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NHS BUCKINGHAMSHIRE

CCG

CONSTITUTION

Version 1.31: 1 October 2020

NHS England Effective Date: 1 October 2020

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VERSION CONTROL Version Section Changes

1.0-1.27 Various as documented within archived versions. V1.10 is final version published post 12 July 2018 interim adoption. V1.20 ratified 14.03.19. V1.21 ratified 12.09.19, V.1.24 noted 14.11.19. 1.25 editorial changes, 1.26 change of office address, 1.27 updates to appendix C list of member practices

1.28 Throughout 1.3.1 Status of this Constitution Clause 6.6.9 joint commissioning arrangements Appendix A definitions/Appendix C LIST OF MEMBER PRACTICES Appendix D COMMITTEES OF THE GOVERNING BODY, THE CCG AND COUNCIL OF MEMBERS (organogram) Appendix D Section 2.3.4 Appendix E Standing Orders Appendix E Standing Orders Appendix F2 Scheme of delegation Appendix K PCCC Terms of Reference

References to Governing Body composition referred to as falling within section 6.6.2 updated to read as 6.7.2. 1.3.1 This Constitution is made between the Member Practices of NHS Buckinghamshire Clinical Commissioning Group and has effect from the 1st April 2020 following NHS England’s approval of merger of NHS Aylesbury Vale CCG with NHS Chiltern CCG. 6.6.9 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the Director of Commissioning and Delivery 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. This section removed as role no longer exists, the model Constitution which includes this is a model, and for Buckinghamshire the Integrated Commissioning Team (ICET) already exists to achieve the same purpose. Detail of localities removed as these no longer exist. 1.2 Committees of the Governing Body

1.2 (f) Description for CCG Executive Committee amended The membership of this committee will comprise of four managers and eight GP Clinical Directors. At least two of the GPs will be locality directors.

This was six managers. Updated to reflect current approved and ratified terms of reference. 1.3 Committees of the CCG

1.3 (e) Description for CHC Exception Panel amended to include: This is accountable to the Integrated Commissioning Executive Team.

Descriptions added for i) IFR Case Review Panel j) Primary Care and Community Transformation Group

Organogram amendments

CHC Exception Panel previously shown as accountable to the CCG Quality and Performance Committee, changed to be accountable to the Integrated Commissioning Executive Team (ICET)

Medicines related ICP boards/groups incorporated with reporting line, but no further detail included as they are not accountable to the Governing Body.

GP Clinical Directors – remove and/or locality as locality director roles no longer exist. Reference to locality meetings throughout changed to read as CCG Council of Members as opportunity for member engagement (or removed from narrative

where appropriate to do so) as locality meetings no longer exist. Section 2.3.4 – appointment process for Locality GP Clinical Directors – section removed. Section 2.3.16 – Director of Commissioning and Delivery removed as a director role Clinical Locality lead definition removed, Director of Commissioning and Delivery definition removed Primary Care Commissioning Committee terms of reference updated following annual review and approval

1.29 Foreword Appendix I Appendix J

Number of member practices changed from 51 to 50. Audit Committee terms of reference are unchanged after annual review. Remuneration Committee terms of reference updated after annual review.

1.30 Appendix E Standing Orders “in line with the CCGs capability policy” removed from grounds for removal from office 2.3.9 Lay Vice Chair, 2.3.10 Registered Nurse and 2.3.14 remaining three Lay Members – as these individuals are not employees and so capability policy does not apply

1.31 Appendix Primary and Community Care Transformation Group dissolved .

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CONTENTS

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 the Constitution ....................................................... 7

2 AREA COVERED .......................................................................................................... 7

3 MEMBERSHIP .............................................................................................................. 9

3.1 Membership of the CCG ....................................................................................... 9

3.2 Eligibility ................................................................................................................ 9

3.3 Termination of Membership .................................................................................. 9

4 PURPOSE, VISION AND PRINCIPLES ...................................................................... 10

4.1 Purpose ............................................................................................................... 10

4.2 Vision .................................................................................................................. 10

4.3 Principles of Good Governance .......................................................................... 10

4.4 Accountability ...................................................................................................... 11

5 FUNCTIONS AND GENERAL DUTIES ....................................................................... 12

5.1 Functions ............................................................................................................ 12

5.2 General Duties .................................................................................................... 13

5.3 General Financial Duties ..................................................................................... 16

5.4 Other Relevant Regulations, Directions and Documents .................................... 16

6 DECISION MAKING: THE GOVERNING STRUCTURE ............................................. 17

6.1 Authority to Act .................................................................................................... 17

6.2 Scheme of Reservation and Delegation .............................................................. 17

6.3 General ............................................................................................................... 17

6.4 Committees of the CCG ...................................................................................... 18

6.5 Joint Arrangements ............................................................................................. 18

6.6 The Governing Body ........................................................................................... 21

7 ROLES AND RESPONSIBILITIES .............................................................................. 22

7.1 Practice Representatives .................................................................................... 22

7.2 All Members of the CCG Governing Body ........................................................... 22

7.3 The Clinical Chair of the Governing Body ........................................................... 23

7.4 The Lay Vice Chair of the Governing Body ......................................................... 23

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7.5 Role of the Accountable Officer .......................................................................... 23

7.6 Role of the Chief Finance Officer ........................................................................ 24

7.7 Joint Appointments with other Organisations ...................................................... 25

8 STANDARDS OF BUSINESS CONDUCT .................................................................. 26

8.1 Standards of Business Conduct .......................................................................... 26

8.2 Conflicts of Interest ............................................................................................. 26

8.3 Declaring and Registering Interests .................................................................... 27

8.4 Managing Conflicts of Interest: contractors and people who provide services to the CCG .............................................................................................................. 27

8.5 Transparency in Procuring Services ................................................................... 27

9 THE CCG AS EMPLOYER .......................................................................................... 28

10 THE CCG AND ITS MEMBER PRACTICES ............................................................... 28

11 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS ...................... 30

11.1 General ............................................................................................................... 30

11.2 Standing Orders .................................................................................................. 30

APPENDICES

Appendix Description Page

A Definitions of Key Descriptions used in this Constitution 33

B Lower Super Output Areas 35

C List of Member Practices 36

D Committees of the Governing Body, the CCG and Council of members

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E Standing Orders 49

F Scheme of Reservation and Delegation 73

G Prime Financial Policies 106

H The Seven Key Principles of the NHS Constitution 119

I Terms of Reference for the Audit Committee 120

J Terms of Reference for the Remuneration Committee 132

K Terms of Reference of the Primary Care Commissioning Committee

140

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FOREWORD

NHS Buckinghamshire Clinical Commissioning Group (from henceforth referred to as CCG) consists of 50 practices in Buckinghamshire. All are committed to working towards the county vision of ‘Everyone working together so that the people of Buckinghamshire have happy and healthier lives.’

This Constitution sets out the way in which the CCG will fulfil its statutory responsibilities as set out in the 2006 Act. It describes the governing principles, rules and procedures that the CCG will establish to provide probity and accountability in the day-to-day running of the CCG. It will ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the CCG. It confirms:

the CCG's legal position

the CCG's purpose, vision, principles and accountabilities

the CCG’s membership and the decisions reserved to the membership

how the membership relates to the CCG’s Governing Body

the CCG's leaders, their roles and how they are selected and expected to behave

the powers of the Governing Body, committees and individuals

the CCG’s meeting arrangements

the CCG's standing orders and prime financial policies

Every Member Practice and every individual member of the Governing Body and its committees, employee and any other person or organisation working for or on behalf of the CCG is responsible for knowing, complying with and for upholding the arrangements for the governance and operation of the CCG as described in this Constitution.

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1 INTRODUCTION AND COMMENCEMENT

1.1 Name

1.1.1 The name of this group is NHS Buckinghamshire CCG.

1.2 Statutory Framework

1.2.1 CCGs are established under the Health and Social Care Act 2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning certain 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 CCGs to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.3

1.2.2 The NHS Commissioning Board, hereafter known as NHS England, is responsible for determining applications from prospective groups to be established as CCGs4 and undertakes an annual assessment of each established CCG.5 It has powers to intervene in a CCG where it is satisfied that a CCG is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6

1.2.3 CCGs are clinically led membership organisations made up of general practices. The Member Practices of the CCG are responsible for determining the governing arrangements for their organisations, which they are required to set out in a Constitution.7 This Constitution does not affect the Constitutions of the Member Practices.

1.3 Status of this Constitution

1.3.1 This Constitution is made between the Member Practices of NHS Buckinghamshire Clinical Commissioning Group and has effect from the 1st April 2020 following NHS England’s approval of merger of NHS Aylesbury Vale CCG with NHS Chiltern CCG.8 The Constitution is published on the CCG’s website at www.buckinghamshireccg.nhs.uk and our definitive signed paper copy can be viewed upon arrangement at our offices.

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 CCGs to commission certain health services are set out in section 3 of the 2006 Act, as

amended by section 13 of the 2012 Act 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 14E of the 2006 Act, inserted by section 25 of the 2012 Act

http://www.buckinghamshireccg.nhs.uk/

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1.4 Amendment and Variation of the Constitution

1.4.1 This Constitution can only be varied in two circumstances.9

a) Where the CCG applies to NHS England and that application is granted;

b) Where in the circumstances set out in legislation NHS England varies the CCG’s Constitution other than on application by the CCG.

2 AREA COVERED

2.1 The NHS Buckinghamshire CCG is responsible for all people who are:

Provided with primary medical services by GP practices who are members of the CCG

Usually resident in the area covered by the CCG and not provided with primary medical services by a member of any CCG

Present in their geographical area and require urgent and emergency care services.

Buckinghamshire CCG’s defined geography is entirely contained within Buckinghamshire County Council along with part of East Oxfordshire which covers the wards of Aston Rowant, Chinnor and Thame North and Thame South. This is shown in the map below. The CCG partially covers one or more local authority areas (e.g. Thame) and is defined using Local Super Output Areas (LSOAs) which are listed in Appendix B.

9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any

regulations issued

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3 MEMBERSHIP

3.1 Membership of the CCG

3.1.1 Membership of the CCG and its council of members is as defined by the list of member practices contained in in Appendix C.

3.1.2 The definitive paper copy also includes the signatures of the Member Practices confirming their agreement to this Constitution.

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 (essential primary medical services to registered patients during core hours), will be eligible to apply for membership of this CCG,10 so long as the practice address is located either on the boundaries, or within, the area covered as described in section 2.1; and provided that the majority of registered patients are resident within the area covered by the CCG.

3.3 Termination of Membership

3.3.1 Membership of a practice in the CCG will automatically terminate where a practice ceases to hold a contract to provide primary medical services to the NHS and so no longer satisfies the eligibility criteria.

3.3.2 Applications to otherwise leave the CCG must be made in writing to the Chair of the Governing Body giving 6 months notice of their intention to leave.

3.3.3 Practice Members wishing to join or leave the CCG should comply with the CCG’s standing orders and will require NHS England approval.

10 See section 14A (4) of the 2006 Act, inserted by section 25 of the 2012. See also application process as described in the appendices 10a Definition “on the boundaries” can vary as the factors which affect its application also vary, e.g. patients flow, practice choice to be aligned to one CCG rather than another. Most frequently will relate to a practice address within a few miles of a ward boundary.

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4 PURPOSE, VISION AND PRINCIPLES

4.1 Purpose

4.1.1 As a clinically led commissioning organisation our purpose is to spend the money allocated to us as wisely as possible to improve quality and experience of care and ensuring we achieve superior health outcomes for all members of our communities. We will do this by being innovative, responsive, productive and caring, taking into account the needs of our member practices and staff, at the same time as creating a financially stable and sustainable organisation.

4.1.2 The CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. Good corporate governance arrangements are critical to achieving the CCG’s objectives.

4.2 Vision

4.2.1 The Bucks system vision is ‘Your community, your care, developing Buckinghamshire together.’

4.2.2 The CCG will publish a yearly statement of underlying values and aims in its annual commissioning plan. This will ensure that values and aims can be adjusted from time to time without having to update the Constitution itself. They must be consistent with the Constitution.

4.3 Principles of Good Governance

4.3.1 In accordance with section 14L (2) (b) of the 2006 Act,11 the CCG will at all times observe “such generally accepted principles of good governance as are relevant to it” 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;12

c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’;

d) the seven key principles of the NHS Constitution;

e) the Equality Act 2010;13

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 http://www.legislation.gov.uk/ukpga/2010/15/contents

http://www.legislation.gov.uk/ukpga/2010/15/contents

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f) the Standards for Members of NHS Boards and Governing Body in England; and

g) Information Governance requirements including but not limited to the requirements of the Data Protection Act 1998 and subsequent General Data Protection Regulations 2016 and compliance with the Information Governance Toolkit.

4.4 Accountability

4.4.1 The CCG will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, in accordance with statutory requirements, by:

a) publishing its Constitution;

b) having a clear policy for the management of conflicts of interests;

c) appointing independent Lay Members and non GP clinicians to its Governing Body;

d) holding meetings of its Governing Body which will be in public (except where the CCG considers that it would not be in the public interest in relation to all or part of a meeting);

e) publishing annually a commissioning plan;

f) complying with local authority health overview and scrutiny requirements;

g) meeting annually in public to publish and present its annual report 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.

4.4.2 In addition to these statutory requirements, the CCG will demonstrate its accountability by:

a) Publishing commissioning and operational plans;

b) Publishing a Communications and Engagement Strategy.

4.4.3 The Governing Body of the CCG will throughout each financial year review the CCG’s governance arrangements to ensure that the CCG continues to reflect the principles of good governance.

4.4.4 The CCG will also be a full member of the Buckinghamshire Health and Wellbeing Board established by the Local Authority.

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5 FUNCTIONS AND GENERAL DUTIES

5.1 Functions

5.1.1 The functions that the CCG is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s Functions of 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:

all people registered with Member Practices, and

people who are usually resident within the area and are not registered with a Member Practice of any CCG;

b) commissioning emergency care for anyone present in the CCG’s area;

c) paying its employees and officers remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the CCG’s employees and officers;

d) determining the remuneration and travelling or other allowances of members of its Governing Body, any committee or sub-committee of the CCG or Governing Body;

e) Its Member Practices; how they should each participate in the exercise of discharging the CCG’s functions; and

f) Discharging a range of statutory duties as described in primary and secondary legislation, and related duty to assist a local authority in the discharge of its functions.

5.1.2 In discharging its functions the CCG will:

a) act14, 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 service15 and with the objectives and requirements placed on NHS England through the mandate16 published by the Secretary of State before the start of each financial year by:

delegating responsibility to:

the CCG’s Governing Body, or

a committee or sub-committee of the CCG, or

an individual with lead responsibility to oversee its discharge (i.e. Accountable Officer, member or employee);

specifying a policy which sets out how the CCG intends to discharge this duty;

14

See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 15

See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 16

See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act

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requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms.

The specific arrangements are in the CCG’s standing orders / scheme of reservation and delegation (contained within appendices).

b) meet the public sector equality duty17 :

Under the Equality Act 2010, CCGs must, in the exercise of their functions, have due regard to the need to:

eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the 2010 Act;

advance equality of opportunity between people who share a protected characteristic and those who do not;

Foster good relations between people who share a protected characteristic and those who do not.

5.2 General Duties

In discharging its functions the CCG 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 arrangements18 by:

a) Statement of Principles

working in partnership with patients and the local community to secure the best care for them

adapting engagement activities to meet the specific needs of the different patient groups and communities

publishing information about health services on the CCG’s website and through other media

encouraging and acting on feedback

monitoring and reporting the CCG’s compliance with the Communications and Engagement Strategy and associated action plan which shall have effect as if incorporated into this Constitution

Implementing transparent, accessible, decision making processes that are open to all, with the aim of ensuring that health services commissioning is informed by the needs and views of the people of Buckinghamshire.

Delegating responsibility to the Governing Body so that the Governing Body shall ensure that the duties described in s.14z of the NHS Act 2006 are met.

The Governing Body reporting to the membership at least annually on the delivery of these arrangements

17

See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act

18 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act

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Discharging the general duties requirements as are described under this section have, since September 2019, been delegated to an Integrated Care Partnership Getting Bucks Involved” Group. However the CCG Governing Body will continue to take any decision as is required to enact formal consultation associated with commissioning planning and/or decisions.

(b) 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 Constitution19.

5.2.2 Work in partnership with our local authority to develop joint strategic needs assessments and joint health and wellbeing strategies.

5.2.3 Act effectively, efficiently and economically20.

5.2.4 Act with a view to securing continuous improvement to the quality of services21.

5.2.5 Assist and support NHS England in relation to its duty to improve the quality of primary medical services22.

5.2.6 Have regard to the need to reduce inequalities23.

5.2.7 Promote the involvement of patients, their carers and representatives in decisions about their healthcare24.

5.2.8 Act with a view to enabling patients to make choices25.

19 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) 20 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 21 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act 22 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 23 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act 24 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act 25 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act

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5.2.9 Obtain appropriate advice26 from persons who, taken together, have a broad range of professional expertise in healthcare and public health.

5.2.10 Promote innovation27.

5.2.11 Promote research and the use of research28.

5.2.12 Have regard to the need to promote education and training29 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 duty30.

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 CCG considers that this would improve the quality of services or reduce inequalities31.

5.2.14 Safeguarding and dignity – the CCG will act to ensure appropriate systems for safeguarding.

5.2.15 Demonstrate a commitment to promoting environmental and social sustainability through its actions as a corporate body as well as a commissioner.

5.2.16 Delegated Responsibilities – the CCG will undertake to ensure appropriate commissioning arrangements with NHS England for the exercise of specified functions of NHS England under delegated arrangements.

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 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 30 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act 31 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act

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5.3 General Financial Duties

The CCG will perform its functions so as to:

5.3.1 Ensure compliance with Section 11 of the Children Act 2004 which places duties to ensure functions, and any contracted services, are discharged having regard to the need to safeguard and promote the welfare of children.

5.3.2 Ensure its expenditure does not exceed the aggregate of its allotments for the financial year32.

5.3.3 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 year33.

5.3.4 Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHS England 34.

5.3.5 Publish an explanation of how the CCG spent any payment in respect of quality made to it by NHS England35.

5.4 Other Relevant Regulations, Directions and Documents

5.4.1 The CCG will:

a) comply with all relevant regulations;

b) comply with directions issued by the Secretary of State for Health or NHS England; and

c) Take account, as appropriate, of documents issued by NHS England.

5.4.2 The CCG will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this Constitution, its scheme of reservation and delegation and other relevant CCG policies and procedures.

5.4.3 The CCG shall prepare its commissioning plans in accordance with any guidance published by NHS England. The Commissioning Plan must set out how the CCG proposes to exercise its functions during the relevant financial year and be published on its website.

32 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act 33 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act 34 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act 35 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act

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6 DECISION MAKING: THE GOVERNING STRUCTURE

6.1 Authority to Act

6.1.1 The CCG is accountable for exercising the statutory functions of the CCG. It may grant authority to act on its behalf to:

a) any of its members;

b) its Governing Body;

c) its employees;

d) A committee or sub-committee of the CCG.

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 CCG as expressed through:

a) this Constitution;

b) the CCG’s scheme of reservation and delegation; and

c) For committees, their terms of reference.

6.2 Scheme of Reservation and Delegation

6.2.1 The CCG’s scheme of reservation and delegation sets out:

a) those decisions that are reserved for the membership as a whole; and

b) those decisions that are the responsibilities of its Governing Body (and its committees), and individual employees

Further details are at Appendix F.

6.3 General

6.3.1 In discharging delegated functions of the CCG, the Governing Body, its committees and individuals (members, employees and officer appointments) must:

a) comply with the CCG’s principles of good governance;

b) operate in accordance with the CCG’s scheme of reservation and delegation;

c) comply with the CCG’s standing orders;

d) comply with the CCG’s arrangements for discharging its statutory duties;

e) Where appropriate, ensure that Member Practices have had the opportunity to contribute to the CCG’s decision making process.

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.

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6.3.3 Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must:

a) identify the roles and responsibilities of those CCGs who are working together;

b) identify any pooled budgets and how these will be managed and reported in annual accounts;

c) specify under which CCG’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.

Although the CCG will be one CCG with one Governing Body, it may still collaborate in lead and associate commissioner relationships with neighbouring CCGs.

6.4 Committees of the Governing Body

6.4.1 The following statutory committees have been established:

a) Audit Committee

b) Remuneration Committee

c) Primary Care Commissioning Committee

Other committees will be established as required by the Governing Body and these will be reflected in the Committees of the CCG as per Appendix D.

6.5 Joint Arrangements

6.5.1 Joint commissioning arrangements with other CCGs – The CCG may wish to work together with other CCGs in the exercise of its commissioning functions.

6.5.2 The CCG may make arrangements with one or more CCGs in respect of:

a) delegating any of the CCG’s commissioning functions to another CCG;

b) exercising any of the commissioning functions of another CCG; or

c) Exercising jointly the commissioning functions of the CCG and another CCG.

6.5.3 For the purposes of the arrangements described at paragraph 6.5.2, the CCG may:

a) make payments to another CCG;

b) receive payments from another CCG;

c) make the services of its employees or any other resources available to another CCG; or

d) Receive the services of the employees or the resources available to another CCG.

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6.5.4 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.

6.5.5 For the purposes of the arrangements described at paragraph 6.5.2 above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 6.5.2c 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.

6.5.6 Where the CCG makes arrangements with another CCG as described at paragraph 6.5.2 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

a) how the parties will work together to carry out their commissioning functions;

b) the duties and responsibilities of the parties;

c) how risk and conflicts of interest will be managed and apportioned between the parties;

d) financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund;

e) Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.5.7 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.5.2 above.

6.5.8 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body.

6.5.9 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement in line with notice as specified individually.

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6.5.10 The CCG has joint committee(s) with the following local authority:

a) Joint committee with Buckinghamshire County Council for both adult and children’s joint commissioning, which is currently known as the ‘Integrated Commissioning Executive Team’ and any successor groups. This committee is accountable to the CCG Governing Body, as well as formally accountable to the Health and Wellbeing Board of the County Council. It is therefore shown as a committee of the Governing Body or as a committee of the CCG.

6.6 Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions

6.6.1 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions.

6.6.2 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.

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.

6.6.3 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.

6.6.4 For the purposes of the arrangements described at paragraph [6.6.2] 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.

6.6.5 Where the CCG enters into arrangements with NHS England as described at paragraph [6.6.2 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.

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6.6.6 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 [6.6.2] above.

6.6.7 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning.

6.6.8 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body.

6.6.9 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the Director of Commissioning and Delivery 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.

6.7 The Governing Body

6.7.1 The purpose of the Governing Body is to ensure that the CCG is carrying out its work effectively, efficiently and economically and with good governance and in accordance with the terms of the Constitution as agreed by its Members.

The Governing Body will take responsibility for key areas (vision, assurance and strategy) and will scrutinise decision making to ensure that it follows due process.

Functions – the Governing Body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this Constitution:36

a) ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG’s principles of good governance (its main function);

b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

c) approving any functions of the CCG that are specified in regulations;37

36 See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act 37 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act

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6.7.2 Composition of the Governing Body - the Governing Body shall comprise of the following voting roles:

a) The Clinical Chair – GP from a Member Practice;

b) Three Member GPs – clinical directors appointed by the Governing Body;

c) Four Lay Members – one to act as the Lay Vice Chair. The Lay Members will between them have a role in Chairing the Audit Committee and remuneration committee; act as conflicts of interest guardian; lead on primary care commissioning; lead on corporate governance; and lead on patient championship, with separation of duties as required;

d) One Registered Nurse;

e) a registered secondary care specialist doctor;

f) The Accountable Officer;

g) The Chief Finance Officer;

h) Two other management directors

The Governing Body can invite non-members to attend and speak but not vote. The Director of Transformation will be co-opted as an additional voting member only in circumstances of conflict of interest material to member GPs/Chair which requires them not to count for quorum purposes. In circumstances relating to remuneration decisions, in which one or more members are materially conflicted, a reduced quorum will be deemed acceptable as required at the discretion of the Chair, Lay Vice Chair or Accountable Officer/Deputy Accountable Officer/Chief Finance Officer dependent upon to whom the material conflict relates.

7 ROLES AND RESPONSIBILITIES

7.1 Practice Representatives

7.1.1 The Health and Social Care Act 2012 allows regulations to be made that require each member of the CCG (i.e. each GP practice) to appoint an individual who is a healthcare professional to act on its behalf in dealings with the CCG. This individual will be known as a Practice Representative. The role of each Practice Representative in this context is described in the Standing Orders (Appendix E).

7.2 All Members of the CCG’s Governing Body

Guidance on the roles of members of the CCG’s Governing Body is set out in a separate document38. In summary, each member of the Governing Body should share responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. Each brings their unique perspective, informed by their expertise and experience.

38 See the latest version of NHS England Authority’s Clinical commissioning group Governing Body

members: Role outlines, attributes and skills

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7.3 The Clinical Chair of the Governing Body

7.3.1 The role of The Clinical Chair of the Governing Body has been defined in the job description and in summary, is responsible for:

a) leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this Constitution;

b) building and developing the CCG’s Governing Body and its individual members;

c) ensuring that the CCG has proper Constitutional and governance arrangements in place;

d) ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties;

e) supporting the Accountable Officer in discharging the responsibilities of the organisation;

f) contributing to building a shared vision of the aims, values and culture of the organisation;

g) leading and influencing to achieve clinical and organisational change to enable the CCG to deliver its commissioning responsibilities;

h) overseeing governance and particularly ensuring that the Governing Body and the wider CCG behaves with the utmost transparency and responsiveness at all times;

i) ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met;

j) ensuring that the organisation is able to account to its local patients, stakeholders and NHS England;

k) Ensuring that the CCG builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the local authority.

7.4 The Lay Vice Chair of the Governing Body

7.4.1 The Lay Vice Chair of the Governing Body deputises for the Chair of the Governing Body where he or she has a conflict of interest or is otherwise unable to act.

7.5 Role of the Accountable Officer

7.5.1 The Accountable Officer of the CCG is a member of the Governing Body.

7.5.2 The role of Accountable Officer has been defined in the job description and as summarised in a national document39 is:



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a) being responsible for ensuring that the CCG fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

b) at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems;

c) working closely with the Chair of the Governing Body, the Accountable Officer will ensure that proper Constitutional, governance and development arrangements are put in place to assure the Members (through the Governing Body) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its members and staff;

d) Ensuring a clinically driven, bottom-up culture that involves Member Practices, patients and the public in deciding everything we do.

7.5.3 In addition to the Accountable Officer’s general duties, he/she will take the lead in interactions with stakeholders, including NHS England.

7.6 Role of the Chief Finance Officer

7.6.1 The Chief Finance Officer is a member of the Governing Body and is responsible for providing financial advice to the CCG and for supervising financial control and accounting systems.

