CONTENTS. Final Version: 5

Transcription

1 CONSTITUTION 1

2 1 Final Version: 5 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 7 3 Membership Membership of the clinical commissioning group Eligibility Inter Practice Agreement and engagement with LMC 10 4 Mission, Values and Aims Vision Aims Principles of good governance Accountability 13 5 Functions and General Duties Functions General duties General financial duties Other relevant regulations, directions and documents 22 6 Decision Making: The Governing Structure Authority to act Scheme of reservation and delegation General Committees of the group Joint arrangements The governing body and its committees 29 7 Roles and Responsibilities Practice representatives Other GPs or primary care health professionals All members of the group s governing body The chair of the governing body The deputy chair of the governing body Role of the accountable officer Role of the chief finance officer Joint appointments with other organisations 35

3 2 Part Description Page 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: contractors and people who provide 40 services to the group 8.6 Transparency in procuring services Specialised Commissioning 41 9 The Group as Employer Transparency, Ways of Working and Standing Orders General Standing orders 43 Appendix Description Page A Definitions of Key Descriptions used in this Constitution 44 B List of Member Practices 46 C Standing Orders 49 D Scheme of Reservation and Delegation 64 E Prime Financial Policies 73 F The Nolan Principles 84 G The Seven Key Principles of the NHS Constitution 85 H Electoral Processes 86 I [Not used] 88 J Membership Processes 89 K Role Outlines 91 L Inter Practice Agreement 121 M Terms of Reference Audit Committee and Remuneration Committee 133

4 3 FOREWORD BY HASTINGS AND ROTHER CCG S CHAIR Hastings and Rother CCG became authorised to act as an NHS body in its own right from 1 April 2013 and will be publicly held to account for its actions and decisions. However, the success of Hastings and Rother CCG in effecting the change associated with GP led Commissioning and maintaining financial balance rests to a great extent with practices. Both practices and the consortium will fail unless this essential partnership for success is clearly communicated and understood. GP-led Commissioning brings together responsibility for clinical decisions and their financial consequences - e.g. referrals, prescribing, management of Long Term Conditions and access. All GPs, Nurses, Allied Healthcare Professionals and Practice staff therefore have a role to play. Each time a patient is referred in to another service or a prescription is issued, a commissioning decision has been made. Practices therefore take commissioning decisions routinely. This presents both risks and exciting new opportunities for patients and the taxpayer, with a clinical perspective now built intrinsically into the commissioning process. Hastings and Rother CCG and its practices will therefore need to embed processes to understand and manage commissioning within their regular operational functioning. This will help to meet patient and population need, to challenge current activity and spend and to demonstrate the best use of public resources. All of the work of Hastings and Rother CCG should be underpinned by integrity and honesty, in line with the Nolan principles for standards in public life, set out in Appendix F. A mission statement and a set of organisational values have been developed and agreed as follows: Mission Statement To use our knowledge about patients and the health care system to ensure availability of care services of consistent quality that improve the lives of the people of Hastings and Rother within the resources available. The health needs of our population are key. Our vision, therefore, is to ultimately ensure appropriate, high quality, timely and easily accessible healthcare. We will continue to drive standards up and to transform our local health services, working alongside our partners, integrating services to achieve seamless healthcare. Strong clinical leadership will continue to evolve to enable us to realise our vision. The Constitution This Constitution sets out the arrangements made by the Hastings and Rother 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

5 4 group will establish to ensure probity and accountability in the day to day running of the clinical commissioning group; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the group. The Constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment: The group s member practices; The group s employees; Individuals working on behalf of the group; Anyone who is a member of the group s Governing Body (including the Governing Body s audit and remuneration committees); and Anyone who is a member of any other committee(s) or sub-committees established by the CCG or its Governing Body. Dr Roger Elias Chair Hastings and Rother Clinical Commissioning Group

