinical areas to allow for the in-depth understanding of pathway dynamics required to ensure effective service integration; d) requiring providers to comply with referral and patient management protocols that aim to ensure efficient, timely and smooth patient journeys. The intention of the Programme Budgeting approach is to support integration; e) monitoring performance on a monthly basis by designated commissioning leads with standardised escalation processes for non-compliance. Clinical networks will provide the soft relationship mechanism for several providers to optimise pathway efficiencies. NHS Oldham CCG Chief Financial Officer will hold responsibility for contractual reviews, if required; f) requiring progress of delivery of this duty to be monitored through the relevant committee or sub-committee. 5.3 General Financial Duties the CCG will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments and any required surplus for the financial year xxxv i 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 xxxv ii 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 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 xxxv iii by: Version 0.7: Effective Date: TBC Page 20 of 61

21 a) requiring the Governing Body at every meeting to review the financial position and forecast of the CCG and take account of specified types of resource and to initiate or agree action to address any concerns. b) requiring the Governing Body to establish an Audit committee to approve and oversee the effectiveness and implementation of any policies and processes to control expenditure in all specified areas. c) allocating practice and / or cluster budgets. To enable budget management at practice level, all member practices will be allocated practice level budgets for most points of delivery. Exceptions to this are those budget lines where there is: a level of financial risk and volume of patients: for example, specialist services are high cost and low volume services, therefore the risk could not be managed at individual GP practice level; a lack of information to devolve to GP practice level: for example, mental health budgets d) having in place contingency funds; e) 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 the NHS England xxxix by: a) charging the Chief Finance Officer with proposing a process for determining how the CCG will spend any payment in respect of quality; b) overseeing the agreed process; c) publishing as part of the Annual Report an explanation of the process and the outcome ; d) requiring progress of the delivery of the duty to be monitored through the appropriate committee Arrangements by the CCG to comply with its functions The CCG will comply with its functions (including its duties and powers) as set out in legislation and this Constitution (paragraphs 5.2 and 5.3 in particular) by : a) The Governing Body being assured that the CCG has appropriate arrangements for ensuring that it functions in an effective, efficient, and economic manner and complies with such generally accepted principles of good governance as are relevant to it. b) The governing body monitoring the performance of functions through the CCGs reporting mechanisms Financial frameworks rewarding delivery of practice-based activities will be developed as further national guidance is issued relating to the quality premium payments. 5.4 Other Relevant Regulations, Directions and Documents NHS Oldham CCG will: a) comply with all relevant regulations; b) comply with directions by the Secretary of State for Health or NHS England; and Version 0.7: Effective Date: TBC Page 21 of 61

22 c) take account, as appropriate, of documents issued by the NHS England. d) develop and implement the necessary systems and processes to comply with these regulations and directions. Documenting them as necessary in this constitution, its scheme of reservation & delegation and other relevant CCG policies and procedures. The Governing Body, through the Strategic Director of Corporate Affairs and Resources, will be responsible for refreshing and updating the Scheme of Reservation and Delegation As part of its intention to be a lean commissioning organisation, the CCG aims to manage its managerial running costs efficiently. This will be achieved by collaborating with other NHS organisations to source commissioning support services, wherever possible, thereby achieving economies of scale, whilst retaining the required local control through in-house expertise. Version 0.7: Effective Date: TBC Page 22 of 61

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