NHS Newcastle Gateshead CCG Governing Body …...2016/09/01 Welcome and Introductions Dr Mark...

NHS Newcastle Gateshead CCG Governing Body Meeting

To be held on Tuesday 29 November 2016 at 2.00 – 4.00pm

Armstrong Stephenson Room, Newcastle Civic Centre, Newcastle upon Tyne, NE1 8QH

Agenda

1. Northumberland, Tyne & Wear & North Durham (NTWND) Sustainability & Transformation Plan (STP)

Presentation Mark Adams

2. Apologies for Absence

Chair

3. Declarations of Interest

Pauline Fox

4.

Quoracy Pauline Fox

5. Minutes of the previous meeting held on 27 September 2016

Enclosure

Chair

6. Matters arising from the minutes

Chair

7. Report from Chief Officer

Verbal Mark Adams

8. Public & Patient Issues 8.1 NHS Gateshead CCG, NHS Newcastle North & East CCG & NHS Newcastle West CCG Patient & Public Involvement (PPI) Update Questions from the public

Enclosure

Paul Gertig/ Mandy Taylor

9. Quality, Finance & Performance 9.1 Executive Integrated Delivery Report Questions from the public

Enclosure

Joe Corrigan/ Neil Morris

10. Public Health Items Director of Public Health Updates (1) Gateshead (2) Newcastle Questions from the public

Alice Wiseman Eugene Milne

11. Strategic Items 11.1 CCG Involvement Strategy 11.2 Application for Delegated Commissioning 11.3 Northumberland, Tyne & Wear & North Durham

(NTWND) Sustainability & Transformation Plan (STP) Questions from the public

Enclosure Enclosure Enclosure

Chris Piercy Neil Morris Mark Adams

12. Assurance, Risk & Governance Items 12.1 Proposed Amendments to the CCG Constitution 12.2 Standards of Business Conduct & Declaration of

Interest Policy 12.3 Revised Terms of Reference for Approval 12.4 CCG Commissioning Forum Revised Terms of

Reference 12.5 Primary Care Commissioning Committee Draft Terms

of Reference 12.6 Risk Assurance Framework Questions from the public

Enclosure Enclosure Enclosure Enclosure Enclosure Enclosure

Pauline Fox Pauline Fox Pauline Fox Pauline Fox Pauline Fox Pauline Fox

13. Items for Information 13.1 Committee Minutes/Reports to be received for

information a) CCG Executive Committee minutes 13 September

& 11 October 2016 b) Audit, Finance & Performance Committee minutes

20 July and 21 September 2016 c) Quality, Safety & Risk Committee minutes 1

September 2016 d) Primary Care Joint Committee minutes 19 July and

27 September 2016 e) Gateshead Health & Wellbeing Board agenda 15

July, 9 September and 21 October 2016 f) Newcastle Wellbeing for Life Board agenda 4

October 2016 13.2 Notes of the Annual Members Meeting – 13

September 2016

Enclosure Enclosure Enclosure Enclosure Enclosure Enclosure Enclosure

14. Date of the next CCG Governing Body Meeting Tuesday 24th January 2017, Gateshead Civic Centre.

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Enclosure 5

Minutes of the Governing Body Meeting held on Tuesday 27 September 2016 at 1.45 – 4.00pm

Lamseley Room, Gateshead Civic Centre, Regent Street,

Gateshead, NE8 1HH

Present: Dr Mark Dornan Chair Dr Guy Pilkington Assistant Clinical Chair Mark Adams Chief Officer Joe Corrigan Chief Finance Officer/Chief Operating Officer Chris Piercy Executive Director of Nursing, Patient Safety & Quality Dr Neil Morris Medical Director Jeff Hurst Lay Member Michael Burke Lay Member Paul Gertig Lay Member Oliver Wood Lay Member Margaret Stewart Lay Member Jackie Cairns Director of Strategy & Integration Dr Alison Smith Member Practice Representative Sheinaz Stansfield Member Practice Representative In Attendance: Alice Wiseman Director of Public Health, Gateshead Louise McAndrew Minute Taker 2016/09/01 Welcome and Introductions Dr Mark Dornan, Chair, welcomed the members of the Governing Body and the members of the public who were attending the meeting and reminded those present that ‘Questions from the public relating to the agenda’ will be taken after every section of the agenda. 2016/09/02 Apologies for absence: Bill Cunliffe Secondary Care Clinician Mandy Taylor Lay Member Julia Young Director of Quality Development Jane Mulholland Director of Operations & Delivery Dr Peter Ward Member Practice Representative Pauline Fox Head of Corporate Affairs Professor Eugene Milne Director of Public Health, Newcastle

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2016/09/03 Declarations of Interest There were no additional declarations of interest made. 2016/09/04 Quoracy It was confirmed that the meeting was quorate. 2016/09/05 Minutes of previous meeting held on 19 July 2016 The minutes were agreed as an accurate record. 2016/09/06 Matters arising from the Minutes There were no matters arising that were not on the agenda. 2016/09/07 Report from Chief Officer Mark Adams, Chief Officer, reported that the CCG is performing well but it is a very challenging year The Sustainability and Transformation Plan (STP) now covers Northumberland/North Tyneside, Newcastle Gateshead, Sunderland/South Tyneside and North Durham. Everyone is working towards submission of the plans on 21 October. On completion of the plans organisations will work together on delivery across the whole STP footprint. Delivery will involve linking the STP into operational plans and contract processes - all operational plans are for two years and should dovetail with our providers plans. Regarding the contracts, in previous years they were expected to be signed at the end of January/beginning of February, they are now expected to be signed by 23 December 2016. 2016/09/08 Patient and Public Involvement Updates 8.1 CCG PPIE Update Paul Gertig, Lay Member, presented the report which briefly summarised progress on Patient, Carer, Public Involvement and Engagement work across the CCG and included locality specific engagement and involvement. It was noted that following the audit of patient and public engagement an event has been organised on 21 November to explore more effective communication and engagement with patients and the public. In relation to item 10.1 in the report Jeff Hurst, Lay Member, queried why the primary care navigators were based in practices and not in the community? Sheinaz Stansfield, Member Practice Representative, answered that the practices are taking responsibility for patients health and well-being. By being located in the practices they get to the patients who need help and they have links with a number of

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voluntary sector organisations. It is not in all practices but it is hoped it will grow over time. Mark Adams commented that he had attended an event the previous week with Sam Jones, Director of NCM National Programme, to meet all the Vanguards across the patch and it became apparent that we need to get better at measuring how effective our processes are. Sheinaz Stansfield added that we need to consider the GP Forward View as she has found that practices are wanting to develop their existing staff skills. It was agreed that we need to make every contact patients have count and not just with GPs.

The CCG Governing Body noted the contents of the report. 8.2 Looked After Children Report – Newcastle & Gateshead Chris Piercy, Executive Director of Nursing, Patient Safety & Quality, presented the report which highlighted the work undertaken by the designated professionals on behalf of Newcastle Gateshead CCG to ensure looked after children (LAC) continue to be protected from abuse and neglect and have their health needs identified and met, across the health community in Newcastle and Gateshead localities Newcastle Gateshead CCG have invested additional resources in the Looked After Childrens Health Teams in both localities and strengthened the representation within the organisation with the Designated Nurse LAC post now sitting within the Safeguarding Team in the CCG. This demonstrates the to meeting the statutory duties and improving the service provision to and outcomes for LAC and care leavers Chris Piercy clarified that the number of unaccompanied children asylum seekers to be taken by each LA is determined centrally. Paul Gertig noted that these children will no doubt have psychological issues and there have been problems in the past regarding access to services - has this been factored in? Chris Piercy confirmed that discussions are ongoing regarding capacity and funding.

The CCG Governing Body noted the contents of the report. 8.3 Safeguarding Children Board Report – Newcastle & Gateshead Chris Piercy presented the report which highlighted the work undertaken by the designated professionals on behalf of Newcastle Gateshead CCG to ensure children are protected from abuse and neglect across the health community in Newcastle and Gateshead localities

The child population of Newcastle is approximately 56, 263,000 (0 – 17yrs) with 27% of children under 16 years living in poverty. In Gateshead there are approximately 40,200 with approximately 21% who live in poverty. Newcastle and Gateshead Local Safeguarding Children Boards (LSCB) although separate local authorities have similar priority areas. The Business Plans 2014-2017

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sets the strategic direction for the LSCB. The Business Plan also reinforces the specific role of the LSCB and the strategic principles of the LSCB are to lead, challenge and support learning. Chris Piercy confirmed that there is a lot of work going on in Newcastle and Gateshead to work with children and young people as part of the Not Seen Not Heard project. Paul Gertig commented on the issue of neglect and queried if there is any emphasis on trying to keep the services going where there are families in need? Chris Piercy responded that health and social care across acute services and mental health services all work together on this. It was noted that the midwifery departments in Newcastle and Gateshead are reviewing their staff skill mix.

The CCG Governing Body noted the contents of the report.

2016/09/09 Quality, Finance & Performance 9.1 Quality, Finance & Performance Report Joe Corrigan, Chief Finance Officer/Chief Operating Officer and Neil Morris, Medical Director, presented the report which appraised members of the high level themes from all aspects of quality and patient safety whilst linking with performance and finance. The report provides context as to the reasons for pressures and actions being taken to mitigate their impact in relation to key quality, performance, contract and finance issues. The data in this report relates to the reporting period June 2016 except where stated. KPIs of note are: 1. Quality and Safety

NuTH reported 2 cases of MRSA in June

PUPoC cases increasing and identified as a high risk to CCG

CHC and SI processes rated as offering “substantial assurance” by Internal Audit

Run of ‘never events’ at Newcastle upon Tyne Hospitals Trust and Gateshead Healthcare

2. Key performance indicators

58 Green (within target) 19 Red (beyond target) 5 indicators have no in year data/target so not rag rated

RTT – Orthopaedics

Diagnostics NUTH

NEAS Response times

% GP referrals made by E-referral

% patients reporting good experience when making a GP appointment

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Quality Premium

NHS Constitution - Cat A Red 1 Ambulance Response times

Increase GP referrals made by e-referral

% patients reporting good experience when making a GP appointment

Better Care Fund

Q1 return has been submitted indicating good progress across all metrics

Improvement and Assessment Framework

6 Clinical Priority Areas: Cancer, Mental Health, Diabetes, LD, Dementia, Maternity to be assessed with an Ofsted style rating

Baseline assessment across 60 indicators to be published at CCG, national and STP level

3. Contract Activity

GHNHSFT – Other services are over performing by £528k at month 3 with QIPP contributing most significantly to this pressure

NuTHFT – Activity and financial variances continue to be affected by coding issues at the provider. An action plan has now been developed which is being monitored by commissioners.

4. Finance

Month 4 reports a surplus of £8,779k or 1.3% of budget.

Pressures continue in CHC at month 4.

Following a query from Margaret Stewart, Lay Member, Neil Morris confirmed that there is now more communication between trusts regarding serious incidents and they are working collaboratively around lessons learnt. A great deal of work is also being done with NEAS and the trusts regarding sepsis. Sheinaz Stansfield commented that there has been a rise in practice SIRMS and feels this is due to the whole system becoming overloaded causing incidents to be passed to practices and queried how this could be taken forward. Neil Morris agreed that we need to see the resources moving to general practice where services have transferred and he will convey the concerns to the trusts. It was confirmed that the quarterly report does go out to practices and is included in the newsletter. Chris Piercy noted that it may need to be more transparent. Going forward, we will produce a more detailed report to go to the Quality, Safety & Risk Committee and for assurance to the Governing Body. Any Lay Members who wish to attend any of the Quality Review Group (QRG) meetings please contact Neil Morris/Chris Piercy. Answering a query from Michael Burke, Joe Corrigan confirmed that a group has been set up to look at where savings can be made either through natural slippage or discontinuing services.

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Paul Gertig queried if the NHS crisis described in the press relates to the south of the country or is it the north as well. Joe Corrigan answered that it is an emerging position nationally. Through the work in the STP and reconfiguration of services we are trying to find solutions but increasingly workforce issues are being highlighted e.g. the shortage of GPs. It was noted that Simon Stevens has said that any additional funding does need to go to social care in the first instance but there does need to be some thought given to general practice. Guy Pilkington, Assistant Clinical Chair, added that there has definitely been a beneficial effect regarding the agency staff cap in trusts.

The CCG Governing Body noted the contents of the report. 2016/09/10 Public Health Items Director of Public Health Updates Gateshead Alice Wiseman, Director of Public Health, gave a verbal update:

“Achieving More Together in Gateshead” - 3 research pilots on how to work better with local communities and how better to respond to this:

o Childhood obesity o Social isolation - have funding for this and an example of a project is an

alternative foodbank for refugees and asylum seekers o Environment - part of which is looking at good quality green spaces using

current resources and volunteers All the projects are being evaluated and will update at future meetings. Newcastle and Gateshead are involved in the Well North project looking at how

to use arts as a way of improving health and wellbeing. It is also looking at school readiness and social cohesion

Reported that in Gateshead, and Newcastle, the local authorities (LAs) are facing major budget challenges and will keep the governing body updated

The Health and Wellbeing Board have held a session regarding the JSNA focusing on ageing well

National Diabetes Prevention Programme - this is CCG led but the LA want to work collaboratively to take this forward

Noted that the Health & Social Care Commission recommendations are looking at how to scale up prevention and system leadership.

Guy Pilkington commented that within the CCG and the LA there is some very good work going on but we must be committed to finding better ways of engaging with communities especially the disadvantaged. He added that the budget situation is very challenging and everyone needs to recognise both the LA and the NHS situation and work collaboratively to get through this. Sheinaz Stansfield reported that the practice health champions have won an award and £2k which they have used to recruit more health champions plus another £2k capacity building fund. She noted that patients and volunteers are making the

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connections for us locally and that we need to find a way to measure this in all practices – little things having a big impact. It was agreed that Sheinaz and Alice Wiseman will discuss this further outside of the meeting. Oliver Wood, Lay Member, commented that it is difficult to sustain a service with volunteers who may move on to other things. There are unique challenges which we need to think about if we want to grow these initiatives. Newcastle Professor Eugene Milne, Director of Public Health in Newcastle, had given apologies for the meeting.

2016/09/11 Strategic Items 11.1 Primary Care Commissioning – Process Assurance Neil Morris presented the paper which provided assurance that due process has been followed to prepare for the application to NHS England to move to level 3 delegated commissioning. The CCG is engaged in a member practice vote following the Annual Members Meeting on 13th September. The closing date for votes is today (27th September) with the count taking place on 4th October.

The Governing Body noted the contents of the report. 11.2 Moving from Sustainability & Transformation Plans (STPs) to Operating

Plans for 2017/18 and 2018/19 Joe Corrigan presented the paper which provided the Governing Body with an early indication of the proposed publication of NHS planning guidance for 2017/18 and 2018/19 by NHS England, the guidance is expected to be released 20 September 2016. This is a change from the usual planning cycle which in previous years has run from December to March. STPs will be completed by October 2016, including credible financial plans for all years at STP level so that the operating planning cycle can run from October to December. It was noted that the team are still working through the guidance which was received last week and a briefing paper will be brought to the Governing Body to appraise members of the main points either at a business meeting or a development session. The contracts need to be signed by the 23rd December 2016 which is shown in the timeline within the report. Paul Gertig commented that did they realise how much stress this was causing NHS staff. Sheinaz Stansfield added that we have had outstanding results even though

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there have been changes to the CCG every year since it was started and we are leading on some of the biggest projects in the region and this is all down to the excellent staff in the CCG.

The CCG Governing Body noted the contents of the report. 2016/09/12 Assurance, Risk & Governance items 12.1 Complaints Policy for approval Joe Corrigan presented the report which updated the Governing Body that the CCG’s Complaints Policy has been reviewed and updated in line with its natural expiration date. To reflect guidance provided by NHS England, actions which are required in relation to complaints containing safeguarding concerns have been added to the policy. This references how the Complaints Policy links with safeguarding procedures, including situations where allegations are made against staff. A further change has been made to the policy with regard to the arrangements for face to face meetings with complainants. Following a recent incident, the CCG/NECS Security Advisor has recommended that meetings with complainants are offered by appointment only. A new section has also been included to reflect Informal Local Resolution (section 5)

The CCG Governing Body approved the policy. 12.2 Assurance Framework for approval Joe Corrigan presented the report which provided a report on the current status of the NHS Newcastle Gateshead CCG Risk Assurance Framework which has been informed by the CCG risk register. All the risks on the risk register have been reviewed.

The CCG Governing Body approved the framework. 2016/09/13 Committee Minutes/Reports to be received for information

13.1(a) Minutes of the CCG Executive Committee meeting held on 12 June, 12

July & 16 August 2019 The CCG Governing Body RECEIVED the minutes.

(b) Minutes from the Audit, Finance & Performance Committees held on

18 May 2016 The CCG Governing Body RECEIVED the minutes.

(c) Minutes from the Quality, Safety & Risk Committee held on 7 July

2016 (d) Minutes from the Primary Care Joint Committee held on 24 May 2016

The CCG Governing Body RECEIVED the minutes.

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(e) Agenda for the Gateshead Health & Wellbeing Board Meeting 10 June 2016

The CCG Governing Body RECEIVED the agenda. (f) Agenda for the Newcastle Wellbeing for Life Board Meeting 7 July

2016 The CCG Governing Body RECEIVED the agenda.

13.2 2015/16 CCG Annual Assessment

The CCG Governing Body RECEIVED the report. 2016/09/14 Date of Next Meeting The next meeting will be held on Tuesday 29 November 2016.

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Cover Sheet

Meeting Title Newcastle Gateshead CCG Governing Body Meeting

Date 29/11/2016

Agenda Item 8.1

Report Title CCG Patient & Public Involvement & Engagement (PPIE) Update

Synopsis This report summarises Involvement and Engagement update. The NHS Gateshead and Newcastle CCGs Involvement Strategy is included as appendix 1. For further details please contact the appropriate Lead: [email protected] [email protected] [email protected] [email protected]

Lead Director Chris Piercy, Executive Director of Nursing, Patient Safety and Quality Jane Mulholland, Director of Delivery and Transformation

Report Author

Norah Stevens, Lindsay Gibbins PPI and Community Development Leads Alison Thompson Patient Experience Lead Steven Bramwell Health Champion Lead

Classification Official

Purpose (click one box only)

Approval ☐ Decision ☐ To note ☐ Information ☒

mailto:[email protected]




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Benefits to patients & the public

The CCG approach to PPI is championed and led by the PPI Lay Representatives and Executive Practice Managers, supported by the Directors of Commissioning. Effective engagement and involvement of patients in commissioning decisions and actions is integral to the business of the CCG.

Links to Strategic objectives

Development and delivery of the CCG commissioning strategy Improving patient experience Enhancing quality and safety of services

Identified risks & risk management actions

N/A

Resource implications

Human resource in place.

Legal implications & equality and diversity assessment

N/A

Sustainability implications

N/A

NHS Constitution Reflects Principle 4 of the NHS Constitution – involving and consulting, reflecting needs and preferences.

Report history Last report 27th September 2016

Next steps None

Appendices None

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CCG Governing Body 29

th November 2016

Patient, Public Involvement and Engagement Update

1. Introduction This paper briefly summarises progress on Patient, Carer, Public Involvement and Engagement work across Newcastle Gateshead CCG and includes locality specific engagement and involvement.

The following sets out progress to date.

2. Patient/Volunteer Achievement - Vanguard Care Home The Care Home Programme’s self-care advocates were honoured at a celebration event for their work in helping to raise awareness of the different health services available to older people in Gateshead - spreading the message of self-care to over 300 older people. The programme was delivered in partnership with North of England Mental Health Development Unit.

Marilyn Young, 67, who volunteered for the programme, said: “Sometimes people don’t like to cause a fuss or feel they are being a burden on services if they’re feeling under the weather. On this programme I learned more about how to help myself and at the same time spread the message to friends and family of ways to keep well and what health services are available to them.

The most rewarding part is giving older people the confidence and knowledge of the different NHS services available so that they don’t hesitate to seek advice if they need it - and are more aware of their own health so that when they do seek medical opinion, they feel more in control to make informed decisions.”

A third cohort is planned to start in the New Year with a focus on including seldom heard groups such as isolated older men. A train the trainer element will be offered to current Self Care Advocates to ensure this programme is sustainable.

3. Involvement and Engagement

3.1 Have Your Say Event 21st November

The CCG Executive Director of Nursing, Patient Safety and Quality chaired an event with patients, public and voluntary sector representatives. The aim of the event was to explore how effective the current involvement and engagement structures are and discuss what the future of involvement and engagement should be across the CCG. A benchmarking survey carried out in November gathering views on the current engagement and involvement structure provided a baseline to begin discussions. The full report including outcomes from the event with be available on the following website; www.newcastlegatesheadccg.nhs.uk

http://www.newcastlegatesheadccg.nhs.uk/

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3.2 Stroke Patients and Carer Engagement Working with the Stroke Association patient and carer engagement has taken place to ensure the new stroke pathway is a positive experience for patients. A survey was circulated to 90 patients who had had a stroke within the last year and a response rate of over 55% was received. The survey identified key themes which were used with focus groups work,33 patients/carers participated. A summary of the patient engagement was shared at the November Stroke Project Board. A final report including all of the findings from the engagement will be produced and shared with the Stroke Project Group. A briefing is available on www.newcastlegatesheadccg.nhs.uk The final patient and carer engagement will be made available on the website.

3.3 Newcastle University Medical Student Workshops – Regional Refugee Forum

and HAREF working together A workshop aimed at giving medical students (as Doctors of the future) ‘food for thought’ in terms of understanding barriers to accessing healthcare services for asylum seekers and refugees was held on 26 October at Newcastle University Medical School. A representative from Newcastle Gateshead CCG, along with a representative of the Regional Refugee Forum who is an asylum seeker, spoke to a group of fourth year medical students about the impact of being a refugee or asylum seeker on an individual’s health, both mental and physical. The aim of the workshop was to highlight the challenges faced by asylum seekers and refugees when accessing healthcare services. The group discussed these challenges and explored options on what could be improved in terms of access to healthcare services for this social group

4. Mental Health and Learning Disabilities Talking Helps Newcastle – patient surveys The second tranche of patient surveys of people accessing psychological therapies are now complete. The survey asks patients if they would recommend the service to family or friends, as well as more in depth questions about their experience of using services. Since July, 65 patients have completed the PEQ questions. Key results are:

90% of patients said they would be either likely or extremely likely to recommend the service to friends or family.

100% of patients felt staff listened and treated their concerns seriously.

92% of patients felt the service helped them to better understand and address their difficulties.

98% of patients felt involved in making choices and decisions about their treatment and care.

95% felt they got the help that mattered to them.

100% of patients had confidence in their therapist and their skills and techniques.

http://www.newcastlegatesheadccg.nhs.uk/

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98% of patients agreed that appointment arrangements were made in a way that was convenient to them.

Results to note from the in-depth questions include:

The majority (67%) are referred to the service by their GP with 25% self-referring into the service.

85% of patients waited less than one month to receive an initial assessment

Positive comments were made about the staff in terms of knowledge, helpfulness and skills.

The assessment process was highly praised.

All patients ranked the quality of the service highly.

Areas for improvement were noted as:

Waiting time between assessment and treatment.

Some patients would have liked the number of sessions to be tailored to individual needs, rather than a standard number for everyone.

The next tranche of surveys will run from 1 January to 31 March 2017

End of Life Strategy and Action Plan (Newcastle) The Steering Group for this work is due to meet in November to discuss progress. Involve North East and other involvement partners HAREF, Deaflink, Skills for People and Newcastle Blind Society are undertaking engagement with seldom heard groups on their experiences, views and priorities on end of life care. As part of this engagement, we are also talking to patients on the palliative care register as well as patients who identify as homeless. Early results from the work have indicated that although a sensitive area of discussion, those invited to take part have been keen to participate, with the discussions leading to two community groups in Newcastle inviting our clinical lead, Dr. Pam Coipel to discuss wider issues on end of life care with them. Feedback comments have also indicated that taking part in the engagement work has prompted participants to raise the topic of end of life care with their families. The results from the engagement work will be collated into a report by Involve North East which will form a key part of the CCGs End of Life Strategy. Results of the work will be report in a future Governing Body report.

5. Children and Young People

5.1 The “Little Orange Book” will be distributed to health visitors, school nurses,

practices, pharmacies, and A&E/WIC as well as community settings over the forthcoming weeks. The Little Orange Book is focused on acute illness and helps parents and carers to recognise and then respond appropriately to a range of diseases, illness and conditions as well as signposting parents to the most appropriate service or clinician should they need further support. In the development of the booklet we have engaged with a wide range of stakeholders and already received positive feedback

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Labriut Healthy Living Centre in Gateshead, commented “Having glanced over the draft, it looks like a very useful and beautifully produced tool for parents”. A practice in Newcastle commented - 'The little orange book' is clear, in understandable Language / format for parents and centered on subjects needed by parents- excellent” Our primary care Child Health Leads will meet again in late November early December for professional development around the sick and injured child and the role of primary care.

6. Long Term Conditions including Cancer and EOL

6.1 We are continuing to roll out the Year of Care work in Newcastle. To date, 14 out of

the 33 practices have attended Year of Care training and are now implementing this work. A further five practices are booked on forthcoming training and five more have expressed an interest in attending future training cohorts. The CCG are also planning to deliver training to all staff groups at future Time Out events.

Care and support planning (CSP) recognises that people who live with long term

conditions (LTCs) make the majority of the decisions that affect their lives, spending relatively little time with a health or/and social care practitioner. CSP seeks to transform the brief contact that does occur into a meaningful and useful discussion, enabled by “preparation” and with a focus on looking forward and planning. Over the course of an individual’s lifetime the nature of these conversations may well change as their health profile and their needs change.

The aim is for CSP to become the usual approach to normal care, being understood

as a continuous process, not a one off event, supporting continuity and planning to meet the changing needs of people.

6.2 The results of previous consultations, focus group work, one to one conversations

with patients written up as patient stories and online survey have been distilled into key themes to inform the Long term Conditions Strategy.

6.3 The Gateshead LTC Patient reference Group continues to meet monthly. Recently

the group have considered the Plan on a page for long term conditions and are working with Mark Shilcock Support, Development and Networking Officer to review Our Gateshead Website.

7. Social Prescribing

Development in Newcastle A business case is being explored to look at developing Primary Care Navigator posts in Newcastle upon Tyne. This work will be supported by the Federation.

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Development in Gateshead All practices in Gateshead now have social prescribing codes to use developed via CBC; this will be used for a few months and data extracted in January for analysis. This data will be helpful and may identify some gaps and opportunities that social prescribing can develop in the future.

7.1 Admin & Reception Roles development Funding is available for admin/reception role training as “signposters”. No plans are yet developed but will develop over the remainder of the financial year and over the next 4yrs. Part of this training is also for clinical coding training.

7.2 Public and Patient Involvement Some promotional work needs to take place to inform the public. Gateshead Healthwatch hosted a listening event (31st October) in which this process will start by speaking to the public about social prescribing, however, further events like this are needed. Some work with the communications team in order to promote “social prescribing” within general practice is also needed and this is being explored.

8 Voluntary and Third Sector Services (Gateshead and Newcastle) 8.1 Voluntary and Third Sector Services (Newcastle)

8.2 Community Forum

The Forum met on 16 November. The focus of the meeting was on asylum seekers’ access to health and other important services. The CCG also gave an update on the Sustainability and Transformation Plan.

8.3 Involvement Forum Dates for the next meeting of the Involvement Forum are to be considered following the conclusion of a review of involvement structures and processes.

9 Patient, Community and Public Communication and Engagement – Newcastle

and Gateshead

9. 1 ACORN patient participation group (Newcastle North and East)

The group now meet on a monthly basis and held their most recent meeting on 13 October. Topics for discussion included updates from individual PPGs and how the group can have more effective communication and engagement with these groups.

The group will meet again on 24 November when a session on the STP is planned 9.2 Newcastle West Patient Forum

The group met on 3 November; Jane Mulholland and Hilary Bellwood provided an update on the STP and asked for feedback from the group, on elements of delivery on the following three areas of focus; prevention, in-hospital collaboration and out of hospital care.

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9.3 Patient User Carer Public Involvement (PUCPI) Group - Gateshead The PUCPI meeting took place on 7 November. The Alzheimer’s Society gave a presentation to the group on their work. Healthwatch Gateshead gave an update which including feedback from an event in held in October and an update on the ‘Mystery Shopper’ exercise they carried out to explore the experience of registering as a new patient at a Gateshead GP practice. Reports will be available on the Healthwatch Gateshead website.

9.4 ‘Together for Health’ Gateshead Local Engagement Board (LEB)

The LEB took place on the 27 October. A CCG update was delivered which included information on long term conditions, urgent care and promoting the flu vaccine. The Five Year Forward View and the STP plan were discussed. An interactive quiz took place with participations exploring the cost of NHS services and discussions focused on how patients and the public could help meet future NHS challenges.

Cover Sheet


Date 29/11/2016

Agenda Item 9.1

Report Title Newcastle Gateshead CCG Integrated Delivery Report

Synopsis The Integrated Delivery Report presented to the Governing Body, brings together high level themes from all aspects of quality and patient safety whilst linking with performance and finance, so that none of the components are seen in isolation. Each report provides context as to the reasons for pressures and actions being taken to mitigate their impact in relation to key quality, performance, contract and finance issues.

Implications and Risks

The report provides context as to the reasons for pressures and actions being taken to mitigate their impact in relation to key quality, performance, contract and finance issues.

Recommendation The Governing Body is asked to note the content of this report.

Lead Director & Report Author

Director: Joe Corrigan Title : Chief Finance Officer and Operating Officer

Author: Jill McGrath, Colin Smith, Claire Dovell, Neil McKnight Title: Provider Management Team


Purpose (click one box only) Decision ☐ Information ☒

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The Integrated Delivery report provides an update and assurance in relation to a range of contractual related issues and specifically provides an update on key quality issues as they impact on patient care.


To embrace the principles of cost effectiveness and improving value for money, in order to ensure we deliver and overall balanced budget.

To improve the quality of services we offer our patients.