6 5 1. INTRODUCTION AND COMMENCEMENT 1.1. Name The name of this clinical commissioning group is NHS Hastings and Rother Clinical Commissioning Group (the group), also referred to below as Hastings and Rother CCG, the group or the 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 The NHS Commissioning Board (hereafter known as NHS England) is responsible for determining applications from prospective groups to be established as clinical commissioning groups 4 and undertakes an annual assessment of each established group. 5 It has powers to intervene in a clinical commissioning group 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 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 Hastings and Rother Clinical Commissioning Group and has effect from 1 April 2013, when NHS England established the group. 8 The constitution is published on the group s website (see Appendix A (Definitions)). 1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 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 4 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 5 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 7 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 8 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act

7 Paper copies of this constitution may be provided upon request by contacting the group s headquarters Amendment and Variation of this Constitution This constitution can only be varied in two circumstances Where the group applies to NHS England and that application is granted; Where in the circumstances set out in legislation NHS England varies the group s constitution other than on application by the group NHS England has published Procedures for the clinical commissioning group constitution change, merger or dissolution. These procedures will be followed.

8 7 2. AREA COVERED 2.1. NHS Hastings and Rother CCG covers both urban, semi-urban, semi-rural areas The key metrics which shape how we will deliver as a group are as follows: Number of practices: 32 Number of GP Performers: 129 Registered patient population: 183,500 Expected commissioning budget: 255m 2.3. The main towns and villages covered are: Bexhill St Leonards Hastings Battle Catsfield Ninfield Robertsbridge Northiam Rye Winchelsea Burwash Sedlescombe Westfield 2.4. NHS Hastings and Rother CCG works in close liaison with: East Sussex County Council Hastings Borough Council Rother District Council

9 8 3. MEMBERSHIP 3.1. Membership of the Clinical Commissioning Group The following practices comprise the members of the group. PRACTICE NAME High Glades Medical Practice Churchwood Medical Practice Sedlescombe House Silver Springs Little Ridge Avenue Carisbrooke House South Saxon House Warrior Square Essenden Road The Station Practice The Plaza Surgery Cornwallis Surgery ADDRESS 9A, Upper Church Rd St Leonards on Sea TN37 7AR Tilebarn Road St. Leonards on Sea TN38 9QU 8 Sedlescombe Road South St. Leonards on Sea TN38 0TA Beaufort Road St. Leonards on Sea TN37 6PP 38 Little Ridge Avenue St. Leonards on Sea TN37 7LS Marlborough House Warrior Square St. Leonards on Sea TN37 6BG 150a Bexhill Road St. Leonards on Sea TN38 8BL Marlborough House Warrior Square St. Leonards on Sea TN37 6BG 49 Essenden Road St. Leonards on Sea TN38 0NN Station Plaza Health Centre, Station Approach, Hastings TN34 1BA Station Plaza Health Centre, Station Approach, Hastings TN34 1BA Station Plaza Health Centre, Station Approach, Hastings TN34 1BA

10 9 Priory Road Beaconsfield Road Hastings Walk In Centre Harold Road Shankill Surgery Roebuck House 1 & 2 Roebuck House 3 Hastings Old Town Surgery Little Common & Old Town Pebsham Albert Road & Sidley Surgery Collington & Ninfield 83 Priory Road Hastings TN34 3JJ 21 Beaconsfield Road Hastings TN34 3TW Station Plaza Health Centre, Station Approach, Hastings TN34 1BA 164 Harold Road Hastings TN35 5NH 21 Fairlight Road Hastings TN35 5ED High Street Hastings TN34 3EY High Street Hastings TN34 3EY High Street Hastings TN34 3EY 82 Cooden Sea Road Bexhill-on-Sea TN39 4SP 13 De La Warr Road Bexhill-on-Sea TN40 2HG 119 Seabourne Road Bexhill-on-Sea TN40 2SD 39/41 Sea Rd Bexhill-on-Sea TN40 1JJ 44 Turkey Road Bexhill on Sea TN39 5HE 23 Terminus Road Bexhill on Sea TN39 3LR

