Item 17.109f NHS WEST NORFOLK CLINICAL COMMISSIONING GROUP CONSTITUTION NHS England Effective Date: 30 th March 2017 Commented [FH1]: TBC
Document Control Sheet Name of Document: Constitution Version: 4 5 File Location / Document Name: Held by Heather Farley: WNCCG Constitution V4 5 Date Of This Version: November 20167 Produced By: Head of Corporate Affairs The Audit Committee Senior Management Team Governing Body in public Consultation of this version: Council of Members Sent to other Norfolk CCGs, Health & Wellbeing Board, NHS England Area team consultation published on CCG website Synopsis And Outcomes Of Equality No adverse impact identified and Diversity Impact Assessment: Ratified By (Committee): NHS West Norfolk CCG Council of Members Date ratified 29 th November 2016 Date ratified by NHS England 30 th March 2017 Distribute To: West Norfolk CCG Council of Members, Governing Body, all staff, web site Date Due For Review: June 2017 November 2018 Enquiries To: Head of Corporate Affairs Commented [FH2]: Action - TBC Commented [FH3]: Action - TBC Revision History Revision Date Summary of changes Author(s) Version Number 25 April 13 See Revision List 1, Graham Copsey 2 14 See Revision List 2, Jean Clark December 14 3 1 See revision List 3, Heather Farley December 4 2016 TBC See revision List 4 Heather Farley 5 Approvals This document requires the following approvals either individual(s), group(s) or board. Name Date of Approval Version Number Council of Members 29 th November 2016 4 5 TBC NHS England 30 th March 2017 TBC 4 5 Page 2 of 126
Contents Part Description Page Foreword 5 1 Introduction and Commencement 6 1.1 Name 6 1.2 Statutory framework 6 1.3 Status of this constitution 6 1.4 Amendment and variation of this constitution 7 2 Area Covered 8 3 Membership 9 3.1 Membership of the clinical commissioning group 9 3.2 Eligibility 10 4 Vision, Values and Aims 11 4.1 Vision 11 4.2 Values 11 4.3 Aims 11 4.4 Principles of good governance 12 4.5 Accountability 12 5 Functions and General Duties 13 5.1 Functions 13 5.2 General duties 14 5.3 General financial duties 21 5.4 Other relevant regulations, directions and documents 22 6 Decision Making: The Governing Structure 23 6.1 Authority to act 23 6.2 Scheme of reservation and delegation 23 6.3 General 23 6.4 The Council of Members 24 6.5 Committees of the group 24 6.6 Joint Arrangements with other Clinical Commissioning Groups 25 6.7 Joint commissioning arrangements with NHS England for the 26 exercise of CCG functions 6.8 Joint commissioning arrangements with NHS England for the 27 exercise of NHS England s functions 6.9 The governing body 29 7 Roles and Responsibilities 32 7.1 Practice representatives 32 7.2 All members of the group s governing body 32 7.3 The chair of the governing body 32 7.4 The deputy chair of the governing body 33 7.5 Role of the accountable officer 33 7.6 Role of the chief finance officer 34 Commented [FH4]: Action - Update page numbers Page 3 of 126
Part Description Page 7.7 Joint appointments with other organisations 34 8 Standards of Business Conduct and Managing Conflicts of Interest 35 8.1 Standards of business conduct 35 8.2 Conflicts of interest 35 8.3 Definitions of an Interest 35 8.3 Declaring and registering interests 37 8.4 Managing conflicts of interest: general 39 8.5 Managing conflicts of interest: contractors and people who 41 provide services to the group 8.6 Transparency in procuring services 41 9 The Group as Employer 42 10 Transparency, Ways of Working and Standing Orders 43 10.1 General 43 10.2 Standing orders 43 Commented [FH4]: Action - Update page numbers Appendix Description Page A Definitions of Key Descriptions used in this Constitution 44 B List of Member Practices and Signatures 46 C Standing Orders 47 D Scheme of Reservation and Delegation 58 E Prime Financial Policies 72 F Framework for Delivering Good Governance 83 G The NHS Constitution 88 H Audit Committee Terms of Reference 90 I Clinical Executive Terms of Reference 96 J Finance and Performance Committee Terms of Reference 98 K Patient Safety and Clinical Quality Committee Terms of Reference 101 L Primary Care Commissioning Committee LM Remuneration Committee Terms of Reference 114 N Information Governance Committee O Conflict of Interest Committee MP Dispute Resolution Procedure 106 NQ List of Revisions 108 Page 4 of 126
Foreword The Health and Social Care Act brought into place new structures for commissioning services here in West Norfolk, with a return to a locally based Health Commissioner, West Norfolk Clinical Commissioning Group (CCG). Since establishment as a statutory body we have remained true to our key principles of clinical engagement across all parts of our local NHS, partnership working with other public bodies in West Norfolk and public involvement in a number of ways, including membership of our key committees, public meetings as part of our commissioning cycle and public questions at Governing Body meetings. Details of our extensive mechanisms for public involvement and engagement were mapped and reported to the Governing Body in September 2014. The revisions to the Constitution for 20167 reflect the continuing evolving strategy of NHS England regarding the role of Clinical Commissioning Groups (CCGs) in Health commissioning, underpinned by their policy and guidance documents. The