7.6.2 This role of Chief Finance Officer has been defined in the job description and as summarised in a national document40 is:

a) being the Governing Body’s professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged;

b) making appropriate arrangements to support and monitor the CCG’s finances;

c) overseeing robust audit and governance arrangements leading to propriety in the use of the CCG’s resources;

d) being able to advise the Governing Body on the effective, efficient and economic use of the CCG’s allocation to remain within that allocation and deliver required financial targets and duties; and

e) Producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS England.



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7.7 Joint Appointments with other Organisations

7.7.1 The CCG may make joint appointments as it considers appropriate. Any joint appointments outside of the CCG will be supported by a memorandum of understanding

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8 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

8.1 Standards of Business Conduct

8.1.1 Employees, members, officers, committee and sub-committee members of the CCG and members of the Governing Body (and its committees) will at all times comply with this Constitution, and the latest statutory guidance as issued by NHS England, and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCG and should follow the Seven Principles of Public Life (the Nolan Principles), set out by the Committee on Standards in Public Life (the Nolan Principles), as well reflecting the expectations set out in the Standards for Members of NHS Boards and CCGs (Nov 2012).

8.1.2 They must comply with the CCG’s code on business conduct, including the requirements set out in the policy for managing conflicts of interest.

8.1.3 Individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.2 Conflicts of Interest

8.2.1 As required by section 14O of the 2006 Act, and as inserted by section 25 of the 2012 Act, the CCG will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without any possibility of the influence of external or private interest. The CCG’s policy for managing conflicts of interest is appended to this Constitution.

8.2.2 Individual members of the CCG, the Governing Body, committees or sub-committees, the committees or sub-committees of its Governing Body, employees and appointed officers will comply with the arrangements determined by the CCG for managing conflicts or potential conflicts of interest which will be in accordance with the latest guidance from NHS England. In addition, they will abide by NHS England’s Code of Conduct .

8.2.3 The Lay member delegated with responsibility for managing conflicts of interest will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the CCG’s decision making processes.

8.2.4 Arrangements for the management of conflicts of interest are to be determined by the Lay member delegated with this responsibility and will be written into a policy reflecting latest guidance from NHS England on managing conflicts of interest and appended to this Constitution.

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8.3 Declaring and Registering Interests

8.3.1 The CCG will maintain one or more registers of interests in accordance with the latest statutory guidance from NHS England as expressed in the conflicts of interest policy appended to this Constitution.

8.3.2 The registers will be published on the CCG’s website at www.buckinghamshireccg.nhs.uk or at the following postal address:

NHS Buckinghamshire CCG, Study Centre, New County Offices, Walton Street, Aylesbury, Bucks HP20 1UX

8.4 Managing Conflicts of Interest: contractors and people who provide services to the CCG

8.4.1 Anyone seeking information in relation to procurement, or participating in procurement, or otherwise engaging with the clinical commissioning group in relation to the potential provision of services or facilities to the group, will be required to make a declaration of any relevant conflict / potential conflict of interest.

8.4.2 Anyone contracted to provide services or facilities directly to the clinical commissioning group will be subject to the same provisions of this Constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.5 Transparency in Procuring Services

8.5.1 The CCG recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

8.5.2 Anyone contracted to provide services or facilities directly to the CCG will be subject to the same provisions of this Constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.5.3 The CCG has published a Procurement Strategy approved by its Governing Body which will ensure that: a) all relevant clinicians (not just members of the CCG) and potential providers,

together with local members of the public, are engaged in the decision-making processes used to procure services;

b) Service redesign and procurement processes are conducted in an open,

transparent, non-discriminatory and fair way.

http://www.buckinghamshireccg.nhs.uk/

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9 THE CCG AS EMPLOYER

9.1 The CCG recognises that its most valuable asset is its people. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCG.

9.2 The CCG will seek to set an example of best practice as an employer and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

9.3 The CCG will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by the CCG. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.4 The CCG will maintain and publish policies and procedures (as appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters.

9.5 The CCG will ensure that its rules for recruitment and management of staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

9.6 The CCG will ensure that employees' behaviour reflects the values, aims and principles set out above.

9.7 The CCG will ensure that it complies with all aspects of employment law.

9.8 The CCG will ensure that its employees have access to such expert advice and training opportunities as they may require in order to exercise their responsibilities effectively.

9.9 The CCG will adopt a Code of Conduct for staff and will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff and Practices have means through which their concerns can be voiced.

Copies of this Code of Conduct, together with the other policies and procedures outlined in this chapter, will be available on the CCG’s website. The CCG will also observe its legal obligations and best practice towards office holders and those working within the CCG who it does not employ.

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10 THE CCG AND ITS MEMBER PRACTICES

The CCG recognises that one of its most valuable assets is its member practices and will discharge its responsibilities to them in accordance with the high standards expected of a public body.

The CCG will ensure that Member Practices have access to such expert advice and training opportunities as they may require to exercise their commissioning responsibilities effectively, and that efforts on behalf of the CCG are recognised and appropriately funded.

The CCG will work with the Local Medical Committee (LMC) as representatives of GPs as providers of patient care.

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11 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS

11.1 General

11.1.1 The CCG will publish annually a commissioning plan and an annual report, presenting the CCG’s annual report to a public meeting.

11.1.2 Key communications issued by the CCG, including the notices of procurements, public consultations, Governing Body meeting dates, times, venues, and related papers will be published on the CCG’s website. The CCG may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public.

11.1.3 Member Practices who have a grievance or complaint about the CCG are invited to raise this with the CCG informally, and if this does not resolve the concerns, then use the procedure as described in the CCG’s Grievance Policy.

11.2 Standing Orders

11.2.1 This Constitution is also informed by a number of documents which provide further details on how the CCG will operate. They are the CCG’s:

a) Standing Orders (Appendix E) - which sets out the arrangements for meetings and the appointment processes to elect the CCG’s representatives and appoint to the CCG’s committees, including the Governing Body;

b) Scheme of reservation and delegation (Appendix F) – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCG’s Governing Body, the Governing Body’s committees and sub-committees, the CCG’s committees and sub-committees, individual members and employees;

c) Prime financial policies (Appendix G) – which sets out the arrangements for managing the CCG’s financial affairs

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APPENDICES

Appendix Description Page

A Definitions of Key Descriptions used in this Constitution 33

B Lower Super Output Areas 35

C List of Member Practices 36

D Committees of the Governing Body, the CCG and Council of members

38

E Standing Orders 49

F Scheme of Reservation and Delegation 73

G Prime Financial Policies 106

H The Seven Key Principles of the NHS Constitution 119

I Terms of Reference for the Audit Committee 120

J Terms of Reference for the Remuneration Committee 132

K Terms of Reference for the Primary Care Commissioning Committee

140

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APPENDIX A

DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Area The geographical area that the CCG has responsibility for, as defined in Chapter 2 of this Constitution

Accountable Officer

An individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by NHS England, with responsibility for ensuring the CCG:

complies with its obligations under:

- sections 14Q and 14R of the 2006 Act (as inserted by

section 26 of the 2012 Act),

- sections 223H to 223J of the 2006 Act (as inserted by

section 27 of the 2012 Act),

- paragraphs 17 to 19 of Schedule 1A of the NHS Act

2006 (as inserted by Schedule 2 of the 2012 Act), and

- any other provision of the 2006 Act (as amended by the

2012 Act) specified in a document published by the

Board for that purpose;

Exercises its functions in a way which provides good value

for money.

CCG Regulations The National Health Service (Clinical Commissioning Groups) Regulations 2012.

Chief Finance Officer The qualified accountant employed by the CCG with responsibility for financial strategy, financial management and financial governance.

Clinical Chair of the Governing Body

The individual appointed by the CCG to act as clinical Chair of the Governing Body

Clinical Commissioning Group (CCG)

A body corporate established by NHS England in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act).

Committee

A committee or sub-committee created and appointed by:

the membership of the CCG;

a committee / sub-committee created by a committee

created / appointed by the membership of the CCG;

A committee / sub-committee created / appointed by the

Governing Body.

Constitution This Constitution.

Council of members The forum comprised of Practice Representatives

Financial year

This usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a CCG is established until the following 31 March.

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Group NHS Buckinghamshire CCG, whose Constitution this is.

Governing Body

The body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a CCG has made appropriate arrangements for ensuring that it complies with:

its obligations under section 14Q under the NHS Act 2006

(as inserted by section 26 of the 2012 Act), and

Such generally accepted principles of good governance as

are relevant to it.

Governing Body member Any individual appointed to the Governing Body of the CCG

Lay member

A Lay member of the Governing Body, appointed by the CCG. A Lay member is an individual who is not a member of the CCG or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations.

Member Practice A provider of primary medical services to a registered patient list, who is a member of this group (see Appendix C).

Non-weighted square root registered list size population

Weighting makes adjustments to account for differences between all patients at a practice, i.e. older population/profile. This is applied so that practices are not disadvantaged in their share of a vote based on their location.

Square root calculation spreads out the share of votes so smaller practices are not unduly disadvantaged in their share of the vote

Practice representatives

An individual appointed by a practice (who is a member of the CCG) to act on its behalf in the dealings between it and the CCG, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act).

Registers of interests

Registers a group is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of:

the members of the CCG;

the members of its Governing Body;

the members of its committees or sub-committees and

committees or sub-committees of its Governing Body; and

Its employees.

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APPENDIX B LOWER SUPER OUTPUT AREAS

11.3 The NHS Buckinghamshire CCG is responsible for all people who are:

Provided with primary medical services by GP practices who are members of the CCG

Usually resident in the area covered by the CCG and not provided with primary medical services by a member of any CCG

Present in their geographical area and require urgent and emergency care services.

NHS Buckinghamshire CCG covers four local authority areas i.e. Chiltern, South Bucks,

Wycombe and Aylesbury Vale District Councils.

The following lower super output areas define the geography of the CCG:

All lower super output areas in the district of Chiltern;

All lower super output areas in the district of South Buckinghamshire;

All lower super output areas in the district of Wycombe

All lower super output areas in the district of Aylesbury Vale

Note: 8 LSOAs belonging to North and South Thame area have been excluded since in these areas Rycote practice has a majority of registered population.

The 8 excluded LSOAs are: E01028666, E01028667, E01028668, E01028669, E01028670, E01028671, E01028672, and E01028673

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APPENDIX C: LIST OF MEMBER PRACTICES

Practice Name Address

Ashcroft Surgery Ashcroft Surgery, Stewkley Road, Wing,LU7 0NE

3W Health Norden House Surgery, Avenue Road, Winslow, Bucks, MK18 3DW

3W Health Wing Surgery, 46 Stewkley Road, Wing, Leighton Buzzard,LU7 0NE

3W Health Whitchurch Surgery, 49 Oving Road, Whitchurch, Aylesbury, HP22 4JF

The Swan

Practice

(incorporating

Verney Close)

1. The Swan Practice, High Street, Buckingham, MK18 1NU

2. Steeple Claydon Surgery, 2 Vicarage Lane, Steeple Claydon, MK18 2PR

3. Verney Close Surgery, Verney Close, Buckingham. Bucks MK181JP

Edlesborough

Surgery

Edlesborough Surgery, 11 Cow Lane, Edlesborough. Dunstable, Beds, LU6

2HT

Waddesdon

Surgery

Waddesdon Surgery, Goss Avenue, Aylesbury, HP18 0LY

Berryfields

Medical Centre

Berryfields Medical Centre, Colonel Grantham Avenue, Buckingham Park,

Aylesbury, HP19 9AP

The Mandeville

Practice

The Mandeville Practice, Hannon Road, Aylesbury Buckinghamshire,

HP21 8TR

Meadowcroft

Surgery

Meadowcroft Surgery, Jackson Road, Aylesbury, Bucks, HP19 9EX

Oakfield Surgery Oakfield Surgery, Oakfield Road, Aylesbury, Bucks, HP20 1LJ

Poplar Grove

Practice

Poplar Grove Practice, Meadow Way, Aylesbury, HP20 1XB

Poplar Grove

Practice

Poplar Grove Practice, Meadow Way, Aylesbury, HP20 1XB

Westongrove

Partnership

1. Aston Clinton Surgery, 136 London Road, Aston Clinton, Aylesbury,

Bucks, HP22 5LB

2. Wendover Health Centre, Aylesbury Road, Wendover, Bucks, HP22 6LD

3. Bedgrove Surgery, Brentwood Way, Aylesbury, Bucks,HP21 7TL

Whitehill Surgery Whitehill Surgery, Oxford Road, Aylesbury, Bucks, HP19 8EN

The Cross Keys 1. High Street, Princes Risborough, HP27 0AX

2. Church Road, Chinnor, OX39 4PG

Haddenham

Medical Centre

Haddenham Medical Centre, Stanbridge Road, Haddenham,

Buckinghamshire,

HP17 8JX

36


Unity Health 1. Unity Health, Thame Health Centre, East Street, Thame, Oxfordshire,

OX9 3JZ

2. Unity Health, High Street, Long Crendon, Aylesbury, Bucks, HP19, 9AF

3. Unity Health, 22 Thame Road, Brill, Aylesbury, Bucks, HP18 9SA

4. Unity Health, Wades Field, Stratton Road, Princes Risborough,

Buckinghamshire, HP27 9AX

5. Unity Health, 5 Station Road, Chinnor, Oxfordshire OX39 4PX

Amersham Health Centre

Chiltern Avenue, Amersham, HP6 5AY

Gladstone Surgery

260-290 Berkhampstead Rd, Chesham, HP5 3EZ

Hughenden Valley Surgery

Valley Road, Hughenden Valley, HP14 4LG

John Hampden Surgery

97 The High Street, Prestwood, HP16 9EU

Little Chalfont Surgery

200 White Lion Road, Little Chalfont, HP7 9NU

Prospect House 108 High Street, Great Missenden, HP16 0BG

Rectory Meadow Surgery

School Lane, Amersham, HP7 0HG

The New Surgery 260–290 Berkhampstead Rd, Chesham, HP5 3EZ

Water Meadow Surgery

Red Lion Street, Chesham, HP5 1ET

Burnham Health Centre

Minniecroft Road, Burnham, SL1 7DE

Denham Medical Centre

Queen Mother Drive, Denham Garden Village, Denham, UB9 5GA

Southmead Surgery

Blackpond Lane, Farnham Common, SL2 2ER

The Allen Practice

Hampden Road, Chalfont St. Peter, SL9 9SA

The Hall Practice Hampden Road, Chalfont St. Peter, SL9 9SA

The Ivers Practice

High Street, Iver, SL0 9NU

The Misbourne Practice

Church Lane, Chalfont St Peter,SL9 9RR

Threeways Surgery

Pennylets Green, Stoke Poges, SL2 4AZ

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Cherrymead Surgery

Queensmead Road, Loudwater, High Wycombe, HP10 9XA

Bourne End and Wooburn Green Medical Centre

8 The Green, High Wycombe HP10 0EE

Highfield Surgery Highfield Way, Hazlemere, HP15 7UW

Millbarn Medical Centre

34 London End, Beaconsfield, HP9 2JH

Stokenchurch Medical Centre

Oxford Road, Stokenchurch, HP14 3SX

The Marlow Medical Group

Victoria Road, Marlow, SL7 1DN

The Simpson Centre

70 Gregories Road, Beaconsfield, HP9 1PS

Carrington House Surgery

19 Priory Road, High Wycombe, HP13 6SL

Chiltern House Medical Centre

45-47 Temple End, High Wycombe, HP13 5DN

Cressex Health Centre

Coronation Road, High Wycombe, HP12 3PP

Desborough Surgery

65 Desborough Avenue, High Wycombe, HP11 2SD

Kingswood Surgery

Hollis Road, High Wycombe, HP13 7UN

Priory Surgery 24-26 Priory Ave, High Wycombe, HP13 6SH

Riverside Surgery George Street, High Wycombe, HP11 2RZ

Tower House Surgery

169 West Wycombe Rd, High Wycombe, HP12 3AF

Wye Valley Surgery

2 Desborough Avenue, High Wycombe, HP11 2RN

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APPENDIX D

COMITTEES OF THE GOVERNING BODY, THE CCG AND COUNCIL OF MEMBERS

1.1 The Council of Members

This is a meeting of the members and will usually meet at least once a year having been arranged by the Governing Body on behalf of the Membership. They will be able to influence strategy and key organisational decisions such as: a. expressing confidence (or lack of confidence) in the Governing Body

and/or Executive Committee; b. voting (balloting) for a clinical member of the Executive Committee; c. agreeing the strategic direction proposed; d. Changing the Constitution (subject to NHS England approval).

There will be one vote per Member Practice, using a non-weighted population square root formula. A 70% majority will be required to confirm a decision. This will apply except in relation to named individuals where processes described in Appendix E will apply. The CCG will hold an annual general meeting for Member Practices to present the previous year’s annual report and agree the next year’s strategy. Further Membership meetings may be requested and/or called by the CCG and/or Member Practices.

1.2 Committees of the Governing Body - the Governing Body has appointed the following committees and sub-committees:

a) Audit Committee (see also appendix I for full terms of reference) – which is accountable to the CCG's Governing Body, shall provide assurance and advice to the Governing Body, and to the Accountable Officer, on the proper stewardship of resources and assets; including value for money, financial reporting, the effectiveness of audit arrangements (internal and

39

external), risk management, and on control and integrated governance arrangements within the CCG.

The Audit Committee has the following aims/objectives in providing assurance to the Governing Body that an appropriate system of internal control is in place:

Ensuring that business is conducted in accordance with the law and proper standards;

Ensuring public money is safeguarded and properly accounted for;

Ensuring Financial Statements are prepared in a timely fashion, and give a true and fair view of the financial position of the CCGs for the period in question;

Ensuring affairs are managed to secure economic, efficient and effective use of resources;

Ensuring reasonable steps are taken to prevent and detect fraud and other irregularities.

The Committee shall critically review financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained. The Committee may also review the adequacy, effectiveness and integrity of:

Financial reporting a. Financial statements of the CCG and any formal announcements relating

to the CCG’s financial performance, whilst ensuring that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG.

b. Reviewing the annual report and financial statements before submission to the Governing Body and the CCG, focusing on:

c. The wording in the governance statement and other disclosures relevant to the committee terms of reference;

d. Changes in, and compliance with, accounting policies, practices and estimation techniques;

e. Unadjusted mis-statements in the financial statements; f. Significant judgements in preparing of the financial statements; g. Significant adjustments resulting from the audit; h. Letter of representation; and i. Qualitative aspects of financial reporting.

Corporate Risk Management, Policies and Processes

a. All risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the CCG.

b. The underlying assurance processes that indicate the degree of achievement of the CCG’s objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

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c. The combined corporate risk register and assurance framework, and related risk action plans, ensuring that risks are appropriately prioritised and adequately controlled and mitigated, and ensuring that high and extreme risks are communicated to the Governing Body.

d. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

e. The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud Service.

f. Satisfying itself on arrangements in place for countering fraud and outcomes of counter fraud work. It shall also approve the counter fraud work programme.

g. Ensure that the CCG has arrangements in place to work effectively with NHS Protect.

It may also seek assurances as appropriate, concentrating on the over-arching critical review of systems, together with indicators of their effectiveness, of integrated governance, risk management and internal control that support the achievement of the CCG’s objectives. This is evidenced through use of an effective assurance framework to guide its work and that of the functions that report to it.

The Committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements. Its work dovetails with that of the Quality and Performance Committee which the CCG has established to seek assurance that robust clinical quality is in place. The Clinical GP Chair of the CCG shall not be a member of the Committee. At least one member of the Committee shall have a recognized accounting qualification. The Committee consists of not less than three members, one of which must be the designated Chair (the Lay member from the Governing Body). The other two members comprise:

Practice Member(s)/ Practice Member Representative(s) –representatives appointed from the CCG.

The number of practice members may not be in the majority and additional Lay representatives may be appointed to ensure that in total the Chair and Lay representative(s) outnumber the total practice representatives. A quorum shall be two members, one of which is the Chair (the Lay member from the Governing Body) or their nominated Deputy from within the membership of the committee. The Practice Representatives cannot form the majority of the quorum.

b) Remuneration Committee (see also appendix J for full terms of reference) – the Remuneration Committee which is accountable to the CCG’s Governing Body makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for

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employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The Governing Body approves and keeps under review the terms of reference for the Remuneration Committee, which includes information on the membership of the Remuneration Committee and is available upon request. The committee shall advise and recommend to the CCG Members (via the Governing Body) a framework for the remuneration, allowances and terms of service for employees of the CCG and people who provide services to the CCG, including:

all aspects of salary, including performance related elements or bonuses and determination of National Recruitment and Retention Premia (“NRRP”);

provision of other benefits;

allowances under any pension schemes they may establish as an alternative to the NHS pension scheme; and

Arrangements for termination of employment and variation of other contractual terms.

The committee is also responsible for ensuring effective oversight of the performance of the CCG Chair, Accountable Officer, Chief Financial Officer and other senior roles, and the scrutiny of redundancy payments. The duties of the committee are to:

note measurable performance objectives for the CCG Chairs and Accountable Officer, which are compatible with the strategic objective of the CCG and are consistent with local and national priorities;

monitor the CCG Chairs’ and Accountable Officer’s assessments of performance of shared senior posts based on measures of individual and corporate targets;

agree any pay policy and payment framework for VSM employees and clinical commissioning roles of the CCG, and people who provide services to the CCG, notwithstanding provisions to mirror the implementation of national agreements;

ensure proper scrutiny of business cases and calculation of termination payments relating to staff employed substantively whose contract is being terminated on the grounds of redundancy or any other non-contractual arrangement;

approve non-contractual payments to staff such as bonus payments to ensure probity and value for money;

periodically be advised by the Human Resources function on Human Resource matters;

ensure that remuneration packages and policy are such as to enable people of suitable calibre to be recruited, retained and motivated – within levels of affordability;

have proper regard to the CCG’s circumstances and performance and to the provisions of any national arrangements where appropriate;

Keep adequate records of its deliberations and conclusions.

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A key responsibility of the committee is to assure the Governing Body that matters pertaining to the remuneration, allowances and terms of service are in line with statutory requirements. Voting Members: Lay Vice Chair, Audit Chair, Lay Member with lead for PPI In attendance only (non-voting): Clinical Chair, Accountable Officer, Chief Finance Officer, Human Resources representative (CSU)

Where a recommendation relates to the pay arrangements for a voting member then this will be made clear in recommendation reporting.

c) Quality and Performance Committee – the Quality and Performance

Committee, which is accountable to each group’s Governing Body, provides assurance on the quality and performance of services commissioned and promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness, outcomes and patient experience, this includes a responsibility to promote research and the use of research and monitor reports made to the National Reporting and Learning System. The Quality and Performance Committee is responsible for advising on new developments for implementation such as NICE. The Governing Body approves and keeps under review the terms of reference for the Quality and Performance Committee, which includes information on the membership of the Quality and Performance Committee and is available upon request.

d) Primary Care Commissioning Committee (see also appendix K for full terms of reference) – the Primary Care Commissioning Committee will enact the responsibilities delegated to the CCG from NHS England for the commissioning of delegated services such as general practice in accordance with the accountability agreement. The Governing Body approves and keeps under review the terms of reference for the Primary Care Commissioning Committee, which includes information on the membership of the Primary Care Commissioning Committee and is available upon request.

(e) Finance Committee – the Finance Committee will oversee financial

performance and activity across the CCG and its programme boards. It will seek to ensure that quality, innovation, prevention and productivity (QIPP) targets are met. The Governing Body approves and keeps under review the terms of reference for the Finance Committee, which includes information on the membership of the Finance Committee and is available upon request.

(f) Executive Committee – the Executive Committee delivers the remit of the CCG.

All functions of the CCG (with the exception of those delegated to the committees above) are delegated to the Executive Committee for the day to day management and delivery. The Executive Committee will make recommendations to the Governing Body on strategy and commissioning plans and take day to day decisions on performance management and risk management to provide robust assurance to the Governing Body. The Governing Body approves and keeps under review the terms of reference for the

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Executive Committee, which includes information on the membership of the Executive Committee.

The membership of this committee will comprise of four managers and eight GP Clinical Directors. At least two of the GPs will be locality directors. This composition will be reviewed and agreed with Member Practices as and when required. Members who are executive directors are members by virtue of their substantive role. GP Clinical Director members are appointed by virtue of their portfolio or locality.

(g) Integrated Commissioning Executive Team

To set out the route map for integration of commissioning and extend integrated commissioning across health and social care demonstrating qualitative, and efficiency improvements for both health and social care.

To oversee discrete areas of collaborative commissioning activity across all ages of the population including assurance and strategic planning for children and young people’s commissioning across health, education and social care; the implementation of the older people's commissioning strategy including out of hospital services; Integrated Community Equipment Services (ICES) and S117 arrangements and further integration of learning disabilities services.

1.3 The above committee descriptions are subject to change as committees and sub-

committees review their roles and responsibilities 1.4 The Governing Body may appoint such other committees as it considers may be

appropriate from time to time and these will be described in Appendix D by way of an amendment to the Constitution, to be approved by NHS England.

1.5 Committees of the Governing Body will only be able to establish their own sub-

committees to assist them in discharging their respective responsibilities if this responsibility has been delegated to them by the Governing Body. All decisions taken in good faith at a meeting of the Governing Body or any committee or sub-committee of it shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting, or the appointment of a member attending the meeting.

1.6 Committees of the CCG

a) Information Governance Steering Group – the Information Governance Steering Group is accountable to the CCG’s Executive Team/Governing Body but will also report to the Audit Committee. Its purpose is to support and drive the broader information governance agenda and provide the CCG with the assurance that effective information governance best practice mechanisms are in place within the organisation. The Audit Committee ratifies and keeps under review the terms of reference for Information Governance Steering Group.

b) Primary Care Operational Group – this group provide assurances to the

Primary Care Commissioning Committee, Executive Committee and Governing Body and NHS England (NHSE) that there are robust systems and

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processes in place for monitoring, managing and assuring the quality and safety of primary medical services and for driving continuous service improvement. The Primary Care Commissioning Committee ratifies and keeps under review the terms of reference for the CCG, which includes information on the membership and are available upon request.

c) Buckinghamshire Infection Control Committee – the overall aim of this

county-wide committee is to minimise the harm to patients, staff and the population by preventing and controlling infections in hospital, primary care and community settings. Its purpose, functions and roles are to:

To provide leadership to drive improvements in infection prevention and control to achieve continued reduction in HCAI in Buckinghamshire.

To monitor and improve measures for infection prevention and control for the population of Buckinghamshire and to minimise the occurrence of HCAI

To advise and report to Buckinghamshire Clinical Commissioning Group Governing Body on matters relating to the control of infection that affect the management, provision and commissioning of services.

To ensure that all commissioned services have the appropriate policies, strategies and procedures in place taking into account national and NHS England initiatives.

To make all healthcare settings a safe environment for patients, visitors and staff.

To deliver the key message that infection prevention and control is everyone’s responsibility.