11 10 Northiam Oldwood Surgery Rye Medical Centre Sedlescombe & Westfield Ferry Road Health Centre Martins Oak Surgery Fairfield Main Street Northiam TN31 6ND Oldwood Station Road Robertsbridge TN32 5DG Kiln Drive Rye Foreign Rye East Sussex TN31 7SQ The Surgery Brede Lane Sedlescombe Battle TN33 0PW Ferry Road Rye TN31 7DN 36 High Street Battle TN33 0EA Fairfield High Street Burwash TN19 7EU 3.2. Eligibility The practices are formed into geographical localities as follows: East Hastings West Hastings St Leonards Bexhill Rural Rother Appendix B of this constitution contains the list of practices and the original copy has the signatures of the practice representatives confirming their agreement to this constitution. 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 group Inter Practice Agreement and engagement with the Local Medical Committee (LMC) The Members have entered into a separate Inter Practice Agreement which sets out the expectations of each Member in relation to their

12 11 obligations to each other as Members of the NHS Hastings and Rother Clinical Commissioning Group. The Inter Practice Agreement sets out how the Members will seek to support one another as well as hold one another to account. The Inter Practice Agreement also contains details of how the Governing Body and Members will work together In agreeing the principles of how they will deal with one another as Members of the NHS Hastings and Rother Clinical Commissioning Group, the Members shall also liaise with the Surrey and Sussex LMC.

13 12 4. VALUES AND VISION 4.1. Vision 4.2. Aims Our vision is to commission high quality, timely and accessible healthcare services for our local communities in EHS As an NHS organisation we aspire to the following core principles and values from the NHS constitution: Principles that guide the NHS: That the NHS meets the needs of everyone, is free at the point of delivery and that care and treatment are based on clinical need, not ability to pay The following values underpin everything we do as clinical commissioners: Working together for patients; Respect and dignity; Commitment to quality of care; Compassion; Improving lives; and Everyone counts The group will improve quality through achieving its overall aims, which are as follows: a) Patient and Public Involvement Outcome: To place the patient and public perspective at the heart of our business and make our organisation accountable to those who use our services. b) Building the organisation Outcome: To design and build a new NHS organisation that is fit to lead the local healthcare economy from a primary care perspective, is able to bear the weight of responsibility for assuring safety and improving quality at a time of national austerity and which reflects the best of primary care. c) Becoming a mature Commissioner Outcome: To enable the group to fulfil its Mission by learning how to direct resources (finance, capacity, expertise) to achieve the best possible health and

14 13 wellbeing for its patients including delivery of the 15 National Performance Measures. d) Partnerships Outcome: To inspire confidence in the group as an organisation that is good to belong to and good to work with. e) Financial Balance Outcome: To enable the local healthcare economy to live within its means. f) The acute and community services landscape Outcome: To achieve a sustainable configuration of services within the distinctive geography of East Sussex that is financially sustainable and clinically safe and of high quality. g) Developing primary care Outcome: To ensure the consistent provision of a core offer of excellent, accessible primary care services and cooperative working between practices Principles of Good Governance In accordance with section 14L (2) (b) of the 2006 Act,9 the group 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; c) The standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles 10 d) The seven key principles of the NHS Constitution; 11 e) The Equality Act Accountability The group will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, including by: Inserted by section 25 of the 2012 Act See Appendix F See Appendix G See

15 14 a) Publishing its constitution; b) Appointing lay members and independent non-gp clinicians to its Governing Body; c) Holding meetings of its Governing Body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting); d) Publishing annually a commissioning plan; e) Complying with local authority health overview and scrutiny requirements; f) Meeting annually in public to publish and present its annual report (which must be published); g) Producing annual accounts in respect of each financial year which must be externally audited; h) Having a published and clear complaints process; i) Complying with the Freedom of Information Act 2000; j) Providing information to NHS England as required In addition to these statutory requirements, the group will demonstrate its accountability through: a) Liaison between practices and their Governing Body members; b) Primary Care Forum; c) Locality meetings; d) Elections of GP members of the Governing Body; e) Annual General Meetings; and f) Extraordinary General Meetings. See further chapters to Appendix C (Standing Orders) in relation to the remit and purpose of (e) and (f) above for more information The group will also be a full member of the Health and Wellbeing Board established by the Local Authority The Governing Body of the group will throughout each year have an on-going role in reviewing the group s governance arrangements to ensure that the group continues to reflect the principles of good governance (including information governance).