Constitution sets out our statutory responsibilities for commissioning care for the residents of West Norfolk. It describes the governing principles, rules and procedures that ensure probity and accountability in the day to day running of the CCG; to ensure that decisions are taken in an open and transparent way and that of the interests of patients and the public remain central to our goals. The Constitution applies to all of the member practices; the group s employees, individuals working on behalf of the group and to anyone who is a member of the group s governing body (including the Governing Body s Audit and Remuneration Committees) and any other committee(s) established by the CCG or its Governing Body. Every member practice, employee or other person working on behalf of the group, or member of the Governing Body or any committees is responsible for knowing, complying with and for upholding the arrangements for the governance and operation of the group as described in this Constitution. Dr Ian MackPaul Williams Chair, West Norfolk Clinical Commissioning Group November 20167 Page 5 of 126
INTRODUCTION AND COMMENCEMENT 1.1. Name 1.1.1. The name of this clinical commissioning group is NHS West Norfolk Clinical Commissioning Group. 1.2. Statutory Framework 1.2.1. 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. 3 1.2.2. The NHS Commissioning Board operating as NHS England (see 1.4.2) 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. 6 1.2.3. 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. 7 1.3. Status of this Constitution 1.3.1. This Constitution is made between the members of NHS West Norfolk 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 at www.westnorfolkccg.nhs.uk. A copy is also available upon request for viewing at the local headquarters. 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 Page 6 of 126
1.4. Amendment and Variation of this Constitution 1.4.1. This Constitution can only be varied in two circumstances. 9 a) Where the group applies to NHS England and that application is granted; b) Where in the circumstances set out in legislation NHS England varies the group s Constitution other than on application by the group. 1.4.2 Note that, with effect from 1 April 2013, although the NHS Commissioning Board remains the legal name of the organisation, it is now known as NHS England. 9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued Page 7 of 126
2. AREA COVERED 2.1 The geographical area covered by NHS West Norfolk Clinical Commissioning Group covers all of the King s Lynn and West Norfolk Borough Council local authority area and the Lower-layer Super Output areas below within Breckland District Council. E01026424 E01026442 E01026443 E01026444 E01026445 E01026455 E01026456 E01026457 E01026458 E01026459 E01026462 E01026492 E01026493 Breckland 012A Breckland 002A Breckland 002B Breckland 012B Breckland 002C Breckland 007A Breckland 007B Breckland 007C Breckland 007D Breckland 007E Breckland 002D Breckland 012C Breckland 012D 2.2 This can be shown on a map thus: Page 8 of 126
3. MEMBERSHIP 3.1 Membership of the Clinical Commissioning Group 3.1.1 The following practices comprise the members of NHS West Norfolk CCG. Commented [FH5]: Action - Red = waiting on confirmation from practices Practice Name Boughton Surgery Dr Simpson & Partner Bridge Street Surgery Dr Scott & Partners Burnham Market Surgery Dr Gorrod & Partners Campingland Surgery Dr Holmes & Partners Feltwell Surgery Dr Sagar & Partners Gt Massingham and Docking Surgeries Partnership Great Massingham Surgery Dr Phillips Black & Partners Grimston Medical Centre Dr Archer & Partners Heacham Group Practice Dr lake Russell & Partners The Hollies Surgery Vida Healthcare Howdale Surgery Dr Hart & Partners Litcham Health Centre Dr Brown Manor Farm Medical Centre Dr Haczewski & Partners Plowright Medical Centre Dr Sorensen-Pound Southgates Medical & Surgical Centre and The Woottons Surgery Dr Atkinson Hotchin & Partners St James' Medical Practice Dr Sherwood & Partners Terrington St Clement s Surgery Dr I Ahmed Terrington St John s Surgery First Health Upwell Health Centre Dr Williams & Partners Vida Healthcare Executive Partner Dr Mark Funnell: Gayton Road Health Centre Fairstead Surgery Hunstanton Medical Practice Carole Brown Health Centre Address Chapel Road, Boughton, King's Lynn, Norfolk PE33 9AG 30/32 Bridge Street, Downham Market, Norfolk PE38 9DH The Burnhams Surgery, Church Walk, Burnham Market, King s Lynn, Norfolk PE31 8DH Campingland, Beech Close, Swaffham, Norfolk PE37 7RD Old Brandon Road, Feltwell, Thetford, Norfolk IP26 4AY Station Road, Great Massingham, King s Lynn, Norfolk PE32 2JQ Congham Road, Grimston, King s Lynn, Norfolk PE32 1DW 45 Station Road, Heacham, King s Lynn, Norfolk PE31 7EX Paradise Road, Downham Market, Norfolk PE38 9JE Howdale Road, Downham Market, Norfolk PE38 9AF Manor Drive, Litcham, King s Lynn, Norfolk PE32 2NW Mangate Street, Swaffham PE37 7QN 1 Jack Boddy Way, Swaffham, Norfolk PE37 7HJ Southgates Medical & Surgical Centre, 41 Goodwins Road, King's Lynn, Norfolk PE30 5QX The Woottons Surgery, Priory Lane, North Wootton, King s Lynn, Norfolk PE30 3PT County Court Road, King's Lynn, Norfolk PE30 5SY Village Health, St Clement s Surgery, Churchgate Way, Terrington St Clement, King s Lynn, Norfolk PE34 4LZ St John s Surgery, Main Road, Terrington St John, Wisbech, Cambs PE14 7RR Townley Close, Upwell, Wisbech PE14 9BT Gayton Road Health & Surgical Centre, Gayton Road, King's Lynn, Norfolk PE30 4DY Centre Point, Fairstead, King s Lynn, Norfolk PE30 4SR Valentine Road, Hunstanton, Norfolk PE36 5DN Formatted: Font color: Red Page 9 of 126