To provide assurance that infection prevention and control issues across all commissioned and relevant non-commissioned services in Buckinghamshire are being managed appropriately

To advise the CCG’s Quality and Performance Committee of infection prevention & control issues, decontamination issues and any significant risks that may impact on Buckinghamshire services and make recommendations to eliminate or reduce them.

To monitor progress on action plans of local providers to comply with the Health & Social Care Act 2008: Code of Practice for health and adult social care on the prevention and control of infections and related guidance and other DH documents

Receive infection prevention and control and decontamination incident report data, including reports from commissioned services and to performance manage limits for HCAIs across the Buckinghamshire health economy.

To monitor progress on action plans of local providers following external inspections and on follow-up actions highlighted from Root Cause Analysis (RCA) of significant incidents

To review significant incidents and outbreaks relating to infections in the county and to monitor progress on any related action plans

Have an overview of infection rates and identify trends across the county

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Encourage independent practitioners, managers of clinical services and their partner organisations to monitor infection prevention and control and decontamination procedures, carry out audits and promote the use of infection prevention and control and decontamination policies, procedures and guidance

To have oversight of immunisation issues affecting patients and staff within the county.

To link with the Buckinghamshire Health Protection Committee and provide information on infection control matters for Bucks to that committee.

To be proactive in identifying and implementing new measures based on scientific evidence for reducing the burden of infections in the community and hospitals

Develop and sustain links with other relevant health organisations including the Public Health England.

d) Safeguarding Steering Group – this is an operational sub-group of the CCG

Quality and Performance Committee and provides assurance to the CCG Governing Body. It is responsible for:

Coordination of CCG safeguarding arrangements and ensures that statutory functions are effectively discharged.

Coordination of the development of health commissioning policy, procedures and strategy for safeguarding children, young people and adults in Buckinghamshire.

Facilitating and coordinate safeguarding arrangements related to healthcare and promote collaborative working arrangements with Buckinghamshire County Council and other partner agencies.

Ensuring that all safeguarding actions and strategic responsibilities related to health are planned and implemented in a coordinated manner, and that appropriate assurances are received to ensure that the safeguarding responsibilities for the local healthcare system are met.

Seeking assurances that all NHS funded healthcare services embrace safeguarding as everybody’s business and that the organisations from which services are commissioned provide a safe system that safeguards children and adults.

Promoting and assisting effective inter-organisation co-operation in order that statutory health bodies operating across Buckinghamshire co-operate and discharge their statutory responsibilities effectively relating to safeguarding children, young people and adults at risk.

Supporting collaborative working and decision making that improves health and social care outcomes in Buckinghamshire.

Facilitate effective partnerships between health, local authority and wider partnership organisations in Buckinghamshire.

Ensure consistency in implementation of relevant policies in an evidence-based, cost effective and safe manner, and support wider CCG commissioning intentions.

e) CHC Exceptions Panel – The CCG operates a CHC Exceptions Panel to

process, triage and assess applications for continuing healthcare funding which

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meet nationally set criteria, and where there are exceptional circumstances to pay more than the minimum for which we could safely meet an individual’s needs. The Panel meets on an as needed basis as opposed at a set frequency, with authority for decisions in line with the CCG’s schemes of reservation and delegation. This is accountable to the Integrated Commissioning Executive Team.

f) Equality and Diversity Steering Group – which meets to discharge the general

duties requirements as are described under section 5.1.2b. g) Premises Sub-Group which has objectives to:

Prepare a Primary Care Estate Strategy.

Ensure primary care premises are developed in Buckinghamshire to support the implementation of CCG commissioning plans and in particular the Primary Care Strategy and STP and aligned to One Public Estate.

Ensure primary care premises are developed to provide the capacity and quality of premises required to meet needs associated with population growth and new housing.

This has been established with the advent of delegated responsibilities for primary care commissioning, along with decision-making regarding premises development that are regulated by the Premises Cost Directions now resting with CCGs.

h) Staff Partner Forum which is established to ensure effective engagement and consultation with senior management and staff representatives in order to:

Provide a regular and effective means of joint discussion between senior management and staff on issues of mutual interest or concern.

Foster maximum involvement of all partners in effective communications, engagement and consultation on working practices and employment.

Ensure legal requirements for employee representation are met in respect of all CCG staff affected by organisational change (except Executive Team members who are not covered by this agreement).

i) IFR Case Review Panel established to support collaborative working and

decision making that improves health outcomes for the patients and public in Buckinghamshire. Specifically the Individual Case Review Panel deals with individual funding requests where:

The evidence base of clinical effectiveness for a particular treatment is low for the general population and therefore is not routinely commissioned

Only patients who meet specific criteria will derive benefit from an intervention

The condition to be treated is rare or exceptional within the general population and the patient pathway is not routinely commissioned Consider if the CCGs’ full requirement for statement of clinical exceptionality as defined in the policy, has been demonstrated within the case submitted for consideration of funding Undertake its decision making in line with the Ethical Framework adopted by the CCGs

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Be consistent in its decision making

Identify and consider new treatments and priorities for future commissioning

Discharging the general duties requirements as are described under section 5.2.1 have, since September 2019, been delegated to an Integrated Care Partnership Getting Bucks Involved” Group.

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Committees of the Governing Body, group and council of members

APPENDIX D

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APPENDIX E

STANDING ORDERS

1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction

1.1.1. These standing orders have been drawn up to regulate the proceedings of the

NHS Buckinghamshire Clinical Commissioning Group so that the CCG can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations.

1.1.2. The standing orders, together with the CCG’s scheme of reservation and delegation41 and the CCG’s prime financial policies42, provide a procedural framework within which the CCG discharges its functions. They set out:

a) the arrangements for conducting the business of the CCG;

b) the appointment of key roles of the CCG;

c) the procedure to be followed at meetings of the CCG, the Governing Body

and any committees or sub-committees of the CCG or the Governing Body;

d) the process to delegate powers;

e) The declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate43 of any relevant guidance.

1.1.3. The standing orders, scheme of reservation and delegation and prime financial

policies have effect as if incorporated into the CCG’s Constitution. 1.1.4. Group Member Practices, employees, officers, members of the Governing Body,

members of the Governing Body’s committees and sub-committees, members of the CCG’s committees and sub-committees and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions.

41 See Appendix F 42 See Appendix G 43 Under some legislative provisions the group is obliged to have regard to particular guidance but under

other circumstances guidance is issued as best practice guidance.

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1.1.5. Failure to comply with the standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal or termination of membership

1.2. Schedule of matters reserved to the CCG and the scheme of reservation and delegation

1.2.1. The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to delegate the CCG’s functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The CCG has decided that certain decisions may only be exercised by the Practice Members of the CCG in formal session.

1.2.2. These decisions and also those delegated are contained in the CCG’s scheme of

reservation and delegation (see Appendix F).

2. THE CCG: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS

2.1. Composition of membership

2.1.1. Chapter 3 of the CCG’s Constitution provides details of the membership of the

CCG (also see Appendix C).

2.1.2. Chapter 6 of the CCG’s Constitution provides details of the governing structure used in the CCG’s decision-making processes, whilst Chapter 7 of the Constitution outlines certain key roles and responsibilities within the CCG and it’s Governing Body, including the role of Member Practice Representatives (section 7.1 of the Constitution).

2.2 Application to become a Member 2.2.1. Any eligible entity may apply to become a Member by making a written

application to the Governing Body. Such written application must:

specify the name and address of the eligible entity;

confirm that the eligible entity is a provider of primary medical services; and

Confirm compliance with eligibility criteria as defined in section 3.2 2.2.2. Upon receipt by the Governing Body of the application, the Governing Body shall

notify NHS England of the application and request NHS England’s acknowledgment that the eligible entity is to become a Member.

2.2.3 Upon receipt by the Governing Body of the acknowledgment by NHS England

(or, if no such acknowledgment is received, within 28 days of the Governing Body’s request for acknowledgment), the Governing Body will make a recommendation as to whether the eligible entity is to become a Member. Note:

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this decision will be in accordance with 2006 Act, i.e. not at total discretion of the Governing Body.

2.2.4 Before becoming a Member, the eligible entity must sign a copy of this

Constitution. 2.2.5 An eligible entity shall be deemed to become a Member on the first day of the

month after it has been accepted into membership and complied with clause 2.2.4 above.

2.3 Key Roles

2.3.1 Paragraph 6.7.2 of the CCG’s Constitution sets out the composition of the CCG’s Governing Body whilst Chapter 7 of the CCG’s Constitution identifies certain key roles and responsibilities within the CCG and its Governing Body. These standing orders set out how the CCG appoints individuals to these key roles.

2.3.2 Practice Representatives

Members shall appoint Practice Representatives in accordance with paragraph 7.1.1 of the Constitution and these Standing Orders. Each Member appoints their Practice Representative to the CCG Council of Members Meetings. Each Member authorises their Practice Representative to: a) receive notice of, attend and vote at any meetings of the CCG Council of

Members or sign any written resolution on behalf of that Member; b) appoint a proxy, complete and return proxy cards, consent to any other

documents required to be signed by the Member; c) Be an active link between the Member practice and the CCG in discharging

the CCG’s functions. The Practice Representative should ensure the Member has a sound understanding of commissioning issues;

d) to attend CCG Council of Members meetings when these are held and act in accordance with the role described below:

2.3.3 Practice Representatives represent their practice’s views and act on behalf of the practice in matters relating to the CCG to the CCG Council of Members. The role of each Practice Representative in this context is to:

a) Brief Locality/CCG on issues raised by Practice colleagues; b) Attend and participate in Council of Members Meetings on a regular basis; c) Attend and participate in CCG Council of Members once a year; d) Brief Practice colleagues on Locality/ CCG developments; e) Inform Practice colleagues on measures proposed to reduce variation

in clinical practices;

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f) Encourage their Practice colleagues to innovate and develop ideas for improved services and reduce the gap in health inequalities at practice/locality/CCG/county levels;

g) Encourage their Practice to promote patient involvement in planning; h) Encourage their Practice to involve patients, their carers and

representatives in decisions about their health care; i) Encourage their Practice to act with a view to enabling patients to make

choices; j) Encourage their Practice to develop and use systems and processes

for monitoring and acting on patient feedback, particularly identifying quality, risk, early warning and safety issues, and that these are raised with the CCG to secure continuous improvements in quality and patient outcomes.

2.3.4 GP Clinical Directors

The GP Clinical Director role is appointed for the following purposes:

1. To give direction and leadership toward the achievement of the CCG’s strategy, objectives, and operational plan.

2. To lead the implementation of portfolio and/or locality specific strategic goals and objectives.

3. To support the CCG’s corporate and governance arrangements by being a voting member or attendee of the Executive Committee.

The role also has specific duties and responsibilities:

1. Support efforts to ensure that the CCG has a long-range strategy which achieves its objectives and towards which it makes consistent and timely progress.

2. Provide clinical leadership in developing organisational and financial plans and carry out plans and policies as required.

3. Promote active and broad participation of members, patients, public and other clinicians in all areas of the CCG’s work.

4. Maintain a working knowledge of significant developments and trends in stated area of expertise.

GP Clinical Director vacancies will be:

a) Advertised to all GPs (non-principals, salaried, locum and partners) within the CCG.

b) Any GP on the performers list (including locums) with the majority of their work performed within the boundaries of the CCG can apply to a vacant post and will be assessed against the National Leadership Framework criteria, a Curriculum Vitae and a letter of application.

c) GPs must be nominated and seconded by a Partner or Salaried GP of one of the Member Practices.

d) A GP working in more than one GP Practice should declare this as a Conflict of Interest.

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e) There will be a competency based interview process. If there are more suitable candidates than there are vacancies following interview, then there will be a vote of the member practices.

f) Voting will be undertaken using the registered list size practice population square root formula. The same process as the election of the Clinical Chair will be followed.

g) The assessment of shortlisted applicants would consist of an interview by panel, to ideally include the Chair, the Accountable Officer, a representative of the Local Medical Committee and a patient who engages regularly with the CCG.

h) GP Clinical Directors will appointed to the CCG on a three year term of office.

I) Vote of no confidence:

Portfolio GP Clinical Director: The Practice Representatives with the support of at least 30% of all Practice Representatives within the CCG can at a Council of Members meeting call a motion of no confidence in a GP Clinical Director with portfolio. If 75% of Member practices approve such a motion the GP Clinical Director must stand down. The Deputy will take over until a new election has taken place. Voting allocation will be one vote per practice (non-weighted square root registered list size population). Locality GP Clinical Director:

Any Practice Representative, with the support of at least 50% of all Practice Representatives within that Locality can at a Locality meeting call a motion of no confidence in the Clinical Director for the Locality. If 75% of Practice Representatives within that Locality, working on a one vote per practice (non-weighted square root registered list size population), approve such a motion the person concerned must stand down. The Deputy will take over until a new election has taken place.

Note: A smaller electorate at locality means a more significant voice, and therefore the threshold is set higher for the % of membership support required to call a motion of no confidence

2.3.5 The Governing Body must advertise to replace any GP Clinical Director if: a) The GP’s contract is due to expire; b) The GP has been disqualified or is no longer eligible to be a GP Clinical

Director; c) The GP has been recalled by the Member Practices and the CCG needs to

elect a replacement; or d) There are capability or conduct issues.

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2.3.6 Election Procedure for Appointments to Clinical Chair

To ensure a proper mandate for The Clinical Chair appointed to the CCG, an election will be held no matter the number of candidates. All members are expected to vote in elections. Ballots may be held electronically or by post.

Principles irrespective of the number of candidates: a) All votes are cast using the registered list size practice population square root

formula as at 1st January of the current calendar year. b) A majority is defined as “a number or percentage equalling more than half of a

total” c) An “abstain” would not count towards the denominator when calculating the

candidate’s % support d) In the event that two thirds of practices do not vote (abstain), the Governing

Body will review the position and make a recommendation to the membership on how to proceed.

Where there is one candidate: Yes/no /abstain options adopted (more than 50% for a majority)

Where there are two candidates: The ballot paper to include yes/no/abstain options (or equivalent) (more than 50% for a majority) Where there are three or more candidates: a) In accordance with the election principles used by the Royal College of GPs,

the election will be run on the Single Transferable Vote system b) Under this scheme a vote ranks the candidates in order of preference

(regardless of number). If, in the first round, no candidate received over 50% of the votes cast, the candidate with the fewest votes will be eliminated. The second preference votes of members who chose the eliminated candidates as first preference will then be redistributed to the remaining candidates. Should this result in no candidates receiving at least 50% of the vote, this will be repeated until a candidate with a majority emerges.

2.3.7 The Clinical Chair, as listed in paragraph 6.7.2a of the CCG’s Constitution, is subject to the following appointment process.

a) Nominations – The Clinical Chair is nominated and seconded by GP

colleagues from other Member practices. Candidates will ideally be received from the pool of clinical directors. The GPs who nominate and second The Clinical Chair must not be from the same Member practice and must not be partners or work at the same practice as the potential clinical Chair;

b) Eligibility - all GPs (non-principals, salaried, locum and partners) within the

CCGs Member Practices demonstrating skills and attributes outlined in guidance documentation and the CCG Regulations and not disqualified by the Regulations or material conflicts of interest;

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c) Appointment process – election of Member practices. One vote per practice with the weighting of that vote being based upon the square root of the registered list size practice population as at 1st January of the current calendar year. Prior to this, all candidates will require a successful competency based interview and approval of the proposed candidates by the Governing Body and NHS England unless an exemption is otherwise agreed with NHS England. The nomination and election process, for the Chair, will be agreed by the LMC Chief Executive (Local Medical Committee), including appointment of Returning Officer, irrespective of the number of candidates. The Lay Vice Chair will discharge the functions of the Chair in his/her absence.

d) Term of office – 3 years. Requirement to stand for re-election between each

term. e) Eligibility for reappointment – agreement to stand for re-election subject to

a maximum of two terms (unless in exceptional circumstances with the agreement of the Governing Body and the Member Practices);

f) Grounds for removal from office –

⁻ Vote of no confidence by members of Governing Body or the Membership ⁻ Gross misconduct ⁻ Loss of clinical registration ⁻ The Practice ceases to be eligible for membership ⁻ Any other disqualification criteria set out in the CCG Regulations ⁻ Material conflicts of interest

j) Vote of no confidence – The Practice Representatives with the support of at least 30% of all Practice Representatives within the CCG can at a Council of Members meeting call a motion of no confidence in the elected GP Chair. If 75% of Member practices approve such a motion the GP Chair must stand down. The Lay Chair will take over until a new election has taken place. Voting allocation will be one vote per practice and the weighting of that vote being based upon the square root of the practice registered list size population.

h) Notice period – 3 months written notice.

2.3.8 Three member GPs, as listed in paragraph 6.7.2.b of the CCG’s Constitution,

are subject to the following appointment process: a) Nominations – nominations from all GPs (non-principals, salaried, locum

and partners) within the CCG;

b) Eligibility – as per 2.3.4 of these standing orders;

c) Appointment process – as per 2.3.4 of these standing orders;

d) Term of office – three years;

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e) Eligibility for reappointment - agreement to stand for re-appointment

subject to a maximum of two terms (unless in exceptional circumstances with the agreement of the Governing Body);

f) Grounds for removal from office –

As reasonably determined by the Chair of the Governing Body in line with the CCG’s capability policy

Gross misconduct

Loss of clinical registration

The Practice ceases to be eligible for membership

Any other disqualification criteria set out in the CCG Regulations

g) Notice period – three months written notice

2.3.9 The one Lay member acting as Lay Vice Chair as listed in paragraph 6.7.2.d

of the CCG’s Constitution, is subject to the following appointment process:

a) Nominations – not applicable – appointment by application;

b) Eligibility – demonstrable knowledge of the Buckinghamshire healthcare

system and local communities; compliant with regulations 12(5 and 6) of the NHS (Clinical Commissioning Group) Regulations 2012; as well as having qualifications, expertise or experience such as to enable the person to express informed views about governance, conflict of interests, financial management and audit matters;

c) Appointment process – open advertisement and competency assessment/ interview by Governing Body members and at least one external assessor;


e) Eligibility for reappointment - eligible for renewal of one term of the

appointment subject to demonstration of continuing competence and agreement of this by the Governing Body;

f) Grounds for removal from office – material failure to comply with the terms of this Constitution, or any disqualification criteria as set out in the CCG regulations and/or as reasonably determined by a vote of no confidence by members of the Governing Body or the Chair of the Governing Body;

g) Notice period – three months written notice.

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2.3.10 the one Registered Nurse appointed to the CCG, as listed in paragraph 6.7.2.d of the CCG’s Constitution, is subject to the following appointment process:


b) Eligibility – a Registered Nurse with local knowledge of the

Buckinghamshire healthcare system and a high level of professional expertise and knowledge but who is NOT working for a main provider of the CCG and is NOT a nurse working in general practice; who possess skills and competencies outlined in the guidance document and the CCG Regulations and is not disqualified by the CCG Regulations or material conflicts of interest;

c) Appointment process – appointment by the Governing Body following

open advertisement in professionally relevant media and short listing, competency assessment/interview by members of the Governing Body and at least one external assessor;


e) Eligibility for reappointment – eligible for renewal of one term of the

appointment subject to demonstration of continuing competence and agreement of this by the Governing Body. Further renewal or re-advertising is at the discretion of the Governing Body;

f) Grounds for removal from office – material failure to comply with the terms of this Constitution, or any disqualification criteria as set out in the CCG regulations and/or as reasonably determined by a vote of no confidence by members of the Governing Body or the Chair of the Governing Body;

g) Notice period – three months written notice.

2.3.11 the secondary care specialist doctor appointed to the CCG, as listed in

paragraph 6.7.2 of the CCG’s Constitution is subject to the following appointment process:


b) Eligibility – a secondary care specialist doctor who has local knowledge of

the Buckinghamshire healthcare system but who is NOT working for a main provider of the CCG who possess skills and attributes outlined in the guidance document and the CCG Regulations and is not disqualified by the CCG Regulations or material conflicts of interest;

Appointment process – appointment by the Governing Body following open advertisement in professionally relevant media and short listing,

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competency assessment/interview by members of the Governing Body and at least one external assessor;

c) Term of office – three years;

d) Eligibility for reappointment – eligible for renewal of one term of the appointment subject to demonstration of continuing competence and agreement of this by the Governing Body. Further renewal or re-advertising is at the discretion of the Governing Body;

e) Grounds for removal from office – material failure to comply with the

terms of this Constitution, or any disqualification criteria as set out in the CCG regulations and/or as reasonably determined by a vote of no confidence by members of the Governing Body or the Chair of the Governing Body in line with the CCG’s capability policy;

f) Notice period – three months written notice.

2.3.12 The Accountable Officer appointed to the CCG, as listed in paragraph 6.7.2.g of

the CCG’s Constitution, is subject to the following appointment process:


b) Eligibility – required to have skills and attributes outlined in NHS England’s

guidance documentation and the CCG Regulations and not be disqualified by the CCG Regulations or material conflicts of interest;

c) Appointment process – This appointment will be subject to national NHS

recruitment and selection policies and guidance. The selection is made by the Governing Body, at least one external assessor and a representative of a Member Practice. The recommendation is made to NHS England who will make the appointment;

d) Term of office – for as long as the post holder remains an employee of the CCG in this role;

e) Eligibility for reappointment – not applicable;

f) Grounds for removal from office – material failure to comply with the terms of this Constitution, any disqualification criteria set out in the CCG regulations, as reasonably determined by the Chair of the Governing Body in line with the CCG’s capability policy and individual contracts of employment, and/or the passing of a vote of no-confidence by the CCG and/or at the request of NHS England on grounds as stated by NHS England;

g) Notice period - Six months written notice

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2.3.13 The Chief Finance Officer appointed to the CCG, as listed in paragraph 6.7.2h of the CCG’s Constitution, is subject to the following appointment process:


b) Eligibility – recognised professional accounting qualification; have skills and

attributes outlined in guidance documentation and the CCG Regulations and not be disqualified by the CCG Regulations or material conflicts of interest. Required to have passed any relevant national competency assessment;

c) Appointment process – By open advertisement in professionally relevant

media and subject to successful competency assessment, interview by the Governing Body and at least one external assessor who is a subject matter expert;

d) Term of office – for as long as the post holder remains an employee of the CCG in this role;

e) Grounds for removal from office – material failure to comply with the

terms of this Constitution or any disqualification criteria set out in the CCG Regulations; and/or as reasonably determined by the Accountable Officer following the CCG’s capability policy and individual contracts of employment;


2.3.14 the remaining three Lay Members appointed to the CCG as listed in paragraph

6.7.2.d, of the CCG’s Constitution, are subject to the following appointment process:

a) Nominations – not applicable – appointment by application

b) Eligibility – to have a non-clinical perspective, to have no connection to the

CCG and be a local resident compliant with regulations 12(5&6) of the NHS (Clinical Commissioning Group) Regulations 2012. To possess skills and attributes outlined in NHS England guidance document;

c) Appointment process – open advertisement and competency

assessment/interview by Governing Body members and at least one external assessor;


e) Eligibility for reappointment - eligible for renewal of the appointment every

three years subject to demonstration of continuing competence and agreement of this by the Governing Body. Further renewal or re-advertising is at the discretion of the Governing Body;

f) Grounds for removal from office – material failure to comply with the

terms of this Constitution, or any disqualification criteria as set out in the

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CCG regulations and/or as reasonably determined by a vote of no confidence by members of the Governing Body or the Chair of the Governing Body;

g) Notice period – three months written notice

2.3.15 The Deputy Accountable Officer appointed to the CCG, as listed in paragraph

6.7.2.i, of the CCG’s Constitution, is subject to the following appointment process:


b) Eligibility – recognised professional management experience;

c) Appointment process – By open advertisement in professionally relevant

media and subject to successful competency assessment, short listing and interview by the Governing Body and at least one external assessor who is a subject matter expert;

d) Term of office - for as long as the post holder remains an employee of the

CCG in this role;

e) Grounds for removal from office – material failure to comply with the terms of this Constitution or any disqualification criteria set out in the CCG Regulations; and/or as reasonably determined by the Accountable Officer following the CCG’s capability policy and individual contracts of employment;


2.3.17 Disqualification criteria - No individual will be eligible to be appointed to the

Governing Body if any of the following apply (i.e. an individual will be disqualified from applying):

a) not eligible to work in the UK; b) a person who is subject to a bankruptcy restrictions order or an interim

bankruptcy restrictions order; if any insolvency event or action is made against her or him or s/he makes any arrangement with her/his creditors;

c) a person who has in the last five years been dismissed from employment by a health service body otherwise than because of redundancy;

d) a person who has received a prison sentence or suspended sentence of three months or more in the last five years;

e) a person who has been dismissed by a former employer (within or outside the NHS) on the grounds of misconduct within the last 5 years;

f) a health care professional whose registration is subject to conditions, or who is subject to proceedings before a fitness to practise committee of the relevant regulatory body, or who is the subject of an allegation or investigation which could lead to such proceedings;

g) a person who is under a disqualification order under the Company Directors Disqualification Act 1986 or the Company Directors Disqualification

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(Northern Ireland) Order 2002, or an order made under section 429(2) of the Insolvency Act 1986 (disabilities on revocation of administration order against an individual);

h) a person who has at any time been removed from the management or control of a charity;

i) a member of parliament or a member of a local authority; j) an individual who provides the CCG with any service which supports the

CCG in discharging its commissioning functions; k) Material conflicts of interest.

For further detail please see Regulations 12(5 & 6) of the NHS (Clinical Commissioning Group) Regulations 2012.

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3 MEETINGS OF THE CCG

3.1 Calling meetings of the Governing Body

3.1.1 Ordinary meetings of the CCG Governing Body shall be held at regular intervals at such times and places as the CCG may determine.

3.1.2 One third or more members of the Governing Body may call a meeting of the

Governing Body in writing. If the Chair refuses, or fails, to call a meeting within seven days of a requisition being presented, the Governing Body Members signing the requisition may call a meeting.

3.1.6 Unless the Chair declares otherwise during the course of a meeting, no business shall be transacted at the meeting other than that specified on the agenda, unless the provisions of Emergency Powers and Urgent Decisions and Suspension of Standing Orders apply.

3.1.7 A Governing Body member desiring a matter to be included on an agenda shall make his/her request in writing to the Chair at least ten working days before the meeting.

3.1.8 The request should state whether there is any reason the item of business

proposed to be transacted should not be discussed in the presence of the public (providing appropriate supporting information as applicable).

3.1.9 Requests made less than ten clear days before a meeting may be included on the agenda at the discretion of the Chair. If no such requests are made, the Chair shall assume that all items on the agenda are suitable to be discussed in the presence of the public.

3.1.10 Before each meeting, a public notice of the time and place of the meeting, and the agenda (excluding any aspects of the agenda that are deemed unsuitable to be discussed in the presence of the public pursuant to clause 3.1.7 above), shall be displayed at the CCG’s offices and on the CCG’s website at least four days before the meeting.