16 15 5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions The functions that the group 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 clinical commissioning groups: 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: i. All people registered with member GP practices; and ii. People who are usually resident within the area and are not registered with a member practice of any clinical commissioning group; b) Commissioning emergency care for anyone present in the group 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 group s employees; and d) Determining the remuneration and travelling or other allowances of members of its Governing Body In discharging its functions the group will: a) Act, 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 service13 and with the objectives and requirements placed on NHS England through the mandate14 published by the Secretary of State before the start of each financial year by: i. Delegating responsibility to the Governing Body and/or its committees (subject to any matters reserved to the member practices in the scheme of reservation and delegation at Appendix D); ii. iii. The member practices, acting through its localities and through meetings of its member practice, agreeing the group s mission, values and overall strategic direction and setting its commissioning strategy; The Governing Body recommending the group s commissioning plan to the member practices to consider and approve; 13 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 14 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act

17 16 iv. The Governing Body preparing operational plans and operational budgets and implementing the commissioning plan through those operational plans and operational budgets; v. The member practices monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the Governing Body to account; and vi. Facilitating two way communications between the governing body and the member practices through the group s localities. b) Meet the public sector equality duty 15 by: i. Delegating responsibility to the governing body and/or its committees (subject to any matters reserved to the member practices in the scheme of reservation and delegation at Appendix D); ii. iii. iv. Working with the governing body and its committees to implement a published Equality and Diversity Strategy, including equality objectives and monitoring compliance; Through the member practices, monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the Governing Body to account; and Publishing information annually to demonstrate compliance with this duty. c) 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 group considers that this would improve the quality of services or reduce inequalities 16 and work in partnership with its local authority to continue to develop joint strategic needs assessments 17 and joint health and wellbeing strategies 18 by: i. Requiring the Accountable Officer, Chair of the Governing Body and up to two further GP representatives to be full and active members of the Health and Wellbeing Board; 15 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act 16 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act 17 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act 18 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act

18 17 ii. iii. iv. Inviting a representative from the local authority to participate as a non-voting member of the Governing Body; Requiring the Governing Body to provide assurance to the practice members that the group s commissioning plans take into account the joint strategic needs assessments and joint health and wellbeing strategies; Require the Governing Body to work within the localities to implement plans; and v. Member practices monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees, and holding the Governing Body to account General Duties - in discharging its functions the group will: Make arrangements to secure patient and public engagement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements, promote the engagement of patients, their carers and representatives in decisions about their healthcare 19 and enable patients to make choices 20 by: a) Delegating responsibility to the Governing Body and/or its committees (subject to any matters reserved to the member practices in the scheme of reservation and delegation at Appendix D); b) Placing the patient and public perspective at the heart of our business and making our organisation accountable to those who use our services; c) Making the phrase No Decision about me, without me a reality in all we do (see the group s Communications and Engagement Strategy); d) Ensuring all Quality, Innovation, Productivity and Prevention (QIPP) plans include detailed engagement plans; e) Ensuring best practice in engagement activities to meet the needs of a wide range of communities; f) Publishing information about health services on the group s website and through other media; g) Encouraging and acting on feedback received from patients and the public; h) Acting at all times in accordance with the group s Communications and Engagement Strategy; 19 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act 20 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act

19 18 i) Monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the governing body to account; j) Establishing patient and public engagement as part of the CCG s governance structure; and k) Publication, annually, of information with regard to this duty Promote awareness of, and act with a view to ensuring that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 21 by: a) Delegating responsibility to the Quality and Governance Committee; and b) The member practices monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the Governing Body to account Act with a view to securing continuous improvement to the quality of services 22 by: a) Delegating responsibility to the Quality and Governance Committee, with a focus on patient safety and risk management; b) Requiring the above committee in relation to patient safety and risk management to: i) Develop appropriate policies and monitoring mechanisms; ii) iii) Report to the Governing Body and to the NHS Commissioning Board; and Give early warning where services are deteriorating in quality/becoming unsafe; c) Using established mechanisms such as contract meetings, the Single Performance Conversation, Planned/Urgent/Integrated Care Networks and the Joint Commissioning Board to support this function; and d) Agreeing lead clinical members of the Governing Body and officers to lead on the fulfilment of these functions Act effectively, efficiently and economically 23 by: 21 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) 22 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act