This paper provides an update on risks relating to quality, performance and finance and identifies mitigating actions where applicable.


Not applicable. This report provides a general update on key quality, performance and finance issues.


To comply with the legal requirements of the Health and Social Care Act 2012. There are no implications for the nine protected characteristics.


Not applicable

NHS Constitution Principle 6: The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.

Report history The Integrated Delivery Report has been considered at the CCG Executive Committee meeting held on 15th November 2016.

Next steps Actions being undertaken are as outlined in the individual CCG reports attached as appendices to this report and progress updates will be provided at the next meeting of the Governing Body.

Appendices

1

Newcastle Gateshead CCG Executive Integrated Delivery Report

15th

November 2016

2

Executive Summary Quality Performance Contracting Contracting Finance

Supported by North of England Commissioning Support Unit

The data in this report relates to the reporting period August 2016 except where stated. KPIs of note are: 1. Quality and Safety page 3

2. Key performance indicators page 16

57 Green (within target) 25 Red (beyond target) 5 indicators have no in year data/target so not rag rated

Quality Premium page 25 Better Care Fund – page 28 Improvement and Assessment Framework – Page 20 3. Contract Activity page 33 4. Finance page 40

NHS Constitution - Cat A Red 1 Ambulance Response times – page 28

Increase GP referrals made by e-referral – Page 27

% patients reporting good experience when making a GP appt – Page 28

RTT – Orthopaedics – page 26

Diagnostics NUTH – page 26

Q1 return has been submitted indicating good progress across all metrics

Further Never Event reported at NuTH – now 5 reported at NuTH and 5 at GHFT since April – page 7

PUPoC target of zero outstanding cases by September not achieved. Agreement reached with NHSE for remaining cases to be cleared by Feb 2017. Still identified as a high risk to CCG – page 15

NuTH identified as an outlier for Venous Thromboembolism (VTE) in the Safety Thermometer – page 15

Month 6 reports a surplus of £8,779k or 1.3% of budget.

Pressures continue in CHC at month 6.

NEAS Response times – page 28

% GP referrals made by E-referral – Page 27

% patients reporting good experience when making a GP

appt – Page 28

Newcastle Gateshead CCG – 15 November 2016

Executive Summary

6 Clinical Priority Areas: Cancer, Mental Health, Diabetes, LD, Dementia, Maternity to be assessed with an Ofsted style rating – page 20

Baseline assessment across 60 indicators to be published at CCG, national and STP level – page 22

GHNHSFT – Other services are over performing by £1,111k at month 5 with QIPP contributing most significantly to this pressure - page 34

NuTHFT – Activity and financial variances continue to be affected by coding issues at the provider. An action plan has now been developed which is being monitored by commissioner - page 35

3


Quality and Safety

4


This report links quality and patient safety alongside finance and performance so that neither component is seen purely in isolation. The quality elements of this report provide a more detailed analysis of quality issues and are in addition to the Alliance Joint Quality, Safety and Risk Committee and the Area Teams Quality Surveillance group. The data used in this section has been sourced from published data sources.

Between 01/09/2015 and 30/09/2016 there have been 160 recorded SIs involving Newcastle Gateshead CCG registered patients for the providers detailed above.

1. Quality and Safety

1.1 Quality and Safety – Serious Incidents by Provider and Category

All serious incidents are formally reviewed and closed by Newcastle Gateshead CCG or other relevant SI Panels. The trends of incidents are also monitored.

5


1.1 Quality and Safety – Serious Incidents by Provider and Category continued

6




7


Reference Reported Date Incident Date Type of SI Organisation Status

2016/8901 01/04/2016 29/03/2016 Surgical/invasive Procedure - wrong site nerve block

GHFT Closed Further Information Requested

2016/12924 12/05/2016 14/11/2015 Surgical/invasive Procedure – wrong side nerve block


2016/13079 13/05/2016 29/04/2016 Surgical/invasive Procedure – wrong site surgery


2016/18395 08/07/2016 07/07/2016 Surgical/invasive Procedure – wrong site surgery

GHFT Listed for Panel

2016/23620 06/09/2016 30/08/2016 Surgical/invasive Procedure – retained foreign object

GHFT Awaiting 60 Day report

2016/4211 12/02/2016 22/01/2016 Surgical/invasive Procedure - wrong site surgery

NuTHFT Completed

2016/5413 25/02/2016 23/02/2016 Surgical/invasive Procedure - wrong site surgery

NuTHFT Closed Further Information Requested

2016/12662 10/05/2016 06/05/2016 Surgical/invasive Procedure – retained swab NuTHFT Closed Further Information Requested

2016/17701 01/07/2016 30/06/2016 Never Event - Medication Incident NuTHFT Overdue

1.2 Quality and Safety – Never Events

8


The HCAI Reduction Partnership continues to closely monitor trends and to develop action plans in conjunction with commissioner and provider organisations.

Newcastle Gateshead CCG is above trajectory September ytd, reporting 76 cases against a trajectory of 72.

51 are community cases.

Trends and themes continue to be monitored by HCAI Partnership – includes RCAs around incidence of community cases.

0

20

40

60

80

100

120

140

160

Newcastle Gateshead CCG: C Difficile 2016/17

Actual Trajectory

0

10

20

30

40

50

60

Community Acquired C Difficile 2016/17

1.3 Quality and Safety – Health Care Acquired Infection (HCAI)

9


Acute Hospitals CDi

Newcastle upon Tyne Hospitals FT are reporting under trajectory September ytd with 39 cases.

Gateshead Health FT are reporting below trajectory with 10 cases September ytd. MRSA August ytd

Newcastle upon Tyne Hospitals FT are reporting 2 cases of MRSA.

1.3 Quality and Safety – Health Care Acquired Infection (HCAI) continued

0

20

40

60

80

100

Newcastle upon Tyne Hospitals FT: C Difficile 2016/17

Actual Trajectory

0

5

10

15

20

Gateshead Health FT:C Difficile 2016/17

Actual Trajectory

10


The following complaints and concerns have been handled by the NECS Complaints Team on behalf of the CCG in the twelve months up to 30 September 2016. All cases, by grade All cases, by lead organisation

CCG cases, by category

0

5

10

15

20

25

Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16

Formal Complaint Concern/advice/other

0

5

10

15

20

25


NHFT STFT NEASFTCHSFT NTWFT NHSE/Primary CareGHFT NGCCG NECSOOH Provider Non-NHS NUTHFT

0

2

4

6

8

10

12

14


Commissioning Decision, OtherIFRProcurement processCommissioning of Patient Transport

1.4 Quality and Safety – Complaints

11


NuTH and GHFT are within expected ranges for both Hospital Standardised Mortality Ratio (HSMR) and Standardised Hospital

Mortality Index (SHMI).

There are no risks currently identified as Red in Gateshead or Newcastle.

All other risks will continue to be monitored and managed by the Newcastle Gateshead working group.

1.5 Quality and Safety – Mortality Rates

1.6 Quality and Safety – Transforming Care - Learning Disabilities

12


Newcastle Gateshead CCG practices reported 209 incidents in September 2016. The graphs below detail the type of incidents reported in September 2016 and the reporting rates from September 2015 to September 2016.

Themes and trends continue to be raised directly with the Trust and at Quality Review Group meetings.

1.7 Quality and Safety – Primary Care

13


The Friends and Family Test now features within all provider contracts.

The following actions have been taken:

Friends and Family Test response rates and scores continued to be monitored via respective contract monitoring meetings and Quality Review Groups.

Both Trusts remain above national average of 95% for Inpatient recommendation.

Both Trusts are above or in line with the national average of 87% for A&E recommendation

NuTH A&E response rate remains very low (3.2%) in August (national average = 13.7%)

80.0%

85.0%

90.0%

95.0%

100.0%

Ap

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May

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Gateshead Health: Friends and Family Test

Accident and Emergency Inpatient

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Ap

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14

May

-14

Jun

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July

-15

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May

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Jun

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Newcastle Hospitals: Friends and Family Test

Accident and Emergency Inpatient

1.8 Quality and Safety – Friends and Family Test

14


Gateshead Health NHS Foundation Trust investigated by NHS Improvement for continuity of services risk (level 2) due to concerns

relating to financial stability (level 1 highest risk, level 4 lowest risk).

Risk to be monitored through QRG and contracting routes.

Newcastle upon Tyne NHS Foundation Trust rated as “Outstanding”.

Gateshead Hospitals rated as “Good”

Northumberland and Tyne & Wear NHS Foundation Trust rated as “Outstanding”

South Tyneside rated as “Needs Improvement”. Newcastle Gateshead GP practices: 4 rated as “Outstanding”, 44 rated as “Good”, 5 rated as “Needs Improvement”. 10 are awaiting

inspection or awaiting publication of inspection report. The practices listed as currently requiring improvement are awaiting re-inspection or report publication. A number of practices were previously listed as requiring improvement, but are now listed as good. The CCG is working with and supports those practices requiring improvement. The report is regularly updated to reflect the changing status of their CQC inspections.

NHS Benchmarking Network latest data collection (August 2015) has highlighted that NTWFT is 3rd highest overall user of restraint

with an average of 7.6 instances per 10 beds compared with the national average of 2.8.

The highest reported incidences of restraint within the Trust are primarily from within Learning Disability and Child Adolescent Mental Health Services.

The Trust’s restraint training package has been revamped and is in the process of re-training trainers on the new programme. The Trust has set a target for all staff to be trained within 18 months.

The Trust is to develop an automated process which will capture trends any trends in the data so that it can show how and when to intervene at the primary stage before secondary stage restraint is required.

A “Talk first programme” was launched in September and within six months all teams will be on their restraint reduction journey. The Trust wants to positively and safely reduce restraint incidents and will be looking at a whole range of indicators including medication.

1.9 Quality and Safety – Monitor Rating

1.10 Latest CQC Inspections

1.11 Quality and Safety – NTW FT Restraint Information

15


The goal of zero cases outstanding by September 2015 has not been achieved. NHS England has agreed a new deadline of February

2017 with the CCG for resolution of all outstanding cases. The CCG however aims to clear the outstanding cases by the end of December.

NECS NGCCG CASES W/E 7th October

W/E 14th Oct

W/E 21st Oct

W/E 28th Oct

W/E 4th Nov

W/E 11th Nov

W/E 18th Nov

W/E 25th Nov

W/E 2nd Dec

W/E 9th Dec

W/E 16th Dec

W/E 23rd Dec

TOTAL FORECAST NGCCG CASES REMAINING @ Week Start 169 150 138 126 112 98 84 70 56 42 28 14

Current Number Remaining @ Week End 150 144 134 0

CHC and PUPoC cases in particular, represents a serious risk to the CCG – and remains a RED risk on the CCG Risk Register

Gateshead Health NHS Foundation Trust is flagged as a PROMS outlier both in knee replacement oxford score and groin hernia

adjusted average health gain. The Trust shared an assurance report with the QRG which outlined the work they are doing in respect to knee replacement services. With regard to Groin hernia an internal meeting with NEQOS is taking place to gain a better understanding on why the Trust is an outlier. A further update will be provided at the next QRG.

The Quality Strategy and Patient & Public Involvement Strategy have been approved by CCG Executive.

The Safety Thermometer looks at four types of harm that patients may suffer: pressure ulcers, falls, venous thromboembolism (VTE) and urinary tract infections (UTI’s) for those patients who have a urinary catheter in situ. This audit takes place one day each month to determine how many patients suffered harm whilst in the Trust’s care.

NuTH is currently identified as an outlier for VTE in the latest NHSE quality dashboard. This will be raised with the Trust at QRG

1.12 Continuing Healthcare (CHC)

1.13 Patient Reported Outcome Measures (PROMS)

1.14 Quality Team Deliverables and Achievements

1.15 Safety Thermometer

16


Performance

17


This table details performance against key performance measures for Newcastle Gateshead CCG.

Newcastle Gateshead CCG - Performance Indicators Source Latest Data

Period

Month

Actual

Actual

to Date

Target

to Date

2016/17

Target

Risk to

Year

End

Trend

RTT incomplete pathways within 18 weeks - NGCCGC; QP;

IAF Aug-16 94.0% 94.0% 92.0% 92.0%

RTT incomplete pathways within 18 weeks - GHFT C Aug-16 93.4% 93.4% 92.0% 92.0%

RTT incomplete pathways within 18 weeks - NUTH C Aug-16 94.7% 94.7% 92.0% 92.0%

RTT 52 weeks for treatment - NGCCG C Aug-16 0 0 0 0

>52 weeks for treatment - GHFT C Aug-16 0 0 0 0

>52 weeks for treatment - NUTH C Aug-16 0 0 0 0

< 6 weeks for the 15 diagnostics tests - NGCCG C Aug-16 1.5% 1.5% 1.0% 1.0%

< 6 weeks for the 15 diagnostics tests - GHFT C Aug-16 2.2% 2.2% 1.0% 1.0%

< 6 weeks for the 15 diagnostics tests - NUTH C Aug-16 1.8% 1.8% 1.0% 1.0%

4 hrs or less in A&E or minor injury unit - NGCCGC; QP;

IAF Aug-1696.8% 96.5% 95.0% 95.0%

4 hrs or less in A&E or minor injury unit - GHFT C Aug-16 97.2% 97.2% 95.0% 95.0%

4 hrs or less in A&E or minor injury unit - NUTH C Aug-16 96.6% 95.9% 95.0% 95.0%

Over 12 hour trolley waits - GH C Aug-16 0 0 0 0

Over 12 hour trolley waits - NUTH C Aug-16 0 0 0 0

2 week wait suspected cancer - NGCCG C; QP Aug-16 96.2% 95.7% 93.0% 93.0%

2 weeks wait suspected cancer - GHFT C Aug-16 97.5% 97.0% 93.0% 93.0%

2 week wait suspected cancer - NUTH C Aug-16 96.5% 96.0% 93.0% 93.0%

2 week wait breast symptoms - NGCCG C Aug-16 97.6% 95.6% 93.0% 93.0%

2 week wait breast symptoms - GHFT C Aug-16 100.0% 96.0% 93.0% 93.0%

2 weeks wait breast symptoms - NUTH C Aug-16 96.4% 96.1% 93.0% 93.0%

62 days suspected cancer - NGCCGC; IAF:

Ca Aug-16 89.0% 87.5% 85.0% 85.0%

62 days suspected cancer - GHFT C Aug-16 91.6% 87.7% 85.0% 85.0%

62 days suspected cancer - NUTH C Aug-16 88.4% 86.8% 85.0% 85.0%

62 days NHS Cancer Screening Service - NGCCG C Aug-16 91.7% 94.1% 90.0% 90.0%

62 days NHS Cancer Screening Service - GHFT C Aug-16 96.7% 94.6% 90.0% 90.0%

62 days NHS Cancer Screening Service - NUTH C Aug-16 96.0% 95.5% 90.0% 90.0%

31 days - NGCCG C Aug-16 98.6% 99.0% 96.0% 96.0%

31 days - GHFT C Aug-16 99.2% 99.7% 96.0% 96.0%

31 days - NUTH C Aug-16 98.2% 98.1% 96.0% 96.0%

Subsequent treatment 31 days - surgery - NGCCG C Aug-16 97.6% 97.2% 94.0% 94.0%

Subsequent treatment 31 days - surgery - GHFT C Aug-16 100.0% 100.0% 94.0% 94.0%

Subsequent treatment 31 days - surgery - NUTH C Aug-16 97.5% 95.8% 94.0% 94.0%

Subsequent treatment 31 days - drugs - NGCCG C Aug-16 100.0% 99.7% 98.0% 98.0%

Subsequent treatment 31 days - drugs - GHFT C Aug-16 100.0% 100.0% 98.0% 98.0%

Subsequent treatment 31 days - drugs - NUTH C Aug-16 100.0% 99.7% 98.0% 98.0%

Subsequent treatment for cancer within 31 days - radiotherapy - NGCCG C Aug-16 98.6% 99.2% 94.0% 94.0%

Subsequent treatment for cancer within 31 days - radiotherapy -GHFT C Aug-16 n/a n/a 94.0% 94.0%

Subsequent treatment for cancer within 31 days - radiotherapy - NUTH C Aug-16 98.4% 98.9% 94.0% 94.0%

Category A (Red 1) 8 minute - NEASC;

IAF;QP Sep-16 63.3% 66.4% 75.0% 75.0%

Category A (Red 1) 8 minute - NGCCG C Sep-16 71.2% 75.4% 75.0% 75.0%

Category A (Red 2) 8 minute -NGCCG C Sep-16 73.4% 75.2% 75.0% 75.0%

Category A 19 minutes - NGCCG C Sep-16 96.1% 96.1% 95.0% 95.0%

Ambulance handover >=30 mins - GHFT C Sep-16 11 197 0 0

Ambulance handover >=30 mins - NUTH C Sep-16 7 50 0 0

Ambulance handover >=60 mins - GHFT C Sep-16 0 1 0 0

Ambulance handover >=60 mins -NUTH C Sep-16 0 2 0 0

Mixed Sex accommodation - NGCCG C Sep-16 0 0 0 0

Mixed Sex accommodation -GHFT C Sep-16 0 0 0 0

Mixed Sex accommodation - NUTH C Sep-16 0 0 0 0

Cancelled operations rescheduled within 28 days - GHFT C Q1 2016/17 96.7% 96.7% 100% 100%

Cancelled operations rescheduled within 28 days - NUTH C Q1 2016/17 99.0% 99.0% 100% 100%

PYLL Preventable Years of Life Lost (PYLL) OA1

Ref:

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18


Newcastle Gateshead CCG - Performance Indicators SourceLatest Data

Period

Month

Actual

Actual

to Date

Target

to Date

2016/17

Target

Risk to

Year

End

Trend

% follow up within 7 days of discharge from psychiatric in patient care C Q1 2016/17 96.7% 96.7% 95.0% 95.0%

% people who access psychological therapies (IAPT) OA2 Jul-16 1.43% 5.80% 5.00% 15.0%

People accessing IAPT moving to recovery OA2;Jul-16 46.73% 47.28% 50.0% 50.0%

IAPT =>6 weeks treatment - NGCCG C Jul-16 93.9% 93.9% 75.0% 75.0%

IAPT =>18 weeks IAPT - NGCCG C Jul-16 98.2% 98.2% 95.0% 95.0%

% first episode of psychosis within two weeks of referral - NGCCG C Aug-16 75.0% 75.0% 50.0% 50.0%

Patient experience of hospital care GHFT OA5 2014/15 8.4 8.4 10.0 10.0

Patient experience of hospital care NuTHFT OA5 2014/15 8.5 8.5 10.0 10.0

Patient experience of GP OOHs services OA6 July 2016

publication 66.9% 66.9%

Satisfaction with the quality of consultation at the GP practice July 2016

publication 449.97 449.97

Satisfaction with the overall care received at the surgery July 2016


Overall experience of making a GP appointment IAF; QP July 2016


Average score (in the GP patient Survey) for people with Long Term Condition OA2; IAF 2014/15 40.0% 40.0%

MRSA NGCCG OA7 Aug-16 0 0 0 0

MRSA GHFT OA7 Aug-16 0 0 0 0

MRSA NUTH OA7 Aug-16 0 2 0 0

Cdiff NGCCG OA7 Sep-16 12 76 72 142

Cdiff GHFT OA7 Sep-16 2 10 12 19

Cdiff NUTH OA7 Sep-16 10 39 41 77

% of people aged 60-69 who were screened for bowel cancer in the previous 30

monthsQP

66.4% 66.4%

% of asthma patients who have had a review in the preceding 12 months (% of

patients receiving the intervention)QP

73.2% 73.2%

The percentage of patients with COPD who have had a review, undertaken by a

healthcare professional, including an assessment of breathlessness using the Medical

Research Council dyspnoea scale in the preceding 12 months (% patients receiving

the intervention)

QP

82.1% 82.1%

Better care Fund - Gateshead

Total non-elective admissions (general & acute), all-age BCF Q1 2016/17 8,096 8,096 5,907

Long-term support needs of older people (aged 65 and over) met by admission to

residential and nursing care homes, per 100,000 populationBCF

Q1 2016/17 150 150 251 1005

Proportion of older people (65 and over) who were still at home 91 days after

discharge from hospital into reablement / rehabilitation servicesBCF

Q1 2016/17 74.2% 74.2% 84.5% 88.7%

Delayed Transfers of Care (delayed days) from hospital per 100,000 population (aged

18+).BCF

Q1 2016/17 880 880 964 3,330

Estimated diagnosis rate for people with dementia BCF Q1 2016/17 70.4% 70.4% 70.0 70.0

Patient/Service User Experience metric

Improve the percentage of patients who responded “ Yes Definitely” to the following

question from the GP patient survey:

“For respondents with a long-standing health condition: In the last 6 months, have you

had enough support from local services or organisations to help you to manage your

long-term health condition(s)? Please think about all services and organisations, not

just health”

BCF

Q1 2016/17 47.9 47.9

Better care Fund - Newcastle

Total non-elective admissions (general & acute), all-age BCF Q1 2016/17 6,844 6,844 8,946

Long-term support needs of older people (aged 65 and over) met by admission to

residential and nursing care homes, per 100,000 populationBCF

Q1 2016/17 152 152 774 720

Proportion of older people (65 and over) who were still at home 91 days after

discharge from hospital into reablement / rehabilitation servicesBCF

Q1 2016/17 83.0% 83.0% 83.0% 84.7%

Delayed Transfers of Care (delayed days) from hospital per 100,000 population (aged

18+).BCF

Q1 2016/17 531 531 508 2,089

Emergency admission rate for injury due to falls (over 65s) - Age Standardised rate

per 100,000 (PHOF indicator 2.4iBCF

Q1 2016/17 2,194.3 2,194.3

ASCOF1B: The proportion of people who use services who have control over their

daily life BCFQ1 2016/17 80 80 79.0 79.0

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Ref:

Be

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C - NHS Constitution Indicator OA – Outcome Ambition Indicator QP - Quality Premium Indicator BCF – Better Care Fund Indicator

19


CCG Improvement and Assessment Framework (IAF) NHS England has introduced a new Improvement and Assessment Framework for CCGs (CCG IAF) from 2016/17 onwards. The Five Year Forward View, and the Sustainability and Transformation Plans (STPs) for each area, have the “triple aim”: (i) improving the health and wellbeing of the whole population; (ii) better quality for all patients; and (iii) better value in a financially sustainable system. The new framework aligns key objectives and priorities and has been designed to supply indicators for adoption in STPs as markers of success. The Framework covers indicators in 4 domains: Better Health, Better Care, Sustainability and Leadership. A baseline assessment has been produced and performance has been detailed below for indicators where this is available. Indicators have been risk assessed as red where Newcastle Gateshead CCG falls into the lowest performing quartile of CCGs for a particular indicator, amber if in line with the national average and green if above the national average and target. This table details performance (where available) against the Improvement and Assessment Framework indicators for Newcastle Gateshead CCG. Newcastle Gateshead CCG falls within the lowest performing quartile nationally for the following areas which will form the focus for improvement for the CCG.

injuries from falls

% children aged 10-11 classified as overweight or obese

inequality in avoidable emergency admissions

inequality for emergency admissions for urgent care sensitive conditions,

one year survival from all cancers

People with a learning disability and/or autism receiving specialist inpatient care

Emergency admissions for urgent care sensitive conditions per 100,000 population

Emergency bed days per 1,000 population

Emergency admissions for chronic ambulatory care sensitive conditions.

20


Newcastle Gateshead CCG - Improvement and Assessment Framework

Indicators Source

Latest Data

Period

Month

Actual

Target

to Date

2016/17

TargetEngland

Risk to

Year

End

Trend

Smoking Maternal smoking at delivery IAF Q1 16/17 14.7% 10.2%

Child obesity Percentage of children aged 10-11 classified as overweight or obese IAF 2014-15 36.2% 33.2%Diabetes patients that have achieved all the NICE-recommended treatment targets:

Three (HbA1c, cholesterol and blood pressure) for adults and one (HbA1c) for

children IAF 2014/15 39.6% 39.8%

People with diabetes diagnosed less than a year who attend a structured education

course IAF 2014/15 9.2% 5.7%

Fa

lls

Injuries from falls in people aged 65 and over IAF Mar-16 2,442 2,014

Utilisation of the NHS e-referral service to enable choice at first routine elective referral IAF; QP Jul-16 58.6% 80.0% 80.0% 52.0%

Personal health budgets IAF Q1 16/17 4.8 11

Percentage of deaths which take place in hospital IAF Q4 15/16 47.7% 47.0%

People with a long-term condition feeling supported to manage their condition(s) IAF 2016 70.6% 64.3%

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions IAF Q4 15/16 1,070 929

Inequality in emergency admissions for urgent care sensitive conditions IAF Q4 15/16 2,748 2,168

Appropriate prescribing of antibiotics in primary care IAF:QP Aug-16 1.2 1.17 1.10

Appropriate prescribing of broad spectrum antibiotics in primary care IAF:QP Aug-16 7.3% 10.0% 9.3%

Ca

rers

Quality of life of carers IAF 2016 76.8% 80.0%

Ca

re

ratin

gs

Provision of high quality providers IAF

To be

determined

Cancers diagnosed at early stage IAF:QP 2014 51.4% 50.7%

One-year survival from all cancers IAF 2013 68.4 89.0%

Cancer patient experience IAF 2015 8.9

People with first episode of psychosis starting treatment with a NICE-recommended

package of care treated within 2 weeks of referral IAF Jul-16 91.1% 72.0%

Children and young people’s mental health services transformation IAF

Crisis care and liaison mental health services transformation IAF

Out of area placements for acute mental health inpatient care - transformation IAF

People with a learning disability and/or autism receiving specialist inpatient care per

million population IAF Q1 16/17 87

Proportion of people with a learning disability on the GP register receiving an annual

health check IAF 2014-15 46.0% 47.0% 47.0%

Neonatal mortality and stillbirths IAF 2014-15 5.9 7.10

Women’s experience of maternity services IAF 2015 82.5

Choices in maternity services IAF 2015 67.4%

Diagnosis rate for people with dementia OA2;OF;

BCF; IAF Aug-16 75.8% 67.0% 67.0% 67.3%

Dementia care planning and post-diagnostic support IAF 2014/15 80.7% 70.0% 70.0% 77.0%

Achievement of milestones in the delivery of an integrated urgent care service IAF August 2016 3

Emergency admissions for urgent care sensitive conditions per 100,000 population IAF Q4 15/16 3,092 2,359

Delayed transfers of care attributable to the NHS per 100,000 population IAF Aug-16 7.6 14.1

Population use of hospital beds following emergency admission IAF Q4 15/16 1.3 1.0

Emergency admissions for chronic ambulatory care sensitive conditions per 100,000 pop IAF Q4 15/16 3,092 2,359

Primary Care Access IAF H1 2016 88.1% 85.2%

Primary Care Workforce IAF H1 2016 1.0 1.0

7 day services Achievement of clinical standards in the delivery of 7 day services IAF 6 monthly

CHC People eligible for standard NHS Continuing Healthcare IAF Q1 16/17 83.3 46.0

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21


6 Clinical Priorities

The Forward View and the planning guidance set out national ambitions for transformation in a number of vital clinical priorities such as mental health, dementia, learning disabilities, cancer, maternity and diabetes. A baseline assessment of the 6 clinical priority areas has been published for each CCG in September 2016. Each clinical priority is rated “top performing”, “performing well”, “needs improvement”, “greatest need for improvement”. The end of year assessments in the clinical priority areas will be overseen by independent groups, whereas the baseline assessment is an initial assessment based on the indicators only, which can be used as a useful starting point for assurance purposes. A summary of the baseline assessment for the 6 clinical priorities is given below which will allow the CCG to focus and provide vision for local actions and planning. An action plan has been developed for all areas detailing, where appropriate, more up to date actions and data. Using the same methodaology as in the baseline assessment, the clinical priorities for Mental Health and Learning Disabilities would have moved up to “Performing well” given the improvements in LD Annual Health checks and Early intervention in Psychosis.

Newcastle Gateshead CCG - Improvement and Assessment Framework

Indicators Source

Latest Data

Period

Month

Actual

Target

to Date

2016/17

TargetEngland

Risk to

Year

End

Trend

Financial plan IAF 2016 Green Green

In-year financial performance IAF Q1 16/17 Green Green

Outcomes in areas with identified scope for improvement IAF

Expenditure in areas with identified scope for improvement IAF

New models of

care Adoption of new models of care IAF

Local digital roadmap in place IAF

Digital interactions between primary and secondary care IAF Quarterly 68.9%

Estates

strategy Local strategic estates plan (SEP) in place IAF 2016-17

Sustainability

and

Transformation Sustainability and Transformation Plan IAF

Probity and

corporate

governance Probity and corporate governance IAF

Staff engagement index IAF 2015 3.87 3.8

Progress against workforce race equality standard IAF 2015 0 0.24

CCGs’ local

relationships Effectiveness of working relationships in the local system IAF 2015/16 67.6%

Quality of

leadership Quality of CCG leadership IAF Jun-16

Sustainability

Financial

sustainability

Allocative

efficiency

Paper-free at

the point of

care

Ref:

Yes

Leadership

Workforce

engagement

22


Newcastle Gateshead CCG - Baseline assessment of 6 clinical priority areas

Clinical Priority Area Overall rating

Cancer early diagnosis Cancer Patient Experience 62 day cancer 1 year survival

2014 CCG: 51.4%

National 50.7%

2015 CCG 8.9

National N/A

Q1 16/17 CCG: 85.8%

National 82.2%

2013 CCG: 68.4%

National: 70.2%

Comparison to national average using 95%

CI Amber if <1% above target

75% ambition by 2020, comparison

to linear trajectory to this

% Diabetes patients received all the

NICE recommended treatment targets

Attended a structured education

course

3 bandings:

Green: >=40.2

Amber 37.8-40.2%

Red<37.8%

CCG: 39.6%

National 39.8%

3 bandings - comparison to national

average

9.2% CCG

National 5.7%

Score out of 100 for womens experience

of maternity services

Score out of 100 for womans choice

of maternity services Rate of still births

Maternal smoking at time of

delivery

2015 82.5 CCG

National N/A

CCG: 67.4

National N/A

2014/15 CCG 5.9

National 7.1

Q1 16/17 14.7% CCG

National 10.2%

Q1 16/17 CCG/TCP 87

National NA

Comparison to national average and put into bandings 1-3

National target 50%, 4 bandings: Band 1 - 50%; band 2 45-49%

Needs

ImprovementCancer

Aug `16 CCG 75.8%

National 67.3%Top

PerformingDementia

Dementia Diagnosis

National target 67%; Band 1 - 76%

Top

PerformingDiabetes

% LD patients having an annual Health check

Rate of inpatients for each TCP area. CCGs are then assigned the TCP

score

CCG 46%; national 47%

Learning Disabilities

Needs

Improvement Comparison to national average and put into bandings 1-3

3 bandings comparison to national average:

41.5% CCG

Green 40.2%

% GP practices participated in national Diabetes audit

Indicator ratings

Care plan review in 12 months

Band 1- 75%; Band 2 50-75%; national target 50%

2014/15 CCG:80.7%

National N/A

Needs

ImprovementMaternity

National target 50%; 4 bandings band 1 ->75%; Band 50-75%;Mental Health

Needs

Improvement

July 16 CCG: 91.1%

National 72.%

People with first episode psychosis starting treatment within 2

weeks.Moving to recovery

June 16 CCG: 47.5%

National: 48.9%

23


Strategic and Transformation Fund Improvement Trajectories

The allocation of the strategic transformation fund (STF) has been calculated by NHS Improvement and agreed with NHS England nationally. The Sustainability and Transformation funding allocated to CCGs will be ring-fenced as pass-through payments to the relevant provider in addition to normal contractual payments. Only providers who have agreed to their control total have access to the STF and have agreed individual performance improvement trajectories linked to this funding. This is applicable to Gateshead Health NHS FT and NEAS NHS FT, but not Newcastle upon Tyne Hospitals NHS FT who did not agree to their control total. Trusts should work to achieve all the criteria of the fund, including individual improvement trajectories in order to receive the funding.