St Augustine s Surgery Watlington Medical Centre Dr Koopowitz & Partners Woottons Surgery Part of Southgates and The Woottons St Nicholas Court, Church Lane, Dersingham PE31 6GZ Columbia Way, Kings Lynn, PE30 2LB Rowan Close, Watlington, King s Lynn, Norfolk PE33 0TU Priory Lane, North Wootton, King s Lynn, Norfolk PE30 3PT 3.1.2 Appendix B of this Constitution contains the list of practices; the signatures of the practice representatives confirming their agreement to this constitution are held at the CCG headquarters. 3.2 Eligibility 3.2.1 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 10. 10 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Regulations to be made Page 10 of 126
Page 11 of 126
4. VISION, VALUES AND AIMS 4.1 Vision West Norfolk CCG s purpose is to commission services for local people in order to improve health and wellbeing, reduce health inequalities, improve the quality of care, prevent disease and premature death and decrease hospitalisation for long term conditions. Our vision is to strengthen local communities to reduce ill health and dependency to the minimum possible. We will work with partners to commission in an integrated, holistic way that addresses the health and wellbeing needs of local people. The principles that underpin this vision are: People are supported to stay well and independent in their own community as long as possible; Patients, carers and practitioners all understand how services are provided and where to find information they may need; When people need care, they receive it safely, in the right place for them and at the right time; Hospital stays will be kept to a safe minimum, with appropriately supported discharge arrangements. The Group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties This vision is supported by a set of clinically driven organisational values: 4.2 Values The values that lie at the heart of the Group s work are: The CCG develops a new culture that ensures the voice of the member practices is heard and the interests of patients and the community remain at the heart of discussions and decisions; The Governing Body and the wider CCG act in the best interests with regard to the health of the local population at all times, in accordance with the Nolan Principles; The CCG commissions the highest quality services to secure the best possible outcomes for their patients within their resource allocation and maintains a consistent focus on quality, integration and innovation; Decisions are taken with regard to securing the best use of public money; The CCG acts in such a way that promotes and upholds the NHS Constitution; The CCG is responsive to the views of local people and promotes self-care and shared decision-making in all aspects of its business; and Good governance remains central at all times. 4.3 Aims The Group s aims are encompassed in its strategic objectives:- 1. To ensure the needs of the people of West Norfolk and clinical quality are at the heart of everything we do 2. To lead the long term sustainability of health & care services for the people of West Norfolk. Page 12 of 126
3. Collaborate in partnerships that promote, and deliver demonstrable improvements in, the health & wellbeing of the people of West Norfolk 4. To meet statutory financial duties 5. To be innovative and to use integration as a means to deliver improvements in care 6. To ensure that the resources and capability are made available to commission services efficiently and effectively 4.4 Principles of Good Governance 4.4.1 In accordance with section 14L(2)(b) of the 2006 Act, 11 the group will at all times observe such generally accepted principles of good governance in the way it conducts its business. These include: 4.5 Accountability 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; 12 c) The standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles 13 d) The seven key principles of the NHS Constitution; 14 e) The Equality Act 2010.15 f) Standards for Members of NHS Boards and Governing Bodies in England 4.5.1 The group 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 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; 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. k) Publishing the Register of Interests for Staff, Governing Body Members and the Council of Members. 11 Inserted by section 25 of the 2012 Act 12 The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004 13 See Appendix F 14 See Appendix G 15 See http://www.legislation.gov.uk/ukpga/2010/15/contents Page 13 of 126