3.1.11 The CCG Governing Body shall also hold an Annual General Meeting (AGM) that will be a meeting Governing Body in public once in each financial year provided that not more than 15 months has elapsed between the date of one AGM and the next.

3.1.12 the matters to be discussed at the AGM shall be set out in the notice, and shall include the consideration and, if thought fit, approval or confirmation of approval of: a) the CCG Accounts; b) the CCG Annual Report; c) the CCG Report on Public Involvement; d) the CCG Annual Plan; e) the appointment of an external auditor; f) the transaction of any other business included in the notice convening the

meeting; and g) The election of members to the Governing Body (or the announcement of the

results of an election if held previously by ballot), where applicable.

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3.2 Agenda, supporting papers and business to be transacted

3.2.1 Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair at least ten working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least seven working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least four working days before the date the meeting will take place.

3.3 Petitions

3.3.1 Where a public petition has been received by the CCG, the Chair of the Governing Body shall include the petition as an item for the agenda of the next meeting of the Governing Body when it meets the thresholds in 3.3.2.

3.3.2 The CCG will treat as a petition any communication which is signed by or sent to us on behalf of a number of people. For practical purposes, the CCG sets the following requirements before considering a petition:

Category Brief Description Signatory Threshold

Petition requiring response

Any petition above a set threshold which requests an action or response by the Executive Team of the CCG

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Petition requiring debate

Any petition above a set threshold which will require the petition to be considered as an agenda item at the next meeting of the Governing Body or the Primary Care Commissioning Committee

500

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3.4 Chair of a meeting

3.4.1 At any meeting of the CCG or its Governing Body or of a committee or sub-committee, the Chair of the CCG, Governing Body, committee or sub-committee, if any and if present, shall preside. If the Chair is absent from the meeting, the Deputy Chair, if any and if present, shall preside.

3.4.2 If the Chair is absent temporarily on the grounds of a declared conflict of interest the Lay Vice Chair, if present, shall preside. If both the Chair and Lay Vice Chair are absent, or are disqualified from participating, or there is neither a Chair or Deputy a member of the CCG, Governing Body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

3.5 Chair’s ruling

3.5.1 The decision of the Chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

3.6 Quorum

3.6.1 The Governing Body will be quorate to make decisions if the following mix of members is all present:

⁻ Clinical GP Chair (or Lay Vice Chair)

⁻ Accountable Officer or Deputy Accountable Officer or Chief Finance Officer

⁻ Two clinicians (one of which must be a Registered Nurse or specialist

hospital doctor)

⁻ Two Lay Members ⁻ One other management director

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3.6.2 The Director of Transformation will be co-opted as an additional voting member only in circumstances of conflict of interest material to member GPs/Chair which requires them not to count for quorum purposes. In circumstances relating to remuneration decisions, in which one or more members are materially conflicted, a reduced quorum will be deemed acceptable as required at the discretion of the Chair, Lay Vice Chair or Accountable Officer/Deputy Accountable Officer/Chief Finance Officer dependent upon to whom the material conflict relates.

3.6.3 Deputies will not generally be allowed but permission can be sought from the Chair.

3.6.4 An employee, who has been formally appointed to act up for a member during a period of incapacity or temporarily to fill an executive vacancy, shall count towards the quorum of the meeting.

3.6.5 Votes are not transferable. A person in attendance but without the power or status to vote at the meeting (excluding a person that may vote by proxy – see section 3.7e) may not count towards the quorum.

3.6.6 An employee attending the Governing Body meeting to represent a Governing Body member during a period of incapacity or temporary absence without formal acting up status will not count towards the quorum of the meeting. An employee’s status when attending the meeting shall be recorded in the minutes.

3.6.7 If the Chair of the Governing Body or member has been disqualified from participating in the discussion on any matter and/or from voting on any resolution by reason of a declaration of a conflict of interest (see section 8 of this Constitution and Appendix H), that person shall no longer count towards the quorum. If a quorum is then not available for the discussion and/or the passing of a resolution or decision on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting. The meeting must then proceed to the next business. Whether any vote for any member sought in advance where there are issues of quorum will count will be at the discretion of the remaining voting members.

3.6.8 For all other of the CCG’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference.

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3.7 Decision making

3.7.1 Chapter 6 of the CCG’s Constitution, together with the scheme of reservation and delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at the Governing Body’s meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required, the process for which is set out below:

a) Eligibility – all members listed in the composition of the Governing Body (section 6.7.2 of the Constitution) will have one vote. An employee formally appointed to act up to cover absence or vacancy of a member and whose status confers quorum may vote. Other individuals may be required to attend meetings to provide professional advice but they will not have voting rights. Individuals co-opted to the Governing Body will not have voting rights except where specified.

b) Majority necessary to confirm a decision – majority carries the motion c) Casting vote – the second vote of the Chair of that meeting. d) Dissenting views – should a vote be taken the outcome of the vote and any

dissenting views must be recorded in the minutes of the meeting. e) Proxy votes - any Governing Body member may nominate any person to

attend a meeting of the Governing Body by proxy provided that the Governing Body member gives the other Governing Body members at least three days’ notice.

f) Conflicts of interest - where members have declared a conflict of interest a

simple majority of the remaining members will be required unless this makes the decision inquorate, in which case the decision will be deferred.

3.8 Emergency powers and urgent decisions

3.8.1 The powers the CCG has reserved to itself (including to the Governing Body and to other committees and sub-committees) may exceptionally, in an emergency or for an urgently immediate and compelling decision, be exercised by the Accountable Officer and the Chair of the Governing Body, after having consulted with at least one Lay member and one other member of the Governing Body who represents the Member Practices. If at all possible, the decision should first be tested by email with all members of the Executive Committee. The exercise of such powers by the Accountable Officer and Chair of the Governing Body shall be reported to the next formal meeting of the Governing Body in public session for formal ratification. In respect of decisions reserved to the CCG, these will be reported to Member Practices at the next

Council of Members.

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3.9 Suspension of Standing Orders

3.9.1 Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or NHS England, any part of these standing orders may be suspended at any quorate meeting, provided the majority of members present are in agreement.

3.9.2 A decision to suspend standing orders for the duration of the meeting together with the reasons for doing so shall be recorded in the minutes of the meeting.

3.9.3 A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Governing Body’s Audit Committee for review of the reasonableness of the decision to suspend standing orders.

3.10 Record of Attendance

3.10.1 The names of all members of the Governing Body present shall be recorded in the minutes of each of the Governing Body meetings.

3.10.2 Quorum will be established and recorded for each meeting where decisions are to be taken.

3.11 Minutes

3.11.1 The minutes of the proceedings of the meeting shall be drawn up by the administrator to the Governing Body and submitted for agreement on the next ensuing meeting, where they shall be signed, personally or electronically, by the Chair of the Governing Body.

3.11.2 No discussion shall take place upon the minutes except upon their accuracy or where the Chair of the Governing Body considers discussion appropriate.

3.11.3 Minutes shall be circulated in accordance with the Governing Body members’ wishes, and in whatever format the Governing Body members’ choose.

3.11.4 Where providing a record of a public meeting, the minutes shall be available to the public as required by the Code of Practice on Openness in the NHS and on the CCG's website.

3.12 Admission of public and the press

3.12.1 Admission and exclusion on grounds of confidentiality of business to be transacted

The public and representatives of the press may attend all formal meetings of the Governing Body, but shall be required to withdraw where the Governing

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Body considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Guidance should be sought to ensure correct procedure is followed on matters to be included in the exclusion notice.

Items which would be considered to be confidential and discussed in private would potentially be:

Information relating to a patient, unless it can be anonymised;

Information relating to an employee or office holder, former employee or applicant for any post or office;

The terms of, or expenditure under, a tender or contract for the purchase or supply of goods or services or the acquisition or disposal of property;

Negotiations or consultation concerning labour relations between the CCG and its employees;

Any issue relating to legal proceedings which are being contemplated or instituted by or against the CCG;

Action being taken to prevent or detect crime or to prosecute offenders;

The source of information given to the CCG in confidence; or

Any other matter which, in the opinion of the Chair, is confidential or the public disclosure of which would prejudice the effective discharge of the CCG’s functions.

Where a meeting is held in private, the relevant reason from the list above must be given.

3.12.2 General disturbances and conduct

The person presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Governing Body’s business shall be conducted without interruption and disruption.

A member must speak to the subject under discussion. The Chair may call attention to any irrelevance, repetition, unbecoming language or other improper conduct on the part of a member and, where the member persists in that conduct, may direct that member to cease speaking.

A ruling by the Chair on any question of order, whether or not provided for by the Standing Orders, shall be final and shall not be open to debate.

In the event of a disturbance which, in the opinion of the Chair, prevents the orderly conduct of business, the Chair may adjourn the meeting for such period as the Chair considers appropriate.

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If a member of the public interrupts the proceedings at any meeting, the Chair may order that person to be removed from the meeting or may order the part of the room which is open to the public to be cleared.

3.12.3 Business proposed to be transacted when the press and public have been excluded

Matters to be dealt with by the Governing Body following the exclusion of representatives of the press and other members of the public in accordance with 3.12.1 and 3.12.2 above, shall be confidential to the members of the Governing Body. Members, officers, any employee of the CCG or any others invited to be present following the exclusion of representatives of the press and other members of the public in accordance with 3.12.1 and 3.12.2 above, shall not reveal or disclose the contents of papers marked ‘In Confidence’ or minutes headed ‘Items taken in private’ outside of the CCG without the express permission of the Governing Body. This prohibition shall apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers.

3.12.4 Use of Mechanical or Electrical equipment for recording or transmission of meetings

Nothing in these Standing Orders shall be construed as permitting the introduction by the public, or press representatives, of recording, transmitting, video or similar apparatus into meetings of the Governing Body. Such permission shall be granted only upon resolution of the Governing Body. Recording of meetings for purposes of accuracy of minutes will be announced and thus permission at the discretion of the Chair of the meeting.

3.13 Observers at Governing Body meetings

The Governing Body will decide what arrangements and terms and conditions it feels are appropriate to offer in extending an invitation to observers to attend and address any of the Governing Body’s meetings and may change, alter or vary these terms and conditions as it deems fit.

3.14 Extraordinary meetings

The Governing Body, or not less than 20% of member practices’ of the CCG acting together (using the non-weighted, square root formula), may call an extraordinary meeting of the CCG membership group. CCG officers and other relevant stakeholders may be invited in order to advise the meeting. Where the outcome of this extraordinary meeting would require the CCG to take a decision

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that falls within the responsibility of the Governing Body, the item will be considered and a decision made at the next scheduled Governing Body meeting. In extremis, an extraordinary Governing Body meeting may be called to consider the decision. In taking the decision, the Governing Body shall have regard to the view of the membership group.

The Chair of the Governing Body may call a meeting of the Governing Body at any time. One third or more members of the Governing Body may request a meeting in writing to the Chair.

APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES

3.15 Appointment of committees and sub-committees

3.15.1 The CCG may appoint committees and sub-committees of the CCG, subject to any regulations made by the Secretary of State44, and make provision for the appointment of committees and sub-committees of its Governing Body. Where such committees and sub-committees of the CCG, or committees and sub-committees of its Governing Body, are appointed they are included in Appendix D of the CCG’s Constitution.

3.15.2 Other than where there are statutory requirements, such as in relation to the Governing Body’s Audit Committee, remuneration or Primary Care Commissioning Committee, the CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG.

3.15.3 The provisions of these standing orders shall apply where relevant to the operation of the Governing Body, its committees and sub-committees and all other committees and sub-committees unless stated otherwise in the committee or sub-committees terms of reference.

3.16 Approval of Appointments to Committees and Sub-Committees

3.16.1 The CCG shall approve the appointments to each of the committees and sub-committees which it has formally constituted including those of the Governing Body. The CCG shall agree such travelling or other allowances as it considers appropriate.

44 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act

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4 DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES

4.1 If for any reason these standing orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the CCG and staff have a duty to disclose any non-compliance with these standing orders to the Accountable Officer as soon as possible.

5 USE OF SEAL AND AUTHORISATION OF DOCUMENTS

5.1 CCG’s seal

5.1.1 The CCG may have a seal for executing documents such as those in section 6.1.2 below. The following individuals or officers are authorised to authenticate its use by their signature:

a. The Accountable Officer;

b. The Chair of the Governing Body;

c. The Chief Finance Officer;

d. The three GP clinicians which are members of the Governing Body;

e. The Deputy Accountable Officer.

Where a document will be a necessary step in legal proceedings on behalf of the CCG, it shall, unless any enactment otherwise requires or authorises, be signed by the Accountable Officer or an officer acting on their behalf.

6.1.2 The seal shall be used in execution of the following documents:

All contracts for the purchase/lease of land and/or building;

All contracts for capital works exceeding £100,000;

All lease agreements where the annual lease charge exceeds £10,000 pa and the period of the lease extends beyond five years;

Any other lease agreement where the total payable under the lease exceeds £100,000;

Any contract or agreement with organisations other than NHS or other public bodies where the annual costs are expected to exceed £100,000.

All other acts/execution of documents can be undertaken as set out below

5.2 Execution of a document by signature

5.2.1 The following individuals are authorised to execute a document on behalf of the CCG by their signature.

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a) The Accountable Officer; b) The Chair of the Governing Body; c) The Chief Finance Officer; d) The three GP clinicians which are members of the Governing Body; e) The Deputy Accountable Officer.

One signature will be required. Where a document will be a necessary step in legal proceedings on behalf of the CCG, it shall, unless any enactment otherwise requires or authorises, be signed by the Accountable Officer or an officer acting on their behalf.

6 OVERLAP WITH OTHER CCG POLICY STATEMENTS / PROCEDURES AND REGULATIONS

6.1 Policy statements: general principles

6.1.1 The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff it employs or appoints. The decisions to approve such policies and procedures will be recorded in an appropriate group minute and will be deemed where appropriate to be an integral part of the CCG’s standing orders. Any permanent change will be reported to Member Practices.

These Standing Orders shall not be varied except in the following circumstances:

a) Upon a recommendation of the Chair or Accountable Officer they are included on the agenda for a meeting of the Governing Body;

b) That two-thirds of the Governing Body members are present at the meeting where the variation or amendment is being discussed;

c) Providing that any variation or amendment does not contravene statutory provision or direction made by the Secretary of State.

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APPENDIX F SCHEMES OF RESERVATION AND DELEGATION (which incorporates standing financial instructions for delegated authority limits for financial commitment) CCG Constitution - APPENDIX F1 - Scheme of Reservation and Delegation -committees, Chair, AO, Deputy AO and CFO *1 also delegated to Oxfordshire equivalent

Policy Area Decision Reserved to the Membership

Reserved /delegated to the Governing Body

Reserved /delegated to the Audit Committee

Reserved /delegated to the Remuneration Committee

Committees and Sub - Committees

Reserved /delegated to the Chair

Reserved /delegated to the Accountable Officer

Reserved /delegated to the Deputy Accountable Officer*1

Reserved /delegated to the CFO*1

REGULATION AND CONTROL

Determine the arrangements by which the members of the CCG approve those decisions that are reserved for the membership

Y


Consideration and approval of applications to the NHS England on any matter concerning changes to the CCG's Constitution

Y

PRACTICE MEMBER REPRESENTATION AND MEMBERS OF THE GOVERNING BODY

Approve the arrangements for * Identifying practice members to represent practices in matters concerning the work of the CCG; and * appointing clinical leaders to represent the CCG's membership on the CCG's Governing Body, for example through election (if desired)

Y


Approve the appointment of Governing Body members, the process for recruiting and removing non-elected members of the Governing Body (subject to any regulatory requirements) and succession planning

Y


Approve arrangements for identifying the CCG's proposed Accountable Officer

Y

STRATEGY AND PLANNING

Agree the vision, values and overall strategic direction of the CCG

Y


Exercise or delegation of those functions of the CCG which have not been retained as reserved by the CCG, delegated to the Governing Body, delegated to a committee or sub-committee of the CCG or to one of its members or employees

Y Y


Prepare the CCG's overarching scheme of reservation and delegation

Y


Approval of the CCG's overarching scheme of reservation and delegation

Y

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Notification to Governing Body of decision to suspend standing orders

Y


Prepare the CCG's operational scheme of delegation, which sets out those key operational decisions delegated to individual employees of the CCG, committees and sub-committees (including joint committees)

Y


Approval of the CCG's operational scheme of delegation that underpins the CCG's overarching scheme of reservation and delegation

Y


Prepare detailed financial policies that underpin the CCG's prime financial policies

Y


Review the prime financial policies at least annually, and recommend amendments to the Audit Committee

Y


Review the prime financial policies at least annually, and recommend amendments to the Governing Body

Y


Approve detailed financial policies Y


Advice on interpretation or application of Prime Financial policies

Y


Final authority on interpretation of the CCG's Constitution and supporting appendices

Y


Report non-compliance of prime financial policies to the next formal meeting of the Audit Committee

Y


Ensure that contractors and their employees are made aware of their responsibilities under the standing orders, prime financial policies and scheme of reservation and delegation

Y Y


Receive reports and/or minutes from its sub-committees

Y


Exercise the powers that the Governing Body has reserved to itself in an emergency or urgent decision

Y


Take any urgent/emergency decisions made by the Chair for ratification in public

Y


Approve arrangements for managing exceptional funding requests

Y Y

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Ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG's principles of good governance

Y


Waive formal tendering procedures and report any such waivers to the Audit Committee. Approve single tender waivers.

Y


Approve the CCG's Code of Conduct, Whistleblowing and Conflicts of Interest Policies

Y


Management of Petitions to the Governing Body Y


Approval of the CCG's operating structure Y


Agree that the CCG's commissioning plans are aligned with the CCG's strategy

Y


Approval of the CCG's commissioning plan Y


Approval of the CCG's corporate budgets that meet the financial duties as set out in the Constitution

Y


Approval of variations to the approved budgets where variation would have a significant impact on the overall approved levels of income and expenditure or the CCG's ability to achieve its agreed strategic aims

Y

ANNUAL REPORTS AND ACCOUNTS

Approval of the CCG's annual report and annual accounts, and report on those accounts to the Governing Body

Y

ANNUAL REPORTS AND ACCOUNTS

Approval of the arrangements for discharging the CCG's statutory financial duties

Y

HUMAN RESOURCES

Approve the terms and conditions, remuneration and travelling or other allowances for Governing Body members and other employees not covered by national arrangements, including pensions and gratuities

Y

HUMAN RESOURCES

Approve disciplinary arrangements for employees, including the Accountable Officer and for other persons working for the CCG

Y

HUMAN RESOURCES

APPROVE disciplinary arrangements where the Accountable Officer is an employee or member of another clinical commissioning group.

Y

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HUMAN RESOURCES

APPROVE arrangements for performance related elements or bonuses to ensure probity and value for money; and determination of National Recruitment and Retention Premia (“NRRP”)

Y

HUMAN RESOURCES

APPROVE the severance/redundancy payments of the Accountable Officer and of other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’ (available on the HM Treasury.gov.uk website).

Y

HUMAN RESOURCES

APPROVE the terms and conditions of employment for all employees of the Group.

Y

HUMAN RESOURCES

APPROVE any pay policy and payment framework for VSM employees and clinical commissioning roles of the CCG, and people who provide services to the CCG, notwithstanding provisions to mirror the implementation of national agreements

Y

HUMAN RESOURCES

APPROVE any other potential alternative remuneration and conditions of service for CCG employees and other persons providing services to the CCG, outside of or in place of national Agenda for Change arrangements, and excluding those covered by standard contracting and procurement arrangements.

Y

HUMAN RESOURCES

APPROVE arrangements for termination of employment for employees and variation of other contractual terms

Y

HUMAN RESOURCES

Making relevant policy decisions within the functions of the Committee as set out in its Terms of Reference as ratified by the Governing Body

Y

HUMAN RESOURCES

Approval of the arrangements for discharging the CCG's statutory duties as an employer

Y

HUMAN RESOURCES

Ensure an effective payroll service and that there are comprehensive procedures for effective processing of payroll

Y

HUMAN RESOURCES

Appoint and ensure the effectiveness of the Senior Leadership Team

Y

QUALITY AND SAFETY

Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes

Y

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QUALITY AND SAFETY

Approve arrangements for supporting NHS England in discharging its responsibilities in relation to securing continuous improvement in quality of general medical services

Y

QUALITY AND SAFETY

Approve arrangements for safeguarding of children and adults; receive the annual report of both Safeguarding Boards

Y

OPERATIONAL AND RISK MANAGEMENT

Prepare an operational scheme of delegation that sets out who has responsibility for operational decisions

Y


Approve the CCG's counter fraud and security management arrangements

Y


Approval of the CCG's risk management arrangements

Y


Approve arrangements for risk sharing and/or risk pooling with other organisations (for example arrangements for pooled funds with other CCG’s or pooled budget arrangements under section 75 of the NHS Act 2006)

CCG members of the Integrated Commissioning Executive Team


Approval of a comprehensive system of internal control, including budgetary control, that underpin the effective, efficient and economic operation of the CCG

Y


Overall responsibility for the CCG's systems of internal control

Y


Approve proposals for action on litigation against or on behalf of the CCG

Y Y


Determining the CCG's arrangement for business continuity and emergency planning

Y Y


Approve the CCG's arrangements for business continuity and emergency planning

Y


Approve the CCG's arrangements for handling of complaints

Y Y


Approve the banking arrangements Y


Approve the arrangements for category two emergency preparedness resilience and response as per the Civil Contingencies Act

Y Y

INFORMATION GOVERNANCE

Confirm appointments of the Senior Information Risk Owner (SIRO) and the Caldicott Guardian

Y

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Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data

Y

PARTNERSHIP WORKING

Approve arrangements to develop joint strategic needs assessments and joint health & wellbeing strategy

Y Y

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Approval of the arrangements for discharging the CCG's statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation

Y


Approval of the CCG’s procurement strategy Y


Approve arrangements for co-ordinating the commissioning services with other groups and or with the local authority where appropriate

Y


Approve arrangements to meet the requirements of the Public Sector Equality Duty and reduction of inequalities

Y

COMMUNICATIONS Approving arrangements for handling Freedom of Information requests

Y

COMMUNICATIONS Determining arrangements for handling FOIs Y Y

VIREMENTS Between Services > £1,000,000 Y

TENDERING AND CONTRACTING

Discretionary Grants >£250,000 Y

EX-GRATIA PAYMENTS

Write off of NHS Debtors and Non-NHS Directors >£250,000 (reported to Audit Committee for information)

Y

PRIMARY CARE COMMISSIONING

Approve arrangements for the review, planning, and procurement of primary care services under delegated authority from NHS England. (up to £100k only)

PCCC Primary Care Operational Group

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Approval of the arrangements for discharging the CCG’s responsibilities and duties associated with its primary care commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation, obtain advice from persons who taken together have a broad range of professional expertise and acting effectively, efficiently and economically. (up to £100k only)



Day to day decisions on provider performance management and risk management associated with Primary Care to provide robust assurance to the Governing Body and NHS England. (up to £100k only)

PCCC

Primary Care Operational Group


Approve and ratify Locally Commissioned Services (up to annual composite value per annum except where brand new which needs to be approved by Governing Body)



Approve and ratify practice improvement schemes, having regard to guidance by the Secretary of State. Monitor and review any such schemes. (up to £1m per annum except where brand new which needs to be approved by Governing Body)



Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements: a. Procurement of new practice provision; (up to £100k only per annum) b. Discretionary payment (e.g. returner/retainer schemes); (up to £100k only per annum) c. Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list); (up to £100k only per annum) d. Premises Costs Directions functions. (up to £100k only per annum)

PCCC Primary Care Operational Group Primary Care Operational Group

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Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements: a. The award of GMS, PMS and APMS contracts for primary care services to some or all of the CCG population where they are within CCG budgets (excluding GP contracts for which core contract approval/monitoring and appraisal sits with NHS England Area Team; This includes: the design of PMS and APMS contracts; and monitoring of contracts; taking contractual action such as issuing branch/remedial notices, and removing a contract); (over £50k per annum change +-)



Advise on or approve matters relating to primary care contracting within agreed levels, specifically in relation to commissioning Locally Commissioned Services, Quality Outcomes Framework (QOF - subject to allowances within NHS England's legal framework), Out of Hour services, Walk-in Centres (including home visits as required and for out of area registered patients); (up to £100k only) within agreed and approved budget.

PCCC

Primary Care Operational Group


Approval proposals for primary care support and development and any associated plans in connection with commissioning and performance monitoring and development within the remit of the CCG. (up to £100k only). Costs associated with allocating a nurse to support a practice on a particular improvement scheme to be signed off by PCOG. Costs associated with new permanent post or service and below £100k signed off by PCCC.

PCCC Primary Care Operational Group Primary Care Operational Group

INDIVIDUAL FUNDING REQUESTS

Approve and Ratify Commissioning Policy Statements (which underpin criteria for Individual Funding Request decisions)

Executive Committee


Delegation relates to both formal external procurement and rollover of national standard or other framework (above £1m annual value otherwise delegated under scheme of delegation) (excepting integrated commissioning)

Executive Committee


Approve and ratify proposals for decommissioning within the CCG operating plan and budget plan (at any value or risk score)

Executive Committee

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Notice to terminate a contract received – decision to accept and mitigate (above £100k annual contract value, otherwise delegated to accountable programme board unless high risk above 12 with value under £100k annual value)

Executive Committee


New or amended national criteria or clinical guidance issued with impact identified (e.g. NICE, royal colleges, CQC, national investigations/public inquiries):1. CCG is non-compliant with investment required to mitigate 2. Current provider is non-compliant and patients require temporary treatment elsewhere (at cost to CCG) whilst mitigated (e.g. specialist services). (Above £25k annually including set up costs irrespective of risk score, otherwise delegated to relevant Programme Board or Formulary Management Group in relation to NICE/Medicines Management).Additional considerations: 1. Separate decision on whether to implement based on whether guidance is or is not mandated.2. No financial impact but high risk to be considered on a case by case basis (which again will depend on whether guidance is or is not mandated)

Executive Committee


Contract Performance Notices (CPNs) and Information Breach Notices (IBNs); issuing and receipt of assurance prior to decision to close.(above £100k annual contract value, otherwise delegated to accountable programme board unless high risk above 12 with value under £100k annual value)

Executive Committee


Approving expenditure where there is variation in the tender price greater than 20% or £250,000 whichever is the higher

Executive Committee


Goods/services > £1,000,000 ( Minimum 3 competitive tenders required ) – subject to OJEU tender limits

Executive Committee


Discretionary Grants >£50,000 and < £250,000

Executive Committee

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DELEGATION TO OTHER COMMITTEES

Approve arrangements for decisions delegated to, and detailed within terms of reference, for the following: • Joint committees established under section 75 of the 2006 NHS Act (Joint Commissioning Programme Board and Integrated Commissioning Executive Team – ICET) • Joint groups or committees established with other CCGs in line with relevant legal frameworks and/or NHS England guidance.