If a provider does not deliver the agreed, contracted recovery trajectory for the standards listed below they will not receive the STF. However they will not be subject to standard contract sanctions on these standards (i.e. there will be no double jeopardy). For assurance purposes however we will continue to monitor the Trust`s performance against the national constitutional standard.

NEAS NHS FT – Performance against NHSI improvement trajectory and NHS Constitution

September performance is currently below recovery trajectory and the NHS Constitution standard. NEAS have a recovery plan in place – see page 33.

Category A (Red 1) Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 62.79% 66.21% 66.23% 65.34% 64.61% 66.36% 72.97% 76.80% 71.83% 74.41% 75.14% 76.41%

Constitution 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

Actual 69.08% 67.10% 65.74% 65.23% 68.07% 63.29%

Category A (Red 2) Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 68.87% 71.37% 69.06% 71.64% 69.93% 71.46% 74.41% 76.40% 74.09% 74.38% 75.54% 76.14%

Constitution 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

Actual 70.06% 70.28% 66.52% 63.94% 65.34% 65.82%

Category A 19 minutes Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 91.00% 94.11% 91.60% 94.64% 92.52% 94.49% 97.49% 97.82% 94.70% 96.79% 96.72% 97.56%

Constitution 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 93.09% 92.75% 91.20% 90.55% 90.81% 91.31%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

NEAS NHS FT Category A (Red1) 2016/17

Actual STP Trajectory Constitution

24


Gateshead Health NHS FT – Performance against improvement trajectory and Constitution

Gateshead Health are currently meeting the required level of performance in line with their recovery trajectories for A&E, RTT and cancer 62 days. Diagnostics are below the STP trajectory and the Constitution target in August.

A&E Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 94.1% 92.5% 95.0%

Constitution 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

Actual 98.5% 96.7% 96.6% 97.3% 97.2%

Diagnostics Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 99.3% 99.4% 99.5% 99.5% 99.4% 99.4% 99.1% 99.3% 99.2% 99.4% 99.4% 99.4%

Constitution 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0% 99.0%

Actual 99.6% 99.5% 99.5% 99.3% 97.8%

RTT Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 92.0% 92.7% 92.8% 93.0% 92.5% 92.1% 92.7% 92.7% 93.0% 92.3% 92.3% 92.3%

Constitution 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0%

Actual 93.8% 94.4% 93.7% 93.6% 93.4%

Cancer 62 day Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

STP Trajectory 82.2% 82.7% 82.0% 87.4% 88.4% 80.5% 88.1% 80.0% 91.1% 82.0% 90.5% 85.4%

Constitution 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

Actual 82.5% 86.7% 86.6% 92.7% 91.6%

85.0%

90.0%

95.0%

100.0%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Gateshead Health NHS FT A&E 2016/17


96.0%97.0%98.0%99.0%

100.0%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Gateshead Health NHS FT Diagnostics 2016/17


70.0%75.0%80.0%85.0%90.0%95.0%

Gateshead Health NHS FT Cancer 62 Days 2016/17


90.0%

92.0%

94.0%

96.0%

Gateshead Health NHS FT RTT 2016/17


25


Measure

Percentage

of Quality

Premium

Value for

CCG Threshold Latest data Risk rating

Eligible QP

Funding

A) 4% (or greater) reduction on 2013/14 or equal to

(or below) the England 2013/14 mean performance of

1.161 items per STAR-PU Aug 16 - 1.19

B) equal to or lower than 10%, or

- to reduce by 20% from each CCG’s 2014/15 value Aug 16 - 7.28%

Cancers diagnosed at early stage 20% £478,224

4% improvement diagnosed at stages 1 and 2 in 2016

compared to 2015 or > 60% of all cancers diagnosed

at stages 1 and 2 in 2016 2015/16 51.4%

Increase in the proportion of GP referrals made by e-referrals 20% £478,224

80% by March 2017 and a year on year increase in

the % of referrals made by e-referrals (or achieve

100% e-referrals), or March 2017 performance to

exceed March 2016 performance by 20 percentage

points July 16 - 58.6%

Overall experience of making a GP appointment 20% £478,224

85% had a good experience, or 3 percentage point

increase from July 2016 publication

July 2016

publication -

75.7%

% of people aged 60-69 who were screened for bowel cancer in

the previous 30 months 10% £239,112

Increase the bowel screening rate to 66.4% by the end

of 2016/17

% of asthma patients who have had a review in the preceding 12

months 10% £239,112

3% increase to bring performance up to 73.2% in

2016/17

The percentage of patients with COPD who have had a review,

undertaken by a healthcare professional, including an assessment

of breathlessness using the Medical Research Council dyspnoea

scale in the preceding 12 months 10% £239,112

3.8% increase in reviews to bring performance up to

82.1% 2016/17

Total £2,391,120 £0

NHS Constitution Adjustment YTD

RTT Incomplete pathways (92%) 25% 94.0% Aug ytd

A&E Waitings <4 hrs (95%) 25% 96.5% Aug ytd

Cat A ambulance (NEAS) 75% 25% 66.4% Sept ytd

Cancer Waiting times 62 Days (85.1%) 25% 87.5% Aug ytd

Antibiotic prescribing Improved antibiotic prescribing in primary

and secondary care

Composite measure:

A) Reduction in the number of antibiotics prescribed in primary

care

B) Reduction in the proportion of broad spectrum antibiotics

prescribed in primary care

10% £239,112

1. Quality Premium

26


The following table provides additional detail for KPIs which are beyond their target or where there is a risk to year end performance.

Performance Area Issues Risks and Key Actions

Referral to Treatment (RTT) - Orthopaedics NUTH -risk

92% standard - incompletes Non-achievement in Q4 of the RTT waiting time standard for incomplete pathways will reduce the Quality premium payment by 25% in 2016/17.

RTT incomplete pathways remain on track overall for both FTs and the CCG.

Orthopaedics (including spinal) performance at NUTHFT remains below target at 82.8% in August although there have been improvements throughout Q1.

The spinal task and finish group has commenced this month to review current pathways and work to reduce long waits in spinal.

Diagnostic > 6 week waiters (NUTH)

GH off track August due to echocardiography

pressures on track September

NUTH continue off track September due to MRI

and sleep studies

NGCCG off track September

NUTH Pressures at NUTH include MRI (24 +6 week waiters) and sleep studies (19 +6

week waiters for NGCCG). A recovery plan is in place (backlog of sleep studies to be addressed. Further delays in the delivery of the sleep studies kit have led to a delay in clearing the backlog despite additional beds and workforce in place. Additional actions in relation to MRI:

Outsourcing established with Newcastle University. Nuffield capacity reinstated to same level as prior to their withdrawal of service in

Dec 15. Transfer of less complex MRI imaging to external vendors has allowed the Trust to

increase Cardiac imaging capacity: additional evening sessions, extra weekend cardiac sessions undertaken in May and June 16. Additional daytime capacity released through transfer of less complex work to 3rd party providers.

Apps training completed and additional cardiac imaging slots have been allocated on the new scanner. Full clinical sessions commenced in July 16.

GH

The trust have now appointed into a long-term vacancy in echocardiography to be in post in November. Locum cover continues until this point. In addition the trust have lined up a sessional locum to support if necessary, as well as confirming that the neighbouring Trust STFT are on hand to support if required. Compliance resumed.

NGCCG – It is expected that NUTH will be in a position to sustain compliance in Q4

2. Key Performance Indicators

27


Performance Area Issues Risks and Key Actions once the sleep studies back log has been cleared.

Mental Health - NGCCG IAPT - Waiting times standards of 75% seen in 18 weeks and 95% in 18 weeks IAF 2016/17 – recovery rate 50% patients accessing IAPT to be moving to recovery.

IAPT 2016/17

Current performance for NGCCG on track against the 6 week and 18 week waiting time standards.

Newcastle Gateshead CCG exceeded the access target for 2015/16 and are on target in July for 6 weeks.

NGCCG July ytd performance for Moving to recovery is below the 50% target at 47.3%.

The New Integrated service in Newcastle has gone live in April 2016. A detailed joint recovery action plan is in place for the now single point of access service in Newcastle. Performance does however continue to be monitored separately as well as jointly. Fortnightly performance meetings are held with the providers to ensure recovery of the standard is achieved through the new service. The integrated service is

o 1. recruiting to step 2 posts in August/ Sept which will increase the proportion of people seen at step 2 with higher recovery rates

o 2. Clinical supervision improved o 3. Case management improved. A trajectory for recovery based on the joint

action plan suggests performance improvement will be 3-6 months down the line

This indicator is at high risk of not being met through 2016/17 on a cumulative basis.

Quality Premium measures – e-referral 2016/17 (20% of QP worth £500K to NGCCG) Increase proportion of GP referrals made by e-referral to 80% by March 2017, from 59% March 2016

Follow up meeting held with NHS Digital and both NUTH and GH in September to review a

report with all the relevant information that will help us in understanding the current

utilisation in the area and what we can do to increase it. Action plan now developed which

includes actions as follows:

Providers to review which services are not available on NHS eRS.

Providers to undertake a data review to ensure MAR data correct

Technical issues with GH PAS to be escalated which is leading to lost utilisation

CCGs to work with lower performing practices to improve utilisation through the

PEP

Quality Premium measures – patient experience 2016/17 (20% of QP worth £500K to NGCCG)

Newcastle Gateshead CCG currently above the national average. Report summarising current and potential action was discussed at the primary care quality and the delivery groups. Key actions include 1) regional positive comms campaign and 2) checklist for

28


Performance Area Issues Risks and Key Actions 85% patients to report a good experience of making an appointment with their GP, or 3 % point increase from July 2016 baseline. NGCCG July 2016 position 75.7%

facilitators to review during practice visits in relation to access.

BCF metrics A separate report is reviewed and actions considered at the BCF programme Board (Gateshead) and the Integrated System Programme Board (Newcastle).

Early indications are that improvements have been made across Q1.

HCAI Outcome ambition

Newcastle Gateshead CCG is exceeding trajectory for CDiff reporting 76 compared to 72 YTD in September.

See Quality section.

NEAS NEAS Cat A Red 1 Response times Non-achievement of the NEAS Q4 Cat A R1 waiting time standard will reduce the Quality premium payment by 25% in 2016/17.

Performance continues off track and NEAS are implementing an updated recovery plan: Performance deterioration is reflective of:

A marked increase in the volume of Red 1 incidents

Adverse system pressure – 40% increase in handover delays over 1 hour from Dec-15 to May-16 compared to the same six month period a year earlier. Modelling from ORH has shown that a five minute reduction in handover times correlates to a 4.2% increase in Red 8 minute performance

An increase in requests from Healthcare Professionals (HCP), including an almost 100% increase in Red incident requests from HCPs in the Northumberland CCG area from June 2015, when the Northumbria Specialist Emergency Care Hospital (NSECH) opened.

Increased pressure to meet Red targets leads to a deterioration in performance for lower acuity patients, Green in particular, which in turn has seen an increase in incidents that have subsequently been upgraded to a Red 2 response.

Demand - Work has been completed to identify the demand drivers that have seen Red incidents increase during 2015/16. This work is being linked between the Operations Centre and Emergency Care front line services to ensure these drivers of demand are targeted – triage rates, HCP requests and increased upgrades from Green to Red priorities when Green performance is low.

29



Capacity -Utilise third party providers to cover shortfalls in the current staffing levels.

Look to further support staff and reduce staff sickness, along with the better management of abstractions.

Extension of the Emergency Medical Response (EMR) pilot with the four local Fire and Rescue Services (FRS).

Increase the level of Rapid Response Vehicles (RRV) available per shift.

Efficiency gains can be made through the influence over both internal and external processes.

Time taken to allocate/mobilise a resource

Handover delays

Downtime

Bypass procedures In September performance has fallen to 63%, and the Trust have indicated there is a significant risk to recovery by Q4. Although the Trust has made significant progress in recruitment increased levels of sickness absence and increasing difficulties in covering overtime have increased pressures in meeting this standard.

Clinical priority area Cancer “Needs improvement”

Despite good performance on 3 of the indicators, the North East has historically

high rates of cancer, due to a range of factors including its industrial heritage, high

levels of deprivation and lifestyle issues like smoking which has a detrimental

impact on survival rate (lowest quartile nationally) and brings the rating down to

"Needs improvement". Actions for CCG on cancer include:

• NICE suspected cancer pathways guidelines currently being rolled out to

practices, training of practices on new referral guidelines underway, to drive earlier

diagnosis

• Straight to test implementation for some pathways at FTs

Working with QEH to gain GP direct access to diagnostic tests including brain MRI

and abdominal CT. This will promote earlier diagnosis.

• PHE promotion of screening campaigns, in particular breast, bowel, cervical

• Bowel Screening in PEP to encourage early presentation

• Long term work on a stop smoking strategy - PHE

30



Clinical priority area Dementia “Top Performing”

Dementia Diagnosis: Continued improvement from the baseline position shows Aug

improving to 75.8%, requirement to 76.7% to be in top banding,

Work continues with practices through Dementia toolkit.

Work continues to encourage practices to Code dementia diagnoses,consider use

of the dementia quality toolkit to cleanse their system and identify patients who

need review/dementia coding. Encourage validating their dementia register with

secondary care data.

Performance nearing a saturation point as there will be those who do not attend

practices or who enter the system in another way.

Primary care dementia support worker (Alzeimer`s UK) is to commence to look at

supporting those patients post diagnosis and also help facilitate dementia care

planning.

Clinical priority area Diabetes “Top Performing”

The baseline assessment was undertaken using 2014/15 data, where NGCCG

were rated within the top banding for % GP practices participating in the national

diabetes audit and patients attending a structured education course. The

percentage of diabetes patients receiving all of the NICE recommended treatment

targets is marginally short of band 2 at 39.6% (target 40.2%).

A review of structured education is currently underway in Ncle and is planned for

Gateshead next year.

CCG working with practices to encourage more practices to take part in diabetes

audit, consultant support offered for practices; through a redesigned pathway in

GH. Final results of participation in the 15/16 audit due out w/c 31 October.

Work to review skills in practices, development of a masterclass to develop skills in practices and improve the management of patients.

Clinical priority area Learning Disabilities “Needs improvement” Current Data for Health Checks moves this to "Performing well"

Baseline data (March 16) for NGCCG TCP lowest performing quartile nationally

(TCP started from a high baseline). The number of beds across the region now

down and Q1 at rate of 87 (remains in lowest quartile). The number of patients has

reduced but not in line with the trajectory. Current number of bed as at Oct for

NGCCG 18.

IP reduction:

31



• Care and Treatment reviews are taking place in NG CCG – 6 planned for

inpatients.

• Work is ongoing in identifying those in the community ‘at risk’ of being admitted or

who have recently been discharged and are at risk of readmission.

LD Health Checks

LD Health checks performance has now significantly improved in 2015/16 and the

Aug 15/16 position was 57.8%, compared to 2014/15 on which this assessment

was based, which should be sufficient to move the CCG up to “performing well”.

Data not yet published.

Actions include:

Inclusion in 15/16 PEP

TITO education

facilitators linking with practices to encourage uptake

inpatients. Work is ongoing in identifying those in the community ‘at risk’ of being admitted or who have recently been discharged and are at risk of readmission.

LD Health checks performance has now significantly improved in 2015/16 through work in the PEP, TITO education and facilitators linking with practices to encourage uptake, compared to 2014/15 on which this assessment was based, which should be sufficient to move the CCG up to “performing well”.

Clinical priority area Maternity “Needs improvement”

Rated as “Needs improvement” as initially all 4 indicators in line with national

average. Maternal smoking at time of deliver performance has moved into the

worst quartile nationally for NGCCG at Q1 16/17 since the baseline results,

although CCG remains at "Needs improvement".

• Work to be undertaken by DJ with the FT maternity leads to explore and

understand the offers of choice to women.

• The role of the GP in maternity care for women is to be reviewed through Child

Health and Safeguarding workshops which would address maternal health such as

smoking and still births.

Clinical priority area Recovery plan for Newcastle IAPT moving to recovery rate is at risk of not meeting

32



Mental Health “Needs improvement” Current data for EIP moves this to "Performing Well"

the required standards on a cumulative basis in this financial year, although there

has been some improvement to date. Actions include

IAPT:

• recruitment of Step 2 worker to increase work in this area where there are higher

recovery rates; increased clinical supervision;

• improvements in referrals and case management

EIP

Current workhas seen current EIP performance improve sufficiently to move into

band 1 July Performance 91.1% which would move the overall CCG Mental Health

rating move into “Performing Well”.

• Actions continue towards meeting NICE guidelines in terms of staff recruitment

33


Contracting

34


3. General Contract Update

This section of the report updates on the current position relating to key contractual issues the Provider Management Team are addressing with our major providers: The contract activity and finance analysis outlined in this paper relates to month five and is based on initial “flex” data. As such, activity has not been fully coded and is therefore subject to change as noted in the following comments: GHNHSFT Month 5 analysis highlights an over performance of £987k which represents an improvement on the July position (+£1.306k). Non elective pressures, previously reported at £535k have reduced, however this is in part a result of ambulatory care activity being removed from this figure and being reported separately. Ambulatory over performance at month 5 is £194k. The GHNHSFT contract price includes a bottom line adjustment to reflect QIPP of £2,576k. At present the monthly target is shown separately under “other services” and is contributing most significantly to the current pressure (£1.1m). It should be noted that the planned impact of QIPP schemes was expected with effect from quarter 2 and work continues to implement initiatives including within planned and urgent care in order to deliver the QIPP across the CCG. NuTH Over performance based on month 5 data is reported at £4,677k. It should be noted that the provider continues to experience coding difficulties with 16% elective (20% in July) and 13% of non-elective (16% in July) activity uncoded on receipt of the initial “flex” data. This represents a further improvement with evidence of sustained recovery in line with the provider’s action plan. This, however, remains a significant issue with actual costs incurred in month 4 reducing by £1.2m between “flex” and fully coded “freeze” data. As above, the NuTH contract price includes a bottom line adjustment to reflect QIPP of £2,971k. QIPP is contributing £1,269k to current contract pressures. This is reflected in the report as contributing to the pressures in A&E (£98k), electives (£317k), non electives (£748k) and out patient first attendances (£106k). It should be noted that the planned impact of QIPP schemes was expected with effect from quarter 2 and work continues to implement initiatives including within planned and urgent care in order to deliver the QIPP across the CCG. The CCG is waiting for a response from NuTH in relation to a number of contract pressures which have been identified in the activity pressures report relating to skin procedures, digestive disorders and orthopaedic activity.

35


Plan Actual Variance Plan Actual Variance

POD Summary

AandE 32,501 31,551 (950) 3,090 3,099 9

Critical Care 1,235 1,071 (164) 2,228 2,016 (212)

Drugs and Devices 0 0 2,054 1,942 (112)

Elective 7,464 7,317 (147) 9,391 9,406 15

Emergency Readmissions (667) (546) 121

Excess Beddays 1,493 1,442 (51) 400 376 (24)

Maternity Pathways 1,641 1,551 (90) 1,846 1,643 (203)

Non Elective 8,588 8,905 317 15,472 15,477 5

Other Services 28,993 31,007 8,972 10,083 1,111

Outpatient Diagnostics 8,600 10,654 2,054 1,081 1,312 230

Outpatient First 14,412 14,119 (293) 2,378 2,268 (110)

Outpatient Follow Up 32,714 35,046 2,332 3,740 3,844 104

Outpatient Procedures 3,667 4,837 1,170 726 982 256

Sub Total 50,712 51,902 1,190

CQUIN 1,225 1,255 30

Penalties 0 (64) (64)

Challenges 0 (169) (169)

Total 51,937 52,924 987

Activity (YTD) £000s (YTD)

3.1 Contract Activity – Gateshead Health overview

Contract Update

• This contract is now a PbR contract for 16/17.

• The contract has been agreed and signed. Data Issues

• A monthly Data Quality Improvement Group meet as a matter of course to review issues. Financial Performance

• The contract is over performing by £987k for month 5.

• Elective admissions are over-performing by £15k, Critical Care is underperforming by £212k and A+E is over performing by £9k.

• Non-Elective admissions are over-performing by £5k.

• Outpatient Diagnostics is over performing by £230k,

• Drugs and Devices are under performing by £112k.

• QIPP has been profiled across the 12 months; the profile of delivery is to be confirmed however it is assumed that this will be phased from month 5. The impact of this on the position is shown in "Other Services" and at 5 months is £1,100k.

0

2,000

4,000

6,000

8,000

10,000

12,000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Total Cost Trend for Gateshead Health NHS Foundation Trust

16/17 Actual

16/17 Plan

0

500

1,000

1,500

2,000

2,500

3,000

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Emergency Admissions against Emergency Re-Admissions Gateshead Health NHS Foundation Trust

Em Admissions

Em Re-Admissions

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000


Non-Elective Analysis for Gateshead HealthNHS Foundation Trust

15/16 Actual

16/17 Actual

16/17 Plan

36



POD Summary

AandE 30,505 31,374 869 4,081 4,248 167

Critical Care 2,409 2,601 192 2,491 2,705 214

Drugs and Devices 0 134 5,196 6,012 816

Elective 14,904 16,055 1,151 18,777 20,203 1,426

Emergency Readmissions 0 0 0 0 0

Excess Beddays 7,457 4,785 (2,672) 2,047 1,502 (545)

Maternity Pathways 2,207 2,165 (42) 2,511 2,421 (90)

Non Elective 13,384 13,064 (320) 25,485 27,345 1,861

Other Services 605,849 645,667 4,647 5,745 1,098

Outpatient Diagnostics 13,254 13,953 699 1,824 2,119 294

Outpatient First 32,368 33,105 737 6,067 5,628 (440)

Outpatient Follow Up 74,045 70,420 (3,625) 8,311 7,668 (643)

Outpatient Procedures 17,189 22,508 5,319 3,678 4,418 740

Sub Total 85,114 90,013 4,899

CQUIN 1,998 2,092 94

Penalties 0 (284) (284)

Challenges 0 (32) (32)

Total 87,112 91,789 4,677


Contract Update

• This contract is based on full PbR principles and as such any over/underperformance will be a pressure/benefit to the CCG’s financial position;

• The contract has now been agreed and signed. Data Issues

• There is a monthly Information and Data Group which analyses all data to ensure consistency in the treatment of PbR Guidance and rules.

• NuTH are now submitting ACM data files, the Information and Data Group meet monthly and review all data submitted to give CCGs assurance that activity is charged to the correct responsible commissioner.

Financial Performance

• Non Elective is over performing by £1,861k but there are a large number of uncoded spells in month 5 data from

the FT.

• Similarly Elective is over performing by £1,426k

• Drugs and devices over by £816k

• Outpatient Procedures is over performing by £740k, the main HRG Sub chapter where this is occurring is JC Skin

Surgery and in particular HRG JC47Z Phototherapy.

• QIPP has been profiled across the 12 months; the profile of delivery is to be confirmed however it is assumed that this will impact from month 5. The impact of this on the position is shown in A&E, elective, non-elective and outpatients and at 5 months is £1,269k.

0

5,000

10,000

15,000

20,000


Total Cost Trend for Newcastle HospitalsNHS Foundation Trust

15/16 Actual

15/16 Plan

0

1,000

2,000

3,000

4,000

5,000

6,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Emergency Admission against Emergency Re-Admissions Newcastle Hospitals NHS Foundation Trust

Em Admissions

Em Re-Admissions

0

1,000

2,000

3,000

4,000

5,000

6,000


Non-Elective Analysis for Newcastle HospitalsNHS Foundation Trust

14/15 Outturn

15/16 Actual

15/16 Plan

3.2 Contract Activity – Newcastle upon Tyne Hospitals overview

0

5,000

10,000

15,000

20,000

25,000


Total Cost Trend for Newcastle HospitalsNHS Foundation Trust

16/17 Actual

16/17 Plan

0

1,000

2,000

3,000

4,000

5,000

6,000

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Emergency Admission against Emergency Re-Admissions Newcastle Hospitals NHS Foundation Trust

Em Admissions

Em Re-Admissions

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


Non-Elective Analysis for Newcastle HospitalsNHS Foundation Trust

15/16 Actual

16/17 Actual

16/17 Plan

37



POD Summary

AandE 2,846 5,609 2,764 491 592 101

Critical Care 78 53 (25) 89 82 (7)

Drugs and Devices 0 0 0 280 218 (63)

Elective 1,660 1,805 145 2,473 2,922 449

Emergency Readmissions 0 0 0 12 (50) (62)

Excess Beddays 277 450 173 76 145 69

Maternity Pathways 157 142 (15) 206 148 (58)

Non Elective 676 942 266 1,131 1,581 450

Other Services 1,747 1,524 (223) 2,572 1,476 (1,097)

Outpatient Diagnostics 787 875 88 141 160 19

Outpatient First 2,733 3,312 579 398 486 88

Outpatient Follow Up 6,343 7,067 724 575 628 53

Outpatient Procedures 951 986 35 218 231 13

Penalties 0 0 (2) (2)

Quality Payments 0 0 0 0

Total 8,661 8,614 (47)

City Hospitals Sunderland NHS FT 4,217 4,628 411 1,469 1,552 83

Connect Physical Ltd 0 0 0 488 456 (32)

County Durham and Darlington NHS FT 2,764 2,524 (241) 818 664 (154)

Newgene 0 0 0 6 8 2

North East Podiatry Ltd 371 0 (371) 87 63 (24)

Northumbria Healthcare NHS FT 5,355 5,477 122 2,058 2,111 53

Nuffield Health 575 658 83 348 468 120

Ramsay Health Care 1,023 758 (265) 299 236 (63)

South Tyneside NHS FT 964 1,069 105 371 394 23

Spire Healthcare 1,037 1,270 233 510 582 72

The Grove Medical Group 0 0 0 17 17 0

Tyneside Surgical Services 1,118 1,476 358 472 650 178

Other - NCA's 1,718 1,413 (305)

Total 8,661 8,614 (47)


3.3 Contract Activity – Other acute contracts overview 3.3 Contract Activity – Other acute contracts overview


• Nuffield Health is over performing by £120k as at month 5.

• Tyneside Surgical is over by £178k, of which £95k is Gastro specialty a

significant pressure on plan.

• Spire Healthcare is over by £72k.

• Northumbria NHS FT is under performing by £53k.

• County Durham is under performing by £154k.

• NCA's under by £305k.

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000


Total Cost Trend for Other Acute Services

16/17 Actual

16/17 Plan

38


Plan Actual Variance

POD Summary

Community MS 152 161 9

OP Psychotherapy 99 136 37

Middlerigg 115 37 (78)

Alnwick - Villa 14 OBD 141 200 59

Tyne - Villa 19 129 102 (27)

Affective Disorders - Inpatients 34 262 228

Hepple House - Head Injury Unit 63 59 (4)

Woodside - Villa 16 366 200 (166)

Other 24,170 24,186 16

CQUIN 632 634 2

Total 25,901 25,977 76

£000s (YTD)

0

1,000

2,000

3,000

4,000

5,000

6,000


Total Cost Trend for Northumberland, Tyne and Wear NHS Foundation Trust

16/17 Actual

16/17 Plan

Contract Update

• This contract is based on a mixture of Block, Cost per Case and Cost & Volume services and as such any over/underperformance will be a pressure/benefit to the CCG’s financial position.

Data Issues

• A retrospective adjustment has been made allocating a patient at Alnwick - Villa 14 to Newcastle - Gateshead CCG previously allocated to Northumbria CCG.


• The contract is currently showing an over performance of £76k.

• The main area where the contract has over performed is in Affective Disorders £228k (Inpatients) offset by underspend in relation to Villa 16, Villa

19and Middlerigg.

3.4 Northumberland Tyne and Wear NHS FT overview

39


Contract Update

• This contract has now been agreed and signed following the mediation process.

• The contract is a block contract covering 999 & PTS.

• Out of area ECR journeys are paid outside of this contract.

• There was an element of the contract agreed through mediation relating to End of Life service. This will be payable in Q4 based on evidence of cost savings to the health economy.

Data Issues

• There are currently no data issues. Financial Performance

• NEAS contract forecast to break even.