20 19 a) Delegating responsibility to the Audit and Remuneration Committee; b) Demonstrating value for money and adhering to procurement regulations; c) Remaining within set revenue and capital resource limits set for the financial year and meeting a control total each year; and d) Making appropriate commissioning support arrangements (quality assured); and e) Appointing internal and external auditors. These arrangements will be reflected in the group s standing orders/scheme of reservation and delegation, respectively at Appendices C and D Assist and support the NHS Commissioning Board in relation to the Board s duty to improve the quality of primary medical services 24 by: a) Delegating responsibility to the Quality and Governance Committee; b) The member practices, acting through localities, agreeing the group s vision, values and overall strategic direction and setting its commissioning strategy; c) The Governing Body recommending the group s commissioning plan to the member practices to consider and approve it, ensuring that it supports the NHS Commissioning Board in its duty to improve the quality of primary medical services; d) Member practices monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the governing body to account; and e) Facilitating two way communications between the Governing Body and the member practices through localities Have regard to the need to reduce inequalities 25 by: a) Delegating responsibility to the Quality and Governance Committee; and b) Monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the Governing Body to account Obtain appropriate advice 26 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: 23 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 24 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 25 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act

21 20 a) Delegating responsibility to the Governing Body and/or its committees (subject to any matters reserved to the member practices in the scheme of reservation and delegation at Appendix D); b) Assisting the Governing Body to develop strategy and implementation plans and working with the Governing Body and its committees to implement plans; and c) Monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the Governing Body to account Promote innovation 27 and promote research and the use of research: 28 a) Delegating responsibility to the Governing Body and/or its committees (subject to any matters reserved to the member practices in the scheme of reservation and delegation at Appendix D); b) The member practices, acting through localities, agreeing the group s vision, values and overall strategic direction and setting its commissioning strategy; c) The Governing Body recommending the group s commissioning plan to the member practices to consider it and ensure that it promotes innovation, research and the use of research, and approving it; d) The Governing Body preparing operational plans and operational budgets and implementing the commissioning plan through those operational plans and operational budgets; e) Monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the governing body to account; and f) Facilitating two way communications between the Governing Body and the member practices through localities Have regard to the need to promote education and training 29 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/her related duty by: a) Delegating responsibility to the Quality and Governance Committee; 26 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act 27 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act 28 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act 29 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act

22 21 b) Developing an annual plan for training and development, to cover: groupemployed staff, minimum requirements for practices and arrangements for them to access support to achieve these, Governing Body development, commissioning skills amongst member practices and clinical and nonclinical skills amongst practices to support the group in its objectives (including the appropriate shift of work from hospital into the community); c) Maximising opportunities for improving patient care by developing staff, through education and training, to meet the primary care needs of the its population; d) Working in partnership with the local education and training institutions to ensure that the process for planning, commissioning and delivering education and training is linked to, and will integrate with, the priorities that the group identifies when it is commissioning services; and e) Monitoring progress through performance reports and minutes of meetings of the Governing Body and its committees and holding the governing body to account General Financial Duties the group will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments for the financial year; Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS Commissioning Board for the financial year; Take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by the NHS Commissioning Board, and Publish an explanation of how the CCG spent any payment in respect of quality made to it by the NHS Commissioning Board 30, by: a) Appointing appropriately qualified Accountable Officer and Chief Financial Officer; b) The member practices, acting through localities, agreeing the group s vision, values and overall strategic direction and setting its commissioning strategy; c) The Governing Body recommending the group s commissioning plan to the member practices to consider it and ensure that it promotes innovation, research and the use of research, before approving it; 30 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act