4.4.1 In addition to these statutory requirements, the group will demonstrate its accountability by committing to high quality patient and public engagement in its planning and decision-making. 4.4.2 The Governing Body of the group will throughout each year have an ongoing role in reviewing the group s governance arrangements to ensure that the group continues to reflect the principles of good governance. 5 FUNCTIONS AND GENERAL DUTIES 5.1 Functions 5.1.1 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 NHS Commissioning Board s Functions of clinical commissioning group, March 2013. 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 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; d) Determining the remuneration and travelling or other allowances of members of its Governing Body. e) Commissioning Primary Care Medical Services (delegated by NHS England). 5.1.2 In discharging its functions the group will: a) Act 16, 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 17 and with the objectives and requirements placed on tnhs England through the mandate 18 published by the Secretary of State before the start of each financial year by delegating the responsibility to the accountable officer to oversee its discharge and requiring progress of delivery of the duty to be monitored through the group s reporting mechanism. b) Meet the public sector equality duty 19 by: i) Advancing equality of opportunity; ii) Not discriminating, harassing or victimising, either in commissioning of services or in the treatment of employees, on grounds of age, disability, gender reassignment, pregnancy 16 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 17 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 18 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act 19 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act Page 14 of 126
and maternity, marriage or civil partnership, race, religion or belief, sex, or sexual orientation; iii) Fostering good relations between those who share a relevant protected characteristic and those who do not; iv) Publishing information to show its compliance with the Equality Act 2010; v) Setting and publishing equality objectives, which are based on evidence, at least every four years; vi) Acting compatibly with the European Convention of Human Rights; vii) Publishing a range of equality data relating to its workforce and the services they provide; viii) Producing equality impact analyses on our policies, strategies and schemes and on the services we commission; ix) Publishing all information in a way that makes it easy for people to access it; x) Working in partnership with patients, the public, staff and staffside organisations to use the NHS Equality Delivery System (EDS) to review its equality performance and to identify future priorities and actions. c) Work in partnership with its local authorities to develop joint strategic needs assessments 20 and joint health and wellbeing strategies 21 by: i) Working and fully co-operating with the Norfolk Health and Wellbeing Board (HWBB) in writing commissioning plans which take into account the evidence of the joint strategic needs assessment and priorities of the Health and Wellbeing Strategy. This strategy will set shared priorities for what the NHS, local authorities and other partners can do individually and collectively to improve care for local people, improve health outcomes and reduce health inequalities; ii) Working with the HWBB in the initial authorisation process and annual review - a process led by NHS England; iii) Working and co-operating with Norfolk HWBB in overseeing and further integrating health, social care and other public sector services; WNCCG will have a representative on the HWBB to enable the above and to communicate to CCG member practices. 5.2 General Duties - in discharging its functions the group will: 5.2.1 Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements 22 by: (a) Adopting the following Statement of Principles: 20 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act 21 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act 22 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act Page 15 of 126
i) Routinely ensuring that patients and the public can share their experiences of health services and use this to inform commissioning. ii) Have a deep understanding of different engagement options, including the opportunities, strengths, weaknesses and risks. iii) Routinely invite patients and the public to respond to and comment on issues in order to influence commissioning decisions and to ensure that services are convenient and effective. iv) Ensure that patients and the public understand how their views will be used, which decisions they will be involved in, when decisions will be made, and how they can influence the process, and publicise the ways in which public input has influenced decisions. v) Proactively challenge and, through active dialogue, raise local health aspirations to address local health inequalities and promote social inclusion. vi) vii) viii) ix) Create a trusting relationship with patients and the public, and be seen as an effective advocate and decision maker on health requirements. Communicate our vision, key local priorities and delivery objectives to patients and the public, clarifying our role as the local leader of the NHS. Respond in an appropriate and timely manner to individual, organisation and media enquiries. Undertake assessments and seek feedback to ensure that the public s experience of engagement has been appropriate and not tokenistic. x) Ensure that providers of healthcare from whom we commission services are also consistently and effectively involving the public. (b) Delivering the Statement of Principles through the following activities: Involving people, patients and their