3.5 Contract Activity – North East Ambulance FT overview

POD Summary Plan Actual Variance Plan Actual Variance

999 Service

111 0 0 0

Additional Non Recurrent Investments 161 161 0

Cross Boundary Flows Adjustment (303) (303) 0

NEAS Hear and Treat Contract Adjustment 83 83 0

NEAS MERIT Contract Adjustment 27 27 0

NEAS Emergency Planning 32 32 0

NEAS HART 269 269 0

NEAS Intensive Care Bed Information Service 5 5 0

NEAS 999 5,886 5,886 0

NEAS - Hear and Treat / Refer 1,765 2,058 293 0 0 0

NEAS - Other 91 76 (15) 0 0 0

NEAS - See and Treat and Convey 6,923 6,999 76 0 0 0

NEAS - See, Treat / Refer 25,323 23,834 (1,489) 0 0 0

NEAS - Urgent and Emergency Care 46,103 45,505 (598) 0 0 0

NEAS Clinical Hub 106 106 0

NEAS Neo-Natal 0 0 0

NEAS EOL Costs 0 0 0

Winter pressures CCG funded 49 49 0

Divert Incentive Penalties 0 7 7

Penalties/reinvestment of penalties 0 0 0

CQUIN Scheme 0 0 0

Sub Total 999 Service 6,315 6,322 7

Patient Transport Service

PTS Contract 1,310 1,310 0

PTS 7 Day Services 41 41 0

PTS Call Centre 33 33 0

PTS Dedicated Vehicle 17 17 0

Winter pressures CCG funded 16 16 0

CQUIN 0 0 0

Sub Total PTS Service 1,417 1,417 0

Renal Transport Service

Renal Transport Service 0 0 0

CQUIN 0 0 0

Sub Total Renal Transport Service 0 0 0

111 Service

111 Service 631 631 0

Penalties 0 0 0

Sub Total 111 Service 631 631 0

Total NEAS Ambulance Service 8,363 8,370 7

£000s (YTD)Activity (YTD)

0

500

1,000

1,500

2,000


Total Activity Trend for North East Ambulance Service NHS Foundation Trust

16/17 Actual

16/17 Plan

on evidence

0

100

200

300

400

500

600


NEAS - Hear and Treat / Refer

16/17 Actual

16/17 Plan

0

5

10

15

20

25


NEAS - Other

16/17 Actual

16/17 Plan

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


NEAS - See Treat and Convey

16/17 Actual

16/17 Plan

0

2,000

4,000

6,000

8,000

10,000

12,000


NEAS - Urgent and Emergency Care

16/17 Actual

16/17 Plan

0

500

1,000

1,500

2,000


NEAS - See and Treat / Refer

16/17 Actual

16/17 Plan

40


Finance

41


The section reports on the financial position of the CCG for the period to September 2016, highlighting any areas of pressure.

Issue and risk Key Issues

NuTH FT: Currently forecasting an £2,431k overspend at month 6.

Despite the reported Month 5 contract position detailed above the current reported over performance for NUTH by year-end is £2,431k overspent. Due to the high level of uncoded data at Month 5 the reported contract over performance will be overstated and circa £500k of spell costs are expected regroup to Specialised Services commissioners once the data is fully coded, as occurred with Months 1-4 data. In addition the QIPP initiatives are expected to impact later in the year, yet the current contract profile is in twelfths. The contract is still forecast to overspend but for the reasons detailed here the month 5 trading position has not been annualised, with QIPP applied to later months. Contract performance will continue to be closely monitored throughout the year, and mitigating actions may be required should initial pressures continue once data coding is complete.

Gateshead Healthcare FT: Currently forecasting £1,479k overspend at month 6.

The current reported position for GHFT is a year-end over performance of £1,479k. This figure is a combination of the cumulative contract over performance to month 5 and increased utilisation of the AQP Audiology contract with GHFT. QIPP initiatives are expected to impact later in the year, yet the current contract profile is in twelfths. Therefore the contract has been forecast to over perform by a lesser extent than current contract position at Month 5 would suggest. Contract performance will continue to be closely monitored throughout the year, and mitigating actions may be required should initial

4.1. CCG Financial Position and Risks - narrative

4. Finance

42


pressures continue once data coding is complete.

Continuing Healthcare (CHC)/Funded Nursing Care (FNC): forecast overspend of £7,292k at Month 6.

The forecast overspend is largely the result of the inflationary increases in recharges from local authorities in Newcastle and Gateshead. This relates to packages of care which the councils contract on behalf of the CCG. The movement in the Month 6 forecast from the Month 5 position was due to using latest information received from Local Authorities in the forecasting model at Month 6.

Non Contracted Activity & Individual Funding Requests: currently forecasting an overspend of £254k at month 6.

Analysis of the charges received to date resulted in reporting an overspend for Month 6. This is an increase from the near breakeven position reported thus far due to the time delay in receiving details of current year charges. Enough data has now been received in 16/17 to allow a more accurate foecast to be developed. The inherently random nature of Non Contracted Activity and out of area charging however means that this position will be closely monitored throughout the year.

Prescribing at month 6 forecast to overspend by £1,178k.

The Prescribing position reported at month 6 is showing an overspend against budgets of £1,178k. This position is a slight improvement on month 5 and is once again based on the PPA forecast model which utilises an estimated monthly expenditure profile for the year. The PPA model had been reporting an artificially high forecast in the first months of this year, however a review of the national assumptions around Cat M drugs used in the PPA model brought this in line with a twelve month rolling average of historic prescribing costs, which the CCG use as a benchmark of national assumptions.

Services for Over 75’s reporting £1,000k underspend at month 6.

Slippage of £1,000k is expected on the £5 per head funded schemes by year end.

The surplus reported at Month 6 is £8,779k. This reported position is in line with the control total agreed with NHS England through the 2016/17 planning process.

43


C

Annual

Budget

Year to Date

Budget

Year to Date

Actual

Year to Date

Variance

Forecast

Outturn

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Funding:

2016/17 Initial Commissioning Allocation 700,165 346,998 346,998 0 700,165 0

2016/17 Running Costs Allowance 10,634 5,317 5,317 0 10,634 0

Additional Allocations 14,649 7,325 7,325 0 14,649 0

Anticipated Allocations 0 0 0 0 0 0

Total Income 725,448 359,640 359,640 0 725,448 0

Running Costs:

Total CCG Running Costs 10,634 5,316 4,424 (892) 8,850 (1,784)

Commissioning Expenditure Budgets:

City Hospitals Sunderland NHSFT Acute 3,491 1,745 1,808 63 3,616 125

Co Durham & Darlington NHSFT Acute 1,964 982 977 (5) 1,953 (10)

Gateshead Hospitals NHSFT Acute 124,773 62,387 63,659 1,273 126,253 1,479

Newcastle upon Tyne Hospitals NHSFT Acute 209,767 104,884 108,263 3,380 212,199 2,431

Northumbria Healthcare NHSFT Acute 4,940 2,470 2,496 26 4,991 51

South Tyneside NHSFT Acute 1,015 508 401 (107) 802 (213)

South Tees NHSFT Acute 360 180 178 (2) 357 (3)

Non NHS Acute Acute 6,004 3,002 3,260 259 6,521 517

Other Acute Acute 2,401 1,201 951 (250) 1,901 (500)

Non Contracted Activity & Individual Funding Requests Acute 3,351 1,676 1,802 127 3,605 254

North East Ambulance Service Amb 18,391 9,196 9,315 119 18,630 239

Northumberland Tyne & Wear NHSFT MH/LD 62,696 31,348 31,362 14 62,724 28

Non NHS MH/LD MH/LD 8,670 4,335 4,265 (70) 8,530 (140)

Packages of Care and Non Contracted Activity MH/LD 2,360 1,180 1,214 34 2,429 68

Newcastle upon Tyne Hospitals NHSFT Community 30,285 15,143 15,186 43 30,371 86

Gateshead Community Services Community 24,060 12,030 11,556 (474) 24,371 312

Non NHS Community Community 5,544 2,772 2,876 104 5,751 207

Local Authority Services Community 756 378 294 (84) 587 (168)

Continuing Healthcare/Funded Nursing Care CHC 62,130 31,484 35,130 3,646 69,422 7,292

Prescribing Prim Care 84,661 42,331 43,669 1,339 85,839 1,178

Commissioned Services & Out of Hours Prim Care 7,884 3,942 3,884 (58) 7,768 (117)

Services for Over 75's Prim Care 2,500 1,250 750 (500) 1,500 (1,000)

Programme Costs Prog 4,083 2,042 2,009 (32) 4,017 (67)

Better Care Fund Prog 15,817 7,908 7,909 0 15,817 0

Total Commissioning Expenditure Budgets 687,906 344,371 353,213 8,842 699,954 12,048

Reserves:

Earmarked Reserves Reserve 19,906 9,953 432 (9,521) 864 (19,043)

Contingency Reserve 7,002 0 0 0 7,002 0

Total Commissioning Reserves 26,908 9,953 432 (9,521) 7,866 (19,043)

Total Commissioning Expenditure 714,814 354,324 353,645 (679) 707,819 (6,995)

Total Expenditure (Running costs & commissioning) 725,448 359,640 358,069 (1,571) 716,669 (8,779)

(Surplus) / Deficit on Total Budget 0 0 (1,571) (1,571) (8,779) (8,779)

4.1.1 CCG Financial Position and risks - Table

44


e

September August Movement

£000's £000's £000's

Non Current Assets Property, plant and equipment 0 0 0

Intangible Assets 0 0 0

Other Financial Assets 0 0 0

Total Non Current Assets 0 0 0

Current Assets Trade and other Receivables 2,289 2,499 (210)

Prepayments and Accrued Income 2,796 2,842 (46)

Cash and cash equivalents 135 15 120

Total Current Assets 5,220 5,356 (136)

Total Assets 5,220 5,356 (136)

Current Liabilities Trade and other payables (12,964) (11,426) (1,538)

Accruals (50,673) (46,703) (3,970)

Other liabilities 0 0 0

Provisions 0 0 0

Borrowings 0 0 0

Total Current Liabilities (63,637) (58,129) (5,508)

Non-Current Assets plus/less Net Current Assets/Liabilities (58,417) (52,773) (5,644)

Non-Current liabilities Other liabilities 0 0 0

Provisions 0 0 0

Borrowings 0 0 0

Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED (58,417) (52,773) (5,644)

Financed by Taxpayers Equity

Capital & Reserves General Fund (58,417) (52,773) (5,644)

Revaluation Reserve 0 0 0

Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY (58,417) (52,773) (5,644)

STATEMENT OF FINANCIAL POSITION - September

4.2 CCG Statement of Financial Position - table

45


Recurrent Non Recurrent Total

£000's £000's £000's

September

Programme Baseline Allocation 700,165 700,165

Running Cost Allocation 10,634 10,634

Return of 15-16 surplus 10,275 10,275

Vanguard Q1 Care Homes Gateshead 373 373

Eating Disorder Service 286 286

NUTH Ambulatory Recoding 221 221

NUTH block drugs disaggregation 2,698 2,698

Vanguard Q2 Care Homes Gateshead 504 504

Local Evaluation Funding 20 20

GP Development Programme 44 44

PMS Review Funding 228 228

0

Total NHS England Allocation September 2016 713,718 11,730 725,448

NHS ENGLAND IN YEAR ALLOCATIONS - NEWCASTLE GATESHEAD CCG - September

Issue and risk Key Actions

Cash Balance: The cash balance for September has increased from £15k in August to £135k in September.

On-going management of cash balances via the Accounting team within NECS.

4.2.1 CCG Statement of Financial Position - narrative

4.3 In year allocations September 2016

46


Cash Flow Forecast March 2014

Actual Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast

April May June July August September October November December January February March

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Income

Balance brought forward 260 242 553 500 37 15 135 166 40 33 74 94

Department of Health Income 49,300 51,900 49,300 48,500 51,100 49,400 52,700 49,800 51,900 54,100 57,800 60,646

Supplementary /Cash Return 0 0 0 0 0 0 1,700 0 0 0 0 0

Prescribing and Home Oxygen Therapy Charge to Cash Limit 6,580 7,192 7,252 6,904 7,347 6,939 6,845 7,243 7,560 7,160 7,878 7,380

CHC Risk Pool Contribution 837 0 0 0 0 0 0 0 0 0 0 0

Other Income 989 371 1,065 300 79 835 100 100 100 100 100 100

Total Income 57,966 59,705 58,170 56,204 58,563 57,189 61,480 57,309 59,600 61,393 65,852 68,220

Expenditure

Pay (414) (420) (426) (434) (444) (445) (430) (430) (430) (430) (430) (430)

NHS Payments including contracts (39,371) (44,685) (40,825) (40,080) (40,473) (40,811) (43,092) (40,349) (40,230) (40,162) (42,153) (43,123)

Other Payments - BACS/CHAPS/Payable orders (8,981) (5,169) (7,122) (7,458) (8,648) (6,878) (9,300) (7,600) (9,700) (11,920) (13,650) (15,590)

Better Care Fund Payments (1,196) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291) (1,291)

Prescribing (6,580) (7,192) (7,252) (6,904) (7,347) (6,939) (6,845) (7,243) (7,560) (7,160) (7,878) (7,380)

CHC Risk Pool Contribution (837) 0 0 0 0 0 0 0 0 0 0 0

Other (345) (395) (754) 0 (345) (690) (356) (356) (356) (356) (356) (356)

Total Expenditure (57,724) (59,152) (57,670) (56,167) (58,548) (57,054) (61,314) (57,269) (59,567) (61,319) (65,758) (68,170)

BALANCE CARRIED FORWARD 242 553 500 37 15 135 166 40 33 74 94 50

CASHFLOW FORECAST - September

4.4 CCG Cash Flow Forecast September 2016

47


The Better Payment Practice Code requires that all valid invoices should be paid by their due date or within 30 days of receipt, whichever is later. Newcastle Gateshead CCG compliance is shown in the table below.

BETTER PAYMENT PRACTICE CODE - September

Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHS

Total Non-NHS Trade Invoices Paid in the Year 7,548 53,356

Total Non-NHS Trade Invoices Paid Within 30 Day Target 7,276 52,239

Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 96.40% 97.91%

NHS

Total NHS Trade Invoices Paid in the Year 1,916 248,076

Total NHS Trade Invoices Paid Within 30 Day Target 1,878 247,613

Percentage of NHS Trade Invoices Paid Within 30 Day Target 98.02% 99.81%

4.5 CCG Better Payment Practice Code – Year to Date September 2016

1

Cover Sheet


Date 29/11/2016

Agenda Item 11.1

Report Title CCG Involvement Strategy

Synopsis The paper states the CCGs proposed approach to involvement and how we are committed to working with the public, patients, carers, communities and stakeholders to ensure health services can be commissioned based on patient experience, stakeholder feedback and community need.

Lead Director Chris Piercy, Executive Director of Nursing, Patient Safety and Quality

Report Author

Christianne Ormston, Norah Stevens PPI and Community Development Leads Alison Thompson Patient Experience Lead Steven Bramwell Health Champion Lead


Purpose (click one box only)

Approval ☐

Decision ☐ To note ☐ Information ☒

2


Effective involvement, patient experience and partnership working will improve commissioning decisions to meet the needs of the local population.


Links to the Locality Commissioning Plan, Organisational Development Plan and the CCG vision and mission.


N/A


Human resource in place.


N/A


N/A

NHS Constitution Reflects Principle 3a of the NHS Constitution: 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

Report history Strategy approved by CCG Executive on 11 October 2016.

Next steps None

Appendices Appendices 1 – 3 contained within the strategy document.

3

CCG Involvement Strategy and 2016/19 action plan

4

Contents

1. Introduction and purpose of document 5

2. Our commitment to effective involvement 5

3. Legislation – our statutory obligations 7

4. Aims of objectives of this strategy 7

5. Public and Patient Involvement 9

6. The Principles of Participation 10

7. Principles for communication and engagement 10

8. Stakeholders 11

9. Methods and structures 11

10. Key messages 13

11. Activity Plan 13

12. Monitoring and evaluation 13

Appendix 1 – Compact 14

Appendix 2 – Stakeholder Map 17

Appendix 3 – Activity Plan 20

5

1. Introduction and purpose of document This strategy states NHS Newcastle Gateshead CCGs robust approach to involvement, and how we are committed to working with the public, patients, voluntary and community sector organisations, carers, wider communities and stakeholders to ensure health services can be commissioned and improved based on patient experience, stakeholder feedback and community need.

It includes:

The aims and objectives of the strategy; including some high level key messages.

Current legislation on the ‘Duty to Involve ‘and the ‘Equality Act 2010’.

The key principles for communication, engagement and consultation.

Proposals for the engagement process including a clear action plan. The strategy has been written by the CCG Patient, Public, Involvement and Experience Team and the content considered by the three patient forum groups across Newcastle and Gateshead as well as the Newcastle Involvement Forum, membership of which is from the voluntary and community sector. The final version of the draft strategy was agreed with the Executive Director of Nursing, Patient Safety and Quality, who presented the strategy to the CCG Executive on 11 October for approval. Implementation of the strategy will be the responsibility of the Executive Director of Nursing, Patient Safety and Quality and members of the CCG public, patient, involvement and experience team.

2. Our commitment to effective involvement NHS Newcastle Gateshead CCG came together as one organisation in April 2015. This followed the merger of the three separate CCGs covering the Newcastle and Gateshead localities. The merger resulted in a staff structure realignment which saw the two existing delivery teams merge into one, as well as changes to some senior management roles including a new Executive Director lead for patient and public involvement and a new post of Patient Experience Lead.

With the new structure, the CCG needs to continue and strengthen the its approach to engagement with the public, patients, voluntary and community sector organisations, carers, wider communities and stakeholders (referred to from this point forward as public and patient involvement). The changing landscape and the increasing demands on the NHS mean that involvement needs to be at the heart of our work to make sure that these voices are at the centre of the services we provide and that we work with our NHS partners and other stakeholders to provide high quality, responsive services.

Throughout this document we also refer to ‘people’, who can equally represent users of services, carers, individuals with enduring health conditions, or members of the public with no active involvement with services, but remain members of the communities in which we work.

It is also recognised that effective involvement means working closely with a wide range of communities across Newcastle and Gateshead, including differing geographical communities, BME communities, those with specific health and social care needs, and, communities of interest. Therefore, innovative and tailored approaches are required to ensure engagement is appropriately planned with, and delivered for, varied audiences.

6

Newcastle Gateshead CCG will transform lives together by prioritising:

Involvement: of our communities and providers to get the best of understanding of issues and opportunities. Experience: people-centred services that are some of the best in the country. Outcome: focusing on preventing illness and reducing inequalities to help people live happier, healthier lives. (reference CCG Commissioning Plan, pg 23, 2012-2017)

The CCG five year Health and Social care system vision requires new Models of Care delivery across care settings underpinned by sustainable, value based, and person centred co-ordinated pathways. Achievement of these will support the triple integration agenda and help narrow the three gaps within our local Health and Social Care system, The Sustainability and Transformation Plan (STP), due to be published in late October 2016, will deliver the NHS Five Year Forward View and robust involvement and engagement plans will ensure an effective process is place. The CCG Engagement Leads are part of a communication and engagement network to ensure patients and the public are engaged and communicated with.

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3. Legislation – our statutory requirements NHS organisations are required to ensure that public and patient involvement ensures opportunities to influence any improvements or changes to services. The process for involving people requires a clear action plan and audit trail, including evidence of how they have influenced decisions at every stage of the process and the mechanisms used.

The CCGs obligations are:

Equality Act Section 242 of the NHS Act 2006 sets out the statutory requirement for NHS organisations to involve and consult patients and the public in:

The planning and provision of services.

The development and consideration of proposals for changes in the way services are provided.

Decisions to be made by NHS organisations that affect the operation of services.

Section 244 of the NHS Act 2006 requires NHS organisations to consult relevant Overview and Scrutiny Committees (OSC) on any proposals for a substantial development of the health service in the area of the Local Authority, or a substantial variation in the provision of services. The Act also places the patient at the heart of the NHS. Section 3a of the NHS Constitution gives the following right to patients: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.” The Gunning Principles are also key for any public consultation, and state:

Consultation must take place when the proposal is still at a formative stage

Sufficient reasons must be put forward for the proposal to allow for intelligent consideration and response

Adequate time must be given for consideration and response The product of consultation must be conscientiously taken into account

The CCG will adhere to these principles when undertaking public consultation exercises.

4. Aims and objectives of this strategy The strategy provides a framework to enable consistent, strong and effective involvement in delivering the CCG operational plan. In addition, NHS England’s guidance for CCGs Transforming Participation in Health and Care) focuses on embedding involvement at every stage of the commissioning cycle. This acts as a strong framework for the CCG public and patient involvement team to plan and deliver on our commitments.

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The key aims of the strategy are: To ensure Governing Body level leadership of public and patient involvement activities.

To underpin the delivery of CCG involvement with public and patient stakeholders.

To raise awareness and understanding of CCG workstreams and the importance of involvement within each.

To work with stakeholders, including the voluntary and community sector and carers to deliver key involvement programmes.

To ensure a consistent, ongoing approach to involvement.

To ensure that appropriate mechanisms are in place so that people feel engaged and informed and have the opportunity to get involved.

To maintain credibility by being open, honest and transparent.

To monitor and gauge public perception throughout the process and respond appropriately.

To be clear about what people can and cannot influence throughout the engagement and consultation phases.

To provide information and context about the proposals in clear and appropriate formats that is accessible and relevant to target audiences.

To maintain trust between the NHS and the public that action is being taken to ensure high quality NHS services in their local area

Through involvement and engagement, the CCG can continue to provide high quality and safe services which provide a positive patient experience.

To demonstrate the NHS is planning for the future.

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5. Public and Patient Involvement There are many different ways in which people might participate in health depending upon their personal circumstances and interest. The ‘Ladder of Engagement and Participation’ is a widely recognised model for understanding different forms and degrees of involvement, (based on the work of Sherry Arnstein). Public and patient activity on every step of the ladder is valuable, although participation becomes more meaningful at the top of the ladder (see below). When involving our stakeholders in our work, the CCG is committed to ensuring true engagement that is honest and transparent through the most appropriate method. We will use the Ladder of Engagement and Participation when planning engagement work to determine and ensure clarity of the work and the level of engagement to be used. The Ladder of Engagement and Participation

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6. The Principles of Participation

NHS England has developed some principles of participation based on a review of research, best practice reports and the views of stakeholders. Working with each other 1. Our relationships will be conducted with equality and respect 2. We will listen and truly hear what is being said, proactively seeking participation from

communities who experience the greatest health inequalities and poorest health outcomes 3. We will use all the strengths and talents that people bring to the table 4. We will respect and encourage different beliefs and opinions 5. We will recognise, record and reward people’s contributions 6. We will use plain language, and will openly share information.

Working well together 1. We will understand what’s worked in the past, and consider how to apply it to the present and

future 2. We will have shared goals and take joint responsibility for our work 3. We will take time to plan well 4. We will start involving people as early as possible 5. We will give feedback on the results of the involvement 6. We will provide support, training and the right kind of leadership so that we can work, learn and

improve together The CCG is committed to these principles of participation in all our work and these also form part of the Compact which we will use when working with public and patients in Steering Groups, Planning Groups etc., and ask partners to sign up to. (See Appendix 1 The Newcastle Gateshead CCG Involvement Compact 2016/17)

7. Principles for communication and engagement

This strategy is underpinned by the following guiding principles for communication and engagement. Clear – communication should be in plain language, jargon free, easy to understand and not open to interpretation. Consistent – there are no contradictions in messages given to different groups or individuals. The priority to those messages may differ, but they should never conflict. Credible – messages have real meaning, recipients can trust their content and expect to be advised of any change in circumstances which impact on those messages. Honest – all information provided is based on known facts and the opportunities and level of influence stakeholder involvement will have is made clear. Inclusive – in terms of language, method, time, and place, ensure there are appropriate opportunities for our population and the diverse communities within it to take part. Open – decision makers are accessible and ready to engage in dialogue. When information cannot be given, the reasons are explained.

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Targeted – the right messages reach the right audiences using the most appropriate methods available and at the right time. Timely – information arrives at a time when it is needed, relevant to the people receiving it, and able to be interpreted in the correct context. Activities are planned to allow maximum time and opportunity for involvement to be effective. Results of the involvement are fed back or published to those who took part. Two-way – there are opportunities for open and honest feedback, and people have the right to contribute their ideas and opinions about issues and decisions.

8. Stakeholders Building and maintaining supportive and trusting relationships with our key stakeholders is critical to the success of our strategy. For the purpose of this strategy, the definition of stakeholders is anyone who will be affected (either positively or negatively) or has an interest in the work of the CCG and the delivery of the Operational Plan.

There are a wide range of stakeholders who will have varying degrees of interest in our work. Broadly, those stakeholders fall into the following categories:

Public and patients

Carers

Voluntary and Community Sector Organisations

Internal

Political audiences

Wider partners including other NHS organisations and Local Authorities

Governance and regulators.

Media Our key stakeholders and how we communicate with them are detailed in Appendix 1 of the strategy. The method of communication has been informed by a benchmarking exercise carried out by the CCG Patient and Public Involvement team in October 2016 to determine the preferred method of involvement of our stakeholders. These preferred methods will form a key part of future involvement of our stakeholders to maximise impact and opportunity for people to be involved.

9. Methods and structures

A wide range of methods and existing structures will be used to communicate with, involve and advise stakeholders of the work of the CCG, as well as highlight opportunities to get involved. These will be scoped and agreed on a project/area of work basis.

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These include, but are not restricted to:

Methods Face to Face

Public events

Partner Listening events

Focus groups

Identified groups for targeted engagement

Interviews

Presentations

Public meetings Online

GP Teamnet – intranet for GP practices

GIN – Gateshead Information Network (intranet for GP practices)

CCG website

CCG hub

CCG stakeholder bulletins

My NHS database

CCG and partner websites

CCG weekly bulletins to GP practices

Social media

Surveys Written communication

Engagement Reports for CCG Governing Body

Materials – e.g. posters, leaflets etc.

Media

Paid for advertising

Surveys

Structures Practice Managers meetings

CCG patient groups

Health Champions (health champion groups)

CCG Commissioning Forum

CCG Engagement Reports Communication and Voluntary sector networks and bulletins.

CCG staff sessions

Engagement by CCG Involvement Contract partners – Involve North East, HAREF and Deaflink and other identified partners

Existing community groups e.g. Community Forum, Involvement Forum, Local Engagement Board

Volunteers via new models of care (Vanguard)

Information shared with community, voluntary and health sector partners

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10. Key messages It is important to reiterate strong, clear and consistent key messages in all involvement work the CCG will undertake. Specific key messages for the area of work will be agreed, however, these will be underpinned by the agreed CCG overarching messages.

Newcastle Gateshead CCG is committed to open, honest and transparent involvement of all our stakeholders.

We are committed to actively engaging with our communities to ensure we fully understand the issues that affect our patients.

We value the views, feedback and experiences of our patients and want to celebrate success and improve services to meet our patients’ needs.

Working with our partner organisations e.g. other NHS organisations, voluntary and community sector is the key to our success

Providing high quality, safe patient care and positive patient experience is at the heart of the CCG.

We are committed to involving as many people as we possibly can.

11. Activity plan The activity plan is detailed in Appendix 2. The plan details the activities to inform stakeholders of the new CCG involvement strategy as well as the regular involvement we will undertake with our partners. One of the key activities is for an Involvement Steering Group to be established who will also identify and detail activities to be undertaken. It is proposed that this group be chaired by one of the CCG Lay Members responsible for patient and public involvement and will include representatives from the local authority, voluntary community sector, patient representatives and health to increase cooperation and reduce duplication. Involvement activities for key pieces of work and projects that are part of the CCG Operational Plan 2016/17 will be scoped, agreed and implemented by the CCG patient and public involvement team and involvement partners, separate to this strategy, however the detail of this activity will be shared with the Involvement Steering Group.

12. Monitoring and evaluation of this strategy This strategy and the activity plan will be monitored by: Ongoing

CCG patient and public involvement team

Involvement Steering Group

CCG Executive and Governing Body Annual

Executive Director of Nursing, Patient Safety and Quality

CCG Executive.

Stakeholder survey with key partners The strategy and the effectiveness of the CCGs success in involving our stakeholders will be monitored by an annual benchmarking survey as well as the completion of evaluation forms at engagement events, where appropriate.

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Appendix 1

Compact between NHS Newcastle Gateshead Clinical Commissioning Group (CCG) and Stakeholders

The CCG agrees that;

We will ensure consistent, strong inclusive and effective patient, public and stakeholder involvement in delivering the CCG operational plan for 2016/17.

We will be clear. Communication should be in plain language], jargon free, easy to understand and not open to interpretation.

We will be consistent. There are no contradictions in messages given to different groups or individuals. The priority to those messages may differ, but they should never conflict.

We will be credible. Messages have real meaning; recipients can trust their content and expect to be advised of any change in circumstances which impact on those messages.

We will be honest. All information provided is based on known facts and the opportunities and level of influence stakeholder involvement will have is made clear.

We will be inclusive – in terms of language, method, time and place and opportunities to do disadvantage any particular community or group of people.

We will be open. Decision makers are accessible and ready to engage in dialogue. When information cannot be given, the reasons are explained.

We will be targeted. The right messages reach the right audiences using the most appropriate methods available and at the right time.

We will be timely. Information arrives at a time when it is needed, relevant to the people receiving it, and able to be interpreted in the correct context. Activities are planned to allow maximum time and opportunity for involvement to be effective. Results of the involvement are fed back or published to those who took part.

We will work together. There are opportunities for open and honest feedback, and people have the right to contribute their ideas and opinions about issues and decisions.

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The CCG asks that;

Our stakeholders and partners to be clear.

Our stakeholders to remain consistent.

Our stakeholders to remain credible.

Our stakeholders to remain inclusive – not only representing the communities they serve but all communities across the CCG.

Our stakeholders to remain open and honest.

Our stakeholders to be responsible for tasks and those tasks are shared.

We will work two-way. There are opportunities for open and honest feedback, and people have the right to contribute their ideas and opinions about issues and decisions.

For ‘critical friends’ to challenge and hold the CCG to account in a constructive and collaborative way.