Executive Committee


Delegation relates to both formal external procurement and rollover of national standard or other framework (above £1m annual value otherwise delegated under scheme of delegation) (integrated commissioning only) * Separate quorum requirements of ICET must otherwise be met for any decision to be transacted under this authority.

CCG members of Integrated Commissioning Executive Team


Ratify the Terms of Reference and annual work plans for all sub-groups that have accountability to the Finance Committee.

Finance Committee


Approve the Terms of Reference for the committee (ratified by Governing Body)

Finance Committee


Approve strategy and Plans and Budgets for ratification by the Governing Body which will allow the CCG to meet its control total each year. To do so, the Committee must oversee the delivery of savings/QIPP plans (that form part of the annual cycle of plans and strategies approved by the Executive Committee), ensuring that expected savings are realised and risks mitigated. It must also ensure that all plans are supported by robust activity and financial information.

Finance Committee


To agree action required to address any slippage in the above plans ; Approving any variations to planned investment within the limits set out in the detailed financial policies of the CCG, ensuring that any amended plans remain within the overall CCG budget and do not adversely affect the strategic performance of the CCG.

Finance Committee

83











To inform the Governing Body when risks occur on best course of action agreed and taken which may be a combination of a) Calling on specific reserves set aside for the risk; b) Re-ordering the priorities within the plan so that some investments are deferred; c) Increasing savings from QIPP; d) Calling on contingencies; e) Calling on the 1% headroom if the risk is non-recurrent (where permitted by NHS guidance); f) As a last resort, reducing planned surpluses.

Finance Committee


Discretionary Grants <£50,000 Finance Committee


Review then approve and ratify policies, procedures and other documents for the management of patient safety risk and quality, as otherwise described within the Development and Approval Policy for Formal CCG Documents

Quality and Performance Committee


Ratify the Terms of Reference and annual work plans for all sub-groups that have accountability to the Quality and Performance Committee



Approve the Terms of Reference and annual work plans for the Quality and Performance Committee (ratified by Governing Body)


INDIVIDUAL FUNDING REQUESTS

Approve and ratify (and receive assurance on) Individual Funding Requests (IFRs) – all request values.


QUALITY AND SAFETY

Review closure of early warning alerts; reported through effective early warning systems which draw on a range of quality indicators and other sources of information to identify gaps in assurance about providers


QUALITY AND SAFETY

Ratify proposals for ensuring quality and developing clinical governance in services provided by the CCG’s providers having regard to any guidance issued by the NHS England


PARTNERSHIP WORKING

Agree the CCG’s arrangements for contributing to and working with agencies responsible for Safeguarding and Infection, Prevention and Control


84

CCG Constitution - APPENDIX F2

Operational Scheme of Delegation

As at

1st October 2019

Subject: Operational Scheme of Delegation

Policy Number

Ratified By: Governing Body

Date Ratified: 12/09/19

Version: 2.1

Policy Executive Owner: Chief Finance Officer

Designation of Author: Deputy Chief Finance Officer

Name of Assurance Committee: Audit Committee

Date Issued: September 2019

Review Date: September 2020

Target Audience: All users of Buckinghamshire CCG including staff, contractors, agency workers etc.

Other Linked Policies: - Standing Orders (SOs)

- Prime Financial Policies

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Purpose The Purpose of this document is to define the Clinical control framework for committing the resources of the Clinical Commissioning Group. The Scheme of Delegation identifies which functions the Accountable Officer shall perform personally and which have been delegated to other Directors or Officers. Scope To ensure that all staff, particularly budget managers and authorised signatories are aware of their authorities and responsibilities for compliance with the relevant procedures. The Scheme of Delegation is consistent with the NHS Code of Conduct and Accountability. Directors and Officers are reminded that powers are delegated to them on the understanding that they would not exercise delegated powers in a manner in which their judgement was likely to be a cause for public concern. The Code of Conduct of Accountability in the NHS sets out the core standards of conduct expected of NHS managers.

To provide details of delegated limits to all officers holding responsibilities. Budget Holders agree to operate within the delegated limits as outlined in this document. It is their responsibility to manage within their budget and to identify any changes to the budget assumptions surrounding activity, timing and staffing issues which may result in changes to financial risk. If a proposed transaction is beyond their authority, it should be referred to their manager. Failure to do so may result in disciplinary action. This document forms part of the CCG’s corporate governance framework which is the regulatory framework for the business conduct of the CCG to which its officers are expected to comply. The aim is not to create a bureaucracy but to protect the CCG’s interests and to protect staff from any accusation that they have acted less than properly. It does this by ensuring that all staff, particularly budget managers and authorised signatories are aware of their authorities and responsibilities for compliance with the relevant procedures. Schedule of Matters Reserved to the CCG and Scheme of Delegation The arrangements made by the CCG as set out in The Scheme of Reservation and Delegation of Decisions. This document shows those matters which are reserved and delegated for the discharge of the CCG’s functions. The CCG remains accountable for all of its functions, including those it has delegated. Delegated Matters Delegated matters in respect of decisions will need to be agreed or reported to other groups such as the Executive Committee or Programme Boards. This policy does not override these but sets out individual powers for committing resources. The delegation shown below is the lowest level to which authority is delegated. Delegation to lower levels is only permitted with written approval of the Accountable Officer who will, before authorising such delegation, consult with other Senior Officers as appropriate. All items concerning Finance must be carried out in accordance with Prime Financial Policies.

86

Scheme of Delegation to Employees Standing Orders (SOs) and Prime Financial Policies set out in some detail the financial responsibilities of the Accountable Officer, Director of Commissioning and Delivery, the Chief Finance Officer and other Managements Directors of the CCG. The scheme of delegation covers only matters delegated by the Governing Body to the Accountable Officer and Directors and certain other specific matters referred to in prime financial policies. Further delegation may be approved.

i) by the governing body in approving specific management policies ii) by the CCG Accountable Officer iii) As part of Financial Procedures approved by the Chief Finance Officer.

Each Director will need to consider the arrangements for authorisation of expenditure against delegated budgets and further delegation of management/professional responsibilities. Financial Control Environment In accordance with Prime Financial Policies the governing body exercises financial supervision and control by:

i) Authorising the operational plan; ii) Requiring the submission and approval of budgets within approved allocations /

overall income; iii) Defining and approving essential features in respect of important

procedures and financial systems (including the need to obtain value for money)

iv) Defining specific responsibilities placed on members of the governing body, committees, members and employees as indicated in the Scheme of Delegation.

v) Approving provision of shared services through the commissioning support unit (CSU)

Once the governing body has reviewed and approved the Operating Plan and any supporting financial plan / budget the governing body will delegate approval to the Accountable Officer, Director of Commissioning and Delivery, the Chief Finance Officer and other directors and employees to commit these resources for the purpose set out in the plan subject to the financial thresholds set out in this scheme of delegation. Please see the end of this document for a glossary of roles used within. NOTE: AS OF 1 OCTOBER 2019, ALL DELEGATED AUTHORITIES TO THE CHIEF FINANCE OFFICER ARE ALSO DELEGATED TO THE EQUIVALENT ROLE HOLDER FOR OXFORDSHIRE CCG

87

DELEGATED MATTER AUTHORITY DELEGATED TO

1. Management of Budgets Responsibility of keeping expenditure within budgets. Authority to spend is only extended where approved budget is available.

(a) At individual budget level (Pay and Non Pay) ( e.g. Locality Team Projects)

Authorised Budget Holders

(b) At Portfolio Level CCG Commissioning Managers or CCG Management Directors

(c) For the totality of services covered by the Clinical Commissioning Group (CCG)

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

(d) For all other areas CFO or DCD or Appropriate Delegated Manager

(e) Approving Expenditure where there is a variation in the tender price up to 10% or £100,000, whichever is the higher (subject to check/ advice from SCWCSU Procurement Team on current and relevant legislation/regulation/thresholds – EU or other)


(f) Approving Expenditure where there is a variation in the tender price greater than 10% or £100,000 tender price and less than 20% or £250,000, whichever is the higher (subject to check/ advice from SCWCSU Procurement Team on current and relevant legislation/regulation/thresholds – EU or other)


2. Virements Virements may not be used to create new budgets.

(a) At individual budget level within a service up to £10,000 Authorised Budget Holders

(b) At individual budget level within a service > £10,000 and < £25,000 CCG Commissioning Managers or CCG Management Directors

(c) At individual budget level within a service > £25,000 and < £100,000 In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

(d) Between Services > £100,00 and < £500,000 In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

(e) Between Services > £500,000 and < £1,000,00 In order of authority to make allowances for absence: (1) CFO (2) AO/DAO. The CFO remains accountable for all decisions.

88

4 Non-Pay Revenue and Capital Expenditure Requisitioning/Ordering/Payment of Goods and Services

a) Non Pay expenditure for which no specific budget has been set up and which is not subject to funding under delegated powers of virement (subject to the limits specified in (a))

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO. The CFO remains accountable for all decisions.

b) Orders exceeding 12 month period (other than under contract) In order of authority to make allowances for absence: (1) CFO (2) AO/DAO.

The CFO remains accountable for all decisions.

5 Capital Schemes

a) Selection of architects, quantity surveyors, consultant engineers and other professional advisors within EU regulations

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO.

The CFO remains accountable for all decisions.

b) Financial monitoring and reporting on all capital scheme expenditure

CFO or Appropriate Delegated Manager

c) Granting and termination of leases with annual rent <£150k CFO or Appropriate Delegated Manager

d) Granting and termination of leases with annual rent >£150k and <£250k

In order of authority to make allowances for absence: (1) CFO Under Seal

and (2) AO/DAO Under Seal. The CFO remains accountable for all

decisions.


3. Maintenance / Operation of bank Accounts Chief Finance Officer / Deputy Chief Finance Officer with the Finance Controller (CSU)

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6 Quotation, Tendering & Contract Procedures

a) Opening Tenders and Quotations (applicable only in the absence of electronic tendering)

i) Estimated value <£50,000 Two senior officers/managers designated by (in order of authority to make allowances for absence) (1) CFO (2) AO/DAO and not from the originating department. The CFO remains accountable for all decisions.

ii) Estimated value >£50,000 Two senior officers/managers designated by (in order of authority to make allowances for absence) (1) CFO including a Lay Member of the Governing Body (2) AO/DAO including a Lay Member of the Governing Body, and not from the originating department. The CFO remains accountable for all decisions.

b) Authorisation of payments to public partnership schemes under existing contracts

May relate to Section 106 (1990 Town & Country Planning Act) private agreements made between local authorities and developers, which can be attached to a planning permission to make acceptable development which would otherwise be unacceptable in planning terms.

May be applied where CCG is asked to endorse Section 106 agreement where one or member practices (and therefore CCG members) are financial beneficiaries of payments under Section 106 in supporting development of primary care estate. The CCG itself would not be a financial beneficiary.

May be applied where there is an existing contract (GMS, PMS, APMS) between the CCG and the practice or practices concerned.

CFO


7 Setting of Fees and Charges ( Income generation) CFO

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DELEGATED MATTER AUTHORITY DELEGATED TO 8 Commissioning Expenditure

a) i) Acute SLAs; Approval of requisitions in line with signed SLA <£100,000,000 ii) Other SLA’s regular monthly invoices against approved Service Level

Agreements

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority. CCG Budget Managers or CCG Directors or Deputy Director of Finance (CSU)

b) Further reimbursement of expenditure within approved allocation CCG Budget Managers or CCG Directors

c) Over / Under performance of commissioning contracts :

i) Agreement of over/under performance ii) Authorisation of Over performance payments

CCG Budget Managers or CCG Directors or Head Contracting Team (CSU) or Deputy Director of Finance (CSU) CFO or Deputy CFO

d) Other Expenditure CCG Budget Managers or CCG Management Directors

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9 Agreements / Licences

a) Preparation and signature of all tenancy agreements/licences for all staff subject to CCG policy on accommodation for staff

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO. The CFO remains accountable for all decisions under this authority.

b) Extensions to existing leases In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

c) Letting of Premises to/from outside organisations In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

d) Approval of rent based on professional assessment CFO

10 Condemning & Disposal

a) Items obsolete, obsolescent, redundant, irreparable or cannot be repaired cost effectively :

i) With current/estimated purchase price <£500 CCG Budget Managers or Deputy CFO

ii) With current/estimated purchase price >£500 In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority.

iii) Disposal of mechanical and engineering plant ( subject to estimated income of <£1,000 per sale)

CCG Budget Managers or Deputy CFO

iv) Disposal of mechanical and engineering plant ( subject to estimated income of >£1,000 per sale)


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DELEGATED MATTER AUTHORITY DELEGATED TO 11 Losses, Write-off & Compensation In conjunction with Audit Committee

a) Losses and cash due to theft, fraud, overpayment and others >£50,000 CFO

b) Fruitless Payments (including abandoned Capital Schemes)

i) <£100,000 CFO

ii) >£100,000 and <£250,000 CFO

c) Bad Debts and Claims Abandoned. Private Patients, Overseas Visitors & Other >£50,000

CFO

d) Damage to buildings, fittings, furniture and equipment and loss of equipment and property in stores and in use due to : Culpable causes (e.g. fraud, theft, arson) or other >£50,000

CFO

e) Compensation payments made under legal obligation CFO

f) Extra contractual payments made to contractors up to £50,000 CFO

g) Extra statutory or exit regulatory payments CFO

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Ex Gratia Payments

g) Patients and staff for loss of personal

effects : i) <£500

ii) >£500 and <£5,000

iii) >£5,000 and £50,000 Any ex Gratia payment relating to termination of employment deemed in excess of or outside of statutory or contractual entitlements would be escalated to the Remuneration Committee for review and recommendation to the Governing Body. It will also be subject to an application with Business Case to NHS England. This would also include novel, contentious or repercussive cases i.e. Severance payments

CCG Budget Managers

CFO

CFO

h) For clinical negligence >£1,000,000 (negotiated settlements) CFO

i) For personal injury claims involving negligence where legal advice has been obtained and guidance applied < £1,000,000 (including plaintiff’s costs)

CFO

j) Other, except cases of maladministration where there was no financial loss by claimant <£50,000

CFO

k) Write off of NHS Debtors :

i) <£250,000

CFO – reported to Audit Committee for information

l) Write off of Non-NHS

Debtors : i) <£250,000

CFO – reported to Audit Committee for information

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12. Reporting of Incidents to the Police

a) Where a criminal offence is suspected :

i) Criminal Offence of a violent nature ii) Theft iii) Other

CCG Budget Managers or CCG Management Directors CCG Management Directors CCG Management Directors

b) Where a fraud is involved ( following referral to the Counter Fraud Service) CFO

c) Where an incident occurs out of normal working hours On Call Director


13. Receiving Hospitality

You must ensure that the best interests of public and patients/clients are upheld in decision making and that any decisions are not improperly influenced by gifts or inducements (as set out in the code of conduct for NHS Managers).

In the exceptional circumstances that a gift or hospitality is accepted, both individual and collective hospitality receipt items in excess of £25 per item received must be declared.

Declarations required in CCG’s Hospitality Register

14. Implementation of Internal and External Audit Recommendations CFO

15. Maintenance & Update of CCG Financial Procedures CFO

16. Investment of Funds CFO

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17. Personnel & Pay

a) Authority to fill funded post on the establishment with permanent staff Authorised Budget Holders and CCG Budget Managers

b) Authority to appoint staff not on the formal establishment CCG Management Directors

c) Additional Increments: The granting of additional increments to staff

within budget, up to a maximum annual equivalent of £142,500 per annum.

CFO with advice from the Director of HR or equivalent (CSU)

d) Upgrading & Regrading : i) All requests for upgrading/regarding shall be dealt with in

accordance with CCG procedure ii) Where appropriate prior approval (annual equivalent of £142,500 or

greater)

CFO

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority. To commend the case before seeking Ministerial support via NHS England

e) Establishments : i) Additional staff to the agreed establishment with specifically

allocated finance ii) Additional staff to the agreed establishment without specifically

allocated finance

CCG Management Directors CFO (Discretionary Spend)

f) Pay: i) Authority to complete standing data forms effecting pay, new

starters, variations and leavers, up to a maximum annual equivalent of £142,500 per annum.

ii) Authority to complete standing data forms effecting pay, new starters, variations and leavers, over an annual equivalent of £142,500 per annum

iii) Authority to complete and authorise positive reporting forms iv) Authority to authorise overtime v) Authority to authorise travel and subsistence expenses vi) Approval of Performance Related Pay Assessment

CCG Management Directors, CFO and Deputy CFO (relevant to staff function and subject to Remuneration Committee recommendation/decision where applicable) CCG Management Directors, CFO and Deputy CFO commend the case before seeking Ministerial support via NHS England In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority (relevant to staff function and subject to Remuneration Committee recommendation/decision where applicable) Line/Departmental Managers, Deputy CFO or CCG Management Directors CCG Management Directors Line/Departmental Managers, Deputy CFO or CCG Management Directors (see also Appendix F3) In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Remuneration Committee. The CFO remains accountable for all decisions under this authority (except where relating to the CFO)

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DELEGATED MATTER AUTHORITY DELEGATED TO g) Payroll Deductions:

i) PAYE, NIC & Pension Payments <£500k

ii) Payment requests <£100,000

CFO

CFO

h) Leave:

i) Approval of Annual Leave

ii) Annual Leave – approval of carry forward up to a maximum of 5

days

iii) Annual Leave – approval of carry forward up to a maximum of 5 days and <10 days

iv) Annual Leave – approval of carry forward 10 days or more

v) Compassionate Leave – approval up to 3 days

vi) Compassionate Leave – approval up to 6 days

vii) Special Leave arrangements:

Paternity Leave

Carers Leave

Line / Departmental Manager Line / Departmental Manager

CCG Management Directors


Line / Departmental Manager


Line / Departmental Manager CCG Management Directors

viii) Unpaid Leave

ix) Time off in Lieu

x) Maternity Leave – Paid and Unpaid


Line Manager / Departmental Manager Automatic approval within

CCG Management Directors (subject to HR guidance)

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i) Sick Leave:

i) Extension of sick leave on half pay ii) Return to work part time on full pay to assist recovery iii) Extension of sick leave on full pay

CCG Management Directors CCG Management Directors CCG Management Directors

j) Study Leave:

i) Medical Staff Study Leave ii) All other Study Leave <5 days iii) All other Study Leave >5 days

CCG Directors and AO or DCD Line Manager/Departmental Manager CCG Management Directors

k) Removal Expenses, Excess Rent and House Purchases : Authorisation of payment of removal expenses incurred by officers taking up new appointments (providing consideration was promised at interview)

i) <£5,000

ii) >£5,000


AO or DAO or DCD

l) Grievance Procedure : All grievances must be dealt with strictly in accordance with the Grievance Procedure and the advice of ConsultHR must be sought .

Line Manager/Departmental Manager

m) Discipline Procedure : All grievances must be dealt with strictly in accordance with the Discipline Procedure and the advice of ConsultHR must be sought .

Line Manager/Departmental Manager

m) Authorised Car & Mobile Phone Users: Requests for car usage, mobile telephone users, I-Phone and VPN access

Budget Managers, Deputy CFO or CCG Management Directors

n) Renewal of Fixed Term Contract CCG Management Directors or AO or DAO or DCD

98 of 27


o) Redundancy :

i) <£50,000

ii) >£50,000 to £95,000 (Maximum allowable under NHS England rules)

CFO

Remuneration Committee or Chair and AO or DCD

p) Ill Health Retirement : Decision to pursue retirement on the grounds of ill-health

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, in conjunction with Occupational Health. The CFO remains accountable for all decisions under this authority

q) Dismissal: In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority

18. Authorisation of Sponsorship Deals Refer to Hospitality and Gifts Policy (including sponsorship arrangements)

19. Authorisation of Research Projects CCG Management Directors

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DELEGATED MATTER AUTHORITY DELEGATED TO 20. Authorisation of Clinical Trials AO or DCD in conjunction with Clinical Leads and CCG Management

Directors

21. Insurance Policies and Risk Management In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority

22. Patients’ and Relatives’ Complaints:

i) Overall responsibility for ensuring all complaints are dealt with effectively

ii) Responsibility for ensuring complaints relating to the CCG are investigated thoroughly

iii) Medico-Legal Complaints – Co-ordination of their management

DCD In conjunction with Patient Experience Team (CSU)

DCD

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority

23. Relationships with media In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD.

24. Infectious Diseases and Notifiable Outbreaks In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD link with Director of Public Health & Area Team

25. Extended Role Activities : Approval of Nurses to undertake duties/procedures which can properly be described as beyond the normal scope of Nursing Practice

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD – Link with NHS England Area Team Chief Nurse

26. Facilities for staff not employed by the CCG to gain practical experience:

i) Professional recognition, Honorary Contracts and Insurance of Medical Staff

ii) Work Experience Students

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD in conjunction with HR (CSU)


27. Review of Fire Precautions AO or DAO or DCD or Appropriate Delegated Director with CSU

28. Review of all statutory compliance legislation and Health & Safety requirements

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. or Appropriate Delegated Director with CSU The CFO remains accountable for all decisions under this authority

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27


29. Review of Medicines Inspectorate Regulations In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority in conjunction with Clinical Leads and CCG Directors

30. Review of compliance with environmental regulations In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated Director with CSU

31. Review of CCG’s compliance with the Data Protection Act In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated CCG Management Director

32. Monitor proposals for contractual arrangements between CCG and outside bodies

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD. The CFO remains accountable for all decisions under this authority

33. Review of CCG’s compliance with the Access to Records Act In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated CCG Management Director

34 Review of CCG’s compliance with the Code of Practice for handling confidential information in the contracting environment and the compliance with ‘safe haven’ per EL92/60

In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated CCG Management Director

35. The Keeping of a Declaration of Interests Register In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated CCG Management Director

36. Attestation of Sealings in accordance with Standing Orders CFO

37. The Keeping of a register of Sealings CFO

38. The Keeping of the Hospitality Register AO or DAO

39. Retention of Records In order of authority to make allowances for absence: (1) CFO (2) AO/DAO (3) DCD, or Appropriate Delegated CCG Management Director

40. Clinical Audit AO or DAO

41. Responsibility officers for medical revalidation, evaluation of fitness to practice and monitoring the conduct and performance of doctors

AO or DAO

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27

GLOSSARY OF TERMS

AO – Accountable Officer

DAO – Deputy Accountable Officer CCD – Clinical Commissioning Directors

DCD – Director of Commissioning and Delivery CCG Management Directors

Where referred to in this document, this will relate to:

The Accountable Officer

The Deputy Accountable Officer

The Chief Finance Officer

The Director of Commissioning and Delivery

The Director of Transformation

Joint Director of Nursing and Quality (with NHS Oxfordshire CCG)

Joint Director of Contracting, Performance and Assurance (with NHS Oxfordshire CCG)

CFO – Chief Finance Officer Budget Manager – e.g. Head Of Joint Care Commissioning, Head of Medicines Management, Programme Manager Urgent Care, aka minimum band 8b

Deputy CFO – Deputy Chief Finance Officer

102

AO DAO CFO DCFO

Up to £5,000 X X X X X X

Up to £10,000 X X X X X

Up to £20,000 X X X X X

Up to £50,000 X X X X

Up to £100,000 X X X

Up to £250,000 X X X

Up to £25,000,000 X X X X

Over £25,000,000 X X X

Any value X X X X X(1) Office Manager

(2) Admin TeamX

CCG investment level up to 10k per

annum/financial year; RISK: Low (<8).

Joint Commissioning Programme Board (as

only remaining CCG Programme Board with

reporting line to CCG Executive Committee)

X X X X

CCG investment level up to £25k per

annum/financial year; RISK: Low (<8),

Medium-High (8-25)

Joint Commissioning Programme Board (as

only remaining CCG Programme Board with

reporting line to CCG Executive Committee)

X X X X

CCG investment level £25k to £250k per

annum/financial year smaller schemes;

RISK: Medium-High (8-25)

CCG investment level >£100k per

annum/financial year; RISK: Medium-High

(8-25)

CCG investment level >£250k per

annum/financial year (including recurrent);

RISK: Medium-High (8-25)

Governing Body (for approval and

ratification, unless assurance is given for

alternative process for reasons of timing or

related application of other decision making

authorities

Fully funded by external body (e.g. NHS

England) which the CCG is (a) mandated

to deliver under direction and/or under

statutory delegation or (b) has option to

deliver implement but must still ensure

appropriate governance for approval and

ratification of Business Case,

n/a

Up to £1,000 X X

Up to £50,000 X

Over £50,000 Finance Committee

Over £50,000 consultancy and agency

interims (Note A)NHS England X

Packages (both new and legacy under

older legislation subject to review) under

£1,500 per week (health part only,

excluding social care costs, with 50/50 split

of estimate costs)

(1) Specialist

Commissioning Manager

(Mental Health),

(2) Specialist


(All age disability)

(3) Commissioning Manager

(Mental Health)




older legislation subject to review) over



of estimate costs)

X


older legislation subject to review) under



of estimate costs)

(1) Specialist


(Mental Health),

(2) Specialist




(Mental Health)



older legislation subject to review) over



of estimate costs)

Packages under £2,000 per week (Adults

and Children) after use of separate and

appropriate funding formula to calculate

expected cost

CHC Assessment Service

(Oxford Health NHS

Foundation Trust)

Packages up to £5,000 per week (Adults

and Children) after use of separate and

appropriate funding formula to calculate

expected cost

Head of Community Models

of Care

CCG Constitution Appendix F3 - individual delegations Non-Pay Revenue and Capital Expenditure (excluding leases)

Requisitioning/Ordering/Payment of Goods and Services

CHC IPAs Adults and Continue Care for Children

Quotation, Tendering & Contract Procedures and authorising related invoices / requisition of goods (excluding discretionary spend and specific categories below)

Clinical and non-clinical goods and services

Subject to Procurement Advice and Procurement Policy on current thresholds for tender/quotes

Includes non-contracted activity

Goods Received Note

Discretionary Spend (whilst process deemed to be active)

IPAs/NCAs Mental Health and Learning Disabilities (i.e. both in and out of area referrals where there is no provider contract in place)

CSU – Continuing

Healthcare Care

Budget /Deputy

Budget Manager

Value limit Committee or other organisation

CCG Management

Directors (*4)Relevant Associate Director

or Head of (within function or

where named)

Relevant Budget Manager

(within function or where

named)

Locality

Business

Support

Managers

(1) Specialist Commissioning Manager (Mental Health),

(2) Specialist Commissioning Manager (All age disability)

(3) Commissioning Manager (Mental Health)

(4) Commissioning Manager (All age disability)

Depending on purpose, CCG Executive

Committee (approval and ratification, unless

escalated for reasons of conflicts of

interest) or Primary Care Commissioning

Committee (PCCC)

Governing Body (for information, unless

escalated for reasons of conflicts of

interest)

(1) Business Case, (2) Service Level Agreement (3) Specification approval prior to award of contract (with or without formal external tender)

Notes: investment decision only where there is a CCG financial implication - governance related to subsequent business case process is described within F4

Approval: Governing Body September 2019

Notes:

(1) a Mental Health Virtual Panel, with reporting line to the Joint Commissioning Delivery Board (JCDB), may be convened to discuss the clinical merits of an application.