representatives in each step of the commissioning cycle: Reviewing existing services, Planning assessing needs, deciding priorities and designing services, Tendering agreeing the specifications for tenders and contracts, choosing providers and agreeing terms and conditions with the chosen provider, and Monitoring managing performance and evaluating services to make sure good quality services are delivered. The findings from this stage also need to inform planning in the next cycle. Building systematic patient and public involvement and engagement into the way we operate. We will do this by: - Including people who use services and appropriate user and carer organisations or individuals on drafting, implementing or monitoring policies, - Including user and carer representation on health improvement, commissioning and other committees, - Ensuring there is training and induction for users and carers to enable them to participate fully in policy and strategy development, and - Keeping people informed of opportunities to get involved and find out what we are doing and why. Page 16 of 126
Ensuring appropriate time for people to comment, to participate and consult within their own organisations within the constraints of nationally driven timetables. Following the Cabinet Office Code of Practice on Written Consultation. Working with existing groups and networks where they are appropriate and fit for the purpose. In particular, we continue to strengthen our relationship with patient participation groups (PPGs). Given the complexity of decision making, being accountable to local people by being clear about how decisions are made and how factors are balanced and weighted against each other. 5.2.2 Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 23 by: a) Ensuring all governing body decisions are made in line with the NHS Constitution. b) The group as a central part of the NHS in West Norfolk will uphold all aspects of the NHS Constitution as set out in Appendix G. 5.2.3 Act effectively, efficiently and economically 24 by: a) Delegating responsibility to the Governing Body for ensuring the CCG complies with its obligations under this duty b) Delegating to the Accountable Officer the lead responsibility for overseeing the discharge of this duty. The Governing Body will in turn receive assurance from: c) The Audit Committee, which will monitor and oversee systems of internal control, risk management and integrated governance d) The Patient Safety and Clinical Quality Committee, which will comment on the effectiveness of patient care e) The Finance & Performance Committee, which will scrutinise performance and financial management through the group s reporting mechanisms. 5.2.4 Act with a view to securing continuous improvement to the quality of services 25 by agreeing clear accountability and reporting lines for patient safety. These will be defined in a formal process to be agreed by the Governing Body, but will include: a) Delegating responsibility to the Governing Body to ensure the discharge of this duty; b) Requiring progress of delivery of the duty to be monitored through the Governing Body reporting mechanism; 23 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) 24 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 25 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act Page 17 of 126
c) Reports of the Patient Safety and Clinical Quality Committee will be a standing item on every Governing Body meeting agenda. This will be supported by: d) Clear arrangements under the Service Level Agreement with the Commissioning Support Unit for what quality monitoring services the NEL Commissioning Support Unit will undertake; e) Regular reports from the Patient Safety and Clinical Quality Committee to the governing body; f) Agreed protocols with NHS England for monitoring and reporting; g) Regular reporting to the National Reporting and Learning System and responding to alerts, and ensuring providers report as required; h) Systematic review of Never Events and Serious Incidents (alongside the CSU and NCB as necessary) and the implementation of remedial actions and learning points. This will include detailed analysis and regular review by the Governing Body of exercises such as Deep Dive and utilising front line clinicians for inspections of services to provide expert clinical insight, maintaining a programme of announced and unannounced provider visits and regular quality review meetings of provider contracts 5.2.5 Assist and support NHS England in relation to the Board s duty to improve the quality of primary medical services 26 by: a) Delegating responsibility to the Governing Body to ensure the discharge of this duty; b) Requiring progress of delivery of the duty to be monitored through the governing body reporting mechanism; c) Agreeing a mechanism with NHS England for working in partnership with NCB to improve the quality of primary medical care, and deal with need and unexpressed demand; d) Maintaining an overview of whether evidence of this work is taking place; 5.2.6 Have regard to the need to reduce inequalities 27 by: a) Ensuring needs are identified within the CCG through review and development of the Joint Strategic Needs Assessment (JSNA) using a variety of information sources and stakeholder input; b) Ensuring the CCG commissioning work streams reduce rather than increase inequalities in access and provision of services; c) Ensuring that known variations in practice (e.g. prescribing, disease registers and management e.g. of diabetes) are reduced and using existing and developing mechanisms to monitor (e.g. prescribing visits, Quality and Outcomes Framework, Governing Body and council members); d) Working with partners where there is known deprivation; e) Ensuring public and patient involvement (e.g. through stakeholder events) is inclusive and informs both commissioning and monitoring of services; 26 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 27 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act Page 18 of 126