To consider the opinions of others to support amicable outcomes.

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Together we will

Keep patients at the centre of all our work

Ensure all communities are represented

Create environments of working to design better services for all

Communicate effectively, clearly and inclusively

Celebrate our success

Recognise challenges and take positive steps to secure successful outcomes

Take opportunities and chances to push boundaries and innovate

Identified outcomes and commit to the task

Adopt a ‘close the loop’ approach ensuring all those involved and impacted are informed - we

will start involving people as early as possible and we will give feedback on the results of the

involvement and how this has changed/impacted the service that we deliver

Be accountable and demonstrate the effectiveness of our outcomes with shared goals and

take joint responsibility for our work

Our relationships will be conducted with equality and respect

We will listen and truly hear what is being said, proactively seeking participation from

communities who experience the greatest health inequalities and poorest health outcomes

We will use all the strengths and talents that people bring to the table

We will recognise, record and reward people’s contributions

We will use plain language, and will openly share information

We will have shared goal and take joint responsibility for our work

We will take time to plan well

We will provide support, training and the right kind of leadership so that we can work, learn

and improve together

Abide to the Nolan Principles of public Life

1. Selflessness

2. Integrity

3. Objectivity

4. Accountability

5. Openness

6. Honesty

7. Leadership

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Appendix 2

Stakeholder map (as at 20 June – existing groups detailed – list prepared prior to benchmarking survey – to be revised)

Stakeholder Group

Stakeholder Stakeholder Prioritisation Category Communication Method(s)

Internal Governing body Key Player Bi monthly update report

Internal Executive Committee

Key Player Monthly update report

Internal CCG staff Key Player Staff briefing sessions

Internal Clinical Leads and Delivery Team

Key Player Regular update meetings and actions

Internal GP practices incl. Practice Managers

Key Player GP teamnet, bulletins, meetings when required. Support in identifying patients when required.

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Patients & Public (general)

Members of the public

Active Engagement and Consultation Face to face meetings and briefings/engagement events and activities to suit project/audience. Website, media and social media, My NHS

Patients & Public

Affected service user groups

Active Engagement and Consultation Meetings with identified service user groups/ engagement events/ consultation events

Patients & Public

GP Patient Participation Groups

Keep Informed and engaged via practices

Meetings/briefings

Patients & Public

ACORN West Forum PUCPI Local Engagement Board

Active involvement Emails, briefing, attendance at meetings.

Community and Voluntary Sector

Involvement Forum Community Forum VCSnetworks/partners

Active Involvement Regular meetings and presentations/ongoing briefings and updates/ consultation and engagement documents

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Political Audiences

Local Councillors Active Engagement and Consultation Regular correspondence updating on progress /OSC/engagement and consultation documents when appropriate

Political Audiences

Overview and Scrutiny Committees

Key Player Meetings & presentations/ regular briefings when appropriate

Media Local and regional media – work with NECS communications team

Keep Informed Pro-active and re-active press releases and statements/ interviews / briefings/ paid-for advertorials and supplements

Governance & regulators

Local health and Wellbeing Board

Key Player Meetings/briefings

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Appendix 3 Activity Plan (activities to be generated following review of meetings, approval of strategy and establishment of Involvement Steering

Group and updated regularly thereafter)

Task Who’s responsible Date

Review of current meetings, forum re agenda, structures, frequency etc. Chris Piercy From April till end September 2016

Draft Strategy reviewed by Executive Director of Nursing, Patient Safety and Quality

Chris Piercy 29 July

Draft Strategy sent to CCG patient groups for comment PPI team 1 August

Final draft Strategy sent to NECS Communications Lead for comment PPI Team September

Benchmarking survey to determine best/effective way of involving and communication with key players

PPI team By end of September 2016

CCG Executive to approve Involvement Strategy Chris Piercy 11 October

Publication of CCG involvement strategy and stakeholders advised. PPI team

Establish Involvement Steering Group PPI team November

Autumn event to explore future set up of patient groups, community groups, forum etc.

PPI team To be held by end November 2016

‘Involvement Awareness Week’ – awareness/showcase to CCG staff about team’s work, achievements, importance of involvement, how involvement can influence their work.

PPI team Summer 2017

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Glossary of Terms

CCG Clinical Commissioning Group

CVS Community and Voluntary Sector

HAREF Health and Race Equality Forum

LEB Local Engagement Board

NECS North of England Commissioning Support

NGCCG Newcastle Gateshead Clinical Commissioning Group

NHS National Health Service

OSC Overview and Scrutiny

PPI Public and Patient Involvement

PUCPI Patient User Care Public Involvement Group

VCS Voluntary and Community Sector

Appendices

Appendix 1 The Newcastle Gateshead CCG Involvement Compact 2016/17

Appendix 2 Stakeholder map

Appendix 3 Activity Plan

1

Delegated commissioning application process and checklist for 2017/18

Introduction

NHS England’s Board has committed to support the majority of CCGs to assume delegated responsibilities for the commissioning of primary medical services from 1 April 2017. Giving CCGs more control over general practice is part of a wider strategy to support the development of place-based commissioning and a key enabler of the development of new care models. The delegated commissioning model is delivering a number of benefits for CCGs and local populations. It is critical to local sustainability and transformation planning (STP), supporting the development of more coherent commissioning plans for healthcare systems and giving CCGs greater ability to transform primary care services. CCGs have also reported that delegated commissioning is giving them greater insight into practice performance issues, greater opportunities to develop a more sustainable primary care workforce and is helping to strengthen relationships between CCGs and practices. In 2016/17, 114 CCGs have delegated commissioning responsibilities. NHS England has invited the remainder of CCGs operating under joint or the “great involvement” co-commissioning models to apply for full delegation between now and 5 December 2016. CCGs are encouraged to have an early conversation about their delegated commissioning application with their NHS England local team and finance leads to ensure that all the necessary documentation is updated and approved in advance. We request that CCGs and the NHS England Director of Commissioning Operations (DCO) jointly complete the delegated commissioning checklist and finance template for delegated budgets for submission nationally. The completed templates should be signed by the CCG and the relevant NHS England DCO and emailed to [email protected], with a copy to regional leads for co-commissioning, details are as follows

Region Regional lead for co-commissioning

Contact email address

North Richard Armstrong [email protected]

Midlands and East Vikki Taylor [email protected]

London Liz Wise [email protected]

South Sarah Khan [email protected]







Next steps towards primary care co-commissioning

Following submission of the checklist, your application will be reviewed by NHS England as part of a short approvals process. We will inform CCGs of the outcomes of this process by early January 2017. Please note we will consider applications from CCGs with directions or in special measures on a case-by-case basis. If you require any further information, please contact your regional co-commissioning lead in the first instance, followed by [email protected].

Delegated Commissioning Application Checklist

This checklist and finance template should be completed jointly by the CCG and the relevant NHS England DCO. All supporting documentation should be submitted to the NHS England DCO and not the national co-commissioning team.


Newcastle Gateshead CCG has set out clearly defined objectives and benefits of the delegated arrangement.

Y

The CCG’s constitution or proposed constitutional amendment has been updated in line with the guidance1 (and this has also been approved by the NHS England regional office with confirmation sent to [email protected] - constitutional amends can be confirmed by 1 April 2017).

Y

The CCG has updated its governance documentation in line with the NHS England guidance (on constitutional amendments).

Y

The CCG has reviewed its conflicts of interest policy in line with NHS England’s revised statutory guidance on managing conflicts of interest for CCGs https://www.england.nhs.uk/commissioning/pc-co-comms/coi/. The CCG confirms that they will be fully compliant with the conflicts of interest guidance by 1 April 2017.

Y

The CCG’s IG Toolkit meets level 2 criteria as a minimum. Y

The CCG’s Year End Assurance rating is Outstanding

1 Constitutional changes will be required if the CCG takes on delegated commissioning because the

CCG will need to establish a new committee to manage the delegated functions and to exercise the delegated powers. In the CCG Model Constitution, the references to this committee will need to be added to sections referenced in 6.4.1.a. and 6.6.3.c. unless there is already a clause permitting new committees without additional direct references. These will also need to refer to the Terms of Reference for this committee.




http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/11/annx-f-delgtd-comms-mod-tor.pdf

https://www.england.nhs.uk/commissioning/pc-co-comms/coi/



The DCO confirms that there are no performance, finance, leadership or governance issues that prevent the CCG taking on the function.

Y / N

Finance template for delegated budgets completed in full (include completed table below): Notes for completing the finance template:

1. Double click into the table to complete the excel template. 2. Please enter the notified numbers for your CCG and how the primary care allocation is

split between GP Services and other primary care services for 2016/17 (below) 3. This will be reconciled back to the area team allocation for primary care and

subsequent in year adjustments. Where possible M6 2016/17 figures should be used.

PART II

Finance Template for delegated budgets

Notified

delegated

Budget

(1)

Movement

out of GP

Services

(2)

Movement

Into GP

Services

(3) Total

£'000 £'000 £'000 £'000

GP Services + - + +/-

General Practice - GMS 32042 32042

General Practice - PMS 9992 9992

Other list based services (APMS) 2898 2898

Premises cost reimbursements 6808 6808

Other premises costs 8 8

Enhanced services 3266 3266

QOF 6771 6771

Other GP services 4097 4097

Primary care NHS property services - GP 0

Sub Total GP services 65882 0 0 65882

N/A + - +/-

Acute services 0

Mental health services 0

Community health services 0

Primary care services 0

Continuing care services 0

Other care services 0

Sub total CCG programme costs 0 0 0

Total 65882 0 0 65882

Please provide a description in the change in spend detailed above

Y

The DCO confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements.

Y / N

The DCO confirms the CCG is capable of taking on delegated functions Y / N



Three scanned / electronic signatures provided at the foot of this email. Typed names unfortunately cannot be used.

Y / N

I hereby confirm that <CCG Name> membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2017/18. NHS England is requested to progress the application to the regional panels for consideration. Signed by <CCG Name> Accountable Officer Signature (scan/electronic version required): Print Name: Position: Date: Signed on behalf of <CCG Name> Audit Committee Chair Signature (scan/electronic version required): Print Name: Position: Date: Signed by NHS England Director of Commissioning Operations Signature (scan/electronic version required): Print Name: Position: Date:

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Delegated Commissioning Objectives and Benefits Vision Our vision for general practice in Newcastle Gateshead CCG is to see;

Groups of practices working together at scale delivering new models of care

that are integrated with community, secondary care, social care and the

voluntary sector.

A flexible workforce with enhanced skills across the system to deliver higher

quality care and improved access.

Patients see the right person at the right time and in the right place.

Clinical systems and a shared clinical record support the new care models.

We see delegated commissioning as enabling the CCG to work more closely with practices to bring about the transformational change needed. This will be supported by the ability to shift services and investment out of hospital and into general practice to ensure a sustainable model of care for the future. Newcastle Gateshead CCG recognises the importance of General Practice and its positioning as the cornerstone of NHS care. Equally, the CCG is aware that the demands being placed on practices and their teams have never been greater. Our emphasis is upon ensuring the sustainability of General Practice which is able to adapt and be central to the emerging new models of care. Our goal is to ensure that in the future General Practice can expand its purpose and become the hub from which we lead, co-ordinate, plan and manage care. The General Practice Forward View (GPFV) aims to facilitate a stepped change in the investment and support into general practice. The CCG is driving this change, implementing initiatives in consultation with our member practices. The GPFV covers 5 key areas; investment, workforce, workload, infrastructure and care design. Our General Practice Strategy broadly mirrors the GPFV structure. Our General Practice Strategy also aims to strengthen and increase the resilience of practices. Our ambition is to facilitate and support transformational change to ensure that General Practice is well placed to play an integral part in delivering the outcome ambitions we have for people living in Newcastle and Gateshead (CCG Five Year Plan 2015-2020). Our collective aim is to support development of a new model for General Practice where people will benefit from;

Innovative service offer through bringing together General Practices and utilising strong partnerships to deliver an increased range of services which enable more pro-active out of hospital care whilst still maintaining core strengths of localism, continuity, familiarity and accessibility.

Communities who are fully engaged in shaping services, sharing ownership of the health challenges they face.

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Increased ability to adapt to the conditions they live with – confident and connected.

Knowing that individual and community assets are valued and fostered.

A voluntary and community service sector fully engaged in the planning and where appropriate provision of services for patients and public.

Integrated working across primary, secondary, tertiary, community, voluntary and social care providers.

High quality secondary care services for those who need to access them.

World renowned specialist services locally accessible to our patients.

Health and social care without walls, organisations without barriers.

Benefits of delegated commissioning The CCG has already started to enable transformational change in general practice through;

The Care Homes Vanguard and Proof of Concept, in particular through the intermediate care redesign.

Clinical work streams such as; o long term conditions Year of Care programme focussing on holistic

care planning o planned care consultant advice and guidance to ensure people see the

person they need to

Urgent care alliance hub working to improve access.

A project is in place to reinvesting PMS monies back into practices.

Investment of health care navigators and the development of a social prescribing strategy.

At scale initiatives such as GP in A&E and centralised home visiting.

Workforce initiatives such as and Integrated Career Start GP posts, Career Start Nurse scheme and Practice Manager Development Programme.

The CCG sees delegated commissioning as a lever which will support the delivery of the GPFV/General Practice Strategy. We see the benefits of delegated commissioning to be as follows;

The CCG will be able to ensure that practices have a strong voice in the development of new models of care and the MCP model in particular.

CCG will be able to drive forward the development of the GP provider models, GPFV and 5YFV agendas.

It will enable the CCG to make decisions to shift investment from acute to primary and community services to support sustainability and the movement towards an out of hospital model.

It will enhance the opportunity for GPs to influence the development and investment in general practice.

It will enable and support new collaborative ways of working with practices.

Budget slippage will be retained for the CCG to invest in primary care locally whereas at level 2 budget slippage is retained by NHSE to spend across the area or return as underspend.

Local knowledge and relationships will increase the potential to;

3

o support collaborative solutions to problems o enable more timely resolution of queries

CCG roles and structures provide easier contact points and ongoing support for practices.

The CCG will have the ability to align GP national schemes (eg DESs) to ensure best fit with local services.

Cover Sheet


Date 29/11/2016

Agenda Item 11.2

Report Title Application for Delegated Commissioning

Synopsis This paper requests that the Governing Body approve the application to NHS England for delegated commissioning (level 3). NHS England has invited the remainder of CCGs operating under joint or greater involvement co-commissioning models to apply for full delegation between now and 5 December 2016. In preparation for this, in September NGCCG member practices voted in support of the move to level 3 delegated commissioning. Under delegated commissioning the CCG will take on the delegated functions which include;

decisions in relation to the commissioning, procurement and management of Primary Medical Services Contracts, including but not limited to:

o Enhanced Services o Local Incentive Schemes including the design of such

schemes o establishment of new GP practices and closure of GP

practices

performance management of GP practices, including liaison with the CQC

management of the Delegated Funds NHS England retains the residual liability for the performance of primary medical care commissioning as well as exercising the Reserved Functions including;

management of the performers list

revalidation and appraisal process

complaints management capital expenditure functions

The specific delegation roles and responsibilities of NHS England and level 3 CCGs are currently being established and will be agreed by the Executive Committee.

2

The NGCCG draft application for delegated commissioning is attached as Appendix 1 for approval, along with the Objectives and Benefits, Appendix 2.


Direct financial implications of taking on the delegated functions

The ability of the Primary Care Commissioning Committee to make effective decisions associated with the delegated functions

CCG commissioning, holding and managing GP contracts including performance management could damage or worsen relationships or lead to conflicts of interest.

Increased risk of conflicts of interest as the CCG will be procuring services from member practices.

The risks will be mitigated through;

Implementation of quality and contract assurance processes within the CCG

The development of a clear agreement of responsibilities with NHSE based on the delegation agreement

Skills development within the CCG

Effective resource planning

Revised corporate documentation e.g. Conflicts of Interest and clear terms of reference

Recommendation To approve the application to NHS England for delegated commissioning (level 3)

Note the Objectives and Benefits

Report history Executive Committee recommended the application for approval to Governing Body


Director: Dr Neil Morris Title : Medical Director

Author: Katharine McHugh Title: Portfolio Manager Primary Care


Purpose (click one box only) Decision ☒ Information ☐

3


Outlined in Appendix 2


Links to all of the strategic objectives


See above implications and risks


Direct financial implications relate to the need to absorb any potential

unforeseen spend.

Capacity resource implications will be identified as the next stage

once the application has been successful and the delegation

responsibilities between the CCG and NHS England identified.


N/A


N/A

NHS Constitution Principles;

1 The NHS provides a comprehensive service available to all

3 The NHS aspires to the highest standards of excellence and

professionalism

6 The NHS is committed to providing best value for taxpayers’ money

and the most effective, fair and sustainable use of finite resources

Next steps Paper to Primary Care Joint Commissioning Committee for information

Submission of application to NHS England before 5th December

Planning for assuming the delegated functions

Appendices Appendix 1 Application Appendix 2 Objectives and benefits

Cover Sheet


Date 29/11/16

Agenda Item 11.3

Report Title

Developing the Northumberland Tyne and Wear Sustainability and North Durham Transformation Plan (NTWND STP)

Synopsis This report provides an update on the progress in implementing the NHS England Planning Guidance released in December 2015 which asked for a five year Sustainability and Transformation Plan (STP), place-based and driving the Five Year Forward View. STPs will drive genuine and sustainable transformation in health and care outcomes, and will help build and strengthen local relationships, enabling a shared understanding of where we are now, our ambition for 2021 and develop a plan as to how we get there, including our plans for closing three identified gaps

• Health and wellbeing gap

• Care and quality gap

• Finance and efficiency gap


Access to additional transformation funding from April 2017 is linked to the most compelling and credible STP.

Recommendation The Governing Body is asked to receive this report and note the progress made in the development of the NTW ND STP.

Report history This is the fourth paper in relation to planning to be brought to the Governing Body.


Director: Mark Adams Title : Chief Officer

Author: Hilary Bellwood Title: Head of Planning & OD



2


Delivery of the Vision set out in the Five year Forward View will ensure better preventative measures are in place to stop people getting sick, when people do need health services, they will gain far greater control of their own care along with seamless care across all services.


The planning guidance for 2016/17 continues to focus on delivery of the vision set out in the Five Year Forward View and so our strategic objectives are aligned with this.


We need to prioritise effectively to ensure there is sufficient resource to deliver.


There will be resource implications in order to develop and deliver the Sustainability and Transformation Plan.


NHS England is legally required to seek to achieve the objectives set out in the Mandate. In turn, CCG’s are required to play their part in delivering the Mandate.


In order to ensure the sustainability of the local health and care system moving forward, it is imperative that we develop a robust place based STP in partnership with all stakeholders.

NHS Constitution The guidance outlines the need to continue to deliver the standards set out in the NHS Constitution.

Next steps We will receive feedback from NHS England regarding the 21st October submission document prior to formal patient, public and stakeholder engagement commencing 23rd November 2016.

Appendices NTWND STP Sections 1, 2 and 3

3

This report updates on the development of the Northumberland, Tyne and Wear and North Durham Sustainability and Transformation Plan (NTWND STP). 1. Background As previously reported to the Governing Body interim checkpoint submissions were made in May and June 2016 including meetings between STP leads, Sir Simon Stevens and representatives from a number of Arms Length Bodies.

At the meetings it was recognised that the NTWND STP is a complex geography with many moving parts, but there was commitment to develop a genuinely sustainable plan with partners that will transform the quality of care for our population over the next five years, with good partnership working across commissioning, provision and local authorities.

However, there were some concerns raised regarding the impact of patient flows from North Durham into both the Newcastle Gateshead LHE, and South Tyneside and Sunderland LHE which needed to be taken into consideration as the shared STP was developed to transform health and care in the communities of the footprint.

Following further consultation it was agreed that the NTW STP footprint would now include North Durham and become Northumberland Tyne and Wear and North Durham (NTWND). 2. Progress to date The STP was submitted to NHS England on 21st October 2016. The plan provides an understanding of the current position against the three gaps set out within the NHS Five Year Forward View, and has been developed through a process of robust analysis and modelling utilising for example JSNAs, scrutiny of clinical quality and safety data, patient and carer feedback, evaluations and organisational financial information.

The plan sets out how we will achieve our vision for health and social care over the next five years, including key actions and activities for the STP developed through a clear understanding of the challenges we face in respect of Health and Wellbeing, Care and Quality and Finance and Efficiency.

It is built upon established programmes of work within each of our Local Health Economies as well as additional new proposals for transformation over the next 5 years with common priorities being delivered at an STP level.

The NTWND health and social care system is one of the strongest in England. We have some of the highest performing providers in the country (consistently delivering NHS Constitutional Standards) and we have 6 Five Year Forward View ‘Vanguard’ and pioneer programmes. Through the implementation of our programmes of work at all levels, the STP indicates how we propose to deliver financial stability.

The STP focuses on a number of key Transformational Areas that will:

• Scale up Prevention, Health and Wellbeing to improve the health and wellbeing of our public and patients utilising an industrialised approach designed by the Directors of Public Health from each of the local authorities.

4

• Improve the quality and experience of care through Out of Hospital Collaboration and the Optimal Use of the Acute Sector by:

• Scaling up of the New Care Models from our Vanguards and development of a resilient and robust primary care sector.

• Ongoing acute service changes underway in our LHEs. For example, the ACO in Northumberland and opening of a new hospital in Northumberland, NSECC, and more recently, South Tyneside FT and Sunderland FT coming together to be managed under a single management team. Further speciality level review is underway to meet the emerging challenges around workforce pressures required to deliver clinical standards within a 7-day service.

• Close the financial gap, which by 2021, if we did nothing to resolve the situation would be, £641million.

While our financial sustainability is based upon a modelling of the NHS budgetary gaps, it should be noted that work continues with our local authority colleagues to understand and reflect the continuing expected impact of austerity and the specific impacts on the NHS. 3. Next steps The work to date in developing the plan has been to create a case for change, which describes the gaps, challenges and on-going work, we now need to work together with partners to design the next steps such as:

How we can better collaborate on prioritising prevention despite many challenges Enabling the out of hospital sector to be stabilised and strengthened as demand

grows Optimising the acute hospital sector to get the best quality within the resources and

financial envelope

One of the key ambitions of the STP is to ensure “no health without mental health”. This will involve the development of an integrated life span approach to the integrated support of mental health, physical health and social need which wraps around the person, from enabling self- management, care and support systems within communities, through to access to effective, consistent and evidence based support for the management of complex mental health conditions.

Joint workstreams have been established to take forward this transformation work, including mental health.

The initial plan was to publish the draft STP on 23rd November, including engagement tools to help people feedback their views. However, there were concerns raised from some stakeholders that we should publish the draft STP earlier than intended, as this had already happened in some parts of the country.

Mark Adams as STP lead therefore took the decision to publish the draft plan on Wednesday 9th November on all CCG websites within the NTWND footprint. The formal engagement process will still commence on 23rd November in order to inform the next version of the plan before consultation. Each website also includes details of how to provide feedback.

PROPOSED AMENDMENTS TO THE CCG CONSTITUTION FOR LEVEL 3

6.5.3 Committees of the Governing Body CURRENT WORDING vi. Primary Care Joint Committee

The primary care joint committee of the CCG is a joint committee with NHS England established to support joint commissioning of primary medical services for the people of Newcastle and Gateshead. The committee is established as a committee of the governing body. The role of the primary care joint committee shall be to carry out the functions

relating to the commissioning of primary medical services under section 83 of

the NHS Act (except those relating to individual GP performance

management, which have been reserved to NHS England) and such CCG

functions under sections 3 and 3A of the NHS Act as have been delegated to

the joint committee.

The Governing Body has approved and keeps under review the terms of

reference for the Primary Care Joint Committee, which includes information

on the membership of the Committee. It has authority to make decisions as

set out within its Terms of Reference and the CCG’s scheme of reservation

and delegation.

Terms of Reference: http://www.newcastlegatesheadccg.nhs.uk/wp-

content/uploads/2015/05/NGCCG-Primary-Care-Committee-Terms-of-

Reference-v2.pdf

PROPOSED REVISION: vi. Primary Care Commissioning Committee

The primary care commissioning committee is established to support commissioning of primary medical services for the people of Newcastle and Gateshead. The committee is established as a committee of the Governing Body. The role of the primary care commissioning committee shall be to carry out the functions relating to the commissioning of primary medical services under delegated authority from NHS England in accordance with section 83 of the NHS Act and such CCG functions under sections 3 and 3A of the NHS Act as have been delegated to the committee.

The Governing Body has approved and keeps under review the terms of reference for the primary care commissioning committee, which includes information on the membership of the Committee. It has authority to make decisions as set out within its Terms of Reference and the CCG’s scheme of reservation and delegation. Terms of Reference: http://www.newcastlegatesheadccg.nhs.uk/publication-category/terms-of-reference/

http://www.newcastlegatesheadccg.nhs.uk/wp-content/uploads/2015/05/NGCCG-Primary-Care-Committee-Terms-of-Reference-v2.pdf



http://www.newcastlegatesheadccg.nhs.uk/publication-category/terms-of-reference/

http://www.newcastlegatesheadccg.nhs.uk/publication-category/terms-of-reference/

PROPOSED AMENDMENTS TO THE CCG CONSTITUTION FOR LEVEL 3

APPENDIX D - NHS NEWCASTLE GATESHEAD CLINICAL COMMISSIONING GROUP: FUNCTIONS, DUTIES AND SCHEME OF RESERVATION AND DELEGATION

SCHEDULE OF MATTERS RESERVED TO THE CCG AND SCHEME OF DELEGATION

Policy Area Decision Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub-Committee

Delegated to Accountable Officer

Delegated to Chief Finance and Operating Officer

Delegated to others

CURRENT WORDING:

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Approve actions in relation to the co-commissioning of primary care services in partnership with NHS England

Joint Committee (Section 6.9 of

the Constitution)

PROPOSED REVISION:

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Make decisions and approve actions in relation to the commissioning of primary care services, operating within the terms of this Constitution and within the agreed Terms of Reference for the committee

Primary Care Commissioning Committee

Cover Sheet


Date 29/11/2016

Agenda Item 12.1

Report Title Proposed Amendments to the CCG Constitution

Synopsis Amendments to the CCG Constitution are required to support the CCG’s application for delegated commissioning for primary care.


The CCG is preparing to apply to NHS England for delegated responsibility for commissioning primary care. The background to this, the member ballot and the details of the application are the subject of a separate report. To support this development two minor changes to the CCG Constitution are required:

Rewording of section 6.5.3 (vi) – Primary Care Joint Committee to Primary Care Commissioning Committee

Changes to the scheme of reservation and delegation to refer to the CCG making decisions about commissioning primary care and identifying that decision making being delegated to the Primary Care Commissioning Committee.

Full details of the changes are given in the attached paper. The draft Terms of Reference for the Primary Care Commissioning Committee are the subject of a separate report. Changes to the CCG Constitution are subject to approval by NHS England. The proposed changes are in line with NHS England guidance and NHS England colleagues have indicated that the application for change will be supported.

Recommendation The Governing Body is asked to note the amendments to the CCG constitution.

Report history This would be the first change to the CCG Constitution


Director: Neil Morris Title : Medical Director

Author: Pauline Fox Title: Head of Corporate Affairs




An accurate and up to date CCG Constitution is part of good governance and transparency.


Create and maintain strong governance assuring that the CCG complies with the legal requirements of the Health and Social Care Act 2012, and the CCG constitution.


No specific risks have been identified


No resource implications have been identified.


The amendments to the CCG Constitution are required to enable the CCG to take implement the delegated commissioning. This paper presents no implications for any of the nine protected equality characteristics.


No specific implications identified.

NHS Constitution Principle Three: The NHS aspires to the highest standards of excellence and professionalism.

Next steps The amendments are subject to NHS England approval. The changes to the CCG Constitution would only be made once NHS England confirms the successful application for delegated commissioning.

Appendices Appendix 1: Proposed amendments to the CCG Constitution

CO19: Standards of Business Conduct and Declaration of Interest Policy (5) draft 2 Page 2 of 61 OFFICIAL

Corporate CO19: Standards of Business Conduct and Declarations of Interest Policy

Version Number Date Issued Review Date

V5 November 2016 November 2019

Prepared By: Senior Governance Manager,

North of England Commissioning Support

Consultation Process:

Head of Corporate Affairs, Newcastle Gateshead CCG Audit Committee, Newcastle Gateshead CCG

Policy Adopted From: Existing Policy

Approval Given By: Governing Body

Document History

Version Date Significant Changes

1 25/01/2013

2 21/12/2015 Removal of redundant web links and revision to Appendix C

3 05/01/2015 Updated to take into account new guidance issued by NHS England on 18 December 2014

4 29/02/2016 Removal of reference to Anti-Fraud, Bribery and Corruption, following the release of the revised Anti-Fraud, Bribery and Corruption Policy (2)

5 14/07/2016 Updated to take into account new guidance “Managing Conflicts of Interest: Revised Statutory Guidance for CCGs” issued by NHS England on 28 June 2016

Equality Impact Assessment

Date Issues

14th July 2016 Please see Section 17 of this document

POLICY VALIDITY STATEMENT This policy is due for review on the latest date shown above. After this date, policy and process documents may become invalid.

Policy users should ensure that they are consulting the currently valid version of the documentation.