(2) The Virtual Panel has no formal accountability to a committee nor collective financial responsibility to agree funding requests.

(3) Whereas its members with individual financial authority are accountable to the Director of Commissioning and Delivery. Those members with financial authority are the same as listed below with

authority to agree funding up to £1,500 per week for placements.

(4) This includes packages of care from out of area where necessary, subject to a proposed package meeting clinical health needs directed related to reason for section under the Mental Health Act as

undertaken by other local authority Care Resource Team or equivalent commissioners and agreed with our joint commissioners

(these are not specifically defined within legislation).

Review: annual (September 2020)

IPAs/NCAs S.117 only (i.e. out of area referrals only where there is no provider contract in place)

103

AO DAO CFO DCFO

Packages up to £5,000 per week (Children

only for health element where tripartite

(Education, Social Care, Health) funding

anticipated based on clinical needs) after

use of separate and appropriate funding

formula to calculate expected cost and/or

percentage split

Head of Integrated

Commissioning (as voting

member of Complex Needs

Panel which considers

tripartite referrals)

Packages over £5,000 per week after use

of separate and appropriate funding

formula to calculate expected cost

Client (and/or representative/s) expresses

wish for more than 10% above Nominal

Budget for placement based on clinical

need (up to £5,000 per week) - adults only

CHC Exceptions Panel (with

recommendation to relevant budget

manager)


of Care


wish for package of care to form part of a

Personal Health Budget (for which they

may or may not already meet criteria)

rather than as a standalone package of

care/Individual Patient Agreement (up to

£5,000 per week) - adults only



manager)


of Care


wish for more than 10% above Nominal

Budget for placement based on clinical

need (over £5,000 per week) - adults only


recommendation to Director of

Commissioning and Delivery)


wish for package of care to form part of a

Personal Health Budget (for which they

may or may not already meet criteria)

rather than as a standalone package of

care/Individual Patient Agreement (over

£5,000 per week) - adults only


recommendation to Director of

Commissioning and Delivery)

Client (and/or representative/s) lodges

appeal following assessment or re-

assessment of clinical need against CHC

criteria (all values) - adults only

Local Review Panel (accountable to CHC

Monitoring Meeting)

Client (and/or representative/s) disagrees

with appeal outcome following assessment

or re-assessment of clinical need against

CHC criteria (all values) - adults only

NHS England Independent Review Panel

(final authority on application of criteria)

Adhoc case escalation for children's

continuing care applications where

deemed necessary and relevant (all

values)



manager)

Client (and/or representative/s) disagrees

with proposed package offer and

undertakes appeal (all values) - children

only

Tribunal prompted by parental request

Up to £20,000 per procedure/treatment per

patient (estimate only)

Head of IFR, SCWCSU

(reported via Case Review

Panel/IFR report) or

nominated deputy during

absence

i.e. SCWCSU Individual

Funding Requests (IFR)

Manager (Clinical)

Over £20,000 per procedure/treatment per

patient estimate only (i.e. additional funding

precedent above threshold which is

exceptional with no previous decision)

IFR Case Review Panel (with

recommendation where possible

considering panel timing to avoid

unnecessary delay in decision)

Z Z Y

Over £20,000 per procedure per patient

within pre-existing pathways (estimate

only)

Z Z Y

Section 96

Up to £50,000 Primary Care Operations Group (PCOG)

Over to £50,000Primary Care Commissioning Committee (on

recommendation from Finance Committee)

Up to £5,000 per annum or transcation Primary Care Manager

Up to £10,000 per annum or transcationSenior Primary Care

Manager

Up to £50,000 per annum or transcationAD Primary Care

Commissioning

Up to £100,000 per annum or transcation(1) Primary Care Commissioning Committee

(2) Primary Care Operational GroupX X X

Over £100,000 per annum or transcation Governing Body (on some decisions)

Up to £50,000 per annum change +/- AD Primary Care

Commissioning

Between £50,000 per annum up to

£500,000 per annum change +/-

(1) Primary Care Commissioning Committee

(2) Primary Care Operational GroupX X X

Over £500,000 Primary Care Commissioning Committee



Notes: this authority relates only to: Approve and ratify proposals for the procurement of primary care services under commissioning arrangements within agreed and approved budgets: The award of

GMS, PMS and APMS contracts for primary care services to some or all of the CCG population

CSU – Continuing

Healthcare Care

Budget /Deputy

Budget Manager


CCG Management



where named)



named)

Locality

Business

Support

Managers

Primary Care including Practice Payments (Direct Awards and Primary Care Development Schemes)

Notes: this authority relates only to:

(1) Approval of the arrangements for discharging the CCG’s responsibilities and duties associated with its primary care commissioning functions, including but not limited to promoting the involvement of

each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation, obtain advice from persons who taken

together have a broad range of professional expertise and acting effectively, efficiently and economically within agreed and approved budget.

(2) Day to day decisions on provider performance management and risk management associated with Primary Care to provide robust assurance to the Governing Body and NHS England within agreed

and approved budget.

(3) Approve and ratify proposals for the procurement of primary care services under commissioning arrangements within agreed and approved budgets:

a. Procurement of new practice provision;

b. Discretionary payment (e.g. returner/retainer schemes);

c. Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with

standards (but excluding any decisions in relation to the performers list);

d. Premises Costs Directions functions.


IFRs

Primary Care contracts


104

AO DAO CFO DCFO

Over £500,000

Governing Body (on some decisions).

Reasons for escalation to Governing Body

could relate to:

• Conflicts of interest for member GPs,

whilst noting that member GPs are standing

invitees to Primary Commissioning

Committee as opposed on having voting

rights on decision in which they may be

materially financially conflicted.

• There may also be reasons of risk or

reputation that might prompt escalation.

Up to £50,000 AD Digitalisation and IM&T

Over £50,000 X

< £1,500 per week (Frimley Only where

there is a PBR contract arrangement) for

step down bed capacity funded from

Frimley winter resilience budget

(1) Winter Director

(1) Head of Urgent Care &

System Resilience &

Locality Link Manager

(2) Director on Call

> £3000 per week (Frimley Only where

there is a PBR contract arrangement) for

step down bed capacity funded from

Frimley winter resilience budget

Director on Call (ONLY if it

cannot wait until next

working day)

< £3000 per week (other local acute

providers) for step down bed capacity

funded from non-recurrent programme

budget

(1) Head of Urgent Care &

System Resilience &

Locality Link Manager

(2) Director on Call

> £1,500 per week (Frimley Only) for step

down bed capacity funded from non-

recurrent programme budget

Director on Call (ONLY if it

cannot wait until next

working day)

Over £10,000 per week

Up to £1,500 for clinical decisions per case

file (Mental Health IPA/Section 117

applications/placements only; only after

Buckinghamshire County Council legal

costs route explored first)

Specialist Commissioning

Manager (Mental Health)

Up to £5,000 per case file (CHC

applications/placements)


of Care - CHC

Up to £10,000 per case file

Over £10,000 per case file

Up to £300 X

Up to £500 Admin Team

Up to £1,000 Office Manager

Up to £5,000 X

Up to £250 X

Over £250 X X X X

Any value X X X X X

Management Staff Any value X X X X X X

Clerical Staff Any value X X X X X X

All Values Z Z X

Contract Variations Z Z X

All Values Z Z X

Contract Variations Z Z X

Up to £50,000 per annual variation Finance Committee

Up to £250,000 per annual variation Executive Committee

Over £250,000 per annual variation Executive Committee

New contracts (irrespective of term) Executive Committee

Up to £1,500 CSU NCA Team

Over £1,500 X Deputy CFO

Authorisation of exceptional cases up to

£50,000 per drug per year for prescribing

purposes where drug request

accompanying IFR request is not on

formulary at the time (aka blacklisted)

AD Medicines Management

(as a CCG voting member of

ICS medicines related

boards/groups)

Lead for Medicines

Optimisation (as a CCG

voting member of ICS

medicines related

boards/groups)

*****

Authorisation of New (or previous

formulary) drugs up to £50,000 per drug

per year for inclusion in formulary, including

their place in therapy and restrictions for

use.

ICS Medicines Optimisation Board (clinical

decision only with financial authorisation

provided in advance by named role holders)




boards/groups)

Lead for Medicines



medicines related

boards/groups)



CSU – Continuing

Healthcare Care

Budget /Deputy

Budget Manager


CCG Management



where named)



named)

Locality

Business

Support

Managers

Health Contracts with Local Authority (including S.75 Pooled Budgets investment commitments)

Non Contractual Activity (i.e. unplanned care out of area, not activity that we haven't commissioned)

Medicines Optimisation

e-Procurement card

Expense claims

Training Expenses

Agency staff timesheet

Healthcare Contracts / SLAs/ Contract Awards (includes rebate agreements)

Non-Healthcare Contracts


As per Discretionary Spend process when active- i.e. CFO. Authority to DCD when process deemed not active

Note:

1. includes step down bed capacity on OPEL 4

2. these thresholds apply only where there is a PBR contract framework between CCG and acute provider; if contract status changes to Block at any time they become irrelevant

3. Buckinghamshire Healthcare NHS Trust is already on block contract, hence the reason the provider is not referred to within these thresholds.

Note: Court of Protection/Deprivation of Liberty Standards (DoLS) cases are excluded in entirety from the discretionary spend process. This is on the basis of there being a statutory duty to meet legal

costs. In relation to Continuing Healthcare and Mental Health/Section 117 applications, given a need to ensure appropriate decisions are reached based on circumstances and clinical need with no

unnecessary delay in the decision making timescale, authority for agreement of legal costs post assessment up to a value per case file of

1) £1,500 for clinical decisions per case file is delegated to the Joint Commissioner (All age Mental Health) for MH IPA/Section 117 applications/placements (only after Buckinghamshire County Council

legal costs route explored first)

2) £5,000 per case file is delegated to the Head of Community Models of Care for CHC IPAs

3) up to £10,000 to the Director of Commissioning and Delivery

Any application for legal advice above this threshold will be subject to the discretionary spend process whilst deemed active. If deemed not active then delegated authority above this threshold is with

the Director of Commissioning and Delivery

GPIT

Adhoc Funding Packages of Care

Legal Fees/solicitor engagement (CHC IPAs, other IPAs)

As per Discretionary Spend process when active- i.e. CFO. Authority to DCD when process deemed not active


105

AO DAO CFO DCFO

Investment required in-year for compliance

with NICE guidelines or technology

appraisals up to £50,000 per intervention

per year (technically no limit as it is

statutory mandated to introduce within 3

months though local decision could be

taken to overrule)

Note: investment identified through horizon

scanning may be incorporated within

annual budget and separate financial

authority, and therefore this process would

not be required)




boards/groups)

Lead for Medicines



medicines related

boards/groups)

Authorisation of New Drugs over £50,000

per drug per year

Executive Committee (financial decision)

ICS Medicines Optimisation Board (clinical

decision only with financial authorisation

provided by Executive Committee)

Investment required in-year for NICE

guidelines or technology appraisal

compliance over £50,000 per intervention

per year (technically no limit as it is

statutory mandated to introduce within 3

months though local decision could be

taken to overrule)

Note: investment identified through horizon

scanning may be incorporated within

annual budget and separate financial

authority, and therefore this process would

not be required)

Executive Committee

ICS Medicines Optimisation Board

(this could take place in either whereby the

Board is aware of need for compliance and

escalates, or through alternative route

where Executive Committee takes financial

decision first)

Rebates and Incentives

Executive Committee where deemed by the

Pharmaceutical Industry Scheme

Governance Board (PISGB) to be

inappropriate or not fully appropriate and

only where there is no discount available

and identified given the material conflict of

interest

Otherwise discussion on participation in

rebate schemes is delegated to the CCG

voting members of the ICS Medicines

Optimisation Board.

Up to £1,000

Head of Service –

Children’s Commissioning

Joint Commissioning

Manager children and

young people

Key:

X Delegated limit

Z CFO and one other signatory

Y Has sight of

V Note to Body concerned

AO Accountable Officer

DAO Deputy Accountable Officer

CFO Chief Finance Officer

DCFO Deputy Chief Finance Officer

Note A:

Note B:

In absence of the CFO for whatever reason, his/her authority will be formally delegated as deemed appropriate at the time, to the Deputy Chief Finance

Officer or Deputy Accountable Officer. Vice versa arrangement applies in respect of the absence of the Deputy Accountable Officer. Equivalent

arrangements will also apply in absence of named CCG Management Directors.



CSU – Continuing

Healthcare Care

Budget /Deputy

Budget Manager


CCG Management



where named)



named)

Locality

Business

Support

Managers

i) Wherever possibly from agencies within the Framework. Appointments from agencies not on the Framework must show value for money.

ii) A day/hourly rate cap is to be set for agency staffing that must not exceed what would be paid to substantive appointments

Child Health Assessments



106

APPENDIX G PRIME FINANCIAL POLICIES

1. INTRODUCTION

1.1. General

1.1.1. These prime financial policies and supporting detailed financial policies shall

have effect as if incorporated into the CCG’s Constitution.

1.1.2. The prime financial policies are part of the CCG’s control environment for

managing the organisation’s financial affairs. They contribute to good corporate

governance, internal control and managing risks. They enable sound

administration; lessen the risk of irregularities and support commissioning and

delivery of effective, efficient and economical services. They also help the

Accountable Officer and Chief Finance Officer to effectively perform their

responsibilities. They should be used in conjunction with the scheme of

reservation and delegation found at Appendix F.

1.1.3. In support of these prime financial policies, the CCG has prepared more detailed

policies, approved by the Audit Committee, known as detailed financial policies.

The CCG refers to these prime and detailed financial policies together as the

clinical commissioning group’s financial policies.

1.1.4. These prime financial policies identify the financial responsibilities which apply to

everyone working for the CCG and its constituent organisations. They do not

provide detailed procedural advice and should be read in conjunction with the

detailed financial policies. The Chief Finance Officer is responsible for approving

all detailed financial policies.

1.1.5. Should any difficulties arise regarding the interpretation or application of any of

the prime financial policies then the advice of the Chief Finance Officer must be

sought before acting. The user of these prime financial policies should also be

familiar with and comply with the provisions of the CCG’s Constitution, standing

orders and scheme of reservation and delegation.

1.1.6. Failure to comply with prime financial policies and standing orders can in certain

circumstances be regarded as a disciplinary matter that could result in dismissal.

107

1.2. Overriding Prime Financial Policies

1.2.1. If for any reason these prime financial policies are not complied with, full details

of the non-compliance and any justification for non-compliance and the

circumstances around the non-compliance shall be reported to the next formal

meeting of the Governing Body’s Audit Committee for referring action or

ratification. All of the CCG’s members and employees have a duty to disclose

any non-compliance with these prime financial policies to the Chief Finance

Officer as soon as possible.

1.3. Responsibilities and delegation

1.3.1. The roles and responsibilities of the CCG’s member practices, employees,

members of the Governing Body, members of the Governing Body’s committees

and sub-committees, members of the CCG’s committee and sub-committee (if

any) and persons working on behalf of the CCG are set out in chapters 6 and 7

of this Constitution.

1.3.2. The financial decisions delegated by members of the CCG are set out in the

CCG’s scheme of reservation and delegation (see Appendix F).

1.4. Contractors and their employees

1.4.1. Any contractor or employee of a contractor who is empowered by the CCG to

commit the CCG to expenditure or who is authorised to obtain income shall be

covered by these instructions. It is the responsibility of the Accountable Officer to

ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies

1.5.1. To ensure that these prime financial policies remain up-to-date and relevant, the

Chief Finance Officer will review them at least annually. Following consultation

with the Accountable Officer and scrutiny by the Governing Body’s Audit

Committee, the Chief Finance Officer will recommend amendments, as fitting, to

the Governing Body for approval. As these prime financial policies are an

integral part of the CCG’s Constitution, any amendment will not come into force

until the CCG applies to NHS England and that application is granted.

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2. INTERNAL CONTROL

POLICY – the CCG will put in place a suitable control environment and effective

internal controls that provide reasonable assurance of effective and efficient

operations, financial stewardship, probity and compliance with laws and policies

2.1. The Governing Body is required to establish an Audit Committee with terms of

reference agreed by the Governing Body (see paragraph 6.6.3(a) of the CCG’s

Constitution for further information).

2.2. The Accountable Officer has overall responsibility for the CCG’s systems of

internal control

2.3. The Chief Finance Officer will ensure that:

a) financial policies are considered for review and update annually;

b) a system is in place for proper checking and reporting of all breaches of

financial policies; and

c) A proper procedure is in place for regular checking of the adequacy and

effectiveness of the control environment.

3. AUDIT

POLICY – the CCG will keep an effective and independent internal audit function

and fully comply with the requirements of external audit and other statutory

reviews

3.1. In line with the terms of reference for the Governing Body’s Audit Committee, the

person appointed by the CCG to be responsible for internal audit and the Audit

Commission appointed external auditor will have direct and unrestricted access

to Audit Committee members and the Chair of the Governing Body, Accountable

Officer and Chief Finance Officer for any significant issues arising from audit

work that management cannot resolve, and for all cases of fraud or serious

irregularity.

3.2. The person appointed by the CCG to be responsible for internal audit and the

external auditor will have access to the Audit Committee and the Accountable

Officer to review audit issues as appropriate. All Audit Committee members, the

Chair of the Governing Body and the Accountable Officer will have direct and

unrestricted access to the head of internal audit and external auditors.

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3.3. The Chief Finance Officer will ensure that:

a) The CCG has a professional and technically competent internal audit

function; and

b) The Governing Body’s Audit Committee approves any changes to the

provision or delivery of assurance services to the CCG.

4. FRAUD AND CORRUPTION

POLICY – the CCG requires all staff to always act honestly and with integrity to

safeguard the public resources they are responsible for. The CCG will not

tolerate any fraud perpetrated against it and will actively chase any loss suffered

4.1. The Governing Body’s Audit Committee will satisfy itself that the CCG has

adequate arrangements in place for countering fraud and shall review the

outcomes of counter fraud work. It shall also approve the counter fraud work

programme.

4.2. The Governing Body’s Audit Committee will ensure that the CCG has

arrangements in place to work effectively with NHS Protect.

5. EXPENDITURE CONTROL

5.1. The CCG is required by statutory provisions45 to ensure that its expenditure does

not exceed the aggregate of allotments from NHS England and any other sums it

has received and is legally allowed to spend.

5.2. The Accountable Officer has overall executive responsibility for ensuring that the

CCG complies with certain of its statutory obligations, including its financial and

accounting obligations, and that it exercises its functions effectively, efficiently

and economically and in a way which provides good value for money.

5.3. The Chief Finance Officer will:

a) provide reports in the form required by NHS England;

b) ensure money drawn from NHS England is required for approved

expenditure only is drawn down only at the time of need and follows best

practice;

45 See section 223H of the 2006 Act, inserted by section 27 of the 2012 Act

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c) Be responsible for ensuring that an adequate system of monitoring financial

performance is in place to enable the CCG to fulfil its statutory responsibility

not to exceed its expenditure limits, as set by direction of NHS England.

6. ALLOTMENTS46

6.1. The CCG’s Chief Finance Officer will:

a) periodically review the basis and assumptions used by NHS England for

distributing allotments and ensure that these are reasonable and realistic and

secure the CCG’s entitlement to funds;

b) prior to the start of each financial year submit to the Governing Body for

approval, a report showing the total allocations received and their proposed

distribution including any sums to be held in reserve; and

c) Regularly update the Governing Body on significant changes to the initial

allocation and the uses of such funds.

7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY

CONTROL AND MONITORING

POLICY – the CCG will produce and publish an annual commissioning plan47

that explains how it proposes to discharge its financial duties. The CCG will

support this with comprehensive medium term financial plans and annual

budgets

7.1. The Accountable Officer will compile and submit to the Governing Body a

commissioning strategy which takes into account financial targets and forecast

limits of available resources.

7.2. Prior to the start of the financial year the Chief Finance Officer will, on behalf of

the Accountable Officer, prepare and submit budgets for approval by the

Governing Body.

7.3. The Chief Finance Officer shall monitor financial performance against budget and

plan, periodically review them, and report to the governing. This report should

46 See section 223(G) of the 2006 Act, inserted by section 27 of the 2012 Act.

47 See section 14Z11 of the 2006 Act, inserted by section 26 of the 2012 Act.

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include explanations for variances. These variances must be based on any

significant departures from agreed financial plans or budgets.

7.4. The Accountable Officer is responsible for ensuring that information relating to

the CCG’s accounts or to its income or expenditure, or its use of resources is

provided to NHS England as requested.

7.5. The Governing Body will approve consultation arrangements for the CCG’s

commissioning plan48.

8. ANNUAL ACCOUNTS AND REPORTS

POLICY – the CCG will produce and submit to NHS England accounts and

reports in accordance with all statutory obligations49, relevant accounting

standards and accounting best practice in the form and content and at the time

required by NHS England

8.1. The Chief Finance Officer will ensure the CCG:

a) prepares a timetable for producing the annual report and accounts and

agrees it with external auditors and the Audit Committee;

b) prepares the accounts according to the timetable approved by the Audit

Committee;

c) complies with statutory requirements and relevant directions for the

publication of annual report;

d) considers the external auditor’s management letter and fully address all

issues within agreed timescales; and

e) Publishes the external auditor’s management letter on the CCG’s website.

9. INFORMATION TECHNOLOGY

POLICY – the CCG will ensure the accuracy and security of the CCG’s

computerised financial data

48 See section 14Z13 of the 2006 Act, inserted by section 26 of the 2012 Act 49 See paragraph 17 of Schedule 1A of the 2006 Act, as inserted by Schedule 2 of the 2012 Act.

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9.1. The Chief Finance Officer is responsible for the accuracy and security of the

CCG’s computerised financial data and shall

a) devise and implement any necessary procedures to ensure adequate

(reasonable) protection of the CCG's data, programs and computer

hardware from accidental or intentional disclosure to unauthorised persons,

deletion or modification, theft or damage, having due regard for the Data

Protection Act 1998 and subsequent General Data Protection Regulations

(GDPR) 2016;

b) ensure that adequate (reasonable) controls exist over data entry, processing,

storage, transmission and output to ensure security, privacy, accuracy,

completeness, and timeliness of the data, as well as the efficient and

effective operation of the system;

c) ensure that adequate controls exist such that the computer operation is

separated from development, maintenance and amendment;

d) Ensure that an adequate management (audit) trail exists through the

computerised system and that such computer audit reviews as the Chief

Finance Officer may consider necessary are being carried out.

9.2. In addition the Chief Finance Officer shall ensure that new financial systems and

amendments to current financial systems are developed in a controlled manner

and thoroughly tested prior to implementation. Where this is undertaken by

another organisation, assurances of adequacy must be obtained from them prior

to implementation.

10. ACCOUNTING SYSTEMS

POLICY – the CCG will run an accounting system that creates management and

financial accounts

10.1. The Chief Finance Officer will ensure:

a) the CCG has suitable financial and other software to enable it to comply with

these policies and any consolidation requirements of NHS England;

b) That contracts for computer services for financial applications with another

health organisation or any other agency shall clearly define the responsibility

of all parties for the security, privacy, accuracy, completeness, and

timeliness of data during processing, transmission and storage. The contract

should also ensure rights of access for audit purposes.

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10.2. Where another health organisation or any other agency provides a computer

service for financial applications, the Chief Finance Officer shall periodically seek

assurances that adequate controls are in operation.

11. BANK ACCOUNTS

POLICY – the CCG will keep enough liquidity to meet its current commitments


a) review the banking arrangements of the CCG at regular intervals to ensure

they are in accordance with Secretary of State directions50, best practice and

represent best value for money;

b) manage the CCG's banking arrangements and advise the CCG on the

provision of banking services and operation of accounts;

c) Prepare detailed instructions on the operation of bank accounts.

11.2. The Audit Committee shall approve the banking arrangements.

12. INCOME, FEES AND CHARGES AND SECURITY OF CASH,

CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS.

POLICY – the CCG will

operate a sound system for prompt recording, invoicing and collection of

all monies due

seek to maximise its potential to raise additional income only to the extent

that it does not interfere with the performance of the CCG or its functions51

ensure its power to make grants and loans is used to discharge its

functions effectively52

12.1. The Chief Finance Officer is responsible for:

50 See section 223H(3) of the NHS Act 2006, inserted by section 27 of the 2012 Act 51 See section 14Z5 of the 2006 Act, inserted by section 26 of the 2012 Act. 52 See section 14Z6 of the 2006 Act, inserted by section 26 of the 2012 Act.

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a) designing, maintaining and ensuring compliance with systems for the proper

recording, invoicing, and collection and coding of all monies due;

b) establishing and maintaining systems and procedures for the secure

handling of cash and other negotiable instruments;

c) Approving and regularly reviewing the level of all fees and charges other

than those determined by NHS England or by statute. Independent

professional advice on matters of valuation shall be taken as necessary;

d) For developing effective arrangements for making grants or loans.

13. TENDERING AND CONTRACTING PROCEDURE

POLICY – the CCG:

will ensure proper competition that is legally compliant within all purchasing

to ensure we incur only budgeted, approved and necessary spending

will seek value for money for all goods and services

shall ensure that competitive tenders are invited for

o the supply of goods, materials and manufactured articles;

o the rendering of services including all forms of management

consultancy services (other than specialised services sought from or

provided by the Department of Health); and

o For the design, construction and maintenance of building and

engineering works (including construction and maintenance of

grounds and gardens) for disposals.

13.1. The CCG shall ensure that the firms / individuals invited to tender (and where

appropriate, quote) are among those on approved lists or where necessary a

framework agreement. Where in the opinion of the Chief Finance Officer it is

desirable to seek tenders from firms not on the approved lists, the reason shall

be recorded in writing to the Accountable Officer or the CCG’s Audit Committee.

13.2. The Executive Committee may only negotiate contracts on behalf of the CCG,

and the CCG may only enter into contracts, within the statutory framework set up

by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with:

a) the CCG’s standing orders;

b) The Public Contracts Regulations 2006 (as amended in 2009 and 2011),

Public Contracts Regulations 2015 and any successor legislation and any

other applicable law; and

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c) Take into account as appropriate any applicable NHS England or the

Independent Regulator of NHS Foundation Trusts (Monitor) guidance that

does not conflict with (b) above.

13.3. In all contracts entered into, the CCG shall endeavour to obtain best value for

money. The Accountable Officer shall nominate an individual who shall oversee

and manage each contract on behalf of the CCG.

14. COMMISSIONING

POLICY – working in partnership with relevant national and local stakeholders,

the CCG will commission certain health services to meet the reasonable

requirements of the persons for whom it has responsibility

14.1. The CCG will coordinate its work with NHS England, other CCGs, local providers

of services, local authority(ies), including through Health & Wellbeing Boards,

patients and their carers and the voluntary sector and others as appropriate to

develop robust commissioning plans.