23 22 d) The Chief Financial Officer and the Accountable Officer preparing the groups operational scheme of delegation; e) The Chief Financial Officer preparing the detailed financial policies and the governing body considering and approving them; f) The Governing Body preparing operational plans and operational budgets and implementing the commissioning plan through those operational plans and operational budgets; g) Monitoring progress through performance reports and minutes of meetings of the governing body and its committees and holding the Governing Body to account; h) Facilitating two way communications between the Governing Body and the member practices through localities; i) Publishing an annual report which will include annual accounts and a remuneration report; and j) Submitting to audit Other Relevant Regulations, Directions and Documents The group 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 group 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 group policies and procedures Safeguarding: The CCG works in firm partnership with ESCC as part of a multi-agency approach to child and adult Safeguarding. As part of this the CCG ensures sign up to the county-wide policies and processes within the Safeguarding framework, including attendance at the Safeguarding Boards The CCG will continue to fulfil its responsibilities in this key area of work, with a firm commitment to working with the County Council.

24 23 6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act The clinical commissioning group is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to: a) Any of its members; b) Its Governing Body; c) Individual employees; d) A committee or sub-committee of the group The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through: a) The group s scheme of reservation and delegation; and b) For committees and sub-committees, their terms of reference Scheme of Reservation and Delegation The group s scheme of reservation and delegation (Appendix D) sets out: a) Those decisions that are reserved for the membership as a whole; b) Those decisions that are the responsibilities of its Governing Body (and its committees), the group s committees and sub-committees, individual members and employees The clinical commissioning group remains accountable for all of its functions, including those that it has delegated General In discharging functions of the group that have been delegated to its governing body (and its committees), all sub-committees and individuals must: a) Comply with the group s principles of good governance; 32 b) Operate in accordance with the group s scheme of reservation and delegation; 31 See Appendix D 32 See section 4.5 on Principles of Good Governance above

25 24 c) Comply with the group s standing orders; d) Comply with the group s arrangements for discharging its statutory duties; and e) Where appropriate, ensure that member practices have had the opportunity to contribute to the group s decision making process When discharging their delegated functions, all committees must also operate in accordance with their approved terms of reference Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) Identify the roles and responsibilities of those clinical commissioning groups who are working together; b) Identify any pooled budgets and how these will be managed and reported in annual accounts; c) Specify under which clinical commissioning group 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; and f) Specify how decisions are communicated to the collaborative partners Decision Making The group will follow the agreed electoral decision making procedure in Appendix H Disputes Resolution The group will develop and follow a disputes resolution procedure, in line with best practice Committees of the group The following statutory committees have been established by the Governing Body: a. Audit Committee (see section 6.6.3(a) below); and b. Remuneration Committee (see section 6.6.3(b) below).

26 The Governing Body and Committees 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 group or the committee they are accountable to Joint Arrangements Joint commissioning arrangements with other Clinical Commissioning Groups The clinical commissioning group (CCG) may wish to work together with other CCGs in the exercise of its commissioning functions The CCG may make arrangements with one or more CCG in respect of: delegating any of the CCG s commissioning functions to another CCG; exercising any of the commissioning functions of another CCG; or exercising jointly the commissioning functions of the CCG and another CCG For the purposes of the arrangements described at paragraph [ ], the CCG may: make payments to another CCG; receive payments from another CCG; make the services of its employees or any other resources available to another CCG; or receive the services of the employees or the resources available to another CCG Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions For the purposes of the arrangements described at paragraph [ ] above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made Where the CCG makes arrangements with another CCG as described at paragraph [ ] above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of: How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties;

27 26 How risk will be managed and apportioned between the parties; Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph [ ] above The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body The governing body of the CCG shall require, in all joint commissioning arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year Joint commissioning arrangements with NHS England for the exercise of CCG functions The CCG may wish to work together with NHS England in the exercise of its commissioning functions The CCG and NHS England may make arrangements to exercise any of the CCG s commissioning functions jointly The arrangements referred to in paragraph [ ] above may include other CCGs Where joint commissioning arrangements pursuant to [ ] above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question Arrangements made pursuant to [ ] above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

28 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph [ ] above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of: How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties; Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph [ ] above The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body The governing body of the CCG shall require, in all joint commissioning arrangements that the Chief Officer of the CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period Joint commissioning arrangements with NHS England for the exercise of NHS England s functions The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions The CCG may enter into arrangements with NHS England and, where applicable, other CCGs to: Exercise such functions as specified by NHS England under delegated arrangements; Jointly exercise such functions as specified with NHS England.