f) Working with Norfolk County Council (NCC) and other agencies to ensure process are scrutinised, challenged and work informed by a wider community; g) Ensuring that any Memorandum of Understanding developed and collaborative commissioning arrangements are aligned with reducing inequalities as measured by health outcomes of people in West Norfolk. h) The Clinical Executive (CLEX) has formal responsibility for ensuring that the CCG has regard for the need to reduce health inequalities in access to, and the outcomes from, healthcare. 5.2.7 Promote the involvement of patients, their carers and representatives in decisions about their healthcare 28 by: a) Ensuring all health and social care providers are giving patients, carers and representatives the opportunity to discuss their concerns and understand the full range of services which are available to them; b) Ensuring all healthcare providers are maximising choose and book systems to enable patients, carers and representatives to have the opportunity to discuss the choices available and to agree the most appropriate appointment day/time for them; c) Ensuring all health and social care providers are providing patients, carers and representatives timely access to services and referral to treatment pathways and that they fully understand all the choices and have significant input into the decision-making process; d) Ensuring patients, carers and representatives are fully involved in developing care pathways to enable them to have ownership of their healthcare needs; e) Ensuring robust monitoring and audit processes are in place to enable timely feedback to providers who are not delivering informed choice as part of their service; f) Ensuring patients, carers and representatives have access to a wide range of information and resources to enable them to make an informed choice; g) Ensuring providers have a robust training programme in place to enable healthcare professionals to develop the skills to fully support patients, carers and representatives in the decision-making process. 5.2.8 Act with a view to enabling patients to make choices 29 by: a) Ensuring that patient rights, as stated in the NHS Constitution, are observed and respected; b) Ensuring that patients are involved in decisions about their healthcare and giving them the information to enable them to do this; c) Ensuring that patients are aware of the choices available in respect of all aspects of the health services provided to them; d) Ensuring that patient information is unbiased, accessible, up to date and accurate. 5.2.9 Obtain appropriate advice 30 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: 28 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act 29 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act 30 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act Page 19 of 126
1. Ensuring the leads are credible role models who will lead and promote the involvement of appropriate personnel to improve patient pathways and clinical outcomes; 2. Ensuring all sub committees and other committees, working groups, networks and programme boards meet in accordance with their terms of reference to include the professional healthcare and public health constituent members as relevant; 3. Ensuring technical healthcare and public health strategy, policy and decision making research is developed in consultation with the relevant professional specialists, including the Local Professional Committees (Local Medical Committee, Local Dental Committee, Local Pharmaceutical Committee, Local Ophthalmic Committee); 4. Ensuring processes to recruit to the Governing Body and Executive Team professional healthcare roles provide assurance on the professional registrations required to fulfil the duties of these roles. 5.2.10 Promote innovation 31 by: a) Creating a dynamic culture where change is actively embraced and feedback on patient pathways and service redesign is actively sought from all members of the wider team; b) Promoting a proactive and can do approach to service delivery at all team and public engagement meetings; c) Demonstrating a continuous cycle of improvement through evaluation, research and clinical audit to achieve optimal patient outcomes; d) Ensuring all key stakeholders are involved in service redesign to promote opportunities for innovative proposals to be explored; e) Affirming this within the group s set of core values at regular intervals through annual review of strategy and operational plans by the public Governing Body meeting, through regular communications with the members and staff of the group; f) Engaging clinicians in the development of care pathway redesign through the work of the programme boards; g) Overseeing the progress in culture shift towards increased innovation through the work of the programme boards; h) Establishing and implementing policy to promote improved outcomes from learning lessons from past complaints and feedback from patient engagement. 