14.2. The Accountable Officer will establish arrangements to ensure that regular

reports are provided to the Governing Body detailing actual and forecast

expenditure and activity for each contract.

14.3. The Chief Finance Officer will maintain a system of financial monitoring to ensure

the effective accounting of expenditure under contracts. This should provide a

suitable audit trail for all payments made under the contracts whilst maintaining

patient confidentiality.

15. RISK MANAGEMENT AND INSURANCE

POLICY – the CCG will put arrangements in place for evaluation and

management of its risks

15.1. The Accountable Officer shall ensure that the CCG has a programme of risk

management, in accordance with relevant guidance, which must be approved

and monitored by the Governing Body.

15.2. The programme of risk management shall include:

a) a process for identifying and quantifying risks and potential liabilities;

b) engendering among all levels of staff and members a positive attitude

towards the control of risk;

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c) management processes to ensure all significant risks and potential

liabilities are addressed including effective systems of internal control, cost

effective insurance cover, and decisions on the acceptable level of

retained risk;

d) contingency plans to offset the impact of adverse events;

e) audit arrangements including; internal financial audit, clinical audit, health

and safety review;

f) Arrangements to review the risk management programme.

15.3 The existence, integration and evaluation of the above elements will assist in

providing a basis to make any statement required within the Annual Report and

Accounts on the effectiveness of Internal Control.

16. PAYROLL

POLICY – the CCG will put arrangements in place for an effective payroll service

16.1. The Chief Finance Officer will ensure that the payroll service selected:

a) is supported by appropriate (i.e. contracted) terms and conditions;

b) has adequate internal controls and audit review processes;

c) Has suitable arrangements for the collection of payroll deductions and

payment of these to appropriate bodies.

16.2. In addition the Chief Finance Officer shall set out comprehensive procedures for

the effective processing of payroll

17. NON-PAY EXPENDITURE

POLICY – the CCG will seek to obtain the best value for money goods and

services received

17.1. The Governing Body will approve the level of non-pay expenditure on an annual

basis and the Accountable Officer will determine the level of delegation to budget

managers

17.2. The Accountable Officer shall set out procedures on the seeking of professional

advice regarding the supply of goods and services.

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a) advise the Governing Body on the setting of thresholds above which

quotations (competitive or otherwise) or formal tenders must be obtained;

and, once approved, the thresholds should be incorporated in the scheme of

reservation and delegation;

b) be responsible for the prompt payment of all properly authorised accounts

and claims;

c) Be responsible for designing and maintaining a system of verification,

recording and payment of all amounts payable.

18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND

SECURITY OF ASSETS

POLICY – the CCG will put arrangements in place to manage capital investment,

maintain an asset register recording fixed assets and put in place polices to

secure the safe storage of the CCG’s fixed assets

18.1. The Accountable Officer will

a) ensure that there is an adequate appraisal and approval process in place for

determining capital expenditure priorities and the effect of each proposal

upon plans;

b) be responsible for the management of all stages of capital schemes and for

ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without

confirmation of purchaser(s) support and the availability of resources to

finance all revenue consequences, including capital charges;

d) be responsible for the maintenance of registers of assets, taking account of

the advice of the Chief Finance Officer concerning the form of any register

and the method of updating, and arranging for a physical check of assets

against the asset register to be conducted once a year.

18.2. The Chief Finance Officer will prepare detailed procedures for the disposals of

assets.

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19. RETENTION OF RECORDS

POLICY – the CCG will put arrangements in place to retain all records in

accordance with NHS Code of Practice Records Management 2006 and other relevant

notified guidance

19.1. The Accountable Officer shall:

a) be responsible for maintaining all records required to be retained in

accordance with NHS Code of Practice Records Management 2006 and

other relevant notified guidance;

b) ensure that arrangements are in place for effective responses to Freedom of

Information requests;

c) Publish and maintain a Freedom of Information Publication Scheme.

20. TRUST FUNDS AND TRUSTEES

POLICY – the CCG will put arrangements in place to provide for the appointment

of trustees if the CCG holds property on trust

20.1. The Chief Finance Officer shall ensure that each trust fund which the CCG is

responsible for managing is managed appropriately with regard to its purpose

and to its requirements.

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APPENDIX H THE SEVEN KEY PRINCIPLES OF THE NHS CONSTITUTION

The NHS Constitution sets out seven key principles that guide the NHS in all it does:

1. The NHS provides a comprehensive service, available to all - irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population

2. Access to NHS services is based on clinical need, not an individual’s ability to pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. The NHS aspires to the highest standards of excellence and professionalism - in the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.

4. NHS services must reflect the needs and preferences of patients, their families and their carers - patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being

6. The NHS is committed to providing best value for taxpayers’ money and the most cost-effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. The NHS is accountable to the public, communities and patients that it serves - the NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose

Source: The NHS Constitution: The NHS belongs to us all (March 2012)53

53 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

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APPENDIX I

Audit Committee Terms of Reference –v1.0

1. Introduction The Audit Committee (the Committee) is established in accordance with NHS Buckinghamshire Clinical Commissioning Group’s (CCGs) constitution as a statutory sub-committee of its Governing Body.

2. Purpose of the Audit Committee

The Audit Committee shall provide assurance and advice to the Governing Body, on the proper stewardship of resources and assets, including value for money; financial reporting, the effectiveness of audit arrangements (internal and external), risk management, and on control and integrated governance arrangements within the group. The Audit Committee takes responsibility for key areas outlined in sections 4 and 5.

3. Aims/objectives The Audit Committee has the following aims/objectives in providing assurance to the Governing Body that an appropriate system of internal control is in place:

1. Ensuring that business is conducted in accordance with the law and proper standards;

2. Ensuring public money is safeguarded and properly accounted for;

3. Ensuring Financial Statements are prepared in a timely fashion, and give a true and fair view of the financial position of the CCGs for the period in question;

4. Ensuring affairs are managed to secure economic, efficient and effective use of resources;

5. Ensuring reasonable steps are taken to prevent and detect fraud and other irregularities.

4. Specific duties and responsibilities

The Committee shall critically review financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained. The Committee may also review the adequacy, effectiveness and integrity of: Financial reporting

1. Financial statements of the Group and any formal announcements relating to the Group’s financial performance, whilst ensuring that the systems for financial reporting to the Group, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Group.

2. Reviewing the annual report and financial statements before submission to the Governing Body and the Group, focusing on:

3. The wording in the governance statement and other disclosures relevant to the committee terms of reference;

4. Changes in, and compliance with, accounting policies, practices and estimation techniques;

5. Unadjusted mis-statements in the financial statements; 6. Significant judgements in preparing of the financial statements; 7. Significant adjustments resulting from the audit; 8. Letter of representation; and

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9. Qualitative aspects of financial reporting. Corporate Risk Management, Policies and Processes

10. All risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the Group.

11. The underlying assurance processes that indicate the degree of achievement of the Group’s objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

12. The combined corporate risk register and assurance framework, and related risk action plans, ensuring that risks are appropriately prioritised and adequately controlled and mitigated, and ensuring that high and extreme risks are communicated to the Governing Body.

13. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

14. The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud Service.

15. Satisfying itself on arrangements in place for countering fraud and outcomes of counter fraud work. It shall also approve the counter fraud work programme.

16. Ensure that the group has arrangements in place to work effectively with NHS Protect.

It may also seek assurances as appropriate, concentrating on the over-arching critical review of systems, together with indicators of their effectiveness, of integrated governance, risk management and internal control that support the achievement of the Group’s objectives. This is evidenced through use of an effective assurance framework to guide its work and that of the functions that report to it. The Committee may also request specific reports from individual functions within the Group as they may be appropriate to the overall arrangements. Its work dovetails with that of the Quality and Performance Committee which the group has established to seek assurance that robust clinical quality is in place.

5. Internal and external audit and other assurance functions

In carrying out its work, the Committee may primarily utilise the work of internal audit, external audit and other assurance functions, but may not be limited to these sources.

Internal Audit The Audit Committee shall ensure that there is an effective internal audit function that meets mandatory Public Sector Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and the Group. This is achieved by:

Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal.

Review and approval of the internal audit strategy, operational plan

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and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework.

Consideration of the major findings of internal audit work (and management’s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources.

Track the implementation of actions from audit recommendations to ensure these are discharged as agreed.

Ensure that the internal audit function is adequately resourced and has appropriate standing within the Group.

An annual review of the effectiveness of internal audit. External Audit The Audit Committee shall review findings of the external auditors and consider the implications and management’s responses to their work. This is achieved by:

Consideration of the performance of the external auditors, as far as the rules governing the appointment permit.

Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

Discussion with the external auditors of their local evaluation of audit risks and assessment of the Group and associated impact on the audit fee.

Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Group and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

The Audit Committee also approves any changes to the provision or delivery of assurance services to the group. It shall ensure through the establishment of an Auditor Panel that that an effective external audit function is appointed that meets mandatory National Audit Office (NAO) Code of Audit Practice and provides appropriate independent assurance to the CCG’s Governing Body. Other assurance functions The Audit Committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the Group. These may include, but may not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).

6. Accountability and reporting

This Audit Committee is formally accountable to the CCG Governing Body as one of its committees. The Audit Committee may delegate

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arrangements certain of its responsibilities to Sub-Groups as required but may remain accountable as if these Sub-Groups were the Audit Committee. The committee provides a report to the meeting of the Governing Body immediately following each meeting of the committee, unless this meeting is within 10 working days of the meeting of the committee in which case the committee provides a report to the following meeting of the Governing Body. Agreed minutes of the Audit Committee meetings are sent to the Governing Body for information, and topics for the urgent matters report agreed at the meeting (prior to the issue of accepted minutes) released to the Executive Committee as soon as possible after the meeting for urgent or significant matters. The committee reports to the Governing Body annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embeddedness of risk management in the organisation and the integration of governance arrangements.

7. Decision making and delegated authority

The Audit Committee has delegated authority to take decisions in accordance with standing orders and schemes of delegation (Appendix 1). The Audit Committee works on the basis that decisions are made by consensus wherever possible. Where this is not possible, a vote may be taken with a simple majority carrying the motion with the chair having a second, casting vote in the event of a tie. Only standing members of the Audit Committee are eligible to vote and each member shall have one vote. If an individual has a conflict of interest for a particular agenda item, they must abstain from voting on that item. The Audit Committee applies best practice in its decision making process and to support this, is authorised to investigate any activity within its terms of reference. In particular it:

complies with current disclosure requirements for remuneration;

Ensures that decisions are based on clear and transparent criteria

Complies with CCG policy and procedures for the declaration of interests

It is authorised to seek any information it requires from any employee and all employees are directed to cooperate with any request made by the Committee. The Committee is authorised to obtain external legal or other independent professional advice and to secure the attendance of advisers with relevant experience and expertise if it considers this necessary, such as commissioning reports or surveys it deems necessary to help fulfil its obligations. Unless the Chair declares otherwise during the course of a meeting, no business shall be transacted at the meeting other than that specified on the agenda, unless the provisions of Emergency Powers and Urgent

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Decisions and Suspension of Standing Orders apply. If a decision were taken by the Governing Body to suspend standing orders, a separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Governing Body’s audit committee for review of the reasonableness of the decision to suspend standing orders. For emergency powers and urgent decisions, refer to the CCG constitution, section 3.8 For suspension of standing orders, refer to the CCG constitution, section 3.9

8. Membership The Committee shall be appointed by the Clinical Commissioning Groups as set out in the CCG’s constitution and may include individuals who are not on the Governing Body. The Clinical GP Chair of the CCG shall not be a member of the Committee. At least one member of the Committee shall have a recognised accounting qualification. The Committee consists of not less than two members, one of which must be the designated Chair (the lay member from the Governing Body). Tenure, appointment or removal Chair, Appendix E; Section 2.3.9 of the CCG constitution. a) Nominations – not applicable – appointment by application; b) Eligibility – demonstrable knowledge of the Buckinghamshire

healthcare system and local communities; compliant with regulations 12(5 and 6) of the NHS (Clinical Commissioning Group) Regulations 2012; as well as having qualifications, expertise or experience such as to enable the person to express informed views about governance, conflict of interests, financial management and audit matters;

c) Appointment process – open advertisement and competency

assessment/ interview by Governing Body members and at least one external assessor;


e) Eligibility for reappointment - eligible for renewal of one term of

the appointment subject to demonstration of continuing competence and agreement of this by the Governing Body. Further renewal or re-advertising is at the discretion of the Governing Body;

a) Grounds for removal from office – material failure to comply with

the terms of this constitution, or any disqualification criteria as set out in the CCG regulations and/or as reasonably determined by a

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vote of no confidence by members of the Governing Body or the chair of the CCG in line with the group’s capability policy;

b) Notice period – three months written notice. The Governing Body can override the appointment process for any of the above roles by appointing to the role on an interim basis for a period not exceeding 12 months following which the role must be filled by appointment on the basis described above.

9. Quorum A quorum shall be two members, one of which is the chair (the lay member from the Governing Body) or their nominated deputy from within the membership of the committee. Deputies (for members other than the chair) are not generally allowed but permission can be sought from the Chair. If the meeting becomes inquorate, the meeting shall either be suspended or decisions adjourned to another date, including virtual agreement by email correspondence. An employee who has been formally appointed to act up for a member during a period of incapacity or temporarily to fill an executive vacancy, shall count towards the quoracy of the meeting. Votes are not transferable. A person in attendance but without the power or status to vote at the meeting (excluding a person that may vote by proxy) may not count towards the quorum. An employee attending the Audit Committee meeting to represent a Audit Committee member during a period of incapacity or temporary absence without formal acting up status may not count towards the quorum of the meeting. If a member is conflicted on a particular item of business they may not count towards the quorum for that item of business. If a member is conflicted on a particular item they may be excluded from discussion of the item. An employee’s status when attending the meeting shall be recorded in the minutes. The Audit Committee may call additional experts to attend meetings on case-by-case basis to inform discussions. Member Practices or others wishing to observe the meeting are welcome to do so.

10. Chair/deputy of a meeting

The named Chair of the Audit Committee shall preside (with a lead role in overseeing key elements of governance and as conflict of interest guardian). The Chair has the responsibility to ensure that the Committee obtains appropriate advice in the exercise of its functions. In the event of the

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chair of the Audit Committee being unable to attend all or part of the meeting, he or she may nominate a replacement from within the Committee’s membership to deputise for that meeting. In the absence of the Chair, another Lay Member may act in this role. The decision of the Clinical GP Chair of the CCG on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

11. Attendance The Chief Finance Officer, or designated representative, shall be required to attend all meetings of the Committee. The Head of Corporate Governance, or designated representative, shall be required to attend all meetings of the Committee. The Accountable Officer and other directors shall attend at the request of the Chair of the Audit Committee and particularly when the Committee is discussing areas of risk or operation that are the responsibility of that individual.

Appropriate Internal and External Audit representatives shall normally attend meetings. At the specific request of the Chair, the Committee reserves the right to hold meetings with external and/or internal audit. Such meetings may exclude CCG officers. In any instance where the Audit Committee needs to meet for separate business such as approving the Annual Accounts, the lay member for Governance/Audit must be present along with a further designated lay/independent member. At least once a year the Committee should meet privately with the External and Internal Auditors. Representatives from NHS Protect may be invited to attend meetings, and may normally attend at least one meeting each year. Regardless of attendance, external audit, internal audit, local counter fraud and security management (NHS Protect) providers may have full and unrestricted rights of access to the Audit Committee. Any NHS Manager/CCG Clinical Directors may be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that Director.

The Accountable Officer would normally be invited to attend and discuss, at least annually with the Committee, the process for assurance that supports the statement on internal control. He or she would also normally attend when the Committee considers the draft internal audit plan and the annual accounts.

The Clinical GP Chair of the CCG may also be invited to attend one

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meeting each year in order to form a view on, and understanding of, the Committee’s operations. Those invited to attend are not be entitled to vote.

12. Member conduct

Members of the Audit Committee have a collective responsibility for its operation. They may participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability. They may endeavour to reach a collective view prior to making any decision where authority to do so is delegated. Conflicts of interest There must be transparency and clear accountability of the Audit Committee. The Chair asks at the beginning of each meeting, as a standing item, whether any member has conflict of interest to declare about any items being discussed at the meeting in accordance with the CCGs’ conflict of interest policy. If a member has a direct or indirect connection with an issue on the agenda which may impact on their ability to be objective they must declare an interest to the Chair. A decision may then be taken by the Chair as to whether it is appropriate or not for this member to remain involved. All declarations of interest and decisions on participation shall be reported in the minutes. A register of interests may be completed by all Audit Committee members and updated at least every six months, and may be available on the CCG website for public scrutiny. If the Chair of the Audit Committee or member has been disqualified from participating in the discussion on any matter and/or from voting on any resolution by reason of a declaration of a conflict of interest (see section 8 of this Constitution and Appendix H), that person shall no longer count towards the quorum. If a quorum is then not available for the discussion and/or the passing of a resolution or decision on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting. The meeting must then proceed to the next business. Confidentiality To allow this Audit Committee to operate effectively, members need to be able to openly discuss commercial and operational issues and requirements. Members accordingly agree to hold all information obtained in the course of meetings in the strictest of confidence and agree not to disclose any information discussed without first seeking authorisation to do so from the Chair. All meetings are held in accordance with the CCG’s agreed corporate behaviours; Nolan Principles of Public Life; and Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in

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England. Annual review It is good practice, at least annually, for the Audit Committee to review its own effectiveness, performance, membership, terms of reference and prepare an annual cycle of business. Any resulting changes to the terms of reference or membership should be ratified by the Governing Body.

13. Meeting arrangements

Each year, the Audit Committee develops a forward plan of planned business aligned to the CCGs’ business cycle and shares this with the Governing Body. The administrative support to the meeting is provided by the Corporate Office. The secretary is responsible for supporting the chair in the management of the committee’s business and for drawing the committee’s attention to best practice, national guidance and other relevant documents, as appropriate. Meetings shall be held at least six times a year (usually bi-monthly) and more frequently (i.e. monthly) when the work plan warrants it. One meeting may be held immediately before the annual financial accounts being presented to the group’s Accountable Officer for approval. There may be no more than 20 weeks between meetings. Members are normally required to attend more than 75% of meetings per annum. Before the meeting Agenda items are accepted up to 2 weeks in advance of the meeting. Apologies should be sent in advance to determine quorum. The agenda and associated papers are circulated five (5) working days of ahead of the meeting. This is the responsibility of the Corporate Office. In exceptional circumstances and at the discretion of the Chair, papers may be tabled where appropriate. Arrangements to dial-in to the meeting may be made where possible and practical, especially if required to ensure quorum. After the meeting Minutes of the meeting, action points/log and detail of decisions taken are recorded and produced and circulated within five (5) working days of the meeting to members only. This is the responsibility of the Corporate Office. Where appropriate, excerpts of papers/minutes only may be sent to others who have attended meetings according to the confidentiality of information.

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Document control These terms of reference are reviewed annually. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the constitution. The Governing Body shall approve and keep under review the terms of reference for the audit committee, which includes information on the membership of the audit committee and is available upon request.

Version (author and date)

Review date (by group/committee)

Date of acceptance, approval (and adoption)

0.1 Audit 14.07.16 n/a

0.2/0.3 Audit 27.07.16 Audit Committee 27.07.16 – recommended to GB.

0.4 Governing Body 11.08.16

Governing Body 11.08.16

0.5 Review by Audit Committees 29.03.17, Governing Bodies 11.05.17

29.03.17 Audit Committees in common 11.05.17 Governing Bodies in common

0.6 n/a – final version post committee reviews

29.03.17 Audit Committees in common 11.05.17 Governing Bodies in common

0.7 Single Audit Committee virtual 30.05.18

0.8 Annual Review 27.03.19

0.9 The other member comprises a remaining lay member appointed to serve on the Audit Committee, who need not be a member of the Governing Body appointed to serve on the Audit Committee This should have been removed at last annual review. Process for appointment of remaining lay members also removed. Removed cross

September 2019

130

referenced page numbers to avoid error

1.0 April 2020

Annual review – no changes

1 April 2020

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APPENDIX 1

(to the terms of reference, not to the Constitution)

SCHEME OF RESERVATION AND DELEGATION

Policy Area Decision Reserved

/delegated


Review the prime financial policies at least annually, and recommend amendments to the Governing Body

Y

ANNUAL REPORTS AND

ACCOUNTS

Approval of the group's annual report and annual accounts, and report on those accounts to the Governing Body

Y

OPERATIONAL AND RISK

MANAGEMENT

Approve the group's counter fraud and security management arrangements

Y


MANAGEMENT

Approval of a comprehensive system of internal control, including budgetary control, that underpin the effective, efficient and economic operation of the group

Y


MANAGEMENT

Approve the banking arrangements

Y


Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data

Y

COMMISSIONING AND

CONTRACTING FOR CLINICAL

SERVICES

Approval of the groups' procurement strategy

Y

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APPENDIX J

Remuneration Committee Terms of Reference

Purpose of the Committee

The Remuneration Committee (the committee), which is accountable to the CCG’s Governing Body, makes recommendations to Governing Body on determinations about:

a) the remuneration, fees, terms and conditions of service and other allowances for Governing Body members and senior members of staff such as the senior management team.

b) the remuneration, fees, terms and conditions and other allowances for employees and for people who provide services to the CCG

The Remuneration Committee is established in accordance with the CCG’s constitution, standing orders and scheme of delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into each clinical commissioning groups’ constitution and standing orders. The Governing Body ratifies and keeps under review the terms of reference which are available upon request. The committee will apply best practice and uphold good governance in decision making processes. It will:

comply with disclosure requirements for remuneration;

have full authority to seek independent advice about remuneration for individuals, to help it fulfil its obligations; and

Ensure remuneration decisions are based on clear and transparent criteria.

Aim/objectives The committee shall advise and recommend to the CCG Members (via the Governing Body) a framework for the remuneration, allowances and terms of service for employees of the CCG and people who provide services to the CCG which delegates authority as is described within committee terms of reference, including:

all aspects of salary, including performance related elements or bonuses to ensure probity and value for money, and determination of National Recruitment and Retention Premia (“NRRP”);

provision of other benefits;

allowances under any pension schemes they may establish as an alternative to the NHS pension scheme; and

Arrangements for termination of employment, and variation of other contractual terms.

The committee is also responsible for ensuring effective review and oversight of the performance and annual salary awards of the CCG Chair, Accountable Officer, Chief Financial Officer and other senior roles (VSM), and the scrutiny of severance/redundancy payments. The work of the committee will take proper regard of the CCGs’ circumstances and the performance of any appropriate national

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arrangements in place. It will observe the highest standards of propriety involving impartiality, integrity and objectivity in relationship to the stewardship of public funds.

Specific duties and responsibilities

The duties of the committee are to:

note measurable performance objectives for the CCG Chairs and Accountable Officer, which are compatible with the strategic objective of the CCG and are consistent with local and national priorities;

monitor the CCG Chairs’ and Accountable Officer’s assessments of performance of shared senior posts based on measures of individual and corporate targets;

ensure proper scrutiny of business cases and calculation of termination payments relating to staff employed substantively whose contract is being terminated on the grounds of redundancy or any other non-contractual arrangement;

periodically be advised by the Human Resources function on Human Resource matters;

ensure that remuneration packages and policy are such as to enable people of suitable calibre to be recruited, retained and motivated – within levels of affordability;

have proper regard to the CCGs’ circumstances and performance and to the provisions of any national arrangements where appropriate;

Keep adequate records of its deliberations and conclusions. A key responsibility of the committee is to assure the Governing Body that matters pertaining to the remuneration, allowances and terms of service are in line with statutory requirements.

Accountability and reporting arrangements

This committee is formally accountable to the Governing Body as one of its committees. An agreed summary of the minutes of the committee and all recommendations and/or decisions will be presented to the Governing Body through its confidential agenda for their agreement and approval, redacting any sensitive or personal information as appropriate. Minutes of the Governing Body’s meetings should record these decisions. The Committee is authorised to create working groups as necessary to fulfil its responsibilities within these terms of reference. The Committee may not delegate executive powers (unless expressly authorised by the Governing Body) and remains accountable for the work of any such group. The Committee will operate at all times in accordance with the Governing Body’s Standing Orders and Prime Financial Policies. It will ensure that it conducts its business in accordance with the principles of good governance and the Nolan seven principles of public life. The Chair shall have the unrestricted right to address the Governing

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Body at any time on matters concerning the conduct, scope and business of the Committee.

Decision making and delegated authority

The committee has delegated authority to take decisions in accordance with standing orders and schemes of delegation (Appendix 1). The committee will work on the basis that decisions will be made by consensus wherever possible. Where this is not possible, a vote will be taken with a simple majority carrying the motion. Only standing members of the remuneration committee will be eligible to vote and each member shall have one vote. If an individual has a conflict of interest for a particular agenda item, they must abstain from voting on that item.

Membership and Quorum

Voting Members Only members of the Governing Body may be members of the Remuneration Committee.

Role Title Organisation

Lay Member (Chair) Buckinghamshire CCG

Lay Vice Chair Buckinghamshire CCG

Lay Member with lead for PPI Buckinghamshire CCG

The committee has the authority to invite any individual as they deem appropriate to items on the agenda. This may include the CCG Chair (standing invitee where time and workload permits) as well as (by necessity) the Accountable Officer, Chief Finance Officer, Human Resources Lead from the Commissioning Support Unit and other independent/external advisors. Relevant CCG employees should not be in attendance for discussions about their own remuneration and terms of service. Quorum The committee will be quorate to make decisions as delegated if the following mix of voting members are all present:

Two Lay Members In the event that a vote is tied, the Chair will be awarded a deciding vote. If quorum has not been reached, then the meeting may proceed if those attending agree, but any record of the meeting should be clearly marked as notes rather than formal Minutes, and no decisions may be taken by the non-quorate meeting. If a decision does need to be made before the date of the next meeting, the matter should be escalated to the Governing Body. If a member/attendee is conflicted on a particular item of business they will not count towards the quorum for that item of business. If an

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individual is conflicted on a particular item they may be excluded from discussion of the item and/or asked to leave the room, both at the discretion of the Chair of the meeting. If this course of action causes the decision to be non-quorate, the matter may be escalated to the Governing Body. No member shall be in attendance, or receive papers for; discussions about his/her own remuneration and terms of service. The Accountable Officer and/or Chief Financial Officer may be asked make written recommendations or appraise options around changes to their own remuneration package or terms and conditions, but will not be present for discussions about the changes. Deputies will not generally be allowed unless they are formally acting up for a member e.g. due to prolonged sickness etc. Permission can be sought from the Chair. The Committee is authorised by the Governing Body to undertake any activity within its terms of reference. The committee may call additional experts to attend meetings on case-by-case basis to inform discussions; including but not limited to Human Resources, Corporate Governance and Finance teams. It is authorised to seek any information it requires, from any member, officer or employee who is directed to co-operate with any request made by this Committee. The Remuneration Committee will seek to be kept informed by these teams of any relevant changes in law and NHSE guidance.