29 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties For the purposes of the arrangements described at paragraph [ ] above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made Where the CCG enters into arrangements with NHS England as described at paragraph [ ] above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of: How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties; Financial arrangements, including payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph [ ] above The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body The governing body of the CCG shall require, in all joint commissioning arrangements that the Chief Officer of the CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement,

30 29 but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period The group has entered into a joint arrangements with the following clinical commissioning groups: a. Shared Staffing Arrangements (with NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group and NHS High Weald Lewes Havens Clinical Commissioning Group). b. Collaborative Working Arrangements (with NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group and NHS High Weald Lewes Havens Clinical Commissioning Group). c. Sussex Collaborative (with NHS Brighton and Hove CCG, NHS Coastal West Sussex CCG, NHS Crawley CCG, NHS Eastbourne, Hailsham and Seaford CCG NHS High Weald Lewes Havens CCG and NHS Horsham and Mid Sussex CCG). d. The administration of Patient Safety services by Brighton and Hove CCG The group has a joint committee in support of its Section 75 agreement with East Sussex County Council: Joint Commissioning Board The group has entered into collaborative commissioning and co-ordinating commissioner arrangements with other Clinical Commissioning Groups (CCGs) in Sussex. These arrangements are detailed in a document entitled Sussex Collaborative and involve: NHS Brighton and Hove CCG; NHS Coastal West Sussex CCG; NHS Crawley CCG; NHS Eastbourne, Hailsham and Seaford CCG; NHS High Weald Lewes Havens CCG; and NHS Horsham and Mid Sussex CCG Note that accountability in relation to recommendations stemming from the joint arrangements remains with the respective CCG Governing Bodies. While joint meetings may make recommendations, all decisions taken in respect of such recommendations will be ratified by the individual CCG Governing Bodies separately The Governing Body and its Committees Functions - the group has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by Section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified

31 30 in regulations or in this constitution. 33 The Governing Body may also have functions of the clinical commissioning group delegated to it by the group. Where the group has conferred additional functions on the governing body connected with its main functions, or has delegated any of the group s functions to its Governing Body, these are set out from paragraph 6.6.1(d) below. The Governing Body has responsibility for: a) Ensuring that the group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the group s principles of good governance34 (its main function); b) Determining the remuneration, fees and other allowances payable to employees or other persons providing services to the group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; c) Approving any functions of the group that are specified in regulations; d) The functions attributed to it in Appendix E (Prime Financial Policies), including but not limited to: i. The approval of budgets; ii. Receiving the reports of the Chief Financial Officer relating to the monitoring of financial performance against budget and plan; and iii. The approval of the consultation arrangements for the group s commissioning plan; e) All other functions of the group, as set out at paragraph 5 above Composition of the Governing Body - the Governing Body shall not have less than thirteen members and it is proposed that the Governing Body will comprise: The Chair; The Accountable Officer (Chief Officer); The Chief Operating Officer (not always appropriate; may be required if the accountable officer is a clinician); The Chief Finance Officer; At least five GP other representatives of member practices (In cases where there are no GP nominees then other primary care clinical professional leads may be nominated and elected in the same way to be appointed to the Governing Body. This will preserve the quoracy and the primary care clinical voice on the Governing Body). An independent secondary care doctor; An independent registered nurse; A deputy chair (Lay member); A Lay member (to lead on audit, remuneration and conflicts of interest); and See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act See section 4.4 on Principles of Good Governance above