Contents 1. Introduction, Aims and Objectives .................................................................................................. 4

2. Guidance and Legal Framework .................................................................................................... 4

3. Application of Public Service Values and Principles to the NHS ................................................... 6

4. Appointments and Roles and Responsibilities ............................................................................... 7

5. The Guidance in Practice ............................................................................................................ 10

6. Recording of gifts, hospitality and sponsorship ........................................................................... 18

7. Declaration of Interests ................................................................................................................ 18

8. Confidentiality .............................................................................................................................. 29

9. Use of resources.......................................................................................................................... 31

10. Fraud/Theft .................................................................................................................................. 31

11. Non-compliance with Policy ........................................................................................................ 31

12. Internal Audit ................................................................................................................................ 32

13. Conflicts of Interest Training ........................................................................................................ 32

14. Linked Policies/Guidance ............................................................................................................ 33

15. Further information ...................................................................................................................... 33

16. Monitoring, Review and Archiving ............................................................................................... 33

17. Equality Analysis .......................................................................................................................... 35

18. Appendix A .................................................................................................................................. 41

19. Appendix B .................................................................................................................................. 42

20. Appendix C .................................................................................................................................. 44

21. Appendix D .................................................................................................................................... 47

22. Appendix E .................................................................................................................................... 48

23. Appendix F .................................................................................................................................... 49

24. Appendix G.................................................................................................................................... 50

25. Appendix H .................................................................................................................................... 55

26. Appendix I ..................................................................................................................................... 57

27. Appendix J ..................................................................................................................................... 60

28. Appendix K .................................................................................................................................... 61


1. Introduction, Aims and Objectives

1.1 For the purposes of this policy, NHS Newcastle Gateshead Clinical

Commissioning Group will be referred to as “the CCG”. 1.2 The purpose of this policy is to ensure exemplary standards of business

conduct are adhered to, as public servants, by Governing Body members, committee and sub-committee members and employees of the CCG (as well as individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG such as those within commissioning support services). Through this Policy individuals will be aware of their own responsibilities as well as the CCG’s responsibilities as corporate bodies (including the constituent Member Practices). The Policy also sets out the responsibilities of the CCG as an employer, especially in light of the individual and corporate obligations set out in the Bribery Act 2010.

1.3 Importantly, the policy draws attention to the consequences of non-compliance

with its requirements which may include disciplinary action and/or legal action. 1.4 The production of this policy draws on the wide range of guidance issued over

the years for NHS bodies in relation to this important matter and to guidance published specifically for Clinical Commissioning Groups.

2. Guidance and Legal Framework

2.1 The NHS Management Executive published guidance, “Standards of business

conduct for NHS staff”, (HSG (93) 5), which remains extant and which provides specific guidance on:

The standards of conduct expected of all NHS staff where their private interests may conflict with their public duties; and

The steps which NHS employers should take to safeguard themselves and the NHS against conflicts of interest.

Specifically, it makes it clear that it is the responsibility of staff to ensure that they are not placed in a position which risks, or appears to risk, conflict between their private interests and their NHS duties.

2.2 The Department of Health’s document, “Code of Conduct for NHS Managers”,

(October 2002), provides guidance on core standards of conduct expected of NHS Managers to act in the best interests of the public and patients/clients to ensure that decisions are not improperly influenced by gifts or inducements. Professional Codes of Conduct governing health care professionals are also pertinent. Similarly, the General Medical Council’s guidance, “Leadership and management for all doctors” (March 2012), details the standards and expectations required of clinicians in leadership and management positions.


2.3 CCGs should observe the principles of good governance as set out in:

The Nolan Principles

The Good Governance Standards for Public Services (2004), Office for Public Management (OPM) and Chartered Institute of Public Finance and Accountancy (CIPFA) sets out the principles of good governance.

The seven key principles of the NHS Constitution

The Equality Act 2010

The UK Corporate Governance Code

2.4 The underpinning legal framework is provided by the Bribery Act 2010, which repeals the Prevention of Corruption Acts, and which;

creates two general offences covering the offering, promising or giving of an advantage, and requesting, agreeing to receive or accepting an advantage,

creates a new offence of failure by a commercial organisation to prevent a bribe being paid for or on its behalf (it will be a defence though if the organisation has adequate procedures in place to prevent bribery),

Bribery is defined as giving someone a financial or other advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so.

Any employee breaching the provisions of this Act will be liable to prosecution which may also lead to the loss of their employment and superannuation rights in the NHS.

2.5 Section 25 of Health and Social Care Act 2012 imposes duties on CCGs in

relation to maintaining registers of interest and managing conflicts of interest. Section 14O of the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) (“the Act”) sets out the minimum requirements of what both NHS England and CCGs must do in terms of managing conflicts of interest .The guidance in the Act is supplemented by the procurement specific requirements set out in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. Further guidance has been set out in Managing conflicts of interest: statutory guidance for CCGs (June 2016)1 published by NHS England and issued under sections 14O and 14Z8 of the Act. This supersedes the previously issued NHS England guidance for CCGs. This new document includes guidance for CCGs when commissioning primary care services, either under joint commissioning or delegated commissioning arrangements.

1 http://www.england.nhs.uk/wp-content/uploads/2014/12/man-confl-int-guid-1214.pdf


2.6 The aims of the guidance are to:

enable CCGs and clinicians in commissioning roles to demonstrate that they are acting fairly and transparently and in the best interest of their patients and local populations;

ensure that CCGs operate within the legal framework, but without being bound by over-prescriptive rules that risk stifling innovation;

safeguard clinically led commissioning, whilst ensuring objective investment decisions;

provide the public, providers, Parliament and regulators with confidence in the probity, integrity and fairness of commissioners’ decisions; and

uphold the confidence and trust between patients and GP, in the recognition that individual commissioners want to behave ethically but may need support and training to understand when conflicts (whether actual or potential) may arise and how to manage them if they do.

2.7 This policy has been produced taking into account all of the current guidance

and legal framework.

3. Application of Public Service Values and Principles to the NHS

3.1 Public service values must be at the heart of the NHS. High standards of

corporate and personal conduct, based on recognition that patients come first, have been a requirement throughout the NHS since its inception. Moreover, since the NHS is publicly funded it is accountable to Parliament for the services it provides and for the effective and economic use of taxpayers’ money.

3.2 The Code of Conduct: Code of Accountability in the NHS (Appointments

Commission/DOH - 2nd Rev: 2004) defines three crucial public service values which must underpin the work of the health service:

Accountability – everything done by those who work in the NHS must be able to stand the test of parliamentary scrutiny, public judgements on propriety and professional codes of conduct.

Probity – there should be an absolute standard of honesty in dealing with the assets of the NHS: integrity should be the hallmark of all personal conduct in decisions affecting patients, staff and suppliers, and in the use of information acquired in the course of NHS duties.

Openness – there should be sufficient transparency about NHS activities to promote confidence between the NHS body and its staff, patients and the public.

3.3 Following the findings of the Nolan Committee in 1994, a set of

recommendations was published by the government setting out ‘Seven Principles of Public Life’ which apply to all in the public service and which are embodied within the CCG’s Constitution. These are attached in Appendix A.


3.4 Standards for members of NHS Boards and Clinical Commissioning Groups

governing bodies in England http://www.professionalstandards.org.uk/publications/detail/standards-for-members-of-nhs-boards-and-clinical-commissioning-group-governing-bodies-in-england have also been set out by the Professional Standards Authority for Health and Social Care which members of the governing body and members of committees should observe in conduct of the CCG’s business.

4. Appointments and Roles and Responsibilities

4.1 NHS employers

The CCG is responsible for ensuring that the requirements of this policy and supporting documents are brought to the attention of all employees and contractors and that machinery is put in place for ensuring that the guidelines are effectively implemented. These responsibilities are particularly important given the corporate responsibility set out in the Bribery Act for organisations to ensure that their anti-corruption procedures are robust. Such awareness will be promoted in:

A clause in written statements of terms and conditions of employment.

Publication on the CCG’s intranet site for staff. 4.2 NHS staff

NHS staff are expected to:

Ensure that the interests of patients remain paramount at all times.

Be impartial and honest in the conduct of their official business.

Use the public funds entrusted to them to the best advantage of the service, always ensuring value for money.

Register with the CCG any interest outside the workplace which could be construed as affecting any part of their work within the CCG.

It is also the responsibility of staff to ensure that they do not:

Abuse their official position for personal gain or to benefit their family or friends;

Seek to advantage or further private business or other interests, in the course of their official duties

It is the responsibility of all staff to raise any concerns regarding staff business conduct. All NHS staff should ensure that they are not placed in a position that risks, or appears to risk, conflict between their private interests and their NHS duties.

http://www.professionalstandards.org.uk/publications/detail/standards-for-members-of-nhs-boards-and-clinical-commissioning-group-governing-bodies-in-england




4.3 Member Practices, Governing Body and Committee/Sub-Committee Members and individuals acting on behalf of the CCG.

Governing Body, Committee/Sub-Committee Members and individuals acting on behalf of the CCG (and its constituent Member Practices), must act in accordance with this policy in circumstances whether they are either employed fully by the CCG, hold appointments with the CCG, are employed on a sessional basis or on an honorary contract, or provide services under a service level agreement with the CCG.

Member Practices and individuals of those individual Practices acting on their behalf in exercise of the CCG’s commissioning functions must act in accordance with this policy.

4.4 CSU Staff

Whilst working on behalf of the CCG, CSU staff will be expected to comply with all policies, procedures and expected standards of behaviour within the CCG, however they will continue to be governed by all policies and procedures.

4.5 Candidates for appointment

Candidates for any appointment with the CCG must disclose in writing if they are related to or in a significant relationship with (e.g. spouse or partner) any Governing Body member or employee of the CCG. The NHS Jobs application form requests this information and therefore must be disclosed before submission. A member of an appointment panel which is to consider the employment of a person to whom he/she is related must declare the relationship before an interview is held. Candidates for any appointment with the CCG shall, when applying, also disclose cases where they or their close relatives or associates have a controlling and/or significant financial interest in a business (including a private company, public sector organisation, other NHS employer and/or voluntary organisation), or in any other activity or pursuit, which may compete for an NHS contract to supply either goods or services to the CCG.

4.6 Canvassing for appointments

It is acknowledged that informal discussions concerning an advertised post can be part of the recruitment process, but canvassing or lobbying of CCG employees, Governing Body members or any members of an appointments committee, either directly or indirectly, shall disqualify a candidate. This shall not preclude a member from giving a written reference or testimonial of a candidate’s ability, experience or character for submission to an appointments panel. Jobs will be awarded on the merit of the individual candidate and not through any such canvassing or lobbying.


4.7 Appointing governing body or committee members and senior employees

On appointing governing body, committee or sub-committee members and senior staff, the CCG will, on a case by case basis, consider whether conflicts of interest should exclude individuals from being appointed to the relevant role. General principles are reflected in the CCG’s Constitution.

4.8 Lay Members

By statute the CCG must have at least two lay members on the Governing Body. The Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2016 recommends a minimum of 3 lay members. Where there are difficulties in recruiting additional lay members the CCG may share lay members with other CCGs in the same Sustainability and Transformation area.

4.9 Conflicts of Interest Guardian

The CCG has appointed a Conflicts of Interest Guardian (akin to a Caldicott Guardian). This role is undertaken by the CCG audit chair and is supported by the CCG’s Governance lead who has responsibility for the day-to-day management of conflicts of interest matters and queries. The CCG Governance lead keeps the Conflicts of Interest Guardian well briefed on conflicts of interest matters and issues arising. The Conflicts of Interest Guardian, in collaboration with the CCG’s governance lead:

Acts as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;

Is a safe point of contact for employees or workers of the CCG to raise any concerns in relation to this policy;

Supports the rigorous application of conflict of interest principles and policies;

Provides independent advice and judgment where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation;

Provides advice on minimising the risks of conflicts of interest.

Whilst the Conflicts of Interest Guardian has an important role within the management of conflicts of interest, executive members of the CCG’s governing body have an on-going responsibility for ensuring the robust management of conflicts of interest, and all CCG employees, governing body and committee members and member practices will continue to have individual responsibility in playing their part on an ongoing and daily basis.


4.10 Primary Care Commissioning Committee Chair To ensure appropriate oversight and assurance and to ensure the CCG audit chair’s position as Conflicts of Interest Guardian is not compromised, the audit chair should not hold the position of chair of the primary care commissioning committee. This is because CCG audit chairs would conceivably be conflicted in this role due to the requirement that they attest annually to the NHS England Board that the CCG has:

Had due regard to the statutory guidance on managing conflicts of

interest; and

Implemented and maintained sufficient safeguards for the commissioning

of primary care.

CCG audit chairs can however serve on the primary care commissioning committee provided appropriate safeguards are put in place to avoid compromising their role as Conflicts of Interest Guardian. Ideally the CCG audit chair would also not serve as vice chair of the primary care commissioning committee. However, if this is required due to specific local circumstances (for example where there is a lack of other suitable lay candidates for the role), this will need to be clearly recorded and appropriate further safeguards may need to be put in place to maintain the integrity of their role as Conflicts of Interest Guardian in circumstances where they chair all or part of any meetings in the absence of the primary care commissioning committee chair.

5. The Guidance in Practice

5.1 Overriding Principle

Employees of the CCG, individuals of Member Practices, Governing Body and Committee members and individuals acting on behalf of the CCG must not accept any fee or reward for work done whilst on CCG duty other than that agreed under their terms and conditions of employment. As a general rule employees should not accept gifts or hospitality arising from their employment or appointment with the CCG, except where these are of a token nature only, in which case employees should inform their manager. This includes gifts or hospitality offered by suppliers and potential suppliers of goods and services to the CCG, and any participation in quasi-official and social events either within or outside normal working hours. Any offers of gifts, hospitality or sponsorship shall be recorded in accordance with section 6.


5.2 Gifts

A ‘gift’ is defined as any item of cash or goods, or any service, which is provided for personal benefit, free of charge or at less than its commercial value.

All gifts of any nature offered to CCG staff, governing body and committee members and individuals within GP member practices by suppliers or contractors linked (currently or prospectively) to the CCG’s business should be declined, whatever their value. The person to whom the gifts were offered should also declare the offer to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality so the offer which has been declined can be recorded on the register.

Gifts offered from other sources should also be declined if accepting them might give rise to perceptions of bias or favoritism, and a common sense approach should be adopted as to whether or not this is the case. The only exceptions to the presumption to decline gifts relates to items of little financial value (i.e., less than £10) such as diaries, calendars, stationery and other gifts acquired from meetings, events or conferences, and items such as flowers and small tokens of appreciation from members of the public to staff for work well done. Gifts of this nature do not need to be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality, nor recorded on the register.

Any personal gift of cash or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality and recorded on the register. In cases of doubt, advice should be sought from the line manager/Chief Officer or the gift should be politely declined.

5.3 Hospitality

Modest hospitality, provided it is usual, responsible and proportionate in the circumstances, (e.g., lunch in the course of working visits), may be acceptable, though it should be similar to the scale of hospitality which the NHS as an employer would be likely to offer. Hospitality of this nature does not need to be declared to the team or individual who has designated responsibility for maintaining the register of gifts and hospitality, nor recorded on the register, unless it is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business in which case all such offers (whether or not accepted) should be declared and recorded.

All other offers of hospitality or entertainment should be politely declined. In cases of doubt, advice should be sought from the line manager / chief officer or the gift should be politely declined.


5.4 The Provision of Hospitality

The Code of Conduct: Code of Accountability in the NHS advises that the use of NHS monies for hospitality and entertainment, including hospitality at conferences or seminars, should be carefully considered. It advises that all expenditure on these items should be capable of justification as reasonable in the light of general practice in the public sector. It reminds NHS organisations that hospitality or entertainment is open to challenge by auditors and that ill-considered actions can damage respect for the NHS in the eyes of the community.

5.5 Payment for speaking at a meeting/conference

Should a member of staff, Member Practices, Governing Body and Committee members and individuals acting on behalf of the CCG, be asked to speak at an event relating to CCG business for which a payment is offered and it is delivered in working hours then there are two choices open to the member of staff which must be agreed with their line manager:

The payment should be credited to the CCG.

The member of staff takes annual leave or unpaid leave and the payment is made to the member of staff as a private matter between the organisation making the payment and the individual member of staff. The member of staff remains responsible for any tax liability which arises.

5.6 Commercial Sponsorship 5.6.1 CCG staff, governing body and committee members, and GP member

practices may be offered commercial sponsorship for courses, conferences, post/project funding, meetings and publications in connection with the activities which they carry out for or on behalf of the CCG or their GP practices.

5.6.2 All such offers (whether accepted or declined) must be declared and

recorded, and the team or individual designated by the CCG to provide advice, support, and guidance on how conflicts of interest should be managed should provide advice on whether or not it would be appropriate to accept any such offers. If such offers are reasonably justifiable and otherwise in accordance with statutory guidance then they may be accepted.

5.6.3 For the purpose of this policy, commercial sponsorship is defined as including

“[NHS funding] from an external source, including funding of all, or part of, the costs of a member of staff, NHS research, staff training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs (including trips abroad), provision of free services (speakers), buildings or premises”.


5.6.4 In all these cases, CCG employees, Member Practices, Governing Body and Committee members and individuals acting on behalf of the CCG must declare sponsorship or any commercial relationship linked to the supply of goods or services and be prepared to be held to account for it. This should be recorded in the Hospitality, Gifts or Sponsorship Register (see section 6).

5.6.5 As a general rule, sponsorship arrangements involving the CCG will be at a

corporate, rather than individual level. 5.6.6 Acceptance of commercial sponsorship must not in any way compromise

commissioning decision of the CCG or be dependent on the supply of goods or services. Sponsors should have no influence over the content of an event, meeting, seminar publication or training. The company logo can be displayed on materials, but no advertising or promotional information should be displayed. Materials should contain a disclaimer which states that sponsorship of the material does not imply that the CCG endorses any of the company’s products or services. No information should be supplied to a company for their commercial gain unless there is a clear benefit to the NHS.

5.6.7 All CCG employees, Member Practices, Governing Body and Committee

members and individuals acting on behalf of the CCG should discuss the implications, with their manager/Chief Operating Officer, before accepting an invitation to speak at a meeting organised by a pharmaceutical company. The company should have no influence over the content of any presentation made by the CCG’s employee/representative. It should be made clear that CCG’s presence does not imply that the CCG endorses any of the company’s products or services.

5.6.8 Under no circumstances will the CCG agree to ‘linked deals’ whereby

sponsorship is linked to future purchase of particular products or to supply from particular sources.

5.6.9 During dealings with sponsors there must be no breach of confidentiality or data protection legislation and, as a rule, information which is not in the public domain should not normally be supplied.


5.7 Placing of orders and contracts 5.7.1 Fair and open competition between prospective contractors or suppliers for

CCG contracts (including where the CCG is commissioning a service through Any Qualified Provider) is a requirement of NHS Standing Orders and of EC Directives on Public Purchasing for Works and Supplies. This means that:

No private, public or voluntary organisation or company which may bid for CCG business should be given any advantage over its competitors, such as advance notice of CCG requirements. This applies to all potential contractors, whether or not there is a relationship between them and the CCG, such as a long-running series of previous contracts.

Each new contract should be awarded solely on merit, taking into account the requirements of the CCG and the ability of the contractors to fulfil them.

No special favour is to be shown to current or former employees or their close relatives or associates in awarding contracts to private or other businesses run by them or employing them in any capacity. Contracts may be awarded to such businesses when they are won in fair competition against other tenders, but scrupulous care must be taken to ensure that the selection process is conducted impartially, and that staff who are known to have a relevant interest play no part in the selection.

5.7.2 All staff, Member Practices, Governing Body, Committee members and

individuals acting on behalf of the CCG, in contact with suppliers and contractors (including external consultants), and in particular those who are authorised to sign orders or place contracts for goods, materials or services, are expected to adhere to professional standards of a kind set out in the ethical code of the Institute of Purchasing and Supply (attached at Appendix B). They are also required to declare any interest if they are participating in a specific procurement and tendering processes.

5.8 Commissioning of Services where GP Practices are potential providers

of CCG-commissioned services.

In the circumstances of commissioning of such services including Local Enhanced Services all individuals must comply with the principles and main content of the NHS Commissioning Board's Code of Conduct in this area.


5.9 Partnership Governance

The CCG should ensure effective arrangements are put in place for the governance of partnerships. The increasing development of partnership based approaches to the commissioning and delivery of care place further emphasis on the necessity for strong governance and performance management in partnership working arrangements. In this respect, there needs to be a clear approach to ensure and demonstrate that investment in partnerships delivers effective and appropriate outcomes for the local population. As part of an effective governance and assurance process the CCG should satisfy itself that managing conflicts of interests and the principles of this policy are applied to partnership working.

5.10 Private Transactions

Individual staff, Member Practices, Governing Body and Committee members and individuals acting on behalf of the CCG, must not seek or accept preferential rates or benefits in kind for private transactions carried out with companies with which they have had, or may have, official dealings on behalf of the CCG. (This does not apply to concessionary agreements negotiated with companies by NHS management, or by recognised staff interests, on behalf of all staff – for example, NHS staff benefits schemes).

5.11 Employees’ secondary employment 5.11.1 The standard contract used across the CCG sets out terms concerning outside

employment: ‘You shall not be employed by any other person, firm or company, without the express permission of the CCG. If you have employment other than your employment with the CCG, you must write to your Manager giving details of the hours and days worked and duties carried out, seeking agreement that this work will not be detrimental to your employment within the CCG’.

5.11.2 Any employee who may be considering outside employment should discuss

this in the first instance with their Manager before undertaking the employment.

5.11.3 Employees should be advised not to engage in outside employment during

any periods of sickness absence from the CCG. To do so may lead to a referral being made to the Local Counter Fraud Specialist for investigation which may lead to criminal and/or disciplinary action in accordance with the CCG’s Anti-Fraud Policy.


5.11.4 The CCG will take all reasonable steps to ensure that employees, committee members, contractors and others engaged under contract are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engage in, any employment or consultancy work in addition to their work with the CCG. The purpose of this is to ensure that the CCG is aware of any potential conflict of interest. Examples of work which might conflict with the business of the CCG, including part-time, temporary and fixed term contract work, include:

Employment with another NHS body;

Employment with another organisation which might be in a position to supply goods/services to the CCG;

Directorship of a GP federation; and

Self-employment, including private practice, in a capacity which might conflict with the work of the CCG or which might be in a position to supply goods/services to the CCG.

5.12 Donations in relation to the organisation 5.12.1 Employees must check with their line manager or director before making any

requests for donations to clarify appropriateness and/or financial or contractual consequences of acquisition. Requests for equipment or services should not be made without the express permission of a senior manager.

5.12.2 Donations from individuals, charities, companies (as long as they are not

associated with known health-damaging products) – often related to individual pieces of equipment or items – provide additional benefits to patients but may have resource implications for the CCG. Further guidance regarding charitable funds and gifts and donations can be requested from the Chief Finance Officer.

5.12.3 Any gifts to the organisation should be receipted and a letter of thanks should

be sent. 5.13 Donations to an individual 5.13.1 Personal monetary gifts to an employee or appointed member should be

politely but firmly declined. Where a member of staff is a beneficiary to a Will of a patient who has been under their care, the member of staff must inform their line manager of the gift or gifts so that consideration can be given to whether or not it is appropriate in all the circumstances for that member of staff to retain the gift or gifts in order to avoid subsequent claims by the beneficiaries to the Estate of inducement, reward or corruption.


5.13.2 In order to determine whether the bequest should be accepted it may be necessary to have the gift valued and where the gift has a value over a certain amount for the gift to either be returned to the Estate or the gift to be donated to a Charity of the member of staff’s choice. Where the gift is to be returned to the Estate and the Trustees of the Estate are of the view having regards to all the circumstances that the member of staff should retain the gift regardless of its value, it may be appropriate for the Trustees to provide a disclaimer for future claims against the gift to avoid subsequent claims on the gift or allegations of inducement or reward being made against the member of staff or the CCG at some point in the future.

5.14 Rewards for Initiative 5.14.1 The CCG will identify potential intellectual property rights (IPR), as and when

they arise, so that they can protect and exploit them properly, and thereby ensure that they receive any rewards or benefits (such as royalties), in respect of work commissioned from third parties, or work carried out by individuals in the course of their NHS duties. Most IPR are protected by statute; e.g. patents are protected under the Patents Act 1977 and copyright (which includes software programmes) under the Copyright Designs and Patents Act 1988. To achieve this, NHS organisations and employers should build appropriate specifications and provisions into the contractual arrangements which they enter into before the work is commissioned, or begins. They should always seek legal advice if in any doubt, in specific cases.

5.14.2 With regard to patents and inventions, in certain defined circumstances the

Patents Act gives employees or individuals in the course of their duties a right to obtain some reward for their efforts, and the CCG will see that this is effected. Other rewards may be given voluntarily to employees or other individuals who, within the course of their employment or duties, have produced innovative work of outstanding benefit to the NHS.

5.14.3 In the case of collaborative research and evaluative exercises with

manufacturers, the CCG will obtain a fair reward for the input it provides. If such an exercise involves additional work for a CCG employee or individual outside that paid for by the CCG under his or her contract of employment, or sessional arrangements, arrangements will be made for some share of any rewards or benefits to be passed on to the employee(s) or individuals concerned from the collaborating parties. Care will, however, be taken that involvement in this type of arrangement with a manufacturer does not influence the purchase of other supplies from that manufacturer.

5.15.4 The CCG’s Intellectual Property Policy should be adhered to.


6. Recording of gifts, hospitality and sponsorship

6.1 All offers of gifts (excess of £10) and hospitality (excess of £25 and in

accordance with Section 5.3) must be declared and recorded. Gifts should be declared if several small gifts worth a total of over £200 are received from the same or closely related source in a 12 month period

6.2 Gifts, hospitality (in accordance with Section 5.3) and sponsorship will be

recorded in a central register in accordance with the guidelines. The form at Appendix C should be completed and returned to the relevant governance lead promptly so that the details can be recorded on the central Register. Failure to notify the CCG may lead to disciplinary action against a member of staff.

6.3 Where gifts, hospitality or sponsorship are offered, but declined, the offer

should still be recorded using the form at Appendix C. 6.4 All hospitality (in accordance with section 5.3) or gifts declared must be

transferred to a register of gifts and hospitality using the template at appendix E

6.5 It is acknowledged that there may be circumstances where hospitality may be

offered by an organisation, as an integral element of a strategic partnership relationship. A fund should be established so that the CCG may meet the costs of that hospitality, thus enabling the benefits to the strategic relationship, but not compromising compliance with the Standards of Business Conduct. Acceptance of such hospitality and associated funding agreement will be authorised by the Chief Officer and recorded in the Register of Hospitality, Gifts and Sponsorship.

7. Declaration of Interests

7.1 Identification and definition of conflicts of interest

7.1.1 A conflict of interest occurs where an individual’s ability to exercise judgement,

or act in a role is, could be or is seen to be impaired or otherwise influenced by his or her involvement in another role or relationship. In some circumstances, it could be reasonably considered that a conflict exists even when there is no actual conflict. In these cases it is important to still manage these perceived conflicts in order to maintain public trust.

7.1.2 Conflicts of interest can arise in many situations, environments and forms of commissioning, with an increased risk in primary care commissioning, out-of-hours commissioning and involvement with integrated care organisations, as clinical commissioners may here find themselves in a position of being both commissioner and provider of services. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment to procurement exercises, to contract monitoring.


7.1.3 Where an individual, i.e. an employee, member of the Clinical Commissioning

Group, a member of the Governing Body, or a member of its committees or sub-committees has an interest, or becomes aware of an interest which could lead to a conflict of interest in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of the CCG’s Constitution and this Policy.

7.1.4 Interests can be captured in four different categories: i. Financial interests: This is where an individual may get direct financial

benefits from the consequences of a commissioning decision. This could, for example, include being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A management consultant for a provider.

This could also include an individual being:

In secondary employment;

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one-off payments, day allowances or travel or subsistence) from a provider;

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).


ii. Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

A member of a particular specialist professional body (although routine GP membership of the RCGP, British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);

A medical researcher.

GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices.

iii. Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure group with an interest in health. iv. Indirect interests: This is where an individual has a close association with an

individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above) for example, a:

Spouse / partner

Close relative e.g., parent, grandparent, child, grandchild or sibling

Close friend

Business partner.

A declaration of interest for a “business partner” in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim).


Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG. Paragraphs 13 to 17 of the Statutory Guidance provide further information.

Note that the Declaration of Interest Form in use sets out the range of interests as a reminder of the types of interests which should be declared.

7.2 Questions to ask when declaring Interests

In determining what needs to be declared, individuals should ask themselves the following questions:

Am I, or might I be, in a position where I or my family or associates gain from the connection between my private interests and my employment with the CCG?

Do I have access to information which could influence purchasing decisions?

Could my outside interest be in any way detrimental to the CCG or to patient’s interests?

Do I have any other reason to think I may be risking a conflict of Interest? If in doubt, the individual concerned should assume that a potential conflict of interest exists.

7.3 Declaring and Registering Interests 7.3.1 It is a requirement of the relevant legislation (Section 14O(3) of the 2006 Act,

as amended by the Health and Social Care Act 2012) for the CCG to maintain registers of the interests of:

All CCG employees, including:

All full and part time staff;

Any staff on sessional or short term contracts;

Any students and trainees (including apprentices);

Agency staff; and

Seconded staff

In addition, any self-employed consultants or other individuals working for the CCG under a contract for services should make a declaration of interest in accordance with this policy, as if they were CCG employees. Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including:

Co-opted members;

Appointed deputies; and

Any members of committees/groups from other organisations.


Where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG. All members of the CCG (i.e., each practice) This includes each provider of primary medical services which is a member of the CCG under Section 14O (1) of the 2006 Act. Declarations should be made by the following groups:

GP partners (or where the practice is a company, each director);

Any individual directly involved with the business or decision-making of

the CCG.

7.3.2 The CCG will need to ensure that, as a matter of course, declarations of

interest are made and regularly confirmed or updated. All persons referred to above must declare any interests as soon as reasonable practicable and by law within 28 days after the interest arises. Further opportunities include;

On appointment: Applicants for any appointment to the CCG or its governing body or any committees should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded.

Six Monthly: Declarations of interest should be obtained from all relevant individuals every six months and where there are no interests or changes to declare, a “nil return” should be recorded.

At meetings: All attendees should be asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interest and action taken to manage that conflict of interest at the meeting should be recorded in minutes of meetings.

On changing role, responsibility or circumstances: Whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g., where an individual takes on a new role outside the CCG or enters into a new business or relationship), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 28 days.


This could involve a conflict of interest ceasing to exist or a new one materialising.

7.3.4 Individuals will declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of the CCG, in writing to the Chief Officer, as soon as they are aware of it and in any event no later than 28 days after becoming aware. The CCG must record the interest in the appropriate registers as soon as the CCG becomes aware of it.