Chair/deputy of a meeting

The named Chair of the committee will be selected from amongst and by the voting members and shall preside. In the absence of the Chair, another Lay Member should take on the responsibilities of meeting chair.

Member conduct

Members of the committee have a collective responsibility for its operation. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability. They will endeavour to reach a collective view prior to making any decision where authority to do so is delegated. The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the CCGs Standards of Business Conduct and Managing Conflicts of Interests and the Nolan Principles. This will ensure that each individual is fairly rewarded for their individual contribution to the CCG, while having proper regard to the CCG’s circumstances and performance, affordability and the public interest. Conflicts of interest There must be transparency and clear accountability of the committee. As required by section 140 of the National Health Service Act 2006, as inserted by section 25 of the Health and Social Care Act 2012, and set

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out in the CCG’s Constitution, the Committee shall ensure that recommendations made will be taken and seen to be taken without any possibility of the influence of external or private interest. The Chair will ask at the beginning of each meeting, as a standing item, whether any member has conflict of interest to declare about any items being discussed at the meeting in accordance with the CCGs’ conflict of interest policy. If a member has a direct or indirect connection with an issue on the agenda which may impact on their ability to be objective they must declare an interest to the Chair. A decision will then be taken by the Chair as to whether it is appropriate or not for this member to remain involved. All declarations of interest and decisions on participation shall be reported in the minutes. A register of interests will be completed by all committee members and updated at least annually, and will be available on the CCGs’ website for public scrutiny. For the avoidance of any doubt, members of the Governing Body will not participate in any discussion or decision that directly or indirectly effects their personal remuneration or terms of office. Confidentiality To allow this committee to operate effectively, members need to be able to openly discuss sensitive and personal issues and requirements. Members accordingly agree to hold all information obtained in the course of meetings in the strictest of confidence and agree not to disclose any information discussed without first seeking authorisation to do so from the Chair.

Meeting arrangements

The committee will meet at least twice annually to meet the requirements of its work plan and otherwise on an as required exceptional basis. The administrative support to the meeting will be provided by the PA to the Accountable Officer. Before the meeting Agenda items will be accepted up to 2 weeks in advance of the meeting. Apologies should be sent in advance to determine quorum. The agenda and associated papers will be circulated five (5) working days of ahead of the meeting. This is usually the responsibility of the Accountable Officer and the PA to the Accountable Officer. However, in some circumstances, to ensure confidentiality of proceedings it may be necessary for reports to only be made available on the day of the meeting. This will be at the determination of the Committee Chair. Arrangements to dial-in to the meeting will be made where possible and practical, especially if required to ensure quorum. The only standing item will be declarations of interest. After the meeting Notes of the meeting, action points/log and detail of decisions taken will be recorded and produced and circulated within five (5) working days of the meeting to members only. This is the responsibility of PA to the Accountable Officer. Where appropriate, excerpts of papers/minutes

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only will be sent to others who have attended meetings according to the confidentiality of information. It is good practice, at least annually, for the Committee to review its own effectiveness, performance, membership and terms of reference.

Document control

These terms of reference will be reviewed annually.

Version (author and date)

Review date (by group/committee)

Date of acceptance, approval (and adoption)

DRAFT v0.2 (Jenny Willis & Nicola Lester -14 Oct 2016)

10th

Nov 2016 (by Remuneration Committee)

10th

Nov 2016 (by Remuneration Committee) with minor changes to create v0.3

Draft 0.3 April 2018 Russell Carpenter

Remuneration Committee 30.05.18

Remuneration Committee 30.05.18

Final 0.3 June 2018 Governing Body 14.06.18

Governing Body 14.06.18

0.4 March 2019 Remuneration Committee 27.03.19

27.03.19

0.5 March 2019 n/a 13.06.19 – version to Governing Body for ratification

0.6 August 2019 n/a Correction of agreed change to delegated authority in opening paragraph in relation to decisions. This had stated: The Remuneration Committee (the committee), which is accountable to the CCG’s Governing Body, makes recommendations to the Governing Body on determinations about: This is amended to:

The Remuneration Committee (the committee), which is accountable to the CCG’s Governing Body, makes decisions on determinations about: This is following agreement at Remuneration Committee 27.03.19: The terms of reference paper was presented by RC. The Committee specifically discussed the delegated authority of the remuneration committee and guidance on role of Governing Body and the view of the lay members was that the remuneration committee had delegated authority from the Governing Body to agree remuneration and is constituted by lay members of the GB. Decisions of the Remuneration Committee are reported to the Governing Body for assurance and oversight.

0.7 October/November 2019

October/November 2019 Remuneration Committee 16 October 2019 Governing Body 14 November 2019

Amended to reflect guidance that Remuneration Committee must make recommendations to Governing Body for pay decisions rather than having delegated authority. Noted Remuneration Committee 16 October 2019, approved and ratified Governing Body 14 November 2019.

0.8 April 2020 Remuneration committees (in common) 14042020

Membership and quorum: The Chair and Vice-Chair of the Committee will be a Lay Member of the Governing Body who is not the Audit Chair.

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Other Lay Member to become Chair to replace the Lay Vice Chair. Only the Clinical Chair is a standing invitee – all other invitees by necessity only. The Clinical Chair is the only standing invitee to the Committee. However, other individuals such as the Accountable Officer, Chief Finance Officer, Human Resources Lead from the Commissioning Support Unit and other independent/external advisors as necessary may be invited to attend for all or part of any Remuneration Committee Meetings.

0.9 Amendments following Remuneration committees (in common) 14042020 (approved subject to these amendments)

The committee has the authority to invite any individual as they deem appropriate to items on the agenda. This may include the CCG Chair (as a standing invitee where time and workload permits) as well as (by necessity) the Accountable Officer, Chief Finance Officer, Human Resources Lead from the Commissioning Support Unit and other independent/external advisors. Meeting arrangements: The committee will meet at least twice annually to meet the requirements of its work plan and otherwise on an as required exceptional basis.

1.0 Amendments following Governing Body ratification 21/05/2020

The Chair and Vice-Chair of the Committee will be a Lay Member of the Governing Body who is not the Audit Committee Chair. Clause removed following Governing Body; Remuneration Committee and Audit Committee chair have historically been the same. The clause is included in the CCG model constitution. The change had originally been made given a benchmark comparison of terms of reference for Buckinghamshire, Oxfordshire and Berkshire West with both others having previously made this change and therefore Buckinghamshire was an outlier. Governing Body felt that continuity and leadership was of greater value than alignment across BOB in this instance. Therefore it accepted and agreed to the risk of non-compliance with the CCG Constitution.

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Appendix 1 – Scheme of reservation and delegation UPDATED

No Policy Area Decision Authority

R1 HUMAN RESOURCES

APPROVE the terms and conditions, remuneration and travelling or other allowances for Governing Body members, senior members of staff, other employees and people who provide services to the CCG not covered by national arrangements, including pensions and gratuities

Governing Body

R2 HUMAN RESOURCES

APPROVE disciplinary arrangements for employees, including the Accountable Officer and for other persons working on behalf of the CCG.

Remuneration Committee

R3 HUMAN RESOURCES

APPROVE disciplinary arrangements where the Accountable Officer is an employee or member of another clinical commissioning group.


R4 HUMAN RESOURCES

APPROVE arrangements for performance related elements or bonuses to ensure probity and value for money; and determination of National Recruitment and Retention Premia (“NRRP”)

Governing Body

R5 HUMAN RESOURCES

APPROVE the severance/redundancy payments of the Accountable Officer and of other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’ (available on the HM Treasury.gov.uk website).

Governing Body

R6 HUMAN RESOURCES

APPROVE the terms and conditions of employment for all employees of the Group.


R7 HUMAN RESOURCES

APPROVE any pay policy and payment framework for VSM employees and clinical commissioning roles of the CCG, and people who provide services to the CCG, notwithstanding provisions to mirror the implementation of national agreements

Governing Body

R8 HUMAN RESOURCES

APPROVE any other potential alternative remuneration and conditions of service for CCG employees and other persons providing services to the CCG, outside of or in place of national Agenda for Change arrangements, and excluding those covered by standard contracting and procurement arrangements.

Governing Body

R9 HUMAN RESOURCES

APPROVE arrangements for termination of employment for employees and variation of other contractual terms


R10 HUMAN RESOURCES

Making relevant policy decisions within the functions of the

Committee as set out in its Terms of Reference as ratified by the Governing Body


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APPENDIX K

Terms of Reference for Delegated Commissioning Arrangements

including Scheme of Delegation and Primary Care Commissioning Committee

Document Version

Date Version Number

Description of Changes Edited by

10.03.15 2.1 Watermark added

Change to paragraph 13 regarding number of votes

Louise Smith

11.03.15 2.2 Reference to Thames Valley area team removed and

replaced with NHS England.

Full Acronyms explained

Change to secretariat from NHSE to AVCCG

Change to membership section to read Chief Officer

or Chief Finance Officer

Louise Smith

Elaine

Baldwin

11.03.15 NOTE Sent to Graham Jackson for Chairs action and full

Governing Body for approval of sign off. Sent to NHS

England (South) as final version.

04.03.16 3.0 Document updated to delegated commissioning

arrangements including scheme of delegation and

Primary Care Commissioning Committee.

Elaine

Baldwin

22.06.16 4.0 Document updated to take account of joint working

arrangements between Aylesbury Vale and Chiltern

CCGs.

Helen

Delaitre

30.8.16 5.0 Document amended to include draft scheme of

delegation at Schedule 4

Helen

Delaitre

7.11.16 6.0 Document amended to include list of voting members,

their deputies and deputising rights.

Helen

Delaitre

11.2.17 7.0 Document amended to reflect Committee in Common

arrangements starting April 2017.

Helen

Delaitre

03.05.17 8.0 Document amended to reflect changes to membership

of PCCC and to include 2017/18 MOU for Primary

Medical Services Support for Delegated CCGs. ToRs

reflect arrangements to make a CCG specific

decision.

Wendy

Newton/

Helen

Delaitre/

Russell

Carpenter

21.02.18 9.0 Document amended to reflect the formal merger of

Wendy

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NHS Aylesbury Vale CCG and NHS Chiltern CCG and

the name of the newly merged organisation (NHS

Buckinghamshire CCG) with effect from 1 April 2018.

NHS Buckinghamshire will have a sole PCCC and

therefore PCCC will no longer be “meeting in

common”.

Membership of PCCC updated to reflect change in

roles. Named individuals removed with membership

only identifiable via designation.

Removal of Schedule 1 – MOU without Appendices –

which details the transitional arrangements for

delegated commissioning between NHS England and

the CCG – the transitional year end on 31 March

2018.

Newton

2.3.18 10.0 Clarification of voting member job titles in Section 1.7,

further correction of job titles

Helen

Delaitre

22.02.19 11.0 Associate Director of Digital and IM&T to become a

standing invitee.

Clear instruction that quoracy relates to delegated

decision making only.

Statement regarding quoracy in the event of voting

members being unable to attend the meeting.

Removal of “if GP members need to withdraw from

decision making for conflicts of interest reasons; the

Committee would still need to be quorate with a Lay

and executive” This is on the basis that those

members are standing invitees and have no voting

rights for delegated decisions.

Scheme of delegation: direct awards becomes locally

commissioned services.

Appendix 1: clear distinction between voting members

and standing invitees.

Wendy

Newton

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Introduction

Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England

was inviting Clinical Commissioning Groups (CCGs) to expand their role in primary care

commissioning and to submit expressions of interest setting out the CCG’s preference for how it

would like to exercise expanded primary medical care commissioning functions. One option

available was that NHS England would delegate the exercise of certain specified primary care

commissioning functions to a CCG.

1. In accordance with its statutory powers under section 13Z of the National Health Service Act

2006 (as amended), NHS England has delegated the exercise of the functions specified in

these Terms of Reference.

2. The CCG has established the Primary Care Commissioning Committee (“Committee”). The

Committee will function as a corporate decision-making body for the management of the

delegated functions and the exercise of the delegated powers.

3. The Committee comprises representatives of the following bodies:

The CCG

NHS England

Healthwatch Bucks

LMC

Health and Well Being Board

Statutory Framework

4. NHS England has delegated to the CCG authority to exercise the primary care commissioning

functions set out in section 13Z of the NHS Act.

5. Arrangements made under section 13Z may be on such terms and conditions (including terms

as to payment) as may be agreed between the Board and the CCG.

6. Arrangements made under section 13Z do not affect the liability of NHS England for the

exercise of any of its functions. However, the CCG acknowledges that in exercising its functions

(including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of

the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

143

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

7. The CCG will also need to specifically, in respect of the delegated functions from NHS England,

exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O);

Duty as respects variation in provision of health services (section 13P).

8. The Committee is established as a committee of the Governing Body of the CCG in accordance

with Schedule 1A of the “NHS Act”.

9. The members acknowledge that the Committee is subject to any directions made by NHS

England or by the Secretary of State.

Role of the Committee

10. The Committee is established in accordance with the above statutory provisions to enable the

members to make collective decisions on the review, planning and procurement of primary care

services under delegated authority from NHS England.

11. In performing its role, the Committee will exercise management of the functions in accordance

with the agreement entered into between NHS England and the CCG, which will sit alongside

the delegation and terms of reference.

12. The functions of the Committee are undertaken in the context of a desire to promote increased

commissioning to increase quality, efficiency, productivity and value for money and to remove

administrative barriers.

13. The role of the Committee shall be to carry out the functions relating to the commissioning of

primary medical services under section 83 of the NHS Act.

14. This includes the following:

GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”);

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Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payments (e.g., returner/retainer schemes).

15. The CCG will also carry out the following activities:

a) To plan, including needs assessment, for primary care services in the CCG’s geographical

area.

b) To undertake reviews of primary care services in the CCG’s geographical area.

c) To co-ordinate a common approach to the commissioning of primary care services

generally.

d) To manage the budget for commissioning of primary care services in the CCG’s

geographical area.

e) To assist and support NHS England in discharging its duty under section13E of the NHS Act

2006 (as amended by the Health and Social Care Act 2012) so far as relating to securing

continuous improvement in the quality of primary medical services.

f) To undertake and deliver an estates strategy across the CCG’s geographical area.

Geographical coverage

16. The Committee will comprise NHS Buckinghamshire CCG. It will undertake the function of

NHS Buckinghamshire CCG commissioning primary medical services for the

Buckinghamshire area, as defined within the Constitution.

Membership

The Chair of the PCCC should not also chair the Audit Committee.

The Chair of the Committee shall be a Lay member of the CCG Governing Body.

The Vice Chair of the Committee shall be a lay member of the CCG Governing Body and agreed by

the Governing Body.

17. Voting Members of the Primary Care Commissioning Committee shall consist of:

Lay member (PCCC Chair)

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Lay member (Deputy PCCC Chair)

Accountable Officer (Deputy is Deputy Accountable Officer)

Chief Finance Officer (Deputy is Deputy Chief Finance Office)

Director of Transformation (Deputy is Associate Director of Primary Care)

Associate Director of Quality and Safeguarding (Deputy is Head of Quality)

Standing Invitees

Invitation to a Healthwatch Bucks representative

Invitation to a Health and Wellbeing Board representative

Local Medical Committee representative

NHS England (South) representative

NHS Buckinghamshire CCG Clinical Director(s)

NHS Buckinghamshire CCG Clinical Chair

NHS Buckinghamshire CCG Associate Director of Primary Care

NHS Buckinghamshire CCG Associate Director of Digital and IM&T

Non-conflicted GPs from other CCGs

Additional Lay Members

Subject Matter experts (e.g. premises, workforce).

Provision will be made for the Committee to have the ability to call on additional lay members or

CCG members when required, for example where the Committee would not be quorate because of

a conflict of interest. It could also include GP representatives from other CCG areas and non-GP

clinical representatives (such as the CCG secondary care specialist).

Meetings and Voting

18. The Committee will operate in accordance with the CCG’s Constitution, Standing Orders and

Prime Financial Policies. The Secretary to the Committee will be responsible for giving notice of

meetings. This will be accompanied by an agenda and supporting papers and sent to each

member representative no later than 5 days before the date of the meeting. When the Chair of

the Committee deems it necessary in light of the urgent circumstances to call a meeting at short

notice, the notice period shall be such as s/he shall specify.

19. Each member of the Committee shall have one vote. The Committee shall reach decisions by a

simple majority of members present, but with the Chair having a second and deciding vote, if

necessary. However, the aim of the Committee will be to achieve consensus decision-making

wherever possible.

20. The Committee has delegated authority to take decisions in accordance with standing orders

and schemes of delegation (Schedule 4).

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Quorum

21. Five members of the Committee must be present for the quorum to be established including:

At least two lay members or one lay member and the Associate Director Quality &

safeguarding; and

Either the Accountable Officer (AO) / Deputy Accountable Officer or the Chief Finance

Officer (CFO).

Quorum only relates to delegated authority for decision making.

The Primary Care Commissioning retains a right to co-opt additional clinical representation,

with suitable skills and experience, either voting membership or standing invitee, to provide

objective input and ensure its delegated authority for decision making is effective. Alternative

independent clinical opinion may be sought (especially where conflicts of interest are

identified) and will be specified in papers accordingly.

Member GPs as standing invitees have a valued role in their clinical opinion of proposals prior to decisions. Appropriateness of their input to be judged on a case by case basis by the Committee Chair depending on whether they are materially conflicted in the outcome of a commissioning decision.

Where quorum may be affected by availability of voting members a pre-decision in advance is

preferable in order to minimise potential delay in decision making.

Frequency of Meetings

22. Meetings will take place in public on a quarterly basis.

23. Meetings of the Committee shall:

a) be held in public, subject to the application of 23(b);

b) the Committee may resolve to exclude the public from a meeting that is open to the public

(whether during the whole or part of the proceedings) whenever publicity would be prejudicial

to the public interest by reason of the confidential nature of the business to be transacted or

for other special reasons stated in the resolution and arising from the nature of that business

or of the proceedings or for any other reason permitted by the Public Bodies (Admission to

Meetings) Act 1960 as amended or succeeded from time to time.

24. Members of the Committee have a collective responsibility for the operation of the Committee.

They will participate in discussion, review evidence and provide objective expert input to the

best of their knowledge and ability, and endeavour to reach a collective view.

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25. The Committee may delegate tasks to such individuals, sub-committees or individual members

as it shall see fit, provided that any such delegations are consistent with the parties’ relevant

governance arrangements, are recorded in a scheme of delegation, are governed by terms of

reference as appropriate and reflect appropriate arrangements for the management of conflicts

of interest.

26. The Committee may call additional experts to attend meetings on an ad hoc basis to inform

discussions.

27. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s

Constitution and relevant policies.

28. The Committee will present its minutes to NHS England and to the Governing Body of the CCG

each quarter for information.

29. The CCG will also comply with any reporting requirements set out in its constitution.

30. The terms of reference will be reviewed at least annually with final approval being sought from

the Governing Body. Amendments will be made, where appropriate, to reflect any updated

national model terms of reference and local need.

Accountability of the Committee

31. The Committee to have delegated authority from the Governing Body:

To carry out the functions relating to the commissioning of primary medical services under

section 83 of the NHS Act.

To assist and support NHS England in discharging its duty under section 13E of the NHS

Act 2006 (as amended by the Health and Social Care Act 2012) so far as relating to

securing continuous improvement in the quality of primary medical services.

To work with NHS England to agree rules for areas such as the collection of data for

national data sets, equivalent of what is collected under QOF and IT inter-operability.

To comply with public procurement regulations and with statutory guidance on conflicts of

interest.

To consult with Local Medical Committee and demonstrate improved outcomes reduced

inequalities and value for money when developing a local QOF scheme or DES.

To approve the arrangements for discharging the group’s statutory duties associated with its

GP practice commissioning functions, including but not limited to promoting the involvement

of each patient, patient choice, reducing inequalities, improvement in the quality of services,

obtaining appropriate advice and public engagement and consultation.

Procurement of Agreed Services

The below is taken from the Next Steps in Primary Care Co-commissioning document for further guidance on this please see link below.

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/11/nxt-steps-pc-cocomms.pdf



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32. The Committee must comply with public procurement regulations and with statutory guidance on

conflicts of interest. The committee may vary or renew existing contracts for primary care

provision or award new ones, depending on local circumstances. If the committee fails to secure

an adequate supply of high quality primary medical care, NHS England may direct the CCG to

act.

33. If the Committee is found to have breached public procurement regulations and/or statutory

guidance on conflicts of interest, NHS England/NHS Improvement may direct the CCG or NHS

England to act. NHS England may, ultimately, revoke the CCG’s delegation. Any proposed new

incentive schemes should be subject to consultation with the Local Medical Committee and be

able to demonstrate improved outcomes, reduced inequalities and value for money.

Consistent with the NHS Five Year Forward View and working with CCGs, NHS England reserves

the right to establish new national approaches and rules on expanding primary care provision – for

example to tackle health inequalities.

Review of Terms of Reference

34. These terms of reference will be formally reviewed by the CCG in April of each year, following

the year in which the Committee is created, and may be amended by mutual agreement at any

time to reflect changes in circumstances which may arise.

35. The Committee will make decisions within the bounds of its remit.

36. The decisions of the Committee shall be binding on NHS England, and the CCG within the

scope of these TOR and the CCG’s Standing Orders.

Schedule 1 – List of Committee Members with voting rights & standing invitees without voting rights

Schedule 2 – Primary Care Commissioning Committee Guidance

Schedule 3 – Extract from Scheme of Delegation relating to Primary Care

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Schedule 1

List of Committee Members with voting rights

ROLE Lay CCG NHS England

CCG Accountable Officer (Deputy Accountable Officer)

X

Director of Transformation (Deputy – Associate Director of Primary Care)

X

Lay Member - PCCC Chair (Deputy Chair - Lay Member)

X

Lay Member (not including PCCC Chair)

X

Associate Director of Quality and Safeguarding (Deputy – Head of Quality)

X

Chief Finance Officer (Deputy – Deputy Chief Finance Officer)

X

List of standing invitees without voting rights

ROLE Lay CCG NHS England

Chief Executive Officer

Local Medical Committee

CCG Clinical Chair X

Clinical Director X

Associated Director of Primary Care X

Health & Well Being Board Representative

Healthwatch Bucks Representative X

Contracts Manager - NHS England (South)

X

Assistant Head of Finance - NHS England (South)

X

Assistant Director of Digitalisation and IM&T

X

Non-conflicted GP’s from other CCG’s

Additional Lay Members X

Subject Matter experts (e.g. premises, workforce)

Additional input ad hoc (e.g. data analyst, contracting etc.)

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Schedule 2 – Primary Care Commissioning Committee Guidance

“It is for CCGs to agree the full membership of their primary care commissioning committee. CCGs will be required to ensure that it is chaired by a lay member and have a lay and executive majority. Furthermore, in the interest of transparency and the mitigation of conflicts of interest, a local Health Watch representative and a local authority representative from the local Health and Wellbeing Board will have the right to join the delegated committee as standing invitees. Health Watch and Health and Wellbeing Boards are under no obligation to nominate a representative, but there would be significant mutual benefits from their involvement. For example, it would support alignment in decision making across the local health and social care system. CCGs will want to ensure that membership (including standing invitees) enables appropriate contribution from the range of stakeholders with whom they are required to work. Furthermore, it will be important to retain clinical involvement in a delegated committee arrangement to ensure the unique benefits of clinical commissioning are retained.”

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Schedule 3 – Extract from Scheme of Delegation

Points to note:

This set of reservations and delegations was approved by the Primary Care Commissioning Committee on 7th March 2019. This set of reservations applies equally to Primary Care Commissioning Committee and Primary Care Operational Group.

Approval is limited to £100k for all decisions listed and delegated except where stated otherwise. Any decision above that threshold would need to be escalated to the Governing Body with a recommendation from the Primary Care Commissioning Committee.

Where a decision relates to either an individual practice or award, or more than one practice or award, a separate decision would otherwise need to be taken and managed accordingly on when the delegated limit of £100k comes into effect. E.g. a decision to approve/award affecting 3 practices at £50k each is under the delegated limit individually, but over the delegated limit as a collective at £150,000k.

However, for the avoidance of doubt, the approval limit of £100k will apply irrespective of the number of contracts or awards underneath.

In relation to P8 below, most QOF payments are likely to routinely fall above the stated threshold, though this delegation gives a flexibility and opportunity for primary care commissioning committee decisions where it is deemed to be relevant.

No Policy Area Decision

P1 PRIMARY CARE COMMISSIONING

Approve arrangements for the review, planning, and procurement of primary care services under delegated authority from NHS England. (up to £100k only)


Approval of the arrangements for discharging the CCG’s responsibilities and duties associated with its primary care commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation, obtain advice from persons who taken together have a broad range of professional expertise and acting effectively, efficiently and economically. (up to £100k only)


Day to day decisions on provider performance management and risk management associated with Primary Care to provide robust assurance to the Governing Body and NHS England. (up to £100k only)


Approve and ratify Locally Commissioned Services (up to £100k only)

P5 STRATEGY AND PLANNING

Approve and ratify practice improvement schemes, having regard to guidance by the Secretary of State. Monitor and review any such schemes. (up to £100k only)


Approve the following primary care services: a. Primary medical care strategy; (up to £100k only) b. Planning primary medical care services (including needs assessment); (up to £100k only) c. Primary Care Estates Strategy; (up to £100k only) d. Premises improvement grants and capital developments; (up to £100k only) e. Practice mergers (up to £100k only)

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No Policy Area Decision


Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements:

a. Procurement of new practice provision; (up to £100k only per annum)

b. Discretionary payment (e.g. returner/retainer schemes); (up to £100k only per annum) c. Decisions in relation to the management of poorly performing GP practices and including, without limitation, decisions and liaison with the CQC where the CQC has reported non-compliance with standards (but excluding any decisions in relation to the performers list); (up to £100k only per annum)

d. Premises Costs Directions functions. (up to £100k only per annum)

P7a PRIMARY CARE COMMISSIONING

Approve and ratify proposals for the procurement of primary care services under co-commissioning arrangements: a. The award of GMS, PMS and APMS contracts for primary care services to some or all of the CCG population where they are within CCG budgets (excluding GP contracts for which core contract approval/monitoring and appraisal sits with NHS England Area Team; This includes: the design of PMS and APMS contracts; and monitoring of contracts; taking contractual action such as issuing branch/remedial notices, and removing a contract); (over £50k per annum change +-)


Advise on or approve matters relating to primary care contracting within agreed levels, specifically in relation to commissioning Locally Commissioned Services, Quality Outcomes Framework (QOF - subject to allowances within NHS England's legal framework), Out of Hour services, Walk-in Centres (including home visits as required and for out of area registered patients); (up to £100k only)


Approval proposals for primary care support and development and any associated plans in connection with commissioning and performance monitoring and development within the remit of the CCG. (up to £100k only)