5.2.11 Promote research and the use of research 32 by: a) Championing a research culture by adopting policy and annual plans in respect of research to oversee discharge of this duty; b) Requiring progress of delivery of the duty to be monitored through the Governing Body reporting mechanism; c) Maintaining a strategic overview of local and national research by carrying out Governing Body activities with research identified as a major substantive item on Governing Body agendas; d) This will be supported by: I. Clear arrangements under the Research and Development agreement with the designated Research Service hosting body; II. CCG committees considering regular reports from the Research 31 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act 32 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act Page 20 of 126
Service provider; III. Supporting Research plans for delivering research, encouraging patient engagement and the use of research evidence. With NHS England encourage appropriate primary care services learning from research audit and incident management; IV. Encouraging and directing research ideas from commissioners, providers and patients into local research development mechanisms; V. Ensuring that appropriate facilities are made available, through the commissioning process, to Universities that have a medical or dental school in connection with research; VI. Agreeing a mechanism to ensure that the NHS meets the statutory requirements for awarding treatment costs for patients who are taking part in research funded by Government and research charity partner organisations. 5.2.12 Have regard to the need to promote education and training 33 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 34 by: a) Delegating responsibility to the Governing Body to agree to adopt policy and annual plans in respect of education and training provided by the provider; b) Supporting system wide plans including pooled funding requirements to enable quality and access to education and training across the region s clinical commissioning groups; c) Delegating lead responsibility in respect of the group s progress in achieving mandatory training compliance to the Head of Corporate Affairs; d) Requiring progress of delivery of the duty to be monitored through the group s reporting mechanism, specifically to the Audit Committee as a committee of the Governing Body; e) Maintenance of the Protected Time for Learning Programme for general practitioners; f) Engaging specialists to support training needs and requirements for providers delivering healthcare services. 5.2.13 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 35 by: a) Working in partnership with the local authority to develop an integrated commissioning team that will commission across health and social care for the locality of West Norfolk; b) Building upon the work of the West Norfolk Alliance Work with system partners to integrate health, social and voluntary sector services clustered in localities around General Practice; Commented [FH6]: Note Updated wording to reflect flexibility on future structures 33 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 34 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act 35 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act Page 21 of 126
c) Commissioning integrated care pathways building requirements into service specifications and Key Performance Indicators; d) Supporting provider organisations across health and social care to work in partnership to deliver integrated care; e) Appointing to integrated management positions across health and social care; f) Involving the people of West Norfolk in all stages of service design. 5.3 General Financial Duties the group will perform its functions so as to: 5.3.1 Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 36 by: a) Delegating responsibility to the Governing Body for ensuring the CCG complies with its obligations under this duty; b) Delegating to the Chief Finance Officer the lead responsibility for overseeing the discharge of this duty; c) Describing within the Prime Financial Policies the mechanisms by which the CCG will discharge this duty; d) Monitoring performance and financial management through the group s reporting mechanisms. 5.3.2 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 37 by: a) Delegating responsibility to the Governing Body for ensuring the CCG complies with its obligations under this duty; b) Delegating to the Chief Finance Officer the lead responsibility for overseeing the discharge of this duty; c) Describing within the Prime Financial Policies the mechanisms by which the CCG will discharge this duty; d) Monitoring performance and financial management through the group s reporting mechanisms. 5.3.3 Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the group does not exceed an amount specified by NHS England 38 by: a) Delegating responsibility to the Governing Body for ensuring the CCG complies with its obligations under this duty; b) Delegating to the Chief Finance Officer the lead responsibility for overseeing the discharge of this duty; c) Describing within the Prime Financial Policies the mechanisms by which the CCG will discharge this duty; d) Monitoring performance and financial management through the group s reporting mechanisms. 36 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act 37 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act 38 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act Page 22 of 126