7.3.5 The CCG must ensure that, when members declare interests, this includes the

interests of all relevant individuals within their own organisations (e.g. partners in a GP practice), who have a relationship with the CCG and who would potentially be in a position to benefit from the CCG’s decisions.

7.3.6 Where an individual is unable to provide a declaration in writing, for example, if

a conflict becomes apparent in the course of a meeting, they will make an oral declaration, and provide a written declaration as soon as possible thereafter.

7.3.7 The Chief Officer will ensure that the registers of interest are reviewed six-

monthly and updated as necessary. 7.3.8 In addition, all CCG Governing Body and Executive members’ appointments

are offered on the understanding that they subscribe to the “Codes of Conduct and Accountability in the NHS”.

7.3.9 The Declaration of Interest proforma for completion by members of the group,

Governing Body members, members of a committee or sub-committee of the group or Governing Body, and employees within the CCG is available at Appendix D.

7.3.10 Failure to notify the CCG of an appropriate conflict of interest, additional

employment or business may lead to disciplinary action against the member of staff and/or criminal action (including prosecution) under the relevant legislation.

7.3.11 An interest should remain on the public register for a minimum of six months

after the interest has expired and the CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired. The published register will state that historic interests are retained by the CCG for the specified timeframe and details of whom to contact to request this information.

7.4 Managing Conflicts of Interest: general 7.4.1 Members of the CCG, committees or sub-committees of the group, the

Governing Body and its committees or sub-committees and employees will comply with the arrangements determined by the CCG for managing conflicts or potential conflicts of interest as set out in this Policy.


7.4.2 The Chief Officer 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 group’s decision making processes.

7.4.3 They will write to the relevant individual with the arrangements for managing

the specific conflict of interest or potential conflicts of interest, within a week of declaration. The arrangements will confirm the following:

when an individual should withdraw from a specified activity, on a temporary or permanent basis;

monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

7.4.4 Where an interest has been declared, either in writing or by oral declaration,

the declarer will ensure that before participating in any activity connected with the CCG’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Chief Officer.

7.4.5 Declaration of Interests is, in addition, an agenda item on all Governing Body

and Committee agendas. Declarations should be made with regard to any specific agenda items. If a conflict of interest is established with regard to a specific agenda item, the conflict of interest should be recorded in the minutes and published in the registers. Similarly, any new offers of gifts or hospitality (whether accepted or not) which are declared at a meeting must be included on the CCG’s register of gifts and hospitality to ensure it is up-to-date.

7.4.6 Where an individual member, employee or person providing services to the

CCG is aware of an interest which:

i. Has not been declared, either in the register or orally, they will declare this at the start of the meeting;

ii. Has previously been declared, in relation to the scheduled or likely

business of the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests.

7.4.7 The chair of the meeting will then determine how this should be managed and

inform the member of their decision. Where no arrangements have been confirmed, the chair of the meeting may require the individual to withdraw from the meeting or part of it. They will not be able to vote on the issue under any circumstances. Where a prejudicial interest is identified, that person must leave the room during the discussion of the relevant item, and cannot seek to improperly influence the decision in which they have a prejudicial interest. The Chair’s decision will be final in the matter and the individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.


7.4.8 Where the chair of any meeting of the groups, including committees or sub-

committees, or the Governing Body, including committees and sub-committees of the Governing Body, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

7.4.9 Any declarations of interests, and arrangements agreed in any meeting of the

groups, including committees or sub-committees, or the Governing Body, including committees and sub-committees of the Governing Body, will be recorded in the minutes. The interest must be subsequently reported to the designated governance lead for recording in the Register.

7.4.10 Where more than 50% of the members of a meeting are required to withdraw

from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed in accordance with the provisions of the Constitution.

7.4.11 In making this decision the chair will consider whether the meeting is quorate,

in accordance with the number and balance of membership set out in the CCG standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Chief Officer on the action to be taken.

7.4.12 In any transaction undertaken in support of the CCG’s exercise of its

commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Chief Officer of the transaction.

7.4.13 The Chief Officer will take such steps as deemed appropriate, and request

information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared.


7.5 Managing Conflicts of Interest throughout the commissioning cycle 7.5.1 Conflicts of interest need to be managed appropriately throughout the whole

commissioning cycle. At the outset of a commissioning process, the relevant interests of all individuals involved should be identified and clear arrangements put in place to manage any conflicts of interest. This includes consideration as to which stages of the process a conflicted individual should not participate in, and, in some circumstances, whether that individual should be involved in the process at all.

7.5.2 In designing service requirements attention should be given to public and

patient involvement at every stage of the commissioning cycle. 7.5.3 It is good practice to engage relevant providers, especially clinicians, in

confirming that the design of service specifications will meet patient needs. Provider engagement should follow the three main principles of procurement law, namely equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all at the same time and procedures are transparent. This mitigates the risk of potential legal challenge.

7.5.4 Specifications should be clear and transparent, reflecting the depth of

engagement, and set out the basis on which any contract will be awarded. 7.5.1 Anyone seeking information in relation to procurement, or participating in a

procurement, or otherwise engaging with the CCG in relation to the potential provision of services or facilities to the CCG, will be required to make a declaration of any relevant conflict / potential conflict of interest.

7.5.2 Anyone contracted to provide services or facilities directly to the CCG will be

subject to the same provisions of the CCG’s Constitution and this policy in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

7.5.3 The CCG must comply with all aspects of procurement law and regulation

when commissioning healthcare services: the NHS procurement regime, and the European procurement regime including:

The NHS procurement regime – the NHS (Procurement, Patient Choice and Competition (No.2)) Regulations 2013: made under S75 of the 2012 Act; apply only to NHS England and CCGs; enforced by NHS Improvement; and

The European procurement regime – Public Contracts Regulations 2015 (PCR 2105): incorporate the European Public Contracts Directive into national law; apply to all public contracts over the threshold value (€750,000, currently £589,148); enforced through the Courts.

7.5.4 The procurement template (Appendix I) should be used to complete the

register of procurement decisions and to provide evidence of the CCG’s deliberations on conflicts of interest.


7.5.5 The CCG must maintain a register of procurement decisions taken, including;

The details of the decision

Who was involved in making the decision

A summary of any conflicts of interest in relation to the decision and how this was managed

The award decision taken 7.5.6 The register should be updated whenever a procurement decision is taken and

must be made publically available by;

Ensuring that the register is available in a prominent place on the web site and

Making the register available upon request for inspection at the CCG’s headquarters

7.5.7 The management of conflicts of interest applies to all aspects of the

commissioning cycle, including contract management. 7.5.8 Any contract monitoring meeting needs to consider conflicts of interest as part

of the process i.e., the chair of a contract management meeting should invite declarations of interests; record any declared interests in the minutes of the meeting; and manage any conflicts appropriately and in line with this guidance. This equally applies where a contract is held jointly with another organisation such as the Local Authority or with other CCGs under lead commissioner arrangements. A template for recording minutes of contract meetings is at Appendix H.

7.5.9 The individuals involved in the monitoring of a contract should not have any

direct or indirect financial, professional or personal interest in the incumbent provider or in any other provider that could prevent them, or be perceived to prevent them, from carrying out their role in an impartial, fair and transparent manner.

7.6 Primary Care Commissioning Committees and Sub-Committees 7.6.1 Each CCG with joint or delegated primary care co-commissioning

arrangements must establish a primary care commissioning committee for the discharge of their primary medical services functions. This committee should be separate from the CCG governing body. The interests of all primary care commissioning committee members must be recorded on the CCG’s register(s) of interests.

The primary care commissioning committee should:

For joint commissioning, take the form of a joint committee established between the CCG (or CCGs) and NHS England; and

In the case of delegated commissioning, be a committee established by the CCG.


7.6.2 As a general rule, meetings of the primary care commissioning committee,

including the decision-making and deliberations leading up to the decision, should be held in public unless the CCG has concluded it is appropriate to exclude the public where it would be prejudicial to the public interest to hold that part of the meeting in public.

7.6.3 CCGs (and NHS England with regards to joint arrangements) can agree the

full membership of their primary care commissioning committees, within the following parameters:

The primary care commissioning committee must be constituted to have a lay and executive majority, where lay refers to non-clinical. This ensures that the meeting will be quorate if all GPs had to withdraw from the decision-making process due to conflicts of interest.

The primary care commissioning committee should have a lay chair and lay vice chair (see section 4.10 for further information).

GPs can, and should, be members of the primary care commissioning committee to ensure sufficient clinical input, but must not be in the majority. CCGs may wish to consider appointing retired GPs or out-of-area GPs to the committee to ensure clinical input whilst minimising the risk of conflicts of interest.

A standing invitation must be made to the CCG’s local HealthWatch representative and a local authority representative from the local Health and Wellbeing Board to join the primary care commissioning committee as non-voting attendees, including, where appropriate, for items where the public is excluded for reasons of confidentiality.

Other individuals could be invited to attend the primary care commissioning committee on an ad-hoc basis to provide expertise to support with the decision-making process.

7.6.4 In the interest of minimising the risks of conflicts of interest, it is recommended

that GPs do not have voting rights on the primary care commissioning committee. The arrangements do not preclude GP participation in strategic discussions on primary care issues, subject to appropriate management of conflicts of interest. They apply to decision-making on procurement issues and the deliberations leading up to the decision.

7.6.5 Whilst sub-committees or sub-groups of the primary care commissioning

committee can be established e.g., to develop business cases and options appraisals, ultimate decision-making responsibility for the primary medical services functions must rest with the primary care commissioning committee. As an additional safeguard, it is recommended that sub-groups submit their minutes to the primary care commissioning committee, detailing any conflicts and how they have been managed. The primary care commissioning committee should be satisfied that conflicts of interest have been managed appropriately in its sub-committees and take action where there are concerns.


7.7 Managing Conflicts of Interests: Local CCG Incentive Schemes

GP Practice members will be required to declare an interest in any discussions at Governing Body or Committee meetings relating to Local Incentive Schemes which relate to their GP Practice. Whilst GP practice members may participate in discussions at those meetings of the CCG regarding the recommendations for development of the Local Incentive Scheme they shall withdraw from any decisions at the Governing Body or Committee regarding approval of the Scheme. Any approval of payments to GP Practices under the Incentive Scheme will be made (as a minimum) by the Chief Officer together with the Chief Finance Officer, or their nominated representatives in line with the CCG's financial scheme of delegation.

7.8 Raising Concerns

Individuals who have concerns regarding conflict of interest or ethical misconduct either in respect of themselves or colleagues, should raise it in the first instance with their line manager and / or COI Guardian / Caldicott Guardian. Alternatively, they can raise it as an issue using the Whistleblowing Policy. If the concern relates to any suspected fraudulent practice, staff should follow the advice given in section 10 of this document.

7.9 Publication of Registers

The CCG will publish the register(s) of interest and register(s) of gifts and hospitality and the Register of Procurement Decisions in a prominent place on the CCG’s website and also as part of the CCG’s Annual Report and Annual Governance Statement; a web link is acceptable.

In exceptional circumstances, where the public disclosure of information could give rise to a real risk of harm or is prohibited by law, an individual’s name and/or other information may be redacted from the publicly available register(s). Where an individual believes that substantial damage or distress may be caused, to him/herself or somebody else by the publication of information about them, they are entitled to submit a written request that the information is not published. Decisions must be made by the Conflicts of Interest Guardian for the CCG, who should seek appropriate legal advice where required, and the CCG should retain a confidential un-redacted version of the register(s).

8. Confidentiality

8.1 Employees, CCG members, members of the Governing Body, or a member of

a committee or a sub-committee of the CCG or its Governing Body should be particularly careful using or making public, internal information of a confidential nature, particularly regarding details covered under the Data Protection Act 1998 or other legislation whether or not disclosure is prompted by the expectation of personal gain.


8.2 Disclosure of information which counts as “commercial in confidence” and which might prejudice the principle of a purchasing system based on fair competition may be subject to scrutiny and disciplinary or criminal action or both.

8.3 This does not affect the CCG’s grievance or complaints procedures in terms of

freedom of expression and is not intended to restrict any of the freedoms protected under Article 10 of the Human Rights Act 1998. It is designed to complement professional and ethical rules, guidelines and codes of conduct on an individual’s freedom of expression.

8.4 An employee or individual who has exhausted all the locally established

procedures, including reference to the Raising Concerns at Work Policy, and who has taken account of advice which may have been given, may wish to consult their MP or the Secretary of State for Health in confidence. Extreme caution should be exercised by anyone considering contacting the media.

8.5 Section 43B (1) of the Public Interest Disclosure Act 1998 provides protection

for disclosure of information where the reasonable belief of the worker making the disclosure, tends to show that:-

a. A criminal offence has been committed, is being committed or is likely to

be committed, b. That a person has failed, is failing or is likely to fail to comply with any

legal obligation to which he is subject, c. That a miscarriage of justice has occurred, is occurring or is likely to

occur, d. That the health or safety of any individual has been, is being or is likely to

be endangered, e. That the environment has been, is being or is likely to be damaged, or f. That information tending to show any matter falling within points a. to e.

has been, is being or is likely to be deliberately concealed. 8.6 Protection from disclosure to the media is highly unlikely to be given, if the

person making the disclosure has not exhausted all internal and external avenues.

8.7 Any employee, member of the Governing Body, or a member of a committee

or a sub-committee of the Governing Body making a disclosure to the media should be mindful that any information that they provide may be misinterpreted thus undermining their genuine concern and potentially wrongly threatening the reputation of colleagues and the CCG. In addition, if they choose to contact the media and the disclosure is not protected by the Public Interest Disclosure Act 1998 their actions might constitute misconduct and will be considered in accordance with the CCG Disciplinary Policy and Procedure.


9. Use of Resources

All managers are required (under the Code of Conduct for NHS Managers) to use the resources available to them in an effective, efficient and timely manner having proper regard to the best interests of the public and patients.

10. Fraud/Theft

If you suspect theft, fraud, or other untoward events taking place at work you should:

Make a note of your concerns and;

In the case of theft contact your Local Security Management Specialist;

In the case of fraud contact the Local Counter Fraud Specialist on or the Chief Finance Officer;

You can also report to the national NHS Fraud and Corruption Reporting Line on 0800 028 40 60 or www.reportnhsfraud.nhs.uk.

Staff should not be afraid of raising concerns and will not experience any blame or recrimination as a result of making any reasonably held suspicion known.

If staff have any concerns about any of the issues raised in this document, they should contact their manager or Human Resources Manager.

11. Non-compliance with Policy

Failure to notify the CCG of an appropriate conflict of interest, secondary employment or business may lead to disciplinary action against the individual including potential dismissal or removal from office in accordance with the CCG’s Disciplinary Policy and procedure and/or criminal action (including prosecution) under the relevant legislation. A review of lessons learned will be conducted by the Accountable Officer following any incident of non-compliance with this policy and the report to be reviewed by the CCG’s Audit Committee. If conflicts of interest are not effectively managed, CCGs could face civil challenges to decisions they make. In extreme cases, staff and other individuals could face personal civil liability, for example a claim for misfeasance in public office. Failure to manage conflicts of interest could lead to criminal proceedings including for offences such as fraud, bribery and corruption. This could have implications for CCGs and linked organisations, and the individuals who are engaged by them.

http://www.reportnhsfraud.nhs.uk/


The CCG has agreed a process for managing breaches of this policy, which includes:

How the breach is recorded

How it is investigated

The governance arrangements and reporting mechanisms

Links to the Raising Concerns at Work Policy and HR policies

Communications and management of any media interest

When to notify NHS England and how

Process for publishing the breach on the CCG web site

The CCG will publish anonymised details of breaches on its web site.

12. Internal Audit

The CCG will undertake an audit of conflicts of interest management as part of the internal audit, on an annual basis. The results of the audit will be reflected in the CCG’s annual governance statement and should be discussed in the end of year governance meeting with NHS regional teams.

13. Conflicts of Interest Training The CCG will ensure that training is offered to all employees, governing body members and members of CCG committees and sub-committees. This training is mandatory and must be completed annually by 31 January each year. Completion rates will be recorded as part of the annual conflicts of interest audit.


14. Linked Policies/Guidance

NHS England: Managing Conflicts of Interest: Statutory Guidance for CCGs

CCG Constitution

NHS England: Standards of Business Conduct Policy Copies of this document are available on the Department of Health website: http://www.england.nhs.uk/wp-content/uploads/2012/11/stand-bus-cond.pdf

Standards for members of NHS Boards and Clinical Commissioning Group governing bodies in England published by the Professional Standards Authority for Health and Social Care http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry

Fraud Policy and Response Plan

Whistleblowing policy

Guidance to staff on completion of travel and subsistence claims

Intellectual Property Policy

Research Governance Policy

Commercial Sponsorship and Joint Working with the Pharmaceutical Industry Policy

Secondary Employment guidance as referred to in the standard contract of employment for staff with their respective CCG

Code of Conduct and Code of Accountability for NHS Boards

Institute of Purchasing and Supply A copy of the ethical code of the Institute of Purchasing and Supply is shown in Appendix B.

15. Further Information

If there are any queries on declaration of interests, acceptance or registering of gifts etc. the Chief Finance Officer, Chief Officer, COI Guardian, Caldicott Guardian and / or CCG Governance Lead can be contacted for further information.

16. Monitoring, Review and Archiving

16.1 Monitoring

The Governing Body will ensure there is in place for monitoring the dissemination and implementation of this policy. Monitoring information will be recorded in the policy database.

http://www.england.nhs.uk/wp-content/uploads/2012/11/stand-bus-cond.pdf

http://www.england.nhs.uk/wp-content/uploads/2012/11/stand-bus-cond.pdf

http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0

http://www.professionalstandards.org.uk/docs/psa-library/november-2012---standards-for-board-members.pdf?sfvrsn=0


16.2 Review 16.2.1 The Governing Body will ensure that this policy document is reviewed in

accordance with the timescale specified at the time of approval. No policy or procedure will remain operational for a period exceeding three years without a review taking place.

16.2.2 Staff who become aware of any change which may affect a policy should

advise their line manager as soon as possible. The Governing Body will then consider the need to review the policy or procedure outside of the agreed timescale for revision.

16.2.3 For ease of reference for reviewers or approval bodies, changes should be

noted in the ‘version control’ table on the second page of this document. NB: If the review consists of a change to an appendix or procedure document,

approval may be given by the sponsor director and a revised document may be issued. Review to the main body of the policy must always follow the original approval process.

16.3 Archiving

The Governing Body will ensure that archived copies of superseded policy documents are retained in accordance with Records Management: NHS Code of Practice 2009.


17. Equality Analysis


Introduction - Equality Impact Assessment

An Equality Impact Assessment (EIA) is a process of analysing a new or existing service, policy or process. The aim is to identify what is the (likely) effect of implementation for different groups within the community (including patients, public and staff). We need to: Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Equality Act 2010 Advance equality of opportunity between people who share a protected characteristic and those who do not Foster good relations between people who share a protected characteristic and those who do not This is the law. In simple terms it means thinking about how some people might be excluded from what we are offering. The way in which we organise things, or the assumptions we make, may mean that they cannot join in or if they do, it will not really work for them. It’s good practice to think of all reasons why people may be excluded, not just the ones covered by the law. Think about people who may be suffering from socio-economic deprivation or the challenges facing carers for example. This will not only ensure legal compliance, but also help to ensure that services best support the healthcare needs of the local population. Think of it as simply providing great customer service to everyone. As a manager or someone who is involved in a service, policy, or process development, you are required to complete an Equality Impact Assessment using this toolkit.

Policy A written statement of intent describing the broad approach or course of action the Trust is taking with a particular service or issue.

Service A system or organisation that provides for a public need.

Process Any of a group of related actions contributing to a larger action.


STEP 1 - EVIDENCE GATHERING

Name of person completing EIA: Liane Cotterill

Title of service/policy/process: Standards of Business Conduct & Declarations of Interest Policy

Existing: x New/proposed: Changed:

What are the intended outcomes of this policy/service/process? Include outline of objectives and aims

The purpose of this policy is to ensure exemplary standards of business conduct are adhered to, as public servants, by Governing Body members, committee and sub-committee members and employees of the CCG (as well as individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG such as those within commissioning support services). The policy covers managing conflicts of interest in accordance with statutory guidance.

Who will be affected by this policy/service /process? (please tick)

X Staff members

If other please state:

What is your source of feedback/existing evidence? (please tick)


Evidence What does it tell me? (about the existing policy/process? Is there anything suggest there may be challenges when designing something new?)

National Reports No challenges identified

Staff Profiles No Challenges identified

Complaints and Incidents No Challenges identified.

Staff focus groups No Challenges identified.

Previous EIA’s No Challenges identified.

Other evidence No Challenges identified.


STEP 2 – IMPACT ASSESSMENT

What impact will the new policy/system/process have on the following staff characteristics: (Please refer to the ‘EIA Impact Questions to Ask’ document for reference)

Age A person belonging to a particular age

No impact identified

Disability A person who has a physical or mental impairment, which has a substantial and long-term

adverse effect on that person's ability to carry out normal day-to-day activities


Gender reassignment (including transgender) Medical term for what transgender people often

call gender-confirmation surgery; surgery to bring the primary and secondary sex characteristics of

a transgender person’s body into alignment with his or her internal self perception.


Marriage and civil partnership Marriage is defined as a union of a man and a woman (or, in some

jurisdictions, two people of the same sex) as partners in a relationship. Same-sex couples can also

have their relationships legally recognised as 'civil partnerships'. Civil partners must be treated the

same as married couples on a wide range of legal matters


Pregnancy and maternity Pregnancy is the condition of being pregnant or expecting a baby.

Maternity refers to the period after the birth, and is linked to maternity leave in the employment

context.


Race It refers to a group of people defined by their race, colour, and nationality, ethnic or national

origins, including travelling communities.


Religion or belief Religion is defined as a particular system of faith and worship but belief

includes religious and philosophical beliefs including lack of belief (e.g. Atheism). Generally, a

belief should affect your life choices or the way you live for it to be included in the definition.


Sex/Gender A man or a woman.


Sexual orientation Whether a person's sexual attraction is towards their own sex, the opposite sex

or to both sexes


Carers A family member or paid helper who regularly looks after a child or a sick, elderly, or

disabled person No impact identified

http://www.oxforddictionaries.com/definition/english/%20http:/www.oxforddictionaries.com/definition/english/helper#helper__2

http://www.oxforddictionaries.com/definition/english/%20http:/www.oxforddictionaries.com/definition/english/sick#sick__2

http://www.oxforddictionaries.com/definition/english/%20http:/www.oxforddictionaries.com/definition/english/elderly#elderly__2

http://www.oxforddictionaries.com/definition/english/%20http:/www.oxforddictionaries.com/definition/english/disabled#disabled__2


STEP 3 - ENGAGEMENT AND INVOLVEMENT

How have you engaged with staff in testing the policy or process proposals including the impact on protected characteristics?

It is an existing policy which has been changed to align with the new NHS England statutory guidance however nothing has been identified which would impact on protected characteristics.

Please state how staff engagement will take place:

Policy will be approved via the normal channels and will made available to staff via the normal channels once approved.

STEP 4 - METHODS OF COMMUNICATION

What methods of communication do you plan to use to inform staff of the policy?

– - Telephone – – Leaflets/guidance booklets


STEP 5 - SUMMARY OF POTENTIAL CHALLENGES Having considered the potential impact on the people accessing the service, policy or process please summarise the areas have been identified as needing action to avoid discrimination.

Potential Challenge What problems/issues may this cause?

1 None identified

STEP 6- ACTION PLAN

Ref no.

Potential Challenge/ Negative Impact

Protected Group Impacted (Age, Race etc)

Action(s) required Expected Outcome

Owner Timescale/ Completion date


Ref no.

Who have you consulted with for a solution? (users, other services, etc)

Person/ People to inform

How will you monitor and review whether the action is effective?

SIGN OFF

Completed by: Liane Cotterill

Date: 14 July 2016

Signed:

Presented to: (appropriate committee) Audit Committee.

Publication date: 14 July 2016


18. Appendix A

The Nolan Principles on Standards in Public Life

The Nolan Committee was set up in 1994 to examine concerns about standards of conduct of all holders of public office, including arrangements relating to financial and commercial activities, and make recommendations as to any changes in arrangements which might be required to ensure the highest standards of propriety in public life. The committee published “seven principles of Public Life”, which it believes should apply to all those operating in the public sector. These principles should be adopted by CCG staff and are as follows: Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. Leadership Holders of public office should promote and support these principles by leadership and example. All staff will be expected to adopt these principles when conducting official business for and on behalf of the CCG so that appropriate ethical standards can be demonstrated at all times.


19. Appendix B

Institute of Purchasing and Supply (IPS) – Ethical Code (Reproduced by kind permission of IPS)

1. Introduction

The code set out below was approved by the Institute's Council on 26 February 1977 and is binding on IPS members.

2. Precepts

Members shall never use their authority or office for personal gain and shall seek to uphold and enhance the standing of the Purchasing and Supply profession and the Institute by:

a. maintaining an unimpeachable standard of integrity in all their business

relationships both inside and outside the organisations in which they are employed;

b. fostering (the highest possible standards of professional competence amongst those for whom they are responsible;

c. optimising the use of resources [or which they are responsible to provide

the maximum benefit to their employing organisation;

d. complying both with the letter and the spirit of; i. the law of the country in which they practise; ii. such guidance on professional practice as may be issued by the

Institute from time to time; iii. contractual obligations;

e. rejecting any business practice which might reasonably be deemed

improper. 3. Guidance

In applying these precepts, members should follow the guidance set out below:

a. Declaration of interest.

Any personal interest which may impinge or might reasonably be deemed by others to impinge on a member's impartiality in any matter relevant to his or her duties should be declared.

b. Confidentiality and accuracy of information The confidentiality of information received in the course of duty should be respected and should never be used for personal gain; information given in the course of duty should be true and fair and never designed to mislead.


c. Competition.

While bearing in mind the advantages to the member's employing organisation of maintaining a continuing relationship with a supplier, any relationship which might, in the long term, prevent the effective operation of fair competition should be avoided.

d. Business Gifts. Business gifts other than items of very small intrinsic value such as business diaries or calendars should not be accepted.

e. Hospitality. Modest hospitality is an accepted courtesy of a business relationship. However, the recipient should not allow him or herself to reach a position whereby he or she might be deemed by others to have been influenced in making a business decision as a consequence of accepting such hospitality; the frequency and scale of hospitality accepted should not be significantly greater than the recipient's employer would be likely to provide in return.

f. When it is not easy to decide between what is and is not acceptable in terms of gifts or hospitality, the offer should be declined or advice sought from the member's superior.


20. Appendix C

Template Declaration of interests for CCG members and employees

Name

Position within, or relationship with, the CCG

(or NHS England in the event of

joint committees):

Declared Interest- (Name

of the organisation and nature of

business)

Type of Interest *See reserve of form for details

Description of Interest

Date of Interest

Action taken to mitigate risk (to be agreed with

line manager or a senior CCG Manager)

Is the interest direct or indirect?

From To

Fin

an

cia

l In

tere

sts

No

n-F

inan

cia

l

Pro

fes

sio

nal

Inte

rests

No

n-F

inan

cia

l P

ers

on

al

Inte

rests


The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that the CCG holds. I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result. I do / do not [delete as applicable] give my consent for this information to published on registers that the CCG holds. If consent is NOT given please give reasons:

Signed: Date: Signed: Position: Date: (Line Manager or Senior CCG Manager) Please return to <insert name/contact details for team or individual in CCG nominated to provide advice, support, and guidance on how conflicts of interest should be managed, and administer associated administrative processes>


Types of interest Type of Interest

Description

Financial Interests

This is where an individual may get direct financial benefits from the consequences of a

commissioning decision. This could, for example, include being:

A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations;

A shareholder (or similar owner interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations.

A management consultant for a provider;

In secondary employment (see paragraph 56 to 57);

In receipt of secondary income from a provider;

In receipt of a grant from a provider;

In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider

In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

Non-Financial Professional Interests

This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

An advocate for a particular group of patients;

A GP with special interests e.g., in dermatology, acupuncture etc.

A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE);

A medical researcher.

Non-Financial Personal Interests

This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is:

A voluntary sector champion for a provider;

A volunteer for a provider;

A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation;

Suffering from a particular condition requiring individually funded treatment;

A member of a lobby or pressure groups with an interest in health.

Indirect Interests

This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include:

Spouse / partner;

Close relative e.g., parent, grandparent, child, grandchild or sibling;

Close friend;

Business partner.


21. Appendix D Template Register of interests for CCGs

Name

Current position (s)

held- i.e. Governing

Body, Member practice,

Employee or other

Declared Interest- (Name

of the organisation and nature of

business)

Type of Interest

Nature of Interest

Date of Interest Action taken to mitigate

risk

Is the interest direct or indirect?

From To

Fin

an

cia

l In

tere

sts

No

n-F

inan

cia

l

Pro

fes

sio

nal

Inte

rests

No

n-F

inan

cia

l P

ers

on

al

Inte

rests


22. Appendix E Template Declarations of gifts and hospitality

Recipient

Name

Position Date

of

Offer

Date of

Receipt (if

applicable)

Details of

Gift /

Hospitality

Estimated

Value

Supplier /

Offeror

Name and

Nature of

Business

Details of

Previous Offers

or Acceptance

by this Offeror/

Supplier

Details of the

officer reviewing

and approving

the declaration

made and date

Declined

or

Accepted?

Reason for

Accepting

or

Declining

Other

Comments

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers that the CCG holds. I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, professional regulatory or internal disciplinary action may result. I do / do not (delete as applicable) give my consent for this information to published on registers that the CCG holds. If consent is NOT given please give reasons:

Signed: Date: Signed: Position: Date: (Line Manager or a Senior CCG Manager) Please return to <insert name/contact details for team or individual in CCG nominated to provide advice, support, and guidance on how conflicts of interest should be managed, and administer associated administrative processes>


23. Appendix F Template: Register of gifts and hospitality

Recipient Name

Position Date of offer

Date of Receipt (if applicable)

Details of Gift /Hospitality

Estimated Value

Supplier / Offeror Name and Nature of business

Details of Previous Offers or Acceptance by this Offeror / Supplier

Details of the officer reviewing and approving the declaration made and date

Declined or Accepted?

Reason for Accepting or Declining

Other Comments


24. Appendix G

Template declarations of interest checklist Under the Health and Social Care Act 2012, there is a legal obligation to manage conflicts of interest appropriately. It is essential that declarations of interest and actions arising from the declarations are recorded formally and consistently across all CCG governing body, committee and sub-committee meetings. This checklist has been developed with the intention of providing support in conflicts of interest management to the Chair of the meeting- prior to, during and following the meeting. It does not cover the requirements for declaring interests outside of the committee process.

Timing Checklist for Chairs Responsibility

In advance of the meeting

1. The agenda to include a standing item on declaration of interests to enable individuals to raise any issues and/or make a declaration at the meeting.

2. A definition of conflicts of interest

should also be accompanied with each agenda to provide clarity for all recipients.

3. Agenda to be circulated to enable

attendees (including visitors) to identify any interests relating specifically to the agenda items being considered.

4. Members should contact the Chair as

soon as an actual or potential conflict is identified.

5. Chair to review a summary report from

preceding meetings i.e., sub-committee, working group, etc., detailing any conflicts of interest declared and how this was managed.

A template for a summary report to present discussions at preceding meetings is detailed below.

6. A copy of the members’ declared interests is checked to establish any actual or potential conflicts of interest that may occur during the meeting.

Meeting Chair and secretariat Meeting Chair and secretariat Meeting Chair and secretariat Meeting members Meeting Chair Meeting Chair


During the meeting

7. Check and declare the meeting is

quorate and ensure that this is noted in the minutes of the meeting.

8. Chair requests members to declare any

interests in agenda items- which have not already been declared, including the nature of the conflict.

9. Chair makes a decision as to how to

manage each interest which has been declared, including whether / to what extent the individual member should continue to participate in the meeting, on a case by case basis, and this decision is recorded.

10. As minimum requirement, the

following should be recorded in the minutes of the meeting:

Individual declaring the interest;

At what point the interest was declared;

The nature of the interest;

The Chair’s decision and resulting action taken;

The point during the meeting at which any individuals retired from and returned to the meeting - even if an interest has not been declared;

Visitors in attendance who participate in the meeting must also follow the meeting protocol and declare any interests in a timely manner.

A template for recording any interests during meetings is detailed below.

Meeting Chair Meeting Chair Meeting Chair and secretariat Secretariat

Following the meeting 11. All new interests declared at the meeting should be promptly updated onto the declaration of interest form;

12. All new completed declarations of

interest should be transferred onto the register of interests.

Individual(s) declaring interest(s) Designated person responsible for registers of interest


Template for recording any interests during meetings

Report from <insert details of sub-committee/ work group>

Title of paper <insert full title of the paper>

Meeting details <insert date, time and location of the meeting>

Report author and

job title

<insert full name and job title/ position of the person who has written this report>

Executive summary <include summary of discussions held, options developed, commissioning rationale, etc.>

Recommendations

<include details of any recommendations made including full rationale>

<include details of finance and resource implications>

Outcome of Impact Assessments completed (e.g. Quality IA or Equality IA)

<Provide details of the QIA/EIA. If this section is not relevant to the paper state ‘not applicable’>

Outline engagement – clinical, stakeholder and public/patient:

<Insert details of any patient, public or stakeholder engagement activity. If this section is not relevant to the paper state ‘not applicable’>

Management of Conflicts of Interest

<Include details of any conflicts of interest declared> <Where declarations are made, include details of conflicted individual(s) name, position; the conflict(s) details, and how these have been managed in the meeting> <Confirm whether the interest is recorded on the register of interests- if not agreed course of action>

Assurance departments/ organisations who will be affected have been consulted:

<Insert details of the people you have worked with or consulted during the process : Finance (insert job title) Commissioning (insert job title) Contracting (insert job title) Medicines Optimisation (insert job title) Clinical leads (insert job title) Quality (insert job title) Safeguarding (insert job title) Other (insert job title)>

Report previously presented at:

<Insert details (including the date) of any other meeting where this paper has been presented; or state ‘not applicable’>


Risk Assessments

<insert details of how this paper mitigates risks- including conflicts of interest>


Template to record interests during the meeting

Meeting Date of Meeting

Chairperson (name)

Secretariat (name) Name of person declaring interest

Agenda Item Details of interest declared

Action taken


25. Appendix H

Template for recording minutes XXXX Clinical Commissioning Group Primary Care Commissioning Committee Meeting Date: 15 February 2016 Time: 2pm to 4pm Location: Room B, XXXX CCG Attendees: Name Initials Role Sarah Kent SK XXX CCG Governing Body Lay Member (Chair) Andy Booth AB XXX CCG Audit Chair Lay Member Julie Hollings JH XXX CCG PPI Lay Member Carl Hodd CH Assistant Head of Finance Mina Patel MP Interim Head of Localities Dr Myra Nara MN Secondary Care Doctor Dr Maria Stewart MS Chief Clinical Officer Jon Rhodes JR Chief Executive – Local Healthwatch In attendance from 2.35pm Neil Ford NF Primary Care Development Director

Item No Agenda Item Actions

1

Chairs welcome

2

Apologies for absence <apologies to be noted>

3

Declarations of interest SK reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of XXX clinical commissioning group. Declarations declared by members of the Primary Care Commissioning Committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: http://xxxccg.nhs.uk/about-xxx-ccg/who-we-are/our -governing-body/

http://xxxccg.nhs.uk/about-xxx-ccg/who-we-are/our%20-governing-body/

http://xxxccg.nhs.uk/about-xxx-ccg/who-we-are/our%20-governing-body/


Declarations of interest from sub committees. None declared Declarations of interest from today’s meeting The following update was received at the meeting:

With reference to business to be discussed at this meeting, MS declared that he is a shareholder in XXX Care Ltd.

SK declared that the meeting is quorate and that MS would not be included in any discussions on agenda item X due to a direct conflict of interest which could potentially lead to financial gain for MS. SK and MS discussed the conflict of interest, which is recorded on the register of interest, before the meeting and MS agreed to remove himself from the table and not be involved in the discussion around agenda item X.

4

Minutes of the last meeting <date to be inserted> and matters arising

5

Agenda Item <Note the agenda item> MS left the meeting, excluding himself from the discussion regarding xx. <conclude decision has been made> <Note the agenda item xx> MS was brought back into the meeting.

6

Any other business

7

Date and time of the next meeting


26. Appendix I

Procurement checklist

Service:

Question Comment/ Evidence

1. How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?

2. How have you involved the public in the decision to commission this service?

3. What range of health professionals have been involved in designing the proposed service?

4. What range of potential providers have been involved in considering the proposals?

5. How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?

6. What are the proposals for monitoring the quality of the service?

7. What systems will there be to monitor and publish data on referral patterns?

8. Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers?

9. In respect of every conflict or potential conflict, you must record how you have managed that conflict or potential conflict. Has the management of all conflicts been recorded with a brief explanation of how they have been managed?


10. Why have you chosen this procurement route e.g., single action tender?2

11. What additional external involvement will there be in scrutinising the proposed decisions?

12. How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process and award of any contract?

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)

13. How have you determined a fair price for the service?

Additional questions when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers

14. How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for proposed direct awards to GP providers

15. What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?

16. In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

17. What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

2Taking into account all relevant regulations (e.g. the NHS (Procurement, patient choice and

competition) (No 2) Regulations 2013 and guidance (e.g. that of Monitor).

CO18: Standards of Business Conduct and Declaration of Interest Policy (4) draft1 Page 59 of 61

Template: Procurement decisions and contracts awarded Ref

No

Contract/

Service

title

Procurement

description

Existing contract

or new

procurement (if

existing include

details)

Procurement

type – CCG

procurement,

collaborative

procurement

with partners

CCG

clinical

lead

(Name)

CCG

contract

manger

(Name)

Decision

making

process and

name of

decision

making

committee

Summary of

conflicts of

interest

noted

Actions

to

mitigate

conflicts

of interest

Justification

for actions to

mitigate

conflicts of

interest

Contract

awarded

(supplier

name &

registered

address)

Contract

value (£)

(Total)

and

value to

CCG

Comments

to note

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information. Signed: On behalf of: Date: Please return to <insert name/contact details for team or individual in CCG nominated for procurement management and administrative processes>


27. Appendix J Template Register of procurement decisions and contracts awarded

Ref No

Contract/ Service title

Procurement description

Existing contract or new procurement (if existing include details)

Procurement type – CCG procurement, collaborative procurement with partners

CCG clinical lead

CCG contract manager

Decision making process and name of decision making committee

Summary of conflicts of interest declared and how these were managed

Contract Award (supplier name & registered address)

Contract value (£) (Total)

Contract value to CCG


28. Appendix K

Template Declaration of conflict of interests for bidders/contractors

Name of Organisation:

Details of interests held:

Type of Interest

Details

Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process

Any other connection with the CCG or NHS England, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgements, decisions or actions

Name of Relevant Person [complete for all Relevant Persons]

Details of interests held:

Type of Interest Details

Personal interest or that of a family member, close friend or other acquaintance?

Provision of services or other work for the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process


Any other connection with the CCG or NHS England, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgements, decisions or actions

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information. Signed: On behalf of: Date:

1

Cover Sheet


Date 29/11/2016

Agenda Item 12.2

Report Title Standards of Business Conduct and Declaration of Interest Policy

Synopsis The policy has been updated to take into account new guidance ‘Managing Conflicts of Interest - Revised Statutory Guidance for CCGs’ issued by NHS England on 28 June 2016. The Governing Body is asked to approve the revised policy and to approve the withdrawal of the partnership governance policy, which is rendered defunct.


Corporate Policy CCG C019: Standards of Business Conduct and Declaration of Interest Policy Key amendments to the policy are:

The recommendation for CCGs to have a minimum of three lay members on the Governing Body, to support conflicts of interest management

The introduction of a CCG conflicts of interest guardian. The CCG Audit Chair has assumed this role, which will be an important point of contact for any conflicts of interest queries or issues

The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and anonymised details of the breach to be published on the CCG’s website for the purpose of learning and development

Strengthened provisions around decision-making when a member of the governing body, or committee or sub-committee is conflicted

Strengthened provisions around the management of gifts and hospitality, including the need for prompt declarations and a publicly accessible register of gifts and hospitality

A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans and to include the findings of this audit within their annual end-of-year governance statement

A requirement for all CCGs employees, governing body and committee members and practice staff with involvement in CCG business, to complete mandatory online conflict of interest training, which will be provided by NHS England. The online

2

training will be supplemented by a series of face to face training sessions for CCG leads in key decisions-making roles.

Corporate Policy CCG CO12: Policy and Framework for Partnership Governance The Governing Body is asked to approve the withdrawal of Corporate Policy CCG CO12 ‘Policy and Framework for Partnership Governance’ as governance arrangements for partnerships have been incorporated in to the revised ‘Standards of Business Conduct & Declaration of Interest Policy’ in section 5.9. The Audit Committee will continue to oversee the effective management of conflicts of interest on behalf of the Governing Body.

Recommendation The Governing Body is asked to note, discuss and approve the revised ‘Standards of Business Conduct and Declaration of Interest Policy.’ The Governing Body is asked to approve the withdrawal of the ‘Policy and Framework for Partnership Governance’ from the CCG Corporate policies, as the relevant information is now in the SoBC&DoI policy.

Report history The Governing Body approved the current Standards of Business Conduct and Declarations of Interest policy in March 2016. The proposed revised policy was reviewed by the Audit Committee in September 2016, and agreed to recommend it for approval.


Director: Joe Corrigan Title; Chief Finance and Operating Officer




3






It is an important part of risk mitigation to have an effective ‘standards of business conduct and declarations of interest policy’ in place.


No additional resource implications have been identified.


The amendments to the CCG policy are required to enable the CCG to comply with the revised statutory guidance. This paper presents no implications for any of the nine protected equality characteristics.



NHS Constitution The NHS aspires to the highest standards of excellence and professionalism.

Next steps Full implementation of the policy across the CCG.

Appendices CO19: Standards of Business Conduct and Declarations of Interest Policy.

NHS Newcastle Gateshead Clinical Commissioning

Group

Quality, Safety and Risk Committee

Terms of Reference 1. Introduction

The Quality, Safety and Risk Committee (the committee) is established as a

committee of the Governing Body of the Clinical Commissioning Group (CCG), in accordance with 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 the CCG constitution and standing orders.

2. Principal Function

The Quality, Safety and Risk Committee is responsible for ensuring the appropriate governance systems and processes are in place to:

commission, monitor and ensure the delivery of high quality safe patient care in commissioned services,

facilitate, monitor and ensure quality improvement in general medical practice.

In achieving this, the committee will seek to promote a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience, to secure public involvement, to promote research and the use of research and to provide assurance to the governing body about the quality, safety and risks of the services being commissioned, and the overall risks to the organisation’s strategic and operational plans. The Committee will, as delegated by the Governing Body, provide oversight and scrutiny of arrangements for supporting NHS England in relation to securing continuous improvement in the quality of primary medical services.

Quality, Safety and Risk Committee Terms of Reference v4 November 3 Jan 2016

2

The Committee will, as delegated by the Governing Body, approve arrangements for handling complaints, information governance including arrangements for handling Freedom of Information requests, and provide oversight and scrutiny on arrangements for business continuity and emergency planning.

3. Accountability

The Quality, Safety and Risk Committee is a Committee of the CCG’s Governing Body.

4. Membership Membership of the Committee will include:

A Lay Member (Chair of the Committee)

A Lay Member

Medical Director

Executive Director of Nursing, Patient Safety and Quality

Secondary Care Specialist Doctor

Two clinical representatives

Director of Operations and Delivery

Director of Strategy and Integration

Director of Quality Development

Head of Corporate Affairs The Chair has the responsibility to ensure that the Committee obtains

appropriate advice in the exercise of its functions. Directors, officers, employees, and practice representatives of the CCG and other appropriate individuals may be invited to attend all or part of meetings of the committee to provide advice or support particular discussion from time to time.

5. Authority 5.1 The Governing Body authorises the Committee to pursue any activity within

these Terms of Reference including to:

(i) Seek any information it requires from CCG employees, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

(ii) Require all CCG employees to co-operate with any reasonable request

made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation;

(iii) Review and investigate any matter within its remit and grants freedom of

access to the organisation’s records, documentation and employees. The


3

Committee must have due regard to the Information Policies of the CCG, regarding personal health information and the CCG’s duty of care to its employees when exercising its authority.

5.2 In discharging its responsibilities the Committee will comply with the CCG’s

Standing Orders and Prime Financial Policies and Conflicts of Interest Policy. 6. Roles and Responsibilities 6.1 Quality in Commissioned Services (scrutiny and validation) 6.1.1 To develop, monitor and review the CCGs vision and framework for commissioning services are high quality, that is safe, clinically effective and provide positive patient/carer experience. 6.1.2 To receive reports on the quality of commissioned services, to review risks arising and monitor progress in implementing recommendations and action plans. 6.1.3 Where the CCG is the coordinating commissioner ensure provision of appropriate quality assurance and improvement information to collaborating CCGs; in particular escalating any areas of concern in timely way. 6.1.4 To receive reports on the quality of commissioned services from other CCGs where they act as the coordinating commissioner and the CCG has contracts. 6.1.5 To seek assurance on the performance of NHS provider organisations in terms of the Care Quality Commission, Monitor and any other regulatory bodies. (Note that the Monitor’s compliance framework relies on assurance from third parties, including local commissioners of services). 6.1.6 To receive and review the draft Quality Accounts of NHS providers where the CCG acts as coordinating commissioner and approve the corroborative statement to the provider within the timescales outlined in the Quality Account Regulations. 6.1.7 To receive and review the published Quality Accounts of NHS Foundation Trusts which, as a minimum, will include those relating to the Foundation Trusts which provide local acute services, community health care services and mental health and learning disabilities services to the Newcastle and Gateshead population. 6.1.8 To oversee the development of quality incentive schemes e.g. CQUIN ensuring alignment to CCG strategic priorities and national requirements. 6.1.9 To ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies in relation to areas of concern, with a view to an external review being carried out and reported to this committee. The Executive Director of Nursing, Patient Safety and Quality will lead on ensuring that this process is managed effectively.


4

6.1.10 To ensure appropriate collaboration with the Local Area Team of the NHS CB e.g. through future Local Area Quality Surveillance Group. 6.2 Improving Quality in General Medical Practice 6.2.1 To ensure that agreements and processes in place with the group’s members to secure improvements in the quality of primary medical services in terms of clinical effectiveness, patient safety and patient experience in GP practices. 6.2.2 To ensure an appropriate interface and collaborative working with the NHS Commissioning Board is maintained in relation to quality in general medical practice. 6.3 Patient Safety – Overarching Systems 6.3.1 To receive reports on clinical risks, incident reporting, serious incidents, ‘Never

Events’, complaints, claims and safety alerts; and monitor progress in implementing recommendations and action plans.

6.3.2 To oversee development of a Patient Safety Assurance Framework with

systems for monitoring quality and safety of care, with reference to a range of indicators which might include Care Quality Commission ratings and reviews, Monitor ratings and any other relevant sources of external assurance.

6.3.3 To receive and scrutinise independent investigation reports relating to patient

safety issues and agree publication plans. 6.3.4 To receive reports on the management of infection control performance,

especially health care acquired infections. 6.3.5 To receive a Medicines Management Report, not less than annually. 6.3.6 To receive a Controlled Drugs monitoring report, not less than annually. 6.3.7 To ensure that appropriate strategies and training plans are in place for

safeguarding of children and vulnerable adults, receiving appropriate reports pertaining to the CCG’s safeguarding duties.

6.4 Patient experience 6.4.1 To ensure that the views of patients and the public are properly reflected in the

development and implementation of CCG Policies and Plans and to receive and act upon reports on patient experience.

6.4.2 To oversee the development and implementation of a structured and planned

approach to the collection and use of patient reported experience in both


5

provider management processes and commissioning decisions. To ensure that this approach includes use of feedback from individual consultations in practice.

6.5 Clinical Effectiveness 6.5.1 To promote and encourage an evidence based culture within the CCG and

wider health economy ensuring CCG’s commissioning takes account of national guidance such as NICE guidance, NICE quality standards and other relevant standards e.g. from Royal Colleges and professional bodies.

6.5.2 To ensure that the CCG promotes research and the use of research. 6.6 Risk 6.6.1 To ensure that all systems are in place and operating effectively for the

identification, assessment and prioritisation of potential risk (including quality and patient safety, financial risk including regarding QIPP, health and safety, emergency preparedness, business continuity, information governance and sustainable development), and to report on any major strategic issues and any associated financial implications to the governing body and to other external agencies as appropriate including the National Reporting and Learning System

6.6.2 To ensure the adequacy of the Board Assurance Framework, using it

operationally to guide the work of the committee in gaining assurances on the principal strategic risks identified within the framework. This will include review of the content of the Corporate Risk Register and to scrutinise controls and actions for high and extreme risks.

6. 6.3 To advise and assure the Clinical Commissioning Group on the development

of policy, strategy and practice in respect of equality, diversity and human rights (supported through the Equality Delivery System), including the Equality Diversity and Human Rights Annual Report to ensure the statutory and legal obligations of the CCG are met.

7. Administration

The Governing Body Secretary will ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members.

8. Quorum The quorum shall be one third of the membership of the committee, including at

least one Lay Member and one clinical member (doctor or nurse). In the event that a meeting of the committee is not quorate, the Chair can

decide that the meeting will progress, but where decisions are required they will


6

be deferred to the next meeting when the committee is quorate.

9. Decision Making The individual members will have delegated authority from their respective

CCGs to make decisions with regard to matters relating to their own CCG, as set out within the CCG’s scheme of delegation.

Generally it is expected that decisions will be reached by consensus. Should

this not be possible then a view of members will be required. In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote.

10. Frequency and notice of meetings Meetings will be held at such interval as the Chair shall judge necessary to

discharge the responsibilities of the Committee, but shall be at least six times per year.

11. Attendance at meetings 11.1 The members of the Committee are required to provide information to progress

and inform the agreed agenda items. 11.2 The Committee members are required to attend each meeting or if apologies

are made any information they are expected to contribute must be supported either through a deputy or in writing to the Chair.

11.3 In addition to the core membership the Committee may co-opt additional

members as appropriate to enable it to undertake its role. 12. Reporting Arrangements The minutes of the meetings shall be formally recorded and submitted to the

Governing Body. The Chair of the committee shall draw to the attention of the Governing Body

any issues that require disclosure to the Governing Body, or require executive action. The committee will report to the Governing Body, at least annually on its work.

13. Conduct of the committee All members of the committee and participants in its meetings will comply with

the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct


7

and the CCG’s Policy on Standards of Business Conduct and Declarations of Interest which incorporate the Nolan Principles.

14. Date of Review

The committee will review its performance, membership and these Terms of Reference at least once per financial year. It will make recommendations for any resulting changes to these Terms of Reference to the Governing Body for approval.

No changes to these Terms of Reference will be effective unless and until they

are agreed by the Governing Body.

Approval Date: 26 January 2016 29 November 2016

Review Date: January 2017November 2017

NHS Newcastle Gateshead Clinical Commissioning

Group

Executive Committee

Terms of Reference 1. Introduction

The Executive Committee of the Clinical Commissioning Group is established as a sub-committee of the Governing Body, in accordance with the clinical commissioning group’s (CCG) 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 the group’s constitution and standing orders.

2. Principal Function

The committee is established to support the clinical commissioning group, its governing body and the chief officer in the discharge of their functions. It will assist the governing body in its duties to promote a comprehensive health service, reduce inequalities and promote innovation. Its remit includes development and implementation of strategy, monitoring and delivery of statutory duties, operational, financial, contractual and clinical performance. It is responsible for ensuring effective clinical engagement and promoting the involvement of all member practices in the work of the CCG in securing improvements in commissioning of care and services. The executive committee will work closely with, and provide support to, the commissioning forum in order to ensure that practices are informed appropriately of commissioning decisions, and are engaged in the commissioning process. The clinical representation will be sought from the two units of planning with appropriate balance across the CCG.

3. Membership

The membership of the committee will consist of:

i). The CCG Chair

Executive Committee Terms of Reference v1 May 2015V2 November 2016

2

ii). The CCG Assistant clinical chair iii). The Medical Director iv). The Chief Officer v). The Chief Finance and Operating Officer vi). Executive Director of Nursing, and Patient Safety and Quality vii). Director of Strategy and Integration Delivery and Transformation

(Newcastle) viii). Director of Operations and Delivery and Transformation (Gateshead) ix). Two Clinical Directors (Newcastle)

Clinical Director (Gateshead) x). Secondary Care Doctor xi). Director of Quality Development

4. Chair

The committee will be chaired by the Assistant Clinical Chair.

The Chair has the responsibility to ensure that the Committee obtains appropriate advice in the exercise of its functions. Officers, employees, and practice representatives of the CCGs and other appropriate individuals may be invited to attend all or part of meetings of the committee to provide advice or support particular discussion from time to time.

4. Secretarial support

Secretarial support to the committee will be provided by the CCG office.

5. Frequency of meetings

Meetings of the Executive Committee will normally be at monthly, and not less than 8 times per financial year. There will be no more than 6 weeks between meetings. Members will be expected to attend each meeting. In exceptional circumstances and where agreed in advance by the chair, members of the committee or others invited to attend may participate in meetings by telephone, by the use of video conferencing facilities and/or webcam where such facilities are available. Participation in a meeting in any of these manners shall be deemed to constitute presence in person at the meeting.

6. Agendas and papers

The agenda for meetings of the committee will be set by the chair. The agenda and papers for meetings of the committee will be distributed 3 working days in advance of the meeting. Items for the agenda should be notified to the chair 5 working days in advance of each meeting. Any agenda items


3

received after the specified deadline will not be included unless specifically directed by the chair of the meeting. The setting of agendas for, and minutes of, each meeting should identify where discussion should rightly be recorded as being of a confidential or commercially sensitive nature.

7. Quoracy and Decision Making

One half of members are needed for the meeting to be quorate, and,

At least the Chief Officer or the Chief Finance and Operating Officer must be present.

At least two primary care clinicians. Generally it is expected that decisions will be reached by consensus. Should this not be possible then a vote of members will be required. In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote.

8. Remit and responsibilities of the Executive Committee

The Executive Committee will be responsible for the following core functions: Supporting the member practices and Governing Body to determine the strategic direction of the CCG Preparation and publication of CCG strategies and operational plans

Maintaining and developing effective contractual arrangements

Ensuring the effective management of finance, performance and quality, providing assurances and escalating issues as required Ensuring effective relationships with member practices Ensuring effective relationships with stakeholders across the health and social care economy Oversight of the effective implementation of corporate strategy including: - Service reform/transformation - OD including leadership/staff development - Informatics and IT

Supporting the Governing Body in ensuring there is a sound system of governance in the CCG


4

Governance

Finance

Performance

Service reform/transformation

Quality & Patient safety

Patient experience

Corporate planning

Strategic planning

OD including leadership/staff development

PPI

Contracting – Finance – Quality

Provider management – Strategic – Operational

Stakeholder relationships

Clinical transformation

Member practices These core functions will be addressed through specific strategy and planning, and delivery processes: 8.1 Strategy and Planning i). Preparing and recommending the strategy and annual commissioning plan

prior to approval by the member practices and the management of its delivery by the governing body.

ii). Formulating and implementing service change and development arising out of

the strategy.

iii). Preparing and recommending to the governing body the Organisational Development Plan and enabling strategies including the Communications and Engagement Strategy, and overseeing their delivery.

iv). Developing CCG input to the Joint Health and Wellbeing Strategy

(Gateshead) and the Newcastle Future Needs Assessment (Newcastle), with a view to reducing inequalities in health.

v). Establishing links and working arrangements with other CCGs, Provider

Trusts, the Local Authority, other health care partners, the Area Team of NHS England and the clinical senate that would support the integration of both health services with other health services and health services with health-related and social care services where the group considers that this would improve the quality of services or reduce inequalities.


5

vi). Ensuring that the views of patients and the public are properly reflected in the

development and implementation of CCG policies and plans.

8.2 Delivery i). Delivering target outcomes and outputs set by the Secretary of State, NHS

England, NICE, CQC and other national/regional authorised bodies and providing assurance to the governing body in this respect.

ii). Ensuring the co-ordination and monitoring of the Group’s clinical work

programme, in delivery of the Group’s annual commissioning plan.

iii). Receiving reports on quality and patient safety and managing any associated clinical risks with appropriate mitigating action.

iv). Managing the performance of the CCG against its financial and non-financial targets including QIPP.

v). Ensuring the control, co-ordination and monitoring within the organisation of risk and internal controls, reviewing the corporate risk register regularly.

vi). Approving business cases and procurement contract awards in line with the CCG’s financial scheme of delegation and approved budgets.

vii). Leading the delivery of the CCG’s educational programme.

viii). Preparing the CCG’s annual report for the audit committee to consider and approve and recommend to the governing body.

ix). Approving the CCG’s operational policies and procedures.

x). Supporting the development of the business cycle of the CCG’s governing body and agenda setting for formal and informal meetings of the governing body.

9. Reporting arrangements

The governing body will hold the Executive Committee to account for the delivery of its remit and responsibilities on behalf of the CCG through exercise of the functions delegated to it, including those functions delegated by the governing body to its sub-committees.

10. Policy and best practice

The committee will apply best practice in its decision making, and in particular it will:


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comply with current disclosure requirements for remuneration;

ensure that decisions are based on clear and transparent criteria The committee will have full authority to commission any reports or surveys it deems necessary to help it fulfil its obligations. The committee will establish such sub-groups to assist with the delivery of its delegated responsibilities and progress its work as it sees fit.

11. Conduct of the Executive Committee

All members of the committee and participants in its meetings will comply with the Standards of Business Conduct for NHS Staff, the NHS Code of Conduct, and the CCG’s Policy on Standards of Business Conduct and Declarations Interest which incorporates the Nolan Principles.

12. Date of Review

The committee will review its performance, membership and these Terms of Reference at least once per financial year. It will make recommendations for any resulting changes to these Terms of Reference to the group for approval. No changes to these Terms of Reference will be effective unless and until they are agreed by the CCG.

Approval Date: 12 May 2015 29 November 2016

Review Date: April 2016 November 2017

Cover Sheet


Date 29/11/2016

Agenda Item 12.3

Report Title Revised Terms of Reference for Approval

Synopsis The purpose of this paper is to seek approval from the governing body to implement and publish the revised Terms of Reference for (1) the Quality, Safety and Risk Committee and (2) the Executive Committee


Terms of Reference for the Quality, Safety and Risk Committee The committee has reviewed its membership. Minor changes are proposed, as per the attached revised terms of reference (with tracked changes shown) (appendix 1) Terms of Reference for the Executive Committee The committee has reviewed its functions and membership. Some changes are proposed to the terms of reference, as per the attached revised terms of reference (with tracked changes shown) (appendix 2).

Recommendation The meeting of the Governing Body is asked to:

Note the content and issues of the report.

Approve the terms of reference for the Quality, Safety and Risk Committee as appropriate.

Approve the terms of reference for the Executive Committee

Report history The Governing Body approved ToR for the Quality Safety and Risk Committee in January 2016 The Governing Body approved ToR for the Executive Committee in May 2015


Director: Mark Adams Title : Chief Officer





Approval of the Terms of Reference for the Quality, Safety and Risk Committee will ensure that the committee continues to provide assurance on issues of patient safety and quality.




No specific risks have been identified with the approval of the terms of reference.


No resource implications have been identified.


The Terms of Reference for the Quality, Safety and Risk Committee are required to enable the committee to be constituted and functional. This paper presents no implications for any of the nine protected equality characteristics.



NHS Constitution Principle Three: The NHS aspires to the highest standards of excellence and professionalism.

Next steps Publication of the Amended Terms of Reference on the CCG website.

Appendices Appendix 1: Terms of Reference for the Quality, Safety and Risk Committee v2a Appendix 2: Terms of Reference for the Executive Committee v2

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