5.3.4 Publish an explanation of how the group spent any payment in respect of quality made to it by NHS England 39 by: a) Delegating responsibility to the Governing Body for ensuring the CCG complies with its obligations under this duty; b) Delegating to the Chief Finance Officer the lead responsibility for overseeing the discharge of this duty. 5.4 Other Relevant Regulations, Directions and Documents 5.4.1 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. 5.4.2 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. 5.4.3 Where it considers it appropriate for the effective discharge of its functions the CCG will engage with local stakeholder bodies, including the Local Medical Committee (LMC) for the area in its role as the local statutory body for GPs. 39 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act Page 23 of 126
6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1 Authority to act 6.1.1 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) Employees; d) A committee or sub-committee of the group. 6.1.2 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, their terms of reference. 6.1.3 Members reserve the right to call for a decision made by the Governing Body to be reviewed through the process outlined in the Standing Orders (see Appendix C, Standing Orders para 3.7.2) 6.2 Scheme of Reservation and Delegation 40 6.2.1 The group s scheme of reservation and delegation sets out: a) Those decisions that are reserved for the membership as a whole; b) Those decisions that are the responsibilities of its Governing Body (and its committees), the group s committees and sub-committees, individual members and employees. 6.2.2 The clinical commissioning group remains accountable for all of its functions, including those that it has delegated. 6.3 General 6.3.1 In discharging functions of the group that have been delegated to its governing body (and its committees, joint committees, sub committees and individuals must: a) Comply with the group s principles of good governance, 41 b) Operate in accordance with the group s scheme of reservation and delegation, 42 c) Comply with the group s standing orders, 43 d) Comply with the group s arrangements for discharging its statutory duties, 44 e) Where appropriate, ensure that member practices have had the opportunity to contribute to the group s decision making process. 40 See Appendix D 41 See section 4.4 on Principles of Good Governance above 42 See Appendix D 43 See Appendix C 44 See chapter 5 above Page 24 of 126
6.3.2 When discharging their delegated functions, committees, sub-committees and joint committees must also operate in accordance with their approved terms of reference. 6.3.3 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; f) Specify how decisions are communicated to the collaborative partners. 6.4 The Council of Members 6.4.1 Each member shall appoint a practice representative who will act on behalf of the member in the dealings between it and the group. 6.4.2 The practice representative shall be a clinician. 6.4.3 Collectively the appointed practice representatives shall form the Council of Members. 6.4.36.4.4 The Governing body will be represented by GP Members at the Council of Members to account for Governing Body decisions. 6.5 Committees of the group Commented [FH7]: Note Added to specify GB accountability to CofM 6.5.1 The following committees have been established by the group: a) The Clinical Executive (CLEX), which is accountable to the Governing Body. The terms of reference are set out in Appendix I; b) Audit Committee, which is accountable to the Governing Body. The terms of reference are set out in Appendix H; c) Remuneration Committee (Remco). The terms of reference are set out in Appendix M; d) The Patient Safety and Clinical Quality Committee, which is accountable to the Governing Body. The terms of reference are set out in Appendix LK; e) The Finance & Performance Committee, which is accountable to the Governing Body. The terms of reference are set out in Appendix J f) Terms of reference for the The Primary Care Commissioning Committee. The Terms of Reference are set out in Appendix L. will be Page 25 of 126
published on the CCG website, alongside the constitution at http://www.westnorfolkccg.nhs.uk/ This can be seen diagrammatically thus: Commented [FH8]: Note Updated as Committee not included in last Constitutional update 6.5.2 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. 6.6 Joint Arrangements with other Clinical Commissioning Groups 6.6.1 The clinical commissioning group (CCG) may wish to work together with other CCGs in the exercise of its commissioning functions. 6.6.2 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 6.6.3 For the purposes of the arrangements described at paragraph [6.6.2], 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. Page 26 of 126